AMERICAN ACADEMY OF PEDIATRICS

CENTERS FOR DISEASE CONTROL AND PREVENTION

AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016

Atlanta, Georgia

Record of the Proceedings
TABLE OF CONTENTS

Page

Summary....... ............................................................................................................................1

Opening Session...................................................................................................................2

Overview of the Pediatric and Public Health Tabletop Exercise.............................................5

Overview of the Pediatric and Public Health Tabletop Exercise Process...............................7

MODULE 1: THREAT OF SMALLPOX...........................................................................................8

Overview of Smallpox......................................................................................................8

Introduction of Module 1 ................................................................................................11

State Team Reports: Module 1 Questions .....................................................................12

MODULE 2: STRATEGIC COMMUNICATIONS AND EFFECTIVE MESSAGING ..................................13

Introduction of Module 2 ................................................................................................14

State Team Reports: Module 2 Questions .....................................................................15

MODULE 3: SMALLPOX VACCINATION .....................................................................................17

Introduction of Module 3 ................................................................................................18

State Team Reports: Module 3 Questions .....................................................................18

Overview of AAP’s Role in the Smallpox Scenario ........................................................20

MODULE 4: STRATEGIC NATIONAL STOCKPILE ........................................................................22

Overview of the Strategic National Stockpile .................................................................22

Introduction of Module 4 ................................................................................................24

State Team Reports: Module 4 Questions .....................................................................24

MODULE 5: SOCIAL MEDIA.....................................................................................................26

Introduction of Module 5 ................................................................................................26

State Team Reports: Module 5 Questions .....................................................................27

Hotwash Session ................................................................................................................31

Closing Session ..................................................................................................................37

Attachment 1: Participants’ Directory ........................................................................................39

Attachment 2: Glossary of Acronyms ........................................................................................46
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 1

 

AMERICAN ACADEMY OF PEDIATRICS

CENTERS FOR DISEASE CONTROL AND PREVENTION

AAP/CDC PEDIATRIC AND PUBLIC HEALTH TABLETOP EXERCISE

January 26, 2016

Atlanta, Georgia

Summary Report

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention 

(CDC) convened the “Pediatric and Public Health Tabletop Exercise” on January 26, 2016. The 

exercise was held at the CDC Tom Harkin Global Communications Center, Auditorium B3, in 

Atlanta, Georgia.

The AAP/CDC Exercise Planning Team organized the Tabletop Exercise with five state teams to 

address a threat of smallpox that would impact children and require the use of supplies from the 

Strategic National Stockpile (SNS). The state teams included public health representatives who 

were CDC Public Health Emergency Preparedness (PHEP) grantees and pediatricians from AAP 

chapters in five Region VI states: Arkansas, Louisiana, Oklahoma, New Mexico and Texas.

The AAP/CDC Exercise Planning Team charged the state teams with establishing and 

maintaining capabilities in three core areas over the course of the Tabletop Exercise.

 Planning: The state teams would conduct a systematic process in the development of 

executable, strategic, operational and/or community-based approaches to meet defined 

objectives. The state teams would engage the entire community in this effort as 

appropriate.

 Operational Coordination: The state teams would establish and maintain a unified and 

coordinated operational structure and process to appropriately integrate all critical 

stakeholders and support the execution of core capabilities.

 Operational Communications: The state teams would ensure the capacity for timely 

communications in support of security, situational awareness and operations by any and 
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 2

all means available in the impact area and all response groups. The state teams would 

facilitate communications among and between all affected communities.

Eric Dziuban, MD, DTM, FAAP

Lead, Children’s Preparedness Unit

Division of Human Development and Disability

National Center on Birth Defects and Developmental Disabilities

Centers for Disease Control and Prevention

Dr. Dziuban moderated the opening session and welcomed the participants to the Tabletop 

Exercise. He introduced the panel of AAP and CDC speakers who would provide welcoming 

remarks.

RADM Stephen Redd, MD

Director, Office of Public Health Preparedness and Response

Centers for Disease Control and Prevention

Dr. Redd thanked the participants for taking time from their busy schedules to travel to Atlanta to 

conduct the Tabletop Exercise. He explained that Dr. Thomas Frieden, Director of CDC, 

established public health/clinical medicine collaboration as one of CDC’s top three priorities for 

the nation to achieve better overall health.

Dr. Redd emphasized that the Tabletop Exercise would serve as an excellent model to support 

this priority, because CDC’s responses to three public health emergencies (PHEs) at this time all 

focus on the clinical care of children to some degree. The CDC has the longest history and most 

experience with polio response efforts. All polio surveillance and interventions are focused on 

children <5 years of age.

Ebola does not have the same impact on children as polio, but the disease still has numerous 

implications for children in West Africa, such as high fatality rates of their parents and poorly 

functioning medical care systems that do not provide adequate care and treatment. Moreover, 

some school-aged children in the United States with family members who returned from Africa 

faced stigma during the early phase of the 2015 Ebola outbreak.

The ongoing Zika virus outbreak in South America is a maternal-pediatric problem that principally 

affects children as well. CDC has not officially activated a response to the lead poisoning crisis 

in the Flint, Michigan water supply at this time, but this PHE also will have a significant impact on 

children.

Opening Session
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Dr. Redd acknowledged that CDC and all of its federal partners need to increase the focus on 

children in their emergency preparedness and response activities. Most notably, the Trust for 

America’s Health published a report in October 2007 that identified critical gaps related to children 

in the U.S. government’s pandemic influenza preparedness efforts. The report noted that children 

and adolescents from 0-19 years of age accounted for nearly 46% of all deaths from H5N1 

influenza, but no pediatric formulations of antiviral drugs had been developed.

Dr. Redd concluded his opening remarks by asking the state team members to identify specific 

processes, outcomes and actions that the public health and clinical communities should jointly 

take to improve pediatric preparedness. He hoped the Tabletop Exercise would serve as a 

starting point in initiating significant changes in this area over the next year.

Coleen A. Boyle, PhD, MSHyg

Director, National Center on Birth Defects and Developmental Disabilities

Centers for Disease Control and Prevention

Dr. Boyle joined her colleagues in thanking the state public health representatives and AAP 

members for their participation in the critically important Tabletop Exercise. She pointed out that 

CDC’s priority to strengthen public health/clinical medicine collaboration in the United States is 

particularly timely. For example, the CDC recently reached out to AAP leadership for assistance 

in developing “Interim Guidelines for the Evaluation and Testing of Infants with Possible 

Congenital Zika Virus Infection-United States, 2016.” The AAP member expertise on the best 

clinical approaches to evaluate children with suspected Zika virus exposure was instrumental in 

helping the CDC experts to refine and finalize the recommendations. The clinical guidelines will 

be featured as an early release in the January 26, 2016, edition of the Morbidity and Mortality 

Weekly Report.

Dr. Boyle confirmed that CDC recognizes the importance of placing a special focus on children 

and their safety. Most notably, Dr. Redd provided leadership in facilitating collaboration across 

multiple National Centers and leveraging funds from various internal budgets to support CDC’s 

children’s preparedness initiative. She also was pleased that AAP is serving as a strong partner 

to CDC in addressing the ongoing Zika virus outbreak.

Georgina Peacock, MD, MPH, FAAP

Director, Division of Human Development and Disability

National Center on Birth Defects and Developmental Disabilities

Centers for Disease Control and Prevention

Dr. Peacock announced that the longstanding AAP/CDC partnership in children’s preparedness 

was initiated with the H1N1 influenza response. The key outcomes of the response were to 

ensure children were immunized, help administer antiviral drugs to children early in the influenza 

season, and clearly define the role and responsibilities of pediatricians in the public health 

response. Since that time, the Office of Public Health Preparedness and Response (OPHPR) and 
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 4

the National Center on Birth Defects and Developmental Disabilities (NCBDDD) have partnered 

to establish a formal children’s preparedness initiative at CDC. This activity still covers influenza 

readiness, but has been expanded over time to include the development of anthrax clinical 

guidelines for children as well as a focus on children’s health issues during the 2015 Ebola 

outbreak and the ongoing Zika virus outbreak.

After Dr. Frieden established public health/clinical medicine collaboration as one of CDC’s top 

three priorities, an agency-wide leadership management team was formed to strengthen 

relationships between the public health and pediatric communities. CDC leadership agreed that 

a tabletop exercise with integrated public health/pediatric teams would be the best mechanism 

for both groups to begin building linkages to better understand the roles, responsibilities, strengths 

and limitations of the other group. These newly-established relationships could then be leveraged 

to enhance children’s preparedness and response efforts at state, local and regional levels.

Dr. Peacock concluded her opening remarks by thanking and formally recognizing several groups 

that have played a key role in CDC’s children’s preparedness initiative.

 CDC staff involved with the children’s preparedness initiative over the past four years

 Members of the CDC leadership management team

 AAP staff, CDC staff and other subject-matter experts (SMEs) on the Tabletop Exercise 

Planning Team

Steven E. Krug, MD, FAAP

Head, Division of Emergency Medicine

Ann & Robert H. Lurie Children’s Hospital of Chicago

Dr. Krug also thanked AAP/CDC leadership and the state team members for their attendance at 

and ongoing support of the Tabletop Exercise. He reiterated remarks by the previous speakers 

in terms of the strong, productive and longstanding AAP/CDC partnership that has successfully 

addressed numerous children’s preparedness issues in the past. He pointed out that the Tabletop 

Exercise demonstrates CDC’s priority to strengthen public health/clinical medicine collaboration.

At the national level, Dr. Krug noted that the Planning Team reflects excellent representation by 

AAP/CDC leadership, SMEs and other professionals with extensive expertise in preparing the 

country to provide better care to children. At state and local levels, he explained that public health 

and AAP chapters must take joint leadership in conducting children’s preparedness and response 

activities. He emphasized that CDC can award funding and offer guidance in this regard, but no 

federal agency has authority over frontline providers in the field.

Dr. Krug added that the AAP/CDC Planning Team anticipates the Tabletop Exercise will serve as 

a mechanism to establish and sustain solid public health/clinical medicine relationships prior to a 

PHE to improve state and local responses to any type of event. Based on its outcomes and 
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January 26, 2016 ♦ Page 5

overall success, AAP chapters intend to present the Tabletop Exercise beyond the five Region VI 

states for replication in the future.

Dr. Krug concluded his opening remarks by thanking and formally recognizing AAP staff and 

members who serve on the Disaster Preparedness Advisory Council and the Exercise Planning 

Team. He announced that the Tabletop Exercise would include a review session or “hotwash”

and designated time for the state team members to complete an evaluation form. The AAP/CDC 

Exercise Planning Team would use this feedback to inform additional children’s preparedness 

exercises in the future.

Dr. Dziuban concluded the opening session with additional acknowledgments.

 Senior leaders from the OPHPR, NCBDDD and other National Centers were thanked for 

their participation and ongoing support, particularly in light of CDC’s competing priority to 

respond to the Zika virus outbreak.

 CDC’s federal partners were thanked for their attendance and ongoing support: Ms. Dara 

Spector (U.S. Department of Health and Human Services (HHS), Region IV, Office of the 

Assistant Secretary for Preparedness and Response) and Mr. James Davis, Jr. (Federal 

Emergency Management Agency (FEMA), Region IV).

 The AAP/CDC Exercise Planning Team members were applauded (Ms. Laura Aird, Mr. 

Michael Bartenfeld, Mr. Sean Diederich and Ms. Wendy Ruben) for their dedicated efforts 

over the past seven months in making travel arrangements and addressing all other 

logistical issues for the participants to attend the Tabletop Exercise.

 The floor was opened for introductions of the state team members in the five Region VI 

states (Attachment 1: Participants’ Directory).

Eric Dziuban, MD, DTM, FAAP

Lead, Children’s Preparedness Unit

Division of Human Development and Disability

National Center on Birth Defects and Developmental Disabilities

Centers for Disease Control and Prevention

Dr. Dziuban presented an overview of the Tabletop Exercise. The overarching mission of the 

CDC Children’s Preparedness Unit is to champion the needs of children in emergency 

preparedness and response by integrating children into public health planning at federal, state 

and local levels. CDC fulfills its mission by conducting four core activities, which are to:

 Build an evidence base of best practices, tools and other resources to guide planning.

Overview of the Pediatric and Public Health Tabletop Exercise
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 Increase awareness of the importance of incorporating children into preparedness 

planning.

 Offer technical assistance and serve as SMEs to federal, state and local public health.

 Develop partnerships with preparedness planning leaders.

The CDC Children’s Preparedness Unit established three key goals to guide its activities. First, 

linkages among public health, pediatricians, children’s hospitals and other stakeholders will be 

fostered and sustained to improve children’s preparedness efforts domestically. Second, the 

need for timely, accurate and comprehensive data and recommendations on the care, treatment 

and involvement of children in PHEs will continue to be emphasized. Third, pre-planning for 

upcoming events will include reviewing lessons learned, developing strategic communications, 

and filling gaps in preparedness for known threats.

