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Morbidity Surveillance Following the Midwest Flood -- Missouri,
1993
Heavy spring and summer rains during 1993 caused flooding by
both the Mississippi and Missouri rivers and by streams in 84 of
the 115 counties in Missouri; all 84 were declared federal disaster
areas. The Mississippi River attained flood stage during July 15-
August 2, and the Missouri River, during July 25-August 2; a total
of 2,060,757 acres were submerged, and approximately 60,000 persons
throughout Missouri were displaced (National Weather Service,
unpublished data, 1993). At the request of the Missouri Department
of Health, CDC provided assistance in implementing a surveillance
system to monitor flood-related injuries and illnesses in the
affected areas. This report presents preliminary findings of these
surveillance efforts.
Routine public health surveillance in Missouri is based on
active and passive surveillance systems for communicable,
environmental, and occupational diseases. Because of public health
concerns regarding the flood, additional surveillance systems were
implemented during the impact and recovery phases of the flood and
included 1) emergency shelter-based active surveillance to identify
disease outbreaks or clusters of adverse health events (local
communicable disease coordinators and other volunteers made daily
phone calls to shelters to monitor flood-related injuries and
illnesses and to obtain total daily census figures) and 2) hospital
emergency department-based passive surveillance in 31 hospitals to
identify flood-related injuries and illnesses.
The highest number of persons reported residing in shelters
was 702 on July 28. The highest number of reported flood-related
injuries and illnesses in shelters was 40 on July 26, when 510
persons resided in shelters. No acute disease outbreaks were
identified by the active surveillance system during or after the
flood.
Emergency departments used a standardized questionnaire to
provide daily reports of visits for injuries and illnesses. During
July 16-September 3, 524 flood-related conditions were reported
through this system. Of these, 250 (47.7%) were injuries, 233
(44.5%) were illnesses, 39 (7.4%) were listed as "other," and two
(0.4%) were listed as "unknown." A total of 234 patients were
treated and released after initial presentation to a hospital
emergency department; 32 were hospitalized. In 249 cases, the
hospitals did not report the patients' final dispositions. Of the
250 reported injuries, the most common were sprains/strains (86
{34%}), lacerations (61 {24%}), "other injuries" (28 {11%}), and
abrasions/contusions (27 {11%}). Of the 233 reported illnesses, the
most frequently reported were gastrointestinal (40 {17%}),
rashes/dermatitis (38 {16%}), heat-related (31 {13%}), and "other
conditions" (47 {20%}).
Reported by: W Schmidt, MPH, M Skala, I Donelon, HD Donnell, Jr,
MD, State Epidemiologist, Bur of Communicable Disease Control,
Missouri Dept of Health. Emergency Response Coordination Group, and
Disaster Assessment and Epidemiology Section, Health Studies Br,
Div of Environmental Hazards and Health Effects, National Center
for Environmental Health; Prevention Effectiveness Activity, Office
of the Director, Div of Surveillance and Epidemiology, and Div of
Field Epidemiology, Epidemiology Program Office; Div of Nutrition,
National Center for Chronic Disease Prevention and Health
Promotion; Div of Parasitic Diseases, National Center for
Infectious Diseases, CDC. Editorial Note
Editorial Note: The findings in this report are consistent with
those in a previous report from Iowa that documented a substantial
number of persons hospitalized for flood-related conditions (1).
These findings underscore the importance of flood-related morbidity
surveillance in assessing the need and planning for public health
intervention measures.
The public health impact of floods and other disasters may
reflect secondary effects of the disaster, such as population
displacement and disruption of existing health services (2). In
Missouri, although widespread flooding caused substantial
population displacement, most persons displaced by the flood had
access to health-care and medical services and to sanitary
facilities throughout the impact phase. In addition, the findings
of active surveillance at emergency shelters suggested that
displaced persons were housed in shelters for only short periods
and that they were able to secure temporary housing. During the
recovery phase, most emergency shelters were not needed and were
therefore closed.
In addition to guiding public health and health-care relief
efforts, the findings in this report assisted public health
officials in responding to public and media inquiries and will
assist in planning surveillance strategies for future disasters.
For example, the surveillance systems in Missouri were limited to
shelters and emergency departments. However, to more accurately
monitor flood-related morbidity in the future, surveillance will be
expanded to include institutions and facilities that have been
effective locations in previous flood disasters (e.g., relief
agencies, outpatient medical clinics, disaster-assistance centers,
state public health facilities, and physicians' offices) (3).
References
CDC. Public health consequences of a flood disaster -- Iowa,
1993.
MMWR 1993;42:653-6.
Noji EK. Natural disasters. Crit Care Clin 1991;7:271-92.
Western KA. Epidemiologic surveillance after natural disaster.
Washington, DC: Pan American Health Organization, 1982:1-94;
scientific publication no. 420.
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