Hurricane preparation and response resource list

Hurricane preparation and response resource list | www.APHLblog.org

Updated September 15, 2017

In the wake of hurricanes Harvey and Irma, public health laboratories in affected regions will be busy testing for potential environmental contamination, monitoring for increased water- and mosquito-borne diseases, or repairing damage to their own facilities. APHL has activated its Incident Command System (ICS) to support member laboratories with their response. The ICS team is participating in CDC’s Emergency Operations Center (EOC) State/Local and Partner Conference Calls, and will assist member labs with their response, facilitate communications between CDC and member labs, and share lab needs/stories with policy makers and the public.

Below are helpful resources for those communities hit by the recent storms. Many of these resources are useful for any severe weather event, not just Hurricanes Harvey and Irma.

Preparing for and weathering the storm

Hurricanes, Preparation and Response, EPA
Hurricane Preparedness Checklist, FDA
Preparing for a Hurricane or Tropical Storm, CDC
Flooding Toolkit, National Public Health Information Coalition
Disaster Assistance.gov, US government platform for locating disaster-related resources
Federal Emergency Management Agency (FEMA) Toll-free FEMA hotline for survivors of Hurricane Harvey: 1-800-621-FEMA

Keeping your family and community healthy after the storm

Food Safety:
Food Safety Tips for Areas Affected by Hurricane Irma, USDA press release
Protect Food and Water Before, During and After a Storm, FDA

Infectious Diseases:
Emerging and Zoonotic Infectious Diseases, CDC
Vector-borne Diseases, CDC​​​​​​​
Waterborne Disease Prevention, CDC

Drinking Water:
Drinking Water Safety and Testing Information for Texas, Texas Commission on Environmental Quality (accredited labs for microbial testing of drinking water, advice for customers of public water systems, disinfecting your well, etc.)
Drinking Water Testing and Information for Houston, TX, City of Houston
Private Wells: What to Do after the Flood, EPA
Private Wells: Water-related Diseases and Contaminants, CDC
Health Department Laboratory, Drinking Water Testing and Information, City of Houston

Other:
Carbon Monoxide Poisoning – Clinical Guidance, CDC
Mold: Cleanup and Remediation, CDC
Mold: Flood Cleanup, EPA
Waste Management, EPA

Rebuilding and repair

Cleanup after a Hurricane, CDC
Status of Systems in Areas Affected by Harvey, Texas Commission on Environmental Quality – drinking water, waste water and sewage, residential wells, flood waters, water infrastructure

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Looking Back: 5 Big Lessons from 2016

Looking through the rearview mirror while driving in the planes

Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response
Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response

CDC is always there – before, during, and after emergencies – and 2016 was no exception. Through it all, we’ve brought you the best and latest science-based information on being prepared and staying safe. Here’s a look back at 5 big lessons from a very eventful year. Follow the links to discover the full stories!

1. Expect the unexpected

Emergencies can devastate a single area, as we saw with Hurricane Matthew, or span the globe, like Zika virus. This year has shown us, once again, that we can’t predict the next disaster.

Zika virus was one of the top public health stories of 2016, and will continue to make headlines in 2017. CDC has worked hard since the start of the outbreak to make sure that people know how Zika is spread and how to protect themselves and their neighbors from the virus, including how to control mosquitos inside and outside the home.

This year, our Strategic National Stockpile was called on to locate and purchase the products to assemble ~25,000 Zika Prevention Kits for pregnant women in the U.S. territories. CDC also issued 180 Zika virus import permits so scientists could conduct research to develop better diagnostic tests, vaccine, and medicines. In any developing crisis, our mission is always to “conduct critical science to inform and communicate health information that protects our nation” against public health threats.

2. A health threat anywhere is a threat everywhereAbout 2/3 of the world remains unprepared to handle a public health emergency.