Dr. Dziuban explained that this exercise arose from results/discussions related to a CDC 

Leadership Management Initiative. Further, he reported that after the AAP and CDC agreed on 

the need to convene the Tabletop Exercise and formed the Exercise Planning Team, the first step 

was to clearly define the purpose of this effort. Connectedness between public health 

preparedness professionals and pediatricians would be improved. The knowledge of 

pediatricians about PHE preparedness and response would be strengthened. Understanding 

among public health professionals regarding the needs of children in disasters and the role of 

pediatricians would be enhanced. Lessons learned would be identified and steps that can be 

taken to help states improve pediatric preparedness would be proposed.

The Planning Team’s next step was to determine objectives and evaluation measures to guide 

the Tabletop Exercise.

1. Identify at least 10 collaborative strategies that AAP chapters, pediatric clinicians and 

public health leaders could implement to advance pediatric preparedness at state and 

local levels.

2. Determine at least 5 steps that states could take to improve communications, specific to 

children’s issues, between public health and pediatric leaders during a response to a PHE 

to sufficiently address the needs of children.

3. Discuss and evaluate strategies to optimize plans for the distribution and dispensing of 

medical countermeasures (MCMs) that would be suitable for pediatric care and relevant 

to the infectious disease threat outlined in the Tabletop Exercise scenario.

To achieve these goals, the Exercise Planning Team invited two public health and two clinical 

pediatric representatives to serve on each of the five state teams. The Planning Team envisioned 

that this structure would provide both groups (public health planners and pediatric leaders) with 

more access to the other group and improve their capacity to effectively collaborate during an 

emergency. Based on the outcomes and overall success of the Tabletop Exercise, the Exercise 
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January 26, 2016 ♦ Page 7

Planning Team hopes to design a virtual exercise for public health and clinical pediatric 

representatives so that other states can participate remotely.

Dr. Dziuban concluded his overview by clarifying that although the Exercise Planning Team 

selected smallpox as the infectious disease threat to children, the Tabletop Exercise would not 

be specific to this disease. Instead, the state teams would have a much broader charge of 

recommending partnership approaches and communication strategies and processes to improve 

children’s preparedness in a natural disaster or any other type of PHE.

David Schonfeld, MD, FAAP

Professor of the Practice in the School of Social Work and Pediatrics

University of Southern California and Children's Hospital Los Angeles

Director, National Center for School Crisis and Bereavement

Margaret C. Fisher, MD, FAAP

Medical Director

The Unterberg Children’s Hospital at Monmouth Medical Center

Drs. Schonfeld and Fisher served as the moderators of the five modules the state teams would 

conduct over the course of the Tabletop Exercise. Dr. Schonfeld began the overview by reviewing 

the ground rules for the state team members.

 Cell phones and other electronic devices should be silenced during the Tabletop Exercise 

and used during breaks only.

 The attention of the state team members should be directed toward their specific tasks

and roles while the modules are being conducted. Discussions should be limited to the 

event and details within the scenario.

 Instructions by the facilitators to advance to the next question should be immediately 

followed because the scenario will be presented in “real time.”

 Reasonable assumptions should be made as needed.

 Questions should be asked only if clarification is important or critical to continue with the 

scenario.

 Ambiguity or lack of detailed information may occur in the scenario as it does during a real 

event and should be managed by the participants when instructed by the facilitators.

 Any event described by the facilitators should be considered as an actual occurrence for 

the purpose of the Tabletop Exercise.

 Debriefing should occur after rather than during the Tabletop Exercise.

 Discussions should immediately cease when the facilitators interject with critical updates 

or additional information as the scenario evolves over the course of the five modules.

Overview of the Pediatric and Public Health Tabletop Exercise Process
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January 26, 2016 ♦ Page 8

 Issues that were overlooked or any other gaps should be addressed if any state team 

completes a module ahead of schedule.

Dr. Fisher provided additional details on the rationale for the Exercise Planning Team’s selection 

of smallpox for the scenario. The possibility of using pandemic influenza as the infectious disease 

threat to children was initially proposed, but the Planning Team noted that this emergency has 

been the subject of numerous tabletop exercises in the past. As a result, the Exercise Planning 

Team agreed that the Smallpox Tabletop Exercise would be a different and unique experience 

for both the public health and clinical pediatric representatives. Moreover, the states likely would 

have no smallpox SMEs on their teams.

Dr. Fisher further noted that significant knowledge gaps exist related to smallpox. Despite the 

common belief of smallpox being eradicated worldwide, the scenario would demonstrate that the 

disease could be a potential threat through an accidental exposure. However, the Tabletop 

Exercise was not intended to strengthen the expertise, knowledge or understanding of the state 

team members in smallpox. Instead, the key outcome would be to enhance communications, 

collaboration and coordination within and across states to improve children’s preparedness and 

response to any type of PHE.

Dr. Fisher concluded the overview by introducing the five facilitators who would provide technical 

assistance while the state teams conducted the modules: Ms. Laura Aird, Dr. Sarita Chung, Mr. 

Sean Diederich, Dr. Eric Dziuban and Dr. Scott Needle.

MODULE 1: THREAT OF SMALLPOX

The session for Module 1 included an overview of smallpox, an introduction of Module 1 (the 

threat of smallpox on days 1-21 of the scenario), and state team reports of their findings in 

response to the Module 1 questions.

Brett Petersen, MD, MPH

Commander, U.S. Public Health Service

Medical Officer, Poxvirus and Rabies Branch

National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention

Overview of Smallpox
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January 26, 2016 ♦ Page 9

Dr. Petersen presented an overview of smallpox and described CDC’s strategic response to a 

potential smallpox emergency. Smallpox is a clinically evident disease with no sub-clinical illness. 

The incubation period lasts 10-12 days on average, but can range from 7-17 days. Although 

persons are not infectious and do not show signs of illness during the incubation period, all 

infected persons show symptoms as the disease progresses over time.

The prodrome period lasts 2-3 days and is characterized by severe influenza-like illness, including 

fever and prostration. A rash that develops lasts for 2-3 weeks on average and progresses from 

macules and papules to vesicles and pustules. Smallpox is transmitted person-to-person through 

close contact with respiratory droplets. Transmission is greatest in the first week after the onset 

of the rash.

Epidemiologic data show that household contacts primarily become infected from cases. 

Modeling data of the current population estimate that 2-4 persons will become infected from a 

case. Untreated persons have a 30% case fatality rate on average, but vaccination with the 

vaccinia virus provides protection from disease. However, smallpox vaccination has not been 

routinely given since 1972. Moreover, vaccination typically provides immunity from smallpox for 

no longer than 20 years.

The CDC maintains vaccine in the SNS as the primary MCM for smallpox. The SNS currently 

stores sufficient vaccine to vaccinate all persons in the United States. The two replicationcompetent vaccines in the SNS require one dose and have a high efficacy rate of >95%. 

ACAM2000TM is a clonal vaccine that is derived from the same virus as Dryvax. The Aventis 

Pasteur Smallpox Vaccine is a historic vaccine.

The attenuated, replication-deficient vaccine in the SNS, IMVAMUNE® (MVA), requires two 

doses and was developed for use in persons who are at high risk for adverse events (AEs). The 

SNS also stores antiviral drugs, including tecoviromat, for the treatment of active disease and 

cidofovir in an intravenous formulation to treat nephrotoxicity. CDC maintains diagnostic capacity 

for smallpox cases through Laboratory Response Network (LRN) sites and its onsite reference 

center for case confirmation.

CDC’s vaccination strategy is guided by several key principles. The core goal of stopping disease 

transmission will be achieved by vaccinating persons with a live, replication-competent smallpox 

vaccine. Data show that pre-exposure smallpox vaccination is most effective. Because the 

efficacy rate of post-exposure smallpox vaccination greatly ranges from 23%-91%, the best 

strategy is to revaccinate persons <7 days post-exposure. The use of attenuated vaccine will 

reduce AEs as well.

The goal of implementing a tiered response to control the spread of disease will be achieved 

through empiric surveillance information, epidemiologic data, case identification, isolation of 

cases, contact tracing and vaccination of contacts. Data show that the epidemic curve of smallpox 

is episodic and slow with a range of 7-17 days between generations. However, the CDC 
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January 26, 2016 ♦ Page 10

recognizes the potential need to modify its tiered response based on the scope and size of the 

outbreak and changes in surveillance data.

CDC gathered strong evidence from the smallpox eradication era in 1968-1969 to support its ring 

vaccination approach of identifying cases and vaccinating contacts. Historical data showed that 

smallpox cases persisted even with a high rate of vaccination coverage in the population. 

However, the implementation of an active surveillance and containment response, including 

contact tracing and vaccination, resulted in a dramatic decrease in the number of smallpox cases 

and successfully eradicated disease.

Overall, smallpox disease is spread through close household contact rather than through casual 

social contact, such as contact on mass transportation. The identification and isolation of cases 

and vaccination of contacts will aid in stopping disease transmission; strategically focusing efforts; 

and targeting both vaccine and human resources to contacts who are most likely to become 

infected. The use of smallpox vaccine should be limited to persons at highest risk because 

vaccines used during the eradication era resulted in death and other severe AEs. This strategy 

will minimize AEs in non-close contacts and other populations with a low likelihood of infection.

Dr. Petersen provided additional details on smallpox in response to specific questions posed by

the participants.

 The primary mode of smallpox transmission is person-to-person through close contact 

with respiratory droplets. The progression of disease includes rashes or lesions in the 

oropharyngeal area, the release of virus through respiratory droplets, and infection of 

mucous membranes in the respiratory system. Smallpox typically is not transmitted by 

fomites, but individuals could have contaminated clothing or bedding because the lesions 

excrete an infectious virus. Moreover, the infectious virus is still present even after the 

lesions heal and develop a crust. Overall, the transmission of smallpox infection through 

fomites or skin-to-skin contact with lesions is possible, but these routes are extremely rare.

 Patients should be considered to be infectious from the onset of fever until all lesions have 

healed, crusted, scabbed and disappeared to reveal healthy skin underneath. Based on 

the timeline between the onset of fever and complete healing of the rash, the infectious 

period lasts 3-4 weeks on average.

 A minimum age has not been established for smallpox vaccination or antiviral treatment. 

Because exposure to smallpox places an individual at great risk for a highly fatal disease, 

no absolute contraindications have been identified for vaccination. However, AEs in 

special populations must be considered. For example, smallpox vaccine can be given to 

pregnant women, but the development of fetal vaccinia is a potential risk to the pregnant 

woman and fetus.

 Several logistical issues must be addressed in smallpox vaccination. Most notably, the 

vaccine is administered by bifurcated needle. The vaccine is a lyophilized or freeze-dried 

formulation that must be administered within 24 hours after reconstitution. The CDC can 

rapidly deploy vaccine from the SNS to states within 24-48 hours.
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January 26, 2016 ♦ Page 11

Dr. Schonfeld introduced Module 1 by describing the threat of smallpox on days 1-21 of the 

scenario.

Day 1

 Amelia Xang is attending a summer science program at a medical school in Wichita, 

Kansas that allows high school students to shadow scientists in laboratory settings. 

Amelia is cleaning a biohazard freezer where smallpox samples are unknowingly stored 

with no security measures. She drops a vial in the hallway that breaks open. She uses 

the bathroom to wash up after noticing that the broken glass has caused a small cut to her 

hand. Brian Yoder also is a student and helps Amelia with the cleanup and disposal of 

the vial in the regular trash. Neither student reports the incident to staff.

Days 13-20

 Amelia becomes febrile on the last day of the program. Although her temperature is 

102°F, she still attends the graduation ceremony and returns home by bus with her 

mother. She and her mother present to a medical clinic on the following day and Amelia 

is diagnosed with a “viral illness.” After her health continues to deteriorate, she and her 

mother travel by bus to a community hospital emergency department (ED). Amelia is 

diagnosed with a “presumptive enterovirus infection.” She and her mother return to the 

hospital ED by bus the following day, and Amelia is admitted. After a macular rash is 

noticed on her face and becomes papular, exposure to smallpox is recognized. She is 

transported to a facility within the Emory Healthcare System that has been designated to 

care for patients with potential smallpox. Amelia’s mother updates her Facebook page 

with a new posting: “Going to Emory for my daughter’s smallpox.” The message goes 

“viral”, and the national media contact the hospital for comment.

Day 21

 A “health expert” from a television news station in Lincoln, Nebraska recommends 

vaccination of all residents in the state. The health expert further speculates that vaccine 

is not being provided to all persons because the smallpox case is a poor minority youth. 

All newspaper and television outlets in the five “TALON” states (Texas, Arkansas, 

Louisiana, Oklahoma and New Mexico) extensively cover the story and broadcast 

messages on the same day. The local hospital contacts public health. The five TALON 

states are asked to implement ring vaccination and identify all potential contacts who might 

have been exposed to smallpox.

Dr. Schonfeld gave the state teams 30 minutes to address the Module 1 questions.

Introduction of Module 1
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January 26, 2016 ♦ Page 12

Dr. Schonfeld moderated a session for the state teams to report their findings in response to the 

Module 1 questions.

1. What is your state team’s follow-up questions about smallpox, its effect on children, or 

children-specific vaccine recommendations for the experts?

 Louisiana advised the experts to address several pediatric-specific questions related to 

smallpox: diagnostic testing of smallpox and its reliability in children; the earliest time 

smallpox can be diagnosed in children; and differences between smallpox isolation 

procedures for children and adults.

