Preparedness, hurricanes Irma and Maria, and impact on health in Puerto Rico

Joshipura, Kaumudi; Martínez-Lozano, Marijulie; Ríos-Jiménez, P.I.; Noboa, Carlamarie; Alvarado-González, Gerardo; Lowe, Sarah R.

doi:10.1016/j.ijdrr.2021.102657

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…The aim of the Preparedness to Reduce Exposures and Diseases Post-hurricanes and Augment Resilience (PREPARE) study was to evaluate risk and resiliency factors related to Hurricanes Irma and Maria, focusing on non-communicable diseases. 18 This study was built on data collected across Puerto Rico before the hurricanes, and additional data were collected post-hurricanes among the same participants. Participants free of diabetes, ages 40 to 65 years, overweight or obese and resident in the San Juan municipality and its vicinity, were recruited from the San Juan Overweight Adults Longitudinal Study (SOALS).…”

Section: Methodsmentioning

confidence: 99%

“…17 A previous study found that lower pre-hurricane preparedness was associated with hurricane-related detrimental health impact (OR = 1.96; 95% CI: 1.31, 2.95) and development of new NCDs (OR = 2.07; 95% CI: 0.92, 4.68). 18 Natural disasters are a consistent predictor of adverse health outcomes, including the development or worsening of chronic diseases. 19 Due to the increasing frequency and severity of hurricanes, we need to understand how these disasters affect NCDs, to reduce the adverse health impact of future hurricanes.…”

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confidence: 99%

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confidence: 99%

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Impact of Hurricanes Irma and Maria on Asthma, Hypertension, and Depression in a Sample of the Puerto Rico Population

Martínez-Lozano,

Fraticelli,

Irizarry

et al. 2023

Disaster med. public health prep.

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Objective: To evaluate the impact of Hurricanes Irma and Maria on 3 major chronic diseases in Puerto Rico. Methods: San Juan Overweight Adults Longitudinal study participants were re-evaluated after Hurricanes Irma and Maria (May 2019–July 2020) for the Preparedness to Reduce Exposures and Diseases Post-hurricanes and Augment Resilience study. This study compared the prevalence and incidence of asthma, depression, and hypertension within the same 364 individuals over time. Results: Asthma and depression prevalence and incidence did not change significantly after the hurricanes. The prevalence of hypertension increased significantly after the hurricanes (OR = 2.2, 95% CI: 1.2, 3.9). The incidence of hypertension after the hurricanes (IR = 9.0, 95% CI: 6.5, 12.4) increased significantly compared to before the hurricanes (IR = 6.1, 95% CI: 4.5, 8.0) (age-adjusted incidence rate ratio [aIRR] = 1.4, 95% CI: 4.5, 8.0) for similar time periods. Conclusion: Hurricanes Irma and Maria were associated with a significant increase in the prevalence and incidence of hypertension in this study population. Contrary to expectations, no significant increases were observed in depression and asthma prevalence after the hurricanes. Results from this study can inform better strategies to prevent and manage hypertension in the population affected by a hurricane.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Impact of Hurricanes Irma and Maria on Asthma, Hypertension, and Depression in a Sample of the Puerto Rico Population

Martínez-Lozano,

Fraticelli,

Irizarry

et al. 2023

Disaster med. public health prep.

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“…4 The healthcare impact caused by these hurricanes immediately became apparent. [5][6][7][8][9][10] In December 2017, the PR Government officially reported 64 deaths, 5 however, a Harvard University study estimated over 4600 deaths. 7 George Washington University's study estimated 2975 deaths, 8 a toll later accepted as official.…”

Section: Introductionmentioning

confidence: 99%

Healthcare and Social Organizations’ Disaster Preparedness, Response, and Recovery Experience: Lessons Learned From Hurricanes Irma and Maria

Noboa

Almodóvar-Díaz

Fernández-Repollet

et al. 2023

Disaster med. public health prep.