Diseases like SARS and Ebola – and now Zika – compel us to focus on stopping outbreaks early and close to the source. As part of the Global Health Security Agenda, teams of international experts travel to countries, including the U.S., to report on how well their public health systems are working to prevent, detect, and respond to outbreaks. This assessment process is called the Joint External Evaluation.

In 2016, we worked at home and around the world to use the law to prepare for global health emergencies, train leaders from 25 countries in public health emergency management, and protect the health of those affected by humanitarian crises.

3. Kids and communities matter

Fred in bathtub

There’s a saying in emergency management that goes something like, “emergencies begin and end locally.” Truer words were never spoken. The minutes, hours, and days immediately following a disaster are the most critical for saving lives, and local communities are our first responders. Every community needs to be resilient and prepared to handle the unexpected.

Prepared communities look like the Georgia Department of Public Health, which conducted a statewide exercise to practice their response to a bioterrorist attack of plague, and New York City, which used lessons learned from West Nile virus to prepare for Zika.

Children are a particularly vulnerable part of our communities, and they have different needs than adults. Children need to be included and involved in planning and preparing for emergencies.

Fred the Preparedness Dog sets a great example by visiting schools across Kansas to teach kids to get a kit, make a plan, and be informed. Parents should also take steps to prepare themselves and their child in case they get separated during or after an emergency.

4. Words save lives

7 Things to Consider When Communicating About Health

In an emergency, the right message at the right time from the right person can save lives. When a crisis hits, communicators need to quickly and clearly inform people about health and safety threats. Communication is especially critical when disaster strikes suddenly and people need to take action right away, as in a flood or hurricane, or when we may not yet have all the answers, as happened with Zika virus.

To make sure people know what to do to protect their health, our trained communicators learn how to put themselves in others’ shoes: Who are the people receiving the message, what do they need to know, and how do they get information? We apply the principles of Crisis and Emergency Risk Communication in every emergency response.

5. Preparedness starts with you

brain

Get a flu shotWash your handsMake a kit. Be careful in winter weather. Prepare for your holidays. Be aware of natural disasters or circulating illnesses that may affect you or those you care about.

There are many ways to prepare, and in 2016 we provided the latest science and information to empower every one of us to take action. Whether we talked about how to clean mold from a flooded home, how to wash your hands the right way, or how to use your brain in emergencies, our timely tips and advice put the power of preparedness in your hands. What you do with it is up to you. Our hope is that you’ll resolve to be better prepared in 2017.

Zika: Old virus, new challenges

Zika: Old virus, new challenges | www.APHLblog.org

Even though Zika is not a new virus, this recent outbreak has brought forth many new challenges and questions. Our partners and colleagues within the public health community are working hard to better understand this outbreak and its effects while also trying to control its spread. As in any outbreak, public health laboratories play a vital role in disease detection and surveillance.

Last updated February 25, 2016

Twelve public health laboratories are testing for Zika – this number will be growing over the next few weeks as the Centers for Disease Control and Prevention (CDC) rolls out the testing protocol to more laboratories. Additionally, CDC is working with the Food and Drug Administration (FDA) to develop the emergency use authorization (EUA) that would enable distribution of test kits. This will allow public health laboratories to more quickly implement testing.

Zika fact sheets, guidance and other general information:

Best way to prevent Zika? Prevent mosquito bites. Here’s how:

What we’re reading about Zika:

Should we eliminate all mosquitoes from the planet?

Made a storify based on a discussion about a new Slate article:

Should we eliminate all mosquitoes from the planet?

Made a storify based on a discussion about a new Slate article:

Unveiling the Burden of Dengue in Africa

Mosquito sucking blood on human skin with nature background

By Tyler M. Sharp  Ph.D. (LCDR,USPHS)

Most travelers to Africa know to protect themselves from malaria. But malaria is far from the only mosquito-borne disease in Africa. Recent studies have revealed that dengue, a disease that is well recognized in Asia and the Americas, may be commonly misdiagnosed as malaria in Africa. So if you’re traveling to Africa, in addition to taking anti-malarial medications you should also take steps to avoid dengue.