 Louisiana noted that the smallpox scenario occurred during the summer, but advised the 

experts to develop a process to consider whether or not there should be school closures 

in response to events occurring during the school year.

2. Based on the current composition of your state team and expertise of the members, what 

other groups in the state would be engaged in the discussion?

 Louisiana would immediately engage its public health epidemiologists and other state 

officials (e.g., Governor’s Office of Homeland Security and Emergency Preparedness 

(GOHSEP), Emergency Operations Center (EOC), and Rapid Response and Strike 

Teams) that have a role in emergency preparedness. These groups are responsible for 

communicating and coordinating with CDC to activate the SNS and conducting contact 

tracing in the state. The Louisiana Hospital Association, AAP chapter and behavioral 

health experts in the state also would be extensively engaged due to their broad networks 

and influence in communities. However, Louisiana would leverage expertise outside of the 

state as needed because the infrastructure of its public health system has been severely 

weakened over the past few years.

 Texas would implement a multi-level approach to engage local, state, regional and national 

groups. The city, county and state public health officials would be engaged to provide 

epidemiologic expertise to the community hospital that diagnosed presumptive enterovirus 

infection. Regional Advisory Councils would be engaged to apply their experience in 

disaster mitigation and response and also to provide technical assistance and resources 

to small, under-funded hospitals. The Texas Medical Association, Texas Pediatric 

Society, AAP chapter and other professional associations would be engaged as well. 

Various federal agencies and national groups would be engaged to coordinate and vet 

communications at the local level. Public policymakers would be engaged at the outset. 

Although Texas recognizes the importance of a multi-level approach, strong efforts would 

be made to clearly define and articulate the roles and responsibilities of each specific 

group.

State Team Reports: Module 1 Questions
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January 26, 2016 ♦ Page 13

 Arkansas would engage national and/or state hospital associations, hospital leadership 

and media spokespersons to clarify the role of health care facilities. Most notably, 

hospitals would be expected to offer infection control expertise and guidance, provide 

appropriate isolation rooms, ensure the availability of an adequate number of beds, and 

designate a full team of physicians, nurses and other healthcare providers (HCPs) to care 

for smallpox patients.

 New Mexico would engage the Chief Information Officer in its state health department to 

develop a plan to address any mass hysteria and confusion caused by inaccurate social 

media postings.

3. What steps would your state team take to identify, outreach to and vaccinate appropriate 

contacts if the smallpox situation occurred in your state?

 Arkansas has a robust communicable disease section in its state health department that 

conducts contact tracing for several diseases. Smallpox would be included in the state’s 

existing infrastructure after health department staff received appropriate training and 

education. Arkansas also would begin to build strong relationships with other state health 

departments because the scenario calls for smallpox exposure to eventually spread to 

other states.

4. Would your state team make any efforts to identify contacts on mass transportation?

 Louisiana’s position was that smallpox would still be infectious on mass transportation 

after day 15 of the scenario. As a result, efforts would be made to identify contacts based 

on the specific bus route, date and time. A toll-free hotline would be publicized through 

the media for persons with potential exposure to contact local public health. However, 

messaging from the Louisiana EOC would be coordinated and thoroughly vetted by the 

governor’s office and state department of public health.

MODULE 2: STRATEGIC COMMUNICATIONS AND EFFECTIVE MESSAGING

The session for Module 2 included an introduction of Module 2 (strategic communications and 

effective messaging on days 1-21 of the scenario) and state team reports of their findings in 

response to the Module 2 questions.
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January 26, 2016 ♦ Page 14

Dr. Schonfeld introduced Module 2 by describing the general principals of communicating during 

a crisis. Communications about a crisis should not serve as a source of further crisis. The two 

basic reasons for public communications in a crisis setting are to reassure the public and provide 

information for individuals to take appropriate actions to decrease their risk. Examples of 

reassuring and actionable messages are outlined below, but the “low-risk” language does not 

apply to smallpox.

Reassuring Messages

 “The risk of infection is low.”

 “The risk of serious illness when infection occurs is low.”

 “Serious outcomes are rare if the disease is identified early after exposure.”

 “Symptoms are easily recognized.”

Actionable Messages

 “Take these simple steps to prevent exposure.”

 “Seek evaluation at [name of place] if you are concerned you might be exposed.”

 “These are the signs of infection you might observe in your children that suggest the need 

for further evaluation.”

Other principles that should guide crisis communication efforts are highlighted as follows. 

Messaging should include language that is direct, simple and easy to understand. Accurate and

timely information should be provided, but speculation should be avoided. A sufficient amount of 

information should be provided for persons to understand the crisis and have knowledge of 

appropriate actions to take, but the level of information should not be overwhelming or cause 

confusion. All information communicated to the general public should be regularly monitored, 

particularly to identify and correct inaccurate information.

Scripts and other communication materials should be developed prior to an event because 

information often is not properly given or received during a stressful crisis situation. Information 

disseminated by multiple sources will convey conflicting messages. Inaccurate information often 

is more interesting and compelling and typically will travel faster than accurate information. 

Persons who are poorly informed often will formulate explanations that are convincing to other 

poorly informed individuals. Persons generally base trust on interpersonal factors (e.g., empathy, 

connectedness and genuineness) and primarily use trusted sources in making decisions on 

information that is “accurate.” “Common sense” typically is uncommon during a crisis.

Dr. Schonfeld gave the state teams 30 minutes to address the Module 2 questions.

Introduction of Module 2 
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 15

Dr. Schonfeld moderated a session for the state teams to report their findings in response to the 

Module 2 questions.

5. What steps would your state team take to collaborate with potential hospital ED contacts (i.e., 

other patients in the ED at the time)?

 Oklahoma would revise its existing process to communicate information from state public 

health to frontline HCPs who will screen and treat smallpox patients. Pediatric infectious 

disease physicians traditionally have been contacted first during a crisis, but other groups 

would now be engaged at the outset as well. The hospital’s public information officer (PIO) 

would be contacted to facilitate ongoing communications with the media. The section 

medical director would be contacted to develop a screening protocol, ensure that smallpox 

patients have no contact with other patients in the ED, triage smallpox patients without 

establishing a secondary triage area or waiting room, and isolate smallpox patients in 

negative flow rooms. Based on its Ebola experience, Oklahoma would implement this 

process by closing the urgent care section.

6. What type of information would your state team provide to contacts, other medical staff and 

the general public?

 Oklahoma would include tribal partners in the dissemination of information during the 

statewide response.

 Oklahoma would activate its Health Alert Network (HAN) to widely and rapidly distribute 

information to all hospitals and primary care physicians in the state. However, Oklahoma 

acknowledges that several gaps need to be addressed at the state level to improve the 

distribution of HAN messages. Most notably, HAN alerts, advisories and updates are 

disseminated during an emergency, but the information often is limited to “top-level” 

officials and other leadership. Information to individual physicians in the hospitals 

generally is distributed on a “need-to-know” basis. For example, the HAN currently is 

being used to distribute daily notices regarding the ongoing Zika virus outbreak, but 

several physicians in Oklahoma hospitals and private practices are not included in these 

communications. Oklahoma’s next steps in improving the HAN will be to ensure that 

pediatric ED physicians, medical staff and other frontline HCPs are continuously given upto-date information as an event rapidly evolves. Oklahoma recognizes that information 

dissemination and communications during an emergency are effective from federal to 

state levels, but need to be enhanced from state to local hospital and private practice 

levels. Oklahoma also intends to address gaps in communications that are specific to 

large health care facilities, small private practices and individual physicians’ offices.

State Team Reports: Module 2 Questions
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January 26, 2016 ♦ Page 16

 New Mexico would monitor social media postings of hospital staff and take other steps to 

prevent the delivery of inaccurate information. For example, hospital personnel who 

updated their Facebook pages with information on an emergency have been terminated 

in the past.

 New Mexico would select appropriate spokespersons for message delivery, information 

dissemination and communications. For example, the New Mexico Secretary of Indian 

Affairs serves on the Homeland Security Advisory Council and would be asked to help 

identify tribal leaders who could serve as spokespersons to the 25 different Tribal Nations 

in the state.

 Louisiana would utilize informal networks to correct inaccurate information that is posted 

on social media during an emergency. For example, a case of suspected meningitis 

caused panic in a local community due to premature, inaccurate information that was 

posted on Facebook about the undiagnosed case. Pediatricians conducted active 

surveillance of the social media postings by obtaining anecdotal reports from patients of 

HCPs in the local community and students who attended school with their children.

 Texas would disseminate different types of information depending on the target audience, 

such as the general public, physicians/other HCPs and first responders. Texas would 

deliver messaging to explain the transmission of and exposure to smallpox, describe the 

signs and symptoms of smallpox, identify centralized sites for persons to present for 

appropriate testing and treatment if needed, outline the characteristics of patients who 

need to be quarantined, and summarize the overall quarantine process.

7. What actions would your state team take at the facility where the exposure occurred (e.g., the 

medical school, clinic, hospital or other locations)?

 Louisiana would use its existing pool of resources to disseminate HAN notices to 

physicians, talking points to spokespersons, updates to hospitals, and accurate 

information to communities during the event. These resources would include the Joint 

Information Center, Emergency Support Function 8 Network, and Designated Regional 

Coordinators (DRCs). The DRCs would closely collaborate with infection control staff and 

facilitate ongoing communications during the event with patients in the ED, the local 

medical school where the smallpox exposure occurred, and clinics/hospitals that treated 

Amelia. Louisiana would engage in extensive discussions with the CDC to obtain more 

information on the infection control practices of the medical school laboratory, such as its 

storage of additional vials of smallpox samples and routine use of universal precautions. 

Louisiana would launch a communications campaign to reach clinic/hospital laboratory 

staff that handled Amelia’s specimens and persons who rode on the same bus as Amelia 

during her infectious period. Because Amelia is not a household contact, however, 

Louisiana’s messaging would emphasize the low risk of exposure. Louisiana would use 

its shelf kits to rapidly distribute pre-scripted messages to first responders, vulnerable 

populations and other potentially affected groups. Louisiana would open a toll-free hotline 

to disseminate smallpox information to community leaders and other members of the 

public. Louisiana would reach out to its Bureau of Media and Communications to ensure 
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 17

that GOHSEP officers, regional medical directors, regional officers and other state officials

post accurate and consistent information on Facebook, Twitter and other social media 

outlets. Louisiana’s shelf kits for smallpox and other events are available in American Sign 

Language (ASL) and can be shared with other states.

8. Would your state team include any component of quarantine for exposed persons or isolation 

for ill patients? If so, what steps would your state team take to implement this process?

 Texas would determine whether public health and local law enforcement officials should 

be involved in the quarantine process. However, Texas acknowledges that resources 

would need to be identified and leveraged to support the quarantine process. Most 

notably, Texas would consult with human resources personnel at the outset to address 

issues related to exposed HCPs who self-quarantine in their homes, such as paid leave 

time.

 Louisiana would replicate its Ebola experience for the smallpox scenario by implementing

a voluntary quarantine process. Strike Teams would actively monitor individuals who selfquarantine in their homes based on their signs and symptoms. Louisiana would consult 

with its legal department in all aspects of the quarantine process, including a review of the 

state’s existing sanitary codes, to avoid future litigation.

 Arkansas would need to obtain expertise from the CDC on whether parents can remain in 

an isolation room with their children who are an index smallpox case. Dr. Fisher explained 

that guidance on this issue will differ depending on the infectious agent (e.g., smallpox, 

Ebola or influenza). Hospital infection control staff should consult with CDC to address 

the complexities related to a specific agent. Dr. Petersen’s position was that parents 

should be allowed to remain in the isolation room with their children. Parents who are 

vaccinated prior to exposure will be provided with some level of protection from smallpox. 

However, smallpox vaccine can still be given to parents who were exposed prior to their 

child’s hospitalization. Based on this feedback, the state teams asked the AAP and CDC 

to develop and issue quarantine and isolation guidelines for pediatric cases of smallpox, 

Ebola and other infectious agents. The state teams pointed out that the new AAP/CDC 

guidelines should emphasize the following message: “Parents are an integral part of the 

care team for children affected by [infectious agent].” The state teams recognized that the 

new quarantine and isolation guidelines would be much easier to implement at a pediatric 

rather than a non-pediatric hospital.

MODULE 3: SMALLPOX VACCINATION

The session for Module 3 included an introduction of Module 3 (smallpox vaccination on days 1-

21 of the scenario), state team reports of their findings in response to the Module 3 questions, 

and an overview of the role of the national AAP office/leaders in the smallpox scenario.
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 18

Dr. Schonfeld introduced Module 3 by announcing that a decision has been made to vaccinate all 

members of the medical staff in the clinic, ED and hospital. Vaccination also is now being offered 

to members of the public health department who were involved in secondary case finding.

Dr. Schonfeld gave the state teams 25 minutes to address the Module 3 questions. For all three 

questions, he instructed the state teams to describe both the content of messages and their 

methods of distribution.

Dr. Schonfeld moderated a session for the state teams to report their findings in response to the 

Module 3 questions.

