Highlights From MMWR: CDC Katrina Evacuation Center Surveillance

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Highlights From MMWR: CDC Katrina Evacuation Center Surveillance and

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Yael Waknine

http://www.medscape.com/viewarticle/522055

Jan. 20, 2006 — The Centers for Disease Control and Prevention (CDC)

reported in the January 20 issue of the Morbidity and Mortality

Weekly Report on outbreak and chronic disease surveillance data from

Hurricane Katrina evacuation centers; inadequate protection among

residents and workers against high mold levels in areas previously

flooded by Hurricanes Katrina and Rita; and an increased prevalence

of HIV testing among individuals aged 15 to 44 years with multiple

opposite-sex partners.

CDC Reports: Outbreak and Chronic Disease Surveillance in Katrina

Evacuation Centers

On September 8, 2005, an existing program designed to conduct

routine, active surveillance for disease and injury among military

personnel was adapted to conduct surveillance of evacuation centers

(ECs) for Hurricane Katrina refugees throughout the state of

Louisiana.

A 1-page daily surveillance form was used to collect and analyze

data on communicable disease syndromes, chronic medical conditions,

injuries, and mental health conditions in 489 ECs with individual

populations ranging from fewer than 10 to as many as 7000 persons.

From September 8 to October 26, 2975 surveillance forms reporting on

39,217 patient encounters were completed during the 49 days of

operation. Most (61%) of ECs submitted at least 1 form.

Although the system enabled daily surveillance of nearly 64% of the

EC population, the average daily proportion under surveillance was

33%, with an average 23% of ECs submitting a form on any given day.

Factors contributing to the low reporting rate may have included the

voluntary nature of the reports; lack of healthcare

training/syndrome recognition among EC staff; rapid staff turnover;

and communication difficulties.

Influenza-like illness (4.7 cases/day; range, 0 - 8.8 cases/day) and

rash (2.7 cases/day; range, 0 - 13.8 cases/day) were the most

commonly reported communicable diseases, with skin infestations such

as scabies or lice occurring in the largest cluster (n = 60 cases).

The CDC notes that the majority of large clusters were attributed to

overreporting; for example, further investigation revealed the 60-

case cluster to involve only 4 confirmed cases of scabies, with the

remainder of patients receiving prophylactic treatment.

Chronic medical conditions such as diabetes, asthma, chronic

obstructive pulmonary disease, high blood pressure or coronary

vascular disease, and mental health conditions accounted for 31% of

encounters. Many of these were related to replacement of lost

medications and resumption of medical treatment; only 9% of

encounters involved mental health conditions.

Post-Hurricane CDC Investigation Finds Mold Protection Inadequate

In the wake of Hurricanes Katrina and Rita, 46% of inspected homes

in previously flooded areas of New Orleans and its environs were

found to contain visible mold. However, many residents and

remediation workers did not consistently use appropriate respiratory

protection, according to the results of an investigation by the CDC

and the Louisiana Department of Health and Hospitals.

A total of 112 occupied homes were inspected, representing a cross-

section of 440,269 residences in a 4-parish area. Flood levels had

been high (>6 feet), medium (3-6 feet), and low (<3 feet) in 18.8%,

17.0%, and 64.3% of homes, respectively; 67.9% of homes had roof

damage with water leakage.

Visible mold growth occurred in 45.5% of homes, and 17% had heavy

mold covering more than 50% of the interior wall on the most-

affected room. The distribution of heavy mold coverage was directly

related to the degree of flooding (high, 52.6%; medium, 36.8%; low,

10.5%).

Residents reported being indoors doing heavy and light cleaning for

an average of 13 and 15 hours, respectively. Many (60.7%) had

inhabited their homes for an average of 25 nights since the

hurricanes.

An analysis of air samples revealed that Aspergillus and Penicillium

species of fungi predominated indoors and outdoors. Mean indoor

endotoxin levels were more than 20 times higher than that normally

expected and exceeded those associated with respiratory symptoms.

Five homes were found to have endotoxin levels comparable to those

of certain industrial settings that have been linked to decreased

pulmonary function.

Assessment of (1 & #8594;3,1 & #8594;6)- & #946;-D-glucan levels also indicated that

mold

growth inside the homes was likely at or above a level sometimes

associated with certain health effects such as cough, airway

hyperreactivity, influenza-like symptoms, ear/nose/throat

irritation, decreased lung function, and skin rash.

Of 159 residents interviewed, the majority (96.2%) were aware that

mold can cause illness and many (67.9%) correctly identified

particulate-filter respirators as appropriate respiratory protection

devices to be used when cleaning mold. However, many of those who

had cleaned up mold (42.1%) did not always use appropriate

respirators (68.7%) for reasons such as discomfort (21.7%) and lack

of availability (21.7%).

Findings were similar among 76 remediation workers interviewed;

although awareness of potential harm from mold and the need for

appropriate respiratory protection was high (94.7%, 85.5%), many of

those who had already participated in mold remediation activities (n

= 69, 90%) had not been fit tested (49.3%) and did not always use

appropriate respirators (34.8%), primarily because of discomfort

(54.2%).

According to the CDC, future public health interventions in this

setting and after catastrophic floods should emphasize the

importance of safe remediation practices and ensure the availability

of recommended personal protective equipment.