{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:27:46Z","timestamp":1785421666411,"version":"3.56.0"},"reference-count":57,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Administration of Strategic Preparedness and Response","award":["U3REP220682"],"award-info":[{"award-number":["U3REP220682"]}]},{"award":["U3REP220682"],"award-info":[{"award-number":["U3REP220682"]}],"id":[{"id":"https:\/\/ror.org\/05tjhqa05","id-type":"ROR","asserted-by":"publisher"}]},{"name":"National Emerging Special Pathogen Training and Education Center","award":["U3REP250781"],"award-info":[{"award-number":["U3REP250781"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiologia"],"abstract":"<jats:p>The National Special Pathogens System (NSPS) stratifies U.S. healthcare facilities by their readiness level to care for patients with high-consequence infectious diseases (HCIDs). While NSPS Level 1 and 2 facilities possess advanced biocontainment capabilities to care for patients for the duration of their illness, most U.S. hospitals fall under a NSPS Level 3 or 4 designation, with limited resources to manage patients with a suspected or confirmed HCID. However, emerging zoonotic threats like H5N1 underscore the need to bolster HCID preparedness across all NSPS Levels. Beginning in March 2024, the U.S. H5N1 outbreak has primarily impacted wild bird flocks, poultry, and cattle, along with some human infections. The continuation of this outbreak in wild and domesticated animals increases the likelihood of further human spillover and eventual viral evolution in human hosts. At the frontlines, rural farming communities are likely to be most affected, with potential outbreaks exacerbated by a lack of accessible NSPS Level 1, 2, or 3 facilities in these regions. Thus, strengthening the HCID preparedness of local NSPS Level 4 facilities is critical to preventing transmission, minimizing societal disruption, protecting communities and the healthcare workforce, along with ensuring an equitable, coordinated response to future emerging infectious disease threats. This manuscript explores the financial, societal and health system impacts of HCID outbreaks to delineate the necessity of strengthening the preparedness of NSPS Level 4 facilities.<\/jats:p>","DOI":"10.3390\/epidemiologia7030079","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T03:24:33Z","timestamp":1780629873000},"page":"79","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Ebola to H5N1: Strengthening the U.S. Special Pathogen Response System"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5618-8645","authenticated-orcid":false,"given":"Anthony Joseph","family":"Lo Piccolo","sequence":"first","affiliation":[{"name":"Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA"},{"name":"Special Pathogens Program, NYC Health + Hospitals\/Bellevue Hospital, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"McGuire","sequence":"additional","affiliation":[{"name":"Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA"},{"name":"Special Pathogens Program, NYC Health + Hospitals\/Bellevue Hospital, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu","family":"Postelnicu","sequence":"additional","affiliation":[{"name":"Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA"},{"name":"Special Pathogens Program, NYC Health + Hospitals\/Bellevue Hospital, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8084-6941","authenticated-orcid":false,"given":"Kathryn","family":"Jano","sequence":"additional","affiliation":[{"name":"New York Medical College School of Medicine, Touro University, Valhalla, NY 10595, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0549-9990","authenticated-orcid":false,"given":"Ryan","family":"Leone","sequence":"additional","affiliation":[{"name":"Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA"},{"name":"National Institute for Defense Health Cooperation, Uniformed Services University, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5360-6223","authenticated-orcid":false,"given":"Eliana","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3473-5905","authenticated-orcid":false,"given":"Angela","family":"Vasa","sequence":"additional","affiliation":[{"name":"Emergency Preparedness and Special Pathogen Programs, Nebraska Medical Center: Global Center for Health Security Scholar, University of Nebraska Medical Center, Omaha, NE 68198, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0310-6371","authenticated-orcid":false,"given":"Michelle","family":"Schwedhelm","sequence":"additional","affiliation":[{"name":"Emergency Management and Clinical Operations, University of Nebraska Medical Center, Omaha, NE 68198, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikramjit","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA"},{"name":"Special Pathogens Program, NYC Health + Hospitals\/Bellevue Hospital, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref_1","unstructured":"(2026, April 06). 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