Kim-Farley Robert J, Celentano John T, Gunter Carol, Jones Jessica W, Stone Rogelio A, Aller Raymond D, Mascola Laurene, Grigsby Sharon F, Fielding Jonathan E
Los Angeles County Department of Health Services, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Prehosp Disaster Med. 2003 Oct-Dec;18(4):313-20. doi: 10.1017/s1049023x00001266.
The smallpox virus is a high-priority, Category-A agent that poses a global, terrorism security risk because it: (1) easily can be disseminated and transmitted from person to person; (2) results in high mortality rates and has the potential for a major public health impact; (3) might cause public panic and social disruption; and (4) requires special action for public health preparedness. In recognition of this risk, the Los Angeles County Department of Health Services (LAC-DHS) developed the Smallpox Preparedness, Response, and Recovery Plan for LAC to prepare for the possibility of an outbreak of smallpox. A unique feature of the LAC-DHS plan is its explicit use of the Standardized Emergency Management System (SEMS) framework for detailing the functions needed to respond to a smallpox emergency. The SEMS includes the Incident Command System (ICS) structure (management, operations, planning/intelligence, logistics, and finance/administration), the mutual-aid system, and the multi/interagency coordination required during a smallpox emergency. Management for incident command includes setting objectives and priorities, information (risk communications), safety, and liaison. Operations includes control and containment of a smallpox outbreak including ring vaccination, mass vaccination, adverse events monitoring and assessment, management of confirmed and suspected smallpox cases, contact tracing, active surveillance teams and enhanced hospital-based surveillance, and decontamination. Planning/intelligence functions include developing the incident action plan, epidemiological investigation and analysis of smallpox cases, and epidemiological assessment of the vaccination coverage status of populations at risk. Logistics functions include receiving, handling, inventorying, and distributing smallpox vaccine and vaccination clinic supplies; personnel; transportation; communications; and health care of personnel. Finally, finance/administration functions include monitoring costs related to the smallpox emergency, procurement, and administrative aspects that are not handled by other functional divisions of incident command systems. The plan was developed and is under frequent review by the LAC-DHS Smallpox Planning Working Group, and is reviewed periodically by the LAC Bioterrorism Advisory Committee, and draws upon the Smallpox Response Plan and Guidelines of the Centers for Disease Control and Prevention (CDC) and recommendations of the Advisory Committee on Immunization Practices (ACIP). The Smallpox Preparedness, Response, and Recovery Plan, with its SEMS framework and ICS structure, now is serving as a model for the development of LAC-DHS plans for responses to other terrorist or natural-outbreak responses.
天花病毒是一种具有高度优先性的 A 类病原体，因其具有以下特点而构成全球恐怖主义安全风险：（1）易于传播且可在人与人之间传播；（2）导致高死亡率并有可能对公共卫生产生重大影响；（3）可能引发公众恐慌和社会混乱；（4）需要采取特殊行动进行公共卫生防范。认识到这种风险后，洛杉矶县卫生服务部（LAC - DHS）制定了《洛杉矶县天花防范、应对及恢复计划》，为天花爆发的可能性做好准备。LAC - DHS 计划的一个独特之处在于其明确使用标准化应急管理系统（SEMS）框架来详细说明应对天花紧急情况所需的各项职能。SEMS 包括 incident command system（ICS）结构（管理、行动、规划/情报、后勤以及财务/行政）、互助系统以及天花紧急情况期间所需的多机构/跨机构协调。事件指挥管理包括设定目标和优先级、信息（风险沟通）、安全以及联络。行动包括控制和遏制天花疫情，包括环状接种、大规模接种、不良事件监测与评估、确诊和疑似天花病例的管理、接触者追踪、主动监测团队以及强化的医院监测，还有消毒。规划/情报职能包括制定事件行动计划、天花病例的流行病学调查与分析以及对高危人群疫苗接种覆盖状况的流行病学评估。后勤职能包括接收、处理、盘点和分发天花疫苗及接种诊所用品；人员；运输；通信；以及人员的医疗保健。最后，财务/行政职能包括监测与天花紧急情况相关的成本、采购以及事件指挥系统其他职能部门未处理的行政方面。该计划由 LAC - DHS 天花规划工作组制定并经常进行审查，由 LAC 生物恐怖主义咨询委员会定期审查，并借鉴了疾病控制与预防中心（CDC）的《天花应对计划和指南》以及免疫实践咨询委员会（ACIP）的建议。《天花防范、应对及恢复计划》及其 SEMS 框架和 ICS 结构，现在正作为 LAC - DHS 制定应对其他恐怖主义或自然疫情应对计划的典范。
