Disasters are upsetting experiences for everyone involved. The emotional toll that disaster brings can sometimes be even more devastating than the financial strains of damage and loss of home, business or personal property.

Children, senior citizens, people with access or functional needs, and people for whom English is not their first language are especially at risk. Children may become afraid and some elderly people may seem disoriented at first. People with access or functional needs may require additional assistance.

Seek crisis counseling if you or someone in your family is experiencing issues with disaster-related stress.

Understand Disaster Events

Understand the individual effects of a disaster.

• Everyone who sees or experiences a disaster is affected by it in some way.
• It is normal to feel anxious about your own safety and that of your family and close friends.
• Profound sadness, grief and anger are normal reactions to an abnormal event.
• Acknowledging your feelings helps you recover.
• Focusing on your strengths and abilities helps you heal.
• Accepting help from community programs and resources is healthy.
• Everyone has different needs and different ways of coping.
• It is common to want to strike back at people who have caused great pain.

Children and older adults are of special concern in the aftermath of disasters. Even individuals who experience a disaster “second hand” through exposure to extensive media coverage can be affected.

Contact local faith-based organizations, voluntary agencies, or professional counselors for counseling. Additionally, FEMA and state and local governments of the affected area may provide crisis counseling assistance.

As you recover, it is a good idea to make sure that you have updated your family disaster plan and replenished essential disaster supplies just in case a disaster happens again. You will always feel better knowing that you are prepared and ready for anything.Signs of Disaster-Related Stress

Seek counseling if you or a family member are experiencing disaster-related stress.

Recognize Signs of Disaster-Related Stress

When adults have the following signs, they might need crisis counseling or stress management assistance:

• Difficulty communicating thoughts.
• Difficulty sleeping.
• Difficulty maintaining balance in their lives.
• Low threshold of frustration.
• Increased use of drugs/alcohol.
• Limited attention span.
• Poor work performance.
• Headaches/stomach problems.
• Tunnel vision/muffled hearing.
• Colds or flu-like symptoms.
• Disorientation or confusion.
• Difficulty concentrating.
• Reluctance to leave home.
• Depression, sadness.
• Feelings of hopelessness.
• Mood-swings and easy bouts of crying.
• Overwhelming guilt and self-doubt.
• Fear of crowds, strangers, or being alone.

Easing Stress

Talk to someone and seek professional help for disaster-related stress.

The following are ways to ease disaster-related stress:

• Talk with someone about your feelings - anger, sorrow and other emotions - even though it may be difficult.
• Seek help from professional counselors who deal with post-disaster stress.
• Do not hold yourself responsible for the disastrous event or be frustrated because you feel you cannot help directly in the rescue work.
• Take steps to promote your own physical and emotional healing by healthy eating, rest, exercise, relaxation and meditation.
• Maintain a normal family and daily routine, limiting demanding responsibilities on yourself and your family.
• Spend time with family and friends.
• Participate in memorials.
• Use existing support groups of family, friends and religious institutions.

Ensure you are ready for future events by restocking your disaster supplies kits and updating your family disaster plan. Doing these positive actions can be comforting.

Helping Kids Cope with Disaster

Disasters can leave children feeling frightened, confused, and insecure. Whether a child has personally experienced trauma, has merely seen the event on television or has heard it discussed by adults, it is important for parents and teachers to be informed and ready to help if reactions to stress begin to occur.

Children may respond to disaster by demonstrating fears, sadness or behavioral problems. Younger children may return to earlier behavior patterns, such as bedwetting, sleep problems and separation anxiety. Older children may also display anger, aggression, school problems or withdrawal. Some children who have only indirect contact with the disaster but witness it on television may develop distress.

Recognize Risk Factors

For many children, reactions to disasters are brief and represent normal reactions to "abnormal events." A smaller number of children can be at risk for more enduring psychological distress as a function of three major risk factors:

• Direct exposure to the disaster, such as being evacuated, observing injuries or death of others, or experiencing injury along with fearing one’s life is in danger.
• Loss/grief: This relates to the death or serious injury of family or friends.
• On-going stress from the secondary effects of disaster, such as temporarily living elsewhere, loss of friends and social networks, loss of personal property, parental unemployment, and costs incurred during recovery to return the family to pre-disaster life and living conditions.

Vulnerabilities in Children

In most cases, depending on the risk factors above, distressing responses are temporary. In the absence of severe threat to life, injury, loss of loved ones, or secondary problems such as loss of home, moves, etc., symptoms usually diminish over time. For those that were directly exposed to the disaster, reminders of the disaster such as high winds, smoke, cloudy skies, sirens, or other reminders of the disaster may cause upsetting feelings to return. Having a prior history of some type of traumatic event or severe stress may contribute to these feelings.

Children’s coping with disaster or emergencies is often tied to the way parents cope. They can detect adults’ fears and sadness. Parents and adults can make disasters less traumatic for children by taking steps to manage their own feelings and plans for coping. Parents are almost always the best source of support for children in disasters. One way to establish a sense of control and to build confidence in children before a disaster is to engage and involve them in preparing a family disaster plan. After a disaster, children can contribute to a family recovery plan.

Meeting the Child’s Emotional Needs

Children’s reactions are influenced by the behavior, thoughts, and feelings of adults. Adults should encourage children and adolescents to share their thoughts and feelings about the incident. Clarify misunderstandings about risk and danger by listening to children’s concerns and answering questions. Maintain a sense of calm by validating children’s concerns and perceptions and with discussion of concrete plans for safety.

Listen to what the child is saying. If a young child is asking questions about the event, answer them simply without the elaboration needed for an older child or adult. Some children are comforted by knowing more or less information than others; decide what level of information your particular child needs. If a child has difficulty expressing feelings, allow the child to draw a picture or tell a story of what happened.

Try to understand what is causing anxieties and fears. Be aware that following a disaster, children are most afraid that:

• The event will happen again.
• Someone close to them will be killed or injured.
• They will be left alone or separated from the family.

Reassuring Children After a Disaster

Suggestions to help reassure children include the following:

• Personal contact is reassuring. Hug and touch your children.
• Calmly provide factual information about the recent disaster and current plans for insuring their safety along with recovery plans.
• Encourage your children to talk about their feelings.
• Spend extra time with your children such as at bedtime.
• Re-establish your daily routine for work, school, play, meals, and rest.
• Involve your children by giving them specific chores to help them feel they are helping to restore family and community life.
• Praise and recognize responsible behavior.
• Understand that your children will have a range of reactions to disasters.
• Encourage your children to help update your a family disaster plan.

If you have tried to create a reassuring environment by following the steps above, but your child continues to exhibit stress, if the reactions worsen over time, or if they cause interference with daily behavior at school, at home, or with other relationships, it may be appropriate to talk to a professional. You can get professional help from the child’s primary care physician, a mental health provider specializing in children’s needs, or a member of the clergy.

Monitor and Limit Exposure to the Media

News coverage related to a disaster may elicit fear and confusion and arouse anxiety in children. This is particularly true for large-scale disasters or a terrorist event where significant property damage and loss of life has occurred. Particularly for younger children, repeated images of an event may cause them to believe the event is recurring over and over.

If parents allow children to watch television or use the Internet where images or news about the disaster are shown, parents should be with them to encourage communication and provide explanations. This may also include parent’s monitoring and appropriately limiting their own exposure to anxiety-provoking information.

Use Support Networks

Parents help their children when they take steps to understand and manage their own feelings and ways of coping. They can do this by building and using social support systems of family, friends, community organizations and agencies, faith-based institutions, or other resources that work for that family. Parents can build their own unique social support systems so that in an emergency situation or when a disaster strikes, they can be supported and helped to manage their reactions. As a result, parents will be more available to their children and better able to support them. Parents are almost always the best source of support for children in difficult times. But to support their children, parents need to attend to their own needs and have a plan for their own support.

Preparing for disaster helps everyone in the family accept the fact that disasters do happen, and provides an opportunity to identify and collect the resources needed to meet basic needs after disaster. Preparation helps; when people feel prepared, they cope better and so do children.

A Child’s Reaction to Disaster by Age

Below are common reactions in children after a disaster or traumatic event.

Birth through 2 years. When children are pre-verbal and experience a trauma, they do not have the words to describe the event or their feelings. However, they can retain memories of particular sights, sounds, or smells. Infants may react to trauma by being irritable, crying more than usual, or wanting to be held and cuddled. The biggest influence on children of this age is how their parents cope. As children get older, their play may involve acting out elements of the traumatic event that occurred several years in the past and was seemingly forgotten.

