1. SITE-SPECIFIC MORBIDITY CAUSES & POTENTIAL FOR ZOONOTIC DISEASE OUTBREAKS ASSOCIATED WITH FLOOD DISASTERS IN TEXAS E.J. HANFORD & Carroll W. Bottoms Environmental Science & Biology Departments Collin College, Frisco TX Collin College, Frisco TX

2. Causes of Flooding in Texas Frontal Squall Lines Mid-Latitude Cyclones Isolated Supercells Hurricanes & Tropical Storms June 19, 2006 2001

3. H. Ike coastal flooding Sept 23, 2008 Crystal Beach Upstream runoff June 2007 Colorado River, Austin

4. Sabine Pass 2008 Cameron Co 2005 - Rita Flash Flood Alley Regional Flooding

5. Potential Exposure Scenarios Edinburg TX - 2008 Tarantulas, ants, snakes Jasper TX

6. Potential Diseases Potential Zoonotic Diseases Mosquito-borne Dengue Eastern Equine West Nile Yellow Fever

7. Tick-borne Borrelia burgdorferi  “Lyme” Tularemia Anaplasma “Erlichia” Southern tick assoc. rash illness (STARI) ? Rickettsia rickettsii  Rocky Mtn Spotted F. Black-legged / “Deer” Ixodes scapularis Lone star Amblyomma americanum American dog Dermacentor variabilis

8. Critter-borne Rabies Bacillus anthracis Streptobacillus moniliformis  rat-bite fever

9. Salmonella Clostridium tetani Vibrio vulnificus V. parahaemoliticus V. cholerae E. coli Water-borne & Food-borne

10. Fecal-borne Leptospires Hantavirus Chagas

11. Multiple pathways Norovirus Rotavirus

12. Myth vs Reality What should we anticipate in TX ? ? ?

13. Search Terms Location & Events: Texas Gulf Coast Evacuation centers Hurricanes Flood / Flash flood Disaster Disease : Morbidity Mortality Disease outbreak Illness Zoonotic disease Bacterial infection Respiratory illness Emerging disease Arbovirus

14. Databases PubMed NCBI Entrez InfoTrac Google Scholar Cross-referencing 647 articles previewed 167 articles reviewed ~ 35 key articles selected Duplicate data identified

15. Good News !! No epidemic occurrences reported Outbreaks reported –Limited to evacuation centers –Post-impact (recovery) –Most are non-life threatening: Gastro-intestinal Norovirus (up to 50 %) Rotavirus Non-toxigenic Vibrio cholerae Non-Typhoidal Salmonella

16. Other Reports of Concern Cases & Fatalities: –Vibrio vulnificus –Vibrio parahaemolyticus Anthrax –1970s: Falls, Kinney, Val Verde, Uvalde, Edwards & Real Counties –Successive episodes to concentrate spores Other infections: –MRSA –“Skin rashes” –“Respiratory” illness

17. Wisdom Gained Expect what is ENDEMIC Early & On-Going Surveillance –Evacuation Centers –Rescue & Relief workers –Pre-existing medical conditions  increased risk B/C of warnings….most morbidity is post-impact –Time duration ~ magnitude of flood event Confounding Factors Changes in human behavior  exposure Reduction in disease control activities Overcrowding Co-morbidities

18. Opportunity !! Education of displaced & impacted –Basic hygiene practices –Prevention & Mitigation techniques –Immunization screening Train public health professionals –Direct & indirect impacts Emphasize surveillance & reporting –Collaborative efforts –Individual & aggregate