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      Hurricane Season Public Health Preparedness, Response, and Recovery Guidance for Health Care Providers, Response and Recovery Workers, and Affected Communities — CDC, 2017

      CDC 2017 Hurricane Incident Management System Team

      MMWR. Morbidity and Mortality Weekly Report

      Centers for Disease Control and Prevention

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          Abstract

          CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) have guidance and technical materials available in both English and Spanish to help communities prepare for hurricanes and floods (Table 1). To help protect the health and safety of the public, responders, and clean-up workers during response and recovery operations from hurricanes and floods, CDC and ATSDR have developed public health guidance and other resources; many are available in both English and Spanish (Table 2). TABLE 1 English and Spanish community guidance for preparing for hurricanes and floods — CDC, 2017 English En Español Information about hurricanes and other tropical storms 
https://www.cdc.gov/disasters/hurricanes/index.html Huracanes y otras tormentas tropicales 
https://www.cdc.gov/es/disasters/hurricanes/index.html Preparations before a hurricane 
https://www.cdc.gov/disasters/hurricanes/before.html Antes de un huracán 
https://www.cdc.gov/es/disasters/hurricanes/before.html Family, health, and safety preparation 
https://www.cdc.gov/disasters/hurricanes/supplies.html Obtenga suministros 
https://www.cdc.gov/es/disasters/hurricanes/supplies.html Key facts about flood readiness 
https://www.cdc.gov/disasters/floods/readiness.html Datos importantes sobre los preparativos para una inundación 
https://www.cdc.gov/es/disasters/floods/readiness.html TABLE 2 English and Spanish guidance for response and recovery from hurricanes and floods, by primary target audience — CDC, 2017 English En Español General audience Be safe after a hurricane* 
 https://www.cdc.gov/disasters/hurricanes/be-safe-after.html Manténgase a salvo después de un huracán 
https://www.cdc.gov/es/disasters/hurricanes/be-safe-after.html After a hurricane 
https://www.cdc.gov/disasters/hurricanes/after.html Después de un huracán 
https://www.cdc.gov/es/disasters/hurricanes/after.html Floods (general information) 
https://www.cdc.gov/disasters/floods/index.html Información sobre inundaciones 
https://www.cdc.gov/es/disasters/floods/index.html After a flood 
https://www.cdc.gov/disasters/floods/after.html Después de una inundación 
https://www.cdc.gov/es/disasters/floods/after.html Flood waters or standing waters health risks 
https://www.cdc.gov/healthywater/emergency/extreme-weather/floods-standingwater.html Agua de la inundación después de un desastre o una emergencia 
https://www.cdc.gov/es/disasters/floods/cleanupwater.html Building and facilities damage: health risks 
https://www.cdc.gov/healthywater/emergency/extreme-weather/building-damage.html —† Cleaning up your home after a disaster or emergency 
https://www.cdc.gov/disasters/hurricanes/cleanup-home.html Limpiar tu casa después de un desastre o emergencia Limpie su casa 
https://www.cdc.gov/es/disasters/hurricanes/cleanup-home.html Generator and furnace safety 
https://www.cdc.gov/co/pdfs/Generators.pdf https://www.cdc.gov/co/pdfs/Furnace.pdf Seguridad con los Generadores y Calentadores 
https://www.cdc.gov/co/pdfs/flyers_Spanish.pdf Pressure washer safety 
https://www.cdc.gov/disasters/pressurewashersafety.html — Carbon monoxide poisoning§ 
 https://www.cdc.gov/co/pdfs/Flyer_Danger.pdf Intoxicación por monóxido de carbono 
https://www.cdc.gov/co/pdfs/campaign_flyer_ES.pdf Carbon monoxide poisoning FAQs 
https://www.cdc.gov/co/faqs.htm Intoxicación con Monóxido de Carbono Preguntas Frecuente 
https://www.cdc.gov/co/es/faqs.htm Chemical hazards: asbestos in your environment: what you can do to limit exposure 
