Hurricanes And Flooding Leave Infections in Their Aftermath

First came the hurricane, decimating parts of Florida and South Carolina with wind and torrential rains. More than 2’ of rain fell in some areas, and flooding persisted days later. Pakistan has been enduring flooding for months, but we hear relatively little about catastrophes outside our borders.

Now we can expect to see a variety of infections following the disaster, in addition to the many problems from interruptions in an individual’s medication (e.g., insulin, inhalers, cardiac medications).

After Hurricane Maria, cases of sepsis and other infections rose. The fungal infection Mucor rose after Katrina. With power outages and no fresh water, various infectious deaths will likely grow in Florida as well. But how will we know? Public health was slashed in Florida even before the pandemic began, cutting employees, and spending dropped from $57 to $34 per resident from 2010-2019. Further budget cuts are planned.

Skin and soft tissue infections

Many injuries occur either as people try to escape or in the initial clean-up after a disaster. Having feet remain sodden can also lead to abrasions and infections. These are often due to common skin bacteria, Staph or Strep, and are usually fairly readily treated. Two water-associated bacteria, Aeromonas and Vibrio, are much more difficult to treat antibiotic-wise. Vibrio, in particular, often causes fulminant infections with rapid shock and death.

A variety of less common skin infections can occur, including fungal and mycobacterial (related to TB), although all of these are less common in the US. Tetanus can also happen here following puncture wounds. These infections can be identified by cultures and require specific treatments.

Respiratory infections

Respiratory infections are common after hurricanes, mainly from people being crowded together in shelters. Of course, Covid is an additional problem now—but we might well never know since most testing is not being reported. Rebekah Jones was fired from her job at the Florida Department of Health after disagreements over her Covid reporting.

Mold exposures increase markedly after flooding; allergic reactions, asthma, and chronic cough soon follow. If you are on immunosuppressive drugs (chemo or monoclonal antibodies), you are at risk of an invasive fungal infection. Respirators should be worn when cleaning up.

Gastrointestinal infections

Sewage systems are overwhelmed, discharging raw sewage after flooding. A variety of gastrointestinal infections should be expected. E coli and norovirus infections are the most common culprits in the US. Cryptosporidium caused an outbreak in Germany (and in Milwaukee from a sewage plant failure, sickening 400,000).

Norovirus is very contagious, requiring a low dose to infect others, and shedding the virus in stool can last weeks. The virus can stay on environmental surfaces without careful cleaning. Vomiting and diarrhea from norovirus were problems in Texas following Hurricane Katrina, affecting more than a thousand people in a shelter.

Hepatitis A is also a significant danger from sewage-contaminated water.

Animal-related infections

Zoonoses, or animal-related infections, are another group to pay attention to. Before Ian, we already had dengue and West Nile cases reported in southern Florida. As more areas remain flooded, you can also expect more cases on the west coast of Florida. Cases of West Nile encephalitis and meningitis doubled a year after Hurricane Katrina.

Sentinel chickens tested positive for Flavivirus infections in Palm Beach and Lee County—the latter received the brunt of the hurricane. Flaviviruses are a group of RNA viruses. It includes yellow fever, dengue, Zika, and West Nile viruses, each spread by mosquitoes.

The other zoonosis to watch for is leptospirosis, a corkscrew-shaped bacteria (spirochete). It’s transmitted through the urine of rodents and commonly causes fever among fresh-water sports participants (like rafting), and causes a non-specific illness with fever and headache. Conjunctivitis (red eyes) is a clue to this infection. Lepto is treated with doxycycline.

There’s an incredible interactive data viz by Camilo Mora, Tristan McKenzie, and colleagues in Nature Climate Change. Their study found that climate change can exacerbate almost 60% of known pathogenic diseases.

These are some of the infections to be on the lookout for over the coming weeks. Expect more as climate change brings more frequent and severe hurricanes and flooding.