Preschool - 3 through 6 years. Preschool children often feel helpless and powerless in the face of an overwhelming event. Because of their age and small size, they lack the ability to protect themselves or others. As a result, they feel intense fear and insecurity about being separated from caregivers. Preschoolers cannot grasp the concept of permanent loss. They can see consequences as being reversible or permanent. In the weeks following a traumatic event, preschoolers’ play activities may reenact the incident or the disaster over and over again.

School age - 7 through 10 years. The school-age child has the ability to understand the permanence of loss. Some children become intensely preoccupied with the details of a traumatic event and want to talk about it continually. This preoccupation can interfere with the child’s concentration at school and academic performance may decline. At school, children may hear inaccurate information from peers. They may display a wide range of reactions — sadness, generalized fear, or specific fears of the disaster happening again, guilt over action or inaction during the disaster, anger that the event was not prevented, or fantasies of playing rescuer.

Pre-adolescence to adolescence - 11 through 18 years. As children grow older, they develop a more sophisticated understanding of the disaster event. Their responses are more similar to adults. Teenagers may become involved in dangerous, risk-taking behaviors, such as reckless driving, or alcohol or drug use. Others can become fearful of leaving home and avoid previous levels of activities. Much of adolescence is focused on moving out into the world. After a trauma, the view of the world can seem more dangerous and unsafe. A teenager may feel overwhelmed by intense emotions and yet feel unable to discuss them with others.

Good personal hygiene and handwashing are critical to help prevent the spread of illness and disease. Sanitation and hygiene become especially important during an emergency, such as a natural disaster, when finding clean, safe water could be difficult.

Learn about important cleanliness tips to keep yourself and loved ones healthy during an emergency.

Wash your hands to prevent the spread of germs

Keep hands clean to help prevent the spread of germs. During a boil water advisory or do not drink water advisory, it may be safe to wash hands with tap water. If local authorities or your doctor recommend extra caution, wash your hands with soap and water that has been boiled or disinfected.

• Wash your hands with soap and water for at least 20 seconds, especially during key times when you are most likely to spread germs.
• If clean tap water is not available, create a temporary handwashing station by using a large water jug.
• If you do not have soap and water use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs and might not remove harmful chemicals. Hand sanitizers are not as effective when hands are visibly dirty or greasy.

Follow local guidance on water that is safe for bathing

If you are on municipal water, listen to your local health and drinking water authorities for guidance on whether you can bathe or shower after a water-related emergency. Sometimes water that is not safe to drink can be used for bathing, but be careful not to swallow any water or get it in your eyes.

Do not bathe:

• In water that may be contaminated with sewage or toxic chemicals.
• In rivers, streams, or lakes that are contaminated by flood water, human sewage, or animal waste.

If you have a drinking water well, listen to your local health authorities for advice on using well water for showering and bathing. If extensive flooding has occurred or you suspect your well may be contaminated, contact your local, state, or tribal health department for specific advice on well testing and disinfection.

Use only clean water to brush your teeth

Use only clean water to brush your teeth after a water-related emergency. Listen to local authorities to find out if tap water is safe to use.

Keep wounds clean and covered

Keeping wounds clean and covered is crucial during an emergency. Open wounds and rashes that have been exposed to contaminated water can become infected. Naturally occurring bacteria such as Vibrio that live in certain coastal waters can also cause a skin infection when an open wound is exposed to salt water or brackish water, a mix of salt and fresh water often found where rivers meet the sea.

To protect yourself and your family:

• Avoid contact with flood waters, salt water, or brackish water if you have an open wound (including cuts and scrapes).
• Keep open wounds as clean as possible by washing well with soap and clean water.
• Cover clean, open wounds with a waterproof bandage to reduce your chance of infection.
• Seek immediate medical care if a wound develops redness, swelling, or oozing.

Follow guidelines for safe diapering

It’s always important to change diapers in a safe, germ-free way, but an emergency can make this difficult. Even a microscopic amount of poop can contain millions of germs.

Highlights

• Clean up, disinfect, and practice good hygiene to avoid illness from bacteria, viruses, mold, and mildew.
• Get medical care if you are injured, sick, or having trouble coping with stress.
• To prevent carbon monoxide poisoning, only use generators, pressure washers, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices outside and away from open windows, doors, and air vents.
• Stay cool and drink plenty of fluids to prevent heat-related illness.

Protect Yourself from Animal and Insect-Related Hazards

• Natural disasters can bring people in closer contact with wildlife, such as snakes, alligators, and insects, especially when there is flooding. Disasters can also increase the spread of certain diseases between animals and people, such as rabies and leptospirosis. Be aware of these risks and avoid contact with wild or stray animals.
• Keep pets in a carrier or on a leash when outside, and only release them indoors until conditions outside improve. Do not let pets interact with strays or wild animals.
• Call local authorities to handle stray, dead, or sick animals as soon as possible.
• For more information, contact your local animal shelter or services, a veterinarian, or the Humane Society for advice on dealing with pets or stray or wild animals after an emergency.

Prevent Carbon Monoxide Poisoning

• Carbon monoxide (CO) is an odorless, colorless gas that can cause sudden illness and death if you breathe it. Never use generators, pressure washers, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices inside your home, basement, garage, or camper—or even outside near an open window, door, or vent.
• Don’t heat your house with a gas oven.
• If you are too hot or too cold, or you need to prepare food, don’t put yourself and your family at risk for CO poisoning—look to friends, family, or a community shelter for help.
• If your CO detector sounds, leave your home immediately and call 911.
• Seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseated.

Clean Up Safely After Floods

• To prevent illness, disinfect and dry buildings and items in them. This will prevent growth of some bacteria, viruses, mold, and mildew that can cause illness.

Keep Food and Drinking Water Safe

• Food may not be safe to eat during and after an emergency. Water may not be safe for cooking.
• Water may not be safe to drink, clean with, or bathe in after an emergency, such as a hurricane or flood. During and after a disaster, water can become contaminated with microorganisms (for example, bacteria), sewage, agricultural or industrial waste, chemicals, and other substances that can cause illness or death.
• Listen to and follow public announcements. Local authorities will tell you if water is safe to drink or to use for cooking or bathing. Follow local instructions to use bottled water or to boil or disinfect water for cooking, cleaning, or bathing.

Wash Your Hands

• Always wash your hands with soap and boiled or disinfected water before preparing or eating food, after toilet use, after participating in cleanup activities, and after handling articles contaminated by floodwater or sewage. Use warm water when available. Wash children’s hands frequently (always before meals).

• Disinfect water for washing by mixing 1/8 teaspoon of household bleach per 1 gallon of water). Let it stand for 30 minutes. If the water is cloudy, use a solution of 1/4 teaspoon of household bleach per 1 gallon of water.
• If water isn’t available, use alcohol-based products made for washing hands.

Infectious Disease

Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted, personal hygiene is difficult to maintain, and people are living in crowded conditions, such as shelters.

Post-hurricane conditions may pose an increased risk for the spread of common infectious diseases, like influenza and less common illnesses, like leptospirosis, hepatitis A, and vibriosis.

Immunizations

For information on immunizations for evacuees, relief workers, emergency responders and travelers, see Immunization After a Natural Disaster.

Protect Mental Health

• The days and weeks after an emergency are going to be rough. Some sleeplessness, anxiety, anger, hyperactivity, mild depression, or lethargy are normal and may go away with time. If you feel any of these symptoms acutely, seek counseling. Your state, local, tribal health departments will help you find local resources, including hospitals or health care providers that you may need.
• Seek medical care if you are injured, feel sick, or have acute stress and anxiety.
• Keep as many elements of your normal routine incorporated into the disaster plans as possible, including activities to calm children’s fears.
• Be aware that you may have fewer resources to attend to your day-to-day conflicts, so it is best to resolve what you can ahead of time.
• Turn to family, friends, and important social or religious contacts to setup support networks to deal with the potential stressors.
• Let your child know that it is okay to feel upset when something bad or scary happens. Encourage your child to express feelings and thoughts, without making judgments.

For additional resources, see
Coping With a Disaster or Traumatic Event.

Monitor your radio or television for up-to-date emergency information.

Prevent Mosquito Bites

The best way to prevent infection from diseases spread by mosquitoes is to prevent mosquito bites. Mosquitoes bite during the day and night. Take the following steps to protect yourself and your family:

• Use EPA-registered insect repellent
• Wear long-sleeved shirts and long pants
• Take steps to control mosquitoes indoors and outdoors

For more information, see our information on how to Protect yourself and your family from mosquito bites.

