[Eric] Hello everyone.
Thank you for joining us today.
I'm Eric Dziuban, team lead
or the Children's Preparedness Unit at CDC.
I also serve as a liaison for the American Academy
of Pediatrics Disaster Preparedness Advisory Committee.
This will be a rapid overview of children's needs,
within the context of public health emergency preparedness.
Let me introduce you what our small team does.
Children's Preparedness Unit is the only group at CDC
that is purely focused on the specific needs of children
in public health emergencies.
We champion those needs, through preparedness
and response efforts, by integrating children's concerns
into public health planning at the federal,
state, and local levels.
These four pillars are our main channels of activity that we use
to accomplish our mission: building an evidence base,
increasing awareness, offering technical assistance,
and developing partnerships.
Children's Preparedness Unit has an overarching goal
of improving children's preparedness efforts
domestically, as well as three supporting strategies
to guide its activities.
First, linkages among public health, pediatricians,
children's hospitals, and other stakeholders will be fostered
and sustained.
Second, the need for timely, accurate and comprehensive data
and recommendations on the care, treatment and involvement
of children in public health emergencies will continue
to be emphasized.
And third, pre-planning
for upcoming events will include reviewing lessons learned,
developing strategic communications,
and reviewing gaps in preparedness for known threats.
Our team sits in CDC's National Center on Birth Defects
and Developmental Disabilities, but we receive funding
from the Office of Public Health Preparedness and Response,
where the bulk of CDC's emergency preparedness
activities take place.
Within our center, we're in the Division of Human Development
and Disability, which has a number of primary programs,
including Children's Preparedness.
I show this to you to highlight how we are situated among many
pediatric experts, especially in the arena of child development.
In 2016, the two largest emergency responses
in which we participated - Zika virus and water contamination
in Flint, Michigan - both were centered on threats
to children's development, and these connections
and resources proved indispensable.
For large CDC emergency responses,
the Children's Preparedness Unit becomes activated
as the Children's Health Team for that response.
Here you can see a timeline of recent activations
where this has occurred.
On the right, you can see some examples
of the content area we often manage
within the Children's Health Team.
These include pediatric medical countermeasures;
liaising with partners, such as AAP, children's hospitals,
and other child-focused organizations;
children's mental health; parental presence in the context
of contagious pathogens requiring isolation
or quarantine; breastfeeding and transmission of pathogens,
toxins, or radioactive elements; pediatric case investigations;
infant diagnostic guidelines;
and finally public communication materials,
such as pediatric frequently asked questions.
We consider all of these focused pediatric efforts necessary
because children have unique needs during an emergency,
which can make them highly vulnerable in times of disaster.
They have specific physiology, anatomy,
and developmental characteristics,
and younger children in particular are partially
or fully dependent on adults.
Providers more accustomed
to adult patients may not be prepared to handle large numbers
of children in an outbreak or disaster setting,
and both pediatric
and non-pediatric resources can become overwhelmed quickly
with an influx or surge of children.
This graphic captures many of characteristics
of young children that give them unique vulnerabilities
in public health emergencies.
Physically, they have a smaller size
and physiological differences,
such as higher respiratory and metabolic rates.
Developmentally, they have different physical activity
patterns, such as time spent with hands in their mouths,
and less ability to articulate their needs or symptoms.
Not shown here are social issues, such as dependence
on caregivers who may also be susceptible
to the same health threats.
And school-aged children have more person-to-person social
contact on a daily basis than younger children or adults,
increasing their risk of pathogen transmission.
Medical Countermeasures, or MCMs, are products
that can be used in public health emergencies stemming
from a terrorist attack, an infectious disease outbreak,
or a natural disaster.
MCMs can be biologic products, such as vaccines,
blood products, or antibodies; drugs, such as antibiotics;
and equipment, such as gloves, respirators, and ventilators.
Children's weight-based dosing may require different
formulations in the Strategic National Stockpile,
different dispensing guidance for public health departments,
and different guidance for the public.
Testing MCMs on children also has serious
ethical considerations.
Many MCMs are not FDA-approved for children
and must be administered
under alternative regulatory mechanisms.
There are systematic challenges associated with pediatric MCMs.
Starting in triage, children will have a different range
of normal vital signs,
and adult-based triage tools may be inaccurate
when used for small children.
Medications used in emergency responses, such as doxycycline
or ciprofloxacin for anthrax inhalation, anti-neutropenics
for radiation exposure, or atropine auto-injectors
for chemical exposures,
have different considerations for children.
These include calculating weight-based dosing
in a potentially chaotic setting,
and different formulations
with possibly limited availability within stockpiles.
These differences could require specific dispensing
and administration guidance from the public health sector.
As an example, the step-by-step guidance on the right goes
through the correct process for weight-based dosing
of doxycycline for children.
Finally, equipment needs will include pediatric sizes
for both durable and single-use materials, such as oxygen masks,
catheters, and tubing equipment.
Devices based on adult sizes
and settings may not work for children.
I hope this has been a helpful overview of the importance
of including children's needs in every stage
of public health emergency preparedness and response.
Preparedness efforts for children,
developed before the emergency occurs, are critical
because there will be child-specific challenges
for clinical management to consider.
Bringing together public health professionals engaged
in preparedness planning and leaders
in the pediatric sector can help states
and local communities address these issues while there is
still time, in order to protect our most precious resource.
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