From the CDC Director’s Emergency Operations Center - P.M. Update, September 16, 2005

Top Line - Public Health

Evacuation-center and hospital surveillance has detected clusters of varicella and scabies or lice. Personal hygiene and measures to prevent disease spread have been encouraged.

CDC is engaged in helping to provide vaccines and vaccinate children displaced by Hurricane Katrina, especially those staying in evacuation centers.

Early Thursday, CDC’s laboratory confirmed a strain of nontoxigenic Vibrio cholerae serogroup 01 bacteria in a sample obtained from a person who had been evacuated. This bacteria does not cause cholera disease.

CDC Public Health Workforce Deployed in Affected Communities:

• Total: 212 (216: 9/14) including the following specialties: public health nursing, occupational, laboratory, medical, epidemiology, sanitation, environmental health, disease surveillance, public information and health risk communication.
• Preparing to Deploy: 20
• Supporting Hurricane Katrina Director’s EOC Response: @ 352 (as of 9/16) includes: CDC senior leadership, team members assigned from centers/institutes/offices, DEOC staff, GIS, Informatics, ITSO, SNS, and ECS, and CDC workforce volunteers.

CDC Public Health Analysis:

Response Rhythm: CDC’s public health disaster response, including its 212 deployed professionals, has entered an active maintenance phase and continues to see no unexpected health concerns related to Hurricane Katrina. Response-worker safety, immunizations, and environmental health concerns top CDC’s response at this time. In addition, monitoring for outbreaks of infectious disease continues at intense levels.

Immunization Effort: Children in evacuation centers are being vaccinated through a coalition of local, state, federal, and private groups in Louisiana. CDC’s immunization experts are helping organize, implement, and assess the evacuation centers vaccination program.

Health Surveys: The health and safety of persons displaced by Hurricane Katrina is a top priority for CDC. CDC has deployed public health surveillance teams to work with local and state partners to conduct two surveys. The behavior migration survey will measure best ways to share information with people who were displaced, and capture an early sense of their relocation or return preferences. A mental health survey will help CDC compare mental well being among persons who were evacuated with populations similar to them who were not evacuated. Vibrio cholerae: Early Thursday, CDC’s laboratory confirmed a strain of nontoxigenic Vibrio cholerae serogroup 01 bacteria in a sample obtained from a person with diarrheal illness. The person was evacuated following Hurricane Katrina and was staying at an evacuation center in Tennessee. CDC confirmed that the sample was negative for the cholera toxin gene, which means it does not cause cholera disease, but can cause milder diarrheal illness.

Likely, this case was identified because public health experts are aggressively searching for infectious diseases following Hurricane Katrina. Therefore, CDC expects that as public health’s intense disease detection efforts continue other cases could be found. While these nontoxigenic bacteria can cause diarrhea, they are not associated with epidemics of cholera disease. Sporadic cases of this type of diarrheal illness are reported to CDC occasionally, though usually they would go unnoticed.

Importantly, in the United States, if a case of V. cholera 01 is detected that does produce the cholera toxin and could cause cholera disease, it would be unlikely to cause an outbreak of disease in an evacuation center or in the greater community if basic clean drinking water and sanitary conditions are available.

In the United States, reports of people infected with toxigenic strains of V. cholerae 01 - true cholera – occur each year, but they do not lead to outbreaks of cholera because sanitary conditions are normal. However, outbreaks of cholera disease are serious health concerns in places where basic drinking water and sanitation are not available (e.g., places where people must drink untreated water) and the organism is present. Therefore, infectious disease monitoring and sanitation controls are important when basic sanitation and water supplies are compromised.

Mosquitoes and Flies Control: Spraying to kill pest flies and adult mosquitoes that could carry the West Nile and other viruses continues today. Vector control experts note that a combination of new mosquitoes and preexisting virus could increase transmission activity approximately three to four weeks after the storm. This makes public health mosquito control measures within the affected communities, as well as individual prevention measures, critically important. People should use insect repellent containing DEET (Look for: N,N-diethyl-meta-toluamide) or Picaridin; wear long sleeved tops and long pants; and avoid outdoor activities, if possible, at dusk and dawn.

Immunization Registries Help Children Avoid Extra Shots:
In Louisiana, Mississippi, and Alabama, many people who had to evacuate lost not only homes and possessions but personal records such as their children’s shot records. Whether some kids are up-to-date on their shots or need a vaccination is being answered through existing immunization information systems. In Louisiana alone, CDC estimated that more than 8,300 queries were made to the Louisiana Immunization Network for Kids Statewide (LINKS) regarding vaccination histories for children who were evacuated. LINKS remains functional because a backup system located in Baton Rouge has been operational since Katrina struck.

An Alabama Department of Public Health professional, spent the day in an evacuation center. When she asked one mother with seven children whether she had any immunization records, the mother said she had nothing. Using the LINKS system, the public health professional found records on six of the seven children. The mother exclaimed, “We have proof that we are real people!”

Thousands of young evacuees throughout the United States have benefited from LINKS by gaining access to their immunization records electronically. Although special provisions are being made to accept students without proof of immunization into their new schools, having an immunization record provides extra assurance that no delays will occur, and no immunizations will be repeated unnecessarily. CDC recommends that children be vaccinated again if records do not exist. CDC estimates that 83 percent of the immunization history queries made to LINKS have been from Texas, particularly from the Houston area.

