The CDC is urging Hurricane Katrina’s victims and relief workers to get their vaccinations updated.
Doing so could help curb vaccine-preventable infectious diseases in hurricane-damaged areas and at relief centers in other states. Here is the CDC’s guidance:
For Displaced Hurricane Survivors
If immunization records are available, children and adults should be vaccinated according to the recommended immunization schedules for kids, teens, and adults.
Many people didn’t have time to grab their medical records as they fled the storm. The CDC’s advice for those people:
Kids younger than 6 years should be “forward vaccinated.” They should be treated as if they were up-to-date with recommended immunizations and given any doses that are recommended for their current age. That includes:
—Diphtheria/tetanus/whooping cough vaccine (DTaP)
—Inactivated polio vaccine (IPV)
—Haemophilus influenzae type B vaccine (Hib)
—Hepatitis B vaccine (HepB)
—Pneumococcal conjugate vaccine (PCV)
—Measles-mumps-rubella vaccine (MMR)
—Chickenpox (varicella) vaccine, if there’s no history of chickenpox
—Influenza vaccine for children aged 6 to 23 months and kids up to age 10 with a high-risk condition
—Follow state immunization practices for hepatitis A, which isn’t routinely recommended in all states.
Children and adolescents aged 11-18should receive the following recommended immunizations:
—Adult formulation diphtheria/tetanus/whooping cough vaccine (DTaP)
—Meningococcal conjugate vaccine (MCV) for ages 11-12 and 15 only
—Influenza vaccine for those who are ill or 6 to 23 months old
Adults aged 18 and oldershould get the following recommended immunizations:
—Adult formulation diphtheria/tetanus/whooping cough vaccine (DTaP)
—Pneumococcal polysaccharide vaccine (PPV) for adults aged 65 and older or with a high-risk condition
—Influenza vaccine for people aged 65 and older, residents of long-term care facilities, people aged 2-64 who are ill, pregnant women, health care workers who provide direct patient care, and household contacts/day care workers for kids younger than 6 months
People in Crowded Group Settings
In addition to the routine vaccinations for each age group, the CDC is urging additional vaccinations for displaced people living in crowded group settings (such as shelters):
—Influenza.Everyone who is at least 6 months old should get an influenza vaccine. Kids who are 8 years old or younger should get two doses, at least one month apart.
—Chickenpox.Everyone who is more than 12 months old and born in the U.S. after 1965 should get one dose of the chickenpox (varicella) vaccine unless they have a history of chickenpox.
—Measles-mumps-rubella.Everyone who is more than 12 months old and born after 1957 should receive one dose of the MMR vaccine.
—Hepatitis A.Everyone who is at least 2 years old should receive one dose of the hepatitis A vaccine unless they have a clear history of hepatitis A.
Important Exceptions
The CDC says the following groups of people should not receive the live viral vaccines or the vaccines for chickenpox and measles-mumps-rubella:
—People with compromised immune systems (such as those with HIV)
—Pregnant women
—People taking systemic steroids
Screening should be done by self-report, says the CDC.
What About Cholera, Typhoid, Rabies?
The CDC does not recommend vaccinations against typhoid and cholera for people displaced by Hurricane Katrina.
“Both diseases are extremely rare in the Gulf states, and there is no vaccine against cholera licensed for use in the United States,” notes the CDC’s web site.
Rabies vaccines should only be used after exposure (for instance, after an animal bite or bat exposure), says the CDC.
For Relief Workers in Hurricane-Hit Areas
Anyone traveling to affected coastal areas in Louisiana, Mississippi, Alabama, and Florida should be immunized against tetanus/diphtheria, the CDC advises.
Those who are highly likely to be exposed to blood and bodily fluids (such as health care workers) should also be vaccinated against hepatitis B, notes the CDC.
The CDC isn’t recommending hepatitis A, typhoid, cholera, meningococcal, or rabies vaccines for emergency responders.
The Most Important Vaccine for Relief Workers
“From a vaccination point of view, the most important thing is that people get a booster for their tetanus status,” George Jackson, MD, tells WebMD. Jackson is Duke University’s director of employee occupational health and wellness. A team of 40-50 Duke University employees is heading to Meridian, Miss., for hurricane relief.
Those staffers have all had tetanus shots; those who needed tetanus booster shots got them, says Jackson. Health officials allow 10 years between booster shots, but “we elected to go with five years for this purpose, just to make sure that they’ve got some extra protection on tetanus,” says Jackson.
