From the CDC Director’s Emergency Operations Center - P.M. Update, September 9, 2005

Top Line - Public Health

Sporadic cases of diarrheal disease appear to be steadily decreasing among people staying in evacuation centers.

Carbon monoxide poisonings remain a serious concern.

CDC explains that contact with lead in waters does not pose an immediate health threat to children. To have increased lead levels from the flood water, the children would have had to drink the flood water.

National Public Health Emergency Situation Update:

• Persons in Evacuation Centers: 647 open, 158,667 people in 14 states (numbers fluctuate daily)
• Damage Assessments: 689,000 without power (858,758 9/8)
• Official Death Numbers: AL 2, FL 14, MS 156, LA 59. Total: 231

CDC Public Health Workforce Deployed in Affected Communities:

• Total: 204 (202: 9/8) including the following specialties: occupational, laboratory, medical, epidemiologist, sanitation, environmental health, disease surveillance, public information and health risk communication
• By State: DC 3; GA 6; LA 71; MS 56 (44 9/8); TX 61 (59 9/8) AR 1 (See bottom for deployment locations map)
• Preparing to Deploy: 19
• Deployed to Director’s EOC: 242 (As of 9/9)

CDC Public Health Analysis:

Laboratory tests confirm 11 persons have become ill from Vibrio spp. infections. Four have died. These pathogens are of greatest threat to persons with weakened immune systems, persons with chronic liver disease and the elderly. The strains identified include V. vulnificus resulting in 8 persons becoming ill and three deaths; V. parahaemolyticus. resulting in one illness and death; non-toxogenic V. cholerae resulting in one illness; and Vibrio (non-specified) resulting in one illness.

The single case of V. cholerae is not from the serogroup that causes cholera epidemics.

• The bacterial species Vibrio cholerae has many different types, or serogroups. Only two of those types have ever caused epidemic cholera: serogroups O1 and O139 (O139 is found only in Asia). Even among those serogroups, strains that lack cholera toxin do not cause cholera.

• The other serogroups are known collectively as "non O1, non O139 V. cholerae." Although these can cause diarrheal illness, it is generally mild, compared with the organism that causes the disease cholera, and do not have epidemic potential. These bacteria also rarely can cause wound infections. Diarrheal illness is treated with rehydration. Sepsis or wound infections require antibiotic treatment.

Carbon monoxide poisoning remains an important concern. Persons should be strongly cautioned to never use generators, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices inside the home, basement, garage, or camper—or even outside near an open window. If someone must use an alternative source of fuel or electricity, they should be sure to use it only outside and away from open windows.

Mosquito and rodent control are priority environmental health concerns in some Hurricane Katrina affected areas. Pest control measures are being instituted, including pesticide spraying to control mosquitoes.

CDC is working closely with vaccine manufacturers to obtain needed supplies of key vaccines such as tetanus and hepatitis A, and are developing additional vaccination plans for persons affected by Hurricane Katrina. For example, as influenza season approaches, influenza vaccination for persons staying in evacuation centers is warranted.

More from CDC Deployed Teams . . .
Louisiana: More than 20 CDC professionals are working with the Louisiana Health Department. They have entered New Orleans and are establishing a staging area at Kindred Health Center. Also, they are working to establish a public health facility. An environmental assessments team is focused on New Orleans and long range planning.

Mississippi: CDC staff are actively conducting enhanced disease surveillance in coordination with the Gulf Coast Command Center. They have collected several hundred injury/illness surveillance forms. The CDC environmental health team has performed environmental surveys of Biloxi, Ocean Springs, D’Iberville and Gulfport. They are looking at conditions in evacuation centers, food distribution, residential areas and hospitals. They are working with FEMA to identify areas that continue to require basic public health needs.

Texas: The CDC surveillance teams have assessed risks in evacuation centers in Dallas, Houston and San Antonio. The health communication team has conducted a preliminary assessment for health education needs. They are working with CDC’s Emergency Communication System to develop and distribute infection control and mental health messages to be displayed in multiple ways in evacuation centers, including health messages to precede movies that play in shelters. The environmental teams have identified environmental control priorities at major evacuation centers and developed reporting systems for maintenance and food service issues.

