Treating Patients in or Recently Returned from Hurricane-Affected Areas

 

Family physicians are an essential part of the emergency medicine safety net. As such, they are encouraged help their patients and communities become aware of the conditions that could lead to the outbreak of infectious diseases following disasters. Compromised drinking water, along with decreased access to safe water, food, and shelter allow for the conditions for outbreaks of infectious diseases to exist.

Recommendations

These recommendations from the Centers for Disease Control and Prevention (CDC)(www.cdc.gov) apply to health care providers treating patients in Puerto Rico and the U.S. Virgin Islands (USVI), as well as those treating patients in the continental U.S. who traveled in hurricane-affected areas during the period of September 2017 to March 2018.

Screen

Health care providers should:

  • Look for community and health care-associated infectious diseases.  
  • Ask patients in the continental U.S. about recent travel to hurricane-affected areas (e.g., during the period of September 2017 to March 2018).
  • Consider screening less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Particularly important infectious diseases include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.

Test and Treat

Health care providers should contact:

  • Their territorial or state health department if they need assistance with ordering specific diagnostic tests.
  • Their territorial or state health department or the Centers for Disease Control and Prevention (CDC) for consultation for certain conditions, such as leptospirosis. Empiric therapy should be considered pending results of diagnostic tests—treatment for leptospirosis is most effective when initiated early in the disease process.

Report

Health care providers should 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 immediately to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of 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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