Journal of the Louisiana State Medical Society
Recognition and Management of Rodent-Borne Infectious Disease Outbreaks After Heavy Rainfall and Flooding
James H. Diaz, MD, MPH&TM, DrPH, FACPM
Climatic events, especially heavy rains and flooding following periods of relative drought, have precipitated both arthropod-borne and rodent-borne infectious disease outbreaks. Heavy rainfall encourages excessive wild grass seed production that supports increased outdoor rodent populations, and flooding forces rodents from their burrows near water sources into the built environment and closer to humans. The objectives of this review are to alert clinicians to the climatic conditions common to hurricane-prone regions, such as Louisiana, that can precipitate outbreaks of the two rodent-borne diseases most often associatedwith periods of heavy rainfall and flooding, leptospirosis (LS) and hantavirus pulmonary syndrome (HPS). It will also describe the epidemiology, presenting clinical manifestations and outcomes of these rodent-borne infectious diseases, and recommend both prophylactic therapies and effective control and prevention strategies for rodent-borne infectious disease outbreaks. Healthcare providers should maintain high levels of suspicion for LS in patients developing febrile illnesses after contaminated freshwater exposures during flooding or recreational events, and for HPS in patients with febrile illnesses that progress rapidly to respiratory failure following rodent exposures in enclosed spaces. Public health educational strategies should encourage limit- ing human contact with all wild and peridomestic rats and mice, avoiding all contact with rodent excreta, safely disposing of all rodent excreta, and modifying the built environment to deter rodents from colonizing households and workplaces.
Climatic events, especially heavy rains and flooding following periods of relative drought, have precipitated both arthropod-borne and rodent-borne infectious disease outbreaks. Heavy rainfall encourages excessive wild grass seed production that supports increased outdoor rodent populations; and flooding forces rodents from their bur- rows near water sources, such as bayous, canals, rivers, and sewers, into the built environment and closer to humans. Unanticipated regional outbreaks of leptospirosis (LS) and hantavirus pulmonary syndrome (HPS) have occurred fol- lowing heavy rainfall and flooding in the United States (US). As a result, the objectives of this review are to alert clini- cians to the climatic conditions common to hurricane-prone regions, such as Louisiana, that can precipitate outbreaks of LS and HPS; describe the epidemiology and presenting clinical manifestations and outcomes of these rodent-borne infectious diseases; and recommend both prophylactic therapies and effective control and prevention strategies for rodent-borne infectious disease outbreaks. METHODS
to examine the latest scientific articles on rodent-borne infec- tious disease outbreaks in the US in order to describe the epidemiology and presenting clinical manifestations and outcomes of leptospirosis (LS) and hantavirus pulmonary syndrome (HPS) outbreaks. They were also used to recom- mend both prophylactic therapies and control and preven- tion strategies for these disease outbreaks. The keywords included hantavirus, New World hantaviruses, American hantaviruses, Sin nombre virus, Bayou virus, Black Creek Canal virus, hantavirus pulmonary syndrome; Leptospira interrogans , leptospirosis, Weil’s disease; infectious disease outbreaks, climatic factors, and rodent-borne. RESULTS Leptospirosis Outbreak 1: Leptospirosis Outbreak Among Athletes Participating in Triathlons - Wisconsin and Illinois, 1998. (Adapted from MMWR , July 24, 1998) 1 Once considered an occupational disease of abattoir and sewer workers, LS outbreaks are now being increas- ingly reported among flood survivors, white water rafters, adventure travelers, soldiers, and triathlon participants. 1-4
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186 J La State Med Soc VOL 166 September/October 2014
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