9a. What is your state team’s strategy for delivering messaging to HCPs at sites where smallpox 

vaccination is offered?

 New Mexico would deliver consistent messaging to HCPs from a single source (ideally the 

state health department). The messaging would thank HCPs for providing excellent care 

to their patients; acknowledge concerns about the safety of patients due to the smallpox 

case that presented to the hospital; describe the risks of smallpox (e.g., the 30% case 

fatality rate among untreated persons); and highlight the benefits of smallpox vaccination 

(e.g., the high efficacy rate of >95%). New Mexico would strongly encourage and advocate 

for smallpox vaccination of HCPs to ensure the safety of their patients and family 

members. Because New Mexico is uncertain of its legislative authority to implement 

mandatory smallpox vaccination of HCPs, the influenza model would be replicated. HCPs 

who receive flu shots have a recognizable sticker on their hospital badges, while HCPs 

who do not receive flu shots are required to wear a mask for the duration of the influenza 

season.

 Texas would launch a campaign to offer smallpox vaccination to the family members of 

HCPs who potentially were exposed and might pose a risk for transmission of infection.

 Oklahoma would first identify the best site for smallpox vaccine delivery to HCPs, such as 

hospitals, the state health department or state Medical Reserve Corps. After selecting the 

vaccine delivery site, Oklahoma would convene hospital town hall meetings to disseminate 

messaging to HCPs at multiple levels; develop and distribute a list of frequently asked 

questions; and provide physicians with rigorous scientific data from the CDC: “No absolute 

contraindications have been identified for smallpox vaccination.” “The two replicationcompetent smallpox vaccines in the SNS have a high efficacy rate of >95%.” Oklahoma’s 

Introduction of Module 3 

State Team Reports: Module 3 Questions
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January 26, 2016 ♦ Page 19

messaging also would provide HCPs with truthful and straightforward information 

regarding the AEs associated with smallpox vaccination, the administration route, and 

necessary monitoring post-vaccination to document uptake.

 Arkansas would present a brief synopsis to HCPs at sites where smallpox vaccination is 

offered. The overview would cover smallpox signs and symptoms, AEs, appropriate 

storage and proper administration of the vaccine, and contact information for smallpox 

SMEs in the state. The HCPs would be given sufficient training to ensure that the integrity 

of smallpox vaccine that the CDC deployed from the SNS is not compromised. However, 

Arkansas would need to modify its existing legislative authority to implement mandatory 

smallpox vaccination of HCPs.

 Louisiana would consult with the CDC to obtain expertise on logistical issues related to 

smallpox vaccine administration. Louisiana does not have sufficient capacity, trained staff 

or other resources at this time to implement mass vaccination to HCPs, first responders 

and their exposed family members during the smallpox scenario. Dr. Dziuban clarified 

that in the smallpox scenario, states could utilize the existing Epi-Aids process to request 

SMEs or other types of technical assistance from the CDC during an emergency.

9b. What is your state team’s strategy for delivering messaging to HCPs at sites in the city or 

state where smallpox vaccination is not offered?

 New Mexico’s messages to this group of HCPs would be similar to those for HCPs at sites 

where smallpox vaccination is offered. However, the messaging would emphasize that 

the state health department only recommends vaccination of HCPs who were directly 

involved with the smallpox case. Any HCPs with questions or concerns regarding their 

potential exposure would be advised to contact the statewide nursing line for referral to an 

epidemiologist at the state health department.

 Texas would use its existing pool of resources to deliver messaging to diverse groups of 

HCPs, including communication channels of local health care facilities to reach individual 

HCPs; the HAN to reach a broader audience of HCPs; and Regional Advisory Councils to 

reach hospital preparedness HCPs, emergency medical services staff and staff in 650 

hospitals.

9c. What is your state team’s strategy for delivering messaging to staff at the medical center 

where the exposure occurred (i.e., the healthcare facility where Amelia received treatment)?

 Texas would offer smallpox vaccination to this group of HCPs first due to their direct role 

in administering the vaccine to Amelia and handling her specimens.
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 20

Benard P. Dreyer, MD, FAAP

President

American Academy of Pediatrics

Karen Remley, MD, MBA, MPH, FAAP

Executive Director & CEO

American Academy of Pediatrics

Drs. Dreyer and Remley joined the Tabletop Exercise by teleconference to describe the role of 

AAP leadership in disseminating information to its entire membership of pediatric providers during 

the smallpox scenario.

Dr. Remley explained that AAP’s first step would be to gather accurate information on all aspects 

of the smallpox exposure from credible sources, such as the CDC and the Kansas Department of 

Health and Environment. The AAP would then begin developing the communications and 

messaging strategy by forming a leadership team with representation by its Executive Committee, 

head of public affairs, and the chairperson of the AAP Committee on Infectious Diseases. Dr. 

Pam Shaw, Vice Chairperson for the AAP district that includes Kansas, also would be engaged 

with the leadership team at the outset.

The AAP would target the communications strategy to both its membership and the general 

public. During the dissemination of information to the public, it would be particularly important to 

address confusion regarding exposure to a disease that is commonly believed to have been 

eradicated. Most notably, the AAP offers a comprehensive Web site for parents or uses 

HealthyChildren.org. This Web site has 86,000 registered subscribers and receives ~2 million 

views per month. A duplicate site is provided in Spanish. The AAP would use 

HealthyChildren.org to inform the public of up-to-date pediatric health news during the smallpox 

scenario and provide links to important information from the CDC. Depending on the questions 

from the “worried well” population, the AAP also would post a video on its Web site to describe 

the events that caused Amelia’s exposure to smallpox and the risk of exposure to other persons.

The AAP leadership would be a key participant in daily teleconferences with the CDC leadership 

over the course of the smallpox scenario. Most notably, the AAP and CDC would designate 

skilled, trusted and experienced liaisons to ensure that the communications strategy was 

organized, systematic, coordinated and collaborative. The AAP and CDC liaisons would have 

oversight of ongoing message delivery to frontline clinical pediatric providers and public health 

officials in the field.

Overview of AAP’s Role in the Smallpox Scenario
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 21

Dr. Dreyer added that AAP would use a variety of mechanisms to facilitate ongoing and rapid 

communications with its membership. The AAP Web sites would be continuously updated with 

messages as the smallpox scenario evolves, particularly protocols for pediatricians to take action. 

The AAP SmartBrief publication would be used to inform pediatricians of emerging developments 

in the smallpox scenario on a daily basis. A set of standardized talking points would be widely 

distributed to ensure that AAP chapters in Kansas and other states deliver consistent and 

accurate messages to local media outlets. Specific state and local information would be directly 

disseminated to leadership and members of the AAP Kansas chapter if needed.

Drs. Dreyer and Remley provided additional details on the AAP communications and messaging 

strategy during the smallpox scenario in response to specific questions posed by the state team 

members.

 The AAP would provide pediatricians in the field with several resources to aid in the 

delivery of consistent messages and the dissemination of accurate information to families 

during the smallpox scenario. For example, the AAP Web sites would be updated with 

links to talking points for pediatricians, information for pediatricians from credible sources, 

and a list of key points for pediatricians to communicate to the parents of their patients. 

Pediatricians would be able to download and print all of these resources to be displayed 

in their offices or distributed to families. The AAP would provide pediatricians with 

guidance on effective and rapid communications with families via email blasts, and 

Facebook, Twitter or other social media outlets. The AAP would reach out to its existing 

pool of respected pediatric communicators and bloggers to develop and disseminate 

videos and press releases to pediatricians in the field. Based on feedback from the state 

teams, however, the AAP leaders acknowledged the need to collaborate with the CDC to 

develop a package of smallpox materials for pediatricians to display in their offices.

 The AAP would implement the communications campaign during the smallpox scenario in 

close collaboration with its large pool of national partners that also advocate for and have 

a strong interest in children’s health.

o The American College of Physicians would be engaged for outreach to its membership 

of internists and other medical sub-specialties.

o The American Congress of Obstetrics and Gynecologists would be engaged for 

outreach to its membership of clinicians who serve women of childbearing age, 

pregnant women and the fetus.

o The American Academy of Family Physicians would be engaged for outreach to its 

membership of family physicians, residents and medical students.

o The American Nurses Association, National Association of Pediatric Nurse 

Practitioners, National Association of School Nurses, and the Association of Public 

Health Nurses would be engaged for outreach to their memberships of pediatric nurse 

practitioners.

o The Association of State and Territorial Health Officials and the National Association 

of County and City Health Officials would be engaged for outreach to their 

memberships of public health officials at state, territorial, city and county levels.
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 22

MODULE 4: STRATEGIC NATIONAL STOCKPILE

The session for Module 4 included an overview of the SNS, an introduction of Module 4 

(deployment of the SNS on days 22-23 of the scenario), and state team reports of their findings 

in response to the Module 4 questions.

Susan Gorman, PharmD, MS, DABAT, FAACT

Associate Director for Science, Division of Strategic National Stockpile

Office of Public Health Preparedness and Response

Centers for Disease Control and Prevention

Dr. Gorman presented an overview of the SNS that the CDC established in 1999. The SNS is a 

$6.5 billion repository that currently maintains 900 different line items (e.g., antibiotics, chemical 

antidotes, antitoxins, vaccines, antiviral drugs and other lifesaving medical material) to 

supplement and re-supply state and local public health agencies in the event of an emergency. 

SNS medical material is held in a network of locations near U.S. transportation hubs and is 

positioned to optimize timely and clinically relevant deployment.

The SNS material utilization plans are integrated with state and local planning and also with a 

broader U.S. government preparedness and response framework. All states and territories have 

developed their individual plans to receive and distribute SNS medicine and medical supplies to 

local communities as quickly as possible. Tribes are incorporated into state and local plans, but 

might request direct support from the SNS. CDC uses FedEx, UPS and other commercial 

partners to deliver materials through their existing capabilities that are used daily throughout the 

United States and internationally.

The CDC can deploy SNS support teams to assist state and local officials in receiving stockpile 

assets during a PHE. The role and responsibilities of the SNS support teams include helping to 

establish federal medical stations and serving as liaisons between EOCs in affected areas and 

the SNS. However, vaccinators do not serve on the SNS support teams.

The CDC rationale for stockpiling material is three-fold. First, some required products, such as 

smallpox vaccine, are not commercially viable or available. Second, because the U.S. 

pharmaceutical supply chain operates on a just-in-time model, commercial products might not be 

available in the projected quantities required or might be unable to reach affected populations in 

adequate timeframes or quantities. Third, the commercial supply chain is not optimized to 

dispense products to affected populations at the required time, volume or level.

Overview of the Strategic National Stockpile
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 23

The CDC has prioritized biological, chemical, radiological/nuclear and pandemic influenza 

formularies in the SNS. Agents treated by these formularies include smallpox, anthrax, botulism, 

viral hemorrhagic fevers, plague, tularemia and nerve agents. The process for requesting SNS 

assets begins with the recognition that drugs and medical supplies have exceeded state and local 

resources. Governors, their designees or other state officials request federal assistance. After 

key officials from HHS, the U.S. Department of Homeland Security, the CDC and the requesting 

state discuss the request, federal officials deploy SNS assets to augment federal, state or local 

medical material resources.

The CDC has developed several product configurations to meet the needs of a particular SNS 

deployment. Forward-placed caches of chemical nerve agent antidotes (i.e., CHEMPACKS) must 

be rapidly administered to be clinically effective. The 12-hour push package includes about 50 

tons of various medical materials that are deployed within 12 hours of federal approval. The CDC 

deploys this product configuration when the threat is unknown. The SNS-managed inventory 

represents the bulk of the repository, including vaccines, antiviral drugs, antibiotics, smallpox 

MCMs and specialized response kits. The vendor-managed inventory stockpiles MCMs that have 

a commercial use. The CDC also has the ability to directly order products that are not stockpiled 

in the SNS at the time of an event.

Smallpox MCMs that are stockpiled in the SNS at this time are highlighted as follows. The three 

smallpox vaccines include ACAM2000TM, WetVax and MVA. A package insert and medication 

guide CD-ROM are deployed with ACAM2000TM because this product is the only smallpox vaccine 

approved for use by the U.S. Food and Drug Administration (FDA). Ancillary supplies needed to 

administer smallpox vaccine include diluent, transfer needles, bifurcated needles and vial 

stabilizers. Other MCMs include vaccinia immune globulin, cidofovir, probenecid and tecovirimat.

The CDC deployment of vaccine from the SNS will depend on the scale of an event. To administer 

smallpox vaccine to all persons in the United States, for example, the CDC developed a plan in 

the early 2000s to deliver the first 75 million doses within 24 hours of a large-scale event. Preconfigured doses would be deployed to each city with a population of >10,000 persons. Smallpox 

vaccine for a smaller, more contained event would be shipped to a receiving/storage/staging area 

that has been pre-designated in each state or the state/local health department. Unlike influenza 

vaccine, the CDC does not ship smallpox vaccine from the SNS directly to individual physicians’

offices.

The CDC has addressed all issues related to shipping smallpox vaccine from the SNS. All of the 

vaccines have a cold-chain requirement of being stored frozen at -20°F, but the products can be 

shipped refrigerated at 2-8°F. This is because the FDA has not approved the use of MVA at this 

time, however, the manufacturer’s preference is for the product to be shipped frozen at -20°F. 

