Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to healthcare workers.

When Hurricane Harvey landed along the Texas coast on August 25, 2017, it caused massive flooding and damage and displaced tens of thousands of residents of Harris County, Texas. Between August 29 and September 23, Harris County, along with community partners, operated a megashelter at NRG Center, which housed 3365 residents at its peak. Harris County Public Health conducted comprehensive public health surveillance and response at NRG, which comprised disease identification through daily medical record reviews, nightly “cot-to-cot” resident health surveys, and epidemiological consultations; messaging and communications; and implementation of control measures including stringent isolation and hygiene practices, vaccinations, and treatment. Despite the lengthy operation at the densely populated shelter, an early seasonal influenza A (H3) outbreak of 20 cases was quickly identified and confined. Influenza outbreaks in large evacuation shelters after a disaster pose a significant threat to populations already experiencing severe stressors. A holistic surveillance and response model, which consists of coordinated partnerships with onsite agencies, in-time epidemiological consultations, predesigned survey tools, trained staff, enhanced isolation and hygiene practices, and sufficient vaccines, is essential for effective disease identification and control. The lessons learned and successes achieved from this outbreak may serve for future disaster response settings. (Disaster Med Public Health Preparedness. 2019;13:97-101)

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Objective1) Describe HCPH’s disease surveillance and prevention activities within the NRG Center mega-shelter; 2) Present surveillance findings with an emphasis on sharing tools that were developed and may be utilized for future disaster response efforts; 3) Discuss successes achieved, challenges encountered, and lessons learned from this emergency response.IntroductionHurricane Harvey made landfall along the Texas coast on August 25th, 2017 as a Category 4 storm. It is estimated that the ensuing rainfall caused record flooding of at least 18 inches in 70% of Harris County. Over 30,000 residents were displaced and 50 deaths occurred due to the devastation. At least 53 temporary refuge shelters opened in various parts of Harris County to accommodate displaced residents. On the evening of August 29th, Harris County and community partners set up a 10,000 bed mega-shelter at NRG Center, in efforts to centralize refuge efforts. Harris County Public Health (HCPH) was responsible for round-the-clock surveillance to monitor resident health status and prevent communicable disease outbreaks within the mega-shelter. This was accomplished through direct and indirect resident health assessments, along with coordinated prevention and disease control efforts. Despite HCPH’s 20-day active response, and identification of two relatively small but potentially worrisome communicable disease outbreaks, no large-scale disease outbreaks occurred within the NRG Center mega-shelter.MethodsActive surveillance was conducted in the NRG shelter to rapidly detect communicable and high-consequence illness and to prevent disease transmission. An online survey tool and novel epidemiology consulting method were developed to aid in this surveillance. Surveillance included daily review of onsite medical, mental health, pharmacy, and vaccination activities, as well as nightly cot-to-cot resident health surveys. Symptoms of infectious disease, exacerbation of chronic disease, and mental health issues among evacuees were closely monitored. Rapid epidemiology consultations were performed for shelter residents displaying symptoms consistent with communicable illness or other signs of distress during nightly cot surveys. Onsite rapid assay tests and public health laboratory testing were used to confirm disease diagnoses. When indicated, disease control measures were implemented and residents referred for further evaluation. Frequencies and percentages were used in the descriptive analysis.ResultsHarris County’s NRG Center mega-shelter housed 3,365 evacuees at its peak. 3,606 household health surveys were completed during 20 days of active surveillance, representing 7,152 individual resident evaluations, and 395 epidemiology consultations. Multifaceted surveillance uncovered influenza-like illness and gastrointestinal (GI) complaints, revealing an Influenza A outbreak of 20 cases, 3 isolated cases of strep throat, and a Norovirus cluster of 5 cases. Disease control activities included creation of respiratory and GI isolation rooms, provision of over 771 influenza vaccinations, generous distribution of hand sanitizer throughout the shelter, placement of hygiene signage, and frequent bilingual public health public service announcements in the dormitory areas. No widespread outbreaks of communicable disease occurred. Additionally, a number of shelter residents were referred to the clinic after reporting exacerbation of chronical conditions or mental health concerns, including one individual with suicidal ideations.ConclusionsEffective public health surveillance and implementation of disease control measures in disaster shelters are critical to detecting and preventing communicable illness. HCPH’s rigorous surveillance and response system in the NRG Center mega-shelter, including online survey tool and novel consultation method, resulted in timely identification and isolation of patients with gastrointestinal and influenza-like illness. These were likely key factors in the successful prevention of widespread disease transmission. Additional success factors included successful partnerships with onsite clinical and pharmacy teams, cooperative and engaged shelter leadership, synergistic internal surveillance team dynamics, availability of student volunteers, sufficient quantities of influenza vaccine, and access to mobile survey technology. Challenges, mostly related to scope and magnitude of response, included lack of pre-designed survey tools, relatively new staff without significant disaster experience, and simultaneous management of multiple surveillance activities within the community. Personal hurricane-related losses experienced by HCPH staff also impacted response efforts. HCPH’s rich disaster response experiences at the NRG mega-shelter and developed surveillance tools can serve as a planning guide for future public health emergencies in Harris County and other jurisdictions.

BackgroundHarris County Public Health (HCPH) is the health department for Harris County, Texas jurisdiction, representing 2.3 million residents. Located in the nation’s Third most populous county, HCPH’s 13 wellness clinics and WIC centers provide services for over 100,000 patients annually.Since late 2015, HCPH confirmed 46 individuals with Zika infection/disease, including two infants with microcephaly and congenital disease. Over two-thirds of these infections were in individuals of Hispanic origin, including all twelve infected pregnant women, two of whom were unaccompanied minors.Due to Harris County’s geographic vulnerability to Zika, highly mobile residents, and HCPH’s largely low-income Hispanic and refugee clinic population, equitably screening and educating patients about Zika exposure is of paramount importance.MethodsUsing U.S. CDC guidelines, HCPH developed a multifaceted Zika Screening Tool (ZST) for use within clinics. Front desk staff, outreach workers, nursing staff, and clinical providers all participate in various portions of the education-based screening process. The ZST is updated as new CDC guidance becomes available.ResultsAll pregnant and high-risk patients received Zika education. Forty-five patients, mostly pregnant females, were additionally referred for testing and further care.ConclusionHCPH’s ZST successfully identified high-risk patients for education and testing. This presentation will explore HCPH’s equity-based rationale for education-oriented screening, the ZST’s evolution over time, and describe ZST forms and their integration into the clinic visit. Successful implementation strategies, challenges, and lessons learned will also be discussed, along with the role of the ZST as an integral part of HCPH’s overall multidisciplinary Zika response effort.Disclosures All authors: No reported disclosures.

In 2015, Harris County (Texas) Public Health responded to the Zika virus (ZIKV) threat by investigating every report of potential ZIKV infection, including those with negative laboratory results, through December 2017. Before investigations, 40.6% of patients who were indicated for testing received it in accordance with Centers for Disease Control and Prevention guidelines. By investigating reports with negative ZIKV results, we increased the number of patients receiving correct and complete laboratory testing to 54.5%, and improved dissemination of evolving guidelines to partners across the health care spectrum.