From the CDC Director’s Emergency Operations Center - P.M. Update, September 12, 2005

Top Line - Public Health

Preventing increases in West Nile virus illnesses because of Hurricane Katrina includes community-based and individual prevention measures.

Leptospirosis disease is a risk for persons in contact with water contaminated with urine from rodents and other animals.

CDC has environmental and occupational health experts deployed to assess health risks to response workers and provide information about avoiding injury and illness.

National Public Health Emergency Situation Update:

• Persons in Evacuation Centers: 443 open, 88,883 people in 18 states (numbers fluctuate daily)
• Damage Assessments: 471,000 without power (689,000 9/9)
• Official Death Numbers: AL 2; FL 14; LA 154; MS 155; ME 1 Total: 326

CDC Public Health Workforce Deployed in Affected Communities:

• Total: 223 (231: 9/11) including the following specialties: public health nursing, occupational, laboratory, medical, epidemiologist, sanitation, environmental health, disease surveillance, public information and health risk communication.
• By State: AR 13; DC 4; GA 6; LA 81; MS 55; TX 63; WV 1 (See bottom for deployment locations map)
• Preparing to Deploy: 14
• Deployed to Director’s EOC: 159 (As of 9/8)

CDC Public Health Analysis:

Public Health Field Actions: CDC subject matter experts are involved in missions in Arkansas, the District of Columbia, Georgia, Louisiana, Mississippi, Texas, and West Virginia. Of the 223 CDC professionals deployed, 82 are involved in assessments and surveys; 24 are conducting epidemiological investigations; 10 are involved in hospital surveillance; 37 are acting as liaisons and supporting command tasks; 8 are involved in patient management such as immunizations; 25 are contributing to public health infrastructure such as information management and laboratory support; 26 are providing support to the Strategic National Stockpile response; 6 are providing technical assistance on vector control; and 5 are deployed in other critical assignments.

Laboratory tests confirm 19 persons have become ill from Vibrio spp. infections. Five 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 15 persons becoming ill and three deaths; V. parahaemolyticus resulting in three illnesses and two deaths; and nontoxigenic V. cholerae resulting in one illness. The single case of V. cholerae is not from the serogroup that causes cholera epidemics. These illnesses are not transmitted from person to person.

Insects and Rodents: Public health professionals remain concerned about mosquito control and health risks posed by other pests such as rodents in some areas affected by Hurricane Katrina.

The public health response includes aerial spraying to kill adult mosquitoes that could carry the West Nile and other viruses. West Nile virus activity peaks in August and September. Individuals can help avoid West Nile illness by applying insect repellent containing DEET (Look for: N,N-diethyl-meta-toluamide) or Picaridin to exposed skin when outdoors. Even a short time being outdoors can be long enough to get a mosquito bite. People should also wear long sleeved tops and long pants, and, if possible, avoid being outdoors during dawn and dusk.

Leptospirosis is a bacterial disease that can infect humans who come into contact with infected rodents and other animals or when exposed to water contaminated with the urine of infected animals. People can reduce their risk of getting leptospirosis by avoiding contact with urine-contaminated water. The disease is not spread from person to person.

CDC is working closely with vaccine manufacturers to obtain needed supplies of key vaccines such as tetanus and hepatitis A, and 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.

Occupational Health Field Response: CDC’s NIOSH is deploying teams to Hurricane Katrina affected areas to assess occupational exposures. They will also be involved in health education and risk communication outreach to response and recovery workers.

Carbon Monoxide Poisonings: CDC is collecting data from poison control centers and from media reports in Hurricane Katrina affected states. This preliminary data indicates that carbon monoxide poisonings could range from 76 to 90, with CO deaths reported through the media. CDC’s Emergency Communication System engaged Home Depot, Lowe’s, and the Consumer Product Safety Commission to provide point of purchase safety messages to educate the public about how to avoid carbon monoxide poisoning.

Public Health Focus: The strategic direction for CDC’s public health response is transitioning. It is moving from acute public health issues such as infectious disease control in evacuation centers to interim issues such as occupational safety and injuries among persons returning to damaged communities. Planning has also begun for long-term public health support such as assessing public health needs for people who were evacuated and are now integrating into new communities.

Public Health Recommendations: Pass it on

Potential for Leptospirosis Infections Following Hurricane Katrina
Outbreaks of leptospirosis have occurred following flood events. CDC cautions that leptospirosis illnesses may occur in the days to weeks following Hurricane Katrina.

Leptospirosis is an infection of both humans and animals. It is caused by bacteria called Leptospira. People get leptospirosis from exposure to infected animals. They can also be infected when exposed to water contaminated with the urine of infected animals. People can reduce their risk of getting leptospirosis by avoiding contact with urine-contaminated water. Protective clothing and footwear should be worn if exposure to urine-contaminated water is unavoidable. People exposed to flood waters from Hurricane Katrina who develop fever should see a healthcare provider. The disease is not spread from person to person.

