Children and Disasters

Issue #21: June 3, 2015

NEWS

  • NEPAL – After a massive community disruption, one of the best ways to restore safety and reassuring normal routines for children is to get them back into school. In Nepal schools are now reopening, sometimes in temporary facilities, after the April 25 earthquake. Initial enrollment is approximately half the usual number of students in the involved areas. Rebuilding damaged schools will proceed over years.
  • THE AMTRAK CRASH – In the aftermath of the Amtrak train crash, we have heard a recapitulation of the usual arguments about funding for disaster prevention. One view is that the crash was not due to inadequate investment on system safety, but entirely explainable by the train engineer going too fast, “The train was going twice the speed limit”. This interpretation leads to the assignment of blame to an individual, and accepts that a single error by a train engineer can be allowed to cause a catastrophe. This is similar to the obsolete idea in hospitals that an accidental medication overdose should be blamed on the nurse who administered the erroneous dose. We now have enormous experience with more effective safety strategies across healthcare and other industries that build redundant safeguards compensating for imperfect individual performance. In the case of railroads, positive train control technology would automatically slow or stop a train whose speed dangerously exceeds safe limits. Such systems have already been required by Congress, but were not yet installed at the site of the crash because of their cost and complexity. It has been noted that the cost of proposed positive train control might be reduced substantially since congressionally mandated systems involve obsolete technology. All this is in the context of a publicly owned Amtrak system that operates under Congressional mandates to serve money-losing low volume routes that guarantee budget deficits, and a decline in American spending on critical infrastructure, now at its lowest level in 22 years. Preview: the same issues of obsolete technology apply to air traffic control in the aviation industry.
  • THE EBOLA EPIDEMIC – Numbers of new Ebola cases continue to decline, but spread of infection persists in densely populated urban areas of Guinea and Sierra Leone. A total of 27,013 Ebola cases have been reported, with 11,134 deaths. Vulnerable orphans face the hardest road ahead.
  • ANTIBIOTIC RESISTANT TYPHOID – Worldwide genetic analysis of the Salmonella enterica Typhi bacteria, which causes typhoid fever, shows that an antibiotic resistant strain is becoming prevalent across Asia and Africa. In some endemic countries where surveillance data are available, typhoid fever is especially a severe disease of children. In non-endemic countries, this emphasizes the importance of healthcare providers obtaining travel histories. An unfamiliar or drug resistant pathogen is one airline flight away.
  • ANTIBIOTIC RESISTANCE & INNOVATION – As drug resistant bacteria become a greater international threat, it is notable how few new antibiotics are available. One obstacle: there is little financial incentive for pharmaceutical companies to invest in new antibiotic development. Even if a new antibiotic is developed against resistant bacteria, it will be reserved for those few patients needing it, while most patients infected with nonresistant bacteria will receive standard antibiotics, providing little financial compensation for the expensive drug development costs. Public incentives are being considered to motivate innovation. Meanwhile, identification of antibiotic resistant bacteria may become much faster with a new electrochemical phenotyping method that shortens detection time from 2-3 days down to an hour.
  • BIRD FLU IN THE MIDWEST – An H5N2 influenza virus is devastating chicken and turkey flocks across the US Midwest. Disrupting the commercial poultry industry, so far the outbreak poses no threat to humans. The mechanism of spread has been a mystery. Animal health officials have had difficulty identifying factors that link infected sites.
  • BUILDING CODES FOR TORNADO COUNTRY – Some have wondered whether families purchasing new homes would be willing to pay the added cost of tornado resistant construction in regions at high risk for extreme weather. Perhaps motivated by the recent local destruction by a tornado, the community of Moore, Oklahoma has decided the benefit is worth the cost. Stricter building codes in Moore will increase construction costs by approximately $1/square foot, or $2,000 for a typical home. For high-consequence-low-probability disasters, people are generally unwilling to pay for prevention. However, as the probability of the hazard increases, the benefits of prevention become clearer. In the case of tornados in Oklahoma, estimates of preventable damage greatly exceed the modest costs of the new building code.
  • PATHOGENS, BIOLABS, AND SAFETY – Worrisome evidence about unsafe practices at biolabs across the US is reported by Alison Young in USA Today.

TOOLS

  • FAILURE TO COMMUNICATE – See the commentary by Fred Burkle and Dan Hanfling on the failure of scientists to communicate their message effectively in political arenas.

SCIENCE

  • ANOTHER REASON TO GET YOUR MEASLES IMMUNIZATION – Introduction of measles immunizations in the US and UK during the 1960s was associated with a steep decline in childhood mortality rates. It has long been suspected that this benefit was due to more than just a reduction in measles mortality. An international re-analysis of data from pre- and post-measles vaccine surveillance indicates that mortality from non-measles infections also dropped after vaccine introduction. This finding is consistent with recent evidence that measles infection interferes with immune function for prolonged periods, particularly suppressing previously acquired immunity. Measles immunizations promote herd immunity for measles virus as well as non-measles organisms by preventing measles-induced immunosuppression.

Edited by: Dr. Bob Kanter

Resource Listing

Pediatric-Specific

General