Transcript The Microbiology of Natural Water Disasters

Natural Water Disasters
Microbiology
and
Disease
Kelley E. Capocelli, MD
October 28, 2005
THIS HAS BEEN A RECORD
YEAR FOR WATER
DISASTERS
HURRICANE KATRINA
HURRICANE RITA
AND IF THAT WASN’T
ENOUGH…
HURRICANE WILMA
COMES ALONG
Infectious Disease after
Natural Water Disaster
• Flooding is associated with an increased
risk of infection, however this risk is low
unless there is significant population
displacement and/or water sources are
compromised
– The major risk factor for outbreaks associated
with flooding is the contamination of drinkingwater facilities
Infectious Disease after
Natural Water Disaster
• Infectious disease outbreaks are rare following
natural disasters, especially in developed
countries
– Specific etiologies are usually predictable, reflecting
infectious diseases endemic to the affected region
before the disaster
– Injury and soft tissue infections are expected during
the first few days after a disaster
– In contrast, airborne, waterborne, and foodborne
diarrheal illness that is easily spread in densely
populated communities can be anticipated after a
natural disaster
Infectious Disease
After Hurricane
• Health Issues
– Waterborne illnesses
– Vectorborne illnesses
– Skin infections
– Airborne illnesses
– Mold/Mildew
– Human Remains
Waterborne Diseases
• Common waterborne diseases in the United
States include:
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Amebiasis
Campylobacteriosis
Cryptosporidiosis
Giardiasis
Hepatitis A
Salmonellosis
Shigellosis
Viral gastroenteritis
Amebiasis
• Caused by Entamoeba histolytica
– Disease is expressed most often as ulcerative and
inflammatory lesions of the colon resulting in a
complete spectrum of colonic signs and symptoms
• Occasionally, amebas gain access to extraintestinal sites,
most commonly the liver, where marked tissue destruction
occurs
– Risk factors that predispose to infection
• Crowding
• No indoor plumbing
• Persons living communally
Amebiasis
• Amebiasis (cont.)
– Factors attributing to increased severity of disease
• Children (esp. neonates)
• Pregnancy
• Corticosteroid use
• Malignancy
• Malnutrition
• Organism morphology
– Trophozoites range in size from 10 to 60 µm
• Have a single 3- to 5-µm nucleus containing fine peripheral
chromatin and a central nucleolus
• Often have ingested erythrocytes
– Cysts average 12 µm in diameter and contain one to
four nuclei with morphology identical to that of
trophozoite nuclei
Campylobacteriosis
• Among the most common bacterial
infections of humans in all parts of the
world, campylobacters cause both
diarrheal and systemic illnesses
– Excreta from infected animals may
contaminate soil or water
• Untreated surface water has been responsible for
both endemic and epidemic campylobacteriosis
• Motile, non-spore forming, commashaped, gram-negative rods
Cryptosporidiosis
• A diarrheal disease caused by microscopic
parasites of the genus Cryptosporidium
– Cryptosporidium parvum and Cryptosporidium hominis
are the most common disease causing species
– Once an animal or person is infected, the parasite lives
in the intestine and passes in the stool
• Millions of crypto organisms can be released in a bowel
movement from an infected human or animal
• The parasite is protected by an outer shell that allows it to
survive outside the body for long periods of time and makes it
very resistant to chlorine-based disinfectants
Cryptosporidiosis
• Life cycle
– Sporulated oocysts, containing 4 sporozoites,
are excreted by the infected host through
feces and possibly through other routes, such
as respiratory secretions
– Following ingestion by a suitable host,
excystation occurs
Cryptosporidiosis
• Life cycle (cont.)