Many different kinds of animals carry Leptospira. Animals may carry the bacterium but have no symptoms. Leptospira have been found in cattle, pigs, horses, dogs, rodents, and wild animals. In Louisiana, leptospirosis occurs in cattle, skunks, and nutria (large rodents). Urban leptospirosis caused by exposure to rats occurs in the United States.

In humans it causes a wide range of symptoms. Some infected persons may have no symptoms. Others may have high fever, severe headache, and muscle aches. In severe cases, people may have jaundice (yellow skin and eyes) from liver failure. Severe disease may also cause kidney damage and respiratory distress. In rare cases death occurs. People may develop symptoms from 2 days to 4 weeks after exposure. Illness usually begins abruptly with fever. Leptospirosis may occur in two phases. In the first phase, fever, chills, headache, muscle aches, vomiting, and diarrhea are common. The individual may get better for a time but become ill again. If a second phase occurs, it is usually more severe. Severely ill people may develop kidney or liver failure. Many of these symptoms can be mistaken for other diseases. Leptospirosis is confirmed by testing of a blood or urine sample.

The illness lasts from a few days to 3 weeks or longer. Without treatment, recovery may take several months. Leptospirosis is treated with antibiotics. Doxycycline or penicillin are usually used. Treatment is most effective when given early in the course of disease. Intravenous antibiotics may be used for severe disease. Persons with symptoms suggestive of leptospirosis should contact a health care provider.

Leptospirosis occurs worldwide but is most common in tropical climates. Many people who work outdoors or with animals may be at risk. People exposed to urine-contaminated water during work or recreation may also be at risk. Between 1965 and 1993, the incidence rate of leptospirosis in Louisiana ranged from 1 to 14 per 100,000 people per year. www.bt.cdc.gov/disasters/hurricanes/katrina/leptofaqs.asp

Communicating Well with Disaster Survivors
The National Response Plan states that communication objectives during a crisis include the following: 1) prevent further illness, injury, or death; 2) restore or maintain calm; and 3) engender confidence in the operational response. Disasters are inherently different from routine daily emergencies and the difference is more than just one of magnitude. Disasters that take a toll on human life are inherently characterized by change, high levels of uncertainty, and interactive complexity.

People affected by the crisis want to accomplish the following five things with the information they get from response officials during the aftermath of a crisis:

• Gain the wanted facts needed to protect them, their families and their pets from the dangers they are facing;

• Make well-informed decisions using all available information;

• Have an active, participatory role in the response and recovery;

• Act as a "watch-guard" over resources, both public monies and donated monies; and,

• Recover or preserve well-being and normalcy, including economic security.

To reduce anxiety, persons will engage in information gathering and processing to look for options and to confirm or disprove their beliefs. The information used by survivors in this process does not have to accurate to be used. In fact, to reduce anxiety, people may be selective about the information they attune to and discount information that is distressing or overwhelming. People who are seeking information to reduce anxiety from dangerous uncertainty:

• Will be more attentive to behaviors and language styles of persons in power

• May choose a familiar source of information over a less familiar source, regardless of the accuracy of the information

• May be less certain of their ability to process information involving complex situations and so choose an advocate to collect and interpret information.

When communicating to survivors from the hurricane, empathy and caring should be expressed. When the speaker is perceived as empathetic and caring it improves the opportunity for the message the speaker is attempting to convey to be received and acted on. Empathy requires voicing the actual emotion the person is currently experiencing such as acknowledge fear, confusion, anxiety, frustration, and uncertainty. Giving people things to do to restore their sense of control in their environment is important. Survivors should be encouraged to get involved in helping themselves and others. When possible empower survivors by giving them choices.
www.cdc.gov/communication/emergency/features/f001.htm

Where to Find Out More About:

Cooking for Groups:
Volunteers should know how to prepare and serve food safely for large groups such as church dinners, community gatherings and evacuation centers. Food that is mishandled can cause very serious consequences for all, especially infants, young children, older adults, pregnant women, and people with weakened immune systems. For this reason it is important that volunteers be especially careful when preparing and serving food to large groups. Foodborne illness often presents itself as flu-like symptoms such as nausea, vomiting, diarrhea, or fever, so many people may not recognize the illness is caused by bacteria or other pathogens in food. When disease-causing bacteria enter the food supply, they can cause foodborne illness. Most cases of foodborne illness can be prevented. Proper cooking or processing of food destroys bacteria. For more information about safe food preparation for group settings, see: www.fsis.usda.gov/OA/pubs/cfg/cfg.htm.

New: Cancer Patient Resources for Hurricane Katrina
www.bt.cdc.gov/disasters/hurricanes/katrina/cancer.asp

Update: Keep Food and Water Safe (new section on Cleaning and sanitizing food-contact surfaces) (translations in process of being updated)
www.bt.cdc.gov/disasters/foodwater.asp

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

Weather Updates: While CDC is responding to immediate public health concerns, the Director’s Emergency Operations Center is resupplying and preparing for future possible public health events, including additional hurricanes this season. National Weather Service, National Hurricane Center, Tropical Prediction Center: www.nhc.noaa.gov.

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.

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