On Oct. 24, the CDC issued a Health Alert Network advisory(emergency.cdc.gov) offering recommendations for assessing patients currently living or working in or recently returned from hurricane-affected areas such as Puerto Rico and the U.S. Virgin Islands (USVI).
The CDC, which has been working with federal, state, territorial and local agencies and global health partners in response to the recent hurricanes, said it's aware of accounts of infectious disease in affected areas stemming from "compromised drinking water and decreased access to safe water, food and shelter."
It's important that family physicians who provide care for patients from these areas remain vigilant for infectious diseases such as leptospirosis, dengue, hepatitis A infection, typhoid fever, vibriosis and influenza.
In September, Hurricanes Irma and Maria made landfall in Puerto Rico and the USVI, causing widespread flooding and damage, which has led to continued natural hazards.
AAFP Foundation's Hurricane Relief
This hurricane season has seen massive devastation from Hurricanes Harvey, Irma, Maria and Nate in the Caribbean and southern United States.
In response to these catastrophes (along with the recent earthquake in Mexico and wildfires in Oregon and California), family physician donors, corporate partners and staff have donated more than $100,000 to the AAFP Foundation.
These contributions have supported on-the-ground relief efforts through the AAFP chapter in Puerto Rico, Heart to Heart International (HHI) and the International Medical Corps (IMC). Both HHI and IMC work directly in disaster areas to provide emergency aid and medical services.
The AAFP Foundation thanks the more than 400 people and organizations that contributed in response to the disasters. You can still donate to the foundation's disaster relief for the hurricanes effort.(www.aafpfoundation.org)
According to the CDC, outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems is disrupted and personal hygiene is difficult to maintain.
In addition, elevated levels of mosquito breeding in standing water that remains in these areas could spark vector-borne diseases. Currently, both Puerto Rico and the USVI are at increased risk for outbreaks of dengue, Zika and chikungunya.
"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 CDC advisory noted.
Fortunately, the agency added, cholera hasn't been an issue in Puerto Rico or the USVI in many decades and isn't expected to appear after the hurricanes.
The CDC advisory's recommendations are intended for health care professionals providing care for patients in Puerto Rico and the USVI, as well as those caring for patients in the continental United States who recently traveled to hurricane-affected areas (e.g., within the past four weeks).
The recommendations call for health care professionals in hurricane-affected areas to monitor for community and health care-associated infectious diseases. The advisory also recommends that those working in the continental United States ask patients about recent travel to hurricane-affected areas. All clinicians providing care for patients from any of these locations should consider less common infectious disease etiologies in patients who present with acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection or other febrile illness. Health care professionals are encouraged to contact their territorial or state health department if they need help ordering specific diagnostic tests.
Additionally, the CDC's advisory recommends that health care professionals
- consider empiric therapy pending results of diagnostic tests for certain conditions, such as leptospirosis -- treatment for leptospirosis is most effective when initiated early in the disease process;
- contact local health authorities regarding patients in whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A infection, typhoid or vibriosis while awaiting laboratory confirmation; and
- report confirmed cases of leptospirosis, dengue, hepatitis A disease, typhoid fever and vibriosis immediately to the territorial or state health department to facilitate public health investigation and mitigate the risk of further transmission.
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