Arkansas: CDC is working with state mental health and the Department of Health and Human Services’ Substance Abuse and Mental Health Services Agency to determine support requirements. The CDC epidemiologic team is working from Little Rock. Disseminating CDC immunization guidance has been a priority.

Public Health Recommendations: Pass it On

Lead Exposure in Children Evacuated from their Homes due to Katrina
Reports of elevated lead levels in New Orleans flood water have caused interest and suggestions that children in shelters receive blood lead testing. CDC has no reason to suspect that any children have elevated blood lead levels as a direct result of the hurricane. Although lead levels in the flood water exceed drinking water standards, we would not expect children to be drinking large amounts of flood water. Children would not have increased lead levels from walking or standing in flood waters. Children cannot give lead poisoning to other children. Lead programs across the country and at CDC can provide information to families and evacuation center operators about measures that will reduce the chance of lead exposure. Also, for future consideration, when the clean up of the affected areas begins, caution must be taken in the disposal of lead painted building components. These components should not be burned in open areas nor should they be cleaned by uncontrolled sanding or scraping of lead-based paint.

Interim NIOSH guidelines for fire fighters working in the response to Hurricane Katrina
Potential problems in responses to hurricanes, floods, and other large scale natural disasters include lapses in command and operating procedures, and lack of or shortages in communication, fire fighting tools and equipment, and personal protective equipment (PPE). The hazards to professional and volunteer fire fighters who are mobilized to fight structural fires in the wake of hurricanes include but are not limited to structural collapse, electrical hazards, helicopter operations, and heat stress.

The following are good basic safety precautions for protecting fire fighters involved in structural fire fighting within the flooded disaster areas affected by Hurricane Katrina.

• Standard operating procedures should be followed in setting up an organized command center at the site, ensuring that fire fighters follow proper precautions, and identifying potential hazards.

• Electrical hazards from downed power lines or other sources should be identified and addressed. Assume that all lines are energized, call the utility company to cut power.

• In areas where helicopters are flying or hovering near the ground, fire fighters should be aware of potential hazards associated with the effects of air turbulence from the helicopter’s spinning blades. The turbulence could raise debris and could cause flames from a fire to behave erratically.

• Precautions should be followed to reduce risks of emotional and physical stress, fatigue, or physical demands from extreme environmental conditions. In particular, heat stress is a common problem. To prevent heat stress, educated fire fighters to recognize the early signs of heat stress, have proper medical evaluation, provide proper fluids and nourishment, and provide rest areas (rehabilitation units) to recover from the heat.

• As needed, provide and use NIOSH-certified respirators and other personal protective equipment that meets Occupational Safety and Health Administration (OSHA) standards.

Where to Find Out More About:

The next CDC DEOC Hurricane Katrina Update will be issued Monday, Sept. 12, 2005, and will be issued Monday, Wednesday, and Friday next week.

CDC Foundation Emergency Preparedness and Response Fund: The CDC Foundation has activated its Emergency Preparedness and Response Fund and is seeking donations. Contributions to the fund help CDC and state and local public health departments immediately obtain the equipment, supplies and services needed to address public health concerns related to Hurricane Katrina. Contributions can be made online at www.cdcfoundation.org or by calling 1-888-880-4CDC.

Interim Immunization Recommendations for Individuals Displaced by Hurricane Katrina www.bt.cdc.gov/disasters/hurricanes/katrina/immunizationqa.asp.

How to prevent carbon monoxide poisonings following power outages
www.bt.cdc.gov/disasters/carbonmonoxide.asp

Tool for Surveillance Among Facilities Housing Hurricane Katrina Evacuees
www.bt.cdc.gov/disasters/hurricanes/katrina/evacueeform.asp

Hurricane Evacuee Medical Intake Form (form adjusted slightly at 7:00p, 9/8)
www.bt.cdc.gov/disasters/hurricanes/katrina/evacueeform.asp

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