One Humanity: Supporting Mothers and Infants in the Syrian Refugee Crisis

Train tracks into Winter Reception Transit Center

The scale of the Syrian crisis is nearly beyond comprehension: 4.8 million refugees, 8.7 million people displaced inside Syria’s borders. But the numbers don’t tell the whole story.

Across the world, CDC has people on the ground working to protect the health of those affected by the crisis – people like Leisel Talley, whose mission is to help mothers and babies get the nutrition they need, despite unimaginable circumstances.

Fifteen minutes to help

In December 2015, Leisel spent time at the Slavonski Brod transit center in Croatia, where refugees fleeing Syria, Iraq, and Afghanistan were processed and registered within Croatia and then sent on to Slovenia. Refugees typically traveled a grueling 12-30 days before reaching Croatia, and only stayed at the Slavonski Brod center for about an hour and a half, during which things moved quickly.

The center provided basic necessities like hygiene kits, hot tea, and meals, as well as reunification services to help people find family members they had lost along the way. The team there also provided access to minimal healthcare, along with space for infant feeding, clothing, and breastfeeding support. This is where Leisel came in. She recalls: “I had 15 minutes to give a comprehensive infant feeding assessment in a 20-foot by 20-foot tent.”

Mother and Baby Tent in Slavonski Brod, Croatia
Mother and baby tent in Slavonski Brod, Croatia

Protecting the smallest refugees

“We asked mothers if they were breastfeeding, which we encouraged,” Liesel explains. “Those who didn’t want to breastfeed were asked to cup-feed infants with a ready-to-use, liquid formula, instead of powdered infant formula, which requires clean water to safely make.”

Globally, less than 40% of children under six months of age are exclusively breastfed, with no other foods or liquids. Babies who are not breastfed are extremely vulnerable to diarrhea and pneumonia, which increases their risk of dying. Breastfeeding lowers the possibility that babies will be fed formula mixed with contaminated water.

Leisel is one of many people working to make the best of a horrible situation. One in every 113 people around the world is now either a refugee, an asylum-seeker, or an internally displaced person. Fifty-one percent of them are children. Working alongside UNICEF, Save the Children and MAGNA, Leisel used every minute she had to help replenish, educate, and prepare the tired refugees for the next leg of their journey.

A day for awareness

August 19th is World Humanitarian Day – an opportunity for us to recognize aid workers and their passion for humanity. The General Assembly designated World Humanitarian Day to coincide with the anniversary of the 2003 bombing of the United Nations (UN) headquarters in Baghdad, Iraq. Please join us in observance of World Humanitarian Day and use the hashtags #sharehumanity and #WorldHumanitarianDay on social media to raise awareness about the millions of people living in crisis around the world and the aid workers who have devoted their lives to this cause.

CDC’s Emergency Response and Recovery Branch has been on the scene in Syria since 2012. The branch has conducted more than 85 humanitarian public health missions related to the crisis, making it the second largest humanitarian response to date, surpassed only by their work following the 2010 Haiti earthquake.

Learn more about the global commitment to humanitarian response:

 

Ready or Not: Communicating During an Emergency in the Country of Georgia

Tbilisi-Flood-blog

Emergencies don’t wait for you to be ready.

In 2015, the country of Georgia invited CDC to conduct a training on the principles of Crisis and Emergency Risk Communication (CERC). But before we could get there, the capital city of Tblisi was struck by a major flood.

The flash flood and ensuing mudslide killed 20 people and covered much of the city in water and mud. There were news reports about the massive damage, human casualties, and even escaped zoo animals.  Ready or not, responders had to jump in and communicate clearly about the emergency.

This is exactly the type of situation CERC training is intended to prepare for. When a crisis hits, people need understandable, trustworthy, and accurate information they can act on. And they need it fast.  CERC helps communicators ensure that the right messenger is delivering the right message at the right time.

CERC saves lives

When we arrived in Georgia, my co-worker Kellee Waters and I discovered that the news reports hadn’t captured the intensity of the flood the way firsthand accounts could. We heard sobering stories from our colleagues about the impact of the disaster: a stream that turned into a raging river; a landslide that caught everyone off guard.

In the aftermath of the flood, many of our Georgian colleagues found themselves needing to use CERC principles — with or without training. They had to quickly and clearly inform people about threats in different parts of the city and communicate what actions the government was taking to rescue people and animals.

