Same goes for Hurricane Sandy

Shelter from the Storm

 

As Katrina's floodwater recedes, health care providers must monitor evacuees for signs of illness.

Hurricane Katrina left Gulf Coast residents facing an unusual situation - too much water and too little water. As floodwater trapped some citizens in their homes for days without food, electricity, or much-needed fresh drinking water, others found shelter in places like the Superdome and were forced to suffer crowded conditions, no air-conditioning, filthy bathrooms, and overflowing trash.

In the wake of Katrina and the close-on-its-heels sister storm, Hurricane Rita, concern over major disease outbreaks has grown. While the spread of cholera and typhoid sounds frightening, experts from the Centers for Disease Control and Prevention say these diseases rarely occur after hurricanes in the U.S. However, the conditions seen since the two hurricanes - defunct water and sewage systems, rotten food, and close quarters - could contribute to the development of a number of other conditions in displaced persons now spread out across the country.

West Nile virus

What's known: West Nile virus is a flavivirus that was first detected in the Western Hemisphere in 1999 and now is present in the continental U.S. Transmission of the virus occurs when a mosquito infected with West Nile bites a human. The disease is not spread via person-to-person contact.

The virus can cause meningitis, encephalitis, fever, headache, fatigue, muscle soreness, and often a rash. Less than 1% of people infected with West Nile develop severe illness; those who become severely ill have fatality rates ranging from 3% to 15%, says the CDC. The highest fatality rates occur among the elderly.

What's expected: "There has been concern all of the standing water [on the hurricane-stricken Gulf Coast] is likely to lead to increased mosquito production," says J. Todd Weber, MD, deputy assistant, National Center for Infectious Disease and team leader of the agency's clinical care team for Hurricane Katrina response during the CDC's Sept. 13 Clinical Outreach and Communication Activity conference call regarding hurricane-related issues.

"In terms of particular risk among evacuees, we would really be looking [at] the three- to four-week period after the water was standing," says Weber. [West Nile virus] "is something to keep in mind for the future."

 

What's known: A bacterial infection affecting both humans and animals, leptospirosis is contracted after exposure to infected animals, including dogs, rodents, and wild animals, or to water contaminated with the urine of infected animals. Fortunately, leptospirosis is not spread via person-to-person contact. Patients with leptospirosis present with a variety of symptoms ranging from none at all to high fever, muscle aches, severe headache, and even jaundice.

What's expected: After spending time in the floodwaters, evacuees may be at risk for developing leptospirosis. Symptoms develop anywhere from two days to four weeks after bacterial exposure.

While there have been no reports of leptospirosis cases, Weber recommends health care providers keep an eye out for the disease in coming weeks.

 

Vibrio vulnificus

What's known: A bacterium living in marshy, brackish waters like those of the Gulf Coast, Vibrio vulnificus can infect wounds exposed to water in which it's present. Infection with the bacterium can cause pain, redness and swelling in wounds, blood blisters on the arms and legs, and even low blood pressure and shock. Patients with weakened immune systems or preexisting liver disease are most susceptible to V. vulnificus.

What's expected: As of Sept. 27, the CDC reported 24 infections and six deaths related to V. vulnificus followed the hurricane.

"There seems to be a short period in which exposures were leading to these infections," says Weber, "but it doesn't seem as if those exposures are continuing at this time. It is quite a severe disease, and if you see someone with increased redness, swelling, or pain in a wound [who has] a history of exposure to brackish water, you have to think of this because it is rapidly progressive."

 

What's known: Weber says this extremely contagious virus causes acute onset of vomiting followed by watery, nonbloody diarrhea. Symptoms also may include fever, soreness, headache, and abdominal cramps lasting from three to five days.

What's expected: The cramped quarters of some relief shelters are an excellent environment for promoting the spread of norovirus. While there is no medical treatment for the virus, patients experiencing vomiting and diarrhea should focus on oral rehydration with water or fruit juice.

Arjun Srinivasin, MD, a medical epidemiologist with the CDC, says handwashing, especially after using the toilet or before eating a meal, should be encouraged among survivors to prevent the spread of the disease.

"In the shelters, there have been sporadic outbreaks of gastrointestinal problems," Srinivasin says. "But less and less of that is being seen as people move to shelters with running water and properly working toilet facilities."

Srinivasin underscores the importance of health care workers' educating those living in evacuee centers on the importance of handwashing and hygiene.

"In these centers," he says, "health care workers are watching for evidence of disease outbreaks and are working to prevent them by teaching handwashing, the use of waterless hand cleansing products, and respiratory etiquette, such as covering the mouth when coughing and using tissues."

  For handwashing education information, read "An Ounce of Prevention Keeps the Germs 

Tuberculosis

What's known: Spread through droplet transmission when an infected person coughs or sneezes, tuberculosis grows in the lungs and can spread to other parts of the body. Patients with active TB may experience a cough lasting longer than three weeks, chest pain, bloody sputum, fatigue, weight loss, diminished appetite, chills, fever, and night sweats.

What's expected: "We haven't seen so far the evidence of exposure and spread of TB among evacuees in the centers," says Weber. To the best of the CDC's knowledge, he adds, most patients with histories of TB before the hurricane have been located by state health departments and placed back on their medication regimens.

"We don't anticipate this to be a large problem, but that may be an unfolding story, " Weber says. "Right now there is no recommendation for doing nontargeted PPD skin testing for evacuees."

 

Influenza

What's known: Each year, more than 200,000 people are hospitalized for flu complications, and 36,000 people die as a result of the illness, the CDC reports. Spread person-to-person via respiratory droplets, infected patients may experience high fever, headache, fatigue, dry cough, sore throat, runny nose, muscle aches, nausea, vomiting, and diarrhea.

What's expected: According to Srinivasin, CDC experts have been concerned about the approach of the influenza season, especially for people living in the evacuee centers. The agency now recommends all evacuees more than six months of age who reside in temporary shelters receive the influenza vaccine. Children 8 years and older should receive two doses of the vaccine at least one month apart, unless they can produce a documented record of a previous dose of influenza vaccine. In that case, one dose of the vaccine should be administered.

Louisiana's Department of Health and Hospitals has begun vaccinating thousands of residents of shelters in the state. Acceptance of the flu vaccine among displaced individuals has been as high as 70% in some shelters, the department reports.