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NIOSH Respiratory Diseases Research Program

Evidence Package for the National Academies' Review 2006-2007

NIOSH Programs > Respiratory Diseases > Evidence Package > 10. Emergency Response and Disaster Preparedness

10.3 Hurricane Response (2005 Hurricane Season)

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Issue

On August 29 2005, Hurricane Katrina, made landfall on the Gulf Coast of the Southern U.S. as a category three storm. The worst affected city was New Orleans because the levees protecting the areas below sea level were breached. More than 1000 people perished in the storm and its aftermath, making Hurricane Katrina the worst natural disaster in U.S. history. Approximately four weeks later (September 24), Hurricane Rita, another category three storm, affected the same geographic area. In the aftermath of the flooding extraordinary mold growth occurred in many homes and commercial buildings.

Hurricanes Katrina and Rita created many needs. Literally hundreds of thousands of people were displaced and needed food, clothing, and shelter. State and local health resources were overwhelmed. In affected areas, severe storm and flood damage to buildings and infrastructure created many hazards for rescue and demolition/reconstruction workers. In addition to risk of injury from hazards such as building collapse, electrocution, and leaks from natural gas lines, workers also encountered respiratory hazards. One issue of great concern was inhalation exposures to mold created by disturbance of mold-contaminated building materials.

Approach

In the immediate aftermath of the storms, RDRP staff were deployed not only to deal with respiratory issues, but also to participate in the broader CDC and NIOSH responses to a wide range of issues. RDRP medical staff was deployed to Baton Rouge and to Brooks Air Force Base in San Antonio, Texas, to provide medical care in field hospitals set up after the disaster. RDRP industrial hygiene staff was deployed to the Houston Astrodome to deal with problems associated with converting it into a massive shelter. Consultation was provided in managing ventilation systems. Hygiene efforts were aggressively imposed to control an outbreak of viral gastroenteritis in the Astrodome. Multidisciplinary teams were also assigned to the affected regions to provide consultation in issues related safety and health of rescue and recovery workers. Many RDRP staff remained at their base locations, but contributed to the response by assisting in preparation of guidance documents and helping with public inquiries. One such document relevant to respiratory disease dealt with burning debris in open fires, a practice not normally used for debris disposal, but needed in view of the extraordinary circumstances.

A major respiratory issue addressed by RDRP was concern about mold exposure. From very early in the response, RDRP staff deployed to Baton Rouge assisted the state government in responding to mold-related public inquiries, and prepared flyers, public service announcements, and instructional materials concerning N-95 respirators. Cooperating agencies in these efforts included the FEMA, EPA, OSHA, and CDC.

From October 18-23, 2005, two RDRP staff surveyed 159 residents and 76 remediation workers regarding their knowledge of mold-associated health risks and usage of respiratory protection. All participants were subsequently instructed on the recommended use of respirators. Despite awareness of potential health effects associated mold exposure, one-third of the respondents could not identify an appropriate respirator, and the majority of those participating in mold clean-up activities reported doing so without consistently using respiratory protection. Most remediation workers (86 percent) could identify particulate-filter respirators as appropriate protection for cleaning up mold. However, one-half of those who had already participated in mold remediation activities had not been fit-tested, as required by OSHA.

From October 22-28, 2005, an RDRP team assessed mold contamination in homes in the New Orleans area. Over 100 randomly selected homes were assessed for visual evidence of mold. Air samples were collected from 20 homes. Findings indicated that visible mold was present in 46 percent of homes and heavy mold growth was present in 17 percent of homes. The team found 1-3, 1-6-b-D-glucan and endotoxin levels sufficiently elevated to be associated with respiratory health effects.

From March 4-12, 2006, a team of RDRP staff randomly surveyed 553 residents of the New Orleans Parish to identify whether residents were able to properly don N95 respirators. Most (80 percent) of the participants did not demonstrate proper donning. Commonly identified mistakes included failure to mold the nose piece, incorrect orientation of the respirator, and improper use of elasticized straps.

Outputs and Transfer

RDRP staff helped write a 52-page CDC document, “Mold: Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes Katrina and Rita” (A10-13). The document described exposure assessment for residents and remediation workers, appropriate methods of clean-up, personal protective equipment, health effects associated with exposure to mold, and public health strategies. The document was posted on the CDC Web site October 24, 2005. An edited, updated version of the document was published in the MMWR in 2006.185 A full length article also appeared in "OEM" recently (A10-13s).

RDRP staff created two public information flyers on mold-related heath risks and exposure prevention strategies:

  • NIOSH Interim Recommendations for the Cleaning and Remediation of Flood-contaminated HVAC Systems: A Guide for Building Owners and Managers was posted on the CDC Web site September 21, 2005 (A10-14).
  • Health Concerns Associated with Mold in Water-Damaged Homes after Hurricanes Katrina and Rita – New Orleans Area, Louisiana, October 2005 was published in the MMWR on January 20, 2006 (A10-15).

Intermediate Outcomes

CDC and NIOSH guidance, to which RDRP contributed significantly, influenced the actions of local government.

The Louisiana Office of Public Health and CDC used the CDC document, “Mold: Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes Katrina and Rita” (A10-13) to create a joint brochure that was placed on the Louisiana Office of Public Health Web site in December 2005.

From September to November 2005, the Louisiana Office of Public Health staff distributed 20,000 of the flyers, “NIOSH Interim Recommendations for the Cleaning and Remediation of Flood-contaminated HVAC Systems: A Guide for Building Owners and Managers” and “Health Concerns Associated with Mold in Water-Damaged Homes after Hurricanes Katrina and Rita – New Orleans Area, Louisiana, October 2005” to residents and workers in the hurricane-devastated regions of Louisiana.

What’s Ahead

RDRP staff will remain ready to deploy and participate in CDC and NIOSH responses to disasters and emergencies.

Results of studies documenting poor donning of respirators by the general public highlight the importance of developing methods for education of the public about respirators, particularly N95 filtering facepiece respirators. This issue is also relevant to planning for emerging infectious respiratory threats such as pandemic influenza (A10-13s).


185. Brandt M, Brown C, Burkhart J, Burton N, Cox-Ganser J, Damon S, Falk H, Fridkin S, Garbe P, McGeehin M, Morgan J, Page E, Rao C, Redd S, Sinks T, Trout D, Wallingford K, Warnock D, Weissman D. Mold prevention strategies and possible health effects in the aftermath of hurricanes and major floods. MMWR Recomm Rep. 2006 Jun 9;55(RR-8):1-27.