https://www.atsdr.cdc.gov/docs/limitingenvironmentalexposures_factsheet-508.pdf — ToxFAQ for asbestos 
https://www.atsdr.cdc.gov/toxfaqs/tf.asp?id = 29&tid = 4 ToxFAQs Asbesto (Amianto) 
https://www.atsdr.cdc.gov/es/toxfaqs/es_tfacts61.html Chemical hazards: mercury 
https://www.atsdr.cdc.gov/dontmesswithmercury/index.html No te metas con mercurio 
https://www.atsdr.cdc.gov/dontmesswithmercury/es/index.html Chemical hazards: lead 
https://www.cdc.gov/nceh/lead/tips.htm Lo que debe saber sobre el envenenamiento del plomo 
https://www.cdc.gov/nceh/lead/tools/know_the_factsspanish.pdf Coping with a disaster or traumatic event 
https://emergency.cdc.gov/coping/index.asp Cómo enfrentar un desastre o evento traumático 
https://emergency.cdc.gov/es/coping/index.asp Food safety for infants after a disaster 
https://www.cdc.gov/breastfeeding/recommendations/food-safety-for-infants-after-a-disaster.html Asegúrese de que los alimentos y el agua se puedan consumir sin correr riesgo (Cómo alimentar a su bebé) 
https://www.cdc.gov/es/disasters/hurricanes/foodwater.html Keep food and water safe after a disaster 
https://www.cdc.gov/disasters/foodwater/facts.html Asegúrese de que los alimentos y el agua se puedan consumir sin correr riesgo 
https://www.cdc.gov/es/disasters/hurricanes/foodwater.html Personal hygiene and handwashing after a disaster or emergency 
https://www.cdc.gov/disasters/floods/sanitation.html Higiene personal y lavado de manos después de un desastre o emergencia 
https://www.cdc.gov/es/disasters/floods/sanitation.html Extreme heat 
https://www.cdc.gov/disasters/extremeheat/index.html Calor Extremo y Su Salud 
https://www.cdc.gov/extremeheat/espanol/index_esp.html Homeowner’s and renter’s guide to mold cleanup after disasters 
https://www.cdc.gov/mold/pdfs/homeowners_and_renters_guide.pdf Guía del propietario y arrendatario para la limpieza de moho después de desastres 
https://www.cdc.gov/mold/pdfs/IEPWG_Mold_Homeowners_and_Renters_Spanish_508.pdf Get rid of mold 
https://www.cdc.gov/disasters/hurricanes/pdf/flyer-get-rid-of-mold.pdf Elimine el moho 
https://www.cdc.gov/es/disasters/hurricanes/pdf/flyer-get-rid-of-mold.pdf Mold FAQs 
https://www.cdc.gov/mold/faqs.htm Preguntas más frecuentes sobre molde 
https://www.cdc.gov/mold/es/faqs.htm Ready Wrigley Prepares for Storm and Flood Recovery (a resource for children) 
https://www.cdc.gov/phpr/readywrigley/documents/17_279940_Ready_Wrigley_mold_508.pdf — More resources for families 
https://www.cdc.gov/disasters/hurricanes/more-resources.html Más recursos para las familias 
https://www.cdc.gov/es/disasters/hurricanes/more-resources.html Public service announcements (PSAs) 
https://www.cdc.gov/disasters/hurricanes/psa.html Anuncios de servicio público (PSA) 
https://www.cdc.gov/es/disasters/hurricanes/psa.html Health care professionals Medical care of ill disaster evacuees: additional diagnoses to consider 
https://www.cdc.gov/disasters/medcare.html — Medical management and patient advisement after a disaster 
https://www.cdc.gov/disasters/management.html — Clinical guidance for carbon monoxide (CO) poisoning after a disaster 
https://www.cdc.gov/disasters/co_guidance.html Directrices clínicas para la intoxicación por monóxido de carbono (CO) después de un desastre 
https://www.cdc.gov/es/disasters/co_guidance.html Safety information for health care professionals 
https://www.cdc.gov/disasters/hurricanes/hcp.html Información de seguridad para los profesionales de la salud 
https://www.cdc.gov/es/disasters/hurricanes/hcp.html Public health professionals and response workers Emergency: response resources for storm, flood, and hurricane response 
https://www.cdc.gov/niosh/topics/emres/flood.html NIOSH advierte sobre los peligros de limpieza después de una inundación 
https://www.cdc.gov/spanish/NIOSH/docs/94-123_sp/ Death scene investigation after natural disaster or other weather-related events: a toolkit 
https://www.cdc.gov/nceh/hsb/disaster/docs/DeathSceneInvestigation508.pdf — Public health assessment and surveillance after a disaster 
