From the CDC Director’s Emergency Operations Center - P.M. Update, September 7, 2005

Top Line - Public Health

Infection control to prevent diarrheal illness is ongoing and a priority for persons staying in evacuation centers. People returning to their damaged homes and communities and those helping in the disaster response face potential injuries and health risks. If a child is well, and was attending school in their home district before the hurricane, they should be allowed to attend school without further screening, decontamination or quarantine.

National Public Health Emergency Situation Update

• Persons in Evacuation Centers: 490 open, 125,491 people in 14 states (numbers fluctuate daily)
• Damage assessments: 858,758 without power (.98 million without power 9/6)
• Official death numbers: AL 2, FL 12, MS 154, LA X. Total: 169

CDC Public Health Workforce Deployed in Affected Communities:

• Total: 182 (148: 9/6) including the following specialties: medical, epidemiologist, sanitation, environmental health, assessment, disease surveillance, public information and health risk communication.
• By State: DC 3; FL 0 (2, 9/6); GA 4; LA 38 (35 09/05); MS 44 (43 9/6); TX 59 (44 9/6) AR 1 (See map for deployment locations)
• Preparing to Deploy: 23
• Deployed to Director’s EOC: 64 (As of 9/3)

CDC Public Health Analysis

To date, 4 people among those affected by Hurricane Katrina were reported to be ill from the bacterial disease, Vibrio vulnificus. Three died. The illness is of greatest threat to persons with weakened immune systems and the elderly. Vibrio vulnificus is a bacteria in the same family as those that cause cholera, some media reports have confused these two.

Vibrio vulnificus can cause an infection of the skin when open wounds are exposed to warm seawater. CDC collaborates with Alabama, Florida, Louisiana, Texas, and Mississippi to routinely monitor the number of cases of V. vulnificus in the Gulf Coast region. In studies, people with chronic liver disease and who are immunocompromised are 80 times more likely to develop V. vulnificus bloodstream infections, which can be fatal, than were health people. Importantly, for persons living in evacuation centers person-to-person transmission of V. vulnificus is highly unlikely.

V. vulnificus infection is diagnosed by routine stool, wound, or blood cultures; the laboratory should be notified when this infection is suspected by the physician, since a special growth medium can be used to increase the diagnostic yield. Doctors should have a high suspicion for this organism when patients present with gastrointestinal illness, fever, or shock following the ingestion of raw seafood, especially oysters, or with a wound infection after exposure to seawater. V. vulnificus infection is treated with antibiotics. Doxycycline or a third-generation cephalosporin (e.g., ceftazidime) is appropriate.

Diarrheal diseases, especially pediatric cases of norovirus, among persons living in evacuation centers continue to be reported. Most cases occur in clusters. Infection control measures include vigorous and consistent hand washing and patient separation from the larger population. Public health and medical personnel are monitoring supplies of oral rehydration therapy and hygiene products, including hand sanitation gel for persons displaced by Hurricane Katrina.

CDC is working with local and state public health professionals and medical care professionals to implement the use of rapid health screening and assessment tools. These include, but will not be limited to, infectious disease concerns such as potential cases of respiratory illnesses.

CDC’s Strategic National Stockpile division is continuing to fill urgent requests for medical materials and medications. Tetanus/diphtheria and hepatitis A vaccines are being closely managed as they are in high demand and supply is limited.

CDC public health teams are working closely with other federal agencies and state and local public health professionals on issues related to potential injuries to persons working in the affected communities and those persons who are displaced and are choosing to return to the area temporarily or permanently. Urgent concerns include vector control, especially mosquito control in Louisiana; fire hazards; water and food contamination, and mental health and wellbeing.

CDC is assessing hospital laboratory capacity in the affected states. The assessment is determining capabilities for sample transport, reagent supply, equipment functioning/spare parts, blood product availability (e.g., packed red cells), and personnel staffing shortages. The needs assessment will be used by federal and partner organizations to quickly help fill gaps.

