From the CDC Director’s Emergency Operations Center - P.M. Update, September 19, 2005

Top Line - Public Health

Persons returning to previously flooded areas should follow health and safety recommendations.

Fewer clusters of infectious diseases are being reported as evacuation center populations decline.

Safety of workers and returning-residents, vaccination programs, and mental well being of persons displaced by Hurricane Katrina are critical public health concerns.

CDC Public Health Workforce Deployed in Affected Communities:

• Total Deployed: 205 (212: 9/16) including the following specialties: public health nursing, occupational, laboratory, medical, epidemiology, sanitation, environmental health, disease surveillance, public information and health risk communication.
• Preparing to Deploy: 4
• Supporting Hurricane Katrina Director’s EOC Response: @ 352 (as of 9/16)

CDC Public Health Analysis:

CDC and EPA assist in planning for residents’ return to LA storm-damaged areas:

The CDC and the Environmental Protection Agency (EPA) have submitted their initial environmental health needs and habitability assessment to local, state and federal officials in New Orleans and Louisiana. The task force’s assessment addresses key environmental health and infrastructure issues critical to decisions regarding the return of business owners and residents to the Hurricane Katrina affected area.

Many survivors are naturally eager to learn the extent of damage to their homes and businesses. The storm, however, severely disrupted essential city services including power, natural gas, water and sewage treatment, and road safety.

The task force emphasized the need for collaboration among private and public organizations as plans move forward. They also noted that it is essential that a mechanism is put in place to regularly and substantively engage and communicate with people displaced by the storm and flood regarding their return to the area.

CDC and EPA continue to collect and provide scientific data to decision makers and the public; however, information from storm-damaged areas is limited and changing. CDC and EPA recommend that decisions about returning to New Orleans should be done neighborhood by neighborhood.

CDC and EPA have been working to help answer the following questions: 1) What are the core environmental health issues that need to be addressed; 2) Which agencies and organizations should be involved and are responsible for the various environmental health issues; 3) What progress had been made and what challenges exist; 4) What should the timetable be; 5) What resources exist to address these issues; and 6) How will success be defined?

Initial assessment issues included the following safety and health concerns: safe drinking water, power, housing, water and debris removal, occupational safety and health, vector (e.g., mosquito and rodent) control, food safety, and other infrastructure concerns. The task force noted that housing issues are complex and critical because a large percentage of city housing was flooded and is believed not to be viable. The large recovery workforce was also a major area of concern for the task force because conditions are intense and extraordinarily difficult.

The task force was formed shortly following Hurricane Katrina’s landfall. CDC’s Henry Falk, M.D., led a multidisciplinary and multiagency team with expertise in the following areas: environmental health science, environmental engineering, medicine, health and risk communication, and logistics. Local, state and federal officials have received the task force’s assessment. CDC Director Julie L. Gerberding, M.D., stated, “The team has produced a document that shows the way forward.”

CDC’s Howard Frumkin, M.D., is now leading a team of CDC experts to expand the initial work done by the task force. They will continue the environmental and public health assessments, especially to identify additional health risks that could arise, and support local, state and federal officials in the return of business owners and residents to the storm-damaged areas. For a copy of the assessment: www.bt.cdc.gov/disasters/hurricanes/environmental.asp

Response Rhythm: CDC’s public health disaster response, including its 205 deployed professionals, has entered an active maintenance phase and continues to see no unexpected health concerns related to Hurricane Katrina. Response-worker safety, immunizations, and environmental health concerns top CDC’s response at this time. In addition, monitoring for outbreaks of infectious disease continues at intense levels.

CDC professionals responding to Hurricane Katrina are doing interim planning by forecasting the following needs: follow-up to prevent illness; ensure services and reassure the public regarding available public health and medical services; and recommend appropriate health screenings between individuals and a health care provider.

Vibrio Infections: To date, CDC has received reports of 32 Vibrio species infections among persons evacuated because of the hurricane; six have died (4 from V. vulnificus, and 2 from V. parahaemolyticus). Among the 32 reports, late Friday, CDC confirmed two additional cases of Vibrio cholerae infection among persons evacuated from the Hurricane Katrina affected area. The person who became ill from nontoxigenic V. cholerae 01 had eaten raw oysters and shrimp between Aug. 27-30. The person who became ill from the V. cholerae non-01, non-0139 had been exposed to flood water.

Mental Well-being: CDC has deployed public health teams to work with local and state partners to conduct two surveys. A migration behavior survey will measure best ways to share information with people who were displaced, and capture an early sense of their relocation or return preferences. A mental health survey will help to describe the mental health of evacuees. Note: The mental health assessment will not compare evacuees to non-evacuee populations as stated in the September 16, 2005, update.

Overall Public Health: CDC professionals report, in most areas, declining concerns about infectious disease transmission as evacuation centers continue to empty. Intense surveillance continues in those centers still operating, and personal and community measures are being taken to decrease the risk of infectious disease outbreaks, including cases of varicella reported in some centers. The majority of medical and health visits among persons staying in evacuation centers involve injuries, medication resupply, oral health, and chronic health conditions. Of serious concern are the continuing reports of carbon monoxide poisonings among persons in Louisiana, Mississippi, and Florida. The surveillance system that tracks hyperbaric oxygen chamber use (needed for treatment of severe carbon monoxide poisonings) reported 25 new cases since September 15.