– The sporozoites are released and parasitize
epithelial cells of the GI or respiratory tract
• Undergo both asexual and sexual multiplication
– Two oocysts are produced
 Thick-walled – commonly excreted from the host
 Thin-walled – involved in autoinfection
• Sites of infection
– Small intestine, most commonly
– Other digestive tract organs, the lungs, and
the conjunctiva
Giardiasis
• Diarrheal illness caused by a one-celled,
microscopic parasite, Giardia intestinalis
– A protozoan flagellate (Diplomonadida)
• Worldwide distribution
– Infection occurs by the ingestion of cysts in
contaminated water, food, or by fecal-oral
route
– The cysts are hardy and can survive several
months in cold water
Giardiasis
• Life cycle
– In the small intestine, encystation releases
trophozoites (each cyst produces two trophozoites)
– Trophozoites multiply by longitudinal binary fission,
remaining in the lumen of the proximal small bowel
where they can be free or attached to the mucosa by
a ventral sucking disk
– Encystation occurs as the parasites transit toward the
colon
• The cyst is the stage found most commonly in nondiarrheal
feces
Hepatitis A
• Small, unenveloped symmetrical RNA virus
– The cause of infectious or epidemic hepatitis
transmitted by the fecal-oral route
• Person to person the most common route
• Quickly spread through close contact, particularly
within families and institutions
• Food and water borne outbreaks also occur
frequently and although almost any food can be
implicated the most common sources are:
– Shellfish eaten raw or poorly cooked from sewagepolluted water.
– Foods handled without sufficient hygiene and not cooked
subsequently.
Salmonellosis
• Salmonella typhimurium and Salmonella enteritidis are
the most common types in the United States
– Usually associated with diarrheal disease, rarely associated with
bacteremia, endocarditis, and wound infections
• Gram negative, non-spore forming, facultatively aerobic
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bacilli 2 to 3 by 0.4 to 0.6 µm in size
Most often, acquisition of organisms occurs by ingestion
of food or water contaminated with human excreta
Usually, waterborne transmission involves the ingestion
of fewer microorganisms and, as a result, has a longer
incubation period and lower attack rate than foodborne
transmission
Shigellosis
• In the United States, over two thirds of
shigellosis cases are caused by Shigella sonnei,
and Shigella flexneri causes most of the
remaining cases
– Outbreaks of shigellosis in the U.S. are typically
caused by S. sonnei and occur in crowded settings
• Personal hygiene limited
• Contaminated food and water
– Fecal-oral transmission causing diarrhea (often
bloody), fever, and stomach cramps
– Gram negative rod, non-lactose fermenter
Escherichia coli
• Infection spreads to people through contact with
human or animal feces
• Contaminated water or food or through person-to-person
contact
• Usually associated with self-limited diarrhea
• Eschericia coli bacteria, not O157:H7, were
measured in flood waters after Hurricane Katrina
• these “generic” E. coli are normally found in all streams,
lakes, and canals
– When there is flooding along with a hurricane, the waters may
contain fecal material from overflowing sewage systems and
agricultural and industrial waste
Viral Gastroenteritis
• Enterovirus
– RNA virus
• can be found respiratory secretions and stool
• Norovirus (Caliciviridae)
– A group of viruses that cause gastroenteritis
• Nonenveloped RNA virus
– Small round structured viruses
• Waterborne outbreaks have been caused by sewage
contamination of wells and recreational water
• Also associated with food poisoning due to fecal-oral
transmission
• Rotavirus
– More commonly in infants and young children
• Fecal-oral transmission
Documented Infection
• Gastroenteritis
– CDC received reports of clusters of diarrheal disease
among persons in evacuation centers in Louisiana,
Mississippi, Tennessee, and Texas
• Have diagnosed norovirus, nontyphoidal Salmonella,
nontoxigenic V. cholerae O1
– More than 1,000 people were treated for diarrhea, vomiting, or
both symptoms between September 2 and September 12,
2005, according to the CDC
• No confirmed cases of Shigella dysentery, typhoid fever, or
infection by toxigenic V. cholerae O1
• Large dilution factor in the flood water—not enough
pathogens to cause disease
Documented Infection
• Conditions that facilitate virus transmission
– Crowding
– Insufficient sanitation in lavatories
– Lack of adequate number of hand-washing
facilities
– Delays in cleaning and decontaminating soiled
areas and bedding
Vibrio Infections
• Vibrio parahaemolyticus
– Primarily causes gastrointestinal illness (rarely wound
infections)
• About half of cases reported to CDC every year
– The most common Vibrio species isolated from humans
– Most people become infected by eating raw or
undercooked shellfish, particularly oysters, or other
food contaminated by raw shellfish
• Vibrio vulnificus is a bacterium that is a rare
cause of illness in the United States
– Persons who develop wound infections do so
following contamination of a pre-existing wound or
through an injury acquired while exposed to warm
coastal waters
Vibrio Infections
• Vibrio cholerae
– Have a natural reservoir in sea and coastal waters
– In an epidemic, the source of contamination is usually
the feces of an infected person
• The disease can spread rapidly in areas with inadequate
treatment of sewage and drinking water
– Associated with serogroup O1 (toxin-producing) and non-O1
(in the United States)
• If there is a clinical suspicion of infection with
Vibrio, use of a selective media thiosulfatecitrate-bile salts-sucrose (TCBS) is
recommended
Vibrio Infections
• Vibrio cholerae (cont.)
