Public Health Issues in the Wake of Katrina

Transcription

1 Public Health Issues in the Wake of Katrina And Rita too. A Presentation by: Pavani K. Ram, MD Research Assistant Professor Department of Social and Preventive Medicine University at Buffalo

2 Public Health in the Disaster Setting: overlapping sectors Health services Shelter Public health Water and sanitation Food security

3 The Sphere Project: the bare minimum Internationally recognized standards for care of crisis-affected populations Fundamental principles All possible steps should be taken to alleviate human suffering arising out of calamity and conflict Those affected by disaster have a right to life with dignity and therefore a right to assistance

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5 Standards for Water Standard: All people have safe and equitable access to a sufficient quantity of water for drinking, cooking and personal and domestic hygiene. Indicators: Average water use is at least 15 liters per person per day Appropriate quantities of water are available consistently or on a regular basis

6 So, how did it go in Louisiana? At the Superdome Two nine-oz bottles of water per person per day Seattle Times, 10/1/05

7 American Red Cross Distribution Site New Orleans, LA (10/19/05)

8 Standards for Sanitation Standard: People have adequate numbers of toilets, sufficiently close to their dwellings, to allow them rapid, safe and acceptable access at all times of the day and night. Indicators Maximum of 20 persons per toilet Separate toilets for men and women People wash their hands after defecation

9 So, how did it go in Louisiana? At the Superdome We pee on the floor. We are like animals" Seattle Times, 9/1/05 Bathrooms had no lights, making people afraid to enter, and the stench from backedup toilets inside killed any inclination toward bravery. Fox News, 9/2/05

10 Shelters in Louisiana 10/17/05-10/18/05 Separate bathrooms available for men and women in shelters Person to toilet ratio was acceptable Handwashing facilities available in sites visited

11 Standards for Hygiene Standard: All facilities and resources provided reflect the vulnerabilities, needs and preferences of the affected population. Indicators: Sufficient soap per person per month Separate bathing facilities for men and women Community mobilization to prioritize key hygiene risks and appropriate hygiene promotion messages

12 So, how did it go in Louisiana?

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15 Observed Public Health Consequences of the Hurricanes

16 Diseases of Epidemic Potential after Natural Disasters Outbreaks are relatively uncommon after natural disasters Extensive attention to possibility of outbreaks of cholera, dysentery, and typhoid fever Vast majority of cholera cases seen in US are acquired overseas or from imported food Underlying principle You can only have epidemics of diseases that are circulating in the population Exceedingly low risk of diseases such as cholera or S. dysenteriae type 1 in US disasters

17 Diarrheal Disease Gastrointestinal illness most common complaint among evacuees Two clusters of norovirus infection detected Causes 23 million cases of GI illness in US annually Spreads in crowded situations (cruises, classrooms) No confirmed cases of cholera or S. dysenteriae type 1

18 Non-choleragenic Vibrio infections Vibrio vulnificus and V. parahaemolyticus Immunocompromised persons at increased risk Gulf Coast states contribute 35% of annual burden of 400 cases 24 cases as of September 30 th Clear increase above baseline Majority were wound infections Likely because of contact with contaminated flood waters US Food and Drug Administration

19 Other Dermatologic Conditions Methicillin-resistant S. aureus skin infections 30 evacuees from New Orleans Suggests close contact and inadequate hygiene

20 Respiratory infections Upper respiratory infections and pneumonias reported Whooping cough in infant rescued from rooftop Appropriate prophylaxis administered No illness detected among contacts Tuberculosis Crowding in shelters may facilitate transmission Detecting new cases critical Continuing treatment for known cases Interruption risks development of drug resistance

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22 The Human Toll: mental health in the wake of the hurricnaes 1 million people displaced Separated from family Living in crowded shelters Access to infrastructure limited Trauma among mainstream population likely to be important public health issue Special needs shelters For people with severe chronic medical problems, psychiatric diagnoses, addictions Anecdotally, insufficient number of trained professionals staffing these shelters

23 Preliminary conclusions Clusters of gastrointestinal, respiratory illness, and wound infections detected No large outbreaks observed Early and ongoing provision of potable water, sanitation, and hygiene tools may have prevented outbreaks Mental health services for previously diagnosed and for general public may need to be enhanced

24 Courtesy of CDC