From the CDC Director’s Emergency Operations Center - P.M. Update, September 14, 2005

Top Line - Public Health

A cluster of 30 adults and children in a Texas evacuation center have skin abscesses: cultures from some of these patients indicate methicillin-resistant Staphylococcus aureus (MRSA) infection.

Early reports, based on limited hospital surveillance, suggest that the most commonly reported hurricane-related injuries are from falls.

A combination of new mosquitoes and preexisting virus could increase West Nile and other virus transmission activity approximately three to four weeks after the storm. Control measures are ongoing in the region.

National Public Health Emergency Situation Update:

• Persons in Evacuation Centers: 348 open, 62,332 people in 18 states (numbers fluctuate daily)
• Damage Assessments: 403,000 without power (435,000 9/13)
• Official Death Numbers: (reporting systems are being standardized)

CDC Public Health Workforce Deployed in Affected Communities:

• Total: 216 (227: 9/13) including the following specialties: public health nursing, occupational, laboratory, medical, epidemiologist, sanitation, environmental health, disease surveillance, public information and health risk communication.
• By State: AR 13; DC 4; GA 6; LA 77; MS 61; TX 53; WV 1
• Preparing to Deploy: 12
• Deployed to Director’s EOC: 159 (As of 9/8)

CDC Public Health Analysis:

MRSA: A cluster of 30 adults and children in a Texas evacuation center have skin abscesses: cultures from some of these patients indicate methicillin-resistant Staphylococcus aureus (MRSA) infection. MRSA is endemic in the United States and can occur as community outbreaks (e.g., football teams). The patients are receiving clinical care and infection control measures are ongoing.

Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) in the nose with staph bacteria. Sometimes, staph can cause an infection. Staph bacteria are one of the most common causes of skin infections in the United States.

MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as community associated or CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people. www.cdc.gov/ncidod/hip/ARESIST/ca_mrsa.htm

Vibrio Update: Laboratory tests confirm 21 persons have become ill from Vibrio spp. infections. Five have died. These pathogens are of greatest threat to persons with weakened immune systems, persons with chronic liver disease and the elderly. The strains identified include V. vulnificus resulting in 16 persons becoming ill and three deaths; V. parahaemolyticus resulting in three illnesses and two deaths; and nontoxigenic V. cholerae resulting in one illness. The two cases of nontoxigenic V. cholerae are not from the serogroup that causes cholera epidemics. These illnesses are not transmitted from person to person.

Overall Illness and Injury Reports: Early reports, based on limited hospital surveillance, suggest that sporadic cases of rash are occurring among people in Hurricane Katrina affected areas, including persons who were evacuated, rescue workers and military personnel. The most commonly reported injuries are from falls. In addition, sporadic reports of diarrheal illness continue, as do reports of acute respiratory illness. Epidemiologic surveillance is ongoing and infection control measures are being encouraged.

Immunization Efforts: CDC is actively coordinating immunization efforts for persons displaced by Hurricane Katrina, especially those staying in evacuation centers. States directly involved in the vaccination needs assessment currently include Louisiana, Mississippi, Texas, Arkansas, Oklahoma, and West Virginia. Immunization plans, including plans for influenza vaccination, will be tailored based on state assessments.

Mosquito Control: Spraying to kill adult mosquitoes that could carry the West Nile and other viruses continues today. CDC has received reports of 17 laboratory positive West Nile illnesses among people in Louisiana and Alabama since August 30. This is peak season for West Nile disease in the Southeast United States. People should use insect repellent containing DEET (Look for: N,N-diethyl-meta-toluamide) or Picaridin; wear long sleeved tops and long pants; and avoid outdoor activities, if possible, at dusk and dawn. Vector control experts note that a combination of new mosquitoes and preexisting virus could increase transmission activity approximately three to four weeks after the storm. This makes public health mosquito control measures within the affected communities, as well as individual prevention measures, critically important.

Future Directions: The strategic direction for CDC’s public health response is transitioning. It is moving from acute public health issues such as infectious disease control in evacuation centers to interim issues such as occupational safety and injuries among persons returning to damaged communities. CDC public health professionals are working with local, state, and federal authorities on the safe and timely return of people to communities affected by Hurricane Katrina.

Public Health Reports from States

Alabama: Alabama reported 3 laboratory-positive human cases of West Nile and no deaths since August 30. All tuberculosis patients from the Hurricane Katrina affected areas have been identified to ensure continuation of TB therapy.

Louisiana: CDC is adding to its deployed public health professionals in Louisiana, including persons to support vessel sanitation, tuberculosis surveillance, and epidemiologists to support ongoing or new disease investigations. CDC entomologists continue to work in Louisiana with local mosquito control authorities. Mosquito surveillance shows a significant increase since before the hurricane. Louisiana reported 14 laboratory-positive human cases of West Nile and no deaths from West Nile, since August 30. Spraying against flies and mosquitoes continues and is expanding. Louisiana continues to identify tuberculosis patients displaced by Hurricane Katrina to ensure continuation of TB drug therapy if needed. Clinical evaluations, including biopsies, of rashes are ongoing. CDC is working with local and state officials to develop plans for rebuilding the public health infrastructure in New Orleans and surrounding areas.

