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DISASTER
RECOVERY

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mitted by the Aedes aegypti mosquito, which is present in Texas.
Health departments warned of potential Zika outbreaks due to
mosquito breeding in flooded areas. Currently available data from
Houston actually show fewer documented cases of Zika (6 cases)
in 2017 compared with 32 cases in 2016.
(http://www.houstontx.gov/health/Epidemiology/Zika/zika_num
bers.html). Among other mosquito control measures post-Harvey
(and post-Katrina), the U.S. Air Force sprayed naled (Dibrom), an
organophosphate insecticide, over mosquito breeding areas. The
Houston Health Department also launched media initiatives to ed-
ucate the public with campaigns like “3-D Zika Defense: protect
yourself from Zika with the 3 D’s”. The “3 D’s” refer to DEET,
Dress, and Drain, encouraging people to use insect repellent, pro-
tective clothing, mosquito nets, condoms (to prevent sexual trans-
mission of Zika), and to drain standing water.
Houston’s success in thwarting a Zika outbreak underlines the
importance of public funding for prevention initiatives. Other post-
disaster countries with more fragile health infrastructure have been
less fortunate, as documented in Haiti, in 2010: “During January 12
–February 25, CDC received reports of 11 laboratory-confirmed
cases of P. falciparum malaria acquired in Haiti. Patients included
seven U.S. residents who were emergency responders, three Haitian
residents, and one U.S. traveler” (MMWR / March 5, 2010 / Vol.
59 / No. 8). ists and diagnostic services. Infectious disease faculty from Baton
Rouge documented that “the only travel assistance for patients
3. Vaccination after disasters: needing to access subspecialty clinics in Baton Rouge has come
The CDC provides useful guidelines related to vaccination after from limited support…. generated by fundraising efforts by one of
disasters, emphasizing the need for TdaP for adults who are unsure the HOP clinic physicians” (Clin Infect Dis, 2006;439(4):485–89).
of the date of their last tetanus booster, Pneumovax and Prevnar Given the importance of controlling TB and other infectious dis-
for individuals aged >/=65 or >19 years if immunocompromised. eases, it is extraordinary that disaster-responding physicians would
In crowded settings, CDC recommends giving most people the fol- have to rise to these occasions, not only out of beneficence for pa-
lowing vaccines (unless documentation of prior vaccination is avail- tients, but also on behalf of society at large.
able): influenza, varicella, and MMR (exclude pregnant women and One of the most important long-term post disaster medical chal-
immunocompromised hosts from live vaccines). It is not routinely lenges is providing adequate mental health care, necessary for the
necessary to vaccinate for Hepatitis A, typhoid, cholera or rabies. high incidence of depression and post-traumatic stress disorder in
Further details may be found at www.cdc.gov/disasters/hurri- disaster victims. Louisiana reported that suicide rates among white
canes/hcp.html. males were higher post-Katrina (J La State Med Soc.
2012;164(5):274-6). Mental health professionals and other specialists
Long Term Challenges were slow to return to New Orleans after Hurricane Katrina; this
After natural disasters, rebuilding infrastructure for safe water and would adversely impact adherence levels for patients being treated
sanitation, reconstitution of primary care services, return of health for chronic infections.
care personnel, and diagnostic capabilities, take far longer than ex- During longer term disaster recovery phases, many communities
pected. Eight months after Hurricane Katrina, patients needing receive an influx of guest laborers: more often than not, these indi-
MTB or sexually transmitted infection screening still had to be re- viduals lack health insurance and face other barriers to health care.
ferred outside New Orleans to health clinics in Baton Rouge or ad- However, these individuals need healthful accommodations, pre-
jacent suburbs (N Engl J Med. 2006 Apr 13;354(15):1549-52). ventive vaccines, and screening for infectious diseases including
A necessary post-Katrina adaptation was fundraising by health HIV, hepatitis, and tuberculosis. Infectious disease screening should
professionals to pay for vouchers allowing transport to subspecial- only take place in settings that can provide linkage to care.

18 San Antonio Medicine • February 2018