The Texas flood registry: a flexible tool for environmental and public health practitioners and researchers.

BACKGROUND: Making landfall in Rockport, Texas in August 2017, Hurricane Harvey resulted in unprecedented flooding, displacing tens of thousands of people, and creating environmental hazards and exposures for many more. OBJECTIVE: We describe a collaborative project to establish the Texas Flood Registry to track the health and housing impacts of major flooding events. METHODS: Those who enroll in the registry answer retrospective questions regarding the impact of storms on their health and housing status. We recruit both those who did and did not flood during storm events to enable key comparisons. We leverage partnerships with multiple local health departments, community groups, and media outlets to recruit broadly. We performed a preliminary analysis using multivariable logistic regression and a binomial Bayesian conditional autoregressive (CAR) spatial model. RESULTS: We find that those whose homes flooded, or who came into direct skin contact with flood water, are more likely to experience a series of self-reported health effects. Median household income is inversely related to adverse health effects, and spatial analysis provides important insights within the modeling approach. SIGNIFICANCE: Global climate change is likely to increase the number and intensity of rainfall events, resulting in additional health burdens. Population-level data on the health and housing impacts of major flooding events is imperative in preparing for our planet's future.

Tuberculosis in Internationally Displaced Children Resettling in Harris County, Texas, USA, 2010-20151.

US guidelines have recommended testing children emigrating from high tuberculosis-incidence countries with interferon-gamma release assays (IGRAs) or tuberculin skin tests (TSTs). We describe the Harris County (Texas) Public Health Refugee Health Screening Program's testing results during 2010-2015 for children <18 years of age: 5,990 were evaluated, and 5,870 (98%) were tested. Overall, 364 (6.2%) children had >1 positive test: 143/1,842 (7.8%) were tested with TST alone, 129/3,730 (3.5%) with IGRA alone, and 92/298 (30.9%) with both TST and IGRA. Region of origin and younger age were associated with positive TST or IGRA results. All children were more likely to have positive results for TST than for IGRA (OR 2.92, 95% CI 2.37-3.59). Discordant test results were common (20%) and most often were TST+/IGRA- (95.0%), likely because of bacillus Calmette-Guérin vaccination. Finding fewer false positives supports the 2018 change in US immigration guidelines that recommends using IGRAs for recently immigrated children.

Provider and Public Health Adaptation to Changing Centers for Disease Control and Prevention Guidance for Zika Virus, 2015-2017.

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.

Influenza A (H3) Outbreak at a Hurricane Harvey Megashelter in Harris County, Texas: Successes and Challenges in Disease Identification and Control Measure Implementation.

ABSTRACTWhen 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).

Functionalized graphene oxide coating on Ti6Al4V alloy for improved biocompatibility and corrosion resistance.

The present study focused on the development of magnesium-functionalized graphene oxide (FGO) coating on titanium alloy (Ti6Al4V) by electrophoretic deposition. Graphene oxide (GO) was synthesized by modified Hummers' method and functionalized with magnesium ions. X-ray diffraction, infrared spectroscopy (IR) and Raman spectroscopy were employed to confirm the synthesis of GO and GO-coatings on Ti6Al4V. Functionalization of GO with Mg ions was confirmed by energy dispersive X-ray spectroscopy. The surface morphology of coated samples was examined through scanning electron microscopy. Reduction of FGO coating (labelled as rFGO) by heating at 200 °C was confirmed by IR. The rFGO coated Ti6Al4V was found to be hydrophilic in nature as determined by contact angle measurement which showed reduction in the contact angle of Ti6Al4V from 95.4° to 42.1°. The percent cell viability over the coated sample was appreciably improved compared to as-received Ti6Al4V sample owing to hydrophilicity of the former. The positive shift in open circuit potential and increase in polarization resistance was observed after coating Ti6Al4V samples with FGO. The significant decrease in the corrosion current density and negative polarization loop in the reverse scan of samples also confirmed the improved corrosion resistance of rFGO-coated Ti6Al4V over uncoated Ti6Al4V in the PBS solution. Furthermore, the impedance spectroscopy revealed that the preferential adsorption of ionic species (indicated by large Rads) at the surface improved the barrier characteristics of rFGO coated samples and exhibited an order of magnitude higher Rct compared to as-received samples.

West Nile Virus Outbreak in Houston and Harris County, Texas, USA, 2014.

Since 2002, West Nile virus (WNV) has been detected every year in Houston and the surrounding Harris County, Texas. In 2014, the largest WNV outbreak to date occurred, comprising 139 cases and causing 2 deaths. Additionally, 1,286 WNV-positive mosquito pools were confirmed, the most reported in a single mosquito season.

From Principles to Practice: One Local Health Department's Journey Toward Health Equity.

Few dispute that social determinants such as economics, education, and the environment are the true drivers of health. In fact, the recent "Public Health 3.0" publication is a national call to action for public health to focus upstream. Where there is less clarity is how to redesign public health practice to address social determinants. As an example of how local health departments can heed this national call, Harris County Public Health describes its movement from health equity principles to practice, which included reframing an understanding of health inequities and applying a multitiered infrastructure of policy and procedures for "retrofitting" practice.

Engagement and education: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

BACKGROUND: Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. CONCLUSIONS: The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians.

Facilitating access to antiviral medications and information during an influenza pandemic: engaging with the public on possible new strategies.

