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Several public health crises in Europe have led to sustained outbreaks, political problems, or have generated social alarm. For this reason, a nationwide study was conducted in Spain with the objective to determine which public health events provoke the most frequent crises, to reach a consensus regarding the appropriate actions to be taken when responding to public health crises, and to provide recommendations for their management. The events which had most frequently provoked crises between 1999 and 2004 were identified. A consensus was obtained by public health experts from the 17 Autonomous Regions of Spain and the National Epidemiological Centre using the RAND/UCLA method which combines the Nominal Groups and Delphi techniques. Legionellosis, foodborne diseases, severe acute respiratory syndrome (SARS), bovine spongiform encephalopathy (BSE), bioterrorism, meningococcal meningitis, tuberculosis, heat waves, and influenza epidemics were found to be cause for most public health crises. In Spain, 75% of the crises identified by senior public health experts from the Autonomous Regions involved infectious diseases. Factors triggering a crisis included the type of disease, social alarm, population affected, and the course of action taken by public institutions and reporting in the media. There was consensus that correct information, qualified personnel, availability of standardised protocols for investigation and control, information distribution, and setting up of 'crisis offices' were actions with a positive effect regarding crisis resolution. Appropriate management of outbreaks or other situations being perceived as a risk to health can mitigate or even contain the generation of public health crises.


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