Groups warn of infectious disease threats in Puerto Rico

After Hurricane Maria hit Puerto Rico on Sep 20, the island lost power, and experienced extensive flooding, leaving thousands homeless and without access to routine medical care. Now, as the waters recede, the Infectious Diseases Society of America (ISDA) is warning that the US territory faces public health threats that need to be countered by immediate funding and aid from the US government.

Underscoring worries about disease threats, local officials are reporting leptospirosis infections and deaths in people affected by the storm.

Concern over disaster relief

"We appreciate that the Trump administration has requested $29 billion in disaster relief funds and request Congress act swiftly, at a minimum, to approve this level of much-needed support," said IDSA president Paul Auwaerter, MD, in a statement published with Melanie Thompson, MD, chair of the HIV Medicine Association (HIVMA) yesterday.

"Additional resources will likely be needed, and we are pleased that federal agencies are assessing additional needs." The $29 billion is for hurricane relief efforts in Texas, Florida, and Louisiana, and non-hurricane relief efforts elsewhere, not just for hurricane relief in Puerto Rico.

Earlier today President Donald Trump tweeted that the US government could not aid Puerto Rico "forever," drawing ire from San Juan's mayor and many others who say the president hasn't treated Puerto Ricans as US citizens.

"Indeed, Puerto Ricans and U.S. Virgin Islanders are U.S. citizens and expect the same federal aid and support during natural disasters as the rest of the United States," wrote Carmen D. Zorilla, MD, an obstetrician from Puerto Rico who penned a perspective piece published in the New England Journal of Medicine yesterday.

Multiple public health threats

Zorilla said every one of Puerto Rico's 3.4 million citizens have been touched by the hurricane, and, 16 days after the storm, only 9.2% of people had power and 54% had access to drinking water.

As an obstetrician-gynecologist on the faculty of the University of Puerto Rico School of Medicine, Zorilla stayed on the 18th floor of a maternity ward during the hurricane to help deliver babies and offer care to pregnant women. She said that the standing water and heavy flooding could bring more Zika, dengue, and chikungunya epidemics to the island.

"The impact of this disaster on morbidity, survival, adherence to treatments, and medical complications has yet to be documented," Zorilla said.

The IDSA named "waterborne pathogens, the spread of infections in crowded shelters, food-borne illnesses, mosquito-borne infections and mold-related illnesses," as a few of the immediate areas of concern for Puerto Ricans. Moreover, the hurricane has jeopardized access to medicines for patients with HIV and tuberculosis, as well as antibiotics, oral hydration solutions, and other basic first aid care.

In an update yesterday, the US Environmental Protection Agency (EPA) said there are reports of residents obtaining, or trying to obtain, drinking water from hazardous waste "Superfund" sites in Puerto Rico. It also added that raw sewage continues to be released into waterways and can be expected to continue until repairs are made and power is restored.

Four dead, 10 infected with leptospirosis

According to the Associated Press (AP), Ricardo Rossello, governor of Puerto Rico, said at a news conference yesterday that 4 people had died and 10 were sickened with leptospirosis, a bacterial illness spread through contact with contaminated animal urine or contact with the urine via water, soil, or other means.

The disease can be spread when people drink water contaminated with animal urine or feces, and without treatment, complications can develop, including kidney damage, meningitis, liver failure, or respiratory distress.

According to the AP, many Puerto Ricans have taken to drinking from local streams because water has been shut off for the last 2 weeks.

To date, the AP said 45 deaths in Puerto Rico have been blamed on Hurricane Maria, but other news stories estimate that the number is much higher.

See also:

Oct 11 IDSA statement

Oct 11 N Engl J Med perspective

Oct 11 EPA press release

Oct 11 AP story

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