TMC PULSE

t m c » p u l s e | o c t o b e r 2 0 1 7 25 25 A fter five days of catastrophic flood- ing at the end of August, Houston is still assessing the extensive destruction Tropical Storm Harvey left in its wake. Floodwaters introduce a slew of health concerns, including infections, mosqui- to-borne diseases, allergic reactions and respiratory problems, according to Peter Hotez, M.D., Ph.D., dean for the National School of Tropical Medicine at Baylor College of Medicine. "We actually have an interesting body of literature now of the infectious disease problems that people faced after Hurricane Katrina more than a decade ago," Hotez said. "There are some similarities—because it is the Gulf Coast region—between what we saw in Katrina and what we can expect in Harvey, so it's instructive to look at that." After Katrina, there were several cases of skin infections from staphylococcus, including an antibiotic-resistant staphylo- coccus, called methicillin-resistant staph- ylococcus aureus or MRSA. Additionally, more than 20 illnesses and five deaths after Katrina were caused by wounds contaminated with vibrio vulnificus, a type of flesh-eating bacteria that can be found along the Gulf Coast. "What that means is people who have been exposed to floodwaters, especially if they have wounds, want to keep those very clean and get medical attention for them," Hotez said. It is also important for people to stay up to date on tetanus shots to protect against disease, he added. "You don't need to do a mass immu- nization of tetanus. The recommendation Health Dangers Left in Harvey's Wake Floodwaters introduce multiple threats to human health is that you should get a tetanus booster every 10 years," Hotez said. "If you've not had one recently, then go and get one— no rush." Standing water also becomes an excel- lent breeding site for mosquitoes, partic- ularly for Culex mosquitoes that transmit West Nile virus and the Aedes aegypti and Aedes albopictus mosquitoes that trans- mit dengue, Zika and chikungunya. "That's going to be something we're going to have to look after, whether we're going to see an uptick in any of those mosquito-transmitted viral diseases in the coming weeks," Hotez said. And it may take some time for these diseases to develop. The number of reported cases of West Nile neuroinvasive disease nearly doubled in Louisiana and Mississippi a year after Hurricane Katrina. Even after floodwaters recede, the damage left behind in homes can threaten the health of residents if mold and bacteria grow in water-damaged walls and floors. Exposure to mold can cause severe allergic reactions, respiratory symptoms and asthma, and can pose a more serious threat to immunocompro- mised individuals. As the mosquito population increases in the weeks after flooding, it's important to use insect repellent that contains DEET to reduce the risk of contracting any mosquito-borne illnesses. Overall, Hotez said, the best thing to do is to "have a low threshold for getting medical attention." "If you start developing symptoms of diarrheal disease or respiratory infections or if you have a wound that looks suspi- cious, then you want to get that taken care of," he said. In the aftermath of Harvey, public health and emergency preparedness have become the center of discourse for city and state officials, but Hotez said preventative measures for infectious and tropical diseases in the Gulf Coast are often disregarded. "If you look at where we live on the Gulf Coast, it represents our nation's most vulnerable area to disease," Hotez said. "Everybody's focused on the two coasts, especially the urban centers in Boston, New York, Silicon Valley and Los Angeles, and we forget everything in the middle. Yet the Gulf Coast, because of the factors of poverty, climate change, rapid urban- ization and human migrations, I think that creates this perfect storm that makes this region particularly susceptible. It's not really happening on a national level to rec- ognize the vulnerability of this region." — Shanley Chien E X P E R T S Facing: The contents of flood-damaged homes line the streets of Meyerland. Peter J. Hotez, M.D., Ph.D. Credit: Courtesy photo

• Cover