Depending on the type of shipping container that the CDC uses, the temperature of frozen or 

refrigerated smallpox vaccine can be maintained from 6-128 hours. Ancillary supplies are shipped 

separately from, but at the same time as smallpox vaccine at room temperature. Each shipment 
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 24

also includes a gauge to verify the temperature of the vaccine and instructions on the time 

restrictions of its storage and use.

Dr. Schonfeld introduced Module 4 by describing plans to deploy the SNS.

Day 22

 The decision is reached to vaccinate all students who attended the same program as 

Amelia in the event of their potential exposure.

 The following information becomes known. Brian Yoder, the student who helped Amelia 

with the cleanup and disposal of the smallpox vial, traveled to Houston, Texas by 

Greyhound bus on day 19 to attend a large family reunion. Brian’s ~75 relatives from the 

five TALON states, Alaska, Idaho, Montana, North Carolina and Oregon already were in 

attendance before he arrived. Although Brian felt ill on day 19 and was febrile on day 20, 

he still attended the family reunion. Brian went to bed later in the day, but several relatives 

hugged him prior to their departure. Brian’s health continued to deteriorate and he was 

taken to a local ED on day 21. He was admitted, but the hospital had no access to his 

medical records. His condition was diagnosed as likely enterovirus infection.

 The hospital is informed that Brian possibly was exposed to smallpox.

Day 23

 The decision is made to broaden vaccination beyond Kansas.

Dr. Schonfeld gave the state teams 30 minutes to address the Module 4 questions.

Dr. Schonfeld moderated a session for the state teams to report their findings in response to the 

Module 4 questions.

10. What other groups would your state team now include in plans for smallpox vaccination?

 Louisiana’s vaccination strategy would include all travelers who rode on the same 

Greyhound bus as Brian, all of his relatives who attended the family reunion, and all local 

ED staff directly involved in his treatment. Louisiana would convene an epidemiologic 

team to conduct contact tracing. Louisiana would consult with the CDC and maintain 

ongoing communications with the other nine states where Brian’s potentially exposed 

relatives reside.

Introduction of Module 4 

State Team Reports: Module 4 Questions
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 25

 Oklahoma would convene teleconferences with the CDC and representatives from the 

other four TALON states to develop an ongoing, effective and coordinated 

communications protocol over the course of the multi-state vaccination strategy. 

Oklahoma would solicit technical assistance and expertise from the CDC to form a team 

of trace workers and epidemiologists. Oklahoma would extensively integrate community 

paramedicine resources into the vaccination strategy, such as EMS providers who have a 

special scope of practice to vaccinate individuals. Oklahoma would vaccinate all of Brian’s 

relatives who attended the family reunion and follow up with their family members who 

were not in attendance. Oklahoma would use CDC’s existing guidelines to follow-up with 

travelers who rode on the same Greyhound bus as Brian.

 Texas would not include travelers who rode on the same Greyhound bus as Brian in its 

vaccination strategy. Because persons are not infectious during the 7- to 17-day 

incubation period, Brian likely posed no risk when he rode on the Greyhound bus and 

became febrile on days 19-20 post-exposure. Moreover, the hospital learned of Brian’s 

potential exposure on day 22, but a smallpox diagnosis was never made. Based on these 

factors, Texas would limit its vaccination strategy to Brian’s family members. Travelers on 

the Greyhound bus would be identified for quarantine, isolation and observation to rule out 

smallpox. However, Texas would need clarification from the CDC regarding the 

turnaround time for polymerase chain reaction (PCR) test results before implementing its 

proposed strategy. Dr. Petersen explained that the CDC uses swabs of the patient’s 

lesions to conduct diagnostic PCR testing of smallpox and can obtain results within 24 

hours after receiving the specimens. To eliminate delays due to shipping specimens to 

the CDC, various LRN sites across the country can be used to conduct variola testing as 

well.

 New Mexico would include all symptomatic persons in its vaccination strategy because 

atopic dermatitis is the only relative contraindication.

11. What recommendations would your state team make to address Brian’s relatives who were 

exposed at the family reunion in Houston and already have returned to their home states? 

(Note: With the exception of two cousins who have upper respiratory infection symptoms and 

a low-grade fever, none of Brian’s other relatives are ill).

 Louisiana would recommend isolation, vaccination and quarantine of all persons with 

identified exposure until the end of the infectious period.

 Oklahoma would deploy Strike Teams to address Brian’s relatives who attended the family 

reunion and already have returned to their home states. This approach would be taken to 

minimize fear and emphasize that the smallpox exposure is confined to a small group of 

individuals.

12. The SNS contains a sufficient supply of smallpox vaccine to immunize all persons in the 

country, but the CDC recommendation is that ACAM2000TM is contraindicated for individuals 

with atopic dermatitis unless clear exposure is evident. MVA is a safer alternative for persons 

with atopic dermatitis, but the SNS has a limited supply of this product. What steps would 
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January 26, 2016 ♦ Page 26

your state team take to ensure that this limited supply is appropriately dispensed among 

children?

 Louisiana would implement a targeted vaccination strategy to ensure that the limited MVA 

supply in the SNS is adequate to meet the needs of children and other populations in the 

state. Louisiana would revise its existing pre-screening vaccination form by including an 

additional question: “Do you or your child have atopic dermatitis?” The use of the revised 

pre-screening form by the epidemiologic team would strengthen Louisiana’s capacity to 

properly allocate limited resources throughout the state.

 New Mexico would take a proactive approach to requesting SNS assets by asking CDC to 

deploy 8,000 doses of WetVax and 4,000 doses of MVA. New Mexico’s position was that 

these doses would be sufficient to vaccinate ~10,000 persons in the state. New Mexico 

has developed a rigorous protocol for distributing and dispensing MCMs, antiviral drugs 

and smallpox vaccine from the SNS throughout the state. New Mexico would notify its 

primary transport resources and maintain ongoing communications with the emergency 

management services (EMS) community.

 Arkansas would conduct surveillance to ensure the judicious use of smallpox vaccine. 

Patients with possible smallpox exposure would be screened to identify a history of atopic 

dermatitis and inform decision-making on vaccination with MVA versus ACAM2000TM. 

Arkansas would develop a pre-screening vaccination form to support this effort.

 Texas is aware that some individuals might falsify their pre-screening vaccination forms to 

receive a safer smallpox vaccine with fewer complications. Texas would verify cases of 

atopic dermatitis before administering MVA by conducting more in-depth screening of the 

patient, asking the patient’s physician to perform a physical examination, or requesting 

written confirmation of atopic dermatitis from the physician based on the patient’s medical 

records.

MODULE 5: SOCIAL MEDIA

The session for Module 5 included an introduction of Module 5 (social media postings on day 25 

of the scenario) and state team reports of their findings in response to the Module 5 questions.

Dr. Schonfeld introduced Module 5 by describing changes in the smallpox scenario in response 

to social media postings. The following messages have appeared on social media outlets as 

plans are being implemented for vaccination.

 “The smallpox vaccine causes and prevents smallpox at the same level.”

Introduction of Module 5
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 27

 “The smallpox vaccine causes heart attacks.”

 “The smallpox vaccine is associated with autism.”

 “The government is going to run out of the vaccine within 24-48 hours.”

A high-ranking official in Louisiana is interested in limiting “scary” messaging about a possible 

case in a second state (e.g., Texas). A high-ranking official in New Mexico recently launched an 

election campaign and is in a period of critical fundraising. She has insisted on vaccination for all 

New Mexico citizens to show her effectiveness as a leader.

Day 25

 Several county hospitals in New Mexico have started diverting all pediatric patients with 

fever or any other symptoms that suggest a possible infectious disease to a children’s 

hospital in Arizona. However, Arizona has no known smallpox cases and none of Brian’s 

relatives from the family reunion are residents of the state. The children’s hospital in 

Arizona has no smallpox treatment unit and has become overwhelmed by the surge in 

patient referrals. Most of these patients do not appear to require evaluation or treatment 

at a specialized children’s hospital.

 Schools are scheduled to resume in your state. Some school and government authorities 

in your state have questioned whether school openings should be postponed.

Dr. Schonfeld gave the state teams 30 minutes to address the Module 5 questions. Unlike the 

other modules, however, he explained that the state teams would partner with their colleagues in 

neighboring states to conduct Module 5.

Dr. Schonfeld moderated a session for the state teams to report their findings in response to the 

Module 5 questions.

13. What advice would your state teams provide to the school systems regarding closures or 

delayed openings?

 Arkansas would encourage schools to remain open and disregard the panic and hysteria 

caused by social media rumors.

 Oklahoma would provide local school superintendents with accurate and up-to-date 

information and expertise on children’s preparedness at the outset to inform their decisions 

on whether to close or delay openings of schools. Oklahoma would implement this 

strategy based on valuable lessons learned during the 2015 Ebola outbreak. Several 

Oklahomans were on one of the cruise ships that returned from Africa, but ~6 school 

districts in the state closed their schools for no apparent reason. Due to losses in revenue, 

work productivity and staff resources, school superintendents now recognize the critical 

State Team Reports: Module 5 Questions
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 28

importance of obtaining guidance from pediatric preparedness experts before making a 

decision to close or delay the opening of a school.

 Louisiana would replicate its mass influenza vaccination campaign in school systems in 

pre-planning activities for smallpox. This effort has resulted in a successful collaboration 

among public health, school systems and individual academicians. For example, school 

superintendents and school nurses have direct contact information to local public health 

officials and pediatricians to rapidly obtain expertise and guidance on closing or delaying 

the opening of a school in response to an infectious disease threat or other health crises. 

Moreover, local public health officials routinely are on school meeting agendas, serve on 

a workgroup with the Department of Education, and regularly engage school nurses in preplanning activities. Close collaboration, coordination and communications are particularly 

important in Louisiana because public, private/parochial and charter schools in the 64 

parishes across the state greatly vary in terms of their leadership, organizational structures 

and operations.

14. What strategies would your state teams implement to respond to each of the social media 

rumors?

 Oklahoma and New Mexico would use existing telephone banks within in their school 

systems to disseminate accurate and factual information via mass text messaging and by 

responding to questions posed by parents, teachers and the general public.

 At the national level, Arkansas would use the CDC, AAP and other professional 

associations as sources of high-level and credible information to respond to social media 

rumors. At the community level, Arkansas would reach out to local leaders and respected 

community members to combat the social media rumors with indisputable facts.

 New Mexico would engage its PIO to monitor social media messages and directly respond 

to rumors with accurate information on Facebook, Twitter or other platforms. Both New 

Mexico and Oklahoma would post the following message on their health department 

Facebook pages: “For correct information, please go to [link].”

15. What approaches would your state teams use to brief HCPs?

 This was believed to have been sufficiently addressed in previous discussions. None of 

the state teams responded to question 15.

16. What steps would your state teams take to create plans for handling up to 25 cases of 

smallpox in your state and for monitoring, isolating and quarantining up to 250 children? (The 

state teams were instructed to consider sharing resources across state lines.)

 Arkansas, Louisiana, Oklahoma and Texas have a long history of planning and 

collaboration, such as launching regional planning exercises for Ebola, conducting a 

recent tabletop exercise, establishing formal memoranda of agreement or understanding 

(MOAs/ MOUs) to support cross-state preparedness efforts, and maintaining strong 
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 29

partnerships and workgroups. The four TALON states would use their existing cross-state 

infrastructure to handle the smallpox cases and monitor, isolate and quarantine additional 

children. However, the four TALON states acknowledged that two key gaps need to be 

addressed to increase opportunities for regional planning and preparedness activities. 

First, the public health community should make stronger efforts to engage AAP to ensure 

pediatric clinicians in each state play a prominent role in future tabletop exercises of

threats that impact children. Second, a strategy should be developed to manage 

thedisconnect and inconsistency between federal regions and AAP districts. For example, 

all five TALON states are within HHS Region VI, while Mississippi and four TALON states 

(Texas, Arkansas, Louisiana and Oklahoma) are within the same AAP district. (It was 

recommended that AAP consider “re-districting” to be consistent with federal regions.)

 New Mexico would replicate the existing system that Oklahoma has established for 

persons who self-quarantine, such as designating individuals to provide food, assistance 

and other necessary resources.

 Texas would use its state Hospital Preparedness Program and health care coalitions to 

establish linkages between private HCPs and public health to collectively handle the 

smallpox cases and monitor, isolate and quarantine additional children. However, the 

composition and organizational structure of health care coalitions vary across states. For 

example, oversight of health care coalitions is by Regional Advisory Councils in Texas and 

by the Missouri Hospital Association in Missouri.

 Texas has a high level of capacity and resources, including several children’s hospitals, to 

handle 25 smallpox cases. Moreover, the National Hospital Available Beds for 

Emergencies and Disaster System is available to all states to rapidly identify the number 

of staffed negative pressure rooms that are available at regional, state and local levels in 

real time. Texas would share these resources with neighboring states to ensure that all 

25 smallpox cases are appropriately handled across state lines. To monitor, isolate and 

quarantine 250 children, Texas would apply its experiences and lessons learned in 

housing and caring for unaccompanied minors who cross the U.S.-Mexico border.

