Date: Thu 12 Oct 2017
Source: Center for Infectious Disease Research and Policy (CIDRAP) [edited]
After Hurricane Maria hit Puerto Rico on 20 Sep , the island lost power and experienced extensive flooding, leaving thousands homeless and without access to routine medical care. Now, as the waters recede, the Infectious Diseases Society of America (ISDA) is warning that the US territory faces public health threats that need to be countered by immediate funding and aid from the US government.
Underscoring worries about disease threats, local officials are reporting leptospirosis infections and deaths in people affected by the storm.
"Indeed, Puerto Ricans and U.S. Virgin Islanders are U.S. citizens and expect the same federal aid and support during natural disasters as the rest of the United States," wrote Carmen D. Zorilla, MD, an obstetrician from Puerto Rico who penned a perspective piece published in the New England Journal of Medicine yesterday [11 Oct 2017, <http://www.nejm.org/doi/full/10.1056/NEJMp1713196
Zorilla said every one of Puerto Rico's 3.4 million citizens have been touched by the hurricane, and 16 days after the storm, only 9.2% of people had power, and 54% had access to drinking water.
As an obstetrician-gynecologist on the faculty of the University of Puerto Rico School of Medicine, Zorilla stayed on the 18th floor of a maternity ward during the hurricane to help deliver babies and offer care to pregnant women. She said that the standing water and heavy flooding could bring more Zika, dengue, and chikungunya epidemics to the island.
"The impact of this disaster on morbidity, survival, adherence to treatments, and medical complications has yet to be documented," Zorilla said.
The IDSA named "waterborne pathogens, the spread of infections in crowded shelters, food-borne illnesses, mosquito-borne infections and mold-related illnesses," as a few of the immediate areas of concern for Puerto Ricans. Moreover, the hurricane has jeopardized access to medicines for patients with HIV and tuberculosis, as well as antibiotics, oral hydration solutions, and other basic first aid care.
In an update yesterday [11 Oct 2017], the US Environmental Protection Agency (EPA) said there are reports of residents obtaining, or trying to obtain, drinking water from hazardous waste "Superfund" sites in Puerto Rico [<https://www.epa.gov/newsreleases/epa-hurricane-maria-update-wednesday-october-11th
>]. It also added that raw sewage continues to be released into waterways and can be expected to continue until repairs are made and power is restored.
The disease can be spread when people drink water contaminated with animal urine or feces, and, without treatment, complications can develop, including kidney damage, meningitis, liver failure, or respiratory distress.
According to the AP, many Puerto Ricans have taken to drinking from local streams because water has been shut off for the last 2 weeks.
To date, the AP said 45 deaths in Puerto Rico have been blamed on Hurricane Maria. [Byline: Stephanie Soucheray]
[Leptospirosis is a zoonotic spirochetal infection that occurs worldwide and is transmitted to humans by exposure to soil or fresh water contaminated with the urine of wild and domestic animals (including dogs, cattle, swine, and especially rodents) that are chronically infected with pathogenic _Leptospira_. _Leptospira_ may survive in contaminated fresh water or moist soil for weeks to months. Outbreaks of leptospirosis frequently follow heavy rainfall, flooding with fresh water, and increasing rodent numbers.
With continued absence of potable water, inadequate sanitation, and flooding in the streets for a large proportion of the population in Puerto Rico, food- and water-borne diseases, like leptospirosis, will be a major problem. - ProMED Mod.ML]
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