CDC Advises Clinicians Treating Patients From Hurricane Areas

Megan Brooks

October 25, 2017

The US Centers for Disease Control and Prevention (CDC) has issued a Health Alert Network (HAN) advisory for health providers treating patients in or recently returned from hurricane-ravaged Puerto Rico and the US Virgin Islands (USVI).

Because of compromised drinking water and decreased access to safe water, food, and shelter, conditions on the islands are ripe for infectious disease outbreaks, the CDC notes.

The purpose of the HAN advisory is to remind clinicians who see patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza, the CDC says.

"The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI," the agency says.

They also want health providers working in facilities that have suffered water damage or contaminated water systems to be aware of the potential for increased risk for infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other gram-negative bacteria associated with water (such as Pseudomonas), especially among critically ill or immunocompromised patients.

The CDC continues to work with federal, state, territorial, and local agencies and global health partners in response to hurricanes Irma and Maria.  The HAN advisory lists the following specific recommendations:

  • Providers in affected areas should look for community and healthcare-associated infectious diseases.

  • Providers in the continental United States should ask patients about recent travel (eg, within the past 4 weeks) to hurricane-affected areas.

  • All providers should consider less common infectious disease causes in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some "particularly important" infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.

  • In the context of limited laboratory resources in hurricane-affected areas, providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.

  • For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests; treatment for leptospirosis is most effective when started early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.

  • Local healthcare providers are "strongly" encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.

  • Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk for local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

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