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Hurricane Harvey Puts Health Officials on Alert for Water-Borne Infections

AUG 28, 2017 | CONTAGION® EDITORIAL STAFF

Leptospirosis

Although incidence of leptospirosis is low in the United States, with the CDC reporting about 100-200 cases each year, 50% of which occur in Hawaii, flood waters in towns increase the risk of infection. The disease is caused by Leptospira bacteria, which are “long, thin, motile spirochetes,” that are spread through the urine of infected animals, according to the CDC. With an incubation period of about 7 days (range of 2 to 29 days), the clinical course for the infection is highly variable. According to the CDC, “symptoms include fever, headache, chills, muscle aches, vomiting, jaundice, anemia, and sometimes a rash;” and, although “the icteric form of the disease (Weil’s disease) is not common, hemorrhage, hepatomegaly, pulmonary hemorrhage, ARDS, and jaundice are among the severe features.” Antibiotics, such as doxycycline or penicillin, are usually administered as treatment for the infection.

Hepatitis A

Outbreaks of hepatitis A infections have made headlines across the United States this year, with cases occurring in San Diego, and last year, with a major outbreak linked with scallops in Hawaii, and additional outbreaks linked with frozen strawberries in multiple states. The highly-contagious liver infection occurs when an individual is infected with the hepatitis A virus. It is “usually transmitted by the fecal-oral route, either through person-to-person contact or consumption of contaminated food or water,” such as would occur during major flooding, according to the CDC. In addition, the CDC states that, “the clinical case definition for acute viral hepatitis is:
  1. Discrete onset of symptoms (eg, nausea, anorexia, fever, malaise, or abdominal pain) and,
  2. Jaundice or elevated serum aminotransferase levels.
Because the clinical characteristics are the same for all types of acute viral hepatitis, hepatitis A diagnosis must be confirmed by a positive serologic test for immunoglobulin M antibody to hepatitis A virus, or the case must meet the clinical case definition and occur in a person who has an epidemiologic link with a person who has laboratory-confirmed hepatitis A (ie, household or sexual contact with an infected person during the 15–50 days before the onset of symptoms).”

Although a vaccine against hepatitis A exists, those exposed to the virus (who have not previously received a vaccine) should “be administered a single dose of single-antigen hepatitis A vaccine or IG (0.02 mL/kg) as soon as possible, within 2 weeks after exposure,” according to the CDC. More information on the guidelines based on age and health status are available on the CDC website.

Hurricane Harvey flood victims are not only at increased risk of water-borne diseases; the risk of vector-borne diseases also increases in times of flooding. Check back on the Contagion® website tomorrow for information on the vector-borne infectious disease outbreak that can occur or be increased as a result of flooding.
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