Prevent Illness from Sewage

• If there is flooding along with a hurricane, the water may contain fecal material from overflowing sewage systems and agricultural and industrial waste.
• If there has been a backflow of sewage into your house, wear rubber boots and waterproof gloves during cleanup. Remove and discard contaminated household materials that cannot be disinfected, such as wall coverings, cloth, rugs, and drywall.
  • People with a weakened immune system, especially people receiving treatment for cancer, people who have had an organ or stem cell transplant, and people taking medicines that suppress the immune system, should avoid cleanup activities.
• If you have any open cuts or sores that will be exposed to floodwater, keep them as clean as possible by washing them with soap and applying an antibiotic ointment to discourage infection and a clean, dry, waterproof bandage.
• Wash clothes contaminated with flood or sewage water in hot water and detergent and separately from uncontaminated clothes and linens.
• Do not allow children to play in floodwater areas and do not allow children to play with floodwater-contaminated toys that have not been disinfected. Disinfect toys by using a solution of one cup of bleach in five gallons of water. Some toys, such as stuffed animals and baby toys, cannot be disinfected; they should be discarded.

Monitor your radio or television for up-to-date emergency information.

Prevent Temperature-Related Illness

• When standing or working in water that is cooler than 75°F (24°C):
  • Wear rubber boots.
  • Ensure that clothing and boots have adequate insulation.
  • Take frequent breaks out of the water.
  • Change into dry clothing when possible.
• Prevent heat–related illness:
  • Stay in air-conditioned buildings.
  • Take breaks in shaded areas or in cool rooms.
  • Drink water and nonalcoholic fluids often.
  • Wear lightweight, light-colored, loose-fitting clothing.
  • Do outdoor activities during cooler hours.

Monitor your radio or television for up-to-date emergency information.

Prevent or Treat Wounds

• Immediately clean out all open wounds and cuts with soap and clean water. Keep wounds covered with clean, dry bandages that are large enough to cover the wound and contain any pus or drainage. Change bandages as needed and when drainage can be seen through the bandage. Contact a doctor to find out whether more treatment is needed (such as a tetanus shot). If a wound gets red, swells, or drains, seek immediate medical attention.
• Avoid wild or stray animals. If you are bitten by any animal, seek immediate medical attention. If you are bitten by a snake, try to identify it, so that if it is poisonous, you can be given the correct anti-venom. Do not cut the wound or attempt to suck the venom out.
• If your skin or eyes may have come in contact with hazardous materials, such as acid from a car battery, wash thoroughly with decontaminated water and seek medical attention as needed.
• If you have wounds, you should be evaluated for a tetanus immunization, just as you would at any other time of injury. If you receive a puncture wound or a wound contaminated with feces, soil, or saliva, have a doctor or health department determine whether a tetanus booster is necessary based on individual records.

Monitor your radio or television for up-to-date emergency information.

• To prevent carbon monoxide poisoning, only use generators, pressure washers, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices outside and away from open windows, doors, and air vents.
• Follow chain saw safety rules and use chain saws according to manufacturer instructions.
• Avoid wild or stray animals.
• Avoid the use of electric tools or appliances while standing in water.
• Drive safely, always wear your seatbelt, don’t drink and drive, and don’t drive when sleepy.

Natural disasters can cause a lot of stress on individuals, families, and communities. Stress can increase the risk for violence in the home, neighborhood, or community. Efforts to prevent violence after a natural disaster should focus on supporting the physical and emotional needs of individuals and families as well as restoring community-based services.

Coping with Stress

It is natural to feel stress and anxiety before, during, and after a disaster. Everyone reacts differently during an emergency. Taking care of emotional health is important during a disaster and will help with recovery.

Parenting Under Stress

Parenting is hard work and a natural disaster can make it even harder. Children are likely to experience stress during an emergency and may respond to disruptions to their routines with tantrums or other behavior problems. It is important during this time to provide emotional support to children, communicate clearly with them, and use discipline consistently.

Increased incidence of acute diarrhea may occur in post-disaster situations where access to electricity, clean water, and sanitary facilities are limited. In addition, usual hygiene practices may be disrupted and healthcare seeking behaviors may be altered.

The primary goal of treating any form of diarrhea—viral, bacterial, parasitic, or non-infectious—is preventing dehydration or appropriately rehydrating persons presenting with dehydration. The following are general guidelines for healthcare providers for the evaluation and treatment of patients presenting with acute diarrhea in these situations. However, specific patient treatment should be determined on the basis of the healthcare provider’s clinical judgment. Any questions should be directed to the local health department.

Infants and Toddlers

Refer children > 3 years old and adults with acute diarrhea for medical evaluation if any of the following are present:

• Elderly age
• History of chronic medical conditions or concurrent illness
• Fever >39 °C (102.2 °F)
• Visible blood in stool
• High output of diarrhea, including frequent and substantial volumes of stool
• Persistent vomiting
• Signs consistent with dehydration (e.g., sunken eyes or decreased tears, dry mucous membranes, orthostatic hypotension or decreased urine output)
• Change in mental status (e.g., irritability, apathy, or lethargy)
• Suboptimal response to oral rehydration therapy already administered or inability to administer oral rehydration therapy

Principles of appropriate treatment for CHILDREN > 3 YEARS OLD AND ADULTS with diarrhea and dehydration

• While sports drinks are fine for maintaining hydration in well persons, they are inappropriate for treatment of persons with diarrhea. In settings of diarrheal illness, oral rehydration solutions (ORS) such as Pedialyte® (Abbott Laboratories)*, Gastrolyte® (Aventis Pharmaceuticals)* or similar commercially available solutions containing appropriate amounts of sodium, potassium and glucose should be used for rehydration whenever patient can drink the required volumes; otherwise appropriate intravenous fluids may be used.
• Oral rehydration should be taken by patient in small, frequent volumes (spoonfuls or small sips); see attached table for recommended volume and time period.
• For rapid realimentation, unrestricted diet is recommended as soon as dehydration is corrected
• Additional ORS or other rehydration solutions should be administered for ongoing diarrheal losses
• No routine laboratory tests or medications are recommended
  • However, if a patient is living in conditions that are crowded or otherwise conducive to outbreaks of gastrointestinal disease, providers should consider testing for bacterial, viral, or parasitic pathogens (www.cdc.gov/foodsafety/outbreaks). If an outbreak is suspected, testing a subset of patients may be sufficient to confirm the outbreak (e.g., 10 stool specimens for norovirus)
• Antimotility agents such as Lomotil® (Pfizer) or Immodium® (McNeil Consumer) should be considered only in adult patients who are NOT febrile or having bloody/mucoid diarrhea. Antimotility agents may reduce diarrheal output and cramps, but do not accelerate cure. Antimotility agents are generally contraindicated for children
• The decision to treat with antimicrobial therapy should be made on a patient-by-patient basis, and may differ by age group (www.cdc.gov/mmwr/preview/mmwrhtml/rr5304a1.htm):
  • Children: may consider treatment based on:
    • Special needs of individual children (e.g., immune-compromised hosts or children with underlying disorders)
    • Clinical suspicion of sepsis
    • In the context of an outbreak of shigellosis, cryptosporidiosis, or giardiasis. Although hand hygiene is the mainstay of prevention, antimicrobial treatment can eliminate carriage and help to control an outbreak if rigorous hand hygiene measures are also observed. Nitazoxanide can be used to treat cryptosporidiosis or giardiasis in immunocompetent persons (www.cdc.gov/parasites/crypto/treatment.html).
  • Adults: may consider treatment based on:
    • Fever
    • Bloody or mucoid stool
    • Suspicion of sepsis
    • In the context of an outbreak of shigellosis, cryptosporidiosis, or giardiasis. Although hand hygiene is the mainstay of prevention, antimicrobial treatment can eliminate carriage and help to control an outbreak if rigorous hand hygiene measures are also observed. Nitazoxanide can be used to treat cryptosporidiosis or giardiasis in immunocompetent persons (www.cdc.gov/parasites/crypto/treatment.html).
• Care-takers should be counseled in appropriate hand hygiene practices

Symptoms of dehydration

Sources: Adapted from Duggan C, Santosham M, Glass RI . The management of acute diarrhea in children: oral rehydration, maintenance, and nutritional therapy. MMWR 1992; 41:1-20; and World Health Organization. The treatment of diarrhea: a manual for physicians and other senior health workers. Geneva , Switzerland : World Health Organization, 1995.

Treatment based on degree of dehydration

* In severe dehydrating diarrhea, normal saline is less effective for treatment because it contains no bicarbonate or potassium. Use normal saline only if Ringers lactate solution is not available, and supplement with ORS as soon as the patient can drink. Plain glucose in water is ineffective and should not be used.

Source: Managing acute gastroenteritis among children. MMWR 2003; 52: –16. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm.

NOTE: Restrictive diets should be avoided during acute diarrheal episodes. Breastfed infants should continue to nurse ad libitum even during acute rehydration. Infants too weak to eat can be given breastmilk or formula through a nasogastric tube. Lactose-containing formulas are usually well-tolerated. If lactose malabsorption appears clinically substantial, lactose-free formulas can be used. Complex carbohydrates, fresh fruits, lean meats, yogurt, and vegetables are all recommended. Carbonated drinks or commercial juices with a high concentration of simple carbohydrates should be avoided.