Lessons from the flood

When we began our training, we found that participants’ experiences from the flood gave them valuable insight. Those who had been involved in communicating about the flood stressed the importance of consistent messaging. They recalled that messages about safety had been quickly reported and repeated in the news and on social media; making information readily available to reporters allowed important safety messages to be disseminated faster and wider and increased their credibility. The government had helped by being the first to report accurate, credible messages that offered action steps for citizens to stay safe – before, during and after the crisis.

Class participants also talked about identifying and connecting with groups of people who did not speak Georgian as their first language. This was crucial so all Georgians could return to a more familiar and normal life as quickly as possible after the flood.

While not everyone in our class had a role in communicating during the flood, they all recognized the value of effective communication in an emergency response. They also noted that good communication takes experience, knowledge, and expertise.

None of the participants would have wished this tragedy on their country, but they all had a strong resolve to use the experience to prepare for future events.

Shaking things up!

Participants with trainers after receiving their CERC certificates.
Participants with trainers after receiving their CERC certificates.

During class, participants learned about the different agencies where they worked and considered how each agency might play a role in future responses. They practiced developing messages and explored strategies for making sure those messages reached the right people.

As part of the training, we used an earthquake scenario to identify the types of information different audiences need in a response, and we looked at how those needs evolved over time.

For example, class participants recognized that a large earthquake would likely receive global news coverage, but that the first priority would be getting safety information to the affected people. They had to make decisions about how to get life-saving information to first responders and those affected while providing enough information for all audiences so that rumors and misinformation would not spread.

Armed with new knowledge, our colleagues in Georgia are now prepared to act more swiftly and effectively to make sure everyone receives the information they need, no matter when or where disaster might strike.

Safe Travels for Zika and Other Dangerous Samples

Barcoded medical samples in transparent tubes

As Zika virus spreads across the globe, scientists in the United States are finding ways to fight it. Currently, there are no vaccines to prevent Zika or medicines for treatment. To create better tests – including rapid tests – and develop vaccines, scientists need to conduct research with the virus in their labs.

CDC manages the permit process for researchers to bring samples of Zika virus safely from other countries into the U.S. for studies, paving the way for lifesaving discoveries.

“Samples come from all over the world,” says LCDR Meredith Pyle, a CDC microbiologist. “While so far, most samples have come from Brazil and Colombia, we have received samples from countries ranging from India to South Korea to Switzerland to Zambia.”

Sending a virus sample from one place to another has to be done safely and securely. Samples of Zika virus can be brought into the U.S. in a variety of forms, including in a tube of blood (plasma or serum), a spot of dried blood, an isolate of the virus itself that has been separated from the blood, or even a live mosquito.

How researchers get a permit

Most permit requests come from laboratories at academic and private institutions. Permits are requested through the Import Permit Program (IPP), which is managed by CDC’s Division of Select Agents and Toxins (DSAT). The program makes sure infectious germs, like Zika virus, as well as other materials that could cause disease in people will be handled appropriately after they arrive in the U.S.

“IPP helps to ensure biological agents imported into the US that could cause disease in people are tracked,” said Dr. Dan Sosin, acting director of DSAT. “We also take steps to ensure that the facilities receiving these permits have appropriate biosafety measures in place to work with the materials.”

When a researcher or institution submits an application to get an import permit for Zika virus, CDC reviews the application to make sure the facility has the appropriate biosafety measures in place to prevent the virus from accidentally being released. The program goal is to approve all Zika virus import permit applications within 24 hours for known, appropriate facilities. DSAT may also conduct an in-person inspection before issuing a permit.

Since last year, the number of permits issued for Zika virus has increased by more than eightfold. As of August 1, 2016, the program had expedited the approval of 137 Zika virus import permits this year alone.

Get more information on the Import Permit Program.

Using the Law to Prepare for Global Health Emergencies

CDC country office sign in Liberia

Countries need to be prepared to handle emergencies. Having the right laws in place is an important part of the preparation.

When laws are not clearly defined, responders can have a hard time figuring out what to do during a public health emergency and who has the authority to take action. When a deadly disease outbreak hits, this can have devastating consequences.

Liberia knows firsthand what can happen when laws don’t match the needs in the field. Their experience with the recent Ebola epidemic exposed gaps in legal authority during the response. This is one reason why Liberia’s government recently reached out to the GHSA Public Health Law Project. The project team is helping them document issues that could be improved by updating Liberia’s public health law, which was last fully revised in 1976.

Advancing the Global Health Security Agenda

Bucket of bleach for washing of hands before entering public buildings and entering counties
Ebola preventive measures in Liberia: Buckets of chlorine solution to wash hands before entering public buildings and entering counties.