CONCLUSION OF THE SMALLPOX SCENARIO

17. The PHE is now over and your state team is convening a task force to develop future 

preparedness plans for children. Your state team is asked to identify potential task force 

members and offer ideas for specific planning. What would be your state team’s potential 

recommendations? Why would your state team provide this guidance? What steps can your

state team take to improve plans for distributing and dispensing MCMs to children?

Recommendations by the New State Task Forces

 Oklahoma was impressed by the children’s preparedness activities conducted by the CDC 

and state health departments overall, but gaps in linking these public health efforts to 

emergency medicine and general pediatrics stakeholders were noted. Oklahoma advised 

the AAP/CDC consider identifying funds to convene a one- or two-day tabletop exercise 

that would specifically focus on filling gaps in public health/pediatric medicine planning and 

readiness. Oklahoma also emphasized the need to invite SMEs and the TALON states to 
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 30

the tabletop exercise. Oklahoma’s position was that a future drill and ongoing AAP/CDC 

support would be extremely valuable in helping the TALON states to organize their task 

forces. Dr. Fisher announced that the AAP offers a mechanism for states to enhance 

disaster preparedness/response efforts through its Friends of Children Fund for disaster 

relief. Although the fund is specifically targeted to recovery efforts, she raised the 

possibility of using these resources to support public health/pediatric medicine disaster 

planning exercises for children.

 Oklahoma advised the TALON states to reach out to their AAP chapters to obtain support 

for children’s preparedness activities in their individual states and localities. Several AAP 

chapters leverage discretionary funding from private foundations that can be used for 

various purposes.

 Texas recommended using the Tabletop Exercise as a model for the TALON states to 

develop children’s preparedness plans for non-infectious disease threats, such as 

preparedness for natural disasters or storm readiness.

 Texas recommended targeting education on children’s disaster preparedness to medical 

residents. This approach would increase the available pool of skilled and trained SMEs 

during a PHE. A representative from Texas currently is developing a disaster 

preparedness educational program for medical residents and would welcome the 

opportunity to share this resource with others after its completion.

 New Mexico recommended providing parents and other caregivers with clear guidance in 

two key areas to improve plans for distributing and dispensing MCMs to children: (1) use 

of purified or distilled water rather than tap water as a diluent to reconstitute amoxicillin 

and (2) instructions for crushing doxycycline tablets. New Mexico emphasized that the 

current doxycycline tablet crushing instructions include erroneous information. Dr. Fisher 

reminded the state teams that MVA is not a licensed smallpox vaccine in the United States, 

but the product can be used under the Emergency Use Authorization mechanism. As a 

result, guidelines also would need to be disseminated on the limitations, restrictions and 

special considerations regarding the use of MVA in children. For example, MVA might be 

excluded from the National Vaccine Injury Compensation Program (NVICP) because 

NVICP only covers AEs from vaccines that are recommended for universal use. However, 

CDC will confirm whether NVICP covers AEs from MVA.

 New Mexico, Louisiana and Texas recommended the following groups to serve on their 

state task forces.

o Law enforcement

o Attorneys to address legal issues related to isolation and quarantine

o Emergency management to ensure core competencies in the FEMA Comprehensive 

Preparedness Guide and other capabilities

o Social workers and representatives from psychological support services to help 

children cope with death and other trauma

o Interpreters, translators and tribal leaders to address specialized issues related to 

cultural competency, language barriers and tribal medicine

o Pediatricians with skills and experience in overcoming vaccine hesitancy and barriers 

to administering vaccine to infants and young children
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 31

Recommendations on Children’s Preparedness Resources

 Texas noted that the HHS Hospital Preparedness Program (HPP) and the CDC PHEP 

cooperative agreements both require exercises to be conducted from the tabletop level up 

to a full-scale event. Texas recommended that the HHS and CDC consult with AAP 

leadership to ensure that language on children’s preparedness exercises is included when 

these funding opportunity announcements are developed. Texas also advised pediatric 

clinicians to contact their local, state or regional health department to propose ideas of 

children’s preparedness exercises so that public health and pediatricians could jointly 

conduct in the future. Dr. Fisher added that AAP members should act on every opportunity 

to ensure children’s issues are fully represented in disaster drills and other preparedness 

exercises routinely conducted by health departments in their individual states. She also 

urged AAP members to make suggestions to health departments in which children’s 

preparedness would serve as the primary focus of upcoming exercises. Dr. Krug 

wholeheartedly agreed with the recommendations by Texas and Dr. Fisher for the state 

teams to strongly advocate for children’s preparedness at state and local levels. He 

pointed out that recent data show that current hospital readiness exercises typically 

exclude children or include no more than two children.

 New Mexico conveyed that the Health Resources and Services Administration funds the 

Emergency Medical Services for Children (EMSC) Program in each state. The state 

EMSC programs have made tremendous progress over time in improving the pediatric 

components of emergency medical care in their states, particularly in the area of mass 

casualty readiness. The state teams should extensively engage EMSC representatives in 

their children’s preparedness efforts, but funding streams greatly vary across states. For 

example, New Mexico allocates all of its EMSC funds to support the program coordinator. 

Colorado allocates all of its EMSC funds to programmatic activities, development and 

outreach because other resources are leveraged to support personnel.

 The FEMA representative informed the state teams that the Emergency Management 

Institute (EMI) has added 4-5 virtual tabletop opportunities over the past two years to be 

conducted in collaboration with local emergency management. These exercises include 

infectious diseases, but pediatric issues generally are excluded. However, the EMI has 

expressed a willingness to allocate its FEMA resources to design tabletop exercises in 

response to proposals that are submitted.

Aaron Gardner, MD, MPH, FAAP

Pediatric Intensive Care Unit

Eastern Idaho Regional Medical Center

Dr. Gardner moderated the hotwash session for the state team members to reflect on the 

objectives of and their individual experiences with the Tabletop Exercise; review key points raised 

Hotwash Session
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 32

during the discussions; highlight effective strategies and lessons learned; propose suggestions to 

improve children’s preparedness efforts in the future; and describe practical changes that will be 

made in states as a result of the Tabletop Exercise.

Effective Strategies

 The AAP/CDC Exercise Planning Team organized an extremely productive Tabletop 

Exercise by convening the five TALON states that already have a history of cross-state 

collaboration. The structure of state teams addressing various issues over the course of 

the smallpox scenario was effective as well. This format enabled the public health and 

pediatric clinical communities to establish new partnerships and identify opportunities for 

collaborative efforts in the future. Generally, the pediatric and public health 

representatives on the state teams had not met each other before, and most were not 

aware of preparedness efforts occurring in other disciplines. Some state teams already 

were proposing future agreements for communication and had identified specific followup actions.

 The AAP/CDC Exercise Planning Team should continue to invite FEMA representatives 

to future children’s preparedness exercises.

 The outstanding facilitators of the Tabletop Exercise were extremely knowledgeable.

Lessons Learned

 Children’s hospitals in the TALON states that provide care to critically ill children should 

establish MOAs/MOUs in advance to ensure ongoing support across state lines and 

minimize the burden on a particular state or region during a PHE. For example, Arkansas 

previously conducted a survey to all EDs in the state to determine their pediatric mass 

casualty plans for any emergency. All EDs that responded to the survey planned to 

transport their pediatric cases to the Arkansas Children’s Hospital in Little Rock during an

event. Based on the survey results, Arkansas would have no capacity to handle 25 

smallpox cases or monitor, isolate and quarantine 250 children. The establishment of 

MOAs/MOUs also would be critical to other rural states that have only one children’s 

hospital.

 EMS should be engaged in children’s preparedness efforts at the outset to resolve 

transport issues well in advance of a PHE. If a smallpox event occurred during influenza 

season, for example, hospitals in one state already would be at full capacity and would 

need to transport their pediatric cases to facilities in other states.

 Opportunities to collaborate with adult preparedness efforts should be identified. These 

groups are well-established and have an existing pool of resources that could be 

leveraged to include children’s preparedness efforts.

 The HPP and PHEP grantees have made strong efforts over time to collaborate in aligning 

their adult preparedness activities. The CDC Division of State and Local Readiness 

should provide national leadership in identifying opportunities for HPP and PHEP grantees 

to coordinate their activities with pediatric preparedness efforts at state and local levels.

Areas of Improvement
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 33

 The AAP/CDC Exercise Planning Team should improve the following areas before the 

Tabletop Exercise is replicated for use by states, localities and regions.

o A stronger focus should be placed on addressing national pediatric surge capacity. 

To enhance efforts in this area, states should leverage their collective assets to create 

a broader base of resources to meet the needs of 25 smallpox cases outlined in the 

scenario.

o More modules and questions that are specific to the SNS (to tap into the specific 

expertise of the state public health SNS representatives) should be included.

o Most real-life PHEs impact multiple states and require collaboration across state 

boundaries. More cross-state collaboration should be included in the exercise for 

state teams to identify common gaps, overlapping activities and potential opportunities 

to share resources. The Tabletop Exercise allowed state teams to partner across 

states in conducting only one of the five modules.

o Module 2 (strategic communications and effective messaging) should be revised to 

include an exercise on overcoming historical cultural issues. For example, African 

American and Native American parents might be particularly distrustful of their children 

being vaccinated, especially with a non-licensed product.

o Module 3 (smallpox vaccination) should be revised with an exercise on engaging PIOs 

in the development and dissemination of messaging to HCPs.

o An existing module should be revised or a new module should be added with an 

exercise on addressing the special health care needs of children with disabilities 

during a PHE. For example, many parents likely would not consent to administering 

smallpox vaccine to their autistic, blind, deaf or wheelchair-bound children.

o Local groups that will be extensively involved in the response in the field should make 

brief presentations to introduce each module, such as an emergency preparedness 

overview by a state police officer or a school superintendent.

o More emphasis should be placed on addressing the limited supply of pediatric medical 

materials in state stockpiles. For example, the supply of adult medical materials in the 

Oklahoma stockpile at this time could not be used to care for pediatric patients.

o Frontline HCPs that play a significant role in PHEs in the field should be invited to 

future exercises, including local public health, EMS, transport providers and hospital 

representatives. Because the state teams would be larger, more resources should be 

devoted to convening future exercises for more than one day.

 The communication strategy that AAP leadership would develop and implement during a 

PHE should include the following message for its membership of pediatricians: “Contact 

your local jurisdiction for specific guidance.” During the 2015 Ebola outbreak, for example, 

local and regional public health staff in several states noticed that different guidance was 

distributed at the local level (compared to national guidance). The fact that there will be 

differences between national and state/local guidance, should be recognized and 

addressed. Consistent guidance that is specific to the local level where the response will 

occur should be disseminated.

Upcoming Changes in States
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 34

 New Mexico will build and maintain a strong relationship between its state health 

department and the EMSC coordinator.

 Louisiana will invite the pediatricians on the state team to serve on its Senior Advisory 

Group at the state health department. Louisiana will use its HAN to disseminate children’s 

preparedness messaging and update its shelf kits with information on pediatric readiness 

issues. The Louisiana Volunteers in Action Registry will be used to determine smallpox 

vaccination coverage among medical and non-medical volunteers who provide assistance 

during emergencies. Louisiana will conduct an inventory of supplies in its cold storage 

stockpile at this time. The Louisiana AAP chapter will use a portion of its foundation funds 

to convene a half- or full-day session on pediatric/public health issues during its August 

2016 AAP chapter meeting. The public health officials on the state team will be invited to 

the AAP chapter meeting along with communication experts, nurses and pediatric hospital 

representatives. The state team will initiate plans to replicate and conduct the Tabletop 

Exercise in public health regions within Louisiana.

 Several states will launch vaccination campaigns for children and their families that plan 

to attend the Summer Olympics in Rio de Janeiro, Brazil in August 2016. Many of these 

travelers might return to their home states with the Zika virus.

Dr. Schonfeld reminded the state team members to complete the worksheet in their meeting 

notebooks requesting them to identify actions and strategies. The AAP/CDC Exercise Planning 

Team would use the written responses from these worksheets and the feedback provided during 

the hotwash session to evaluate the overall success of the Tabletop Exercise, share effective 

strategies with other groups that also have an interest in pediatric preparedness exercises, and 

identify areas of improvement based on specific outcome measures.

WRITTEN RESPONSES TO THE EVALUATION QUESTIONS

What collaborative strategies could AAP chapters, pediatric clinicians and public health 

leaders implement to advance pediatric preparedness at state and local levels?

 The CDC should extensively engage public policymakers and hospital affiliations in its 

pediatric planning efforts.

 States should increase the use of their HANs to improve smallpox knowledge and subjectmatter expertise. The AAP chapters should encourage their memberships of pediatric 

providers to register to receive HAN alerts and text messages in their states.

 The CDC should provide contact information for its EOC staff to enable public health and 

pediatric providers at state and local levels to obtain guidance in response to their

smallpox questions.

 States should implement a process to determine current smallpox vaccination coverage 

among first responders and emergency volunteers in their states and localities.

