Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-22T19:08:52.091Z Has data issue: false hasContentIssue false
  • English
  • Français

Medical Countermeasures for Children in Radiation and Nuclear Disasters: Current Capabilities and Key Gaps

Published online by Cambridge University Press:  02 November 2018

Aaron H. Gardner ,
Eric J. Dziuban ,
Stephanie Griese ,
Nairimer Berríos-Cartagena ,
Jennifer Buzzell ,
Karen Cobham-Owens ,
Georgina Peacock ,
Ziad Kazzi  and
Joanna M. Prasher
Aaron H. Gardner
Affiliation:
Eagle Medical Services, LLC, San Antonio, TX
Eric J. Dziuban*
Affiliation:
U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
Stephanie Griese
Affiliation:
CDC, Office of Public Health Preparedness and Response, Atlanta, GA
Nairimer Berríos-Cartagena
Affiliation:
Gap Solutions Inc., Herndon, VA
Jennifer Buzzell
Affiliation:
CDC, National Center for Environmental Health, Atlanta, GA
Karen Cobham-Owens
Affiliation:
Carter Consulting, Inc., Atlanta, GA
Georgina Peacock
Affiliation:
U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
Ziad Kazzi
Affiliation:
CDC, National Center for Environmental Health, Atlanta, GA
Joanna M. Prasher
Affiliation:
CDC, Office of Public Health Preparedness and Response, Atlanta, GA
*
Correspondence and reprint requests to Dr Eric J. Dziuban, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 4700 Buford Hwy, Mailstop E-88, Atlanta, GA 30342 (e-mail: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Despite children’s unique vulnerability, clinical guidance and resources are lacking around the use of radiation medical countermeasures (MCMs) available commercially and in the Strategic National Stockpile to support immediate dispensing to pediatric populations. To better understand the current capabilities and shortfalls, a literature review and gap analysis were performed.

Methods

A comprehensive review of the medical literature, Food and Drug Administration (FDA)-approved labeling, FDA summary reviews, medical references, and educational resources related to pediatric radiation MCMs was performed from May 2016 to February 2017.

Results

Fifteen gaps related to the use of radiation MCMs in children were identified. The need to address these gaps was prioritized based upon the potential to decrease morbidity and mortality, improve clinical management, strengthen caregiver education, and increase the relevant evidence base.

Conclusions

Key gaps exist in information to support the safe and successful use of MCMs in children during radiation emergencies; failure to address these gaps could have negative consequences for families and communities. There is a clear need for pediatric-specific guidance to ensure clinicians can appropriately identify, triage, and treat children who have been exposed to radiation, and for resources to ensure accurate communication about the safety and utility of radiation MCMs for children. (Disaster Med Public Health Preparedness. 2019;13:639-646)

Keywords

childrenmedical countermeasuresnuclearradiationradiologic
Type
Systematic Review
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 3 , June 2019 , pp. 639 - 646
Copyright
Copyright © 2018 Society for Disaster Medicine and Public Health, Inc. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Noack, R. 3 ways the Fukushima nuclear disaster is still having an impact today. The Washington Post. March 12, 2015. https://www.washingtonpost.com/news/worldviews/wp/2015/03/12/3-ways-the-fukushima-nuclear-disaster-is-still-having-an-impact-today/?utm_term=.ba6b1a9e407c. Accessed March 28, 2017.Google Scholar
2. Bartenfeld, MT, Peacock, G, Griese, SE. Public health emergency planning for children in chemical, biological, radiological, and nuclear (CBRN) disasters. Biosecur Bioterror. 2014;12(4):201-207.Google Scholar
3. American Academy of Pediatrics. Committee on Environmental Health. Radiation disasters and children. Pediatrics. 2003;111(6 Pt 1):1455-1466.Google Scholar
4. American Academy of Pediatrics. Committee on Environmental Health. Risk of ionizing radiation exposure to children: a subject review. Pediatrics. 1998;101(4 Pt 1):717-719.Google Scholar
5. Couig, MP, Martinelli, A, Lavin, RP. The National Response Plan: Health and Human Services the lead for Emergency Support Function #8. Disaster Manag Response. 2005;3(2):34-40.Google Scholar
6. Centers for Disease Control and Prevention. Strategic National Stockpile. https://www.cdc.gov/phpr/stockpile/. Accessed January 25,2017.Google Scholar
7. Centers for Disease Control and Prevention. Acute radiation syndrome: a fact sheet for clinicians. https://emergency.cdc.gov/radiation/arsphysicianfactsheet.asp. Accessed March 27, 2017.Google Scholar
8. Centers for Disease Control and Prevention. Neupogen® (filgrastim): general information for clinicians. 2016 https://emergency.cdc.gov/radiation/physicianneupogenfacts.asp. Accessed March 27, 2017.Google Scholar
9. Food and Drug Administration. Emergency preparedness and response. Emergency use authorization. https://www.fda.gov/emergencypreparedness/counterterrorism/ucm182568.htm. Accessed May 12, 2017.Google Scholar
10. Koenig, KL, Goans, RE, Hatchett, RJ, et al. Medical treatment of radiological casualties: current concepts. Ann Emerg Med. 2005;45(6):643-652.Google Scholar
11. Food and Drug Administration. Center for Drug Evaluation and Research (CDER). Guidance potassium iodide as a thyroid blocking agent in radiation emergencies. Published 2001. https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM080542.pdf. Accessed January 25, 2017.Google Scholar
12. Centers for Disease Control and Prevention. Neupogen® (filgrastim): General information for the public. 2016. https://emergency.cdc.gov/radiation/neupogenfacts.asp. Accessed February 17, 2017.Google Scholar
13. Centers for Disease Control and Prevention. Radioisotope brief: cesium-137 (Cs-137). 2014. https://emergency.cdc.gov/radiation/isotopes/cesium.asp. Accessed March 2, 2017.Google Scholar
14. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. HHS news. Published March 9, 2011. https://www.phe.gov/Preparedness/news/Pages/prussianblue.aspx. Accessed February 17, 2017.Google Scholar
15. International Atomic Energy Agency. Chernobyl accident. Published April 25, 2016. http://www.who.int/ionizing_radiation/chernobyl/en/. Accessed May 12, 2017.Google Scholar
16. International Atomic Energy Agency. The radiological accident at Goiânia. 1988. http://www-pub.iaea.org/MTCD/publications/PDF/Pub815_web.pdf. Accessed May 12, 2017.Google Scholar
17. International Atomic Energy Agency. Fukushima nuclear accident. 2016. https://www.iaea.org/newscenter/focus/fukushima. Accessed May 12, 2017.Google Scholar
18. Lurie, N, Manolio, T, Patterson, AP, et al. Research as a part of public health emergency response. N Engl J Med. 2013;368(13):1251-1255.Google Scholar
19. Faherty, LJ, Rasmussen, SA, Lurie, N. Planning for research on children during public health emergencies. Pediatrics. 2016;137(2):e20153611.Google Scholar