– Gastroenteritis
• Non-O1 = mild to severe watery diarrhea
• O1 = fever and bloody diarrhea
– Sepsis
• Non-O1 = in immunocompromised people and in
people with liver disease
– Wound infections
• Non-O1 = rarely
Vibrio Infections
• During August 29-September 11, 2005,
surveillance identified 22 new cases of Vibrio
with five deaths
– Caused by V. vulnificus, V. parahemolyticus, and
nontoxigenic V. cholerae
– Eighteen wound-associated Vibrio cases were
reported
• Mississippi = 7
• Louisiana = 5
• Texas = 2 (from Louisiana)
• Arkansas = 2 (from Louisiana)
• Arizona = 1 (from Louisiana)
• Florida = 1 (from Mississippi)
Vibrio Infections
• Non-wound associated illnesses
– Four persons were reported with non-wound
associated Vibrio infections
• Mississippi = 2
– Nontoxigenic V. cholerae gastroenteritis (non O1
subtype)
 Two month old boy and an adult
• Louisiana = 1
• Arizona (from Louisiana) = 1
Vibrio Infections
• Speciation
– V. vulnificus = 14
– V. parahemolyticus = 4
• Deaths
– V. vulnificus = 3
– V. parahemolyticus = 2
• An underlying condition that might have increased risk for severe
Vibrio illness was reported in 13 of the patients with wounds
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Heart disease = 7
Diabetes mellitus = 4
Renal disease = 3
Alcoholism = 3
Liver disease = 2
Peptic ulcer disease = 1
Immunodeficiency = 1
Malignancy = 1
Leptospirosis
• Leptospirosis—a zoonotic bacterial disease
– Caused by the bacteria Leptospira
• a flexible, spiral-shaped, Gram-negative spirochete with
internal flagella
• Leptospirosis is a worldwide zoonosis affecting
many wild and domestic animals
– Humans acquire the infection by contact with the
urine of infected animals
– Human-to-human transmission is extremely rare
• Between 1965 and 1993, the incidence rate of
leptospirosis in Louisiana ranged from 1 to 14
per 100,000 people per year
– Outbreaks of leptospirosis have occurred following
flood events
Leptospirosis
• Clinical presentation
– Wide variety of clinical manifestations, ranging
from a mild flu-like illness to a serious and
sometimes fatal disease
• May occur in two phases
– Phase 1 – fever, chills, severe headache, muscle aches,
vomiting, or diarrhea
 Also jaundice, abdominal pain, or a rash
 Patient may recover for a time but become ill again
– Phase 2 – Weil’s syndrome
 Jaundice, renal failure, hemorrhage, and myocarditis
with arrhythmias
Leptospirosis
• Clinical criteria for leptospirosis:
1. Fever > 38.0°C (100.4°F)
2. AND at least TWO from COLUMN A or ONE from
COLUMN B
COLUMN A
COLUMN B
Headache
Myalgias
Jaundice
Chills/Rigors
Skin rash
Conjunctival suffusion without
purulent discharge
Aseptic meningitis
Acute renal failure
Hemorrhagic pneumonitis
Cardiac arrhythmias, EKG abnormalities
Liver failure
Jaundice with acute renal failure
Vector-borne Illnesses
• Floods may indirectly lead to an increase in
vector-borne diseases through the expansion in
the number and range of vector habitats
– Standing water caused by heavy rainfall or overflow
of rivers/oceans can act as breeding sites for
mosquitoes
• Enhance the potential for exposure of the disaster-affected
population and emergency workers to infections such as
dengue, malaria, and West Nile fever
• Flooding may initially flush out mosquito breeding but it
comes back when the waters recede—lag time is usually
around 6-8 weeks before the onset of a malaria epidemic
West Nile Virus
• A single-stranded RNA virus of the family
Flaviviridae, genus Flavivirus
– Flaviviruses share a common size (40-60 nm),
symmetry (enveloped, icosahedral nucleocapsid),
nucleic acid (positive-sense, single stranded RNA
approximately 10,000-11,000 bases), and appearance
in the electron microscope.
