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Children and Disasters

Issue #12: September 2, 2014

NEWS

  • INFECTIOUS OUTBREAKS REPORT
    • EBOLA – As of August 28 the World Health Organization reported 3068 probable and confirmed cases of Ebola virus disease with 1552 deaths. The outbreak continues to accelerate with 40% of the cases occurring in the past 3 weeks, so far limited to Guinea, Liberia, Nigeria, Sierra Leone, and Senegal. The largest number of cases has been identified in Liberia where the outbreak currently includes the capital city of Monrovia (population approximately 1 million). Quarantine of an urban neighborhood of Monrovia enforced by the military sparked a violent reaction and caused shortages of food and essential supplies. The quarantine effort proved to be ineffective, and was discontinued on August 29. The only children’s hospital in Sierra Leone has been temporarily closed with staff quarantined after exposure to a child with Ebola. The United Nations estimates 20,000 cases may occur before the outbreak is controlled. An epidemiological study published in late August estimated that 30,000 individuals would warrant prophylaxis or treatment if such therapies were available, as a result of current disease, exposure, or high risk of exposure. The goal of hospital isolation of symptomatic patients in endemic areas, most of whom have conditions other than Ebola (malaria, gastroenteritis), presents impossible logistical problems for hospitals already exceeding their maximum capacity. While no vaccine or therapy has been proven effective, the National Institutes of Health has announced a phase 1 trial to test the safety of an investigational vaccine. New evidence on molecular mechanisms of disease may inform specific anti-Ebola therapy. The US Centers for Disease Control and Prevention continues to provide guidance for infection control in the US. The Harvard School of Public Health has conducted a national survey indicating that 39% of Americans anticipate a large outbreak in the US, suggesting the need for intensified risk and management communications by public health agencies and the media. Published age-specific information about pediatric disease and management continues to be unavailable.
    • POLIOIn the US, 696 cases have been reported from 46 states. Most of these occurred in travelers returning from endemic areas of the Caribbean, South America, Pacific Islands, or Asia, however 6 locally acquired cases were identified in Florida.  
    • MIDDLE EAST RESPIRATORY SYNDROME (MERS) – After a major outbreak during the spring, only 1 new case has been identified in Saudi Arabia during August.
    • MEASLES – The US measles outbreak has tapered off with 585 cases through July 25 and leveling off to 592 through August 28.
    • WEST NILE VIRUS – As of August 26, West Nile Virus infection has been identified in 297 individuals in 44 states in the US. 47% had meningitis or encephalitis. Most cases have been in the west and midwest.
  • DISASTER REPORT CARD – Save the Children has released findings for their 2014 Disaster Report Card. Findings highlight the need for parents and their children to be pro-active in preparedness activities at school and at home. 54% of US families have been affected by a disaster, 40% do not have an emergency plan, and yet 74% of parents are not willing to rely on the federal government to protect their children. 

TOOLS

  • GUIDANCE FOR CRITICAL CARE IN PANDEMICS AND DISASTERS – A supplement in the journal Chest provides an update to the 2008 Task Force recommendations for mass critical care in pandemics and disasters. This new series of documents expands guidance for the critical care of adults and children, including supplies, evacuation, triage, legal framework and ethical considerations.

SCIENCE

  • PANDEMIC VENTILATOR ALLOCATION – In a pandemic, needs for ventilators might overwhelm the limited supply. Outcome predictors have been proposed to guide ventilator triage allocation decisions in which identification of a subgroup more likely to survive with a short course of mechanical ventilation would improve population outcomes. However, pandemic triage predictors have not been validated. A quantitative simulation study from the National Center for Disaster Preparedness evaluated outcomes resulting from allocation strategies varying in their performance for selecting short-stay survivors as favorable candidates for ventilators. Triage predictors with intermediate-quality performance resulted in a median daily mortality of 80%, similar to first-come, first-served allocation in a hypothetical pandemic. A poor-quality predictor resulted in a worse mortality of 90%. Only a high-quality predictor (sensitivity 90%, specificity 90%) resulted in a substantially lower 60% mortality. Poor performance of unvalidated predictors proposed for triage would represent an inadequate plan for stewarding scarce resources and would deprive some patients of fair access to a ventilator, thus falling short of sound ethical foundations.
  • STATE PUBLIC HEALTH EMERGENCY DECLARATIONS – An empirical analysis of 11 public health emergency declarations in 8 states during 2005-12 included 7 responding to H1N1 influenza, 3 related to hurricanes, and 1 dealing with prescription drug abuse. The small number of declarations may indicate state reluctance to use emergency powers as a result of limited prior experience and ambiguity in legal definitions and lack of operational procedures.

Edited byDr. Bob Kanter

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