Health Professionals Can Plug In
For health professionals only, several means exist for accessing immunization history data from LINKS, including using Health Level 7 (HL7) messaging or just “view only” access. HL7 enables not only access to information but also the ability to input information. For example, if a provider administers a vaccination to a child who was displaced, they may input this information into LINKS directly from their location and the immunization record stays up-to-date. Currently, 6 states and the city of Houston have HL7 direct access to LINKS. “View-only” enables a provider to access LINKS and to view the immunization history from their location. Currently, 29 states, Washington DC, and 9 cities have “view-only” access to LINKS.

Alabama’s statewide immunization information system contains the records of approximately 1.9 million people of all ages. This includes 14.8 million individual immunization records. Data reported by Alabama as of December 31, 2004 suggest that 99% of the children ages 0 – 6 (332,665 of 336,625 children ages 0 – 6) have at least two immunizations recorded in the system. All immunizations billed through Medicaid and Medicare are included in the system.

Louisiana’s immunization information system contains the records of approximately 1.4 million people of all ages. Fourteen million individual immunizations records are stored in the system. Data reported by Louisiana as of December 31, 2004 suggest that 79% of children ages 0 – 6 (289,438 of 365,874 children ages 0 – 6) have at least two immunizations recorded in the system.

Mississippi’s immunization registry system contains the records of approximately 1.5 million people of all ages. Data reported by Mississippi as of December 31, 2004 suggest that 89% of the children ages 0 – 6 (210,674 of 235,503 children ages 0 – 6) have at least two immunizations recorded in the system.

See the LINKS map below. For more information about the computerized immunization registries, contact CDC’s Gary Urquhart by email at gau5@cdc.gov or by calling 404 639-8277.

Public Health Recommendations: Pass it On

Clean Hands Save Lives
Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others. It is best to wash your hands with soap and clean running water for 20 seconds. However, if soap and clean water are not available, use an alcohol-based product to clean your hands. Alcohol-based handrubs significantly reduce the number of germs on skin and are fast acting.

When using an alcohol-based hand rub:

• Apply product to the palm of one hand
• Rub hands together
• Rub the product over all surfaces of hands and fingers until hands are dry.

When should you wash your hands?

• Before preparing or eating food
• After going to the bathroom
• After changing diapers or cleaning up a child who has gone to the bathroom
• Before and after tending to someone who is sick
• After blowing your nose, coughing, or sneezing
• After handling an animal or animal waste
• After handling garbage
• Before and after treating a cut or wound

New: Clean Hands Saves Live Stickers in Spanish and English
www.bt.cdc.gov/disasters/hurricanes/katrina/cleanhands.asp

The CDC has produced many health education items that can be shared with hurricane evacuees and volunteers. Free information is available in many languages on topics such as hand washing, returning to your home, protecting yourself from carbon monoxide poisoning and from mold. A comprehensive index of available resources can be found at: www.bt.cdc.gov/disasters/hurricanes/printindex.asp

Where to Find Out More About:

Clinician/Patient Consultation Help: Clinicians with specific questions about the management of individual patients can get telephone consultations for management assistance. Additionally, patients can now also access this service. The National Institutes of Health (NIH) in partnership with the Association of American Medical Colleges have established the “Medical Coordination and Referral for Healthcare Professionals Hotline.”

The call center is linked to a nationwide network of academic health center centers. It is available 24 hours a day, 7 days a week and is currently able to provide expertise in: infectious diseases and tropical/geographical medicine, ophthalmology, oral medicine, psychiatry, cardiac/pulmonary diseases, genetic diseases, pediatric, endocrinology, pediatric metabolism, obstetrics/gynecology, and adult endocrinology. They are in the process of building additional capacity.

The toll-free number for the call center is: 1-866-887-2842.
www.bt.cdc.gov/disasters/hurricanes/clinicalconsultation.asp

FBI Government Fraud Line: The FBI has launched a tip line, 1-800-CALL FBI or 1-800-225-5324, to collect information and complaints of public corruption and government fraud in connection with the Hurricane Katrina aftermath. Information related to these matters can be provided toll-free, 24 hours a day, seven days a week. These lines will be staffed by FBI personnel, and the information collected will be analyzed, investigated, and shared with state, local, and federal law enforcement personnel.

FEMA Help: Individuals and families who suffered losses as a result of Hurricane Katrina are encouraged to call the U.S. Department of Homeland Security's Federal Emergency Management Agency (FEMA) toll-free registration number at 1-800-621-FEMA (3362) . People who are speech- or hearing-impaired should call TTY 1-800-462-7585 . Phone lines are open 24 hours a day, 7 days a week until further notice.

Applicants should be prepared to provide some basic information when calling, including their social security number, a telephone number where they may be reached, the address of the damaged property, their insurance information, and their bank account information. If applicants do not know the necessary information to sign up for a direct deposit (bank account number and routing number), they should contact their banks to get this information before starting an application. FEMA strongly encourages people to sign up for direct deposit because many residents are relocating following Hurricane Katrina, and mailed checks may not reach them. Anyone who can access the Internet may register online at www.fema.gov.

Small Bussiness Administration: Homeowners and renters who suffered damage from Hurricane Katrina are eligible for low-interest disaster loans from the U. S. Small Business Administration (SBA). SBA disaster loans are not just for small businesses: SBA makes the majority of its disaster loans to homeowners and renters. Homeowners and renters should begin by contacting the Federal Emergency Management Agency at 800-621-FEMA.

CDC Foundation Emergency Preparedness and Response Fund: The CDC Foundation has activated its Emergency Preparedness and Response Fund and is seeking donations. Contributions to the fund help CDC and state and local public health departments immediately obtain the equipment, supplies and services needed to address public health concerns related to Hurricane Katrina. Contributions can be made online at www.cdcfoundation.org or by calling 1-888-880-4CDC.

The next CDC DEOC Hurricane Katrina update will be Monday, Sept. 19, 2005

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