In the aftermath of Hurricane Katrina's devastation in the Gulf Coast region, it is important for physicians in the United States to consider the infectious disease risks for children who have been displaced or who are still living in affected areas. These risks include infections acquired through ingestion of waterborne organisms; wound infections; lack of immunization continuity; and overcrowding, which increases the risk of respiratory or GI infections. In addition, problems will arise from disruption of therapy for select populations of children, such as those who are HIV-infected; those receiving immunosuppressive treatment; and those in need of continuous antibiotic prophylaxis, such as those who have sickle cell disease.
The effect of hurricanes on public health has been well documented. In 1999, Campanella reported a significant increase in the incidence of acute diarrhea and acute respiratory tract infections after Hurricane Mitch in Nicaragua.1 The increased incidence of GI infection is closely related to the flooding, as demonstrated by Kunii and collaborators,2 who studied the impact on health and risk factors for diarrhea epidemics in the 1998 Bangladesh floods. Examples of infections caused by waterborne organisms in this type of disaster include hepatitis A and viral gastroenteritis, which is commonly associated with dehydration. Factors that may increase the risk of diarrheal disease during floods include use of pond water in the kitchen, improper hand washing before eating, open-field defecation, and storage of drinking water in wide-mouth vessels.3 A helpful set of recommendations for the prevention of diarrheal diseases in evacuation centers has been developed by the CDC and can be found at http://www.bt.cdc.gov/disasters/ hurricanes/katrina/diarrheal.asp.
Besides diarrheal disease, other infectious conditions that should be considered in flooding situations, especially in the areas affected by Hurricane Katrina, include infections with Vibrio species, particularly Vibrio vulnificus, and those caused by atypical mycobacterial organisms such as Mycobacterium marinum (CDC Health Advisory. Available at http://www.phppo.cdc.gov/ HAN/ ArchiveSys/ViewMsgV.asp? AlertNum=00233). These organisms and others, such as Staphylococcus aureus, can cause skin and soft tissue infections or systemic manifestations that can result from lesions sustained during or after a storm.
An additional consideration is the potential for an increase in the mosquito population in flooded areas, which carries the associated risk of mosquito-borne illnesses, such as infection with West Nile virus. A catastrophe of this magnitude should raise the index of suspicion for conditions that normally are not highly prevalent. An example is leptospirosis, which has also been reported elsewhere as an infection associated with flooding, especially when environmental conditions favor the spread and survival of Leptospira species. Those conditions include warm temperatures and the presence of animal reservoirs, such as dogs and rodents.
In addition to the potential for development of infection directly related to environmental conditions in the areas affected by the hurricane, it is important to consider the risk of infections that may occur as a consequence of displacement or living in crowded environments. These include vaccine-preventable diseases that may arise as a result of lack of immunization continuity among displaced children. Physicians should also consider the higher risk of respiratory infections with agents such as respiratory syncytial virus, parainfluenza virus, and influenza virus, to which children living in shelters or crowded conditions may be more vulnerable. Every effort should be made to continue routine immunizations among displaced children. Interim immunization recommendations for evacuees of Hurricane Katrina have been published by the CDC and can be found at http://www.bt.cdc.gov/disasters/ hurricanes/katrina/pdf/ vaccrecdisplaced.pdf.