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The U.S. Environmental Protection Agency (EPA) has announced the flood waters in the afflicted Hurricane Katrina areas have tested positive for Escherichia coli (E. coli), chloroform bacteria, and lead -- all of which are at levels which greatly exceed EPAs recommended levels for contact.
Preliminary analysis shows an immediate problem. Human contact with the flood water should be avoided as much as possible, warns EPA Administrator Stephen L. Johnson.
The EPA tested for bacteria as well as more than 100 compounds, including items such as pesticides and metals. Lead concentrations were found to exceed what EPA considers safe for drinking water levels. These levels are of greatest concern to children, they warn.
I want to be very clear, Johnson adds, emergency personnel and the public should avoid direct contact with any flood water as much as possible. If you should come into contact with the water, we strongly advise you to use soap and clean water to clean off all exposed areas.
The chloroforms we have found are a marker of sewage. We have not gone in and looked for every single kind of bacteria or pathogen that could be in the water, says CDC Director Dr. Julie Gerberding, MD, MPH.
To be more specific of greatly exceeding levels, Johnson explains EPAs protocol for these kinds of situations is that the maximum capacity of the protocols measure 10 times what would be an acceptable level of bacteria. Every single one of those samples, as I understand, hit the maximum, Johnson states. Our testing showed that each one exceeded 10 times what would be safe. Its a major health concern.
Water analysis will be an ongoing effort in the afflicted areas, which will include daily sampling. Todays results are of water collected Sept. 3 in downtown New Orleans, and do not include any industrial areas. In addition, the water was only tested for certain bacteria and the 100 compounds afore mentioned. Oil slicks have been observed throughout the area, but have not as yet been tested. It is feared, according to Johnson, that oil is seeping into some areas and testing will soon begin to address the problem.
These initial results represent the beginning of our extensive sampling efforts, and may not necessarily represent the condition of all flood waters throughout the area, according to Johnson. EPA is still in the process of testing in Mississippi and Alabama.
This water is not going to be safe to drink or to be in any time soon, Gerberding adds.
The EPA estimates the number of water systems affected by the hurricane to now be 73 in Alabama, 555 in Mississippi, and 469 in Louisiana. In Alabama, many water systems were disabled or impaired by loss of electrical power. Eight systems in Alabama currently have boil water advisories. In addition, approximately 378 drinking water systems are not in operation in Louisiana. with another 48 systems on a boil water notice.
EPA also estimates the number of wastewater treatment facilities affected is now 13 in Alabama, 114 in Louisiana, and 85 in Mississippi.
The Threat of Infectious Disease in the wake of Katrina: What the Experts Say
The area right now is obviously an infection control nightmare, says Joseph Cervia, MD, infectious disease physician, professor of clinical medicine and pediatrics at Albert Einstein College of Medicine in New York, and medical director at Pall Medical, Pall Corporation. The immediate threat is of enteropathogens because wastewater obviously gets into all of the water that seeps through the streets and into peoples homes and businesses and hospitals, etc. Obviously, for a long while, drinking water will not be potable in that area.
In the areas affected, I know they are using bottled water for drinking. The water there will not be considered safe for some time because of the seepage of enteropathogens into the water system.
The water is full of sewage, says Gerberding. The health hazard of this water is still a very important threat to the people who have yet to evacuate.
Gerberding states there are many common intestinal illnesses that can be transmitted by ingesting this sewage and by being in the waters without the proper personal protective wear. There have already been sporadic reports of gastrointestinal illness among the people in the shelters, most of which are related to Nora virus, she says.
Every possible case is a reason for concern, and there are reports of diarrheal illness that are under active investigation in Texas right now. Gerberding also says they have teams of individuals documenting whether there is in fact an actual outbreak or whether this is just a distribution of diarrhea that you would normally see in a population. We wont be surprised if this proves to be a situation where infectious illnesses can spread, we just have to identify them early and be prepared to take the appropriate steps to contain them, she says.
Cervia advises clinicians treating patients that have been to these affected areas to be aware of the vast array of organisms that can be associated with water.
