Management of Prevalent Infections in Children Following a Disaster

Several factors may be involved in the high mortality rates pandemics cause in developing countries. These include lack of access to adequate medical care, weak public health infrastructures, social factors such as housing conditions and population density, and host factors such as nutritional status and co-existing medical conditions. Core interventions to control or mitigate the effects of an influenza pandemic include pharmaceutical interventions such as vaccines and antiviral agents, and nonpharmaceutical interventions such as quarantine, isolation, social distancing, and personal hygiene.

Antiviral agents are particularly useful in the early stages of a pandemic when there is shortage of vaccines. Stockpiling of neuraminidase inhibitors is part of many industrialized countries pandemic preparedness plans however stockpiles of antiviral agents available in developing countries is small and limited. The most critical limiting factor for stockpiling neuraminidase inhibitors in developing countries is their high cost and allocating scarce resources to stockpile sufficient quantities of oseltamivir for an unpredictable influenza pandemic. Because only a limited number of vaccines will be initially available, particularly in the early stages of a pandemic, and most of them would likely be supplied to industrialized countries, developing countries will need to focus initially on nonpharmaceutical interventions. Maintaining a balance between pharmaceutical and nonpharmaceutical interventions is necessary to achieve the best use of limited resources.

During an influenza pandemic, additional essential medical supplies such as gloves, masks, syringes, antipyretics, and antimicrobial agents will also be required. These supplies are insufficient in healthcare facilities in developing countries, even in nonemergency situations. Lack of these supplies may hamper provision of adequate medical care for patients with pandemic influenza. Basic PPE such as disposable gloves and surgical masks are needed for protecting healthcare workers. Anti-microbial agents are expected to be effective for secondary bacterial pneumonia, which can be a major cause of death for patients with pandemic influenza.

Providing better medical care during a pandemic is essential to reduce the health consequences of the pandemic including death. Since the availability of pharmaceutical interventions in developing countries is less likely, nonpharmaceutical interventions such as social distancing and personal hygiene may be the only available interventions. Essential medical supplies such as masks, gloves, and antimicrobial agents should be available in hospitals and clinics. The stockpiles of these basic supplies can be more cost-effective in developing countries than stockpiles of more expensive antiviral agents. Healthcare personnel should be trained for infection control measures, especially hand hygiene and use of personal protective equipment. The overarching goal is to maintain the current healthcare and public health systems needed to minimize the impact of a pandemic.

PAHO’s Pandemic Influenza A (H1N1) 2009 manuals describes preparedness planning, infection prevention and control, nonpharmaceutical strategies and IMCI diagnosis, treatment and management protocols in Spanish, English, Portuguese and French.