Public Health Recommendations: Pass it On

Contact with Floodwaters
Floodwaters from multiple locations across the New Orleans area were sampled by EPA and analyzed for chemicals and bacteria. These initial results represent the beginning of extensive sampling efforts and do not represent the condition of all flood waters throughout the area. However, given their preliminary results, emergency response personnel and the public should avoid direct contact with standing water when possible. In the event contact occurs, EPA and CDC strongly advise the use of soap and water to clean exposed areas if available. Flood water should obviously not be swallowed and all mouth contact should be avoided. People should immediately report any symptoms to health professionals. The most likely symptoms are stomach-ache, fever, vomiting and diarrhea. Additional information regarding health and safety issues for both the public and emergency responders can be found on the Center for Disease Control (CDC) website (www.bt.cdc.gov/disasters/hurricanes) and the Occupational Safety and Health Administration’s (OSHA) website (www.osha.gov/OshDoc/hurricaneRecovery.html).

Recommendations Regarding Wound Injuries
The risk for injury during and after a natural disaster is high. Tetanus is a potential health threat for persons who sustain wound injuries. Tetanus is a serious, often fatal, toxic condition, but is virtually 100% preventable with vaccination. Any wound or rash has the potential for becoming infected and should be assessed by a health-care provider as soon as possible. These principles can assist with wound management and aid in the prevention of amputations. In the wake of a flood disaster resources are limited. Following these basic wound management steps can help prevent further medical problems.

• Examine wounds for gross contamination, devitalized tissue, and foreign bodies.
• Cleanse the wound periphery with soap and sterile water or available solutions, and provide anesthetics and analgesia whenever possible.
• Irrigate wounds with saline solution using a large bore needle and syringe. If unavailable, bottled water is acceptable.
• Leave contaminated wounds, bites, and punctures open. Wounds that are sutured in an unsterile environment, or are not cleansed, irrigated, and debrided appropriately, are at high risk for infection due to contamination. Wounds that are not closed primarily because of high risk of infection should be considered for delayed primary closure by experienced medical staff using sterile technique.
• Remove devitalized tissue and foreign bodies prior to repair as they may increase the incidence of infection.
• Cover wounds with dry dressing; deeper wounds may require packing with saline soaked gauze and subsequent coverage with a dry bulky dressing.

For more specific information on wound management directed at health professionals: www.bt.cdc.gov/disasters/emergwoundhcp.asp.

Immunizations for Persons in Crowded Group Settings
In addition to the vaccines given routinely as part of the child, adolescent, and adult schedules, the following vaccines should be given to displaced person living in crowded group settings:

• Influenza: Everyone > 6 months of age should receive influenza vaccine. Children 8 years old or younger should receive 2 doses, at least one month apart.
• Varicella: Everyone >12 months of age should receive one dose of this vaccine unless they have a reliable history of chickenpox.
• MMR: Everyone >12 months of age and born after 1957 should receive one dose of this vaccine.
• Hepatitis A: Everyone > 2 years of age should receive one dose of hepatitis A vaccine unless they have a clear history of hepatitis A.

Immunocompromised individuals, such as HIV-infected persons, pregnant women, and those on systemic steroids, should not receive the live viral vaccines, varicella and MMR. Screening should be performed by self-report.

Where to Find Out More

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.

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 hurricanes this season. National Weather Service, National Hurricane Center, Tropical Prediction Center: www.nhc.noaa.gov.

Find Family Members: Family Links Registry: Please go to www.redcross.org. For those who do not have Internet access to www.redcross.org, please call 1 877-LOVED-1S, a toll-free hot line for finding family members.

Missing and Found Children: U.S. Department of Justice is working with the National Center for Missing and Exploited Children. View photos of children looking for their parents and of missing children. If you have any information, call their hot line: 1-888-544-5475.

Click on map for larger image