The likelihood of waterborne environmental pathogens needs to be kept in mind by those who treat individuals who have been in that area. Given the gravity of the situation and the amount of press that it has received, people will be thinking along those lines, but its not always the case. Occasionally, people forget that in this kind of a disaster, people do move around quite a bit. There will be folks from the afflicted areas that will relocate to many different areas of the country where they may become ill and where people will have to keep this kind of history in mind.
In the long run, wastewater is going to be contaminated with a host of different microorganisms that can result in infection in more vulnerable hosts. For example people injured in the flood or in its aftermath. In evacuation efforts, people sustain all kinds of lacerations and open wounds -- and individuals who have those wounds infected, can be infected with organisms that would not have been ordinarily expected to contaminate wounds. In day-to-day situations when you sustain a laceration, ordinarily it is the same organisms that we see time and again -- staph (Staphylococcus aureus) and strep (Streptococcus); skin organisms. Here, when youre waist-deep, and in some cases neck-deep, in water thats been contaminated with sewage, you can have a host of organisms including gram-negatives that you would not ordinarily expect. Clinicians need to be aware that when individuals present with signs or symptoms of infection, having been in those conditions, that it may not be the same garden variety organisms that produce infection. They have to think more broadly -- including waterborne organisms including gram-negatives, for example Pseudomonas aeruginosa, Enterobacteriaceae, among others.
In fact, the CDC says four hurricane victims have become infected with Vibrio vulnificus, three of which are believed to have died as a direct result of the infection. A CNN report states the bacteria is a form of the bacteria that also causes cholera (Vibrio cholerae), however, Gerberding says this is untrue.
The media has confused this organism with cholera. It in no way resembles cholera. It is not spread person to person. Its something that is commonly associated with exposure to salt water, particularly in people who already developed skin wounds or have other ways the bacteria can enter their skin.
The chances of that (cholera) becoming a big problem are small, not zero, but they are small, says Peter Katona, MD, associate professor of clinical medicine at UCLA. We dont have cholera in that part of the country. There is cholera in the Gulf of Mexico, but its not like were in Bangladesh were there is indigenous cholera all around.
There are a lot of different vibrios and theyre going to be in the water. My gut feeling is that that is not going to be a big problem. The different strains of Vibrio are not contagious or epidemic-prone the way Vibrio cholera is. These Vibrio vulnificus that you may see occasional cases of here and there, but its not a huge issue as far as Im concerned. We have to be careful, and if it happens, we have to be diligent about it, but I dont see that as a huge risk.
The diseases that evolve are those that were present in the population and in the sewage, prior to the event, adds Gerberding. Those who are immunocompromised are most at risk at developing serious infections from this type of bacteria, and thats what we see in these scattered cases. This does not represent an outbreak.
As Cervia shares, obviously enteropathogens are always the biggest problem, that is diarrheal pathogens -- the E. coli, for example. These organisms are in all human waste and whenever there is contamination of water with that, there is going to be a spread of enteropathogens.
It was absolutely inevitable, says Central Michigan University biology faculty member Elizabeth Alm of the E. coli contamination of the Hurricane Katrina flood waters in New Orleans. E. coli is abundant in human and animal feces, sewage and sewage-contaminated waters. The real concern is not so much the E. coli themselves, but that E. coli are indicators of sewage contamination and the potential presence of disease-causing microorganisms.
Concern also has arisen from the unknown number of dead bodies in the water further transmitting disease, however, Gerberding says this is not the case. From a health standpoint, bodies in the water do not pose an infectious disease threat. The only conceivable concern would be if someone had direct contact with the blood of one of these victims and that person happened to be carrying a bloodborne infection, she says.
What people need to understand is for almost all infectious agents, when the body dies, so does the agent, Michael T. Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota at Minneapolis told Medpage Today.
Other infectious disease possibilities are being addressed. There has been some investigation of potential cases of tuberculosis (TB), according to Gerberding. Some of the people in the shelters were already known to have TB and were already receiving medication. Getting them their medications and making sure they are not in an infectious state is obviously a priority. If new cases of TB emerge, they are being investigated and the appropriate containment steps are being taken.
I think were much more concerned about the common illnesses that any crowded condition can promote, she adds.
The CDC is advising several vaccinations including tetanus for workers in the afflicted areas, and influenza vaccines for everyone involved in the areas. In addition, the CDC is working feverishly to ensure children from the afflicted areas are brought up to date on their childhood vaccinations.