Appendices

Table of Contents

Acronyms

  • ACIP  Advisory Committee on Immunization Practices
  • ACPHP  Academic Center for Public Health Preparedness
  • AIDS  Acquired Immune Deficiency Syndrome
  • AIIR  Airborne infection isolation room
  • ALT  Alanine amiontransferase
  • AMA  American Medical Association
  • APHL  Association of Public Health Laboratories
  • ASPH  Association of Schools of Public Health
  • AST  Aspartate transaminase
  • AVA  Anthrax Vaccine Adsorbed
  • AVRP  Anthrax Vaccine Research Program
  • ASPH  Association of Schools of Public Health
  • ASTHO  Association of State and Territorial Health Officials
  • ATSDR  Agency for Toxic Substances and Disease Registry
  • CADE  Center for Acute Disease Epidemiology
  • CBRN  Chemical, Biological, Radiological/Nuclear
  • CDC  Centers for Disease Control and Prevention
  • CDOR  Center for Disaster Operations and Response
  • CHI  Consolidated Health Informatics
  • CIA  Central Intelligence Agency
  • CIO  Centers, Institutes and Office
  • CISM   Critical Incident Stress Management
  • CLIA  Clinical Laboratory Improvements Act
  • CPHP  Centers for Public Health Preparedness
  • COOP  Continuity of Operations Plan
  • CSTE  Council of State and Territorial Epidemiologists
  • DEEDS  Division of Epidemiology, EMS, and Disaster Operations
  • DNA  Deoxyribonucleic Acid
  • DHHS  Department of Health and Human Services
  • DHS  Department of Homeland Security
  • DOE  Department of Energy
  • ECS  Emergency Communication System
  • EOC  Emergency Operations Center
  • EPA  Environmental Protection Agency
  • Epi-X  Epidemic Information Exchange
  • EIS  Epidemic Intelligence Service
  • EISO  Epidemic Intelligence Service Officer
  • ELISA  Enzyme Linked Immunosorbent Assay
  • ELR  Electronic Laboratory-Based Reporting
  • EPO  Epidemiology Program Office
  • ERT  Emergency Response Team
  • FBI  Federal Bureau of Investigation
  • FEM  Federal Emergency Management Agency
  • FMO  Financial Management Office
  • FDA  Food and Drug Administration
  • FRP  Federal Response Plan
  • FRER  Federal  Radiological Emergency Response Plan
  • FTE  Full Time Equivalent
  • GIS  Geographic Information System
  • GMP  Good Manufacturing Practices
  • GPRA  Government Performance and Results Act of 1993
  • HACCP  Hazard Analysis Critical Control Point
  • HAN  Health Alert Network
  • HHS  Health and Human Services
  • HICPA  Healthcare Infection Control Practices Advisory Committee
  • HIPAA  Health Insurance Portability and Accountability Act
  • HIV  Human Immunodeficiency Virus
  • HPP  Hospital Preparedness Program
  • ICRC  Injury Control Research Center
  • ICS  Incident Command System
  • IDSS  Iowa Disease Surveillance System
  • IDPH  Iowa Department of Public Health
  • IM  Intramuscular
  • IMS  Incident Management System
  • IOM  Institute of Medicine
  • IoWANS  Institutional and Waiver Authorization and Narrative System
  • IT  Information Technology
  • IV  Intravenous
  • LPA  Local   Public Health Agency
  • LRN  Laboratory Response Network
  • ME  Medical examiner
  • MSEHPA  Model State Emergency Health Powers Act
  • NACCHO  National Association for City and County Health Officials
  • NCBDDD  National Center for Birth Defects and Developmental Disease
  • NCCDPHP  National Center for Chronic Disease Prevention and Health Promotion
  • NCEH  National Center for Environmental Health
  • NCHS  National Center for Health Statistics
  • NCHSTP  National Center for HIV, STD and TB Prevention
  • NCID  National Center for Infectious Disease
  • NCIPC  National Center for Injury Prevention and Control
  • NEDSS  National Electronic Disease Surveillance System
  • NGO  Non-Governmental Organization
  • NHSN  National Healthcare Safety Network
  • NIP  National Immunization Program
  • NIOSH  National Institute for Occupational Safety and Health
  • NIH  National Institutes of Health
  • NLTN  National Laboratory Training Network
  • NPHIC  National Public Health Information Coalition
  • NPPTL  National Personal Protective Technology Laboratory
  • NPS  National Pharmaceutical Stockpile
  • NYCDOH  New York City Department of Health
  • OC  Office of Communication
  • OHS  Office of Health and Safety
  • OTPER  Office of Terrorism Preparedness and Emergency Response
  • OD  Office of the Director
  • OSEP  Office of Security and Emergency Preparedness
  • PPE  Personal Protective Equipment
  • PCP  Pneumocystis Carinii Pneumonia
  • PCR  Polymerase Chain Reaction
  • PFGE  Pulse Field Gel Electrophoresis
  • PHA  Public Health Advisor
  • PH  Public Health
  • PHEP  Public Health Emergency Preparedness
  • PHER  Public Health Emergency Response
  • PHIN  Public Health Information Network
  • PHPPO  Public Health Practice Program Office
  • PMR  Preventive Medicine Resident
  • PVS  Pre-Event Vaccination System
  • SAP  Select Agent Program
  • SARS  Severe Acute Respiratory Syndrome
  • SCBA  Self Contained Breathing Apparatus
  • SLPP  State and Local Preparedness Program
  • SME  State Medical Examiner
  • SNS  Strategic National Stockpile
  • SVP  Smallpox Vaccination Program
  • SWOC  Strengths, Weaknesses, Opportunities and Challenges
  • TARU  Technical Advisory Response Unit
  • TED  Training, Education and Demonstration Package
  • TOPOFF  Top Officials
  • TRPLT  Terrorism Response and Preparation Leadership Team
  • US  United States
  • USDA  United States Department of Agriculture
  • VAERS  Vaccine Adverse Effects Reporting System
  • VFC  Vaccines for Children
  • VIG  Vaccinia Immune Globulin
  • VMI  Vendor Managed Inventory
  • WaterCAD  Water Computer Aided Design
  • WHO  World Health Organization
  • XML  Extensible Markup Language
  • 24x7  Twenty four hours a day, seven days a week