https://www.cdc.gov/disasters/surveillance/ Formas de vigilancia de mortalidad relacionadas con desastres están disponibles en español 
https://www.cdc.gov/es/disasters/surveillance/pdf/disaster-mortality-instructions.pdf 
 https://www.cdc.gov/es/disasters/surveillance/pdf/disaster-mortality-form.pdf Community Assessment for Public Health Emergency Response (CASPER) 
https://www.cdc.gov/nceh/hsb/disaster/casper/ — Emergency Responder Health Monitoring and Surveillance (ERHMS) 
https://www.cdc.gov/niosh/erhms/default.html — Assessment of Chemical Exposures (ACE) toolkit 
https://www.atsdr.cdc.gov/ntsip/ace_toolkit.html — Chemical hazards: lead information for workers 
https://www.cdc.gov/niosh/topics/lead/safe.html Instituto Nacional para la Seguridad y Salud Ocupacional (NIOSH) plomo 
https://www.cdc.gov/spanish/niosh/topics/plomo.html Chemical hazards: resources for emergency responders for chemical or radioactive materials 
https://www.cdc.gov/niosh/topics/emres/chemagent.html 
 https://www.atsdr.cdc.gov/substances/ToxEmergency.asp Seguridad de productos químicos 
https://www.cdc.gov/spanish/niosh/topics/quimicos.html Preventing carbon monoxide poisoning from small gasoline-powered engines and tools 
https://www.cdc.gov/niosh/docs/96-118/ Prevención de envenenamiento con monóxido de carbono producido por herramientas y equipos con motores pequeños de gasoline 
https://www.cdc.gov/spanish/niosh/docs/96-118_sp/ Heat and outdoor workers https://www.cdc.gov/disasters/extremeheat/workers.html 
 Los trabajadores al aire libre y el calor 
https://www.cdc.gov/extremeheat/espanol/workers_esp.html Indoor environmental quality 
https://www.cdc.gov/niosh/topics/indoorenv/ — Indoor environmental quality: preventing occupational respiratory disease from exposures caused by dampness in office buildings, schools, and other nonindustrial buildings 
https://www.cdc.gov/niosh/docs/2013-102/ Prevención de enfermedades respiratorias ocupacionales por exposición causadas por la humedad en edificios de oficinas, escuelas y otros edificios no industriales 
https://www.cdc.gov/spanish/niosh/docs/2013-102_sp/ Indoor environmental quality: recommendations for the cleaning and remediation of flood-contaminated HVAC systems: a guide for building owners and managers 
https://www.cdc.gov/niosh/topics/emres/Cleaning-Flood-HVAC.html — Safety: guidance on personal protective equipment and clothing for flood cleanup workers 
https://www.cdc.gov/niosh/topics/emres/ppe-flood.html Equipo de protección personal y la ropa para las personas que trabajan en la limpieza después de las inundaciones 
https://www.cdc.gov/spanish/niosh/topics/flood_sp/ppe-flood_sp.html Safety: information for response and cleanup workers 
https://www.cdc.gov/disasters/hurricanes/workers.html Información de seguridad para trabajadores de respuesta a emergencias y de limpieza 
https://www.cdc.gov/es/disasters/hurricanes/workers.html Worker safety after a flood 
https://www.cdc.gov/disasters/floods/workersafety.html Seguridad de los trabajadores después de una inundación 
https://www.cdc.gov/es/disasters/floods/workersafety.html Traumatic incident stress: symptoms and recommendations for responders 
https://www.cdc.gov/niosh/topics/traumaticincident/ Estrés por sucesos traumáticos: Información para el personal de emergencia 
https://www.cdc.gov/spanish/niosh/docs/2002-107_sp/ Tree removal: preventing chain saw injuries during tree removal after a disaster 
https://www.cdc.gov/disasters/chainsaws.html Cómo prevenir lesiones causadas por motosierras después de un desastre 
https://www.cdc.gov/es/disasters/psa/chainsaw.html Tree removal: preventing falls and electrocutions during tree trimming 
https://www.cdc.gov/niosh/docs/92-106/ Retiro de árbol: prevención de caídas y electrocuciones durante la poda de árboles 