*The use of trade names or commercial sources does not imply endorsement by the Centers for Disease Control and Prevention or the Department. of Health and Human Services.

Highlights

• Avoid wild or stray animals.
• Protect yourself from mosquitoes by using EPA-registered insect repellents.
• To avoid attracting rodents, remove potential sources of food, water, and shelter such as garbage, dirty dishes, and debris.
• Be aware of snakes that may be swimming in the water to get to higher ground and those that may be hiding under debris or other objects.

General

• Avoid wild or stray animals.
• Call local authorities to handle animals.
• Secure all food sources and remove any animal carcasses.
• Get rid of dead animals, according to guidelines from your local animal control authority, as soon as you can.

Prevent Mosquito Bites

• Adult mosquitoes do not generally survive high winds during a hurricane.
• Immediately following a hurricane, flooding occurs. Mosquito eggs laid in the soil by floodwater mosquitoes during previous floods hatch. This results in very large populations of floodwater mosquitoes. Most of these mosquitoes are considered nuisance mosquitoes.
• In general, nuisance mosquitoes do not spread viruses that make people sick. The types of mosquitoes that can spread viruses may increase 2 weeks to 2 months after a hurricane, especially in areas that did not flood but received more rainfall than usual.

The best was to prevent infection from diseases spread by mosquitoes is to prevent mosquito bites. Mosquitoes bite during the day and night. Take the following steps to protect yourself and your family:

• Use EPA-registered insect repellent
• Wear long-sleeved shirts and long pants
• Take steps to control mosquitoes indoors and outdoors

Prevent Contact With Rodents

• Remove food sources, water, and items that can provide shelter for rodents.
• Wash dishes, pans, and cooking utensils immediately after use.
• Dispose of garbage and debris as soon as possible.

Prevent or Respond to a Snake Bite

• Be aware of snakes that may be swimming in the water to get to higher ground and those that may be hiding under debris or other objects.
• If you see a snake, back away from it slowly and do not touch it.
• If you or someone you know are bitten, try to see and remember the color and shape of the snake, which can help with treatment of the snake bite.
• Keep the bitten person still and calm. This can slow down the spread of venom if the snake is venomous. Seek medical attention as soon as possible. Dial 911 or call local Emergency Medical Services. Apply first aid if you cannot get the person to the hospital right away.
  • Lay or sit the person down with the bite below the level of the heart.
  • Tell him/her to stay calm and still.
  • Wash the wound with warm soapy water immediately.
  • Cover the bite with a clean, dry dressing.

HIGHLIGHTS

• Generators, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices should never be used inside a home, basement, garage, or camper – or even outside near an open window.
• Every home should have at least one working carbon monoxide detector. The detector’s batteries should be checked at least twice annually, at the same time smoke detector batteries are checked.

Important CO Poisoning Prevention Tips

• Never use a gas range or oven to heat a home.
• Never leave the motor running in a vehicle parked in an enclosed or partially enclosed space, such as a garage.
• Never use a generator, pressure washer, or any gasoline-powered engine inside your home, basement, or garage or less than 20 feet from any window, door, or vent. Use an extension cord that is more than 20 feet long to keep the generator at a safe distance.
• When using a generator, use a battery-powered or battery backup CO detector in your home.
• Never run a generator, pressure washer, or any gasoline-powered engine inside a basement, garage, or other enclosed structure, even if the doors or windows are open, unless the equipment is professionally installed and vented. Keep vents and flues free of debris, especially if winds are high. Flying debris can block ventilation lines.
• Never use a charcoal grill, hibachi, lantern, or portable camping stove inside a home, tent, or camper.
• If conditions are too hot or too cold, seek shelter with friends or at a community shelter.
• If CO poisoning is suspected, call 911 or your local Poison Control Center at 1-800-222-1222 or consult a health care professional right away.

Carbon monoxide (CO) is an odorless, colorless gas that can cause sudden illness and death if inhaled.

When power outages occur during emergencies such as hurricanes or winter storms, the use of alternative sources of fuel or electricity for heating, cooling, or cooking can cause CO to build up in a home, garage, or camper and to poison the people and animals inside.

Every year, more than 400 people die in the U. S. from accidental non-fire related CO poisoning.

CO is found in combustion fumes, such as those produced by small gasoline engines, stoves, generators, lanterns, and gas ranges, or by burning charcoal and wood. CO from these sources can build up in enclosed or partially enclosed spaces. People and animals in these spaces can be poisoned and can die from breathing CO.

How to Recognize CO Poisoning

Exposure to CO can cause loss of consciousness and death. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. People who are sleeping or who have been drinking alcohol can die from CO poisoning before ever having symptoms.

Stay Safe

• Wear proper protective clothing and glasses.
• Choose the proper size of chain saw to match the job.
• Operate, adjust, and maintain the saw according to manufacturer’s instructions.
• Take extra care in cutting “spring poles” trees or branches that have been bent, twisted, hung up on, or caught under another object during a high wind.
• Be sure that bystanders are at a safe distance from cutting activities.

Check around the tree or pole for hazards, such as nails, power lines, or cables, before cutting.

Be aware of the risk of chain saw injury during tree removal

Each year, approximately 36,000 people are treated in hospital emergency departments for injuries from using chain saws. The potential risk of injury increases after hurricanes and other natural disasters, when chain saws are widely used to remove fallen or partially fallen trees and tree branches.

Safeguards against injury while using a chain saw

• Operate, adjust, and maintain the saw according to manufacturer’s instructions provided in the manual for the chain saw.
• Properly sharpen chain saw teeth and properly lubricate the blade with bar and chain oil. Additionally, periodically check and adjust the blade to keep the correct tension on the chain to keep it from coming off the blade, and ensure good cutting action.
• Choose the proper size of chain saw to match the job, and include safety features such as a chain brake, front and rear hand guards, stop switch, chain catcher and a spark arrester.
• Wear the appropriate protective equipment, including hard hat, safety glasses, hearing protection, heavy work gloves, cut-resistant legwear (chain saw chaps) that extend from the waist to the top of the foot, and boots which cover the ankle.
• Check around the area where you are cutting for possible hazards like nails or cables, both inside the wood itself, or in debris laying around the tree or limb.
• Avoid contact with power lines until the lines are verified as being de-energized.
• Always cut at waist level or below to ensure that you maintain secure control over the chain saw.
• Clear the area of cut limbs and wood as you work to allow for safer use of the saw, and to provide an escape path in case of sudden unanticipated movement by trees and limbs.
• Bystanders or coworkers should remain at least 2 tree lengths (at least 150 feet) away from anyone felling a tree and at least 30 feet from anyone operating a chain saw to remove limbs or a fallen tree
• If injury occurs, apply direct pressure over site(s) of heavy bleeding; this may save lives.

Beware of injury from the release of bent trees or branches

Take extra care in cutting “spring poles” trees or branches that have gotten bent, twisted, hung up on, or caught under another object during a high wind. If the tree or the branch is suddenly released, it may strike the person cutting it, or a bystander, with enough force to cause serious injury or death. Even a seemingly small tree or branch (2 inches in diameter, for example) may pose a hazard when it is released from tension.

To avoid injury:

• Identify the maximum point of tension on the spring pole
• Slowly shave the underside of the tree rather than cut through to allow the tree or branch to release tension slowly

How the public can help

• It is best to have a chain saw operator who has training and experience in safe chain saw use and cutting techniques to fell and remove limbs from trees.
• Be sure that bystanders are at a safe distance from cutting activities, the chain saw operator uses personal protective equipment, and workers follow safety guidelines.

During emergencies such as hurricanes and floods, household, medical, and industrial chemicals can be released into the environment.

Protect yourself and your home by taking these steps:

• Stay out of floodwater. It can contain human and livestock waste, coal ash , and other contaminants that can lead to illness.
• Call 911 or the national poison control center at 1-800-222-1222 if you suspect someone has been poisoned by a chemical.
• Call the Animal Poison Control Center at 1-888-426-4435 if you suspect a pet has been poisoned by a chemical.
• Call local authorities or the National Response Center at 1-800-424-8802 to report oil and chemical spills, abandoned containers, or other containers you suspect may contain chemicals. Do not touch or move unknown containers.
• Listen to announcements or alerts from authorities about chemical safety and disposal issues.
• Listen to local announcements for guidance on what to do in the event of a chemical release. You may need to evacuate or stay inside (shelter in place) until you are told it is safe to leave.
• Wash skin that may have come into contact with chemicals or floodwater with soap and clean water as soon as possible. You may need to remove and dispose of your clothing, then decontaminate yourself to reduce or remove the chemical so it is no longer a hazard.

