As recovery efforts continue in the flooded areas of New Jersey, questions are being raised regarding the need for tetanus shots or other vaccinations. According to the Centers for Disease Control and Prevention (CDC), outbreaks of infectious disease after floods such as we experienced here in NJ are unusual, and there is generally no increased risk of getting vaccine-preventable diseases. Mass immunization clinics are not a standard recommendation. However, since each situation is unique, there may be the need to vaccinate particular individuals involved in clean-up efforts, those providing medical care or displaced individuals living in communal settings.
The same recommendations that apply at any other time also apply during a flood. Everyone should be immunized with a primary series of tetanus, diphtheria and pertussis-containing vaccine. You should get a booster dose of tetanus-diphtheria toxoid (Td) if you have not had a booster dose within the last 10 years. Td boosters every 10 years are recommended for all adults routinely: the concern with flooding is that clean-up and repairs present an increased risk of injury and tetanus from such injuries is preventable by vaccination. Adults who did not receive DTP or DTaP as a child, or whose tetanus vaccination history is not known should receive a primary series of three doses of adult Td in accordance with the Advisory Committee on Immunization Practices (ACIP) recommended schedule. Please take this opportunity to vaccinate individuals with Tdap to provide protection against pertussis in addition to tetanus and diphtheria as per ACIP recommendations, if appropriate. Information about the schedules is available on the CDC website at http://www.cdc.gov/vaccines/recs/schedules/default.htm.
People who sustain some type of wound should check with their healthcare provider promptly to see if they need to be vaccinated. That decision will depend on an assessment of the wound and the patient's past immunization history. For people who sustain puncture wounds, or wounds at risk for contamination (e.g., exposure to substances contaminated with feces, soil, or saliva) a tetanus shot is recommended if they haven't had one within the last five years. If they haven't had at least three previous tetanus shots at some point in the past, a dose of tetanus immune globulin is recommended. For people who sustain clean, minor wounds, a tetanus-containing shot is recommended if they haven't had one within the past ten years. Further information regarding wound management is available through the CDC website at http://www.bt.cdc.gov/disasters/disease/tetanus.asp and the appropriate chapter of the Epidemiology and Prevention of Vaccine-Preventable Diseases available at http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm .
Hepatitis B Vaccine
As always, hepatitis B vaccine is recommended for people who will be providing direct patient care, or who are otherwise expected to have routine contact with the blood and bodily fluids of others. There is no increased risk of hepatitis B during a flood unless unvaccinated volunteers or healthcare workers are involved in high-risk activities.
Hepatitis A Vaccine
There is no recommendation for mass vaccination with hepatitis A during flood events. The virus is not common in the US and is generally not present even in sewage. For persons responding to the disaster, the risk of getting the disease is extremely low, and so the vaccine is not recommended for them. During Hurricane Katrina, hepatitis A vaccine was not specifically recommended for response workers. However, hepatitis A can be transmitted if displaced people live in crowded conditions for a long time and in these circumstances, vaccination is recommended for people living in these communal settings. Again, vaccination would be done on a case-by-case basis.
In support of vaccination efforts, the New Jersey Vaccines for Children (VFC) program will make adult formulations of Tdap, hepatitis A and hepatitis B vaccines available through established enrollees in the program. Td is not available as part of this program. Local health departments (LHD) and Federally Qualified Health Centers (FQHC) enrolled as ADULT PROVIDERS in the VFC program should order through their established mechanisms (via fax or IMODS) and note their order as "Hurricane Irene Vaccinations." It is critical that you use your Adult Provider PIN to ensure proper funding for this effort is identified. The vaccination of non-VFC eligible children will be discussed on a case-by-case basis. Please contact the New Jersey VFC program at 609-826-4862 with any questions regarding LHD/FQHC Adult Vaccine eligibility.
Protection Against Infectious Diseases
Regardless of your vaccination status, there are steps you can take to avoid injury and prevent infection while working in flood-affected areas. Recommendations include:
.Clean your hands as often as possible. Use soap and water if your hands are visibly soiled, and rub your hands together for at least 15 seconds. Use an alcohol-based hand rub if your hands are not visibly soiled.
.Take care of cuts or wounds immediately
oClean your hands thoroughly with soap and water before cleaning a wound
oClean the wound with soap and clean water and apply a clean, dry dressing
oSee a healthcare provider for potentially contaminated wounds, bites or punctures
oContact your healthcare provider if you are bitten by an animal.
.Wear protective clothing
oHeavy, waterproof, cut-resistant work gloves
oHeavy, hard-soled boots
oLong-sleeved shirt and long pants
Further information is available at
New Jersey Department of Health and Senior Services Provide Guidance to Prevent Illness From Food and Water During Flooding and Hurricane Conditions
From the Office of the Governor:
The Department of Health and Senior Services urges all residents to throw away any food that may have come in contact with flood or storm waters and individuals that have suffered power outages should keep their refrigerator and freezer doors closed as much as possible to maintain the cold temperature.
"Perishable food such as meat, poultry, seafood, milk, and eggs that are not kept adequately refrigerated or frozen may cause illness if consumed, even when they are thoroughly cooked," said Health and Senior Services Commissioner Mary O'Dowd.
Commissioner O'Dowd urged all residents to dispose of any perishable food that may have been above 40 degrees for two hours or more. Food will stay cold in the refrigerator for about 4 hours if it is unopened. A full freezer will keep the temperature for approximately 48 hours (24 hours if it is half full) if the door remains closed. However, food above 40 degrees for 2 hours or more must be discarded.
Thawed food that contains ice crystals or is 40 degrees or below can be refrozen or cooked. If you plan to eat refrigerated or frozen meat, poultry, fish or eggs while it is still at safe temperatures, it's important that each item is thoroughly cooked to the proper temperature to assure that any foodborne bacteria that may be present is destroyed.
