Increases in Gonorrhea Among High School Students Following Hurricane Katrina
M. J. Nsuami; S. N. Taylor; B. S. Smith; D. H. Martin
Abstract
Objective: To determine the prevalence of Neisseria gonorrhoeae in a student population before hurricane Katrina and after their residential neighbourhoods were devastated in the wake of the hurricane.
Methods: Students in a New Orleans public high school were offered urine screening for N gonorrhoeae and Chlamydia trachomatis using nucleic acid amplification tests before (n = 346) and after (n = 333) hurricane Katrina. Based on studies showing gonorrhea clustering in physically deteriorated neighbourhoods, it was hypothesised that the post-Katrina gonorrhea prevalence would be higher among students whose neighbourhoods still showed signs of deterioration in the aftermath of the hurricane.
Objective: To determine the prevalence of Neisseria gonorrhoeae in a student population before hurricane Katrina and after their residential neighbourhoods were devastated in the wake of the hurricane.
Methods: Students in a New Orleans public high school were offered urine screening for N gonorrhoeae and Chlamydia trachomatis using nucleic acid amplification tests before (n = 346) and after (n = 333) hurricane Katrina. Based on studies showing gonorrhea clustering in physically deteriorated neighbourhoods, it was hypothesised that the post-Katrina gonorrhea prevalence would be higher among students whose neighbourhoods still showed signs of deterioration in the aftermath of the hurricane.
Results: Before and after hurricane Katrina, the prevalence of gonorrhea increased from 2.3%, respectivel. In logistic regression of gonorrhea controlling for gender, age, chlamydia infection and exposure to hurricane-affected residential neighbourhood conditions, gonorrhea was significantly associated with female gender and with chlamydia infection. Although of weak statistical significance, there was a strong independent positive trend toward testing positive for gonorrhea after the hurricane.
Conclusions: The analysis indicates that the odds of testing positive for gonorrhea more than doubled among students after the hurricane, indicating that surveillance activities should be restored to monitor sexually transmitted infections (STIs) among at-risk populations. Redoubled efforts should be put into STI screening programmes as soon as possible following natural disasters to prevent resurgent STI incidence rates.
Introduction
If things haven't changed by our next visit, we may have to announce a revolution.Mikhail Gorbachev, Former Soviet President, while touring the Lower-Ninth Ward in New Orleans on 5 October 2007 Populations affected by a natural disaster face health threats that include the spread of communicable diseases. The risks of communicable diseases following a natural disaster are particularly higher among displaced populations and are proportional to population density. Watson and colleagues from the Humanitarian Emergencies Program at the World Health Organization recently reviewed communicable disease outbreaks that have affected populations displaced by natural disasters around the world. Displaced populations following earthquakes, floods, tsunamis, volcanoes, typhoons or hurricanes have suffered outbreaks of diarrhoeal diseases, acute respiratory infections, measles, meningitis and malaria among others. It is estimated that between 60% and 95% of reported deaths among refugees and displaced populations are attributed to malnutrition, diarrhoeal diseases, measles, acute respiratory infections and malaria.
In addition to these health threats to displaced populations, the physical damage to residential neighbourhoods and to public health and clinical care infrastructures force individuals temporarily displaced who return in their disaster affected areas and those who do not evacuate to live for months or years, depending on the pace of recovery, in neighbourhoods characterised by a certain degree of deterioration with inadequate access to primary healthcare services. Studies have reported associations between physically deteriorated neighbourhoods and poor health. These associations suggest that the neighbourhood physical deterioration in the wake of a natural disaster can increase the vulnerability of affected populations to poor health.
Applying the boarded-up housing characteristics of the US Census Bureau and the broken windows theory in sexually transmitted disease (STD) research, Cohen et al found a clustering of gonorrhea cases in physically deteriorated neighbourhoods in 107 US cities, independent of individual factors that included race, poverty, unemployment, marital status, level of education and lack of insurance. Although, in disaster emergency response, communicable diseases of primary concerns are diseases associated with high transmissibility, high morbidity and high mortality such as waterborne, airborne or vectorborne diseases, in the long term, the ecological studies by Cohen et al provide grounds for considering an association between deteriorated neighbourhood conditions in the wake of a natural disaster and STDs. Despite expressed concerns for sexually transmitted infections (STIs) as risk factors for human immunodeficiency virus (HIV) infection in emergency preparedness and response, we were unable to find any published study reporting on the prevalence of STIs before and after a natural disaster.
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Conclusions: The analysis indicates that the odds of testing positive for gonorrhea more than doubled among students after the hurricane, indicating that surveillance activities should be restored to monitor sexually transmitted infections (STIs) among at-risk populations. Redoubled efforts should be put into STI screening programmes as soon as possible following natural disasters to prevent resurgent STI incidence rates.
Introduction
If things haven't changed by our next visit, we may have to announce a revolution.Mikhail Gorbachev, Former Soviet President, while touring the Lower-Ninth Ward in New Orleans on 5 October 2007 Populations affected by a natural disaster face health threats that include the spread of communicable diseases. The risks of communicable diseases following a natural disaster are particularly higher among displaced populations and are proportional to population density. Watson and colleagues from the Humanitarian Emergencies Program at the World Health Organization recently reviewed communicable disease outbreaks that have affected populations displaced by natural disasters around the world. Displaced populations following earthquakes, floods, tsunamis, volcanoes, typhoons or hurricanes have suffered outbreaks of diarrhoeal diseases, acute respiratory infections, measles, meningitis and malaria among others. It is estimated that between 60% and 95% of reported deaths among refugees and displaced populations are attributed to malnutrition, diarrhoeal diseases, measles, acute respiratory infections and malaria.
In addition to these health threats to displaced populations, the physical damage to residential neighbourhoods and to public health and clinical care infrastructures force individuals temporarily displaced who return in their disaster affected areas and those who do not evacuate to live for months or years, depending on the pace of recovery, in neighbourhoods characterised by a certain degree of deterioration with inadequate access to primary healthcare services. Studies have reported associations between physically deteriorated neighbourhoods and poor health. These associations suggest that the neighbourhood physical deterioration in the wake of a natural disaster can increase the vulnerability of affected populations to poor health.
Applying the boarded-up housing characteristics of the US Census Bureau and the broken windows theory in sexually transmitted disease (STD) research, Cohen et al found a clustering of gonorrhea cases in physically deteriorated neighbourhoods in 107 US cities, independent of individual factors that included race, poverty, unemployment, marital status, level of education and lack of insurance. Although, in disaster emergency response, communicable diseases of primary concerns are diseases associated with high transmissibility, high morbidity and high mortality such as waterborne, airborne or vectorborne diseases, in the long term, the ecological studies by Cohen et al provide grounds for considering an association between deteriorated neighbourhood conditions in the wake of a natural disaster and STDs. Despite expressed concerns for sexually transmitted infections (STIs) as risk factors for human immunodeficiency virus (HIV) infection in emergency preparedness and response, we were unable to find any published study reporting on the prevalence of STIs before and after a natural disaster.
DOWNLOAD COMPLETE PDF HERE
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