Glossary

Antigen - That part of an agent (bacteria, virus, etc.) capable of stimulating the production of specific antibodies.

Antibody - An immunoglobulin found in tissue fluids and blood serum that is produced in response to the stimulus of a specific antigen and is capable of combining with that antigen to neutralize or destroy it.

Airborne precautions - Precautions that apply to patients known or suspected to be infected with epidemiologically important pathogens that can be transmitted widely by air currents and may become inhaled by or deposited on a susceptible host within the same room or, depending on environmental factors, over a longer distance from the source patient. These precautions are designed to reduce the risk of such airborne transmission of infectious agents through personal protection devices, such as N95 masks, and special air handling and ventilation systems, such as airborne infection isolation rooms. (Adapted from CDC/HICPAC guidelines.)

Airborne infection isolation room (AIIR) - A single patient room in which environmental factors are controlled to minimize the transmission of infectious agents that can be transmitted by the airborne route. These rooms have specific requirements for controlled ventilation, negative pressure, and air filtration and monitoring that are detailed in Guideline for Environmental Infection Control in Health-Care Facilities, 2003.

Arthralgia - Pain in a joint without objective signs (see arthritis).

Arthritis - Swelling, redness, tenderness, or other specific signs of inflammation in a joint.

Aseptic - Absence of infectious microorganisms; free from infection; sterile. (Sometimes used to mean absence of bacteria, example; aseptic meningitis may be caused by virus).

Asymptomatic - Without objective evidence of disease or condition.

Attack Rate - A measure of the frequency of cases of a disease in a narrowly defined population during a specific interval of time, as in epidemics (# of cases/# of people exposed x 100). Usually expressed as a percent.

