|
Shelter from the Storm
Jennifer Thew, RN, MSJ, and Phyllis Class, RN
As Katrina’s floodwater recedes, health care providers must monitor evacuees for signs of illness.
Hurricane Katrina left Gulf Coast residents facing an unusual situation — too much water and too little water. As floodwater trapped some citizens in their homes for days without food, electricity, or much-needed fresh drinking water, others found shelter in places like the Superdome and were forced to suffer crowded conditions, no air-conditioning, filthy bathrooms, and overflowing trash.
In the wake of Katrina, as with other major storms, concern over major disease outbreaks grew. While the spread of cholera and typhoid sounds frightening, experts from the Centers for Disease Control and Prevention say these diseases rarely occur after hurricanes in the U.S. However, the conditions seen after Katrina — defunct water and sewage systems, rotten food, and close quarters —could contribute to the development of a number of other conditions in displaced persons now spread out across the country.
Photos courtesy of CDC.
West Nile virus
What’s known: West Nile virus is a flavivirus that was first detected in the western hemisphere in 1999 and now present in the continental U.S. Transmission of the virus occurs when a mosquito infected with West Nile bites a human. The disease is not spread via person-to-person contact.
The virus can cause meningitis, encephalitis, fever, headache, fatigue, muscle soreness, and often a rash. Less than 1% of people infected with West Nile develop severe illness; those who become severely ill have fatality rates ranging from 3% to 15%, says the CDC. The highest fatality rates occur among the elderly.
What’s expected: “There has been concern all of the standing water [in the hurricane-stricken Gulf Coast] is likely to lead to increased mosquito production,” says J. Todd Weber, MD, deputy assistant, National Center for Infectious Disease and team leader of the agency’s clinical care team for Hurricane Katrina response during the CDC’s Sept. 13 Clinical Outreach and Communication Activity conference call regarding hurricane-related issues.
“In terms of particular risk among evacuees, we would really be looking for the three- to four-week period after the water was standing,” says Weber. “We’re not quite in that period yet, but it [West Nile virus] is something to keep in mind for the future.”
For more information about West Nile virus symptoms and treatment, visit the CDC’s West Nile home page at www.cdc.gov/ncidod/dvbid/westnile/index.htm. For continuing education credit on this topic, visit West Nile Virus: Spread of the mosquitoborne illness.
Leptospirosis
What’s known: A bacterial infection affecting both humans and animals, leptospirosis is contracted after exposure to infected animals, including dogs, rodents, and wild animals, or to water contaminated with the urine of infected animals. Fortunately, leptospirosis is not spread via person-to-person contact. Patients with leptospirosis present with a variety of symptoms ranging from none at all to high fever, muscle aches, severe headache, and even jaundice.
What’s expected: After spending time in the flood waters, evacuees may be at risk for developing leptospirosis. Symptoms develop anywhere from two days to four weeks after bacterial exposure.
While there have been no reports of leptospirosis cases, Weber recommends health care providers “keep an eye out for” the disease in coming weeks.
For more information on leptospirosis and its treatment, visit www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm.
Vibrio vulnificus
What’s known: A bacterium living in marshy, brackish waters like those of the Gulf Coast, Vibrio vulnificus can infect wounds exposed to water in which it’s present. Infection with the bacterium can cause pain, redness and swelling in wounds, blood blisters on the arms and legs, and even low blood pressure and shock. Patients with weakened immune systems or preexisting liver disease are most susceptible to V. vulnificus.
What’s expected: The CDC reports there have been 16 infections and three deaths related to V. vulnificus.
“There seems to be a short period in which exposures were leading to these infections,” says Weber, “but it doesn’t seem as if those exposures are continuing at this time. It is quite a severe disease, and if you see someone with increased redness, swelling, or pain in a wound [who has] a history of exposure to brackish water, you have to think of this because it is rapidly progressive.”
For more information on Vibrio vulnificus infection and treatment, view the CDC’s Vibrio vulnificus fact sheet at www.bt.cdc.gov/disasters/vibriovulnificus.asp.
Norovirus
What’s known: Weber says this extremely contagious virus causes acute onset of vomiting followed by watery, nonbloody diarrhea. Symptoms also may include fever, soreness, headache, and abdominal cramps lasting from three to five days.
What’s expected: The cramped quarters of some relief shelters are an excellent environment for promoting the spread of norovirus. While there is no medical treatment for the virus, patients experiencing vomiting and diarrhea should focus on oral rehydration with water or fruit juice.
Arjun Srinivasin, MD, a medical epidemiologist with the CDC, says handwashing, especially after using the toilet or before eating a meal, should be encouraged among survivors to prevent the spread of the disease.
“In the shelters, there have been sporadic outbreaks of gastrointestinal problems,” Srinivasin says. “But less and less of that is being seen as people move to shelters with running water and properly working toilet facilities.”
Srinivasin underscores the importance of health care workers’ educating those living in evacuee centers on the importance of handwashing and hygiene.
“In these centers,” he says, “health care workers are watching for evidence of disease outbreaks and are working to prevent them by teaching handwashing, the use of waterless hand cleansing products, and respiratory etiquette, such as covering the mouth when coughing and using tissues.”
For more information on norovirus, visit the CDC’s website at www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm. For handwashing education information, read “An Ounce of Prevention Keeps the Germs Away” at www.cdc.gov/ncidod/op/handwashing.htm.
Tuberculosis
What’s known: Spread through droplet transmission when an infected person coughs or sneezes, tuberculosis grows in the lungs and can spread to other parts of the body. Patients with active TB may experience a cough lasting longer than three weeks, chest pain, bloody sputum, fatigue, weight loss, diminished appetite, chills, fever, and night sweats.
What’s expected: “We haven’t seen so far the evidence of exposure and spread of TB among evacuees in the centers,” says Weber. To the best of the CDC’s knowledge, he adds, most patients with histories of TB before the hurricane have been located by state health departments and placed back on their medication regimens.
“We don’t anticipate this to be a large problem, but that may be an unfolding story, ” Weber says. “Right now there is no recommendation for doing nontargeted PPD skin testing for evacuees.”
For continuing education credit on this topic, visit TB or Not TB?
Influenza
What’s known: Each year, more than 200,000 people are hospitalized for flu complications, and 36,000 people die as a result of the illness, the CDC reports. Spread person-to-person via respiratory droplets, infected patients may experience high fever, headache, fatigue, dry cough, sore throat, runny nose, muscle aches, nausea, vomiting, and diarrhea.
What’s expected: According to Srinivasin, CDC experts are concerned about the approach of the influenza season, especially for people living in the evacuee centers. For now, he says, the agency’s long-standing recommendations regarding influenza vaccines for those in high-risk groups remain the same, but are under scrutiny.
“The situation in the evacuation centers is being reviewed, so it is conceivable there would be a change in those [influenza vaccine] recommendations,” Weber says. “Those [recommendations] are being reviewed right now by influenza experts.”
For more information on influenza vaccine recommendations, visit www.cdc.gov/flu/.
|
|
| Jennifer Thew, RN, MSJ, is a senior staff writer and editorial director for the Heartland and Midwest divisions of Nursing Spectrum. Phyllis Class, RN, is editorial director for the Florida and Southeast divisions of Nursing Spectrum. |
 |
|