https://www.cdc.gov/spanish/niosh/docs/92-106_sp/ * Information on this webpage is available in 11 different languages. † Currently not available in Spanish. § This fact sheet is available in six additional languages, available at https://www.cdc.gov/co/factsheets.htm. Hurricane Harvey made landfall on the Texas coast on August 25, 2017, as a Category 4 storm. In southeast Texas, record rainfall caused extensive flooding and damage to public infrastructure and communities, and displaced thousands of persons. As of September 12, 2017, the media have reported >80 storm-related deaths attributed to Hurricane Harvey (medical examiner confirmation is pending for some deaths). Most of these deaths likely were caused by drowning in flood waters within the first few days after impact (e.g., drowning at home or in vehicles). On September 7, 2017, a Category 5 hurricane, Irma, reached the Lesser Antilles, including the U.S. territories of Puerto Rico and the Virgin Islands. Hurricane Irma then continued its path across the Greater Antilles and made landfall in south Florida on September 10, 2017. Irma’s hurricane-force winds and related storm surges caused substantial damage in the Caribbean and Florida. Many areas in Texas, Louisiana, Florida, Georgia, and the U.S. territories affected by these storms are still experiencing disruptions in essential services, including electricity, potable water, food, and communications. Numerous health care and public health systems sustained damage. Environmental health impacts from the hurricanes included effects on industries, chemical plants, and hazardous waste sites. Many displaced persons remain in shelters or other temporary housing. As part of the overall U.S. Department of Health and Human Services response and recovery operations, CDC and ATSDR are supporting public health and medical care functions for affected communities and persons displaced by the hurricanes. As of September 12, 2017, CDC and ATSDR had sent pharmacy and federal medical station supplies to Texas, Louisiana, and Florida. CDC and ATSDR have also activated and deployed members of the U.S. Public Health Service Commissioned Corps and other personnel to provide technical support for critical public health functions. Field operations and the CDC and ATSDR Emergency Operations Center are supporting mortality and morbidity surveillance; public health messaging and risk communication; water, sanitation, safety, and facility assessments; community rapid needs assessments; mold abatement; industrial and residential contaminant exposure prevention; and vector control. There are potential public health and safety concerns after hurricane impact. Many injuries and illnesses from hurricanes and floods occur during the response and recovery phases. Common hazards include vehicle- and nonvehicle-related drowning, carbon monoxide poisoning (e.g., from any gasoline-powered engine, including generators and clean-up equipment), electrocution, falls, lacerations, and exposure to mold and industrial and household chemicals ( 1 – 8 ). In addition, exacerbation of existing chronic conditions and development of acute mental health symptoms are frequent reasons for seeking health care services following a disaster ( 9 – 11 ). Guidance and other resources to assist in addressing many of these hazards and risk are available (Table 2). CDC and ATSDR also offer a disaster response clinical consultation service to assist health care providers, public health professionals, and emergency response partners. This service can be accessed by emailing CDC IMS Clinical Inquiries at eocevent168@cdc.gov. For additional assistance, health care providers, public health professionals, and members of the public can also use CDC and ATSDR’s information service, CDC-INFO. Live agents provide up-to-date science-based health information. CDC-INFO can be reached Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern Time at 1–800-CDC-INFO (1–800–232–4636) or by submitting a web-based form (https://wwwn.cdc.gov/dcs/ContactUs/Form). Services are available in English and Spanish.