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Background: Healthcare and social organizations (HSOs) are first respondents after natural disasters. Hence, their preparedness and resilience are critical components for addressing future disasters. However, little is known about HSOs’ experiences prior to, during, and after hurricanes. Objective: To describe preparedness, response, and recovery experiences from hurricanes Irma/ Maria among HSOs in Puerto Rico and the US Virgin Islands. Methods: Using a convenience sample, semi-structured interviews were conducted with 52 key-informants. Content analysis for common and recurring themes and patterns was performed by HSO type. Results: Most HSOs (80.8%) had a preparedness plan and 55.8% responded providing emergency supplies. HSOs’ human resources (61.2%) was the main recovery facilitator/ enabler, while 36.5% identified the lack of economic resources and the lack of an integrated emergency plan as the top barriers. The main lesson learned include understanding the need to make improvements to their emergency preparedness plans (56.3%), and to establish an integrated/ centralized plan between relevant parties. Conclusion: Lessons learned after hurricanes allowed HSOs to identify gaps and opportunities to become more resilient. Infrastructure capacity, human resources, communication systems, and economic support, as well as training, partnerships, and new policies should be defined, revised, and/ or integrated into the HSOs’ preparedness plans to mitigate the impact of future disasters.

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“…It was one of the deadliest natural disasters in the United States, with an estimated 4,645 excess deaths and more than $90 billion in damages ( 33 , 34 ). Puerto Ricans experienced negative health impacts and post-traumatic stress due to a combination of physical and psychological challenges, including hazardous exposures, economic hardship, and prolonged and extensive disruptions in electricity, water supply, communication, transportation, and medical services ( 35 – 37 ). Pregnant women were a vulnerable population and endured widespread structural damage in their homes, insufficient healthcare access, nutritional food shortages, and increased exposures to pollutants ( 35 , 38 ).…”

Section: Introductionmentioning

confidence: 99%

Infants exposed in utero to Hurricane Maria have gut microbiomes with reduced diversity and altered metabolic capacity

Zhang,

de Ángel Solá,

Acevedo Flores

et al. 2023

mSphere

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The gut microbiome is a potentially important mechanism that links prenatal disaster exposures with increased disease risks. However, whether prenatal disaster exposures are associated with alterations in the infant’s gut microbiome remains unknown. We established a birth cohort study named Hurricane as the Origin of Later Alterations in Microbiome (HOLA) after Hurricane Maria struck Puerto Rico in 2017. We enrolled vaginally born Latino term infants aged 2 to 6 months, including n = 29 infants who were exposed in utero to Hurricane Maria in Puerto Rico and n = 34 infants who were conceived at least 5 months after the hurricane as controls. Shotgun metagenomic sequencing was performed on infant stool swabs. Infants exposed in utero to Hurricane Maria had a reduced diversity in their gut microbiome compared to the control infants, which was mainly seen in the exclusively formula-fed group ( P = 0.02). Four bacterial species, including Bacteroides vulgatus , Clostridium innocuum , Bifidobacterium pseudocatenulatum , and Clostridium neonatale , were depleted in the exposure group compared to the control group. Compositional differences in the microbial community and metabolic genes between the exposure and control groups were significant, which were driven by the formula feeding group ( P = 0.02 for the microbial community and P = 0.008 for the metabolic genes). Metabolic modules involved in carbohydrate metabolism were reduced in the exposure group. Prenatal maternal exposure to Hurricane Maria was associated with a reduced gut commensal and an altered microbial composition and metabolic potential in the offspring’s gut. Breastfeeding can adjust the composition of the gut microbiomes of exposed infants. IMPORTANCE Climate change is a serious issue that is affecting human health. With more frequent and intense weather disasters due to climate change, there is an urgent need to evaluate and understand the impacts of prenatal disaster exposures on the offspring. The prenatal stage is a particularly vulnerable stage for disease origination. However, the impact of prenatal weather disaster exposures on the offspring’s gut microbiome has not been evaluated. Our HOLA study starts to fill this knowledge gap and provides novel insights into the microbiome as a mechanism that links prenatal disaster exposures with elevated disease risks. Our major finding that reduced microbial diversity and altered metabolic capacity are associated with prenatal hurricane exposures warrants further studies to evaluate the impact of weather disasters on the unborn.

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Preparedness, hurricanes Irma and Maria, and impact on health in Puerto Rico

Cited by 12 publications

References 31 publications

Impact of Hurricanes Irma and Maria on Asthma, Hypertension, and Depression in a Sample of the Puerto Rico Population

Impact of Hurricanes Irma and Maria on Asthma, Hypertension, and Depression in a Sample of the Puerto Rico Population

Healthcare and Social Organizations’ Disaster Preparedness, Response, and Recovery Experience: Lessons Learned From Hurricanes Irma and Maria

Infants exposed in utero to Hurricane Maria have gut microbiomes with reduced diversity and altered metabolic capacity

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