Mississippi: Food service inspections have begun in affected counties. Mississippi has reported no laboratory-positive human cases of West Nile since August 30. All tuberculosis patients from the Hurricane Katrina affected areas have been identified to ensure continuation of TB drug therapy if needed. Clinical evaluations, including biopsies, of rashes are ongoing. A CDC 5-person vector surveillance team was deployed to Mississippi to concentrate on mosquito control.

Texas: CDC surveillance systems are reporting on gastrointestinal, respiratory, fever, and rash illnesses among persons staying in evacuation centers. Public education and infection control measures are ongoing.

Comparison with CDC Web Traffic During Other Events
(Days selected for comparison are days of peak traffic during an event, from outside CDC)

Public Health Recommendations: Pass it on

Prevent and Treat Trench Foot or Immersion Foot
Trench foot, also known as immersion foot, occurs when the feet are wet for long periods of time. It can be quite painful, but it can be prevented and treated.

Symptoms of trench foot include a tingling and/or itching sensation, pain, swelling, cold and blotchy skin, numbness, and a prickly or heavy feeling in the foot. The foot may be red, dry, and painful after it becomes warm. Blisters may form, followed by skin and tissue dying and falling off. In severe cases, untreated trench foot can involve the toes, heel, or entire foot.

When possible, air-dry and elevate your feet, and exchange wet shoes and socks for dry ones to help prevent the development of trench foot. Treatment for trench foot is similar to the treatment for frostbite. Take the following steps:

• Thoroughly clean and dry your feet.

• Put on clean, dry socks daily.

• Treat the affected part by applying warm packs or soaking in warm water (102° to 110° F) for approximately 5 minutes.

• When sleeping or resting, do not wear socks.

• Obtain medical assistance as soon as possible.

If you have a foot wound, your foot may be more prone to infection. Check your feet at least once a day for infections or worsening of symptoms.
www.bt.cdc.gov/disasters/trenchfoot.asp

New: Recommendations for Persons Undergoing Blood Glucose Monitoring in Evacuation Centers for the Prevention of Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Transmission
www.bt.cdc.gov/disasters/diabetes/

New: Keep It With You: Personal Medical Information Form
www.bt.cdc.gov/disasters/hurricanes/katrina/kiwy.asp

Grief in a Cultural Context
In a catastrophic event in the United States, communities or the nation may face what experts call “death out of time.” The death of someone who dies unexpectedly (e.g., the death of a child) can be much more difficult to cope with. People communicating to an individual or community experiencing the extreme pain and grief that accompanies loss through death must be especially aware of how this grief is suffered. Grief is experienced in a broad social context. Bereavement, mourning, and grief are culturally based and although loss of a loved one in all cultures involves strong feelings of sadness, the emotions and activities surrounding that loss can be quite different. What is acceptable in the bereavement process depends on the culture in which one was raised and lives. One’s ethnicity may touch on every aspect of dying and death, including how one handles the dead body, the disposal of the body, and the rituals to mark the loss.

Although it is important to understand the cultural context of the bereavement process, it is also important not to discount individual aspects of bereavement such as personality traits.

Communicating About Death One-on-One
The following are some basic thoughts about communication styles in an intimate but highly emotional health emergency situation:

When speaking to grieving family members, your presence is more important than conversation. Family members may voice feelings with such strong emotion as “I don’t know how I’m going to live without my husband,” or “Why would God allow this to happen?” Short statements of condolence, such as “I’m so sorry,” “This is a sad time,” or “You’re in my prayers,” are enough of a response. If a persons tenses at your touch, withdraw. Use “death” or “dying” not softer euphemisms. Many people feel patronized by words like “expired” or “received his heavenly reward.” Use the same words as the grieving person to respect cultural differences. Refrain from platitudes—“She lived a good life,” or “She is no longer suffering.” These statements can trivialize the family’s loss.

Avoid sharing your personal experiences of death and grief so you can keep the focus on the family member. Be careful to avoid sending signals that you are distracted or need to do something else. Don’t glance at papers, your watch, the elevator, the clock, or others in a conversation. Focus on the person and speak gently and without haste. Offer support—don’t wait to be asked.
www.cdc.gov/communication/emergency/features/f001.htm

Where to Find Out More About:

Friday, September 16, 2005, has been designated a National Day of Prayer and Remembrance for the Victims of Hurricane Katrina. Hurricane Katrina was one of the worst natural disasters in U.S. history and has caused unimaginable devastation and heartbreak throughout the Gulf Coast region. www.whitehouse.gov/news/releases/2005/09/20050908-12.html

International Help to U.S. for Hurricane Katrina. As of Sept. 12, 117 countries and 12 international organizations have offered or sent money, food, vital supplies and technical assistance to the United States for Hurricane Katrina response. www.whitehouse.gov/ask/20050912.html.

The Department of Education launched a website, Hurricane Help for Schools, at www.ed.gov/katrina. The site helps match schools with displaced students with companies, organizations, other schools and individuals willing to donate.

A bibliography of GAO products related to disaster preparedness, response, and reconstruction has been posted on GAO's Internet site at www.gao.gov/docsearch/featured/dprr.html.

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.

The next CDC DEOC Hurricane Katrina update will be Friday, Sept. 16, 2005

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