Hurricane Harvey: Responding to Public Health and Infectious Disease Threats

Statement from IDSA President William Powderly, MD, FIDSA and HIVMA Chair Wendy Armstrong, MD, FIDSA:

The membership of the Infectious Diseases Society of America and the HIV Medicine Association stand with the individuals, families and communities affected by flooding in the aftermath of Hurricane Harvey, and urge care, preparation and precautions in confronting health impacts that may pose risks in the days and weeks ahead. We would like first to emphasize that while widespread disease outbreaks after flooding remain uncommon in the United States, hand hygiene, clean water, as well as access to medications will be essential for preventing and limiting the spread of infectious diseases during this time.

Settings that include residences now without electricity and compromised by flooding, as well as shelters housing large numbers of people can provide fertile breeding grounds for noroviruses and other infections, making frequent hand-washing or use of an alcohol hand gel an important measure.  Because cholera and typhoid are not commonly found in the U.S. Gulf States area, it is very unlikely that they will occur as a result of the hurricane or the flooding in its aftermath.  At the same time pathogens that include Vibrio vulnificans, non-tuberculosis mycobacteria, and Legionella are found in water, with flooding increasing risks of exposures, and while they remain unusual, avoiding contact with floodwater if possible is an appropriate precaution.  We urge people who are concerned about the risks of any exposure they have experienced to seek medical care.

For people living with HIV maintaining adequate supplies of medications will be critical to prevent treatment disruptions. The HIV/AIDS Bureau that administers the Ryan White HIV/AIDS Program has indicated that Texas and Louisiana have implemented processes allowing displaced Ryan White patients to receive medications in other areas of the state.  The Bureau also has encouraged Ryan White Program grantees in surrounding areas to streamline eligibility processes to facilitate HIV care and treatment access for displaced patients. (Information on medication assistance and HIV clinic status is available from the Texas Department of State Health Services here.)

We recognize that the aftermath of this catastrophic event will pose additional, lingering and serious health threats. Suboptimal vaccination rates can exacerbate the potential for infections to spread, particularly in crowded conditions, and Texas already has experienced clusters of mumps infections this year.  Lack of electricity and poor housing in Houston provide an atmosphere ripe for consumption of unsafe food and water, and illnesses such as E. coli should be anticipated.  Persons with HIV and other diseases, and persons with common treatable infections such as pneumonia or skin infections, may suffer complications due to delayed diagnosis and treatment. Immediately after winds and flood, the mosquito populations diminish.  However, they will return, and standing water that remains for long periods of time may contribute to increased mosquito breeding.  In addition, loss of housing may lead to individuals spending longer periods outdoors and increase risk of mosquito-borne illnesses, including West Nile Virus and Zika.  As individuals return to damaged homes, mold-related illnesses such as severe asthma might be seen. 

The public health response to Hurricane Harvey must also be serious and long-standing. We stand ready to offer our guidance, and our voices for the funding and resources that will be needed as communities in the path of the storm proceed with their recoveries.