• WNV is a member of the Japanese encephalitis
virus antigenic complex
– includes Japanese encephalitis, St. Louis encephalitis,
Murray Valley encephalitis, and Kunjin, an Australian
subtype of WNV.
West Nile Virus
• West Nile Virus (cont.)
– Hurricanes brought no increase in West Nile
cases
• The storm blew away most of the established
mosquito population
– Predicted that survivors will soon repopulate the area
and old eggs now submerged in water will hatch and
pupate quickly
– The increase in the insect population will bring back
many bird species probably including those carrying West
Nile and St. Louis encephalitis.
West Nile Virus
• Documented West Nile Infection
– Thirty cases reported in Louisiana in the
second week of October 2005
• Approximately the same number of cases as in
2004
– Louisiana 2005 = 129 West Nile cases, 6 deaths
– Louisiana 2004 = 114 West Nile cases, 7 deaths
– Mississippi 2005 = 60 West Nile cases, 4 deaths
– Post-hurricane cases mostly occurred in the
Baton Rouge area and the north shore area of
Lake Pontchartrain, where the virus was
heavily present before the hurricanes
Skin Infections
• Methicillin Resistant Staphylococcus aureus
– September 26, 2005 (MMWR Dispatch)
• 30 pediatric and adult patients at an evacuee facility in Dallas,
Texas
– Majority were skin infections, including pimples and boils
– Three cases confirmed with culture
• Tinea corporis
– Military personnel from two locations working in the wet
environment of early evacuation efforts
• Folliculitis
– Erythematous, papular, and pustular lesions among
military personnel in Mississippi
Airborne Illnesses
• Upper respiratory infections and pneumonias
– Pertussis in a 2-month old infant who was rescued
from a rooftop in New Orleans and evacuated to
Tennessee
• Tuberculosis
– A homeless person without a diagnosis of TB who
was evacuated from New Orleans to Philadelphia
– Eight other patients initially identified as having TB
were subsequently determined to have other
conditions
• Lung cancer
• Nontuberculous mycobacteria (including one with MAC from
Denver Health)
Airborne Illnesses
• Known TB patients
– A total of 195 persons known by the public
health authorities in Alabama, Mississippi, and
Louisiana to be undergoing treatment for TB
• Sought out by TB program staff to assure that
therapy continued
– 42 TB patients from Louisiana not yet located
 41 assumed to be noncontagious at the time the
hurricane made landfall
 Decision based on disease site, treatment duration,
or smear status
Legionnaires’ Disease
• Caused by Legionella bacteria
– Thrive in stagnant, warm water
• Favor a temperature of 25-42 C (77-108 F) for growth
• Outbreaks of this disease have been associated
with cooling towers, evaporative condensers,
showers, faucets, hot tubs/whirlpool spas, and
other sources of aerosolized water
– Because many buildings and cooling towers were shut
down during hurricanes Katrina and Rita, the water in
those systems has been sitting stagnant for days to
weeks, providing an increased risk of Legionnaires’
disease once the systems are restarted
Legionnaires’ Disease
• Legionnaires’ disease is contracted when
people breathe in mist or vapor that has
been contaminated with the bacteria
– The bacteria are NOT spread from person to
person
• Causes death in up to 30% of cases
Mold/Mildew
• Health Effects of Mold
– Infection
• Particularly in people with suppressed immune
systems
– Allergy
• Fever
• Skin rash
• Exacerbation of respiratory illnesses
– Toxin-mediated disease
Mold/Mildew
• Molds are multicellular and are composed of
filamentous structures called hyphae
– Hyphae are approximately 5-50 µm long and 2-4 µm
in diameter
