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EINet Alert ~ Sep 07, 2005


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Hurricane Katrina, Overview
- USA (Mississippi): Biloxi shelter shut as hurricane evacuees fall ill
- USA (Gulf States): Post-hurricane--Vibrio vulnificus infection

1. Notifications
- HHS: Health Care Professionals and Relief Personnel Worker Page
- CDC: Interim Guidance for Healthcare Professionals Advising Travelers to Hurricane Affected Areas in the US.
- CDC: After a Hurricane: Key Facts About Infectious Disease
- CDC Comprehensive Hurricane Recovery Page
- CDC: Impact of Hurricane Katrina on Vaccine Storage
- USDA assists with Hurricane Katrina relief efforts
- Federal Emergency Management Agency
- American Public Health Association response to Hurricane Katrina


Americas
Hurricane Katrina, Overview
In view of devastating Hurricane Katrina, APEC EINet is on heightened alert for disease occurrence in the affected areas. EINet sends sympathy to those affected by this devastating disaster. The primary challenges now are providing access to clean water, food supplies, sanitation, healthcare and medical supplies, and adequate shelter. Many relief organizations are responding and we will update our users as we learn useful information about these efforts. Doctors on the scene have now reported seeing some cases of diarrhea and skin infections.

Michael Leavitt, secretary of Health and Human Services, declared a public health emergency for Hurricane Katrina-affected areas 31 Aug 2005. The biggest risk is expected to come from contaminated water, which as well as being harmful to health, provides an ideal breeding ground for mosquitoes. CDC is advising people to throw away food that may have come into contact with flood water and only to drink bottled water. CDC records from previous US disasters show the majority of medical problems after the events have been associated with diarrhea and asthma. West Nile Virus, which peaks in the US in August and September, may also be a problem (PAHO/BBC 9/1/05).

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USA (Mississippi): Biloxi shelter shut as hurricane evacuees fall ill
A shelter for evacuees was shuttered 4 Sep 2005, after more than 20 people fell ill in what could be an early sign of a public health crisis that extends Katrina's wrath. Officials at the Biloxi, Mississippi shelter suspected that those felled by vomiting and diarrhea had contracted dysentery, as they slogged to safety through fetid water. In addition to the ongoing risk of dehydration, health experts are warning of numerous dangers to those in New Orleans and the shelters around the region. Some, like hepatitis and salmonella, could lurk in the contaminated water. Others, such as West Nile virus, could be transmitted by the mosquitoes that thrive in stagnant waters. Although the diagnosis of shigellosis has apparently not yet been confirmed, bacterial dysentery due to shigellosis is of great concern, since the infectious dose of shigella is much lower than that of most enteric pathogens. This very low infectious dose facilitates person-to-person spread. (Promed 9/5/05)

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USA (Gulf States): Post-hurricane--Vibrio vulnificus infection
Authorities said 5 Sep 2005 that some of Hurricane Katrina's evacuees have contracted a bacterial disease that is considered a more benign cousin of cholera, but is potentially fatal in the immunocompromised. CDC Officials said the bacterium Vibrio vulnificus might have been picked up by people with open wounds who were forced to wade through polluted floodwaters for a long time. Von Roebuck, a CDC spokesman, said officials had detected the disease among some storm evacuees and stragglers but had not been able to determine how many cases there were. A 60 year old man, a refugee from the New Orleans hurricane disaster, was admitted to a Dallas Texas hospital 2 Sep 2005 complaining of pain in legs. Blood cultures drawn on admission grew Vibrio vulnificus. The patient developed characteristic hemorrhagic bullous skin lesions on both lower extremities. He died from complications of septic shock despite treatment with doxycycline, cefepime, and levofloxacin as well as activated protein C. The organism was susceptible in vitro to all 3 antibiotics. The patient was on medication for hypertensive cardiomyopathy with a history of congestive heart failure.

Wound infections with V. vulnificus result either from contaminating an open wound with sea water harboring the organism, or by lacerating part of the body on coral, fish, etc, followed by contamination with the organism. The ingestion of V. vulnificus by healthy individuals can result in gastroenteritis. The "primary septicemia" form of the disease follows consumption of raw seafood containing the organism by individuals with underlying disease. In these individuals, the microorganism enters the blood stream, resulting in septic shock, rapidly followed by death in many cases. Over 70 per cent of infected individuals have distinctive bulbous skin lesions. The much more severe disease in diabetes, cirrhotics, and other immunologically challenged individuals draws a parallel to melioidosis, which clustered in the area of the recent tsunami. (Promed 9/6/05)

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1. Notifications
HHS: Health Care Professionals and Relief Personnel Worker Page
The Department of Health and Human Services has established a website (https://volunteer.hhs.gov) and toll-free number (1-866-KAT MEDI) to help identify health care professionals and relief personnel to assist in Hurricane Katrina relief efforts. Multidisciplinary healthcare professionals and relief personnel with expertise in the desired areas are listed on: https://volunteer.hhs.gov (registration possible through this site) and encouraged to register to volunteer for appointment by HHS. Individuals selected will be non-paid temporary Federal employees, and will be eligible for coverage under the Federal Tort Claims Act for liability coverage and Workman's Compensation when functioning as HHS. Although there will not be any salary, travel and per diem will be paid. Individuals must be healthy enough to function under field conditions. Volunteers with no healthcare background can find information on volunteering at USAFreedomCorps.gov or by calling 1-877-USA-CORPS. (HHS 9/5/05)