 States should facilitate opportunities for public health preparedness staff and EMSC 

coordinators to build and sustain strong collaborative relationships over time.
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 35

 States should ensure that pediatric providers are routinely included in their cross-state 

public health preparedness drills and other exercises. (It was noted that an AAP chapter 

contact for disaster preparedness is already available in every state.)

 States and localities should conduct joint public health/pediatric exercises and training 

events that are similar to the Smallpox Tabletop Exercise to strengthen collaboration in 

children’s preparedness.

 States should designate a children’s preparedness page on their Web sites that would 

allow pediatric providers to download information on the current event in real-time, toolkits

and other resources. States could use the medical licenses of pediatric providers to 

control access to and ensure the security of their Web sites.

 States and localities should widely publicize the following message during an emergency

involving children: “If you believe you were exposed, call [toll-free hotline] or seek care at 

[name of alternate care facility]. This approach would decrease the surge at EDs and the 

offices of pediatric providers.

 States should establish formal MOAs/MOUs in advance to enable pediatric providers to 

prescribe MCMs across state lines during an emergency involving children.

 Schools and public health should leverage their existing collaborative efforts in children’s 

preparedness, such as school-based influenza vaccination campaigns, to improve 

pediatric planning and readiness efforts at state and local levels.

 States should convene pre-planning and preparedness meetings to clearly define the roles 

and responsibilities of specific groups during a pediatric event: health departments, AAP 

chapters, epidemiologic staff, hospital associations, infection control staff, PIOs, tribal 

partners, behavioral health experts and the HAN.

 States and localities should establish a toll-free hotline and develop a list of frequently 

asked questions in advance that would be available to the public during a pediatric event.

 Localities should direct persons with potential exposure or those showing symptoms to an 

alternate care site to protect ED patients from exposure.

 States and localities should extensively engage pediatric providers with emergency 

preparedness experience outside of children’s hospitals and other health care facilities.

 States should reach out to the Texas AAP chapter to obtain guidance in developing a

pediatric screening form for all Category A agents.

 States should use their health care coalitions to establish and maintain linkages to 

pediatric preparedness efforts.

 The HHS/HPP and CDC/PHEP grantees should engage pediatric providers in their 

federally-funded preparedness efforts.

 States should conduct an assessment to determine needs, identify other specific issues, 

and evaluate the current level of capacity in children’s preparedness at state, local and 

regional levels.
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 36

What steps could states take to improve communications that are specific to children’s 

preparedness?

 States should designate a page on their Web sites with standardized scripts, key talking 

points and other resources that would be available to pediatric providers to facilitate 

children’s preparedness communications.

 State public health representatives should collaborate with their AAP chapters to increase 

the number of pediatric providers who subscribe to and regularly use the HAN. States 

also can expand their HANs to include medical trainees and other health partners in 

children’s preparedness communications. However, states should first take steps to 

update, improve and fill gaps in the messaging capabilities of their HANs. Most notably, 

pediatric providers should be educated on the ability of state HANs to deliver unified 

messaging. States should closely collaborate with the CDC to ensure that information 

and messaging from its national HAN are disseminated to all levels of the pediatric 

healthcare community in the field. The AAP leadership should determine whether the 

national or state HANs have sufficient capacity to handle children’s preparedness 

communications to its entire membership of ~64,000 pediatric health care providers 

across the country.

 States should establish toll-free hotlines for the public to make inquiries about current 

health concerns related to a pediatric event in the state and specific localities.

 States should engage their EOCs or Incident Command Systems in advance to facilitate 

ongoing children’s preparedness communications to the following groups during an event: 

schools/departments of education (including messaging in ASL and non-English 

languages that are spoken in the community), child care facilities/home child care centers

and the Indian Health Service. However, state planning efforts should include the 

administration of a survey to determine current capacity to deliver messaging in ASL and 

specific non-English languages.

 States should collaborate with the extensive pool of social media experts within the AAP 

Council on Communications and Media to rapidly communicate up-to-date children’s 

preparedness information to the public through Facebook, Twitter and other platforms.

 States should allocate resources to local schools and their partners to establish a reverse 

911 system in advance to respond to questions by families during a pediatric event.

 States should allocate hospital preparedness program and other funding to localities to 

conduct tabletop exercises that specifically focus on gaps in children’s preparedness and 

related communications.

 States should engage local law enforcement and attorneys in preparedness discussions 

to address legal issues related to the quarantine of children during an emergency.

What strategies could be implemented to optimize plans for distributing and dispensing MCMs 

that are suitable for pediatric care and relevant to the smallpox scenario?

 States should conduct exercises that include actual case studies in which MCMs were 

distributed and dispensed to children in previous pediatric events.

 States should establish formal MOAs/MOUs with pharmacies and large businesses to 

distribute and dispense MCMs to children.
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 37

 The CDC SNS support teams should develop and disseminate a clear and succinct list of 

pre-screening guidelines to assist in properly dispensing MCMs and preparing adult 

formulations for children. For example, ACAM2000TM is the only smallpox vaccine that 

the FDA has approved for use in the United States, but the product is contraindicated for 

persons with atopic dermatitis. Purified or distilled water rather than tap water should be 

used as a diluent to reconstitute amoxicillin for children. The guidelines should be widely 

available to pediatric providers on CDC, AAP and state health department Web sites.

 States should identify the most appropriate site (e.g., health departments, hospitals or 

Medical Reserve Corps stations) to distribute and dispense MCMs to children and conduct 

follow-up.

 States should implement a rapid notification process to inform local pediatric providers of 

the delivery and availability of SNS assets from the CDC.

 States should engage law enforcement, attorneys and social services to address legal 

and other specialized issues related to administering MCMs to children.

 The CDC should continue to collaborate with the AAP to inform its membership of pediatric 

health care providers across the country as to whether AEs from vaccines (eg, MVA, a 

smallpox vaccine that is not licensed for use in the United States), would be covered by 

NVICP.

 All states, particularly those with large rural areas, should establish a protocol in advance 

for EMS providers who have a special scope of practice to administer smallpox or other 

vaccine during a pediatric event.

 The CDC should clarify two issues: whether the SNS maintains information related to 

MCMs for pediatric care beyond crushing directions of adult medications for children’s 

dosages and if true pediatric doses will be included in the SNS in the future.

Other Comments

 The five TALON states have a well-established collaborative history of addressing

preparedness issues, but this type of partnership is not common in most other regions.

 The PIOs should be extensively engaged in Module 3 (smallpox vaccination).

 The EMS representatives should be included in all disaster preparedness efforts.

Dr. Dziuban announced that the AAP/CDC Exercise Planning Team would convene a series of 

children’s hospital teleconferences for all-hazard preparedness. The first teleconference will be 

held on February 9, 2016 and would include a synopsis of key outcomes from the Tabletop 

Exercise. He asked one pediatrician and one public health official from the state teams to 

participate on the teleconference and provide their individual feedback.

Dr. Krug explained that the next steps would be to determine how best to replicate national public 

health/pediatric clinical partnerships in states and localities. An evaluation survey would be 

Closing Session
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 38

administered to the state teams to provide additional feedback. Efforts would be made to develop 

a virtual, less resource-intensive tabletop exercise for states and localities to conduct to improve 

their children’s preparedness capacity.

Dr. Peacock thanked the state teams for providing their thoughtful insights and perspectives on 

preparing for and responding to a smallpox scenario at state and local levels that involved 

children. She hoped the state team members would sustain their new relationships and maintain 

ongoing communications over time to improve the health of children during an emergency.

Drs. Krug and Peacock asked the participants to join them in thanking and commending several

groups and individuals who played an instrumental role in the Tabletop Exercise.

 The AAP/CDC Exercise Planning Team was applauded for organizing an excellent and 

productive Tabletop Exercise.

 Drs. Fisher and Schonfeld were applauded for developing and facilitating the five smallpox 

scenario modules.

 Dr. Petersen was thanked for serving as the smallpox SME for the Tabletop Exercise.

 The state team members were thanked for remaining highly engaged over the course of 

the Tabletop Exercise and providing AAP and CDC with outstanding input.

 The CDC was applauded for providing AAP with solid expertise, ongoing support and 

funding. The CDC also was thanked for its national leadership in and ongoing commitment 

to engaging professional associations and other private-sector partners to improve public

health, especially in regards to children’s preparedness.
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 39

 

Attachment 1: Participants’ Directory

Arkansas Team Members

Cathie Bodenhamer, RN

Communicable Disease Nurse Specialist

Arkansas Department of Health

206 Bucher Drive

Mountain Home, AR 72653

Phone: 870-404-8916

Email: Catherine.Bodenhamer@arkansas.gov

Cassandra Harvey, BSN, RN

Communicable Disease Nurse Specialist

Arkansas Department of Health

1501 Dawson Road

Forrest City, AR 72335

Phone: 870-633-6812 Ext. 103

Email: Cassandra.Harvey@arkansas.gov

Kristin Lyle, MD, FAAP

(Disaster Preparedness Chapter Contact)

Disaster Medical Director

Arkansas Children's Hospital

Assistant Professor of Pediatrics

University of Arkansas for Medical Sciences

1 Children's Way

Little Rock, AR 72202

Phone: 501-364-1598

Cell: 501-529-0074

Email: LyleKristinC@uams.edu

Shane McKinney, MD, MS, FAAP

Pediatric Emergency Medicine Fellow

University of Arkansas for Medical Sciences

Arkansas Children’s Hospital

1 Children’s Way, Slot 512-16

Little Rock, AR 72202

Phone: 501-364-1089

Email: smmckinney@uams.edu

Louisiana Team Members

Rodolfo Begue, MD, FAAP

Head, Pediatric Infectious Diseases

Louisiana State University Children’s Hospital

200 Henry Clay Avenue

Infectious Diseases, ACC 2316

New Orleans, LA 70118

Phone: 504-896-9820

Email: rbegue@lsuhsc.edu

Doris G Brown, Med, MS, RN, CNS

Director, Center for Community Preparedness

Office of Public Health

Department of Health and Hospitals

8453 Veterans Memorial Boulevard

Baton Rouge, LA 70807

Phone: 225-354-3511

Email: doris.brown@la.gov

Glennis Gray, MSN, RN-BC

Strategic National Stockpile Coordinator

Office of Public Health

Department of Health and Hospitals

Center for Community Preparedness

8453 Veterans Memorial Boulevard

Baton Rouge, LA 70807

Phone: 225-354-3511

Email: glennis.gray@la.gov

John A. Vanchiere, MD, PhD, FAAP

(LA Chapter Vice President)

Chief, Pediatric Infectious Diseases

LSU Health Sciences Center-Shreveport

1501 Kings Highway, #5-303

Shreveport, LA 71103

Phone: 318-675-6081

Office: 318-458-5309

Email: jvanch@lsuhsc.edu
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 40

New Mexico Team Members

Sandra Cole, BA, RN

Quality Assurance Manager

New Mexico Department of Health

Bureau of Health Emergency Management

2843 Plaza Rojo

Santa Fe, NM 87507

Phone: 505-476-8292

Email: sandra.cole@state.nm.us

David Jolley, MD, FAAP

Pediatric Emergency Medicine Fellow

Department of Emergency Medicine

University of New Mexico 

HSC11 6025

1 University of New Mexico

Albuquerque, NM 87131

Phone: 505-272-9432

Email: dajolley@salud.unm.edu

John Miller, CEM

Strategic National Stockpile and Medical 

Countermeasure Coordinator

New Mexico Department of Health

1301 Siler Road, Building F

Santa Fe, NM 87507

Phone: 505-476-8258

Cell: 505-409-3511

Email: johnw.miller@state.nm.us

Robert E. Sapién, MD, MMM, FAAP

(Disaster Preparedness Chapter Contact)

Chief, Division of Pediatric Emergency Medicine

University of New Mexico Health Sciences 

Center, Department of Emergency Medicine

MSC 11 6025

1 University of New Mexico 

Albuquerque, NM 87131

Phone: 505-272-5062

Cell: 505-550-0119

Email: rsapien@salud.unm.edu

Lori Zink, MD, FAAP

(Disaster Preparedness Chapter Contact)

BCA Medical Associates

New Mexico Pediatric Society Disaster 

Preparedness Chairman and Key Contact

608 N 1st Street

Artesia, NM 88220

Phone: 575-746-8880

Email: lori.zink@bcapediatrics.com

Oklahoma Team Members

Darrell Eberly, MPH

Emergency Manager

Oklahoma State Department of Health

1000 NE 10th Street

Oklahoma City, OK 73117

Phone: 405-271-0900

Email: DarrellE@health.ok.gov

Glenda Ford-Lee, MHR

Statewide At-Risk Populations Coordinator

Oklahoma State Department of Health

Emergency Preparedness & Response Services

1000 N.E. 10th Street

Oklahoma City, OK 73117-1299

Phone: 405-271-9444, ext. 56426

Email: GlendaFl@health.ok.gov

Curtis Knoles, MD, FAAP

University of Oklahoma College of Medicine

Children's Hospital at OU Medical Center

10432 Chitwood Farms Road

Jones, OK 73049

Phone: 405-514-4877

Email: Curtis-knoles@ouhsc.edu

Eve Switzer, MD, FAAP

(Oklahoma AAP Chapter President)