– In most molds, hyphae are divided into distinct, celllike units by crosswalls termed septa
• Hyphae that contain septa are called septate
– When growing in nature and in culture in the
laboratory, hyphae typically branch and intertwine,
forming a compact mass called a mycelium, which
constitutes the mold colony
Mold/Mildew
• In medical mycology, the term dimorphism is limited to
pathogenic fungi that exist as molds at room
temperature and convert to a yeast phase at 35° or 37°C
– These organisms are true or primary pathogens and include
the causative agents of serious, systemic infections that are
often fatal
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Blastomyces dermatitidis
Histoplasma capsulatum
Paracoccidiodes brasilensis
Sporothrix schenskii
Coccidiodes immitis
--differs in that in tissues or when grown at 37°C on special media, it
produces spherules instead of growing as a yeast
Blastomycosis
• Most likely primary systemic mycosis
infection in Southeastern coastal states
after hurricane
– Blastomycosis
• Causative agent = Blastomyces dermatitidis
• Habitat = unknown
– Outbreaks have been associated around streams or
rivers with high content of moist soil enriched with
organic debris and/or rotting wood
• Geographic distribution
– Mid-western and southeastern regions of North America,
Central America and South America, and parts of Africa
Blastomycosis
• Blastomycosis (cont.)
– The infection is acquired via inhalation of the
conidia, which transform into the yeast form
once in the lungs
• After 30 to 45 days an acute pulmonary disease
indistinguishable from a bacterial pneumonia may
occur
• Most cases become manifest during a chronic and
indolent phase that may affect the lungs, the skin,
the bones, the genitourinary tract and other
reticuloendothelial organs
Blastomycosis
• Forms of blastomycosis
– Acute pulmonary
• Lobar or segmental consolidation
– Chronic pulmonary
• Lobar infiltrates with or without cavitation, mass mimicking
bronchogenic carcinoma, or fibronodular infiltrates
– Skin disease
• Either a verrucous or ulcerative lesion with an indolent
course
– Subcutaneous nodules
• Abscesses commonly associated with systemic manifestations
Blastomycosis
• Forms of blastomycosis (cont.)
– Bone and joint infection
• Long bones, ribs, and vertebrae
– Osteolytic, well-delineated lesions
– Genitourinary tract infection
• Prostate and epididymis (10 to 30% of cases)
– Others
• Central nervous system
• Thyroid
• Pericardium
• Adrenal glands
• Gastrointestinal tract
Blastomycosis
• Histopathology of blastomycosis
– Combination of acute suppurative and granulomatous
inflammation
– Fungi are usually seen at the edge of the abscess
– The yeast cells are globose to ovoid in shape and
approximately 8-15 µm in diameter
• The single blastoconidium is attached by a broad base to the
parent cell
• In most cases, predominantly single cells without attached
blastoconidia are seen
• The cell wall of the yeast is thick and appears doubly
refractile
– The mold is composed of septate hyaline hyphae and
unbranced short conidiophores
• The coniodiophores arise at right angles to the vegetative
hyphae
Opportunistic Mycoses
• Most likely opportunistic system mycosis
infections in Southeastern coastal states
after hurricane
– Aspergillosis
– Zygomycosis
– Hyalohyphomycosis
– Phaeohyphomycosis
Aspergillosis
– Aspergillosis
• Diseases caused by molds of the genus
Aspergillus, most commonly A. fumigatus , A.
flavus, and A. niger
• These organisms are widespread in the
environment including the home
• Many species of Aspergillus are xerophilic,
thermotolerant, and tolerant to freezing
Aspergillosis
– Aspergillosis (cont.)