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          Deaths Associated with Hurricane Sandy — October–November 2012

          On October 29, 2012, Hurricane Sandy* hit the northeastern U.S. coastline. Sandy’s tropical storm winds stretched over 900 miles (1,440 km), causing storm surges and destruction over a larger area than that affected by hurricanes with more intensity but narrower paths. Based on storm surge predictions, mandatory evacuations were ordered on October 28, including for New York City’s Evacuation Zone A, the coastal zone at risk for flooding from any hurricane (1). By October 31, the region had 6–12 inches (15–30 cm) of precipitation, 7–8 million customers without power, approximately 20,000 persons in shelters, and news reports of numerous fatalities (Robert Neurath, CDC, personal communication, 2013). To characterize deaths related to Sandy, CDC analyzed data on 117 hurricane-related deaths captured by American Red Cross (Red Cross) mortality tracking during October 28–November 30, 2012. This report describes the results of that analysis, which found drowning was the most common cause of death related to Sandy, and 45% of drowning deaths occurred in flooded homes in Evacuation Zone A. Drowning is a leading cause of hurricane death but is preventable with advance warning systems and evacuation plans. Emergency plans should ensure that persons receive and comprehend evacuation messages and have the necessary resources to comply with them. Red Cross tracks deaths during disasters to provide services to surviving family members, including crisis counseling, assistance with disaster-related expenses, locating emergency housing, identifying recovery resources, and addressing disaster-related health needs. Red Cross volunteers search for reports of disaster-related deaths from sources such as funeral home directors, the Federal Emergency Management Agency (FEMA), hospitals, and news reports. Volunteers then obtain information about these deaths from sources including the medical examiner/coroner, physician, fire department/police, and family of the decedent (2). Deaths included in this analysis were any Sandy-related death recorded on a Red Cross mortality form with a date of death up to November 30, 2012. Mortality forms included the decedent’s age, sex, race (white, black, Asian, other, or unknown), and date and location of death. Disaster-related deaths were categorized as direct or indirect. Directly related deaths are deaths caused by the environmental force of the disaster (e.g., wind or flood) or by the direct consequences of these forces (e.g., structural collapse). Indirectly related deaths are defined as deaths occurring in a situation in which the disaster led to unsafe conditions (e.g., hazardous roads) or caused a loss or disruption of usual services that contributed to the death (e.g., loss of electrical services) (2). Deaths without direct or indirect classification were reported as unknown or possibly related deaths. Daily counts of direct, indirect, and unknown/possibly related deaths were calculated based on the dates of each death. The characteristics of drowning deaths were compared with all deaths using chi-square tests of trend and t-tests. Home addresses of decedents whose drowning death occurred in the home were examined with respect to FEMA’s hurricane storm surge area (field-verified as of November 11, 2012 [3]) and known, geographically defined areas under evacuation order (i.e., New York City’s Evacuation Zone A) (1). What is already known on this topic? Despite advances in hurricane warning and evacuation systems, drowning remains one of the leading causes of hurricane-related deaths. What is added by this report? A total of 117 deaths related to Hurricane Sandy were reported via the American Red Cross mortality tracking system. Drowning was the leading cause, accounting for approximately one third of the deaths. More than half (52.5%) of the drowning deaths occurred in the decedent’s home; the majority of these homes were located in New York City’s Evacuation Zone A. What are the implications for public health practice? Drowning is a preventable cause of hurricane-related death. Hurricane response plans should ensure that persons receive and comprehend evacuation messages and have the necessary resources to comply with them. A total of 117 deaths were reported on Red Cross mortality forms. The source of information for the mortality forms was a medical examiner/coroner for 94 (80.3%) cases and the family of the decedent for 10 (8.5%) cases (Table). Most deaths occurred in New York (53 [45.3%]) and New Jersey (34 [29.1%]); the other deaths occurred in Pennsylvania, West Virginia, Connecticut, and Maryland. The deaths occurred during October 28–November 29, 2012 (Figure 1). Approximately half of the deaths (60 [51.3%]) occurred on the first 2 days of the storm’s landfall, with a peak of 37 deaths on October 30, 2012. Decedents ranged in age from 1 to 94 years (mean: 60 years, median: 