From the CDC Director’s Emergency Operations Center - P.M. Update, September 23, 2005

Top Line - Public Health

Falls and puncture wounds are occurring frequently among people returning to Hurricane Katrina affected areas.

Hundreds of restaurants in Mississippi affected by Hurricane Katrina were inspected for food and water safety and were cleared to reopen.

Encouraging mental health resilience is important for persons experiencing the ongoing stress from displacement by Hurricane Katrina.

CDC Public Health Workforce Deployed in Affected Communities:

• Total: 128 (161: 9/21) 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: 13
• Supporting Hurricane Katrina Director’s EOC Response: @ 352 (as of 9/16)

CDC Public Health Analysis:

Vibrio: A total of 34 Vibrio species illnesses have been reported to CDC; 33 are known to be related to Hurricane Katrina. Six deaths have resulted from these illnesses, 4 from V. vulnificus and 2 from V. parahaemolyticus.

URI: Upper respiratory infections are being reported among persons in Louisiana affected by Hurricane Katrina. For example, a small outbreak of mild viral URI occurred among some DoD personnel housed in a gym. They did not have occupational exposures to mold or other agents. CDC epidemiologists are attempting to determine if these illnesses represent an increase above normal levels in the population.

Mosquito Control: Of the 264 mosquito pools collected in Mississippi coastal areas between Sept. 9 and Sept. 12, all have been negative for West Nile Virus. Spraying for mosquitoes in Mississippi and Louisiana, especially the Orleans Parish area, is ongoing. CDC field teams are working with the Texas mosquito control program in anticipation of potential concerns following Hurricane Rita’s landfall.

Mississippi: 582 food establishments in the 6 coastal counties have been inspected and cleared to open.

Injuries: Limited hospital surveillance in the Hurricane Katrina affected areas of Louisiana found that, among unintentional injuries, falls and puncture wounds were most prevalent. Bites and stings were also numerous.

New Orleans Safe Return: Recently, CDC’s Hurricane Katrina Environmental Needs Assessment Team (ENAT) traveled to New Orleans to explore critical public health issues and consult with local, state and federal officials about issues related to the return of residents and business owners to New Orleans. They have returned to Atlanta, pending the outcome of Hurricane Rita, and continue their work with the Louisiana Department of Environmental Quality and the Louisiana Department of Health.

The Greater New Orleans Public Health Support Team (GNOPHST) is made up of local, state, and federal agencies, including CDC. The GNOPHST’s mission includes providing acute public health services during rescue and reconstruction and rebuilding the public health system for the return of residents. Critical issues involve worker safety, environmental health, health surveillance, mental health, and injury prevention. As part of GNOPHST, CDC team members represent expertise in environmental health and hazards; occupational health; injury prevention; mental health and resilience; health risk communication; air, water and sewer; food safety, animal and vector control; assessment; laboratory support; surveillance; and mission support.

Public Health Recommendations: Pass it on

Chainsaw Injury Prevention
Each year, approximately 36,000 people are treated in hospital emergency departments for injuries from using chain saws. The potential risk of injury increases after hurricanes and other natural disasters, when chain saws are widely used to remove fallen or partially fallen trees and tree branches.

Some safeguards against injury while using a chain saw include the following:

• Operate, adjust, and maintain the saw according to manufacturer’s instructions provided in the manual accompanying the chain saw.

• Wear the appropriate protective equipment, including hard hat, safety glasses, hearing protection, heavy work gloves, cut-resistant legwear (chain saw chaps) that extend from the waist to the top of the foot, and boots which cover the ankle.

• Avoid contact with power lines until the lines are verified as being de-energized.

• Always cut at waist level or below to ensure that you maintain secure control over the chain saw.

• Bystanders or coworkers should remain at least 2 tree lengths (at least 150 feet) away from anyone felling a tree and at least 30 feet from anyone operating a chain saw to remove limbs or cut a fallen tree

• If injury occurs, apply direct pressure over site(s) of heavy bleeding; this act may save lives.

www.bt.cdc.gov/disasters/hurricanes/chainsaws.asp

Psychological Concerns Among Disaster Survivors
Among people involved in natural disasters, all will be affected to some level emotionally, cognitively, physically, and interpersonally. Emotional responses will range from mild upset to shock, blame, anger, and guilt. Cognitive effects will include impaired concentration, impaired decisionmaking, memory impairment, decreased self-esteem, and worry. People are also affected physically, including fatigue, insomnia, hyperarousal, increased physical pain, reduced immune response, headaches, and vulnerability to illness. Potential effects on social interactions include the following: increased relational conflict, social withdrawal, distrust, denial, and externalization of vulnerability.

In the United States, disasters that affect economic security are particularly stressful. Social factors that predicted an adverse outcome for disaster victims included the following: displacement, extensive loss of property, horror, life threat, bereavement, injury, and separation from family. Psychological impairment was more likely as the numbers of these stressors increased.

Research has shown that mental toughness was more important than physical ability for survival in a disaster. In addition, having a sense of direction during the crisis increased survival because persons who could focus on a goal or action such as "helping their family survive" gave the individual's mind relief from thoughts of the problem. Another predictor of a positive outcome for a disaster victim was experience. For less severe crises, prior experience with the type of disaster reduced anxiety, increased the likelihood the person had prepared for the hazard in advance, and the individual was more likely to follow directions from response officials such as evacuation orders.

A perception of self control increases mental well-being; therefore people should be given options or choices when possible. In addition, being embedded in a social system increases mental health resilience as does receiving social support.