• Infection is usually acquired via inhalation of
airborne conidia
• The clinical manifestation and severity of the
disease depends upon the immunologic state of
the patient
– Lowered host resistance due to such factors as
underlying debilitating disease, neutropenia,
chemotherapy, disruption of normal flora, and an
inflammatory response due to the use of antimicrobial
agents and steroids can predispose the patient to
colonization, invasive disease, or both
Aspergillosis
• Forms of aspergillosis
– Allergic bronchopulmonary
• Sinuses, lungs
– Pulmonary aspergilloma
• Pre-existing lung cavity
– Invasive aspergillosis
• CNS
• Pulmonary
• Sinonasal
• Osteomyelitis
• Endophthalmitis
• Endocarditis
• Renal abscesses
• Cutaneous
Aspergillosis
• Histopathology of aspergillosis
– The tissue reaction is acute suppurative
inflammation with areas of ischemic necrosis
• Blood vessel invasion, thrombosis, infarction, and
dissemination are extremely common
– The fungus proliferates as septate hyphae
2.5-4.5 µm in diameter
• The hyphae branch dichotomously (approx. 45
degree angle)
Zygomycosis
• Zygomycosis
– The angiotropic (blood vessel-invading)
infection produced by the various
Zygomycetes
• The leading pathogens in this group are species of
the genera Mucor, Rhizopus, Rhizomucor, and
Absidia
– These fungi are ubiquitous in the
environment, being found in soil and on
decaying matter, as well as on fruit and bread
Zygomycosis
• Zygomycosis (cont.)
– Conditions and factors that place patients at
risk for zygomycosis include poorly controlled
diabetes mellitus, leukemia, lymphoma,
corticosteroid therapy, malnutrition, organ
transplantation, and extensive burns
– Mycoses are generally acute and rapidly
developing in debilitated patients
Zygomycosis
– Zygomycotic infection
• The infection typically involves the rhino-
facial-cranial area, lungs, gastrointestinal
tract, and skin
• The fungi show a predilection for vessel
(arterial) invasion resulting in embolization
and necrosis of surrounding tissue
• Rhinocerebral disease in acidotic patients
usually results in death, often within a few
days
Zygomycosis
• Histopathology of zygomycosis
– The tissue reaction is usually slight
• Acute suppurative inflammation predominates with
focal areas of granulomatous inflammation
– Hyphae usually vary from 6-50 µm in
diameter, are sparsely septate, and irregularly
branched
– The organism characteristically invades the
walls of adjacent blood vessels, producing
thrombosis and infarction, but rarely
disseminates through the vessels
Zygomycosis
• Isolation of Zygomycetes
– Inoculate the material onto Sabouraud
dextrose agar and incubate at 30ºC.
– Sterile bread in a test tube may recover
Zygomycetes when other media fail
Hyalohyphomycosis
• Hyalohyphomycosis
– Encompasses infections caused by relatively
unusual hyaline molds and yeasts
• Includes over 40 different species classified in 23
genera
– Fusarium species
– Pseudallescheria boydii
Fusarium
• Fusarium species
– A filamentous fungi commonly found in soil,
on plants, and in organic debris
• Cause of localized infections of the skin, nails, and
cornea, usually the result of trauma
• In immunocompromised patients can cause sinoorbital, pulmonary, or disseminated infections
– Infections usually follow inhalation, but some have
originated from cutaneous lesions associated with
infected nails
Pseudallescheria boydii
• Pseudallescheria boydii
– A filamentous fungus found worldwide
• Has been isolated from soil, sewage, contaminated
water, and the manure of farm animals
– An emerging opportunistic infection
• Usually acquired via contact with soil and following
minor trauma
• Causes cutaneous, sinus, eye, CNS, lung, bone,
joing, and disseminated infections
Phaeohyphomycosis
• Phaeohyphomycosis
– A group of mycotic infections characterized by
the presence of dematiaceous (dark-walled)
septate hyphae and sometimes yeast or a
combination of both in tissue
• These fungi, commonly called “black molds,”