Top 10 conditions: From limited needs assessments among persons staying in evacuation centers, between Sept. 10-12, 2005

Public Health Reports from the States…

Louisiana: The CDC Greater New Orleans Public Health Support Team and the Department of Defense have worked with state and local health officials to focus on the safe return of residents. They have developed and are distributing health messages to returning business owners and residents. Topics include immunizations, mental health and resilience, and other environmental issues, including 100,000 flyers on carbon monoxide safety available at re-entry points. Three areas of intense work include needs assessments among persons in evacuation centers, vaccinations for people who were displaced, and primary care.

Mississippi: CDC’s Mississippi team is transitioning a new field team to the state to provide epidemiologic support and helping to integrate public health and mental health recovery efforts. The environmental health team is working with local officials to scout for any materials in containers that may be harmful to humans and may have spread in flooded neighborhoods. The immunization effort is in full swing and the current vaccine needs have been met.

Texas: Evacuation centers have or will soon close in Dallas and San Antonio. CDC is working with state and local public health officials to ensure public health services are provided to persons transitioning from evacuation centers. Immunization services continue and the state now has the vaccine needed to meet current needs, including supplies of influenza vaccine.

Public Health Recommendations: Pass it on

Reentering Your Flooded Home
When returning to a home that’s been flooded after natural disasters such as hurricanes, tornadoes, and floods, be aware that your house may be contaminated with mold or sewage, which can cause health risks for your family.

When You First Reenter Your Home

If you have standing water in your home and can turn off the main power from a dry location, then go ahead and turn off the power, even if it delays cleaning. If you must enter standing water to access the main power switch, then call an electrician to turn it off. NEVER turn power on or off yourself or use an electric tool or appliance while standing in water.

• Have an electrician check the house’s electrical system before turning the power on again.

• If the house has been closed up for several days, enter briefly to open doors and windows to let the house air out for awhile (at least 30 minutes) before you stay for any length of time.

• If your home has been flooded and has been closed up for several days, presume your home has been contaminated with mold. (See “Protect Yourself from Mold” at www.bt.cdc.gov/disasters/mold/protect.asp.)

• If your home has been flooded, it also may be contaminated with sewage. (See “After a Hurricane or Flood: Cleanup of Flood Water” at www.bt.cdc.gov/disasters/floods/cleanupwater.asp.)

Mold in Homes and Other Buildings
After natural disasters such as hurricanes, tornadoes, and floods, excess moisture and standing water contribute to the growth of mold in homes and other buildings. When returning to a home that has been flooded, be aware that mold may be present and may be a health risk for your family.

People with asthma, allergies, or other breathing conditions may be more sensitive to mold. People with immune suppression (such as people with HIV infection, cancer patients taking chemotherapy, and people who have received an organ transplant) are more susceptible to mold infections.

People who are sensitive to mold may experience stuffy nose, irritated eyes, wheezing, or skin irritation. People allergic to mold may have difficulty in breathing and shortness of breath. People with weakened immune systems and with chronic lung diseases, such as obstructive lung disease, may develop mold infections in their lungs. If you or your family members have health problems after exposure to mold, contact your doctor or other health care provider. You may recognize mold by:

• Sight (Are the walls and ceiling discolored, or do they show signs of mold growth or water damage?)

• Smell (Do you smell a bad odor, such as a musty, earthy smell or a foul stench?)

Clean up and dry out the building quickly (within 24 to 48 hours). Open doors and windows. Use fans to dry out the building. To remove mold growth from hard surfaces safely use commercial products, soap and water, or a bleach solution of 1 cup of bleach in 1 gallon of water. Use a stiff brush on rough surface materials such as concrete. www.bt.cdc.gov/disasters/mold/protect.asp

Respiratory Protection for Residents Reentering Flooded Areas and Homes
If you need to collect belongings or do basic clean up in your previously flooded home, you do not usually need to use a respirator ( a mask worn to prevent breathing in harmful substances). Before you enter your home or any other building, make sure it:

• Is structurally safe

• Doesn't have natural gas leaks or other safety problems

You do not usually need to wear a respirator when you are inside a home or building unless you are doing something that creates a lot of dust in the air like sweeping dust, using power saws and equipment, or cleaning up mold. If you have to be around dust,

• Limit your contact with the dust as much as possible.

• Use wet mops or vacuums with HEPA filters instead of dry sweeping.

• Wear a respirator that protects against dust in the air.

Additional information on respirator use can be found at the following website: www.cdc.gov/niosh/npptl/topics/respirators/
factsheets/respfact.html

Where to Find Out More About:

Free Health Education Information:
The CDC has produced free information in many languages on topics such as hand washing, returning to your home, protecting yourself from carbon monoxide poisoning and from mold. A comprehensive index of available resources can be found at: www.bt.cdc.gov/disasters/hurricanes/printindex.asp

A number of free Public Service Announcements produced by both CDC and HHS are available at: www.bt.cdc.gov/disasters/hurricanes/psa.asp

FBI Government Fraud Line: The FBI has launched a tip line, 1-800-CALL FBI or 1-800-225-5324, to collect information and complaints of public corruption and government fraud in connection with the Hurricane Katrina aftermath.

FEMA Help: Toll-free registration number, 1-800-621-FEMA (3362). People who are speech- or hearing-impaired should call TTY 1-800-462-7585 . Phone lines are open 24 hours a day, 7 days a week until further notice. Anyone who can access the Internet may register online at www.fema.gov.

CDC Foundation Emergency Preparedness and Response Fund: The CDC Foundation has activated its Emergency Preparedness and Response Fund and is seeking donations. Contributions can be made online at www.cdcfoundation.org or by calling 1-888-880-4CDC.

The next CDC DEOC Hurricane Katrina update will be Wednesday, Sept. 21, 2005

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