Bacteria - Unicellular microorganism. There are three principal forms: spherical or ovoid forms called cocci; rod-shaped forms called bacilli or vibrios; and spiral forms called spirilla or spirochetes.

Bioemergency - A situation in which a pathogen poses an immediate and severe threat to the lives or health of people in Iowa, to the extent that day-to-day operations of public health authorities are insufficient to address this threat.

Carrier - A person or animal that harbors a specific infectious agent (but manifests no discernible clinical disease) and is a potential source of infection for man or animals. The carrier state can occur in an individual after an infection (which was either asymptomatic or symptomatic and resolved).

Case - An infected or diseased person or animal having specific clinical, laboratory, or epidemiologic characteristics.

Case Definition - A set of standard criteria for deciding whether a person has a particular disease or health-related condition, by specifying clinical criteria and limitations on time, place, and person (Retrieved from CDC at www.cdc.gov/osels/ph_surveillance/nndss/casedef/index.htm on 3/15/11).

Case Fatality Rate - A measure of the likelihood that an ill person (i.e., one who exhibits symptoms) will die as a result of that illness (adapted from Gordis, 2000:44); can be expressed by the ratio: number who die within a specified time after disease onset or diagnosis number ill

Chemoprophylaxis - The administration of a medicine, including antibiotics, to prevent the development of an infection or prevent the progression of an infection to clinical disease. Example: Rifampin for exposure to meningococcal disease.

Cohort - Any defined group of persons selected for a special purpose or study. (From the Latin cohors, warriors, the tenth part of a legion).

Cohorting - Method to isolate separate infectious persons from susceptible ones by grouping persons with the same infection together. Cohorting of staff is to assign specific staff to a group of patients and not have them do care on the unaffected clients.

Colonization - Propagation of a microorganism on or within a host without causing cellular injury or infection. A colonized host can serve as a source of infection. Carriers are often said to be colonized with a pathogen.

Communicable Disease - An illness which is caused by a specific infectious agent or its toxic products, and which arises through transmission of that agent or its products from a reservoir to a susceptible host.

Complement - A chemical in the immune system which can provoke the disintegration of bacteria. It is present in all sera. Complement is not an antibody but may work with antibodies to destroy bacteria.

Contact - A person or animal that has been in such association with an infected person or animal, or a contaminated environment, as to have had an opportunity to acquire the etiologic agent.

Contact Precautions - Precautions that apply to patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct or indirect contact. Direct-contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person, while indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object. (Adapted from CDC/HICPAC guidelines.)

Culture - The growth of microorganisms on or in substances (especially laboratory media prepared for this purpose).

Droplets - Liquid particles expelled into the air during the act of talking, spitting, singing, coughing, or sneezing. Droplets are formed through aerosolization of secretions present in the mouth, nasopharynx and bronchi. They can contain infectious microorganisms.

Droplet Nuclei - The dried residues of droplets which may contain one or more infectious microorganisms. In contrast to droplets, droplet nuclei can remain suspended in the air for long periods.

Droplet Precautions - Precautions that apply to any patient known or suspected to be infected with epidemiologically important pathogens that can be transmitted by infectious droplets generated from the source person during coughing, sneezing, or talking or during the performance of certain procedures such as suctioning or bronchoscopy. Unlike airborne precautions, because droplets travel only short distances (< 3 ft.) and do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission. (Adapted from CDC/HICPAC guidelines.)

Ecchymosis - A large, irregularly formed hemorrhagic area of skin. Like a large bruise the color is blue-black changing to a greenish-brown or yellow. May occur with a large bruise.

Epidemic - The occurrence of cases of a disease in human populations in a particular geographic area clearly in excess of the usual incidence.

Common-source epidemic - An epidemic in which one human or one animal or specific vehicle (e.g., food or water) is responsible for transmitting the agent to the case/s identified.

Point-source epidemic - like a common source but limited to a short time period (e.g., a meal).

Propagated-source epidemic - An epidemic in which infections are transmitted from person to person or animal to animal in such a fashion that identified cases cannot be attributed to a single source.