Dispose of your waste safely

To expedite debris removal,

• Separate yard waste, hazardous chemical waste, and household waste.
• Follow guidance of local officials when preparing waste for pickup.

You can be exposed to chemicals from everyday items such as household cleaners, paints, fertilizers, and pesticides that may spill or leak and cause a fire during an emergency.

• Listen to local officials to find out how to safely get rid of cleaning products and chemicals in your area.
• Do not empty chemical container contents onto the ground, into drains, or into waterways.
• Be alert for leaking containers and reactive household chemicals, such as caustic drain cleaners and chlorine bleach.
• Keep children and pets away from stored, leaking, and spilled chemicals.
• Leave damaged or unlabeled chemical containers undisturbed whenever possible.
• Follow your local solid waste authority’s guidance for disposal of broken, leaking, empty, or unlabeled chemical containers. Do not throw them away with your regular trash.

• Use your safety belt at all times.
• Drive at a speed that is safe for road and weather conditions.
• Recognize that traffic control information may not be posted because of damage to traffic signs.
• Stop lights and street signs may be missing or not working – Treat intersections where lights are out as a four-way stop.
• Recognize that police/law enforcement may be unable to enforce traffic laws.
• Be alert for trash in the road and for road damage.
• Be alert for trash falling from haul trucks and other vehicles.
• Keep space between you and other vehicles.
• Make sure to secure cargo or trash carried by your vehicle – shifting loads may fall or make the vehicle unstable.
• Avoid driving through water, especially when it is fast moving.
  • As little as six inches of water may cause you to lose control of your car or truck.
  • Two feet of water will carry most cars away.
• Do not drive through standing water if fallen electrical wires are in the water.
• Avoid driving when tired, fatigued, or upset.
• Do not use a cell phone while operating a vehicle.
• Avoid other distractions, such as eating, drinking, or adjusting vehicle controls, while driving.
• Plan your route in advance.

Stay safe after a hurricane, flood or other natural disaster

• NEVER touch a fallen power line.
• Do not drive through standing water if downed power lines are in the water.
• If you believe someone has had electric shock, call or have someone else call 911 or emergency medical help.

Avoid electrical hazards both in your home and elsewhere:

• Never touch a fallen power line. Call the power company to report fallen power lines.
• Avoid contact with overhead power lines during cleanup and other activities.
• Do not drive through standing water if downed power lines are in the water.
• If a power line falls across your car while you are driving, stay inside the vehicle and continue to drive away from the line. If the engine stalls, do not turn off the ignition. Warn people not to touch the car or the line. Call or ask someone to call the local utility company and emergency services. Do not allow anyone other than emergency personnel to approach your vehicle.
• If electrical circuits and electrical equipment have gotten wet or are in or near water, turn off the power at the main breaker or fuse on the service panel. Do not enter standing water to access the main power switch. Call an electrician to turn it off.
• Never turn power on or off yourself or use an electric tool or appliance while standing in water. Do not turn the power back on until electrical equipment has been inspected by a qualified electrician. All electrical equipment and appliances must be completely dry before returning them to service. Have a certified electrician check these items if there is any question.
• If you see frayed wiring or sparks when you restore power, or if there is an odor of something burning but no visible fire, you should immediately shut off the electrical system at the main circuit breaker.
• Consult your utility company about using electrical equipment, including power generators. Do not connect generators to your home’s electrical circuits without the approved, automatic-interrupt devices. If a generator is on line when electrical service is restored, it can become a major fire hazard and it may endanger line workers helping to restore power in your area.

If you believe someone has had electric shock take the following steps:

1. Look first. Don’t touch. The person may still be in contact with the electrical source. Touching the person may pass the current through you.
2. Call or have someone else call 911 or emergency medical help.
3. Turn off the source of electricity if possible. If not, move the source away from you and the affected person using a non-conducting object made of cardboard, plastic or wood.
4. Once the person is free of the source of electricity, check the person’s breathing and pulse. If either has stopped or seems dangerously slow or shallow, begin cardiopulmonary resuscitation (CPR) immediately.
5. If the person is faint or pale or shows other signs of shock, lay him or her down with the head slightly lower than the trunk of the body and the legs elevated.
6. Don’t touch burns, break blisters, or remove burned clothing. Electrical shock may cause burns inside the body, so be sure the person is taken to a doctor.

The risk for injury during and after a hurricane and other natural disasters is high. Flood waters and standing waters pose various risks, including infectious diseases, chemical hazards and injuries. Prompt first aid can help heal small wounds and prevent infection.

Take the following steps to protect yourself and your family:

• Avoid contact with flood waters if you have an open wound.
• Keep open wounds as clean as possible by washing thoroughly with soap and clean water.
• Cover clean, open wounds with a waterproof bandage to reduce chance of infection.
• Seek immediate medical care if a wound develops redness, swelling, or oozing or other signs of working infection such as fever, increasing pain, shortness of breath, fast heart rate, or confusion or disorientation, high heart rate.

Take Care of Wounds

• Wash your hands thoroughly with soap and clean water, if possible.
• Avoid touching the wound with your fingers while treating it (if possible, use disposable, latex gloves).
• Remove obstructive jewelry and clothing from the injured body part.
• Apply direct pressure to any bleeding wound to control bleeding.
• Clean the wound after bleeding has stopped.
  • Examine wounds for dirt and foreign objects.
  • Gently flood the wound with bottled water or clean running water (if available, saline solution is preferred).
  • Gently clean around the wound with soap and clean water.
  • Pat dry and apply an adhesive bandage or dry clean cloth.
• Leave unclean wounds, bites, and punctures open. Wounds that are not cleaned correctly can trap bacteria and result in infection.
• Provide pain relievers when possible.
• Review the wound every 24 hours.

Seek medical attention as soon as possible if:

• There is a foreign object (soil, wood, metal, or other objects) embedded in the wound;
• A wound is a result of an animal bite;
• A wound is a result of a puncture by a dirty object;
• The wound is infected (pain and soreness, swelling, redness, draining, or you develop a fever);
• You have signs of sepsis such as confusion or disorientation, shortness of breath, high heart rate, fever or shivering, extreme pain or discomfort or clammy or sweaty skin.

If you have wounds, you should be evaluated for a tetanus immunization. If you receive a puncture wound or a wound contaminated with feces, soil, or saliva, have a health care professional determine whether a tetanus booster is necessary based on individual records.

Do you manage evacuation shelters or provide alternate camps and sites for care? Then you likely know that disasters affect the most vulnerable populations. But do you know that disasters make people especially vulnerable to human trafficking? Use this information in your shelter and share it with others who provide these services so we all know more about how to recognize and act to prevent human trafficking before it happens.

Human trafficking is a serious public health concern, both domestically and worldwide.

• Human trafficking is a crime that occurs when a trafficker compels a victim by force, fraud, or coercion to perform labor, services, or commercial sex. Anyone can be targeted by a trafficker.
• Perpetrators of human trafficking manipulate and exploit others’ vulnerabilities for profit.
• Even if victims initially consent to go with or work for the perpetrator, that consent is rendered meaningless when perpetrators exploit them for labor, services, or commercial sex.

Instability after a disaster can make people especially vulnerable to trafficking.

People may be more vulnerable because they are:

• Displaced from their homes (temporarily living in a shelter)
• Separated from family and friends
• Disconnected from supportive services
• Unable to safely earn income and be self-sufficient

People who don’t speak a local language may be more vulnerable because they:

• Can’t communicate to authorities
• Are afraid of physical harm or stigma
• Have no access to assistance, services, or protection provided by local laws

Some populations are at higher risk for human trafficking.

While anyone can be affected by human trafficking, some populations you may encounter in your work are at higher risk:

• Migrant and seasonal workers, refugees, or asylees
• Disconnected or homeless youth or runaways
• People with physical, emotional, or cognitive disabilities
• Native persons
• Lesbian, gay, bisexual, transgender, queer or questioning, intersex (someone who has natural bodily variations), and Two-Spirit (Native American or Alaskan Native who combine activities or traits of both men and women) individuals
• Persons with a substance use disorder or with a history of substance use
• Those transitioning out of child welfare, foster care, or juvenile justice and prison systems
• Members of lower socio-economic groups
• Survivors of other forms of violence

Traffickers gain control over victims by exploiting their vulnerabilities.

During environmental or public health disasters, traffickers can control victims through their need for basic resources such as food, water, and shelter. Other control methods include:

• Physically assaulting or threatening serious harm
• Psychologically manipulating or shaming
• Providing false promises about work or living conditions
• Pretending to have an intimate relationship
• Pretending to provide protection
• Withholding wages or debt bondage
• Isolating the victim

If you think someone may be a victim of human trafficking, call or encourage them tocall the National Human Trafficking Hotline at 888-373-7888. Or, text “HELP” or “INFO” to 233733.