Map of areas around the world affected by Dengue.Dengue is a mosquito-transmitted illness that is recognized as a common illness throughout Southeast Asia and much of the Americas. In fact, a study published in 2013 estimated that 390 million dengue virus infections occurred throughout the tropics in 2010. Although 70% of infections were predicted to have occurred in Southeast or Southcentral Asia, the next most affected region (16% of infections) was Africa, followed by the Americas (14% of infections). The large estimated burden of dengue in Africa came as a surprise to some, since dengue is not often recognized to be a risk in Africa.

Dengue is Hard to Diagnose in Africa

 

There are several reasons why dengue has limited recognition in Africa. First, the lack of laboratory-based diagnostic testing leads to many patients not being diagnosed with dengue. This can be perilous because without early diagnosis and appropriate clinical management, dengue patients are at increased risk for poor outcome. However, in order for a clinician to request dengue testing, they must first be aware of the risk for dengue. This awareness usually comes in the form of a positive diagnostic test result. Hence, without testing there is limited clinical awareness, and without clinical awareness there is limited testing.

Finding Dengue in Africa

Map of Africa
Brown indicates countries in which dengue has been reported in residents or returned travelers and where Aedes aegypti mosquitoes are present. Light brown indicates countries where only Ae. aegypti mosquitoes have been detected.

How do we know that there actually is dengue in Africa? First, since 1960 at least 15 countries in Africa had reported locally-acquired dengue cases. In addition, travelers returning home with dengue had been detected after visiting more than 30 African countries. Still more African countries are known to have the Aedes mosquitos that transmit the 4 dengue viruses. These findings together provide strong evidence that dengue is a risk in much of Africa.

Thus, it was not a surprise in the summer of 2013 when dengue outbreaks were detected in several sub-Saharan African countries. In many cases, detection of dengue was facilitated by the availability of rapid dengue diagnostic tests that enabled on-site testing.

Dengue Field Investigations in Angola and Kenya

In a past blog I described the initial findings of a dengue outbreak in Luanda, Angola, in west-central Africa outbreak: dengue cases were initially identified with a rapid diagnostic test and confirmatory diagnostic testing and molecular epidemiologic analysis performed as CDC demonstrated that the virus had actually been circulating in the region for at least 45 years. This provided strong evidence that dengue was endemic in the area. During the outbreak investigation, CDC and the Angola Ministry of Health conducted house-to-house surveys wherein blood specimens and questionnaires were collected. Of more than 400 participants, 10% had been recently infected.

Teams from the Angola Ministry of Health conduct a dengue serosurvey in Mombasa, Luanda. Image courtesy of the Angola Field Epidemiology Training Program.
Teams from the Angola Ministry of Health conduct a dengue serosurvey in Mombasa, Luanda. Image courtesy of the Angola Field Epidemiology Training Program.

Though nearly one-third reported recently dengue-like illness, and half had sought medical care, none of the patients with laboratory evidence of infection with dengue virus had been diagnosed with dengue, including one person who had symptoms consistent with severe dengue. Although this investigation yielded more questions than answers, it was clear that there was much more dengue in Luanda than was being recognized clinically. By improving clinical awareness through training of clinicians and strengthening disease surveillance, the ability for diagnosis of individuals ill with dengue or other emerging infectious diseases was improved.

On the opposite coast of Africa in Mombasa, Kenya, although dengue outbreaks had been reported for decades, the first outbreak to be confirmed with laboratory diagnostics occurred in the early 1980s. When an outbreak of non-malarial illness was reported in 2013, blood specimens were sent to a laboratory at Kenya Medical Research Institute (or KEMRI) to determine the cause of the outbreak. Three out of the four dengue viruses were detected during this outbreak, which alone suggested that dengue was endemic in the area. To get a better idea for how much dengue there was in Mombasa, CDC and the Kenya Ministry of Health conducted a representative survey in a populous neighborhood of Kenya. Over 9 days, 1,500 people were enrolled in the serosurvey and testing revealed that 13% of participants were currently or recently infected with a dengue virus. Nearly half of infected individuals reported a recent dengue-like illness, most of which had sought medical care.

