SITE-SPECIFIC MORBIDITY SITE-SPECIFIC MORBIDITY CAUSES & POTENTIAL FOR CAUSES & POTENTIAL FOR

ZOONOTIC DISEASE OUTBREAKS ZOONOTIC DISEASE OUTBREAKS ASSOCIATED WITH FLOOD ASSOCIATED WITH FLOOD

DISASTERS IN TEXASDISASTERS IN TEXAS

E.J. HANFORD & Carroll W. BottomsE.J. HANFORD & Carroll W. BottomsEnvironmental Science & Biology DepartmentsEnvironmental Science & Biology Departments

Collin College, Frisco TX Collin College, Frisco TX 

Causes of Flooding in TexasCauses of Flooding in Texas• Frontal Squall Lines• Mid-Latitude Cyclones• Isolated Supercells• Hurricanes & Tropical

Storms

June 19, 2006

2001

• H. Ike coastal flooding Sept 23, 2008 Crystal Beach

• Upstream runoff June 2007 Colorado River, Austin

Sabine Pass 2008

Cameron Co 2005 - Rita

Flash Flood Alley Regional Flooding

Potential Exposure Scenarios

Edinburg TX - 2008Tarantulas, ants, snakes

Jasper TX

Potential Potential Zoonotic Diseases Diseases

Mosquito-borne

Dengue

Eastern Equine

West Nile

Yellow Fever

Tick-borne

Borrelia burgdorferi “Lyme”

Tularemia

Anaplasma “Erlichia”

Southern tick assoc. rash illness (STARI)

?Rickettsia rickettsii Rocky Mtn Spotted F.

Black-legged / “Deer”Ixodes scapularis

Lone star Amblyomma americanum

American dog Dermacentor variabilis

Critter-borne

Rabies

Bacillus anthracis

Streptobacillus moniliformis

rat-bite fever

Salmonella

Clostridium tetani

Vibrio vulnificus

V. parahaemoliticus

V. cholerae

E. coli

Water-borne & Food-borne

Fecal-borne

Leptospires

Hantavirus

Chagas

Multiple pathways

Norovirus

Rotavirus

Myth vs Reality

What should we anticipate in TX ? ? ?

Search Terms

Location & Events:• Texas• Gulf Coast• Evacuation centers• Hurricanes• Flood / Flash flood• Disaster

Disease:• Morbidity• Mortality• Disease outbreak• Illness• Zoonotic disease• Bacterial infection• Respiratory illness• Emerging disease• Arbovirus

Databases

• PubMed• NCBI Entrez• InfoTrac• Google Scholar• Cross-referencing

• 647 articles previewed• 167 articles reviewed• ~ 35 key articles selected• Duplicate data identified

Good News !!

• No epidemic occurrences reported

• Outbreaks reported– Limited to evacuation centers– Post-impact (recovery)– Most are non-life threatening: Gastro-intestinal

• Norovirus (up to 50 %)• Rotavirus• Non-toxigenic Vibrio cholerae• Non-Typhoidal Salmonella

Other Reports of ConcernCases & Fatalities:

– Vibrio vulnificus – Vibrio parahaemolyticus

Anthrax– 1970s: Falls, Kinney, Val Verde, Uvalde,

Edwards & Real Counties – Successive episodes to concentrate spores

Other infections:– MRSA – “Skin rashes”– “Respiratory” illness

Wisdom GainedWisdom Gained• Expect what is ENDEMIC• Early & On-Going Surveillance

– Evacuation Centers – Rescue & Relief workers– Pre-existing medical conditions increased risk

• B/C of warnings….most morbidity is post-impact– Time duration ~ magnitude of flood event

Confounding Factors• Changes in human behavior exposure• Reduction in disease control activities• Overcrowding• Co-morbidities

Opportunity !!Opportunity !!

• Education of displaced & impacted– Basic hygiene practices – Prevention & Mitigation techniques– Immunization screening

• Train public health professionals– Direct & indirect impacts

• Emphasize surveillance & reporting– Collaborative efforts– Individual & aggregate