Communicable Diseases for IMTmanaged Incidents LCDR Antonio Neri

Communicable Diseases for IMT-managed Incidents LCDR Antonio Neri MD, MPH Centers for Disease Control and Prevention January 26 th, 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 Haiti Source: http: //images. mirror. co. uk/upl/m 4/jan 2010/8/0/leogane-haiti-pic-dm-ian-vogler-745564000. jpg

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

Skin Infections “heat rash” Poison Ivy Source: http: //children. webmd. com/slideshow-common-childhood-skin-problems MRSA Source: http: //www. dshs. state. tx. us/idcu/health/antibiotic_resistance/mrsa/picpage. asp

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 │----- 12 feet? ------│ Source: http: //media. photobucket. com/image/sneeze/chuan 3205/sneeze_682_473022 a. jpg

Influenza • Virus • Types A, B, C

Influenza A H 1 N 1 • Central America origin? (Usually SE Asia) • Predominant influenza strain worldwide • Transmission • Person-to-Person, mainly from coughing and sneezing • Also from contaminated surfaces and inanimate objects – NOT transmitted from: • Eating pork • Drinking water • Recreational water

Current US Influenza Activity n n 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 ≥ 3 ft – Head-to-Toe orientation

Influenza – Prevention Measures • Vaccinations – Consider seasonal influenza vaccination – H 1 N 1 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 norovirus

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/foodestablishment s/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 Inside. NPS; click swine flu (H 1 N 1) under Hot Topics on right-hand side http: //inside. nps. gov/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. region 4 amrc. org/documents/2009 march/AMERICAN%20 RE D%20 CROSS%20 GUIDE%20 FOR%20 SHELTER %20 MANAGERS. 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/TG 314. pdf

Questions? LCDR Antonio Neri MD, MPH US Centers for Disease Control and Prevention Work: 770 -488 -3378 Email: aneri@cdc. gov CDC EOC 800 -232 -4636 770 -488 -7100 eocreport@cdc. gov