To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission.

Pilot prospective multicenter surveillance study.

The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals.

All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data.

In total, 408 isolates were collected from 358 patients; 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure.

Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital; most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients).

Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.

The West African Disaster Preparedness Initiative held a disaster preparedness tabletop exercise with representatives from the Economic Community of West African States (ECOWAS) in November 2015. The tabletop exercise was hosted by the Republic of Ghana’s National Disaster Management Organization and partners in Accra, Ghana.

ECOWAS Commission delegates and representatives from 10 member states were confronted with a series of simulated crises. Participants utilized existing national preparedness plans and web-based information technologies to research and communicate about internal disaster threats and those from neighboring countries. After each of the exercise’s three phases, facilitators distributed participant surveys.

A total of 106 individuals participated in the tabletop exercise. During the exercise, national teams utilizing well-developed disaster contingency plans and emergency operations center (EOC) standard operating procedures (SOPs) reached out to help less-prepared national teams. Key issues identified in the survey were language and cultural issues as barriers, effectiveness of disaster management agencies linked to heads of state, and the need for data sharing and real-time communication for situational awareness and multisector coordination.

This tabletop exercise helped improve and refine the ECOWAS regional and member states’ national SOPs that teams will employ to prepare for, respond to, and recover from future disasters. (Disaster Med Public Health Preparedness. 2019;13:400-404)

The Ebola outbreak demonstrated the need for improved disaster response throughout West Africa. The West Africa Disaster Preparedness Initiative was a training and assessment effort led by US Africa Command and partners to strengthen capacities among 12 West African partner nations (PNs).

Series of 3-week training sessions with representatives from each PN were held from 13 July through 20 November 2015 at the Kofi Annan International Peacekeeping Training Centre in Accra, Ghana. A team conducted Disaster Management Capabilities Assessments (DMCAs) for each PN, including a review of key data, a survey for leaders, and in-person interviews of key informants.

All 12 PNs generated a national Ebola Preparedness and Response Plan and Emergency Operations Center standard operating procedures. DMCA metrics were generated for each PN. Top performers included Ghana, with a plan rated good/excellent, and Benin and Burkina Faso, which both achieved a satisfactory rating for their plans. More than 800 people from 12 nations were trained.

PNs have improved disaster management capabilities and awareness of their strengths and weaknesses. The Economic Community of West African States has increased its lead role in this and future planned initiatives. (Disaster Med Public Health Preparedness. 2017;11:431–438)

The Republic of Senegal Disaster Preparedness and Response Exercise was held from June 2-6, 2014, in Dakar, Senegal. The goal was to assist in familiarizing roles and responsibilities within 3 existing plans and to update the National Disaster Management Strategic Work Plan.

There were 60 participants in the exercise, which was driven by a series of evolving disaster scenarios. During the separate Disaster Management Strategic Work Plan review, participants refined a list of projects, including specific tasks to provide a “road map” for completing each project, project timelines, and estimated resource requirements. Project staff administered a survey to conference participants.

A total of 86% of respondents had improved knowledge of Senegal disaster plans as a result of the exercise. A total of 89% of respondents had a better understanding of their ministry’s role in disaster response, and 92% had a better understanding of the role of the military during a pandemic. Participants also generated ideas for disaster management system improvement in Senegal through a formal “gap analysis.”

Participants were in strong agreement that the exercise helped them to better understand the contents of their disaster response plans, build relationships across ministerial lines, and effectively enhance future disaster response efforts. (Disaster Med Public Health Preparedness. 2017;11:183–189)