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Infection control in earthquake rescue team
in their thirties and forties killed more people in offices, homes, parks, and community centres in a couple of weeks last summer than school shooters did in 2 years, the authorities do not acknowledge middle-aged violence. Since the fastest-growing criminal population is also the most powerful and affluent, politicians and institutions have ignored the last two decades’ eruption of middle-aged crime in favour of sowing fear of the growing youth population’s hypothetical menace. Authorities have manufactured the teenage superpredator spectre by combining two disparate images: the statistics of a sharp increase in homicide among impoverished black and Hispanic young men during early 1990s gang and crack-cocaine warfare in industry-abandoned cities; and sensational anecdotes of heinous, though rare, crimes by white suburban teenagers, such as the recent school shootings. In reality, data from California, New York, and other states show that homicide has declined among white (non-Hispanic) teenagers over the last 15–30 years. Today’s young people are less prone to serious or petty crime and drug abuse than their 1970s counterparts. In 1997, youths perpetrated 8% of US homicides.2 As your editorial reports,1 the USA (one of only three nations to execute juveniles) is awash with legislation to crack down on kids still more, accompanied by finger-pointing at media images, teenage hormones, and peer culture. (If these really are causal influences, they deserve credit for the improvements in adolescent behaviour.) As with lamentable claims by leading US scientists about the inferiorities of African Americans, Japanese, Eastern Europeans, Jews, and women in past decades, assertions of adolescent moral and biological flaws have long been debunked. 4,5 Authorities’ reflex to scapegoat powerless groups and push popular panaceas is the main reason why the USA fails to address its appalling, uncontrolled cycles of violence, gun casualty, drug and alcohol abuse, and other risks that public health-oriented policies in other nations more successfully constrain. Mike A Males School of Social Ecology, University of California at Irvine, Santa Cruz, CA 95061, USA (e-mail: [email protected]) 1
Editorial. Guns, lies, and videotape. Lancet 1999; 354: 525. 2 Federal Bureau of Investigation. Uniform crime reports for the United States, 1975–1997 (annual). Washington, DC: US Department of Justice, 1998.
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Criminal Justice Statistics Center. Crime and delinquency in California, 1975–1998 (annual). Supplement: California criminal justice profiles, statewide, 1977–1998 (annual). Sacramento, CA: Department of Justice, 1999. 4 Offer D, Schonert-Reichl KA. Debunking the myths of adolescence: findings from recent research. J Am Acad Child Adolesc Psychiatry 1992; 31: 1003–14. 5 Quadrel MJ, Fischhoff B, Davis W. Adolescent (in)vulnerability. Am Psychol 1993; 48: 102–16.
Infection control in earthquake rescue team Sir—Previous studies have suggested that major disasters can be followed by an increase in incidence and outbreaks of infectious diseases in victims. 1–3 There are no reports, however, on infectious diseases among medical staff working in these situations. We report the experience of the Israel Defence Force (IDF) search and rescue (SAR) team during the aftermath of the earthquake in northern Turkey. 365 IDF Home Front Command personnel took part in the rescue operation between Aug 18 and Aug 25, 1999. Before departure, all participants had a series of immunisations, including immune serum globulin, and a booster of diphtheria-tetanus-toxoid vaccine. The medical and SAR staff also had hepatitis-B vaccination. There were several factors that would contribute to an increased risk of infectious morbidity in the SAR troops. These were very hot weather conditions, close contact with the local population who were rendered homeless after the event, and the absence of proper water supplies and sanitation facilities in the area. However, only a few probable cases of infectious diseases were reported among the IDF team at the main rescue site in the town Golguk. These included two cases of very mild folliculitis and two of conjunctivitis, which resolved after treatment with sulfacetamide eye drops. An outbreak of mild gastroenteritis occurred among SAR personnel at the secondary rescue site at the town Chinargik, where 30 of 62 IDF soldiers complained of having two to three loose or watery stools accompanied by abdominal pain. The event was attributed to bad foodhandling practices, because cooked meats had been stored unrefrigerated for several hours. No other diseases originating during the operation were noted and none were reported during the first month after the operation ended. The very low frequency of infectious diseases at the main rescue site can be attributed to the
strict enforcement of personal and environmental hygiene rules in the IDF camp, and to the food-handling procedures in the area where the teams worked. The absence of running water was a serious threat to personal hygiene practices, but mineral water for washing was supplied in ample quantities along with baby wet wipes. Food was limited to combat rations (canned meat, vegetables, jam, &c) and imports of fresh supplies from Israel. No local food products from the disaster area were allowed. Close medical guidance was given to all food handlers, and supervision of environmental hygiene was done continuously during the mission. These methods, together with immunisations, have kept morbidity to a minimum. At the secondary rescue site, where these measures were applied less strictly, there was a gastroenteritis attack rate of 48%. *Michael Gdalevich, Isaac Ashkenazi Pinsker 8/4, Rehovot, Israel 76308 (e-mail: [email protected]) 1
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3
Aghababian RV, Teuscher J. Infectious diseases following major disasters. Ann Emerg Med 1992; 21: 362–67. Binder S, Sanderson LM. The role of the epidemiologist in natural disasters. Ann Emerg Med 1987; 16: 1081–84. Schneider E, Hajjeh RA, Spiegel RA, et al. A coccidioidomycosis outbreak following the Northridge, California earthquake. JAMA 1997; 277: 904–08.
