In the aftermath of Hurricane Irma (and with further such events in imminent prospect), the European Centre for Disease Prevention and Control (ECDC) has issued a rapid risk assessment concerning communicable diseases.
The assessment concludes that the most immediate risks in the affected areas of the Caribbean are increased transmission of diarrhoeal diseases related to lack of access to safe drinking water and acute respiratory infection in children accommodated in overcrowded shelters. The risk of an upsurge in cholera cases in areas with previous transmission and flood-specific risks (e.g. tetanus and leptospirosis) should be given priority when adopting mitigating measures. Mosquito-borne diseases represent a delayed risk that should be taken into account in this context.
The prevention of gastrointestinal illnesses is dependent on adequate sanitation, availability of safe drinking water (chlorinated or boiled) and appropriate food hygiene – i.e. regularly washing hands with soap, eating thoroughly cooked food, washing fruits and vegetables with bottled or chlorinated water and avoiding consumption of raw sea food products.
It is also important to prevent the transmission of respiratory infections in crowded settings through early detection, treatment and appropriate infection control measures.
In flood-affected areas where Aedes mosquito-borne diseases or malaria are present, health authorities and clinicians should be sensitised to the possibility of a delayed increase in vector-borne disease outbreaks in the aftermath of the hurricane. The best protection from mosquito-borne diseases is preventing mosquito bites indoors and outdoors. These measures include:
- use of mosquito repellent in accordance with the instructions indicated on the product label;
- wearing long-sleeved shirts and long trousers;
- sleeping or resting in screened or air-conditioned rooms;
- use of mosquito nets.
Additional vaccination measures should also be considered for residents/visitors to the affected areas:
- tetanus vaccination and booster doses and the use of tetanus immunoglobulin for management of high-risk exposures in those not up-to-date with vaccination;
- vaccination and chemoprophylaxis for contacts of meningococcal meningitis cases in accordance with local guidelines;
- vaccination against food- and waterborne diseases, such as hepatitis A, cholera and typhoid fever for individuals at risk of infection, especially those involved in the cleaning of wastewater and sewage and in charge of re-engineering the clean water system;
- cholera vaccination, for travellers to areas with active transmission, especially for rescue and community workers;
- vaccination against hepatitis B for workers in rescue and emergency services who may be exposed to blood and other bodily fluids.
Surveillance of infectious diseases in the aftermath of a hurricane is important for the early detection and confirmation of outbreaks. Consideration should be given to setting up a syndromic surveillance alert system if there is a need to reinforce surveillance capacity. Laboratory capacity should be assessed for confirming outbreaks of infectious diseases and a referral mechanism established for testing samples of epidemic-prone diseases, if required. [Source: ECDC Rapid Risk Assessment, 11 September 2017. https://ecdc.europa.eu/en/publications-data/rapid-risk-assessment-hurricane-irma-risk-communicable-diseases-affected]