Field workers from CDC and the Kenya Ministry of Health conduct a dengue serosurvey in Mombasa, Kenya. Image courtesy of Dr. Esther Ellis.
Field workers from CDC and the Kenya Ministry of Health conduct a dengue serosurvey in Mombasa, Kenya. Image courtesy of Dr. Esther Ellis.

However, nearly all patients had been diagnosed with malaria. Because Mombasa is a port city that is also popular tourist destination, not only was the apparent magnitude of the outbreak a concern for patient diagnosis and care in Mombasa, it also meant that visitors to Mombasa may not be aware of the risk of dengue and therefore could be getting sick and/or bringing the virus home with them.

What next?

There is not yet a vaccine to prevent infection or medication to treat dengue. Unlike the night-time biting mosquitoes that transmit malaria, the Aedes mosquitoes that spread dengue are day-time biters. Consequently, both residents of and travelers to Africa should protect themselves from mosquito bites to avoid dengue by using mosquito repellent. Other strategies, like staying in places with air conditioning and screens on windows and doors and wearing long sleeve shirts and pants, can also help whether you’re traveling to Africa or other regions of the tropics. For clinicians, if travelers recently returned from Africa with acute febrile illness, consider dengue as a potential cause of the patient’s illness.

We still have much to learn about dengue in Africa, but learning where there is risk of dengue is the first step to avoiding it.

 

Vector-borne disease vs chemicals in bug spray: Weighing the risks

By Michelle M. Forman, senior media specialist, APHL

Vector-borne disease vs chemicals in bug spray: Weighing the risks | www.aphl.orgWith hot and humid weather comes news of diseases spread by mosquitos and ticks, while we also hear of concerns around the bug sprays we’re supposed to use to protect ourselves. What exactly are people supposed to do? Which pieces of information should you believe? How are you to decide the best way to protect yourself and our family from bites, disease AND harmful chemicals all at the same time? At this point, locking yourself inside until winter might seem like the only option.

Not to worry. The important thing is to consider whether the risks associated with each vector-borne disease are more or less worrisome than the risks associated with the chemicals found in bug sprays. Here is our breakdown of those risks.

While vector-borne diseases refer to illnesses transmitted by many tours of insects, we’re going to focus on mosquitoes and ticks here.

Note the severity of each vector-borne disease and impacts of applications described below may differ based on individual conditions such as age, predetermined health status, access to healthcare, etc. If you have any questions or concerns, please speak with your physician.

Mosquito-Borne Diseases

West Nile virus (WNV)WNV is found in all 48 contiguous states. The number of cases annually varies. 2012 was the deadliest year with 286 deaths.

  • The bad news: Those who show symptoms will typically have headache, body aches, joint pain, vomiting, diarrhea and/or rash within about a week of the infectious bite. In some cases, fatigue and weakness can last for months. In more severe cases, people can even develop neurologic conditions like encephalitis or meningitis. About 10% of those people will die. There are no medications or treatments for WNV aside from pain medication to reduce fever or relieve some of the symptoms. Those experiencing the most severe symptoms may be hospitalized.
  • The good news: Not every person bitten by an infected mosquito will show symptoms.

Eastern equine encephalitis virus (EEEV) – In the United States, an average of six human cases of EEE are reported annually. Cases mostly occur in the Atlantic and Gulf Coast states, although there have been some cases in the Great Lakes region as well.

  • The bad news:  EEE can be very serious. Severe cases will experience headache, high fever, chills and vomiting which could progress into disorientation, seizures, encephalitis and coma. Approximately one-third of patients who develop EEE die, and many of those who survive have mild to severe brain damage. Some of the long-term effects can cause death years later. There is no specific antiviral treatment for EEE; people showing symptoms should see their healthcare provider who can determine if supportive treatment is necessary and available.
  • The good news: Most cases will not show any symptoms, and only about 4-5% of EEEV cases become EEE.