Epidemiologist - A person who applies epidemiologic principles and methods to the prevention and control of disease.

Epidemiology - The study of the distribution and causes/risk factors of disease in human populations.

Epidemiologically linked case - A case in which a) the patient has had contact with one or more persons who either have/had the disease or have been exposed to a point source of infection (i.e., a single source of infection, such as an event leading to a foodborne-disease outbreak, to which all confirmed case-patients were exposed) and b) transmission of the agent by the usual modes of transmission is plausible. A case may be considered epidemiologically linked to a laboratory-confirmed case if at least one case in the chain of transmission is laboratory confirmed.

Erythema - Redness of the skin due to capillary dilatation.

Etiology - The study or theory of the causes of disease. An etiologic agent is that which causes disease.

Exposure - The opportunity of a susceptible host to acquire an infection by either a direct or indirect mode of transmission. Example: being bitten by an ill skunk is a potential exposure to rabies.

Fomites - Inanimate objects, such as toys or articles of clothing, which can become contaminated and, therefore, be a vehicle for transmission.

Fungi - Simple, dependent plants including molds, rusts, mushrooms, toadstools, lichens and yeasts. Some forms are pathogenic to animals. Example: vaginal "yeast infections".

Hand Hygiene - A general term that applies to hand washing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis. (CDC)

Health Care Provider - A person who is trained and licensed to give health care. Also, a place licensed to give health care. Doctors, nurses, hospitals, skilled nursing facilities, some assisted living facilities and certain kinds of home health agencies are examples of health care providers. (From the Medicare web site.)

Host - Organisms, including humans, that are capable of being infected by a specific agent.

Hypothesis - An unproven assertion or statement based on available information, which commonly deals with the identity of an etiologic agent, the source of infection and the mode of transmission. Its role is to provide a rational basis for further investigation.

Illness - A subjective state, or experience, characterized by the impairment of normal physiological function and affecting part or all of an organism (Last, 2001:90 and Princeton University, retrieved 3/10/04).

Immune Globulin - A sterile solution of proteins made up of antibodies that are present in adult human blood. Example: RIG - rabies immune globulin.

Immunoglobulin - A protein that functions as an antigen receptor. 

Immunity - Immunity is often used to refer to antibody status.

  • Passive immunity refers to antibodies acquired from an outside source either naturally (by maternal transfer) or artificially (by inoculation of specific protective antibodies -- convalescent or immune serum, or immune globulin). Passive immunity is of brief duration (days or months).
  • Active immunity lasts years, and is acquired either naturally (by actual infection), or artificially (by inoculation with a vaccine).

Immunodeficient - Lacking in the ability to mount an immune response in response to an antigen.

Incidence - Number of new cases of a disease occurring within a particular population during a specified period of time.

Index Case - The first case among a number of similar cases which are epidemiologically related. Index cases are often identified as a source of contamination or infection.

Induration - Extremely hard or firm tissue (e.g. what is measured in a reactive Tuberculin skin test)

Infection - The entry and multiplication of an infectious agent in body tissues of man or animal, resulting in cellular injury.

Infectious Agent - An organism, usually a microorganism but including larger parasites (such as worms), that is capable of producing infection or infectious disease.

Infectious Disease - A disease of man or animal resulting from an invasion of the body by pathogenic agents and the reaction of the tissues to these agents and/or the toxins they produce.

Infection Control Precautions - Measures used for decreasing the risk of transmission of microorganisms, particularly in health care facilities or when otherwise providing medical care. These fall into standard, contact, droplet, and airborne categories, which are also defined in this section. (Adapted from CDC/HICPAC guidelines)

Infectivity - A measure of the likelihood that a person exposed to a pathogen will become infected (i.e., the agent enters, multiplies, and survives within the host) (adapted from Nelson, 2001:27); can be expressed by the ratio: number infected / number exposed

Infestation - The lodgment, development, and reproduction of arthropods (e.g., scabies, lice on the body or in the clothing.)

Inflammation - Normal tissue response to cellular injury or foreign material, characterized by dilation of small blood vessels (capillaries) that usually cause erythema (redness) and warmth and mobilization of defense cells (blood and tissue white blood cells that form pus).

