Children and Disasters

Issue #8: May 1, 2014

NEWS

  • A NEW PHASE OF MIDDLE EAST RESPIRATORY SYNDROME  First recognized in Saudi Arabia in 2012, MERS is caused by a novel coronavirus. Among symptomatic patients the mortality rate is greater than 30%, far higher than SARS (caused by a different coronavirus) or H1N1 influenza. The incidence of asymptomatic or mild illness in endemic areas is unknown. Although most cases have been identified in adults, children can be infected. In addition to respiratory failure, severely ill patients suffer shock, renal failure, and thrombocytopenia. Human to human transmission is common and infection control measures in hospitals are crucial. We are currently observing a dramatic surge in cases with more cases diagnosed during January through March than in all of 2013. MERS is rapidly becoming a global illness with new cases throughout the Middle East, Europe, and Malaysia. Antiviral treatment and vaccines are not yet available. Preliminary progress has been reported in developing an efficient animal research model.

TOOLS

  • EMERGENCY MEDICAL SERVICES FOR CHILDREN NATIONAL RESOURCE CENTER – The EMSC National Resource Center will upgrade its website and change to a new web address on May 1, 2014: www.emscnrc.org

SCIENCE

  • OSELTAMIVIR FOR INFLUENZA REEVALUATED – Results of previous prospective randomized placebo controlled clinical trials of oseltamivir for influenza were combined and reviewed. In symptomatic adults and children, treatment reduced the time to first alleviation of symptoms by 16.8 and 29 hours, respectively. Oseltamivir did not reduce hospital admissions. Effects on pneumonia were inconsistent among studies, dependent on diagnostic criteria. There was no benefit in reduction of “serious complications”. Oseltamivir was associated with an increase in nausea, vomiting, headaches, and psychiatric adverse effects. Observations did not indicate any reduction of viral transmission. This review does not make oseltamivir look like a miracle drug. However, it is worth remembering that a retrospective analysis of children with critical illness due to influenza showed a slight mortality reduction in the cohort treated with neuraminidase inhibitors, compared with untreated patients, after controlling for observable risk factors. Neuraminidase inhibitors including oseltamivir, zanamivir, and peramivir are effective against both influenza A and B. Very few influenza infections during the 2013-14 season have been resistant to neuraminidase inhibitors.
  • PUBLIC HEALTH PRACTICE VERSUS RESEARCH – Confusing the public health practices of surveillance, outbreak investigations, and program evaluation versus research may subject public health agencies to inappropriately strict human subjects regulatory standards. Distinguishing public health practice and research can be difficult because similar methods are used to conduct both types of investigation. Lifesaving public health responsibilities may be delayed by unnecessary administrative burdens and IRB reviews. An algorithm has been proposed to help distinguish these activities.

Edited byDr. Bob Kanter

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