Duplicate acronyms Sir—I note that you have published an article from the TRACE Study Group in Denmark (July 3, p 9).1 The acronym stands for TRAndolapril Cardiac Evaluation study. We have had a TRACE trial running here in Wales, which is a Medical Research Council multicentre study. We coined the acronym without realising there was another TRACE group. Our acronym stands for TRial of genetic Assessment in breast CancEr. This ambiguous area may cause trouble in the future because many multicentre studies are mentioning the TRACE group, which refers to two sets of papers that are totally unrelated. Further, listing of the TRACE study collaborators could cause problems in bibliographic searches. I wonder if the editors of journals have thought about this issue. R E Mansel Division of Surgery, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK 1
Torp-Pedersen, Køber L, TRACE Study Group. Effect of ACE inhibitor trandolapril on life expectancy of patients with reduced left-ventricular function after acute myocardial infarction. Lancet 1999; 354: 9–12.
THE LANCET • Vol 354 • October 30, 1999
Editorial. Guns, lies, and videotape. Lancet 1999; 354: 525. 2 Federal Bureau of Investigation. Uniform crime reports for the United States, 1975–1997 (annual). Washington, DC: US Department of Justice, 1998.
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Criminal Justice Statistics Center. Crime and delinquency in California, 1975–1998 (annual). Supplement: California criminal justice profiles, statewide, 1977–1998 (annual). Sacramento, CA: Department of Justice, 1999. 4 Offer D, Schonert-Reichl KA. Debunking the myths of adolescence: findings from recent research. J Am Acad Child Adolesc Psychiatry 1992; 31: 1003–14. 5 Quadrel MJ, Fischhoff B, Davis W. Adolescent (in)vulnerability. Am Psychol 1993; 48: 102–16.
Infection control in earthquake rescue team Sir—Previous studies have suggested that major disasters can be followed by an increase in incidence and outbreaks of infectious diseases in victims. 1–3 There are no reports, however, on infectious diseases among medical staff working in these situations. We report the experience of the Israel Defence Force (IDF) search and rescue (SAR) team during the aftermath of the earthquake in northern Turkey. 365 IDF Home Front Command personnel took part in the rescue operation between Aug 18 and Aug 25, 1999. Before departure, all participants had a series of immunisations, including immune serum globulin, and a booster of diphtheria-tetanus-toxoid vaccine. The medical and SAR staff also had hepatitis-B vaccination. There were several factors that would contribute to an increased risk of infectious morbidity in the SAR troops. These were very hot weather conditions, close contact with the local population who were rendered homeless after the event, and the absence of proper water supplies and sanitation facilities in the area. However, only a few probable cases of infectious diseases were reported among the IDF team at the main rescue site in the town Golguk. These included two cases of very mild folliculitis and two of conjunctivitis, which resolved after treatment with sulfacetamide eye drops. An outbreak of mild gastroenteritis occurred among SAR personnel at the secondary rescue site at the town Chinargik, where 30 of 62 IDF soldiers complained of having two to three loose or watery stools accompanied by abdominal pain. The event was attributed to bad foodhandling practices, because cooked meats had been stored unrefrigerated for several hours. No other diseases originating during the operation were noted and none were reported during the first month after the operation ended. The very low frequency of infectious diseases at the main rescue site can be attributed to the
strict enforcement of personal and environmental hygiene rules in the IDF camp, and to the food-handling procedures in the area where the teams worked. The absence of running water was a serious threat to personal hygiene practices, but mineral water for washing was supplied in ample quantities along with baby wet wipes. Food was limited to combat rations (canned meat, vegetables, jam, &c) and imports of fresh supplies from Israel. No local food products from the disaster area were allowed. Close medical guidance was given to all food handlers, and supervision of environmental hygiene was done continuously during the mission. These methods, together with immunisations, have kept morbidity to a minimum. At the secondary rescue site, where these measures were applied less strictly, there was a gastroenteritis attack rate of 48%. *Michael Gdalevich, Isaac Ashkenazi Pinsker 8/4, Rehovot, Israel 76308 (e-mail: [email protected]) 1
2
3
Aghababian RV, Teuscher J. Infectious diseases following major disasters. Ann Emerg Med 1992; 21: 362–67. Binder S, Sanderson LM. The role of the epidemiologist in natural disasters. Ann Emerg Med 1987; 16: 1081–84. Schneider E, Hajjeh RA, Spiegel RA, et al. A coccidioidomycosis outbreak following the Northridge, California earthquake. JAMA 1997; 277: 904–08.
Duplicate acronyms Sir—I note that you have published an article from the TRACE Study Group in Denmark (July 3, p 9).1 The acronym stands for TRAndolapril Cardiac Evaluation study. We have had a TRACE trial running here in Wales, which is a Medical Research Council multicentre study. We coined the acronym without realising there was another TRACE group. Our acronym stands for TRial of genetic Assessment in breast CancEr. This ambiguous area may cause trouble in the future because many multicentre studies are mentioning the TRACE group, which refers to two sets of papers that are totally unrelated. Further, listing of the TRACE study collaborators could cause problems in bibliographic searches. I wonder if the editors of journals have thought about this issue. R E Mansel Division of Surgery, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK 1
Torp-Pedersen, Køber L, TRACE Study Group. Effect of ACE inhibitor trandolapril on life expectancy of patients with reduced left-ventricular function after acute myocardial infarction. Lancet 1999; 354: 9–12.
THE LANCET • Vol 354 • October 30, 1999