PENNSYLVANIA DEPARTMENT OF HEALTH
HEALTH ADVISORY # 16
FLOOD RECOVERY RECOMMENDATIONS
DATE:
TO:
FROM:
September 20, 2004
Health Alert Network
Calvin B. Johnson, MD, MPH
Secretary of Health
SUBJECT:
Flood Recovery Recommendations
COUNTIES AFFECTED: Statewide Distribution
This transmission is a “Health Advisory”, provides important information for a specific
incident or situation; may not require immediate action.
HOSPITALS: PLEASE SHARE THIS WITH ALL MEDICAL, INFECTION CONTROL,
LABORATORY, AND NURSING STAFF IN YOUR HOSPITAL
LOCAL HEALTH JURISDICTIONS: PLEASE DISTRIBUTE AS APPROPRIATE
PROFESSIONAL HEALTH ORGANIZATIONS: PLEASE DISTRIBUTE TO YOUR
MEMBERSHIP AS APPROPRIATE
EMS COUNCILS: PLEASE DISTRIBUTE AS APPROPRIATE
FQHC: PLEASE DISTRIBUTE AS APPROPRIATE
LOCAL EMAs: PLEASE DISTRIBUTE AS APPROPRIATE
The Pennsylvania Department of Health (PADOH) is releasing the following information
regarding recommendations for recovery after a flood.
Several issues should be considered when dealing with recovery after a flood to help people
protect themselves from illness, injury, and death:
Disease and Immunization:

Rates of diseases may increase because of sanitation and living conditions.

Outbreaks of communicable diseases are unusual. However, the potential exists for
waterborne diseases, such as shigellosis, hepatitis A, etc., among others, to be transmitted.

Infections from these diseases are best avoided by consuming only safe water (bottled,
boiled, treated, public water supply) and diligent hand washing with soap and water before
preparing or eating food, after toilet use, after participating in flood cleanup activities and
after handling articles contaminated with flood water or sewage. If the water supply is
questionable, residents are advised to use water that has been boiled for 1 minute (allow the
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water to cool before washing hands) or water that has been disinfected for personal hygiene
use (solution of ⅛ teaspoon of household bleach per 1 gallon of water). Let it stand for 30
minutes. If the water is cloudy, use a solution of ¼ teaspoon of household bleach per 1
gallon of water.

Mass immunizations for victims of floods are not recommended, including hepatitis A,
typhoid and tetanus immunizations. However, management of flood-associated wounds,
e.g., puncture wound or a wound contaminated with feces, soil, or saliva should include
appropriate evaluation of tetanus immunity (and immunization if indicated) as at any other
time:
 For clean and minor wounds occurring during the 10-year interval, no additional
booster is recommended.
 For other wounds, a booster is appropriate if the patient has not received tetanus
toxoid (Td) within the preceding 5 years.
 For patients that have not completed the primary Td vaccination, see the table
below for guidance:
Summary guide to tetanus prophylaxis in routine wound management
====================================================================================
Clean, minor
All other
History of
wounds
wounds *
adsorbed tetanus ----------------------toxoid (doses)
Td(+) TIG
Td(+) TIG
--------------------------------------------------------------------Unknown or
= Three (&)
No(@) No
No(**) No
----------------------------------------------------------------------* Such as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions;
and wounds resulting from missiles, crushing, burns and frostbite.
+ For children <7 years old; DTP (DT, if pertussis vaccine is contraindicated) is preferred to tetanus toxoid alone.
For persons >= 7 years of age, Td is preferred to tetanus toxoid alone.
& If only three doses of fluid toxoid have been received, then a fourth dose of toxoid, preferably an adsorbed toxoid,
should be given.
@ Yes, if >10 years since last dose. ** Yes, if >5 years since last dose. (More frequent boosters are not needed
and can accentuate side effects).
======================================================================================
Centers for Disease Control. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures:
recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991:40(No. RR-10): (inclusive page numbers).

Emergency Responders assisting with flood clean up who have not had a tetanus
booster in the last 10 years and are at higher risk due to extensive clean-up activities,
may receive tetanus booster from the Department of Health. This request should be
coordinated through the county EMA through a resource request to PEMA for distribution.

Requests for tetanus immunization from the general public should be referred to their
primary care provider for evaluation.

Following a properly administered primary series, almost all persons develop a protective
level of antitoxin. Antitoxin levels decrease with time. While some persons may be protected
for life, most persons have antitoxin levels that approach the minimal protective level by 10
years after the last dose. As a result, routine boosters are recommended every 10 years. In
a small percentage of individuals, antitoxin levels fall below the minimal protective level
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before 10 years have elapsed.

To ensure adequate protective antitoxin levels in individuals who sustain a wound that is
other than clean and minor, a booster is recommended for these persons if more than 5
years have elapsed since their last dose.

Large pools of standing water remaining will increase mosquito populations. This may
increase the risk for some mosquito borne diseases.
Carbon Monoxide (CO) Poisoning:

Carbon Monoxide poisoning is a frequent consequence of the aftermath of storms.

Exposure to CO can cause loss of consciousness and death. The most common
symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest
pain, and confusion. People who are sleeping or who have been drinking alcohol can die
from CO poisoning before ever having symptoms.

For more information on CO poisoning visit the CDC’s web site.
Water Quality:

The Department of Environmental Protection (DEP) is advising homeowners that free water
testing kits are available for residents who rely on water wells or springs for their drinking
water in counties that have been declared disaster areas by Governor Edward G. Rendell.

Any resident whose well-water system may have been affected by flood waters in those
counties should first contact the DEP office in their area and request the fact sheet entitled
“Disinfection of Home Wells and Springs.”

Citizens should follow the fact sheet directions and disinfect their wells before getting a test
kit from DEP. The test kit contains a water bottle and instructions on obtaining a water
sample, which is then returned to DEP for analysis at its laboratory.

The lab will perform a total coliform test for bacteria, and report results in 48 to 72 hours. If
the test is negative, residents can resume using their well water for drinking and cooking. If
the test is positive, residents are asked to contact the regional or district office for information
on additional steps needed to be taken to disinfect the well.

DEP stressed that those served by public water systems do not need to test their drinking
water supplies but should always follow any instructions from the supplier concerning water
safety.

For copies of the fact sheet and more flood recovery information on re-entering and cleaning
homes and businesses, cleaning up home heating oil, reporting spills and other
environmental emergencies, contact your nearest DEP regional office, or visit DEP’s Web
site at www.dep.state.pa.us, Keyword “Flood Recovery Information.”
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Food Safety:

Throw away food that has come in contact with flood waters. Some canned foods may
be salvageable. If the cans are dented or damaged, throw them away. Food contaminated
by flood waters can cause severe infections.

For more information see PADOH’s web site
Several fact sheets on “Flood Recovery” are available at CDC’s web site for downloading and
distribution to your patients, staff and community members. Other important links are:




Pennsylvania Emergency Management Agency (PEMA)
Department of Environmental Protection (DEP)
American Red Cross
Federal Emergency Management Agency (FEMA)
If clinicians have any questions or patients of concern they would like to discuss, please contact
your local health department or the Department of Health at 1-877-PA-HEALTH.
Categories of Health Alert messages:
Health Alert: conveys the highest level of importance; warrants immediate action or attention.
Health Advisory: provides important information for a specific incident or situation; may not require immediate action.
Health Update: provides updated information regarding an incident or situation; unlikely to require immediate action.
This information is current as of September 20, 2004, but may be modified in the future. We will continue to post updated
information regarding the most common questions about this subject.
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