Communicable Diseases for IMT-managed Incidents

LCDR Antonio Neri MD, MPHCenters for Disease Control and

PreventionJanuary 26th, 2010

Views are those of the presenter and do not necessarily represent official policies and procedures of CDC/ATSDR or the US DHHS

Post-disaster Situations

Katrina – via Dr. Eric Stern

Source: http://images.mirror.co.uk/upl/m4/jan2010/8/0/leogane-haiti-pic-dm-ian-vogler-745564000.jpg

Haiti

Roadmap

• Review of common diseases and their prevention

• Resources

• Questions

Common Diseases During Incidents

• Skin infections– Methicillin-Resistant Staphylococcus Aureus (MRSA)– “Rashes”

• Respiratory disease– Influenza– Colds

• Gastrointestinal Illness– Norovirus– “food poisoning”

Warning!

• The next series of slides contain pictures of rashes, not the most appealing topic.

Source: http://www.deletetheweb.com/unstuck/tank-sign.jpg

Kosovo bridge sign

Skin Infections

Source: http://children.webmd.com/slideshow-common-childhood-skin-problems

“heat rash” Poison Ivy

Source: http://www.dshs.state.tx.us/idcu/health/antibiotic_resistance/mrsa/picpage.asp

MRSA

Skin Infections – Heat Rash

Cause - Occluded sweat ducts

Tx – gentle cleaning, keep dry, antihistamine

Skin Rashes – Poison Ivy

• Tx – Dishsoap to break up oils on skin and clothes, clean dressing, ± MD visit

Methicillin-Resistant Staphylococcus Aureus

(MRSA)

Source: http://www.dshs.state.tx.us/idcu/health/antibiotic_resistance/mrsa/picpage.asp

MRSA

• Locations – Existing cuts, hair follicles• Transmission – Skin-to-skin or shared items

– Towels, razors, soap, weights, etc…

• Tx – MD visit, use clean bandage, avoid contact with pus

Skin Rash – Prevention

• Heat Rash – Hygiene, mild soap

• Poison Ivy – Identify area, safety briefing

• MRSA– Handwashing, > 60% ETOH hand sanitizer– Individual soap / razors, wipe down surfaces– Cleaner / bleach (1 tablespoon / gallon)

• Eye, nose, throat irritation if overused

– Isolate infected, medical care

Respiratory Diseases

Source: http://media.photobucket.com/image/sneeze/chuan3205/sneeze_682_473022a.jpg

│---------- 12 feet? -----------│

InfluenzaInfluenza

• VirusVirus• Types A,B,CTypes A,B,C

Influenza A H1N1Influenza A H1N1

• Central America origin? (Usually SE Asia)Central America origin? (Usually SE Asia)• Predominant influenza strain worldwidePredominant influenza strain worldwide• TransmissionTransmission

• Person-to-Person, mainly from coughing and sneezingPerson-to-Person, mainly from coughing and sneezing• Also from contaminated surfaces and inanimate objectsAlso from contaminated surfaces and inanimate objects

– NOT transmitted from:NOT transmitted from:• Eating porkEating pork• Drinking waterDrinking water• Recreational waterRecreational water

Current US Influenza Activity During week 52 (December 27, 2009 – January 2, 2010), influenza activity

decreased slightly in the U.S.(as of January 2, 2010) Case rates highest in persons 5-14 years old

Influenza – Treatment

• Symptomatic (fluids, rest, fever control)• Oseltamivir (Tamiflu) Zanamivir (Relenza)

– Symptoms for ≤ 2 days– Early Tx – Pregnancy & pre-existing diseases

• Stay home for at least 24 hours after your fever is gone– If you have to go out and you are ill, consider

wearing a mask to prevent spreading germs to others

Influenza – Prevention Measures• Cover your cough• Hand washing• Hand sanitizer

– availability in group settings ↓ resp illness• Avoid touching your eyes/nose/mouth• Bed spacing ≥ 3ft

– Head-to-Toe orientation

Influenza – Prevention Measures

• Vaccinations– Consider seasonal influenza vaccination– H1N1 vaccine now available everywhere

• Self-isolation of ill persons for observation

• Cleaning surfaces (heat, bleach, alcohols)– Infectious up to 8 hrs after contact with surface

Gastrointestinal Illness

• Staphylococcus aureus• Norovirus• Bacillus cereus • Clostridium• E. coli• Salmonella• Shigella• Giardia

Source: http://www.voiceinthedesert.org.uk/weblog/archives/images/norovirus.gif

Staphylococcus aureus – GI illness

• Pre-formed toxin– Bacteria grow on UN-refrigerated food and

produce toxin– Irritate upper GI tract → vomiting

• Cause – Poor food handling practices

• Tx – Symptomatic, ± MD

Norovirus – GI Illness

• In US population (1999 estimates)

– Estimated 76 million total cases / year – Estimated 23 million cases of norovirus

• ~ 38% of cases caused by norovirusGTS Constellation Outbreak of Acute Gastrointestinal Illness

Sailing Oct. 16 - Oct. 27 & Oct. 27 - Nov. 7Epicurve by Reporting Date (n=137 Passengers, 14 Crew)

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Norovirus – Transmission

• Infectious dose ≤ 100 particles

• Viable on surfaces for extended periods

• Rapid onset diarrhea / vomiting – Lasts ~ 24 Hrs.

• Excretion in stool 12 – 72 hours (2 Wks?)

Norovirus scanning Electron Micrograph (CDC Public Health Image Library)

Norovirus – Transmission

• Foodborne– Sick handler– Poor food handling practices

• Person-to-person– Small infectious dose + long viability

• Occurs in– Schools, cruise ship, refugee camps,

hospitals, etc…

Preventing Foodborne Illness

• Make sure foods are within their appropriate handling temps for a given time – < 40 °F or > 140 °F

• Certified Kitchen Manager course– http://www.dshs.state.tx.us/

foodestablishments/cfm.shtm

• “Design out” poor food handling processes– Sneeze guards, servers vs. self-serve

Discussion – Hand Washing

• Key features of a successful program– Accessible facilities– Leadership by demonstration– Personal interactions

Courtesy CAPT George Vaughan, CDC, Vessel Sanitation Program

Discussion – Hand Sanitizer

• Varying alcohol concentrations

• Contradictory research findings

• CDC advocates sanitizer as an adjunct

Courtesy CAPT George Vaughan, CDC, Vessel Sanitation Program

Roadmap

• Review of common diseases and their prevention

• Resources

• Questions

Resources for IMTs - NPS

InsideNPS; click swine flu (H1N1) under Hot Topics on right-hand sidehttp://inside.nps.gov/waso/waso.cfm?lv=2&prg=122

External website http://www.nps.gov/public_health/di/flu.htm

Resources for IMTs - NPS

ARC guidelines for shelters http://www.region4a-mrc.org/documents/2009march/AMERICAN%20RED%20CROSS%20GUIDE%20FOR%20SHELTER%20MANAGERS.htm

CDC Shelter assessment survey http://www.bt.cdc.gov/shelterassessment/

SPHERE guidance for minimum standards of water / sanitation http://www.sphereproject.org/

US Army recommendations for preventing acute infectious disease for close-quarter living http://usachppm.apgea.army.mil/documents/TG/TG314.pdf

Questions?

LCDR Antonio Neri MD, MPHUS Centers for Disease Control and PreventionWork: 770-488-3378Email: aneri@cdc.gov

CDC EOC 800-232-4636770-488-7100eocreport@cdc.gov