The GHSA Public Health Law Project takes a close look at how the law can help (or hinder) countries as they prepare to handle public health emergencies through the Global Health Security Agenda (GHSA). Right now, over 50 countries around the world are working through the GHSA to improve their ability to prevent, detect, and rapidly respond to infectious disease threats. The GHSA Public Health Law Project currently covers nearly half of the GHSA countries. The team helps analyze the laws of a country and provides training to country officials to help them understand the importance of law as a public health tool.

The team begins its work by gathering information about existing laws and talking to experts about how public health law works in their country. In Liberia, the team found that people felt unclear about their roles during the Ebola response. As one country health official told the team, “There is confusion about roles in an emergency and enforcement. What is the role of the police? The ministry of health? The military? [This] needs to be better defined.”

Public Health Law in Liberia

Before the CDC team arrived in Liberia, the Ministry of Health’s Legal Counsel were already taking the lead to help modernize the law. This is a massive undertaking that the Government of Liberia hopes to accomplish as soon as possible.

The Liberian Ministry of Health’s (MOH) Legal Counsel and CDC’s Country Office Director invited the CDC project team to help them reach this goal through research and analysis of where there may be gaps in the law. The project team worked with a team from the University of North Carolina’s School of Government, who were invited for public health law support by Liberia’s Chief Medical Officer.

CDC Public Health Law team
From Left to Right: Jeff Austin (University of North Carolina), Emily Rosenfeld (CDC), Akshara Menon (CDC), Tomik Vobah and Aimee Wall (University of North Carolina)

Liberia will be able to use the information gathered by the team as they update their public health law. Once the laws are updated, the next step is making sure people are aware of them. A county health official laid out the problem he saw in Liberia: “Fundamentally, what is wrong is that the public health law is not widely known.” This official had been a practicing doctor for 11 years, but he had only read Liberia’s public health law for the first time two weeks prior to talking with the team.

Planning for the Future

The GHSA Public Health Law Project is being done collaboratively between CDC’s Center for Global Health and the Public Health Law Program. The project is compiling the laws from these countries into a single, searchable database to give a more complete picture of the legal landscape relating to the GHSA. The legal data obtained from this project will be a valuable resource when countries want to update their public health laws.

This initial legal mapping phase is only the beginning. What is really vital is how countries will use this information to help guide their work. The law can be an effective tool in meeting global health security goals and protecting people’s health — not only when a crisis hits, but every day.

Using Data to Prepare for the Next Heat Wave

A road sign in Death Valley warning travelers of Caution Extreme Heat Danger

Extreme heat events, or heat waves, are a leading cause of weather-related deaths in the United States. Between 1999 and 2012, extreme heat caused more than 7,400 heat-related deaths in the United States.  Extreme heat increases hospital admissions for heart disease, respiratory disease, and stroke.

CDC’s Climate and Health Program funds 16 states and two cities through the Climate Ready States and Cities Initiative.  Through this initiative, CDC helps states and cities partner with local and national climate scientists to understand potential climate changes in their areas, including extreme heat.  CDC also assists states and cities in developing and using models to predict health impacts, to monitor health effects, and to identify the areas that are most vulnerable to these effects to help ensure that communities are prepared for the health challenges associated with climate change.

Evaluating the effectiveness of different preparedness actions and interventions is an important step in protecting people from extreme heat.  States can use data on heat-related illnesses from the National Environmental Public Health Tracking Network to help make decisions about the best ways to prepare for extreme heat.

Identifying who is at risk

The Minnesota Tracking Program analyzed data on heat-related illnesses and deaths to understand more about the people who are at the most risk during extreme heat events. The analysis revealed two new pieces of information:

  • People between the ages of 15 and 34-years old are at risk during extreme heat–not just people over the age of 65.
  • The rates of extreme-heat-related hospital stays and emergency department visits were higher across the entire state of Minnesotathan in the metropolitan area that includes the seven counties in and around the Twin Cities.

State and local health professionals used the tracking data to develop and update maps showing areas with populations that are at the highest risk for illness or death during heat waves. They are using the maps to identify areas that need additional support and planning to prepare for heat waves.

Taking action and being preparedThermometer reading 100 degrees

The 2006 North American heat wave began in mid-July of that year.  Between July 15 and August 27, 140 people died as a result of extreme heat in California, which had the most severe death toll in the country due to heat.  An additional 515 people were suspected to have died from this period of extreme heat in California.  The heat wave resulted in an estimated $133 million in health-related costs for the state of California.

