Sayali Shelke’s research while affiliated with Texas A&M University and other places

Concerns about infectious disease in mega-shelters following hurricanes should be a top priority. The COVID-19 pandemic demonstrated the challenge of implementing standard evacuation and sheltering procedures for hurricanes during an outbreak of a respiratory disease and the lessons learned from the 2020 hurricane season must be applied to future response efforts. In this article, we examine the current risk framing for hurricane preparedness and response utilizing Prospect Theory. We also examine how the COVID-19 pandemic has complicated this traditional framing and offer a new framework for which to provide adequate sheltering following a hurricane, while minimizing the risk of respiratory disease to those seeking shelter. We argue that such a framework is necessary to protect American citizens in future hurricane seasons.

Purpose: The purpose of the research discussed in this paper is to better understand the negative health outcomes resulting from Hurricane Katrina and the disaster response that followed. This understanding can inform future disaster response. Design: We conducted 10 in-depth interviews with individuals who lived in New Orleans at the time of Hurricane Katrina. We conducted thematic analysis on the interview content and identified patterns across all 10 interviews. Findings: Four primary patterns emerged across all interviews. These were: (1) FEMA's response to the crisis created greater physical and mental health hazards for interviewees; (2) Hurricane Katrina led to long-term mental health issues for interviewees, even those who evacuated before the storm; (3) displacement from homes following the storm typically resulted in overcrowded living conditions, which increased interviewees' risk of infectious disease; and (4) the discrimination faced by interviewees in the months and years following Hurricane Katrina had a profound and lasting impact on their well-being. Originality: Numerous studies have been conducted to understand the mental health impacts of disaster and a limited number have looked at the physical health impacts or the threat of infectious disease. This study is unique because it incorporates both mental and physical health impacts, but also examines how disaster response itself plays a role in health outcomes for survivors. Additionally, this paper also incorporates the role of racial inequities in disaster response and how those inequities impact survivor health.

Background: Autoimmune neutropenia (AIN) is a common cause of chronic neutropenia in childhood. Despite an expected benign clinical course, many patients undergo extensive evaluation. Data on healthcare utilization and rates of bloodstream infections in young patients with AIN are limited. Methods: All patients with a diagnosis code of leukopenia, neutropenia, or AIN followed within the outpatient hematology clinic of a single institution from 2014 to 2016 were identified. Patients aged ≤5 years with absolute neutrophil count (ANC) ≤500/µL persisting for ≥3 months, a clinical diagnosis of AIN, and documented resolution of neutropenia were included. Data on clinical management, including infectious outcomes and emergency center (EC) encounters, were collected. Results: Forty-three patients with AIN (18 male [42%], median age at diagnosis 12 months) met eligibility criteria. Children were followed by hematology for a median duration of 18 (range, 2-85) months. Diagnostic evaluations were variable. Thirty patients (70%) had ≥ 1 EC encounters for evaluation of isolated fever with a total of 113 EC encounters for the overall cohort. Patients with ANC < 500/µL and isolated fever were admitted for observation, which resulted in 24 hospitalizations in 16 patients. Of 138 blood cultures drawn, two were positive, both later determined to be contaminants. Conclusion: At a large tertiary care center, no bloodstream infections were identified in a cohort of 43 children with AIN presenting to the EC for assessment of fever. A less-intensive, more cost-effective management paradigm, which continues to prioritize patient safety, among young children with AIN is needed.

Background: Autoimmune neutropenia (AIN) is the most common chronic neutropenia of childhood. Despite the expectation of a benign clinical course, many such patients undergo extensive evaluation to rule out congenital neutropenia or malignant disease, are followed within a subspecialty hematology clinic until resolution, and are given strict infectious precautions including emergency center (EC) assessment during febrile episodes. Data on healthcare utilization and rate of serious infections in young patients with AIN is limited. Objective: To evaluate the utilization of routine subspecialty and emergency healthcare and incidence of serious bacterial infections in young children with AIN at a large tertiary care children's hospital. Methods: All patients with a diagnosis code of leukopenia, neutropenia, or AIN followed within the outpatient hematology clinic of a large tertiary hospital from 2014 to 2016 were identified. Manual review of the electronic medical record was performed to assess patient eligibility and perform data collection. Patients age ≤5 years, with absolute neutrophil count (ANC) ≤500/µL persisting for ≥3 months, and a clinical diagnosis of AIN as determined by a hematology provider were included. Patients were excluded if they were lost to follow up prior to neutropenia resolution, had AIN secondary to underlying systemic autoimmune or immunologic disorder, neutropenia persisting beyond age 5 years, or if the etiology of neutropenia was unclear. Data on clinical assessment, laboratory parameters, immune and infectious evaluations, and total number of outpatient and EC assessments for fever were collected. Results of anti-neutrophil antibody testing were reviewed but no patients were included or excluded based on those results. EC visits for evaluation of fever in 3 representative patients were reviewed for charge capture data. All charges during the reviewed time period remained constant. Results: From 2014 to 2016, 46 patients (20 male [44%], median age at diagnosis 12 months) diagnosed with AIN met eligibility criteria and were followed in the outpatient hematology clinic for a total of 450 outpatient visits (Table 1). Median duration from initial identification of neutropenia to discharge from hematology clinic was 19 months (range 6 to 85 months). Thirteen patients (28%) had bone marrow evaluation to rule out infiltrative disease or marrow failure etiologies. Nine patients (20%) had genetic testing, the majority of which (n=6) were targeted sequencing for congenital neutropenia. Thirty-six patients (78%) had one or more EC encounters for evaluation of fever, and the cohort had a combined 125 such encounters. Of 155 blood cultures drawn, 3 returned positive. Positive cultures resulted in repeat blood cultures being drawn and hospital admission for antibiotics and clinical monitoring. However, all were determined to be contaminants that did not require treatment. Total charges associated with EC visits for the cohort are estimated at $471,375 based on a cost of$3771 per visit (Table 2). Those patients with ANC <500/µL at the time of presentation with isolated fever were admitted for observation per hospital policy, resulting in 29 inpatient hospitalizations after initial hematology visit. Conclusion: Over a 3-year period, no serious bloodstream or life-threatening infections were identified in a cohort of 46 young children with AIN presenting to the EC for assessment of fever at a single, large tertiary care children's hospital. A conservative estimate of EC charges for this cohort totaled just under half a million dollars for all visits in the study period. Costs would be expected to vary by center, and additional intangible costs include parental and patient anxiety, travel costs, and missed school or work. Further prospective research is needed to determine the potential for shifting toward a less intensive, more cost-effective management paradigm among young children with AIN without compromising patient safety. Disclosures Despotovic: Novartis: Research Funding; AmGen: Research Funding; Sanofi: Consultancy.