Global Perspectives on Pediatric & Perinatal HCID Care: Lessons From U.S. and U.K. Leaders in Preparedness

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In the last year, NETEC’s International Partnerships & Programs has hosted two Global Rounds sessions specifically focused on pediatric and perinatal high-consequence infectious disease (HCID) care. These sessions brought together clinicians, preparedness experts, and emergency response professionals from around the world, with participants joining from multiple continents to explore one of the most challenging and least understood areas of HCID response.

These scenarios are exceptionally rare in real-world settings. Most clinicians will never encounter them. Evidence is extremely limited, case reports are sparse, and clinical teams must often rely on simulation rather than experience. This makes global information-sharing not just valuable, but essential. Each country’s lessons—whether learned through an exercise, a near miss, a real activation, or a planning challenge—fill gaps that no single system can fill alone.

The sessions featured presentations from high-level isolation unit (HLIU) teams in both the U.S. and the U.K., each highlighting different areas of emphasis. The U.S. teams focused on emotional and developmental support for children and families, while the U.K. teams emphasized structured national pathways and rigorous procedural containment models. Together, these perspectives help shape a more complete picture of what HCID readiness can—and should—look like.

U.S. Approaches: Family-Centered, Developmentally Informed, and Regionally Integrated

Preparing Families in Quarantine and Containment (HHS Region 7 RESPTC – UNMC)

The University of Nebraska Medical Center, serving as the HHS Region 7 Regional Emerging Special Pathogen Treatment Center, highlighted the unique complexities of caring for exposed families rather than individual patients. Their National Quarantine Unit (NQU) is designed not only for containment but for maintaining the routine, comfort, and developmental stability of children during quarantine.

Their approach includes unidirectional workflows, behavioral health considerations, breastfeeding (if needed) and dietary support, and cultural accommodations. Child-friendly spaces and symptom monitoring tools help create an environment where both safety and psychosocial needs can be met.

Helping Children Navigate Stress & Uncertainty (HHS Region 3 RESPTC – Children’s National Hospital)

Children’s National Hospital, the HHS Region 3 RESPTC, provided a depth of insight through the Tranquil Passport exercise—a multinational full-scale transport operation involving air and ground transportation.

One of the most impactful observations was that children were distressed not by PPE, but by movement and sensory overload. Sudden vibrations, loud mechanical sounds, the clatter of aircraft doors, and the abrupt “drop” when unloading an ambulance proved far more frightening than the presence of staff in full protective gear.

Children’s Dr. Tress Goodwin described how, after each transfer, children serving as simulated patients in the exercise needed several minutes to “recalibrate”—a period when they remained hyper-alert, unsure of what to expect next. Allowing this pause before any medical procedure was essential for safety. Built-in decompression time is now part of their Concept of Operations.

Comfort kits, noise-reducing headphones, preloaded tablets, and even simple decorations inside transport equipment helped the children involved in the exercise build trust and regain emotional control. Staff also used photo badges to make PPE less intimidating. These strategies demonstrate how child-centered care directly enhances safety, especially during high-risk transport phases.

Testing Pediatric Biocontainment Operations (HHS Region 4 RESPTC – Children’s Healthcare of Atlanta)

Children’s Healthcare of Atlanta (CHOA), the Region 4 RESPTC, shared findings from pediatric HCID exercises that stress-tested communication pathways, rapid mobilization procedures, and biocontainment workflows. The scenarios reinforced the importance of cross-team situational awareness and the need to anticipate both clinical deterioration and emotional escalation in pediatric patients.

Together, these U.S. examples highlight the importance of pediatric emotional, developmental, and psychosocial needs as integral components of operational safety.

U.K. Approaches: Structured National Pathways and Two Complementary Models

A National HCID Framework Built for Rarity and Risk

The United Kingdom’s approach to high-consequence infectious diseases (HCIDs) is grounded in a nationally coordinated framework developed through a joint initiative between NHS England and Public Health England (now the UK Health Security Agency; UKHSA). Between 2016 and 2018, the HCID program focused on defining and strengthening end-to-end pathways for suspected and confirmed HCID cases—integrating clinical care, public health response, and the management of contacts.

As part of this work, NHS England commissioned Airborne HCID (A-HCID) treatment centers, including pediatric service provision, across seven NHS hospital trusts in England that already had established infectious disease expertise. Since that time, the network has continued to evolve, adding centers, refining national guidance, and strengthening training and preparedness through ongoing evidence review, simulation, and practice.

Alongside this airborne capability, the U.K. maintains a defined and stable infrastructure for contact HCIDs. The system includes two adult High-Level Isolation Units (HLIUs), both equipped with Trexler isolators, with a combined adult bed capacity of four. One of these units is also capable of delivering PPE-based care when clinically appropriate. In addition, since 2024, St Mary’s Hospital in London has provided PPE-based care for pediatric contact HCID cases only, with no adult HCID care delivered at that site.

The Challenging Realities of VHFs in Pregnancy

U.K. clinicians provided lessons learned from their firsthand experience treating a pregnant patient with a viral hemorrhagic fever (VHF) as well as lessons learned from recent exercises. They emphasized the extreme risk that VHFs pose to both pregnant patients and neonates. Clinical options are limited; maternal and fetal outcomes are often poor. Their work underscores the need for models that prioritize containment while acknowledging the unique challenges associated with neonatal care.

Two U.K. Approaches: Trexler Isolator vs. PPE-Based Care

A major insight from the U.K. presentations was the side-by-side comparison of two different clinical models used for perinatal and pediatric HCID care:

1. The Trexler Patient Isolator Model (Royal Free Hospital)

The Trexler is a flexible-film negative-pressure isolator surrounding the patient.

Benefits include:

• Near-total biocontainment
• Fewer doffing episodes, reducing staff exposure
• Less need for ongoing PPE training for non-ID specialists

However, there are serious constraints:

• Emergency C-sections are slower
• Physical dexterity is more limited for surgical procedures
• Providing care to an unwell neonate is more restricted
• Slower provision of care has the potential to worsen neonatal outcomes

2. The PPE-Based Care Model (Newcastle Royal Victoria Infirmary)

The PPE-based model allows clinicians to work directly around the patient with their usual equipment.

Benefits include:

• Faster surgical procedures
• More familiar ergonomics for obstetric and neonatal teams
• Rapid neonatal resuscitation
• Ability to rapidly escalate care, potentially improving neonatal viability

Challenges include:

• More people and equipment in the room
• Higher exposure risk
• Possibility of significant contamination of the room with infectious body fluids, for example, following a massive hemorrhage
• Greater training burden, especially for non-ID specialists

The Newcastle team noted that their facility layout lends itself to PPE-based operations, while the Royal Free HLIU is focused on care delivered in patient isolators. This demonstrates how the U.K. adapts its model to the strengths of each center, while maintaining consistent national decision pathways and adhering to biocontainment principles for VHFs. Having two different approaches provides flexibility to the UK network. The approach used is decided by the network on a case-by-case basis, after considering various factors and trying to balance optimal clinical care with the need for strict biocontainment.

Why Global Information-Sharing Matters

Because real pediatric and perinatal HCID cases are so rare, most of what the world knows about caring for these patients comes not from clinical literature, but from exercises, near-misses, and the willingness of teams to share openly—successes and challenges alike.

Global Rounds like these ensure that the lessons learned in one city, one center, or one region ripple outward across borders. They help ensure that when a real case emerges—whether in a small rural hospital or a national specialty center—care teams will have the benefit of collective, global experience guiding their decisions.

NETEC remains committed to hosting and supporting these cross-national conversations so that global HCID readiness continues to grow stronger, together.