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CDC: Interim Guidance for Healthcare Professionals Advising Travelers to Hurricane Affected Areas in the US.
This information is current as of September 6, 2005 (Released: September 2, 2005). This notice is intended to provide information to health-care professionals who assess travelers (e.g. relief workers) going to areas affected by the recent hurricane about current health risks in those areas and recommended vaccines and other measures to minimize infection or injury in travelers. Affected areas include coastal areas of the following states: Louisiana, Mississippi, Alabama, and Florida. The response to the recent hurricane will probably be both immediate and long term. Persons traveling to affected areas should ideally be assessed by a health-care professional at least 4-6 weeks before travel so recommended vaccines can be completed and provide maximum benefit however the following recommendations apply even if travel is imminent. Travelers who are acutely ill, medically or psychologically unstable, or pregnant should be advised to postpone travel if at all possible. http://www.cdc.gov/travel/other/hurricane/guidance_hp_travelers.htm (CDC 9/6/05 )

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CDC: After a Hurricane: Key Facts About Infectious Disease
Although infectious diseases are a frightening prospect, widespread outbreaks of infectious disease after hurricanes are not common in the US. Rare and deadly exotic diseases, such as cholera or typhoid, do not suddenly break out after hurricanes and floods in areas where such diseases do not naturally occur. Unless a disease is brought into a disaster area from elsewhere, any outbreaks that occur are almost always from diseases that were already in the disaster-affected area before the disaster struck. Communicable disease outbreaks of diarrhea and respiratory illness can occur when water and sewage systems are not working and personal hygiene is hard to maintain. No disease outbreaks have been reported as of September 3, 2005 in areas affected by Hurricane Katrina. Decaying bodies create very little risk for major disease outbreaks. As has been the case in past hurricanes, the U.S. Department of Health and Human Services quickly sets up tracking systems that monitor illnesses in hurricane-affected areas. In the unlikely event that a disease outbreak occurs, these systems provide an early warning that enables prompt public health response. http://www.bt.cdc.gov/disasters/hurricanes/infectiousdisease.asp (CDC 9/6/05)

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CDC Comprehensive Hurricane Recovery Page
• Hurricane Katrina Health Information:
http://www.bt.cdc.gov/disasters/hurricanes/katrina.asp

o General Health and Safety Info—e.g. Infectious Diseases
o Health Hazards from Food or Water—e.g. Sanitation and Hygiene
o Health Hazards From Animals or Insects—e.g. Animal Disposal Following an Emergency
o Mold and Clean up—e.g. Protect Yourself from Mold
o Immunization Information—e.g. Interim Immunization Recommendations for Individuals Displaced by Hurricane Katrina
o Responder Guidance—e.g. Interim Health Recommendations for Workers who Handle Human Remains
o Shelters—e.g. Hand Hygiene in Emergency Situations
o Health Professionals—e.g. Guidelines for the Management of Acute Diarrhea

• Health & Safety: e.g. Key Facts About Hurricane Recovery
• Information for Specific Groups: e.g. Worker Response & Cleanup; Shelters; Health Professionals http://www.bt.cdc.gov/disasters/hurricanes/index.asp (CDC 9/6/05)

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CDC: Impact of Hurricane Katrina on Vaccine Storage
In areas where vaccine supplies were affected by temporary power outages, the guidance developed for providers during the 2003 Northeast Power Outage may be helpful:

• Do not open freezers and refrigerators until power is restored.
• Most refrigerated vaccines are relatively stable at room temperature for limited periods of time. The vaccines of most concern are MMR and Varivax, which are sensitive to elevated temperatures.
• Monitor temperatures; don't discard; don't administer affected vaccines until you have discussed with public health authorities.
http://www.bt.cdc.gov/disasters/hurricanes/katrinavaccinestorage.asp (CDC 9/4/05)

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USDA assists with Hurricane Katrina relief efforts
Agriculture Secretary Mike Johanns issued two directives to further meet the food and housing needs of Hurricane Katrina survivors: 30,000 Housing Units and $50 million in Food Assistance. Johanns authorized states to pre-load electronic food benefit cards with $50 worth of assistance, which will enable displaced residents to immediately purchase food even before their application has been processed to receive complete benefits. These cards can then be distributed to displaced residents as they move from shelters to temporary housing. The food stamp program is administered by states and fully funded by USDA. USDA has earmarked $50 million dollars to provide emergency food assistance to Hurricane Katrina survivors. USDA will ensure that schools are able to provide free lunches to students who have been relocated because of the hurricane. Johanns also directed USDA Rural Development staff to coordinate with the private sector to identify privately owned rental housing nationwide that is available to house displaced residents. The USDA Rural Development program currently has 30,000 available housing units across the country. USDA is coordinating with the Federal Emergency Management Agency (FEMA) and faith-based organizations to match residents left homeless by Hurricane Katrina with these homes and apartments. http://www.usda.gov/wps/portal/usdahome (USDA 9/5/05)

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Federal Emergency Management Agency
Federal disaster aid is now available to affected counties to in states hosting evacuees from Hurricane Katrina. The goal is to ensure those directly affected by Hurricane Katrina have safe, sanitary shelter during this first step on their road to recovery. FEMA funds will be available to counties in the following reception states: Arkansas, Colorado, Florida, Georgia, Oklahoma, North Carolina, Tennessee, Texas, Utah, and West Virginia. http://www.fema.gov/ (FEMA 9/6/05)

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American Public Health Association response to Hurricane Katrina
Due to the devastating situation in New Orleans, the APHA 2005 Annual Meeting & Exposition has been moved to Philadelphia, December 10-14, 2005. The website includes informative sections on: How to Help; How to Volunteer; Frequently Asked Questions; How to Find Family and Friends; APHA Resources; and For More Information. http://www.apha.org/preparedness/Katrina_relief.htm (APHA 9/6/05)

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