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DATE: 9/13/2005
Health Advisory on Medical Conditions Affecting Evacuees and Responders

Scottsdale, Ariz. - The Arizona Department of Health Services (ADHS) today released the following health advisory:

As a result of Hurricane Katrina, our state has welcomed more than 1,000 evacuees from the Gulf Coast. Many of these evacuees have received some medical assessment and many more may present with storm-related health care needs as they begin the process of moving out of shelters and possibly resettling in our state. Additionally, many of our emergency and relief responders from Arizona have traveled to the Gulf Coast and many more will be going and returning over the next several months. The information below is provided to help assess the health of evacuees and responders returning from the Gulf Coast.

These are the primary medical conditions that providers should be aware of when providing care to evacuees and responders.

1. Gastroenteritis (diarrhea) caused by waterborne organisms such as: (a) Bacterial - Enterotoxigenic Escherichia coli, Enterohemorrhagic Escherichia coli, Campylobacter jejuni, Salmonella spp, Shigella spp, Vibrio spp, Leptospirosis, Aeromonas hydrophila, Pleisiomonas shigelloides, Yersinia enterocolitica (b) Parasitic- Cryptosporidium, Giardia, Toxoplasmosis, Entamoeba histolytica, Cyclospora (c) Viral- Enteroviruses, Norovirus, West Nile Virus (mosquito borne)

2. Rash: Think of fungal infections, Staphylococcus aureus, Streptococcus (Group A beta-hemolytic)

3. Injuries: like skin abrasions etc. that may be infected with waterborne organisms as listed above. CDC has been tracking several cases of Vibrio spp. related skin infections. Please contact ADHS Epidemiology if you suspect such an infection (602-364-3676).

The following conditions may require additional supportive care:

1. Leptospirosis: Caused by exposure to contaminated water by animal urine. The signs and symptoms include fever, headache, chills, myalgia, vomiting, jaundice, anemia and sometimes rash. The incubation period is usually 7 days; persons may get sick 2 days to 4 weeks after exposure.

2. Norovirus: The presentation is consistent with gastroenteritis, which includes nausea, vomiting, diarrhea, stomach cramps, low-grade fever, headache, chills, myalgia. The incubation period is 12 to 72 hours and symptoms can last from 1 day to 2 weeks.

3. Vibrio spp.- the ones to be aware of are V. vulnificus, V. cholerae non-01 and non-0139. V. vulnificus infection occurs after a wound is exposed to contaminated water or acquired by eating raw or undercooked seafood. Signs and symptoms are redness and swelling at wound site with fever. V. cholerae non-01 and non-0139 symptoms include watery diarrhea, cramps, vomiting and low grade fever. Symptoms begin 1 to 3 days after exposure. Vibrio species are characteristically susceptible to doxycycline and fluoroquinolones.

If you have any questions about this information or appropriate follow-up laboratory tests, please call the ADHS Epidemiology section at 602-364-3676.

Many of the above conditions are reportable under the Arizona communicable disease reporting rules (A.A.C. R9-6-202). Please submit reports to your local health department as appropriate. Go here for a complete list of Arizona‘s reportable diseases. A note on the report that the patient is a recent evacuee will be helpful for further disease tracking and follow-up.

For additional information, please reference the official CDC web site.