From the CDC Director’s Emergency Operations Center - P.M. Update, September 8, 2005

Top Line - Public Health

Carbon monoxide deaths and poisoning among Hurricane Katrina affected states are being reported and people should be urgently cautioned about this hazard.

The potential for post-storm and flooding injuries is a concern. CDC offers guidance on protective clothing and equipment for people returning to storm or flood areas.

Rapid health assessments for public health delivery, infectious and environmental health concerns, and mental well-being are ongoing.

National Public Health Emergency Situation Update:

• Persons in Evacuation Centers: 504 open, 143,712 people in 14 states (numbers fluctuate daily)
• Damage Assessments: 825,903 without power (858,758 9/7)
• Official Death Numbers: AL 2; FL 14; LA 59; MS 154 Total: 229

CDC Public Health Workforce Deployed in Affected Communities:

• Total: 202 (182: 9/7) including the following specialties: laboratorians, medical, epidemiologist, sanitation, environmental health, assessment, disease surveillance, public information and health risk communication.
• By State: DC 3; GA 6; LA 79 (63 09/07); MS 51 (44 9/7); TX 61 (59 9/7) AR 1 (See map for deployment locations)
• Preparing to Deploy: 5
• Deployed to Director’s EOC: 159 (As of 9/7)

CDC Public Health Analysis:

To date 13 people among those affected by Hurricane Katrina were reported to be ill from infections caused by Vibrio spp. The majority of these infectious are wound infections associated with Vibrio vulnificus. This remains a small but increasing number of confirmed illnesses. Infection control includes avoiding warm seawater from coming into contact with broken skin or wounds, and vigorous wound cleaning and medical evaluation. The illness is of greatest threat to persons with weakened immune systems and the elderly. This illness is not transmitted person to person. CDC is working with local and state public health officials and clinicians in shelters to conduct rapid disease detection and ongoing disease surveillance. A fact sheet and Health Advisory have been disseminated.

In addition, to correct misreports about the types of illnesses that are being detected, it may be helpful to know that the bacterial species Vibrio cholerae has many different types, or serogroups. Only two of those types have ever caused epidemic cholera: serogroups O1 and O139 (O139 is found only in Asia).Even among those serogroups, strains that lack cholera toxin are not going to cause cholera.

The other serogroups are known collectively as "non O1, non O139 V. cholerae." Although these can cause diarrheal illness, it is generally mild, compared with the organism that causes the disease cholera, and do not have epidemic potential. These bacteria also rarely can cause wound infections. Diarrheal illness is treated with rehydration. Sepsis or wound infections require antibiotic treatment.

Like other Vibrios, non 01, non 0139 V. cholerae:

• have a natural reservoir in the brackish waters along the coast, particularly warm, subtropical waters.

• the most common route of infections is from eating raw or undercooked shellfish harvested from those waters, especially raw oysters.

• infections are seasonal, with a peak in the late summer, early fall coinciding with the warmest water temperatures

Sporadic Disease Clusters

Sporadic outbreaks of diarrheal diseases 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.

CDC’s National Institute for Occupational Safety and Health (NIOSH) has provided guidance to flood cleanup workers in the Hurricane Katrina affected areas. Workers and volunteers involved with flood cleanup should avoid direct skin contact with flood waters if possible and through the use of appropriate personal protective equipment (PPE) and clothing. People should wear sturdy boots (not sneakers), heavy work gloves and hats. Goggles and ear protection are also recommended.

A medical intake form is now available. CDC has created an interim form to be used for medical intake assessment and triage of evacuees entering an evacuation center. The form can be used to identify persons who were evacuated who may need additional medical evaluation and treatment. The form can be used to anonymously report medical conditions among evacuees such as respiratory illness, gastrointestinal illness, dermatologic conditions, mental health conditions, and injuries. It also can be used to identify chronic health issues and medication needs. For more information and a electronic copy of the intake form: www.bt.cdc.gov/disasters/hurricanes/katrina/evacueeform.asp.

Public Health Recommendations: Pass it On

Preventing Carbon Monoxide Poisoning
People in areas with power outages due to Hurricane Katrina, should 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.

People uncomfortable in their homes should look to friends or a community evacuation center for help. If someone must use an alternative source of fuel or electricity, they should be sure to use it only outside and away from open windows. Every year, more than 500 people die from accidental CO poisoning. CO is found in combustion fumes, such as those produced by small gasoline engines, stoves, generators, lanterns, and gas ranges, or by burning charcoal and wood. CO from these sources can build up in enclosed or partially enclosed spaces. People and animals in these spaces can be poisoned and can die from breathing CO in an enclosed or partially enclosed space.

How to Recognize CO Poisoning: Exposure to CO can cause loss of consciousness and death. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. People who are sleeping or who have been drinking alcohol can die from CO poisoning before ever having symptoms. If you think you may have CO poisoning, consult a health care professional right away.

Important Tips

• Never use a gas range or oven to heat a home.

• Never use a charcoal grill, hibachi, lantern, or portable camping stove inside a home, tent, or camper.

• Never run a generator, pressure washer, or any gasoline-powered engine inside a basement, garage, or other enclosed structure, even if the doors or windows are open, unless the equipment is professionally installed and vented. Keep vents and flues free of debris, especially if winds are high. Flying debris can block ventilation lines.

• Never run a motor vehicle, generator, pressure washer, or any gasoline-powered engine outside an open window or door where exhaust can vent into an enclosed area.

• Never leave the motor running in a vehicle parked in an enclosed or partially enclosed space, such as a garage.

For more information on carbon monoxide poisoning: www.bt.cdc.gov/disasters/carbonmonoxide.asp

Guidance for Flood Cleanup Workers
CDC’s National Institute for Occupational Safety and Health (NIOSH) has provided guidance to flood cleanup workers in the Hurricane Katrina affected areas. Workers and volunteers involved with flood cleanup should avoid direct skin contact with flood waters if possible and use appropriate personal protective equipment (PPE) and clothing. In most instances, the selection of PPE will be dependent on site specific conditions, hazards, and tasks. The following are some of the PEE and clothing recommendations for flood response workers:

• Electrically insulated, watertight boots with steel shank, toe, and insole. Tennis shoes or sneakers should not be worn because they will transfer contamination and will not prevent punctures, bites, or crush injuries. Hip waders may be appropriate to help prevent contact with flood waters;

• Heavy, waterproof, cut-resistant work gloves. Other types of protective gloves may be required if handling identified material hazards;

• Goggles, safety glasses with side shields or full face shields. Sun/glare-protective lenses may be needed in some work settings;

• Soft hat or other protective head cover. Wear an American National Standards Institute (ANSI) rated hardhat if there is any danger of falling debris or electrical hazards;

• Hearing protection (when working in an environment with any noise that you must shout over to be heard);

• Comfortable, form fitting, light-weight clothing including long pants and a long sleeved shirt or coveralls;

• Under some work conditions, NIOSH approved respirators may be necessary (e.g., for exposures to mold-contaminated materials/environments, or other recognized chemical, physical, or biological hazards).

For more information: www.cdc.gov/niosh/topics/flood/ppe-flood.html

Where to Find Out More About:

Hurricane Katrina Recovery
This site includes information on what the government is doing, how to get help, and how to find family and friends from government and nongovernment sources.
www.firstgov.gov/Citizen/Topics/PublicSafety/
Hurricane_Katrina_Recovery.shtml.

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.

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

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