From the CDC Director’s Emergency Operations Center - P.M. Update, September 30, 2005

Top Line—Public Health:

Carbon monoxide poisonings pose a serious risk for people in storm-damaged areas. CDC encourages cautioning returning residents often and widely about the deadly risk of CO poisoning.

Relief workers who are doing animal rescues are concerned about bites and the potential for rabies. CDC’s veterinary experts are helping workers reduce bites and determine treatment needs.

Health officials are cautioning returning residents to the greater New Orleans area about potential serious public health risks, especially related to safe drinking water.

CDC Public Health Workforce Deployed in Affected Communities:

• Total: 136 for Hurricane Katrina (116: 9/28) and 63 for Hurricane Rita (68: 9/28): including the following specialties: veterinarians, public health nursing, occupational, laboratory, medical, epidemiology, sanitation, environmental health, disease surveillance, public information and health risk communication

• Preparing to Deploy: 18 for Hurricane Katrina-related missions and 1 for Hurricane Rita-related missions

• Supporting Hurricane Katrina Director’s EOC Response: @ 600 (as of 9/28)

CDC Public Health Analysis:

New Orleans Safe Return:
The city of New Orleans has reinitiated their reentry plan. As hotels, restaurants, grocery stores and other businesses proceed with plans to reopen in the New Orleans area, state health officials warned citizens intending to return to their homes and/or visit these establishments, as well as business owners, about serious public health risks.

Clean drinking water and proper sewage systems are not available in the east bank area of New Orleans at this time. The parts of the greater New Orleans area previously cleared by health officials as meeting the public health standards for reopening are Algiers and the West and East Bank areas of Jefferson Parish and the Belle Chasse area of Plaquemines Parish.

Orleans Parish’s east bank water system remains under a boil advisory, meaning that potentially-harmful bacteria is still in the water supply and could be ingested if people use the water for drinking, cooking or for any other activities such as bathing, brushing their teeth or washing their hands.

In order for a food establishment to reopen, the facility must undergo an inspection to ensure the conditions for safe food preparation and storage are in place. Once the restaurant is inspected and approved by health officials, an official placard will be conspicuously displayed at that establishment, indicating the restaurant has been inspected and is approved for reopening. Food establishments that do not have a placard from the health department do not meet the state sanitary code and are not cleared to reopen.

The Greater New Orleans Public Health Support Team’s (GNOPHST) 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.

Injury Surveillance:
In Louisiana storm-damaged areas, surveillance of hospital and clinic visits indicates that unintentional injuries top the list. Of the injury visits, 98% are related to unintentional injuries. Falls lead at 23%, followed by stings, cuts and blunt trauma. Only 3% of visits to hospitals are for violence-related injuries.

Dog Bites:
Concerns about dog bites in hurricane damaged areas are increasing and some relief workers who have been working with animal rescue have expressed concern about the potential for rabies exposure and possible post-exposure treatment. CDC is working with local and state health officials to ensure relief workers reduce the potential for bites and receive treatment if necessary.

Hospital Capacity:
In Hurricane Rita damaged areas of Louisiana, 38 of its 60 hospitals are fully restored, 8 are partially restored, and 14 are not restored. The primary reasons for hospital closures were lack of utilities and sanitation challenges.

Southeast Texas:
The key public health concerns in southeast Texas, hardest hit by Hurricane Rita, include extreme environmental conditions, reduced medical services, and a damaged public health infrastructure. CDC and state and local health officials are addressing disease control and injury prevention issues for returning residents. Carbon monoxide poisonings are an urgent concern.

CDC’s Strategic National Stockpile Update:

Hurricane Katrina:
From Aug. 30 to Sept. 16, CDC’s Strategic National Stockpile sent more than $38 million worth of medical supplies for Hurricane Katrina response. This included 14 Federal Medical Contingency Station (FMCS) units accounting for 3,500 beds – 6 units (1,500beds) to Mississippi and 8 units (2,000 beds) to Louisiana. (These assets have since been recovered and readied for future operations.) A total of 439,925 doses of Hepatitis A and Hepatitis B vaccine, Tetanus vaccine and Diphtheria vaccine were sent to the region ($8.2 million of vaccines to Louisiana and over $800,000 of vaccine to Mississippi). In addition to vaccine, hundreds of thousands of doses of antibiotics, maintenance medications for chronic diseases such as diabetes, heart disease, high blood pressure, pain, anxiety, diarrhea, and other conditions have been sent to the region. A 12-hour Push Package containing 50 tons of pharmaceuticals and medical supplies was sent to Mississippi. In addition, 39 people were deployed to help state and local health officials with stockpile materials.

