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Disease After Disaster

Tetanus considered primary risk for rescuers, survivors

TUESDAY, Sept. 19, 2001 (HealthDayNews) -- As rescue workers and cleanup crews dig through the rubble of the World Trade Center and the Pentagon, health authorities face a new challenge -- minimizing the risk of disease.

The combination of dust, debris and shards of razor-sharp metal pose a risk of tetanus both for victims still alive in the ruins and for emergency workers combing through the debris, say officials.

The U.S. Department of Health and Human Services (HHS) is also determining whether so many corpses within the wreckage of the New York City complex may be a risk either to relief workers or to the public. Experts disagree on whether the remains create a risk of diseases like cholera or hepatitis. Almost 5,000 people are known to be missing from the New York site; about 200 are estimated to be dead in Washington, D.C., but almost 100 bodies have been removed from the Pentagon as of yesterday.

The Centers for Disease Control and Prevention (CDC) and HHS wouldn't comment about specific public health concerns, but the CDC is taking samples of air, water and soil in New York.

Dr. David Cone, an associate professor of emergency medicine at Yale University School of Medicine in New Haven, Conn., says that rescue workers generally wear gloves, masks and protective eyewear such as goggles.

"We get some training on how to protect yourself, but it basically to make sure that your gloves don't have holes in them, and keep a mask on," he says. "There's no extra equipment or anything that we carry to provide special protection."

"You can't wear anything particularly protective," Cone adds, because bulky clothing or gear would interfere with the job at hand. "Regular firefighting clothes aren't meant to provide good protection from biohazards anyway."

He says that medical personnel receive tetanus shots on a regular basis, and also receive hepatitis B immunizations. In his experience, rescue workers don't receive any special medical screening after the rescue and cleanup operation ends.

Cone says that a risk of communicable diseases could arise because of the large numbers of bodies trapped in the rubble, but that little can be done to protect rescue workers or the public.

"They ran into this a little bit in Oklahoma City, just because of how long it took to get everybody out," says Cone. "There's not a whole lot you can do … and obviously, the longer into it you get, the worse things are going to get."

However, Colleen Terriff, an assistant professor of pharmacy practice at Washington State University in Spokane, Wash., doubts that the risk of diseases like cholera or typhoid are significant, because the pathogens are unlikely to contaminate the local drinking water supply.

"The rescue workers are taking every precaution," says Terriff, who prepared a city contingency plan for a bioterrorism attack after an anthrax scare in Spokane. "If they're able to wash their hands, and they're gowning and gloving, that's the best first step they can take to protect themselves."

But she says that some concern exists for blood-borne diseases like hepatitis B and C and HIV. "This is a different scenario because [relief workers] might be reaching into an area and easily get cut from the metal," says Terriff. "If there was a victim that was bleeding in the area, there's always those concerns."

Still, she says that those risks, while real, are of minimal concern.

In a press conference on Sept. 12, Secretary of Health and Human Services Tommy Thompson outlined the department's emergency medical response to the attacks in New York and Washington, D.C.

"There has been questions raised concerning health risks posed by bodies buried in the rubble of buildings, and this is a valid concern," said Thompson. "HHS, led by the Centers for Disease Control and Prevention, is working with state and local officials to protect from water- and airborne health risks."

According to Thompson, roughly 270 people from the HHS's Disaster Mortuary Operational Response Teams were making sure that bodies were removed from the site and transported to makeshift morgues around the city as quickly as possible.

On the day of the attacks, Thompson authorized the first emergency use of the National Pharmaceutical Stockpile, releasing one of the eight "12-Hour Push Packages" stored around the country. Each package consists of truckloads of drugs, intravenous equipment, bandages and other supplies needed to respond to a mass casualty situation.

At the same time, he said, 50,000 doses of tetanus vaccine had been shipped to the New York City Public Health Department in Manhattan. Swiftwater, N.J.-based Aventis Pasteur donated the 50,000 vaccine doses, along with another 3,000 sent to New Jersey Public Health Department.

Len Lavenda, a spokesman for Aventis Pasteur, says that more vaccine is available. "Based on the president's request for the country to unify and to work together to respond to this, we felt that this was our way of responding to the president's call for action," says Lavenda.

At this stage, however, authorities have not asked the company for supplies related to any other diseases.

What To Do

The CDC Web site provides information about cholera, hepatitis B and C, HIV and tetanus (You'll need Adobe Acrobat Reader to open the tetanus page).

You can also find out more about the National Pharmaceutical Stockpile.

SOURCES: Interviews with David C. Cone, M.D., associate professor, Department of Emergency Medicine, Yale University School of Medicine, New Haven, Conn.; Len Lavenda, spokesman, Aventis Pasteur, Swiftwater, N.J.; Colleen M. Terriff, Pharm.D., assistant professor, Department of Pharmacy Practice, Washington State University, Spokane, Wash.; Sept. 12, 2001, statement by Health and Human Services Secretary Tommy G. Thompson.
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