Heat waves will continue to impact all regions of California, including urban, rural, inland, and coastal areas.  These periods of extreme heat are expected to get longer and to become more frequent over time.  In order to inform preparedness initiatives for the extreme heat, the California Tracking Program conducted a study to determine whether heat alerts accurately predicted the times when people suffered the most heat illness.

The findings from the study provided scientific proof of a link between heat alerts and heat illness.  Decision-makers in San Jose used the results to approve opening cooling centers as part of the city’s heat alert response plan.  Cities and counties nationwide must be prepared in this way to respond to heat alerts and to take preventative actions, such as opening cooling centers where people can gather for life-saving relief from the heat.

The California Tracking Program and the National Weather Service (NWS) are conducting similar studies in other parts of California, including Los Angeles. This information will help cities to make decisions about heat wave preparedness policies and help NWS refine its heat alert system for each region.

Learn more about extreme heat at http://emergency.cdc.gov/disasters/extremeheat

  • Check out this infographic about how to prepare yourself and your loved ones for the next heat wave.
  • Check out the National Environmental Public Health Tracking Network’s Info by Location feature to view data and information on extreme heat for your county.

Healthy and Safe Swimming Week 2016

Healthy and Safe Swimming Week 2016

Summer is here! For many, it is time to hit the pool or take your children on a summer outing to the waterpark. Swimming is a great way to exercise, have fun and relax while spending time with family and friends. However, like many activities, it is not risk-free.

Thousands of U.S. public pools and other aquatic venues are closed each year due to serious health and safety violations. Inspections of public aquatic venues are critical to prevent illness, drowning and pool chemical–associated injuries, including poisoning or burns.

This year, during Healthy and Safe Swimming Week, CDC is encouraging swimmers to protect themselves and their loved ones from getting sick or hurt while enjoying the pool, hot tub/spa, or water playground. CDC’s Michele Hlavsa is a nurse and the chief of CDC’s Healthy Swimming Program. As a mom, it is important for her to know how to keep her child healthy and safe in water.  Michele points out, “We check out inspection results before eating out, why not check out inspection results before swimming?” Swimmers and parents of young swimmers, like Michele, can take steps to protect their health and safety and that of their families while having fun in the water this summer.

Check the latest inspection results for public pools, hot tubs/spas, water playgroundsDo your own inspection before you swim

Before jumping into any type of treated water this summer, you can do your own simple and quick inspection.

  • Use a test strip (available at most superstores or pool-supply stores) to determine if the water’s pH and free chlorine or bromine concentration are correct.[1]
  • Make sure the drain at the bottom of the deep end is visible.
    • Clear water allows lifeguards and other swimmers to see swimmers underwater who might need help.
  • Check that drain covers at the bottom appear to be secured and in good repair.
    • Swimmers can get trapped underwater by a loose or broken drain cover.
  • Confirm that a lifeguard is on duty at public pools. If not, check whether safety equipment, such as a rescue ring with rope or pole, is available.

Bring any problems that you find during your inspection to the attention of the person in charge of the facility so they can be fixed before you get in the water. If the problems are not addressed, you can report the issues to your state or local health department.  You can also download an inspection checklist on the Healthy Swimming website.

Think Healthy. Swim Healthy. Be Healthy!

Recreational water illnesses can be caused by swallowing germs or coming into contact with – or breathing in mists or sprays of – contaminated water in swimming pools, hot tubs/spas, water playgrounds, lakes, rivers, or oceans.  These illnesses result in a wide variety of infections, including gastrointestinal, skin, ear, respiratory, eye, neurologic, and wound infections.

Staying safe in and around the water is important, too. Don’t forget sun safety and drowning prevention. Learning swimming skills like floating, wearing life vests and, swimming under the supervision of parents, caregivers, or life guards who know CPR can prevent drowning.

Before jumping into the pool this summer, don’t forget to:What's in your cannonball?

Keep the pee, poop, sweat, blood, and dirt out of the water.

  • Stay out of the water if you have diarrhea.
  • Stay out of the water if you have an open wound (for example, from surgery or a piercing) that is not covered with a waterproof bandage.
  • Shower before you get in the water – Rinsing off in the shower for just 1 minute removes most of the dirt or anything else on your body.

Protect yourself and others!

  • Protect against sunburn by using sunscreen with at least SPF 15 that blocks both UVA and UVB rays.
  • Use well-fitting Coast Guard approved life jackets for flotation assistance rather than foam or air-filled toys.