How will evacuation centers receive adequate vaccine to immunize evacuees?

CDC will work with immunization program and other public health staff in each state where there are evacuation centers to coordinate with staff at the evacuation centers, staff deployed from CDC, and others, about administering vaccine in the evacuation centers.

Will persons who have not completed the entire hepatitis B vaccine series be protected against the virus?

About 75-80% of adults who have received 2 valid doses of vaccine have developed a protective antibody level. Standard precautions to protect against exposure to blood or blood-containing fluids should be used. If a responder who is not fully vaccinated comes into contact with blood or body fluids, post exposure precautions should be taken according to previously published recommendations https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm.

Is it okay to get the hepatitis A vaccine around the same time as the hepatitis B vaccine?

Yes. Hepatitis A vaccine and hepatitis B vaccine do not interfere with each other and are often given together. However, hepatitis A vaccine is not one of the vaccines routinely recommended for responders.

What vaccines are recommended for evacuees of a disaster?

The major concern for anyone exposed to unsanitary conditions is that they be up to date with tetanus-containing vaccine, because if they are injured (as is common in disaster settings) the injury is likely to be contaminated. Routinely recommended vaccines are recommended for evacuees, just like they are for everyone else. Full CDC recommendations for vaccines for evacuees are posted on our website at http://emergency.cdc.gov/disasters/disease/vaccrecdisplaced.asp.

What immunizations should be offered/administered to a person who was displaced by a disaster and was not able to recover their original vaccination records?

Providers seeing persons displaced by a disaster should follow CDC’s recommendations for those persons who were not able to recover documentation of immunizations.

Thus:

• Children aged 10 years and younger should be treated as if they were up-to-date for their age and given any doses recommended for their current age and not received in the interim. (This guidance applies to any child except when there is information, e.g., parental report, that the child was not up-to-date.)
• Children/adolescents aged 11-18 years should receive recommended vaccines (Tdap, MCV, HPV, and influenza if indicated) if not already received.
• Adults should receive Tdap, PCV13 (if high-risk) and PPSV23 (if high-risk and /or agre-appropriate), and influenza vaccines (if indicated).
• In addition, any displaced person living in a crowded group setting should receive influenza, varicella, and MMR vaccines. Immunocompromised persons in these settings should not receive the live virus vaccines MMR and varicella.

I evacuated before a hurricane struck but hope to go home soon. Are there any special vaccination recommendations for me?

There are no special vaccination recommendations for persons returning to their homes in the disaster area. However, you should get a booster dose of a tetanus vaccine if you have not had a booster dose within the last 10 years. Tetanus-diphtheria (Td) boosters are routinely recommended every 10 years for all adults; the concern in this setting is that clean-up and repairs present an increased risk of injury and tetanus from such injuries is preventable by vaccination. Adults should receive the pertussis-containing Tdap vaccine rather than Td if this is available and has not been previously received. Children and adolescents 11 through 18 years should receive the pertussis-containing Tdap vaccine rather than Td if this is available.

What if I do not know if I never received any tetanus-diphtheria toxoid?

Persons who did not receive DTP or DTaP as a child, or whose tetanus vaccination history is not known should receive a primary series of three doses of adult Td. The first two doses should be separated by 4 weeks and the third dose should follow the second by at least 6 months. For persons 11 years and older Tdap should be substituted for ONE of these doses, preferably the first dose.

What is the immunization guidance for child evacuees entering school?

As a result of a disaster, many school-age children may be displaced from their schools to other schools away from home. To facilitate school enrollment for child evacuees, some states may opt to waive their school entry immunization requirements for these children. CDC has indicated its support for these actions and ASTHO encourages states to consider waiving school entry requirements as the situation warrants, consistent with state laws.

Leptospirosis is a bacterial disease that occurs worldwide and can cause serious illnesses such as kidney or liver failure, meningitis, difficulty breathing, and bleeding. Cases of leptospirosis can increase after hurricanes or floods when people may have to wade through contaminated water or use it for drinking or bathing.

How do people get leptospirosis?

People can get leptospirosis when they have contact with water or soil containing urine or other body fluids from infected animals, if they directly touch the urine from an infected animal or if they consume food or water contaminated by urine. The bacteria can survive for months in urine-contaminated water and soil. A variety of animals can spread leptospirosis, including rodents, dogs, livestock, and wildlife. During a hurricane or heavy rain, animal urine in the soil or on other surfaces can run into floodwater, contaminating it. Streams and other natural water sources can also be contaminated.

What are the symptoms of leptospirosis?

Symptoms usually start from 5 to 14 days after contact with the bacteria that causes leptospirosis. However, symptoms can begin anywhere from 2 to 30 days after contact. Early symptoms can include:

• Fever
• Headache
• Muscle aches
• Red eyes
• Vomiting
• Diarrhea
• Abdominal pain
• Jaundice (yellowing of the skin and eyes)
• Skin rash
• Cough

Who is at risk?

Leptospirosis most often affects people who work outdoors or with animals, or those who take part in recreational activities involving water or soil, like swimming, boating, and gardening. After floods or heavy rains, anyone who has been in contact with floodwater, contaminated freshwater (rivers and streams) or soil could be at risk for infection.

Some activities that increase your risk of leptospirosis include

• Drinking from potentially contaminated water sources, including floodwater, streams, rivers, or unsafe tap water.
• Bathing or wading in floodwater or contaminated fresh water, especially when putting your head under water or if you have an open wound or scratch.
• Eating food that has been exposed to contaminated water or potentially urinated on by rodents.

How can I avoid leptospirosis?

The most important way you can prevent leptospirosis is to avoid touching or drinking water that may be contaminated. If that is not possible, follow these steps to reduce your risk of leptospirosis:

• Treat water to make it safe to drink by boiling or using an appropriate chemical treatment, especially if it has been collected from a source that could be exposed to urine from animals or contaminated by floodwater runoff.
• Cover cuts or abrasions with waterproof bandages or other coverings that seal out water.
• Do not wade, swim, bathe, submerse your head in, or swallow floodwater or any fresh water source that may contain animal urine or be contaminated by floodwater runoff.
• Wear waterproof protective clothing, shoes or boots near floodwater or other water or soil that may be contaminated with animal urine.
• Prevent rodent infestation by keeping food, water and trash in closed containers, and trapping any rodents you see.
• Avoid eating food that rodents may have had access to.
• If you suspect your pet or livestock have leptospirosis, contact a veterinarian. Symptoms of leptospirosis in dogs may include fever, fatigue, lack of appetite and increased or decreased urination. Symptoms of leptospirosis in livestock may include abortion, decreased milk production and weak offspring.

How is leptospirosis treated?

If you have symptoms of leptospirosis, contact a doctor right away. If your doctor thinks you have leptospirosis, they will likely give you antibiotics. Treatment is most effective when started as soon as possible.

After natural disasters such as hurricanes, tornadoes, and floods, excess moisture and standing water contribute to the growth of mold in homes and other buildings. When returning to a home that has been flooded, be aware that mold may be present and may be a health risk for your family.

People at Greatest Risk from Mold

• People with asthma, allergies, or other breathing conditions may be more sensitive to mold.
• People with immune suppression (such as people with HIV infection, cancer patients taking chemotherapy, and people who have received an organ transplant) are more susceptible to mold infections. People with weakened immune systems can develop invasive mold infections days to weeks after exposure to fungi that live in the environment. People with a weakened immune system, especially people receiving treatment for cancer, people who have had an organ or stem cell transplant, and people taking medicines that suppress the immune system, should avoid cleaning up mold. Children should not take part in disaster cleanup work.

Possible Health Effects of Mold Exposure

People who are sensitive to mold may experience stuffy nose, irritated eyes, wheezing, or skin irritation. People allergic to mold may have difficulty in breathing and shortness of breath. People with weakened immune systems and with chronic lung diseases, such as obstructive lung disease, may develop mold infections in their lungs. If you or your family members have health problems after exposure to mold, contact your doctor or other health care provider.

Safely Preventing Mold Growth

Clean up and dry out the building quickly (within 24 to 48 hours). Open doors and windows. Use fans to dry out the building. Position fans to blow air out doors or windows.

• When in doubt, take it out! Remove all porous items that have been wet for more than 48 hours and that cannot be thoroughly cleaned and dried. These items can remain a source of mold growth and should be removed from the home. Porous, noncleanable items include carpeting and carpet padding, upholstery, wallpaper, drywall, floor and ceiling tiles, insulation material, some clothing, leather, paper, wood, and food. Removal and cleaning are important because even dead mold may cause allergic reactions in some people.
• To prevent mold growth, clean wet items and surfaces with detergent and water.
• Homeowners may want to temporarily store items outside of the home until insurance claims can be filed. 