Some people may feel that the familiar normal world they knew is gone and feel a sense of dissociation. This may be mitigated with quick, firm directions for action, and by reconnecting these traumatized survivors with the world reminding them that the larger community shares societal values of altruism and goodness.

www.bt.cdc.gov/mentalhealth

The National Suicide Prevention Lifeline’s mission is to provide immediate assistance to individuals in suicidal crisis by connecting them to the nearest available suicide prevention and mental health service provider through a toll-free telephone number:
1-800-273-TALK (8255). It is the only national suicide prevention and intervention telephone resource funded by the Federal Government. In the wake of Hurricane Katrina, and in anticipation of Hurricane Rita, the National Suicide Prevention Lifeline would like to pass on information and resources that may be useful to crisis center staff and members of the public who might be concerned about persons reside in the Gulf Coast region.

The Lifeline Media Outreach Toolkit Is Now Available Online!
Spread the word that mental health problems are treatable and help is available. This comprehensive toolkit provides you with everything you need to conduct a promotional campaign throughout the year as well as during mental health events. The toolkit includes media outreach materials, marketing materials, and partnership development materials.

www.suicidepreventionlifeline.org

Pet Safety Before, During and After an Emergency
Make plans to ensure your pets’ safety before, during, and after an emergency. Find out what your community’s plans and resources are for protecting pets in an emergency.

As persons are displaced from their homes into evacuation centers, they often wish to bring companion animals with them. Having a pet nearby may serve as a source of comfort to someone who has lost their possessions and, perhaps, family members. Unfortunately, many disaster evacuation centers (and specifically Red Cross evacuation centers) cannot accept pets because of states' health and safety regulations. Pets kept at human evacuation centers can sometimes pose a risk of disease or injury to other shelter inhabitants. In fact, service animals that assist people with disabilities are currently the only animals allowed in some evacuation centers.

Animal evacuation centers and foster homes may accommodate animals while owners reside in temporary evacuation centers, but these services may not be available everywhere. The following Questions and Answers were developed to address health and safety concerns regarding animals kept in non-Red Cross public evacuation centers.

Q: What are the potential health risks of housing animals and people in one location?

A: Close contact between humans and other animals in evacuation evacuation centers may pose a risk for injury or illness. Scared and stressed animals may be more likely to bite or scratch their owners, other people, or other pets. In addition to injury and potential infection from bites and scratches, bites from dogs, cats, and ferrets may present a risk for rabies. Serious bite wounds may require surgical repair. Furthermore, proper care of the animal, such as collection and disposal of urine and feces, may be difficult in public evacuation centers. This poses an additional risk of infection for people, particularly the immunocompromised. People may also be allergic to furred or feathered pets. These problems may be more serious when people do not have access to their usual medications.

Q: What are some diseases that may be transmitted by contact with pets?

A: Routine contact with dogs, and especially cats, may pose a risk for ringworm, which is a skin infection caused by a fungus. Animal feces and fecal-contaminated skin and fur may pose a risk of diarrheal illness from Campylobacter, Salmonella, and some intestinal parasites. Although these risks are usually small, in the wake of natural disasters such as hurricane Katrina, physical stress and exposure to floodwaters and contaminated food and water may increase the risk for diarrheal infections. Most reptiles (lizards, snakes, iguanas, turtles) shed Salmonella in their feces; children younger than 5 years old are at high risk for this disease if they handle reptiles. Although people usually acquire toxoplasmosis by ingesting meat containing tissue cysts, young cats may rarely shed Toxoplasma oocysts in their stool. Prompt removal of stool from the environment minimizes this risk. Some pet rodents, such as hamsters, gerbils, and guinea pigs, can transmit lymphocytic choriomengitis virus (LCMV). Toxoplasma and LCMV can cause birth defects in an unborn child if a pregnant woman becomes infected.

Q: What are the risks associated with animal bites?

A: The consequences of animal bites, especially dog bites, can be serious. The risk of a bite injury may be greater in situations that promote close contact between people and unfamiliar animals. Bites from dogs, cats, or ferrets carry a risk for rabies, even if the animal has been vaccinated and appears healthy. If a dog, cat, or ferret bites a person or another animal, they must be confined and observed for 10 days to see whether they develop signs of rabies. If the biting animal shows signs of rabies or cannot be reliably confined and observed, that animal must be euthanized and tested for rabies. Serious bite wounds require medical care, and surgical repair in some cases. Animal bites may also result in infection, and the injured person may need to be treated with antibiotics, a tetanus booster or receive other medical care.
www.bt.cdc.gov/disasters/animalspubevac.asp
www.bt.cdc.gov/disasters/petprotect.asp

Where to Find Out More About:

Flood Insurance: The National Flood Insurance Program (NFIP), which is administered by FEMA, announced today it has waived the usual requirement that policyholders must submit a proof-of-loss and instead where the policyholder agrees, will rely on a report by the claims adjuster. Additionally, the NFIP has urged insurance companies to provide advance checks of around $3,000 to policyholders who carry contents coverage. A listing of insurance company phone numbers, along with additional insurance information, is also available at www.fema.gov/press/2005/katrinainsurance.shtm.

DHHS Helplines: Mental health 1 800-273-TALK (1 800-273-8255); Head Start services 1 866-763-6481; Medicare 1 800-MEICARE (1 800-633-4227); Elder Care 1 800-677-1116.

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

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 Monday , Sept. 26, 2005

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