65 years); 60.7% were male, and 53.8% were white. Of the 117 deaths, 67 (57.3%) were classified as directly related deaths, and 38 (32.5%) were indirectly related to the storm. Of the directly related deaths, the most common mechanism was drowning (40 [59.7%]), followed by trauma from being crushed, cut, or struck (19 [28.4%]). Poisoning was the most common indirectly related cause of death; of the 10 poisonings, nine were caused by carbon monoxide. Most directly related deaths occurred during the first few days of the storm, whereas indirectly related deaths continued from the day before the storm into the middle of November. Comparing the 40 drowning deaths to all Sandy-related deaths, the age, sex, and race distributions of decedents were similar (Table). The majority of drowning deaths (29 [72.5%]) also occurred in the initial phase of the storm, during October 29–31. Twenty-one (52.5%) drowning deaths occurred in the decedent’s home, and 11 (27.5%) occurred outside; one person drowned in a flooded commercial building lobby, and another person drowned while intentionally swimming off a storm-affected beach. For six deaths, circumstances of the drowning were not available. The location of drowning deaths by state was significantly different (p<0.05) compared with all Sandy-related deaths. The majority of drowning deaths (32 [80.0%]) occurred in New York, whereas deaths in New York accounted for only 27.3% of nondrowning deaths. Twenty decedents drowned in flooded homes in New York, and home addresses for 18 (90.0%) of them were located in Evacuation Zone A (Figure 2); the other two decedents’ homes were in or near areas of flooding and near Evacuation Zone A. Notes written by Red Cross volunteers on these 20 deaths captured decedents’ reasons for not evacuating, such as “afraid of looters,” “thought Hurricane Irene was mild,” and “unable to leave because did not have transportation.” Editorial Note The “perfect storm” weather conditions of Hurricane Sandy resulted in extensive damage to infrastructure and large flood zones (4). The direct and indirect impacts of the storm led to challenging, and sometimes deadly, conditions for residents, including prolonged power outages, storm surges, and disrupted services. More than half (51.3%) of deaths from Sandy occurred within the first 2 days of the storm, and the most common cause of death was drowning. Approximately half of the drowning deaths were in flooded homes located in areas that were under mandatory evacuation orders as of October 28, 2012, the day before Sandy’s landfall (1). Before the 1970s, drowning from wind-driven storm surges was by far the most common cause of hurricane-related death (5). Advances in hurricane warning and evacuation systems have helped to reduce drowning deaths. Since that time, hurricanes have had other leading causes of death, such as trauma for the Florida hurricanes in 2004 and 2005, and carbon monoxide poisoning for Hurricane Ike in 2008 (6,7). However, drowning continues to be an important cause of death, and was the leading cause for Hurricane Katrina (2005) and Sandy (8). The findings in this report are subject to at least two limitations. First, the number of deaths reported is limited to those captured through Red Cross mortality tracking, which is only activated in areas with a Red Cross Disaster Relief Operation. In an evaluation of Red Cross mortality tracking versus Texas’ active disaster-related mortality surveillance during Hurricane Ike, Red Cross had a sensitivity of 47% (Red Cross cases compared with Texas cases) and positive predictive value of 92% (Red Cross Ike cases compared with all Red Cross cases); thus, the cases presented in this report are likely to be actual cases but are unlikely to include all Sandy-related deaths (2). Media sources have reported 131 fatalities in the United States from the storm (9); Sandy mortality statistics, including death certificates, are pending official release. Second, the specific location of death was only available for decedents who died at home, limiting other geographic comparisons. Additionally, New York City’s Evacuation Zones provided the only geographic data available for identifying areas of evacuation; however, 95% of all drowning deaths at home were in or near these areas. Hurricane-related drowning deaths in evacuation zones are preventable. A successful evacuation depends on officials providing timely messaging to all affected persons, on persons receiving those messages, and on persons having the capacity, resources, and willingness to evacuate. The penetration of evacuation messages to decedents or their communities was not assessed in this report, but future research should evaluate the effectiveness of the hurricane evacuation orders. Given the inability and unwillingness of some residents to evacuate, additional research is needed to identify barriers and motivators for persons during an evacuation and the effectiveness of interventions designed to assist these persons.
