449. Post-Hurricane Maria Surveillance for Infectious Diseases in the Veterans Affairs San Juan Medical Center, Puerto Rico
Session: Poster Abstract Session: Global Health and Travel Medicine
Thursday, October 4, 2018
Room: S Poster Hall
  • Oda_HurricaneMariaSurveillancePoster_IDWeek2018.pdf (978.3 kB)
  • Background: On September 20, 2017 Category 4 Hurricane Maria made landfall in Puerto Rico (PR), causing widespread flooding, power outages, and lack of water service. Given the potential for infectious disease outbreaks, the Department of Veterans Affairs (VA) and Centers for Disease Control and Prevention established enhanced surveillance to actively monitor priority infections at VA facilities.

    Methods: We queried VA data sources from August 27, 2017 – February 3, 2018 (pre-storm dates included to establish baselines). Trends in infectious disease ICD-10 syndrome groupings (respiratory illness/pneumonia, Influenza-like illness (ILI), gastrointestinal illness, conjunctivitis, rash-like Illness, jaundice) as a percent of total emergency department (ED) visits were tracked. The total number of laboratory tests performed, and percent positive per week, for influenza, hepatitis A, dengue (DENV), zika (ZIKV), leptospirosis, and chikungunya (CHIKV) were calculated.

    Results: ILI increased from 9.3% to 12.6% during the surveillance period (peak epi week 52: 15.7%) (Figure 1), while other ICD-10 based syndromes remained relatively stable. Weekly influenza testing increased shortly after landfall averaging 105 rapid influenza tests per week (epi weeks 41-4) (Figure 2).  Influenza positivity increased in epi weeks 41 and 42 (7%), dropping the following weeks, and peaked at 15% in epi week 2 (Figure 3). Four acute infections were detected: 2 +leptospirosis DNA, 1 +CHIKV RNA, and 1 +Hepatitis A IgM. The remaining 34 positive tests were ZIKV, CHIKV, or DENV IgM positive or equivocal, awaiting confirmation (Figure 3).

    Conclusion: We quickly established a simple surveillance system to monitor trends in priority infectious diseases. Increases in ILI, weekly influenza testing volume, and percent positive of influenza tests coincided with onset of influenza season. Diseases of public health importance were identified through laboratory-based surveillance. The impact of Maria on VA healthcare operations, including clinic closures, power outages, and disrupted care seeking patterns limited this system. However, the timeliness and flexibility of this surveillance system provides a model for disease monitoring following future natural disasters.

    Figure 1

    Figure 2.

    Figure 3.

    Gina Oda, MS1, Almea Matanock, MD2, Jennifer C. Hunter, MPH, DrPH3, Anita Patel, PharmD, MS4, Satish Pillai, MD, MPH5, Timothy Styles, MD, MPH6, Sonia Saavedra, MD7, Mirsonia Martinez, CIC7, Makoto Jones, MD, MS8, Carter Mecher, MD9, Russell Ryono, Pharm. D.1 and Mark Holodniy, MD, FIDSA, FSHEA1, (1)Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, CA, (2)Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA, (3)Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Atlanta, GA, (4)National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (5)Centers for Disease Control and Prevention, Atlanta, GA, (6)Hurricane Response, Centers for Disease Control and Prevention, Atlanta, GA, (7)VA Caribbean Healthcare System, San Juan, PR, (8)Internal Medicine, VA Salt Lake City Health Care System, Salt Lake City, UT, (9)Patient Care Services, Department of Veterans Affairs, Washington, DC


    G. Oda, None

    A. Matanock, None

    J. C. Hunter, None

    A. Patel, None

    S. Pillai, None

    T. Styles, None

    S. Saavedra, None

    M. Martinez, None

    M. Jones, None

    C. Mecher, None

    R. Ryono, None

    M. Holodniy, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.