“The reality is that most people are not going for extended periods of time,” says Jackson. “Hepatitis A and hepatitis B also would be reasonable things to think about. The problem is that [the hepatitis A and B vaccines] take a fair amount of time to be effective, and so if people are going down for a couple of weeks, both of those vaccines are not going to do anything for you.”
The Duke staffers had essentially all been vaccinated against hepatitis B. Those who wanted the hepatitis A shot got it, though the time frame might be too short for protection.
“The real trick there is for them to be very careful,” says Jackson, noting that hepatitis A is spread through fecal-oral transmission.
“They just need to be really careful about the water they’re drinking and where they’re consuming the food and they shouldn’t be handling contaminated stuff, which they wouldn’t in Meridian. Meridian is about 100-and-some miles away from the coast, so it’s unlikely they’d handle much contaminated material and then handle their food, or something like that. But they’re all health care people and they know that’s not something they should do, anyhow. So it’s a relatively low-risk situation for them.”
Planning Ahead
Jacksonsays relief workers headed to the hurricane-hit areas should plan carefully. “Think about the circumstances you’re going to be in,” he says.
“If you’re going down there to muck around in a swampy situation, your biggest risk is probably falling because everything is going to be slippery and slimy. You better think about how you’re going to get around safely if you’re going to do something of that nature. So something as mundane as boots and safety shoes would be important,” he says.
Bring mosquito repellent, he suggests. Those working in health care settings might also want to pack hand sanitizers, he adds.
Don’t Become Part of the Problem
“I think that one of the most disastrous elements that all of these relief agencies complain about is getting gobs of people coming down to help out who become a problem in and of themselves,” says Jackson.
“Where are you going to live, how are you going to shelter yourself, how are you going to feed yourself, where are you going to get clean water from? All of those kinds of things that everybody there is faced with, and if you go down there, you’re going to be faced with the same situation. And I think that unless you’re going with a highly organized group that knows what they’re doing, you better be sure of yourself,” he says.
Jacksonsays he hopes that people “go down with their eyes open and don’t contribute to the problem by going unprepared.”
Helping Displaced Storm Victims
Jackson says no special measures (apart from good hygiene) are needed for people assisting or around displaced storm victims.
“I can’t imagine any particular problem that those individuals might have,” except possibly diarrhea or gastrointestinal illnesses, says Jackson. Washing hands and disinfecting surfaces with soap and water can help in those cases, he says.
“These people are not carrying exotic diseases of any kind. If they have diarrhea, obviously the individual who has diarrhea would want to be particularly careful about their own hygiene as well as those who interact with them,” says Jackson.
More Advice From the CDC
The CDC also offers this advice for relief workers headed to affected areas:
—Avoid contaminated water.
—Wear sturdy footwear.
—Get wounds or rashes assessed by a health care worker as soon as possible.
—Immediately clean any wounds, cuts, or animal bites with soap and water.
—Use basic first aid to treat any injury until medical care is available.
—Avoid downed power lines.
—Boil or disinfect water if you can’t get bottled water from a trusted source.
—Bring enough food (canned or processed may be best), water, or means of water purification.
—Antibiotics can be given for self-treatment of diarrhea.
—Get medical attention for diarrhea accompanied by high fever or bloody stools.
—Washhands frequently with either soap and water or a waterless, alcohol-based hand wash.
—Use insect repellents containing DEET or picaridin and wear long-sleeved shirts and pants when outside.
—If you encounter a snake, don’t try to kill it.
—Wear wrap-around sunglasses and use sunscreen and lip screen with an SPF of at least 15 that protects against UVA and UVB rays.
—Watch out for heat stroke.
—Take care of your mental health. Check in with family and close friends from time to time for support. Consider bringing a family photo, favorite music, religious material, or whatever you find comforting.
—See a doctor if you fall ill when you get back home.
By Miranda Hitti, reviewed by Brunilda Nazario, MD
SOURCES: CDC: “Interim Immunization Recommendations for Individuals Displaced by Hurricane Katrina.” CDC: “Update: Influenza Vaccine Supply and Recommendations for Prioritization During the 2005-06 Influenza Season.” CDC: “Interim Guidance for Healthcare Professionals Advising Travelers to Hurricane Affected Areas in the United States.”
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