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            Longitudinal Impact of Hurricane Sandy Exposure on Mental Health Symptoms

            Hurricane Sandy hit the eastern coast of the United States in October 2012, causing billions of dollars in damage and acute physical and mental health problems. The long-term mental health consequences of the storm and their predictors have not been studied. New York City and Long Island residents completed questionnaires regarding their initial Hurricane Sandy exposure and mental health symptoms at baseline and 1 year later (N = 130). There were statistically significant decreases in anxiety scores (mean difference = −0.33, p < 0.01) and post-traumatic stress disorder (PTSD) scores (mean difference = −1.98, p = 0.001) between baseline and follow-up. Experiencing a combination of personal and property damage was positively associated with long-term PTSD symptoms (ORadj 1.2, 95% CI [1.1–1.4]) but not with anxiety or depression. Having anxiety, depression, or PTSD at baseline was a significant predictor of persistent anxiety (ORadj 2.8 95% CI [1.1–6.8], depression (ORadj 7.4 95% CI [2.3–24.1) and PTSD (ORadj 4.1 95% CI [1.1–14.6]) at follow-up. Exposure to Hurricane Sandy has an impact on PTSD symptoms that persists over time. Given the likelihood of more frequent and intense hurricanes due to climate change, future hurricane recovery efforts must consider the long-term effects of hurricane exposure on mental health, especially on PTSD, when providing appropriate assistance and treatment.
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              Mold prevention strategies and possible health effects in the aftermath of hurricanes and major floods.

              Extensive water damage after major hurricanes and floods increases the likelihood of mold contamination in buildings. This report provides information on how to limit exposure to mold and how to identify and prevent mold-related health effects. Where uncertainties in scientific knowledge exist, practical applications designed to be protective of a person's health are presented. Evidence is included about assessing exposure, clean-up and prevention, personal protective equipment, health effects, and public health strategies and recommendations. The recommendations assume that, in the aftermath of major hurricanes or floods, buildings wet for <48 hours will generally support visible and extensive mold growth and should be remediated, and excessive exposure to mold-contaminated materials can cause adverse health effects in susceptible persons regardless of the type of mold or the extent of contamination. For the majority of persons, undisturbed mold is not a substantial health hazard. Mold is a greater hazard for persons with conditions such as impaired host defenses or mold allergies. To prevent exposure that could result in adverse health effects from disturbed mold, persons should 1) avoid areas where mold contamination is obvious; 2) use environmental controls; 3) use personal protective equipment; and 4) keep hands, skin, and clothing clean and free from mold-contaminated dust. Clinical evaluation of suspected mold-related illness should follow conventional clinical guidelines. In addition, in the aftermath of extensive flooding, health-care providers should be watchful for unusual mold-related diseases. The development of a public health surveillance strategy among persons repopulating areas after extensive flooding is recommended to assess potential health effects and the effectiveness of prevention efforts. Such a surveillance program will help CDC and state and local public health officials refine the guidelines for exposure avoidance, personal protection, and clean-up and assist health departments to identify unrecognized hazards.
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                Author and article information

                Journal
                MMWR Morb Mortal Wkly Rep
                MMWR Morb. Mortal. Wkly. Rep
                WR
                MMWR. Morbidity and Mortality Weekly Report
                Centers for Disease Control and Prevention
                0149-2195
                1545-861X
                22 September 2017
                22 September 2017
                : 66
                : 37
                : 995-998
                Affiliations
                1
                [1 ]Emergency Operations Center, CDC.
                Author notes
                Corresponding author: CDC Joint Information Center Administrator, eocjicad@ 123456cdc.gov .
                Article
                mm6637e1
                10.15585/mmwr.mm6637e1
                5657774
                28934182

                All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated.

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