NEWS

• VACCINATIONS REQUIRED FOR CALIFORNIA SCHOOLCHILDREN – After a California measles outbreak earlier this year threatened nationwide spread, new legislation requires that California schoolchildren be fully immunized in order to qualify for school enrollment. Although medical exemptions are authorized, personal and religious exemptions will no longer be accepted. Because it is so contagious, preventing measles requires community immunization rates well over 90%. Many California school districts fall below the critical safe level. The first measles death in the current US outbreak occurred in an immunocompromised individual after exposure to an unrecognized measles patient in a healthcare facility. Patients with immune system deficiencies cannot be immunized and they face the greatest risks if they are infected with the measles virus.

• NEPAL & CHILD EXPLOITATION – Children separated from their families are always vulnerable to exploitation. In the aftermath of the Nepal earthquakes there is concern of trafficking involving orphans and lost children. Restrictions have been imposed on the travel of unaccompanied children across district and international boundaries in an attempt to control the problem.

• EBOLA – Recently free of cases, Liberia now reports new Ebola infections, adding to the ongoing low level of transmission in Guinea and Sierra Leone in the continuing West Africa Ebola epidemic.

• MIDDLE EAST RESPIRATORY SYNDROME – After the index case brought the MERS coronavirus to Korea, subsequent spread in the Korean outbreak is entirely the result of exposures within healthcare facilities. If we didn’t learn it sufficiently during the Ebola outbreak, this is another wake-up call to strengthen infection control in American hospitals. Even more than Ebola in 2014, MERS in 2015 is highly contagious in the healthcare setting. Spread not only by close contact, but also by airborne transmission, MERS requires prompt recognition and isolation of patients, as well as evidence-based quarantine of asymptomatic but potentially exposed individuals. Infection control involves no innovative technology, but rather the reliable application of traditional methods to screen for cases and prevent spread when they are found. As the small 2014 US Ebola outbreak showed, voluntary guidelines were ineffective in motivating timely hospital preparedness. It is time for mandatory requirements for hospital infection control for highly transmissible dangerous infections.

• TERRORIST THREATS IN THE US – Perceptions of terrorist threats in the US tend to focus on the international sources of conflict. In fact, deaths from terrorist actions since 2002 in the US are almost twice as likely to be the result of domestic terrorists acting on a variety of white supremacist and antigovernment ideologies. “With non-Muslims, the media bends over backward to identify some psychological traits that may have pushed them over the edge…whereas if it’s a Muslim, the assumption is that they must have done it because of their religion.”

• CYBER ATTACKS – Sophisticated cyber attacks on business and government continue to take their toll. Meanwhile, lower-tech attacks have also caused internet disruption.

TOOLS

• THE MEDICAL HOME AND CARE COORDINATION IN DISASTER RECOVERY – In postdisaster settings, health care providers encounter secondary surges of unmet primary care and mental health needs that evolve throughout disaster recovery phases. Whatever a community’s predisaster adequacy of health care, postdisaster gaps are similar to those of any underserved region. A paper from the National Center for Disaster Preparedness proposes that existing practice and evidence supporting medical homes and care coordination in primary care for the underserved provide a favorable model for improving health in disrupted communities.

• BECAUSE SURVIVAL IS INSUFFICIENT – Sometimes fictional literature is a better way to explore motives, fears, and desires than empirical observations. “Station Eleven” by Emily St. John Mandel is a wonderful account of a traveling symphony and theater group making the rounds of small towns along the shores of the Great Lakes, all that remains of civilization, twenty years after a pandemic almost wipes out humanity and all its vital infrastructure collapses. Not a disaster story, but a meditation on family and the things that are worth remembering.

SCIENCE

• GROUNDWATER UNDER STRESS – Measurements from NASA satellites reveal that more than half of the world’s largest aquifers were shrinking between 2003 and 2013. The most stressed water sources are in poor densely populated regions. In the US, the Central Valley Aquifer of California showed the largest deficit.

• ALLOCATING VENTILATORS IN A PANDEMIC – In a severe pandemic, hospitals would not have enough ventilators to provide care to projected numbers of patients. Rationing schemes would either involve a randomized selection of patients or else would select patients on the basis of their higher likelihood of survival after a short period of mechanical ventilation. Unfortunately, until now no evidence has been available to predict short stay survivors on the basis of clinical characteristics at the time treatment is initiated. A new study provides such predictions on the basis of observations from a large pediatric intensive care registry. This paper included input from the National Center for Disaster Preparedness.

Edited by: Dr. Bob Kanter