If there is mold growth in your home, you should clean up the mold and fix any water problem, such as leaks in roofs, walls, or plumbing. Controlling moisture in your home is the most critical factor for preventing mold growth.

To remove mold growth from hard surfaces use commercial products, soap and water, or a bleach solution of no more than 1 cup of household laundry bleach in 1 gallon of water. Follow the manufacturers’ instructions for use (see product label). Use a stiff brush on rough surface materials such as concrete.

If you choose to use bleach to remove mold:

• Never mix bleach with ammonia or other household cleaners. Mixing bleach with ammonia or other cleaning products will produce dangerous, toxic fumes
• Open windows and doors to provide fresh air. Use fans to dry out the building. Position fans to blow air out doors or windows.
• Wear non-porous gloves and protective eye wear.
• If the area to be cleaned is more than 10 square feet, consult the U.S. Environmental Protection Agency (EPA) guide titled Mold Remediation in Schools and Commercial Buildings.
• Always follow the manufacturer’s instructions when using bleach or any other cleaning product.

If you plan to be inside the building for a while or you plan to clean up mold, you should buy N95 masks (or respirators with a higher protection level) at your local home supply store and wear one while in the building. Make certain that you follow instructions on the package for fitting the mask tightly to your face. Even if you go back into the building for a short time and are not cleaning up mold, you still need to wear an N95 mask.”

A pressure washer is a power tool that sprays water at high pressures to clean large, sturdy surfaces such as buildings, farm equipment and roads. Pressure washers may be used more often during disaster clean-up when the risk of injury may be higher.

When using a pressure washer, always follow the safety instructions included in the owner’s manual.

Risks

• The strong spray from a pressure washer can cause serious wounds that might first appear minor. Wounds that appear minor can cause a person to delay treatment, increasing risk for infection, disability or amputation.
• The fast, strong spray can throw objects that strike and injure others who are close by.
• Electric shock can occur if the pressure washer is not used properly and if safety instructions are not followed.
• Using small, gasoline-powered engines can cause carbon monoxide poisoning. Workers should not use any equipment powered by gasoline engines inside buildings or other partially enclosed spaces unless the gasoline engine can be placed outdoors and away from air intakes.

Precautions

• Never point a pressure washer at yourself or others.
• Never attempt to push or move objects with spray from the washer.
• Never use a gasoline powered washer in an enclosed space.
• Always test the ground fault circuit interrupter (circuit breaker or outlet) before using a pressure washer.
• Always plug a properly grounded pressure washer into a properly grounded receptacle.
• If an extension cord must be used, keep the pressure washer’s power cord connection out of any standing water, and use a heavy duty extension cord with components rated for use in wet locations.Keep both the power cord and extension cord connections as far away as possible from the item being washed and away from any water runoff.
• Wear rubber-soled shoes that provide some insulation when using the pressure washer.
• Never cut or splice the pressure washer’spower cord or extension cords.
• Never remove the grounding prong from the pressure washer’s power cord plug or the extension cord.
• Always have a qualified electrician check the pressure washer for electrical problems after it has tripped a circuit breaker.
• Never allow children to operate a pressure washer. Keep children at a safe distance when an adult is using a pressure washer.

If you are hurt by a pressure washer:

• Call 911 if emergency help is needed.
• Take care of any wounds:
• Before treating the wound, wash your hands with soap and clean water.
• Remove any object that is in the way of caring for the wound.
• Put pressure on the wound with a clean cloth to stop bleeding.
• After bleeding has stopped, pour bottled or clean running water over the wound.
• Gently clean around the wound with soap and clean water.
• Pat dry and use an adhesive bandage or dry clean cloth to cover the wound.
• Leave unclean wounds open.

Persons who have high pressure spray wounds are urged to get medical attention as soon as possible. A medical professional might X-Ray the injured area, provide a tetanus shot and antibiotics, or make a referral to a specialist.

High-Pressure Water Injection Injury Management

As disaster clean-up efforts are underway, pressure injection injuries from use of pressure washers may increase.

The seriousness of high pressure injection injuries is generally underestimated. The wounds often appear benign, but these injuries can result in serious infection, disability and amputation if not treated appropriately. The potential for serious injury should be considered with any device that produces greater than 100 pounds per square inch (PSI) of pressure.

Immediate recognition of the injury is crucial to successful management.

Evaluation

• Assess the wound (often appears very small and innocuous)
• Assess neurovascular status
• Assess tendon function

Treatment

• X-Ray the injured area to check for presence of subcutaneous air or foreign body
• Administer tetanus vaccination or ensure that tetanus prophylaxis is up to date
• Administer antibiotics
• Refer urgently to a surgeon for probable wound debridement
• Avoid use of digital blocks

People crowded together in places such as evacuation centers are vulnerable to outbreaks of respiratory illnesses. In some cases, such as with influenza, germs can spread very rapidly in these settings and may have important health consequences for residents and workers, particularly for persons who are at higher risk for complications from influenza. This document provides guidance for evacuation center workers and residents on some simple measures that can help prevent transmission.

Facts about Spread of Respiratory Diseases

• Many of the germs that cause respiratory (breathing) diseases are spread by droplets that come from coughing and sneezing. These germs usually spread from person to person when uninfected persons are in close contact with a sick person. Some people may become infected by touching something with these germs on it and then touching their mouth or nose.
• In general, the best way to help prevent spread of respiratory germs is to avoid contact with droplets or secretions of saliva, mucus and tears. Things that can help include the following:
  • Minimize close contact with persons who have symptoms of respiratory illness, such as coughing or sneezing.
  • Help ill persons contain droplets that result from their coughing and sneezing.
  • Wash your hands regularly.
  • Avoid sharing personal items such as eating or drinking utensils, toothbrushes, and towels. You should especially avoid sharing these items with sick persons.
  • Maintain a clean environment.
• Some respiratory illnesses, such as influenza, can be prevented with a vaccine. Check with local health officials to see if influenza vaccination is available at your evacuation center.

Infection Control Measures to Prevent the Spread of Respiratory Diseases

Screening guidance for clinicians and evacuation center workers

To prevent the spread of respiratory illness in evacuation centers, clinicians and staff should try to identify ill persons and use appropriate infection control measures as soon as possible. Evacuation center workers should screen evacuation center residents for symptoms of respiratory illness. In addition, they should refer ill persons for medical evaluation in order to ensure appropriate diagnosis and treatment. Early diagnosis can be an important part of prevention.

• If possible, post visual reminders in the residential areas of evacuation centers that instruct residents and workers to report symptoms of a respiratory infection. You should also use visual alerts to encourage the practice of respiratory hygiene and cough etiquette.
• If possible, screen for respiratory illness among residents and workers upon initial evacuation center admission or registration.
  • Ask every resident and worker about the following symptoms of respiratory illness:
    • Cough
    • Sneezing
    • Sore throat
    • Fever
    • Wheezing
    • Shortness of breath
    • Night sweats
    • Runny nose
    • Weight loss
  • Ask persons with respiratory symptoms if they have asthma or chronic obstructive pulmonary disease (COPD), including emphysema.
• Refer any person meeting one of the following criteria for medical evaluation:
  • Any person with respiratory symptoms that are accompanied by fever, wheezing, or shortness of breath
  • Any person with a chronic cough (a cough that persists for weeks or months) that is accompanied by either fever, night sweats, or weight loss
  • Any person with respiratory symptoms who also has asthma or COPD
• If residents do not have symptoms of respiratory illness upon initial evacuation center admission or registration, tell them to report any new respiratory symptoms to staff when they first occur.

Highlights

• If you see a snake in your home, immediately call the animal control agency in your county.
• Be aware of snakes that may be swimming in the water or hiding under debris or other objects.
• If you or someone you know are bitten, try to see and remember the color and shape of the snake.
• Do not pick up a snake or try to trap it.

After a natural disaster, snakes may have been forced from their natural habitats and move into areas where they would not normally be seen or expected. When you return to your home, be cautious of snakes that may have sought shelter in your home. If you see a snake in your home, immediately call the animal control agency in your county.

How to Prevent Snake Bites

• Be aware of snakes that may be swimming in the water to get to higher ground and those that may be hiding under debris or other objects.
• If you see a snake, back away from it slowly and do not touch it.

Signs of Snake Bites

If you have to walk in high water, you may feel a bite, but not know that you were bitten by a snake. You may think it is another kind of bite or scratch. Pay attention to the following snake bite signs.