Isolation - The separation, for the period of communicability, of infected persons or animals from those that are not infected, in such places and under such conditions as will prevent the direct or indirect transmission of the infectious agent from those infected to those who may be susceptible or who may spread the agent to others.

Mean - Called "the average" in arithmetic. The mean is calculated by adding together all the observed values and dividing by the number of observations.

Monospot - Agglutination test to detect the Epstein-Barr virus (the cause of mononucleosis).

Morbidity - Any departure from a state of well-being.

Myalgias - Tenderness or pain in the muscles.

Nanometer - One billionth of a meter.

Nosocomial Infection - An infection resulting from exposure to a source within a health-care facility. The term is applied to such infections transmitted between inpatients, visitors, and hospital personnel.

Nosocomial - A term used to denote a new disease or condition acquired within a healthcare setting, for example a hospital-acquired infection.

Outbreak - The occurrence of two or more cases of a disease which are epidemiologically related.

Pandemic - An epidemic disease affecting people in several countries or continents. Example: In 1919, there was an influenza pandemic.

Parasite - An organism (often microbial) which lives in or on another organism, at their expense. Parasites are not necessarily harmful to their host.

Pathogen - An agent capable of causing disease.

Pathogenicity - The ability of an agent to cause disease in a susceptible host.

Permucosal - By means of a mucous membrane. Example: Permucosal spread of hepatitis B can occur, especially in health care settings.

Personal Protective Equipment - The equipment and clothing required to mitigate the risk of injury from or exposure to hazardous conditions encountered during the performance of duty. (From the National Oceanographic and Atmospheric Association)

Petechiae - Small, purplish, hemorrhagic spots on the skin, mucous membranes, or serous surfaces. These are small areas under the skin, which may be due to an abnormality of blood clotting mechanism.

Phagocyte - A cell which engulfs and destroys foreign particles or microorganisms by digestion.

Primary Case - The person who first introduces a disease into a defined group, such as a family, and therefore the means by which members of this group may contract the disease. Compare with the definition for index case (adapted from Last, 2001:142 and Gordis, 2000:22).

Prodromal Period - The prodromal period is that lapse of time between the first vague symptom of disease and the full clinical syndrome upon which a diagnosis can be based.

Prophylaxis - Measures taken to prevent the development or spread of disease.

Protozoa - A unicellular animal which usually reproduces asexually by fission.

Public Health Disaster - Defined in Iowa Code section 135.140 as “a state of disaster emergency proclaimed by the governor in consultation with the department [i.e., IDPH] pursuant to section 29C.6 for a disaster which specifically involves an imminent threat of an illness or health condition that meets any of the following conditions of paragraphs I and II:

  • I.  Is reasonably believed to be caused by any of the following:
    • a. Bioterrorism or other act of terrorism. The appearance of a novel or previously controlled or eradicated infectious agent or biological toxin. A chemical attack or accidental release.
    • b. An intentional or accidental release of radioactive material.
    • c. A nuclear or radiological attack or accident.
  • II. Poses a high probability of any of the following:
    • a. A large number of deaths in the affected population. A large number of serious or long-term disabilities in the affected population.
    • b. Widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of the affected population.”

Although this statutory definition includes the conditions for a “bio-emergency,” as defined earlier in this section, it also encompasses conditions that are not addressed in this plan, including chemical, radioactive, radiological, and nuclear incidents.  Also, not every set of conditions that may be considered a bio-emergency by IPDH officials will result in the proclamation of a public health disaster.

Purpura - A small hemorrhage in the skin, mucous membrane or serosal (serous membrane) surface which can have various manifestations. Hemorrhage into the skin becomes red, then darkens into purple, then brownish-yellow and finally disappears in 2-3 weeks. Areas of discoloration do not disappear under fingertip pressure.

Quarantine - The limitation of freedom of movement of persons or animals that have been exposed to a communicable disease, within specified limits marked by placards, for a period of time equal to the longest usual incubation period of the disease.

