Oct
06
2018

Health Risks After Hurricanes

By | Infectious Disease, Lung Disease, Mortality, Prevention

We hear a lot about the dangers of hurricanes when they are in a region, but very little regarding health risks after hurricanes. I thought it would be interesting to review all of the health risks in a blog.

Health risks during a hurricane

A lot of the health risks during a hurricane are directly related to the risks from the wind severity, the amount of rain per hour and the physical damage from the hurricane. The excessive wind can uproot trees and they may fall right onto a house. This happened in the beginning of hurricane Florence. The amount of rain that comes down in a short time frame can be astounding. It causes flooding, which together with the high wind speeds can make you lose your footing. There is flying debris, torn away pieces of wood and drywall that can become a hazard to any person. It is a hazard that could kill you right there. It is best to be out of the way of a hurricane, if you can at all. But you need to watch hurricane predictions on the Internet or the news, so you know what is going on long before the hurricane arrives. This gives you enough time to travel away from the danger zone. People who live on islands need to be particularly proactive, so that they get out of harms way in time.

Be safe from floodwaters

If you live in a low-lying area, it is safer for you to leave and go to a shelter before the hurricane hits. Otherwise you end up drowning. Being on top of your house in a hurricane is dangerous as the roof may fly off any minute from the force of the wind. You are also the target of flying debris, wood pieces and other flying objects.

Contaminated water is one of the major health risks after hurricanes

With hurricane Maria in 2018 it appeared in the first few days that only 16 to 18 people had died from the physical effects of the hurricane in Puerto Rico. But in the subsequent weeks and months people died en masse because of infections from contaminated drinking water. It is unbelievable that huge water supplies had been brought in by FEMA following the hurricane Maria, but it was not distributed to the people who needed it. The total death toll is now around the 3000 mark. FEMA calculated this by subtracting 13,000 deaths due to natural causes from the total deaths of 16,000. The difference is about 3,000 deaths, attributable to hurricane Maria.

Providing clean drinking water important

Providing clean drinking water should be the first priority following a hurricane. This will prevent that people get the typical water-born bacterial and viral illnesses following a hurricane.

One patient in Puerto Rico with chronic emphysema was on a breathing machine. The interruption of electricity as a result of hurricane Maria meant his death. Some people are so vulnerable that the interruption of electricity ends their life.

Communicable diseases from floodwaters

The WHO has brought out a fact sheet regarding communicable diseases from floodwaters. People need to be aware that floodwaters are contaminated and avoid them as much as possible. However, they also point out that unless you have bruises or cuts where bacteria from contaminated waters could grow the danger is smaller than generally believed.

Mold from water damage to houses

After hurricane Katrina in New Orleans 2005 there was a lot of mold growth in houses that were flooded. This caused an overwhelming odor that was difficult to cope with. Bleach water removes mold initially until a professional crew can clean it up at a later date. I mention this here because following a hurricane there will not be enough professional people around to help. Mold is particularly devastating for asthmatics and people with chronic respiratory conditions. These people need evacuation from such living environments until the house is clean from molds. Flare-ups of asthma and chronic obstructive pulmonary disease can be deadly. Under normal circumstances people with respiratory problems can manage, but these people are at a severe risk of dying from an aggravation of their underlying conditions. Hurricane Katrina will be remembered for this.

Living in destroyed homes

Often with a direct hit of hurricane the roofs of homes are missing. The hurricane ripped them off and they literally flew away. A home without a roof is prone to water damage from future precipitation. There is the danger of mouse and rat infestation. Birds can enter and partake in the leftover meals. Their droppings may contain contagious bacteria like salmonella causing typhoid fever. Builders  work hard and long hours; it can take months or years before life is normal again. It may be wiser to live with a relative for a few months until the house is in livable condition again. When electricity is restored and the water lines are functioning again, there may still be an issue about getting safe drinking water and uncontaminated water to have showers and baths. Also, without proper shelter there are risks of mosquitoes transferring communicable diseases. This happened in the Dominican Republic.

Malaria in the Dominican Republic

In September 2004 Hurricane Jeanne struck the Dominican Republic. Subsequently there was more flooding from heavy rainfalls. The end result was a mini-epidemic of 17 cases of malaria, because the flooded areas gave the mosquitoes more breeding ground to multiply. Fortunately no one died, as all the malaria cases responded to chloroquine and primaquine. But some patients had to be treated in the Intensive Care Unit of a hospital. As already mentioned there are other water born illnesses that can cause diarrhea, vomiting and fever. These people need to get immediate access to a hospital where the medical staff will rehydrate them intravenously. Otherwise they could die.

Health Risks After Hurricanes

Health Risks After Hurricanes

Conclusion

Hurricanes pose enormous problems for the communities where landfall occurs. Close to the eye of the hurricane are the worst structural damages to properties and trees. But even miles away from that there can be flooding due to excessive winds and rain. Most people are reasonable during the initial phase when the hurricane hits. This means they stay inside so they can protect themselves from the direct impact of the storm. But hurricanes can pull roofs off and people can get hurt.

Illnesses from contaminated water

Later there is a disruption of the electrical supply as well as the water supply. The restoration of the utilities may take days or weeks. Immediately you depend on fresh and clean water supply, and when you run out, there may not be enough fresh water available. Illnesses from contaminated water become a huge problem at that point. This is where a lot of mortality comes from in the aftermath of a hurricane.

If you can, it is wiser to escape this all by visiting a relative far away from the hurricane area. In this case you must leave well in time before the hurricane hits. You can check with the authorities when it would be safe to return home. At least you know that you have survived. Everything else can wait. You will gradually take care of it. But it may take a long time for things to return to normal.