Information about municipalities that have issued boiled water advisories as well as instructions for safely boiling water for drinking can be found at http://www.state.nj.us/cgi-bin/dhss/njnewsline/view_article.pl?id=3766
Below are some additional food safety tips to prevent illness during power outages, flooding and hurricane conditions:
Add block ice or dry ice to your refrigerator if the electricity is expected to be off for more than four hours. Fifty pounds of dry ice should keep an 18-cubic foot fully-stocked freezer cold for two days.
Discard any food that is not in a waterproof container if there is any chance that it has come into contact with flood water. Food containers that are not waterproof include those with screw-off caps, snap lids and pull tops.
Discard cardboard juice/milk/baby formula boxes and home canned foods if they have come in contact with flood water, because they cannot be effectively cleaned and sanitized.
Inspect canned foods and discard any food in damaged cans. Can damage is shown by swelling, leakage, punctures, holes, fractures, extensive deep rusting, or crushing/denting severe enough to prevent normal stacking or opening with a manual, wheel-type can opener.
Check to ensure that the freezer temperature is at or below 0 °F and the refrigerator is at or below 40 degrees
Wash fruits and vegetables with water from a safe source before eating.
For infants, if using formula, try to use prepared, canned baby formula that requires no added water. When using concentrated or powdered formulas, prepare with bottled water if the local water source is potentially contaminated.
During power outages, the appliance thermometers will indicate the temperatures in the refrigerator and freezer to help you determine if the food is safe.
Once Power is Restored . . .
You'll need to determine the safety of your food. Here's how:
If an appliance thermometer was kept in the freezer, check the temperature when the power comes back on. If the freezer thermometer reads 40 degrees or below, the food is safe and may be refrozen.
If a thermometer has not been kept in the freezer, check each package of food to determine its safety. You can't rely on appearance or odor. If the food still contains ice crystals or is 40 degrees or below, it is safe to refreeze or cook.
Refrigerated food should be safe as long as the power was out for no more than 4 hours and the refrigerator door was kept shut. Discard any perishable food (such as meat, poultry, fish, eggs or leftovers) that has been above 40°F for two hours or more.
For additional information on food safety and power outages, please visit http://www.nj.gov/health/er/natural.shtml and http://emergency.cdc.gov/disasters/hurricanes/recovery.asp.
Christie Administration Announces Local Boil Water Advisories
TRENTON, NJ -- Boil water orders have been issued for a number of New Jersey municipalities statewide to ensure the public health and safety of State residents, as a result of the effects of Hurricane Irene.
Water companies across the State are reaching out to their customers to advise them of the situation and to detail what steps to take in case of water quality issues. If you are unsure of your water system's situation, check the web site for your specific water company or phone their offices.
State, county and local officials are monitoring water quality carefully. Listen to and follow public announcements that will advise residents if and when water is safe to drink or use.
Municipalities that have instituted boil water orders, so far, include Florham Park, Irvington, Maplewood, Millburn, Short Hills, Springfield, Summit, and West Orange, which are all part of the New Jersey American Water Company's Short Hills system. Boil water orders also are in effect for Hightstown, Rockaway Township, and South Amboy, and more are likely.
Reasons for these boil water orders include disruptions to water supply treatment or delivery due to power outages and flooding caused by the storm. Additionally, damage to roadways throughout may be delaying transportation of supplies that may be needed to sustain operations.
The DEP is urging any New Jersey residents who are unsure of their water supply - from either a municipal water system or personal well -- to either use bottled water or boil your potable water before use.
If there is evidence of a water supply problem, including cloudy or turbid water, or there has been complete loss of water service or intermittent water service, it would be advisable to boil water before consumption. Cloudy or turbid water, or complete or intermittent loss of water service could mean your water supply may be compromised with disease-causing organisms.
As a precaution, users of the potentially affected water supply are advised to bring water to a rolling boil for one minute (not including the time to bring the water to a boil) before consuming or to use commercial bottled water for consumption and food preparation.
Consumption includes brushing teeth, washing fruits and vegetables and making beverages and ice. Tap water that has not been boiled may be used for showering, bathing, shaving and washing, so long as care is taken not to swallow or allow water in the eyes or nose or mouth.
Children and disabled individuals should have their bath supervised to ensure water in not ingested. Though the risk of illness is minimal, individuals who have recent surgical wounds, are immuno-suppressed, or have a chronic illness may want to consider using bottled water for cleansing until the concern of water quality has passed.
Businesses and non-residential sites should take steps such as posting notices at or disabling water fountains and ice machines during the period of concern over the water quality. If water is provided to visitors or employees, use of commercially produced bottled water for drinking and beverage preparation, such as for coffee, is appropriate. Food service and health care operations have additional requirements from their regulatory agency.
Here are some tips regarding Water Safety during and after and emergency event:
. Boiling water will kill most types of disease-causing organisms that may be present. Boil the water for one minute, let it cool, and store it in clean containers with covers.
. If you can't boil water, you can disinfect it using household bleach. Bleach will kill some, but not all, types of disease-causing organisms that may be in the water.
. If water is cloudy, filter it through clean cloths or allow it to settle, and draw off the clear water for disinfection.
. Add 1/8 teaspoon (or 8 drops) of regular, unscented, liquid household bleach per each gallon of water. Stir it well and let it stand for at least 30 minutes before you use it.
. Store disinfected water in clean containers with covers.
. If you have a well that has been flooded, the water should be tested and disinfected after flood waters recede. If you suspect that your well may be contaminated, contact your local or state health department or agriculture extension agent for specific advice.
For more information on water safety visit the following sites: http://nj.gov/health/er/natural.shtml or http://www.bt.cdc.gov/disasters/earthquakes/food.asp