Antiviral medications can decrease the severity and duration of influenza, but they are most effective if started within 48 hours of the onset of symptoms. In a severe influenza pandemic, normal channels of obtaining prescriptions and medications could become overwhelmed. To assess public perception of the acceptability and feasibility of alternative strategies for prescribing, distributing, and dispensing antivirals and disseminating information about influenza and its treatment, the Institute of Medicine, with technical assistance from the Centers for Disease Control and Prevention (CDC), convened public engagement events in 3 demographically and geographically diverse communities: Fort Benton, MT; Chattanooga, TN; and Los Angeles, CA. Participants were introduced to the issues associated with pandemic influenza and the challenges of ensuring timely public access to information and medications. They then discussed the advantages and disadvantages of 5 alternative strategies currently being considered by the CDC and its partners. Participants at all 3 venues expressed high levels of acceptance for each of the proposed strategies and contributed useful ideas to support their implementation. This article discusses the key findings from these sessions.

Mass casualty triage: an evaluation of the science and refinement of a national guideline.

Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.

Emerging disease syndromic surveillance for Hurricane Katrina evacuees seeking shelter in Houston's Astrodome and Reliant Park Complex.

Transmission of infectious diseases became an immediate public health concern when approximately 27,000 New Orleans-area residents evacuated to Houston's Astrodome and Reliant Park Complex following Hurricane Katrina. This article presents a surveillance system that was rapidly developed and implemented for daily tracking of various symptoms in the evacuee population in the Astrodome "megashelter." This system successfully confirmed an outbreak of acute gastroenteritis and became a critical tool in monitoring the course of this outbreak.

Houston's medical disaster response to Hurricane Katrina: part 2: transitioning from emergency evacuee care to community health care.

After Hurricane Katrina hit the Gulf Coast on August 29, 2005, thousands of ill and injured evacuees were transported to Houston, TX. Houston's regional disaster plan was quickly implemented, leading to the activation of the Regional Hospital Preparedness Council's Catastrophic Medical Operations Center and the rapid construction of a 65-examination-room medical facility within the Reliant Center. A plan for triage of arriving evacuees was quickly developed and the Astrodome/Reliant Center Complex mega-shelter was created. Herein, we discuss major elements of the regional disaster response, including regional coordination, triage and emergency medical service transfers into the region's medical centers, medical care in population shelters, and community health challenges.

Houston's medical disaster response to Hurricane Katrina: part 1: the initial medical response from Trauma Service Area Q.

After Hurricane Katrina hit the Gulf Coast on August 29, 2005, thousands of ill and injured evacuees were transported to Houston, TX. Houston's regional disaster plan was quickly implemented, leading to the activation of the Regional Hospital Preparedness Council's Catastrophic Medical Operations Center and the rapid construction of a 65-examination-room medical facility within the Reliant Center. A plan for triage of arriving evacuees was quickly developed and the Astrodome/Reliant Center Complex mega-shelter was created. Herein, we discuss major elements of the regional disaster response, including regional coordination, triage and emergency medical service transfers into the region's medical centers, medical care in population shelters, and community health challenges.

Widespread outbreak of norovirus gastroenteritis among evacuees of Hurricane Katrina residing in a large "megashelter" in Houston, Texas: lessons learned for prevention.

BACKGROUND: After Hurricane Katrina, an estimated 200,000 persons were evacuated to the Houston metropolitan area, >27,000 of whom were housed in 1 large "megashelter," the Reliant Park Complex. We investigated an outbreak of gastroenteritis reported among the evacuees who resided in the Reliant Park Complex to assess the spread of the infectious agent, norovirus, and to implement and evaluate the effectiveness of interventions used for control. METHODS: Public health authorities conducted surveillance of gastroenteritis among evacuees treated at the Reliant Park Medical Clinic during 2-12 September 2005. Basic demographic and clinical data were recorded. Specimens of stool and vomitus were collected and tested for bacteria, parasites, and viruses. Shelter census data were used to estimate the daily incidence of disease. RESULTS: During a period of 11 days, >1000 patients were treated at the clinic for gastroenteritis, which accounted for 17% of all clinic visits. Norovirus was the sole enteric pathogen identified, but multiple different strains were involved. Among the evacuees residing in the Reliant Park Complex, the incidence of gastroenteritis was estimated to be 4.6 visits per 1000 persons per day, and among the evacuees who resided there for 9 days, 1 (4%) of 24 persons would have been ill. Intensive public health measures were promptly instituted but did not definitively slow the progression of the outbreak of norovirus gastroenteritis. CONCLUSIONS: Our investigation underscores the difficulties in managing such outbreaks in crowded settings and the need for rapid, sensitive laboratory assays to detect norovirus. Additional research is needed to establish more effective measures to control and prevent this highly contagious gastrointestinal illness.

Hurricane Katrina: medical response at the Houston Astrodome/Reliant Center Complex.

On September 1, 2005, with only 12 hours notice, various collaborators established a medical facility--the Katrina Clinic--at the Astrodome/Reliant Center Complex in Houston. By the time the facility closed roughly two weeks later, the Katrina Clinic medical staff had seen over 11,000 of the estimated 27,000 Hurricane Katrina evacuees who sought shelter in the Complex. Herein, we describe the scope of this medical response, citing our major challenges, successes, and recommendations for conducting similar efforts in the future.