Ratio - A measure of the frequency of one group of events (e.g., the number of males having a specified disease) relative to the frequency of a different group of events (e.g., the number of females having the specified disease). Example: The male to female ratio for legionellosis is 2.5/1.

Resistance - The sum total of host mechanisms which interpose barriers to invasion or multiplication of infectious agents, or that prevent damage by the agent's toxic products.

Reservoir - The habitat where the etiologic agent of a disease normally thrives, grows, and replicates. A reservoir may be human (anthroponotic), animal (zoonotic), or a nonliving environment, such as soil or water (sapronotic). A characteristic feature of most diseases with non-human reservoirs is that once transmitted to humans, the epidemic chain is usually aborted, although the clinical course might be sometimes quite severe, even fatal. (Hubálek:403).

Rickettsia - A class of bacteria, which like viruses, can only multiply inside other cells.

Risk - The likelihood that a person having specified characteristics (e.g., age, sex, immune status) will acquire a specified disease.

Secondary Attack Rate - The frequency of new disease cases among close contacts of known cases. Secondary attack rates are usually calculated for household contacts. Example: The household secondary attack rate for Shigella can be over 50%.

Sepsis - When a symptomatic person is found to have pathogenic microorganisms or their toxins in the blood.

Serotyping - The characterization of different strains of a microorganism by the reaction of different stocks of sera with that organism. 

Sign - Objective (can be detected by others) evidence of a disease.

Sporadic Case - A case with no known epidemiological relationship to any other case(s).

Standard Precautions - Precautions designed for the care of all patients in health care facilities regardless of their diagnosis or presumed infection status and intended to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection. The main focus is on hand hygiene, the use of protective barriers, and the proper handling of clinical waste. The precautions apply to (1) blood; (2) all body fluids, secretions, and excretions (except sweat), regardless of whether or not they contain visible blood; (3) non-intact skin; and, (4) mucous membranes. (Adapted from CDC/HICPAC guidelines.)

Surveillance of Disease - The continuing scrutiny of the aspects of the occurrence and spread of a disease that are pertinent to effective control.

Susceptible - A person or animal lacking sufficient resistance to a particular pathogenic agent to prevent disease if exposed.

Symptom - Subjective (cannot be detected by others) evidence of a disease.

Syndrome - The set of signs and symptoms which typify a particular disease.

Toxin - Proteins or conjugated protein substances which can cause disease. They are produced by some higher plants, certain animals, and pathogenic bacteria.

Toxoid - A preparation containing detoxified toxin. Toxoids are used to induce specific active immunity to the related toxin.

Transmission Mode - The means by which disease organisms are spread. For the purposes of this plan, the term applies to how they are spread to humans.

Travel Advisory - A recommendation against nonessential travel to the area(s) for which it is issued. Travel advisories are issued when the health risk for travelers is thought to be high, and are intended to reduce the number of travelers to high-risk areas and the risk for spreading disease to other areas. (Adapted from CDC guidance).

Travel Alert - A lower-level notice than a travel advisory that provides information about the disease outbreak and informs travelers how to reduce their risk of acquiring the infection. An alert does not include a recommendation against nonessential travel to the area. (Adapted from CDC guidance).

Triage - The process for sorting ill or injured people into groups based on their need for or expected benefit from medical treatment. The purpose is to provide for the efficient use of medical and nursing staff and associated facilities.

Vaccine - A preparation containing killed or living whole microorganisms or a fraction of the organisms having antigenic properties. Vaccine is employed to induce, in the recipient, a specific active immunity to an infectious agent (usually an antibody response).

Vector - An insect (e.g., tick) or any living carrier that transports an infectious agent from a source of infection to a susceptible host.

Vehicle - An object or substance that can carry microorganism to a new host.

Virus - Minute organisms not visible with ordinary light microscopy. They can reproduce only inside of a host cell.

Virulence - The amount of power and the degree of pathogenicity possessed by organisms.

Zoonosis - An infection or an infectious disease transmissible under natural conditions between animals and man.