contain the dark brown pigment melanin in their
cell walls
• Many of these fungi are found in soil or on
decaying plant debris
• The most commonly encountered genera are
Alternaria, Bipolari, Curvularia, and Exserobilum
Phaeohyphomycosis
• Forms of phaeohyphomycosis
– Superficial
– Cutaneous
– Corneal
– Subcutaneous
– Respiratory tract (sinus/lung)
– CNS
– Bone
Phaeohyphomycosis
• Morphology of phaeohyphomycosis
– The hyphae may be short to elongate,
distorted or swollen (toruloid hyphae),
regularly shaped, or any combination of the
above
– The yeast will be variable in size and will show
budding
• Histopathology
– Varied, ranging from tissue reactions
associated with walled abscesses to active
tissue invasion by hyphae
Human Remains
• The notion that dead bodies pose an urgent
health threat in the aftermath of a disaster is
one of several myths about disasters and relief
efforts that the Pan American Health
Organization and the World Health Organization
have been trying to counter for nearly two
decades
– The most enduring myth is the idea that dead bodies
cause epidemics
• Survivors are much more likely to be a source of disease
outbreaks
• Most victims of natural disasters die of trauma, drowning, or
burns rather than infection
Human Remains
• The microorganisms that are involved in
decomposition are not the kind that cause
disease
– Most viruses and bacteria that do cause disease
cannot survive more than a few hours in a dead body
• Exception = HIV, has been shown to live up to 16 days in a
corpse under refrigeration
– Blood-borne viruses, such as HIV and hepatitis B and
C, as well as tuberculosis and gastrointestinal
infection, do pose a slight risk for relief workers
charged with handling bodies
Other Issues That I Do Not
Have Time To Discuss
• Tetanus
– Td or Tdap given to all evacuees and
emergency responders with wounds and
unknown vaccination history or > 5 years
since last dose
– Tetanus immune globulin (TIG) also given to
evacuees with unknown vaccination history
(or < 3 lifetime doses)
• Rabies – no documented cases post-
hurricane
• Non-tuberculous mycobacterial infections
References
• Barclay, L. “Epidemiologic Consequences of Hurricane Katrina: A
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Newsmaker Interview with Raoult Ratard, MD”,
www.medscape.com/viewarticle/513376
“Blastomyces sp.” www.doctorfungus.org/thefungi/Blastomyces
“Blastomycosis”, www.doctorfungus.org/mycoses/human/blasto
Centers for Disease Control and Prevention, “Interim Health
Recommendations for Workers who Handle Human Remains”,
www.bt.cdc.gov/disasters
Centers for Disease Control Media Relations, “Update on Health Issues
Related to Mold, Mildew, and Mud in Hurricane and Flood Affected Areas”,
www.cdc.gov/od/oc/media/transcripts/t050928, September 28, 2005
Eberwine, D. “Disaster Myths That Just Won’t Die”, Perspectives in Health,
2005, 10(1): 2-7.
Merck, Introduction to Medical Mycology: Monographs in Medicine. Merck &
Co, 2001.
MMWR Dispatch, “Infectious Disease and Dermatologic Conditions in
Evacuees and Rescue Work After Hurricane Katrina—Multiple Stats AugustSeptember, 2005”, September 26, 2005/54 (Dispatch); 1-4
References
• MMWR Dispatch, “Vibrio Illness After Hurricane Katrina – Multiple States,
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August-September 2005”, September 14, 2005/54 (Dispatch); 1-4
World Health Organization, “Flooding and communicable diseases fact
sheet: Risk assessment and preventive measures”,
www.who.int/hac/techguidance/ems/flood
www.bt.cdc.gov/disasters/foodwater.asp
www.bt.cdc.gov/disasters/hurricanes/katrina/pdf/katrina-leptoclin.pdf
www.bt.cdc.gov/disasters/vibriovulnificus.asp
www.cdc.gov/foodborneoutbreaks/vibrio_sum
www.dpd.cdc.gov/dpdx/HTML/A-F/Cryptosporidiosis/body_Cryptosporidiosis
www.dpd.cdc.gov/dpdx/HTML/Frames/G-L/Giardiasis/body_Giardiasis
www.reutershealth.com, “Hurricanes bring no increase in West Nile cases”,
October 12, 2005
“Zygomycosis”, www.doctorfungus.org/mycoses/human/zygo/zygomycosis