Once you are in the water…

  • Don’t pee or poop in the water.
  • Don’t swallow the water.
  • Keep an eye on children at all times. Kids can drown in seconds and in silence.

Every hour—everyone out!

  • Take kids on bathroom breaks.
  • Check diapers, and change them in a bathroom or diaper-changing area–not poolside–to keep germs away from the pool.
  • Reapply sunscreen.
  • Drink plenty of fluids.
  • Dry ears thoroughly with a towel after swimming.

Learn more about how to stay healthy and while swimming, visit CDC’s Healthy Swimming Website and/or Drowning Prevention Website.

[1] CDC recommends pH 7.2–7.8. The free chlorine concentration should be at least 1 ppm in pools and at least 3 ppm in hot tubs/spas. The free bromine concentration should be at least 3 ppm in pools and at least 4 ppm in hot tubs/spas. Use test strips to test pH and free chlorine or bromine concentration. Most superstores, hardware stores, and pool-supply stores sell test strips. Follow the manufacturer’s directions.

Spring Adventures: 6 Apps for Healthier Travels

Map with camera, compass, plane and journal

It’s that time of the year again! Students and parents are packing their bags for Spring Break! Before you set out on your next big adventure, be sure to take a look at these helpful mobile apps to prepare for your trip.

TravWellTravWell app

CDC’s TravWell app helps you plan for safe and healthy international travel. This app allows you to get vaccine recommendations for specific destinations, a checklist of tasks to prepare for travel, and a customizable, healthy packing list. You can also use this app to keep your medication and immunization records and set reminders to take medicines or get vaccine booster doses while you’re traveling. This would be especially important for someone taking medicines like malaria prophylactics (drugs to prevent malaria). TravWell also lets you take pictures of important documents (passport, visa, etc.) and store them on the app as a backup in case they get lost. This app also has up-to-date recommendations from CDC for international travelers. Another great bonus is that many features are available offline, so you don’t need a data connection to access information. The app also includes local emergency service phone numbers for each country.

Can I Eat This?

Can I Eat This? appThe dreaded Montezuma’s revenge, Delhi belly, or travelers’ diarrhea—whatever you call it, can really zap the fun out of international travel. Download CDC’s Can I Eat This? app to help keep your stomach steady. First, select the country you’re in and the app will ask you a few questions about what you’re preparing to eat or drink (e.g. Does the water have ice in it? Is the meal from a street vendor?). The app will tell you whether it’s likely to be safe to eat. With this app in your corner, you can be more confident about making healthy choices abroad so you won’t spend your international trip in the bathroom. Another advantage of this app is that a data connection is not needed for access.

Yellow Book app2016 Yellow Book

We’re not talking about that old phone book! CDC Health Information for International Travel (commonly called the Yellow Book) is published every two years by CDC as a reference for health professionals. However, you may find it to be a useful reference to make sure you’re following CDC recommendations for immunizations. This app is a good resource if you are planning to meet with your healthcare provider before traveling internationally. It also has advice on how to monitor yourself for illnesses after returning from international travel, which is especially important if there is a current disease outbreak where you are traveling. The app has a simple display, is easy to understand, and includes maps for several countries.

FEMA App

FEMAYou don’t need to leave the continent to practice personal preparedness! The FEMA app is a great resource for preparedness alerts and safety tips while traveling within the U.S. Not only does the app allow you to set up alerts from the National Weather Service, but it also provides FEMA safety tips on how to stay safe in over 20 types of emergency situations. When you are traveling in an unfamiliar area, it’s also important to be aware of local disaster resources. The FEMA App provides driving directions to local shelters and other disaster recovery centers. The app is also available in Spanish.

Safe Traveler appSmart Traveler

Stay safe and be smart while traveling abroad. The Smart Traveler app, developed by the State Department, gives you easy access to official country information, including maps and U.S. embassy locations. Get travel alerts and warnings all in one place and create personal itineraries and organize your trips. The app also allows you to enroll in the Smart Traveler Enrollment Program (STEP) for free. This program helps the State Department assist you in an emergency, including natural disasters. It can also help your family and friends get in contact with you if there is an emergency.

First Aid

First Aid appThis American Red Cross First Aid app gives you expert first aid advice for your day-to-day emergencies. The app provides step-by-step instructions for first aid situations you might encounter in your day to day life. You can also get safety and preparedness tips for a variety of emergencies, including winter weather, hurricanes and tornados. No internet access is required and the content is available in Spanish.

For more information on making international travel plans, visit CDC’s Traveler Health page. Happy trails!