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Children and Disasters

Issue #11: August 4, 2014

NEWS

  • INFECTIOUS OUTBREAKS SCOREBOARD
    • EBOLA – The largest outbreak of Ebola virus disease ever recognized continues to spread in the west African countries of Guinea, Liberia, and Sierra Leone. One case has been reported in Lagos, Nigeria (city population, 21 million) in a patient who died after arriving at the Lagos airport from an endemic country. As of July 31, the World Health Organization reported 1,323 cases and 729 deaths. Severe infection leads to multi-organ failure and shock, with a case fatality rate of 55-90%. Little published evidence is available yet regarding pediatric specific issues. Infection is transmitted in body fluids of symptomatic patients, as well as postmortem spread during funeral preparations. Treatment is limited to general supportive care, with no specific antiviral therapy or vaccine available. No expert consensus on supportive care has been published. Investigational treatments include vaccines, monoclonal antibodies, RNA interference agents, and nucleoside analogs, but none of these have undergone human clinical trials. Strict infection control procedures appear to be substantially effective in protecting healthcare providers. In an effort to control international spread, Liberia closed most of its borders on July 28, restricting travel to well monitored points. Local public health efforts have been complicated by misunderstanding and fear that outside healthcare workers are spreading the disease. As a result, security concerns have made many villages inaccessible to the Red Cross and other aid groups. Because of the deteriorating security situation and the rapidly growing epidemic, the Peace Corps and some other aid groups have begun evacuating staff from involved areas. The Centers for Disease Control and Prevention advises against nonessential travel to involved areas, but that the west African outbreak presents little current risk to populations in the US. Strict infection control protocols must be implemented if symptomatic individuals traveling from West Africa arrive at American airports.
    • POLIO – The international effort to control a growing polio outbreak in Africa, southwest Asia, and the Middle East continues to be complicated by violent conflict. In Pakistan, Taliban leaders have banned vaccinations, regarding vaccination as a Western plot to undermine the nation. 
    • WEST NILE VIRUS – As of July 22, West Nile Virus infection has been identified in 35 individuals in the US. 46% had meningitis or encephalitis. Most cases have been in the west and midwest.

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SCIENCE

  • CHILDREN’S VULNERABILITY  LONG TERM FOLLOW-UP AFTER HURRICANE KATRINA – Drs. Lori Peek and Alice Fothergill summarize long term observations of children in communities disrupted by Hurricane Katrina. Attention is warranted to the subgroup of children who experience ongoing disruption of family, school, housing, and health, even as others in recovering communities regain a stable equilibrium. Confirming previous studies, vulnerability prior to the storm, including poverty, parental unemployment, insecure housing, unsafe neighborhoods, and unreliable access to healthcare, were associated with long term post-disaster difficulties. The findings will be reported in detail in the forthcoming book, Children of Katrina, Austin, TX, University of Texas Press, 2015. 
  • DECLINING FUNDING FOR HOSPITAL PREPAREDNESS  Federal grants to fund public health departments and hospital disaster preparedness will be cut this year to $840 million, down from $916 million in 2013 and from $971 million in 2012. All this at a time when gaps in hospital preparedness are highlighted by suboptimal responses to major emergencies [1, 2, 3]. And worse news, the evidence basis to guide efficient and effective use of scarce funding is almost negligible (see Allocation of Scarce Resources During Mass Casualty Events. AHRQ Evidence Report No 207, 2012, pages 65-70). An analysis of federally funded extramural research on public health and preparedness reveals that only 10% of funded projects address natural disasters; nuclear, radiological, and explosive threats were addressed in 4% of funded studies; and only 6% of funded studies addressed improvements in the performance of the healthcare system in disasters. This is a truly negligible proportion of federal research funding across all fields. Without grant-funded research, science in any field becomes a hobby and lacks seriousness. Without rigorous evidence, we walk blindly into catastrophe.

Edited byDr. Bob Kanter

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