Hurricane Rita:
In response to Hurricane Rita, CDC deployed a Technical Advisory Response Unit (TARU) and FMCS personnel to Texas on Friday, Sept. 23, 2005. In total, 18 people deployed and 9 people are currently positioned in the Texas/Louisiana region. CDC’s Strategic National Stockpile sent medical supplies and FMCS equivalents (totaling 2,000 beds) to assist in local response efforts, and FMCS beds were set up at Texas A&M, Waco, and Marlin, Texas. To date, CDC has invested $60,000 to re-supply FMCS supplies in Texas and has ordered $1.6 million of additional FMCS supplies to achieve the desired total of 10,000 beds, pharmaceuticals and medical supplies needed to construct 40 250-bed sets.

Public Health Recommendations: Pass it on

Carbon Monoxide Kills:
Never use generators, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices inside your home, basement, garage, or camper—or even outside near an open window.

Carbon monoxide (CO) is an odorless, colorless gas that can cause sudden illness and death if you breathe it. When power outages occur during emergencies such as hurricanes or winter storms, you may try to use alternative sources of fuel or electricity for heating, cooling, or cooking. CO from these sources can build up in your home, garage, or camper and poison the people and animals inside.
www.bt.cdc.gov/disasters/cofacts.asp

School-age evacuees do not pose an increased health risk in schools:
The migration of residents from hurricane-affected areas to other states has caused concern about the potential for disease outbreak. Children from hurricane-affected areas do not pose an increased health risk to their new classmates. Further, parents in communities absorbing evacuees do not need to worry about their children’s new classmates spreading diseases that are preventable by vaccines.

Schoolchildren, including those from hurricane-affected areas, are required to have up-to-date vaccinations prior to beginning the school year. If a child was in school prior to the hurricane, they should be treated as if their vaccinations are up to date.

Another concern is whether children from affected areas who have been exposed to contaminated water, food, and other environmental hazards pose a health threat in their new schools. There is no increased health risk, either. No disease outbreaks have been reported from the affected areas that these children would have been exposed to prior to arriving in their new school.

Children in classrooms with evacuees, or the evacuees themselves, that develop any kind of illness should seek medical attention as they would under normal circumstances.

www.bt.cdc.gov/disasters/hurricanes/katrina/newschools.asp

Rabies Control and Prevention:
Because of hurricane wind and flood damage, stray animals, both wild and domestic, may be moving unattended in residential areas. Be careful about approaching these animals, and call animal control to remove all stray animals from your neighborhood since these animals may be unvaccinated or ill. Although the majority of rabies cases occur in wildlife, most humans are given rabies vaccine as a result of exposure to domestic animals. While wildlife are more likely to be rabid than are domestic animals in the United States, the amount of human contact with domestic animals greatly exceeds the amount of contact with wildlife. Your pets and other domestic animals can be infected when they are bitten by rabid wild animals. When "spillover" rabies occurs in domestic animals, the risk to humans is increased. Pets are therefore vaccinated by your veterinarian to prevent them from acquiring the disease from wildlife, and thereby transmitting it to humans

What should someone do if they have been bitten?
If bitten, you should seek medical evaluation for any animal bite. However, rabies is uncommon in dogs, cats, and ferrets in the United States. Very few bites by these animals carry a risk of rabies. If the cat (or dog or ferret) appeared healthy at the time you were bitten, it can be confined by its owner for 10 days and observed. No anti-rabies prophylaxis is needed. No person in the United States has ever contracted rabies from a dog, cat or ferret held in quarantine for 10 days.

If a dog, cat, or ferret appeared ill at the time it bit you or becomes ill during the 10 day quarantine, it should be evaluated by a veterinarian for signs of rabies and you should seek medical advice about the need for anti-rabies prophylaxis. The quarantine period is a precaution against the remote possibility that an animal may appear healthy, but actually be sick with rabies.

People usually get rabies from the bite of a rabid animal. It is also possible, but quite rare, that people may get rabies if infectious material from a rabid animal, such as saliva, gets directly into their eyes, nose, mouth, or a wound. Medical assistance should be obtained as soon as possible after an exposure.

Can rabies be transmitted from one person to another?
The only well-documented cases of rabies caused by human-to-human transmission occurred among 8 recipients of transplanted corneas, and recently among three recipients of solid organs.

www.cdc.gov/ncidod/dvrd/rabies/ques&ans/q&a.htm

Where to Find Out More About:

FDA- Center for Drug Evaluation and Research (CDER) Drug Shortages Team is monitoring for potential drug shortages and drug product vulnerabilities and issued an updated version of "Safety of Medications That May Have Been Affected by Flood Waters and High Temperatures" (www.fda.gov/cder/emergency/water-refrig.htm).

HHS Help: Complete information on the full range of accelerated benefits available from HHS for hurricane victims is available at http://www.hhs.gov/katrina.

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 Tuesday, October 4, 2005

Click for larger image