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Children and Disasters

Issue #10: July 1, 2014

NEWS

  • INFECTIOUS OUTBREAKS SCOREBOARD
    • POLIO – Polio has long been endemic in Afghanistan, Pakistan, and Nigeria. Low immunization rates and disruption of public health infrastructure by violent conflict have resulted in polio spread to Cameroon, Equatorial Guinea, Ethiopia, Iraq, Syria, Kenya, and Somalia in 2013 and 2014. The stunning context for this is that 51 million people worldwide are refugees from civil war, and half of these are children. The rapidly evolving crisis in Pakistan is likely to displace an additional large population, some of whom may be shedding polio virus, and many of whom are not immunized. Now the Global Polio Eradication Initiative has identified an additional 10 countries in Africa at greatest risk for further outbreaks.
    • CHIKUNGUNYA – Cases of this mosquito borne viral infection, with no treatment or vaccine, have surged in the Caribbean and Central America during 2014. Chikungunya is now being recognized in tourists returning to the US from endemic areas. Public health officials are concerned that locally acquired cases may occur in the US if mosquitos spread the virus from infected individuals. Symptoms include fever, severe joint pain, myalgia, fatigue, and headache. Fatalities occur infrequently but symptoms may last for months. Obviously, these symptoms may be difficult to distinguish from many other infectious causes, warranting laboratory diagnosis to confirm clinical suspicion and to inform infection control.
    • MIDDLE EAST RESPIRATORY SYNDROME (MERS) – Caused by a novel coronavirus, MERS is still viewed by the World Health Organization as a serious concern, but not yet an international public health emergency, which would trigger mandatory infection control interventions. Follow NCDP’s MERS-CoV On The Watch page for the latest news and updates on this topic.
    • MEASLES – As of June 13, the CDC reports 477 cases of measles in 2014, the largest number since US measles “elimination” in 2000. Physicians should review clinical recognition and be aware of the potential for life threatening encephalitis and pneumonia. Measles is vaccine preventable.
    • PERTUSSIS – In California, pertussis (whooping cough) has reached epidemic levels, with 3,458 reported cases and two infant deaths as of June 10. Pertussis is vaccine preventable.

TOOLS

  • CRITICAL INCIDENT REGISTRY – In order to learn from rare high consequence public health emergencies, a registry will promote the collection of consistent and useful observations. Data in such registries should focus on specific response issues by public health agencies, using consistent definitions and reporting protocols to enable cross case analysis, and must provide explicit incentives to promote collection of the observations.
  • TRANSFORMING AN ADULT ICU INTO A PEDIATRIC ICU – A key concept in planning crisis standards of care for large pediatric emergencies is that scarce children’s hospital resources may be inadequate to meet overwhelming needs, and that care of children must be integrated into general regional systems. Resources usually serving adults may have to be adapted for the care of children. The experience of one hospital is described in transforming an adult ICU to serve critically ill and injured children after a hurricane.

SCIENCE

  • SUSTAINABLE COASTAL COMMUNITIES – Worldwide flooding disasters in the last 15 years provide convincing evidence that coastal cities face dangerous and costly storm surges with increasing frequency. To inform policy development, a multidisciplinary flood management strategy has been applied to New York City as an example of a vulnerable coastal megacity. Solutions include building code enhancement to elevate or flood-proof buildings, and barriers to reduce the likelihood of floods. The optimal allocation of scarce resources to specific interventions is chosen in benefit-cost analyses. Costs of interventions are balanced against estimated losses in various probabilistic flood risk models. Improved building codes are the most cost effective strategy. However, barrier enhancement becomes economically favorable in pessimistic models of climate change and storm surge severity. Unanswered question: who pays for these protections? Private-public partnerships make sense in sharing the costs of infrastructure improvements toward sustainable coastal communities. However, the track record of such partnerships is complex and fraught with failure. Costs of insurance coverage may be a major driving force motivating communitywide protections. Current policies may limit coverage for disaster losses and many homeowners currently go without disaster insurance coverage.

Edited byDr. Bob Kanter

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