(Disaster Preparedness Chapter Contact)

Northwest Pediatrics

3201 North Van Buren, Suite 300

Enid, OK 73703

Phone: 580-402-4554

Email: kidoctr@hotmail.com
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 41

Texas Team Members

Oscar “Skip” Brown, MD, FAAP

(TX AAP Chapter President)

Professor of Pediatrics &

Vice Chair of Clinical Affairs, Department of 

Pediatrics

University of Texas Medical Branch

Galveston Texas

301 University Boulevard

Galveston, TX 77555-0351

Phone: 903-240-5790

Email: owbrown@utmb.edu

Shana Godfred-Cato, DO, FAAP

General Pediatrician at Austin Regional Clinic

4100 Everett Avenue, Suite 400

Kyle, TX 78640

Phone: 254-931-2510

Email: Shanaecato@gmail.com

Brent Kaziny, MD, MA, FAAP

(Disaster Preparedness Chapter Contact)

Assistant Professor

Texas Children’s Hospital

Baylor College of Medicine

6621 Fannin Street, Suite A210

Houston, TX 77030

Cell Phone: 713-569-5711

Office: 832-824-5988

Email: bxkaziny@texaschildrens.org

Robert Kirkpatrick, MSPM

Assistant State Strategic National Stockpile 

Coordinator

Department of State Health Services

1320 Amistad Drive

Round Rock, TX 78664

Phone: 512-776-6374

Cell: 512-659-1206

Email: robert.kirkpatrick@dshs.state.tx.us

Lisette Osborne, RN-BC, MSN, CHEP

Preparedness Branch Manager

Texas Department of State Health Services

PO Box 149347, Mail Code 1926

Austin, TX 78714-9347

Phone: 512-776-7228

Cell: 410-371-2076

Email: Lisette.Osborne@dshs.state.tx.us

AAP/CDC Exercise Planning Team 

Members

Laura Aird, MS

Manager, Disaster Preparedness and Response

American Academy of Pediatrics

Department of Child Health and Wellness

141 Northwest Point Boulevard

Elk Grove Village, IL 60007

Phone: 847-434-7132

Email: laird@aap.org

Michael Bartenfeld, MA

Public Health Advisor

Center for Global Health

Centers for Disease Control and Prevention

1600 Clifton Rd. MS D-69

Atlanta, GA 30329-4027

Phone: 404-498-6203

Email: mbartenfeld@cdc.gov

Sarita Chung, MD, FAAP

(Member, AAP Disaster Preparedness Advisory 

Council)

Director of Disaster Preparedness

Division of Emergency Medicine

300 Longwood Avenue

Boston, MA 02115-5724

Phone: 617-355-6624

Email: sarita.chung@childrens.harvard.edu
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 42

Sean Diederich

Program Coordinator, Disaster Preparedness 

and Response

American Academy of Pediatrics

Department of Child Health and Wellness

141 Northwest Point Boulevard

Elk Grove Village, IL 60007

Phone: 847-434-7125

Email: sdiederich@aap.org

Eric Dziuban, MD, DTM, FAAP

Lead, Children’s Preparedness Unit

Division of Human Development and Disability

National Center on Birth Defects and 

Developmental Disabilities

Centers for Disease Control and Prevention

4770 Buford Highway NE

Atlanta, GA 30341

Phone: 404-718-8394

Email: esv8@cdc.gov

Margaret C. Fisher, MD, FAAP

(Member, AAP Disaster Preparedness Advisory 

Council)

Medical Director

The Unterberg Children’s Hospital at Monmouth 

Medical Center

300 Second Avenue

Long Branch, NJ 07740-6303

Phone: 732-923-7250

Email: mfisher@barnabashealth.org

Aaron Gardner, MD, MPH, FAAP

(Disaster Preparedness Chapter Contact)

Pediatric Intensive Care Unit

Eastern Idaho Regional Medical Center

3100 Channing Way

Idaho Falls, ID 83404

Phone: 801-360-8725

Email: aaronhgardner@gmail.com

Stephanie Griese, MD, MPH, FAAP

Medical Epidemiologist

Office of Public Health Preparedness and 

Response

Office of Science and Public Health Practice

Centers for Disease Control and Prevention

1600 Clifton Road NE, MS-D44

Atlanta, GA 30329-4027

Phone: 404-639-7501

Email: ftw4@cdc.gov

Mark Hall

Emergency Management Specialist

Office of Public Health Preparedness and 

Response, Division of Emergency Operations

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30329-4018

Phone: 404-639-0304

Email: hnq9@cdc.gov

Bill Howard

Emergency Management Specialist

Office of Public Health Preparedness and 

Response, Division of Emergency Operations

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30329-4018

Phone: 404-639-1757

Email: wsf1@cdc.gov

Frank Long

Emergency Management Specialist

Office of Public Health Preparedness and 

Response, Division of Emergency Operations

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30329-4018

Phone: 404-639-0337

Email: fvk4@cdc.gov
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 43

Steven E Krug, MD, FAAP

(Chairperson, AAP Disaster Preparedness 

Advisory Council)

Head, Division of Emergency Medicine

Ann & Robert H. Lurie Children’s Hospital of 

Chicago

225 East Chicago Avenue

Chicago, IL 60611-2991

Phone: 312-227-6086

Email: skrug@luriechildrens.org

Joe Merlino

Public Health Advisor

Office of Public Health Preparedness and 

Response, Division of State and Local 

Readiness

Centers for Disease Control and Prevention

1600 Clifton Road NE, MS-D08

Atlanta, GA, 30329

Phone: 404-639-2628

Email: byp6@cdc.gov

Scott Needle, MD, FAAP

(Member, AAP Disaster Preparedness Advisory 

Council)

(Disaster Preparedness Chapter Contact)

Chief Medical Officer

Healthcare Network of Southwest Florida

548 Carpenter Court

Naples, FL 34110

Phone: 239-591-4393

Email: sneedlemd@gmail.com

Georgina Peacock, MD, MPH, FAAP

(Exercise Director)

Division Director

Division of Human Development and Disability

National Center on Birth Defects and 

Developmental Disabilities

Centers for Disease Control and Prevention

4770 Buford Highway NE

Atlanta, GA 30341

Phone: 404-498-4347

Email: ghn3@cdc.gov

Richard (Rick) S. Roman, MS

Deputy Director

Division of Human Development and Disability

National Center on Birth Defects and 

Developmental Disabilities

Centers for Disease Control and Prevention

4770 Buford Highway, MS-E88

Atlanta, GA 30341

Phone: 404-498-0966

Email: rsr1@cdc.gov

Wendy Ruben, MS, CHES

Public Health Analyst

Division of Human Development and Disability

National Center on Birth Defects and 

Developmental Disabilities

Centers for Disease Control and Prevention 

4770 Buford Highway NE

Atlanta, GA 30341

Phone: 404-498-0230

Email: hif0@cdc.gov

David Schonfeld, MD, FAAP

(Member, AAP Disaster Preparedness Advisory 

Council)

Professor of the Practice in the School of Social 

Work and Pediatrics at the University of 

Southern California and Children's Hospital Los 

Angeles

Director, National Center for School Crisis and 

Bereavement

1150 South Olive Street, Suite 1400

Los Angeles, CA 90015-2211

Phone: 213-705-3445

Email: schonfel@usc.edu

Additional Participants

Onika Blaize

Public Health Advisor

Office of Public Health Preparedness and 

Response

Division of State and Local Readiness

Centers for Disease Control and Prevention

1600 Clifton Road Atlanta, GA 30329-4018

Phone: 404-718-2017

Email: oba1@cdc.gov
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 44

Coleen A. Boyle, PhD, MSHyg

Director, National Center on Birth Defects and 

Developmental Disabilities

Centers for Disease Control and Prevention

4770 Buford Highway, MS-F34

Atlanta, GA 30341-3717

Phone: 404-498-3800

Email: cab3@cdc.gov

Karen Cobham-Owens

Contractor, Emergency Preparedness

Disability and Health Branch

Division of Human Development and Disability

National Center on Birth Defects and 

Developmental Disabilities

Centers for Disease Control and Prevention

4770 Buford Highway, MS-E88

Atlanta, GA 30341-3717

Phone: 404-498-1454

Email: KCobham-Owens@cdc.gov

Barbara Cooper

Public Health Advisor

Division of Preparedness and Emerging 

Infections

National Center for Emerging and Zoonotic 

Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road NE, MS C-18

Atlanta, GA 30329

Phone: 678-662-6407

Email: bic1@cdc.gov

James (Jim) Crockett

Emergency Management Specialist, Emergency 

Management Unit Lead

Office of Public Health Preparedness and 

Response

Division of State and Local Readiness

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30329-4018

Phone: 404-639-2640

Email: gvg8@cdc.gov

James (“Jim) R. Davis, Jr., MS, LMHC

Emergency Program Specialist

Federal Emergency Management Agency, 

Region IV

3003 Chamblee Tucker Road, Room 233

Atlanta, GA 30341

Phone: 770-220-5617

Email: James.davisjr@fema.dhs.gov

Susan Gorman, PharmD, MS, DABAT, FAACT

Health Scientist 

Division of Strategic National Stockpile

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30329-4018

Phone: 404-639-2583

Email: spg4@cdc.gov

Kimberly Newsome

Health Scientist

Office of Noncommunicable Diseases, Injury 

and Environmental Health

National Center on Birth Defects and 

Developmental Disabilities

Centers for Disease Control and Prevention

4770 Buford Highway NE

Atlanta, GA 30341

Phone: 404-498-0605

Email: kan3@cdc.gov

Anita Patel, PharmD, MS

(Acting) Pandemic Medical Care and 

Countermeasures Lead

Influenza Coordination Unit

National Center for Immunization and 

Respiratory Diseases

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30329-4018

Phone: 404-433-2667

Email: bop1@cdc.gov
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 45

Brett Petersen, MD, MPH

Commander, U.S. Public Health Service

Medical Officer, Poxvirus and Rabies Branch

Division of High-Consequence Pathogens and 

Pathology

National Center for Emerging and Zoonotic 

Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, MS A30

Atlanta, GA 30329-4027

Phone: 404-639-5464

Email: bpetersen@cdc.gov

Rebecca Pass Philipsborn, MD

Third-Year Pediatric Resident

Global Health Track/Emory Pediatrics

49 Jesse Hill Jr. Drive, SE, 2nd Floor

Atlanta, Georgia 30303

Phone: 404-778-1440

Email: rpass@emory.edu

RADM Stephen Redd, MD

Director, Office of Public Health Preparedness 

and Response

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30329-4018

Phone: 404-639-7855

Email: scr1@cdc.gov

Ariane Reeves, RN, BSN, MPH

Public Health Advisor

Office for State, Tribal, Local and Territorial 

Support

Division of Public Health Performance 

Improvement

Centers for Disease Control and Prevention

1825 Century Center Boulevard

Atlanta GA 30345

Phone: 404-498-0397

Email: vfi6@cdc.gov

Karen Remley, MD, MBA, MPH, FAAP

Executive Director & CEO

American Academy of Pediatrics

141 Northwest Point Boulevard

Elk Grove Village, IL 60007-1019

Phone: 847-434-7500

Email: kremley@aap.org

Dara Spector, RN, MSN, MS, FNP-C

Regional Emergency Coordinator

U.S. Department of Health and Human Services, 

Region 4, Office of the Assistant Secretary for 

Preparedness and Response

Office of Emergency Management

Atlanta Federal Center

61 Forsyth Street, SW, Suite 5B-95

Atlanta, GA. 30303

Phone: 404-955-4024

Email: gqw6@cdc.gov

Lorine M. Spencer, RN, BSN, MBA

Public Health Analyst

Office for State, Tribal, Local and Territorial 

Support

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30333

Phone: 770-488-1524

Email: akx4@cdc.gov
Summary Report: AAP/CDC Pediatric and Public Health Tabletop Exercise

January 26, 2016 ♦ Page 46

 

Attachment 2: Glossary of Acronyms

AAP American Academy of Pediatrics

AEs Adverse Events

ASL American Sign Language

CDC Centers for Disease Control and Prevention

DRCs Designated Regional Coordinators

ED Emergency Department

EMI Emergency Management Institute

EMS Emergency Management Services

EMSC Emergency Medical Services for Children

EOC Emergency Operations Center

FDA U.S. Food and Drug Administration

FEMA Federal Emergency Management Agency

GOHSEP Governor’s Office of Homeland Security and Emergency Preparedness

HAN Health Alert Network

HCPs Health Care Providers

HHS U.S. Department of Health and Human Services

HPP Hospital Preparedness Program

LRN Laboratory Response Network

MCMs Medical Countermeasures

MOAs; MOUs Memoranda of Agreement; Memoranda of Understanding

MVA IMVAMUNE®

NCBDDD National Center on Birth Defects and Developmental Disabilities

NVICP National Vaccine Injury Compensation Program

OPHPR Office of Public Health Preparedness and Response

PCR Polymerase Chain Reaction

PHEP Public Health Emergency Preparedness

PHEs Public Health Emergencies

PIO Public Information Officer

SMEs Subject-Matter Experts

SNS Strategic National Stockpile