Chikungunya – While there have only been four reported cases of locally acquired chikungunya in the US, experts are concerned because the disease spreads so rapidly. Chikungunya first reached the Caribbean in December 2013 and by March 2014 there were 15,000 reported cases.Chikungunya has now been identified in nearly 40 countries in Asia, Africa, Europe and, most recently, the Americas.

  • The bad news:  Nearly everyone who is bitten by an infected mosquito will develop fever and joint pain; other symptoms may also include headache, muscle pain, joint swelling or rash. The joint pain is often very debilitating, but usually lasts for a few days or possibly weeks. In some cases joint pain may continue for months or years. There have been some reports of lasting gastrointestinal, eye, neurological and heart complications. There is no treatment for chikungunya aside from over the counter pain medication to reduce discomfort.
  • The good news: Most people fully recover.

Dengue virus – According to CDC, there are over 100 million cases of dengue worldwide each year. It is a leading cause of death in many tropical areas of the world. While it is not typically found in the continental US, dengue is endemic in Puerto Rico and many parts of Latin America, Southeast Asia and the Pacific Islands where Americans vacation.

  • The bad news: Typical symptoms include high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding (e.g., nose or gums bleed, easy bruising). Dengue hemorrhagic fever, a more severe form of dengue virus, is characterized by a fever that lasts from 2 to 7 days. It can be fatal if unrecognized and not properly treated in a timely manner.
  • The good news: Early detection and treatment will lower the rate of fatality to below 1%.

Tick-Borne Diseases

Lyme – According to CDC, Lyme disease is the most commonly reported vector-borne illness in the United States with over 20,000 cases annually. However it does not occur nationwide, but tends to be heavily concentrated in the northeast and upper Midwest.

  • The bad news: Bulls-eye rash occurs in 70-80% of infected people. Other symptoms include fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes. 10-20% of cases treated with antibiotics have muscle and joint pains, cognitive defects, sleep disturbance, or fatigue that lasts months or even years. In extremely rare cases (1% of cases), Lyme disease bacteria can enter the heart tissue causing Lyme carditis which can be fatal.
  • The good news: Patients can be treated with antibiotics and the prognosis is best when treatment begins early.

Rocky Mountain Spotted Fever – Spread through the bite of an infected tick, Rocky Mountain Spotted Fever occurs throughout the US.

  • The bad news: Symptoms typically begin with a sudden fever and headache, but many patients will eventually develop a rash, stomach pain, nausea, fatigue or muscle aches. (Not all cases develop every symptom.)  Severe cases can lead to life-long complications such as neurological problems and internal organ damage.  In extremely rare cases (less than 1% of cases), Rocky Mountain Spotted Fever can be fatal. Diagnosis can be difficult as the symptoms can resemble other conditions, and diagnostic tests looking for antibodies are often negative within the first 7-10 days. Treatment is most successful if started in the first five days.
  • The good news: While the number of cases has been higher than usual, the fatality rate is at an all-time low.

Bug Spray – These chemicals have been determined to be the most effective in preventing mosquito and tick bites:

DEET

  • The bad news: DEET has been linked to various health risks such as skin irritation, eye irritation and even neurological damage. But those cases are very rare, and many studies have found the connection between DEET and serious health risks to be inconclusive.
  • The good news: DEET is widely regarded as the most effective chemical in personal bug repellant. The stuff works! Better yet, using DEET with caution appears to significantly limit any serve risks; in fact, many now feel that DEET is safer than once believed. By using lower concentrations (10-30% for children), only using when it is necessary and following the instructions on the label the benefits of DEET far outweigh any risks.