Depending on the type of snake, the signs and symptoms may include:

• A pair of puncture marks at the wound
• Redness and swelling around the bite
• Severe pain at the site of the bite
• Nausea and vomiting
• Labored breathing (in extreme cases, breathing may stop altogether)
• Disturbed vision
• Increased salivation and sweating
• Numbness or tingling around your face and/or limbs

What TO DO if You or Someone Else is Bitten by a Snake

• If you or someone you know are bitten, try to see and remember the color and shape of the snake, which can help with treatment of the snake bite.
• Keep the bitten person still and calm. This can slow down the spread of venom if the snake is venomous.
• Seek medical attention as soon as possible.
• Dial 911 or call local Emergency Medical Services (EMS).
• Apply first aid if you cannot get the person to the hospital right away.
  • Lay or sit the person down with the bite below the level of the heart.
  • Tell him/her to stay calm and still.
  • Wash the wound with warm soapy water immediately.
  • Cover the bite with a clean, dry dressing.

What NOT TO DO if You or Someone Else is Bitten by a Snake

• Do not pick up the snake or try to trap it (this may put you or someone else at risk for a bite).
• Do not apply a tourniquet.
• Do not slash the wound with a knife.
• Do not suck out the venom.
• Do not apply ice or immerse the wound in water.
• Do not drink alcohol as a pain killer.
• Do not drink caffeinated beverages.

What is trench foot?

Trench foot, also known as immersion foot, occurs when the feet are wet for long periods of time. It can be quite painful, but it can be prevented and treated.

What are the symptoms of trench foot?

Symptoms of trench foot include a tingling and/or itching sensation, pain, swelling, cold and blotchy skin, numbness, and a prickly or heavy feeling in the foot. The foot may be red, dry, and painful after it becomes warm. Blisters may form, followed by skin and tissue dying and falling off. In severe cases, untreated trench foot can involve the toes, heel, or entire foot.

How is trench foot prevented and treated?

When possible, air-dry and elevate your feet, and exchange wet shoes and socks for dry ones to help prevent the development of trench foot.

Treatment for trench foot is similar to the treatment for frostbite. Take the following steps:

• Thoroughly clean and dry your feet.
• Put on clean, dry socks daily.
• Treat the affected part by applying warm packs or soaking in warm water (102° to 110° F) for approximately 5 minutes.
• When sleeping or resting, do not wear socks.
• Obtain medical assistance as soon as possible.

If you have a foot wound, your foot may be more prone to infection. Check your feet at least once a day for infections or worsening of symptoms.

You may have heard that you can get Vibrio infection from eating raw or undercooked oysters and other seafood. But did you know you can also get a Vibrio infection through an open wound? This can happen when a wound comes into contact with raw or undercooked seafood, its juices, or its drippings or with saltwater or brackish water.*

One species, Vibrio vulnificus, can cause life-threatening wound infections. Many people with Vibrio vulnificus infection require intensive care or limb amputations, and about 1 in 5 people with this infection die, sometimes within a day or two of becoming ill.

Some Vibrio vulnificus infections lead to necrotizing fasciitis, a severe infection in which the flesh around an open wound dies. Some media reports call this kind of infection “flesh-eating bacteria,” even though necrotizing fasciitis can be caused by more than one type of bacteria.

Who is more likely to get a Vibrio wound infection?

Anyone can get a Vibrio wound infection. But some people are more likely to get an infection and have severe complications—for example, people who have liver disease or take medicine that lowers the body’s ability to fight germs. Find out if you are at increased risk for infection.

How can I prevent a Vibrio wound infection if I have a wound?

You can reduce your chance of getting a Vibrio wound infection by following these tips:

• If you have a wound (including from a recent surgery, piercing, or tattoo), stay out of saltwater or brackish water, if possible. This includes wading at the beach.
• Cover your wound with a waterproof bandage if it could come into contact with saltwater, brackish water, or raw or undercooked seafood and its juices. This contact can happen during everyday activities, such as swimming, fishing, or walking on the beach. It could also happen when a hurricane or storm surge causes flooding.
• Wash wounds and cuts thoroughly with soap and water after they have contact with saltwater, brackish water, raw seafood, or its juices.

What are the signs and symptoms of Vibrio vulnificus infection?

Signs and symptoms of Vibrio vulnificus infection can include:

• Watery diarrhea, often accompanied by stomach cramping, nausea, vomiting, and fever
• For bloodstream infection: fever, chills, dangerously low blood pressure, and blistering skin lesions
• For wound infection, which may spread to the rest of the body: fever, redness, pain, swelling, warmth, discoloration, and discharge (leaking fluids).

How is infection diagnosed and treated?

Infection is diagnosed when Vibrio bacteria are found in the wound, blood, or stool (poop) of an ill person. The infection is treated with antibiotics. Doctors may need to amputate a patient’s legs or arms to remove dead or infected tissue.

* Brackish water is a mixture of fresh and salt water. It is often found where rivers meet the sea.

What you need to know if you are pregnant or might be pregnant…

After a hurricane many people are affected, here are some tips on how to protect yourself and your baby.

I’ve heard that people are getting sick after the hurricane.  What happens if I get sick?  Will it hurt my unborn baby?

If you do get sick, talk to a doctor or nurse right away. Explain that you are pregnant or think you might be pregnant. Some infections might harm your growing baby. The sooner you get the care you need, the better. While you are sick, drink plenty of clean water and follow the doctor or healthcare provider’s orders. Drinking lots of clean water and resting is very important for all pregnant women, especially when they are sick.

I think I might be pregnant and need to take medicine for a health problem.  Do I need to tell someone first?

Before you start taking any medicines, even ones that you can buy at the store, talk with a doctor or nurse first. Make sure to tell the doctor or nurse that you are pregnant or might be pregnant. Some medicines are not good for women to take when they are pregnant, but others are okay. If you are already taking a medicine, talk to your doctor before stopping the medicine.

What are immunizations?

Immunizations are also called vaccines or shots.  Vaccines make it less likely that you get sick from some kinds of infections like the flu.  Many vaccines are safe for you and your baby, but there are some that might not be safe.  If you are pregnant or think you might be pregnant, tell the doctor or nurse before they give you any shots or medicine.

I have been hearing about carbon monoxide poisoning.  Should I be worried about harm to my unborn baby?

Using generators, kerosene heaters, grills, or camp stoves indoors can lead to carbon monoxide poisoning.  Do not use these machines in a closed space.  Always be sure that a window or door is open near by.  Carbon monoxide is a gas with no color or smell.  It is a poison to you and your baby.  If you breathe it, it can make you very sick.  It can even kill you.  Carbon monoxide is a poison for anyone, whether you are pregnant or not.  If you’ve breathed carbon monoxide, you might feel like throwing up or feel very tired.  If you are having problems and think you were exposed to carbon monoxide, you should tell a doctor or nurse.

What do I do if there is flood water around me?  I am worried that it will make me and my unborn baby sick.

If possible, do not touch or walk in flood water. If you do touch the water, make sure to use soap and clean water to wash the parts of your body that came in contact with the water. Do not swallow any of the flood water and be careful to keep it away from your mouth. If you feel sick in any way, talk to a doctor or nurse right away. Remember to explain that you are pregnant or think you might be pregnant.

I have heard that mosquito bites can make me sick and cause problems for my pregnancy. What can I do to protect myself and my baby?

After a hurricane has passed through an area and flooding occurs, mosquitoes will lay eggs near standing water. Mosquito populations usually increase greatly after flooding. Most of these mosquitoes will not spread viruses, but some could. If you are pregnant, you should follow steps to prevent mosquito bites to reduce your risk for illnesses spread by mosquitoes, including Zika virus and West Nile virus.

• Wear long-sleeved shirts and long pants.
• Stay and sleep in places with air conditioning or that use window and door screens.
• Use EPA-registered insect repellents with one of the following active ingredients:
  • DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol, or 2-undecanone
• Once a week, empty and scrub, turn over, cover, or throw out items that hold water, such as trash containers, tires, buckets, toys, planters, flowerpots, birdbaths or pools.

I have been under a lot of stress since the hurricane.  Can stress hurt me and my baby?

Stress can cause problems like having your baby come too soon or having a baby that is under weight.  It is important to choose healthy ways to deal with your stress.  Some ways are:

• Understand that the stress you are feeling is normal.
• Get plenty of rest – it is important for you and your baby.
• Do your best to eat healthy foods and drink lots of water.
• Find healthy ways to relax.  Taking just a few minutes a couple times during the day to close your eyes in a quiet place can help.  Reading, listening to music, or writing in a journal can also help you to relax.
• Avoid the urge to drink alcohol, smoke or take drugs as ways of coping with stress.
• Talk to friends, family members, or clergy for comfort and share your experiences and feelings with them.
• If you feel like you can’t deal with your stress or that your friends or family can’t help, talk to a counselor, doctor or nurse.