Jan
31
2013

Staying Healthy During Exotic Travel

By | Health, Infectious Disease, Prevention, vaccinations

A study of 82,825 ill travelers from Europe, North America, Israel, Japan, Australia and New Zealand was published who were interested in staying healthy during exotic travel. They had traveled the world between June 1996 and August 2011. The data was based on the GeoSentinel surveillance network database. There were 3,655 patients (4.4%) who were seriously sick with one of 13 tropical diseases. There were 13 deaths (=0.4%), 10 of which were from malaria. Two died from melioidosis. This is an infectious disease caused by a bacterium found in soil in Southeast Asia (including Thailand, Laos, southern China, Singapore, Malaysia, Burma and Vietnam), Taiwan and northern Australia. One person died from severe dengue. The interesting fact is that there was not a single case of Ebola virus, although this is a highly publicized and lethal illness in Africa. The majority of travelers sustained malaria and typhoid.

The tropical diseases were either due to viral illnesses, bacterial infections or protozoan infections.

Frequent viral illnesses encountered by visitors to Asia were dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS); avian influenza, Lassa fever as well as other tropical hemorrhagic fevers, Japanese encephalitis including other tropical encephalitis cases, Rift Valley fever and yellow fever.

This is a list of the bacterial infections that were reported: Anthrax, Carrion’s disease (=Bartonella bacilliformis), epidemic typhus, leptospirosis, melioidosis, murine typhus, paratyphoid fever, plague, relapsing fever, scrub typhus, spotted fever group rickettsioses and typhoid fever.

An interesting side-note is that even in familiar places like Hawaii leptospirosis is re-emerging as this link shows. So, it is important for visitors to Kauai and the Big Island of Hawaii (Waipio valley) to refrain from swimming in streams or natural ponds and to not expose your face to cascading waterfalls as leptospirosis can enter through the eyes, the nose, the mouth and scratches on the skin.

Finally, the following protozoan infections were found frequently: East African sleeping sickness, falciparum malaria and Plasmodium knowlesi malaria.

Staying Healthy During Exotic Travel

Staying Healthy During Exotic Travel

Each travel region has its special infection characteristics. With travel to Central America infectious diseases ranked in decreasing frequency like this: typhoid fever, leptospirosis, falciparum malaria and paratyphoid fever. In the Caribbean falciparum malaria was followed by typhoid fever, leptospirosis and paratyphoid fever. In South America the highest on the list was again falciparum malaria, followed by typhoid fever, paratyphoid fever and leptospirosis. In Sub Saharan Africa the highest number of falciparum malaria cases were registered (2633 of them), followed by 42 cases of typhoid fever, paratyphoid fever and leptospirosis. In the Middle East only one case of falciparum malaria, one case of typhoid fever and 2 cases of paratyphoid fever were reported. In contrast there were many more infections reported in South Central Asia (India): 286 cases of typhoid fever, followed by parathyroid fever, falciparum malaria and leptospirosis. All of the cases of typhoid fever and parathyroid fever in India were adequately treated with antibiotics and no deaths resulted from that. This is an example where no vaccine is available for prevention, but swift medical treatment could help immediately when an infection had occurred.

In South East Asia (Malaysia, Philippines, Indonesia) leptospirosis was on top, followed by typhoid fever, falciparum malaria and parathyroid fever. North East Asia (Korea, Mongolia), had only 3 cases of typhoid fever and 1 case of paratyphoid fever. Oceania (Polynesia) reported 26 cases of falciparum malaria, followed by paratyphoid fever and typhoid fever.

Several interesting observations were made with regard to this study.

  1. Most patients with travel acquired tropical illnesses presented within less than 17 days at the doctor’s office at home and 91% of them had developed a fever.
  2. The spectrum of the tropical disease that was diagnosed and treated varied according to the geographic destination where the traveler had been, which is consistent with the observations mentioned above (different distribution of tropical diseases depending on which area was traveled). Visitors to West Africa had a high rate of falciparum malaria, visitors to India sustained largely enteric fevers; and leptospirosis,  scrub typhus and murine typhus were the dominant tropical diseases for visitors to South East Asia.
  3. Males were found to be less diligent in using chemoprophylaxis for malaria prior to their travel than females. Overall only a minority had attended a travel clinic prior to their travel for immunizations and chemoprophylaxis for preventable tropical disease such as malaria.
  4. Other global life-threatening diseases like meningitis, other forms of septicemia, severe bacterial pneumonia and legionnaires also have to be considered as they occurred in roughly 30% of returning travelers.
  5. Malaria was the largest percentage of the tropical diseases that travelers brought home and 67% of all cases were male patients. They were mostly visiting West Africa where they acquired malaria (typically from Nigeria,  Ghana and the Ivory Coast). As mentioned they accounted for 10 of the 13 deaths.

The authors recommend that travelers should prepare themselves for trips to the tropics and subtropics, preferable visiting one of the travelers’ clinics. The recommended procedures should be followed meticulously. Not all of the diseases can be prevented, but if the traveler turns sick, they should seek medical advice as soon as possible in the country where they travel as these physicians often have special expertise in these tropical diseases.

One of the comments of the study was that often people visit relatives and friends in an area where tropical disease exists without any chemoprophylaxis or vaccinations beforehand. The visitors were under the impression that prior living in the area as a child would still protect them now during the travel as an adult, which is not the case. This can be prevented by visiting a travel clinic well before the planned trip, so there is enough time for vaccinations and possible blood tests.  

More information on:

1. Traveler’s diarrhea:  http://nethealthbook.com/infectious-disease/parasites/travelers-diarrhea/

2. Parasites: http://nethealthbook.com/infectious-disease/parasites/