Picaridin

  • The bad news: Picaridin has not been as effective for as long a period of time as DEET in some studies. It also does not protect against all species of mosquitoes. Picaridin is also a relative new kid on the block, so surveillance data is still lacking.
  • The good news: Picaridin is structurally made from the chemicals in pepper, so it is more natural than DEET. It is less likely to irritate skin, doesn’t have the same strong odor as DEET and seems to have a safer profile than DEET.

IR3535

  • The bad news: Concentrations of less than 10% were considered ineffective. IR3535 can be very irritating to the eyes, and has been shown to damage plastics.
  • The good news: IR3535 has been used in Europe for over 20 years. It has a safer profile than its competitors.

Oil of lemon eucalyptus and para-menthane-diol (PMD – synthetic concentration of lemon eucalyptus oil)

  • The bad news: Oil of lemon eucalyptus enhanced with PMD is not recommended for children under the age of 3. It can be irritating to the lungs and cause possible allergic reactions. Protection time seems to be less than DEET.
  • The good news: Higher concentrations seem to be as effective as 15-20% DEET. While lower concentrations will reduce the risk of allergic reaction and lung irritation, they are considerably less effective in repelling mosquitoes and ticks. For those insisting on a botanical bug spray, this is considered the best option.

So what’s the answer to our initial questions? Well, it isn’t really that easy. There is no one right answer for every person in every situation. Vector-borne diseases present a serious health risk that should be avoided. DEET is the most effective chemical for repelling insects available, and studies have shown that risk is low and effectiveness is still high when using concentrations under 30%. The other chemicals listed above may also be reasonable options for you and your family.

Our recommendation: The benefits associated with the chemicals far outweigh the risks. Wearing long pants and sleeves, wearing a hat and eliminating standing water will also help decrease the risk of mosquitoes and ticks. But the best way to avoid vector-borne diseases is to use bug spray when you are in an area with a high number of mosquitoes and ticks.

Love work of @billgates but "mosquitoes kill more people than people do" is just wrong

I truly love the work Bil Gates and the Gates Foundation have been doing over the last years.  Absolutely wonderful stuff.  But I have a bone (or perhaps a proboscis) to pick with this latest effort: The Deadliest Animal in the World | Bill Gates.  The article discusses some "facts" about how many people different animals kill.  And it uses this to argue for the need for more attention to be placed on mosquitoes.  I agree with the conclusion.  Mosquitoes are a big deal and need much much much more work and attention.  But the data is just, well, not sound.  Here is the problem I have

1. Many of the animals, including mosquitoes, are on the list are there because of the diseases they transmit.  For example, dogs are there (for rabies), and tsetse flies are there for sleeping sickness.  That is, they do not kill people directly but indirectly because of a disease they transmit.

2. If we follow that logic, which I am fine with, then we need to add a whole lot of deaths to the "human" column.  After all, humans transmit a whole heck of a lot of diseases that kill humans.  One source I found has the following #s
  • HIV/AIDS: 1.78 million per year
  • Tuberculosis: 1.34 million per year
  • Flu: 250-500,000 per year
  • HAIs: >100,000
  • Syphilis: 100,000
  • Measles: 600,000
and many many many more.   The totals are probably greater than 5 million per year that are killed by infectious diseases where it was humans who transmitted the agent to other humans.  Way more than the mosquitoes.  Again, I agree with the conclusion.  We need lots more attention on mosquitoes.  But there seems little doubt to me which animal is most responsible for the spread of deadly pathogens to humans.  And that animal is us.


UPDATE 5/3

Am kind of annoyed at the press coverage of this Gates - mosquitoes are the deadliest animal - concept.  Here are some examples where people just ate up the idea without really asking any questions about its accuracy
And many many more.  It is a cute concept.  And an important one.  It just happens to be wrong.

UPDATE 5/4. Some Tweets of relevance






UPDATE 5/5
See Vox post: No, mosquitoes aren't deadlier than humans

Also see these posts which run with the Gates meme
UPDATE 5/6