Blackout of 2003: public health effects and emergency response

Revision of "Nutritional Reference Values for Feeding at Evacuation Shelters" and Model Menus: A Qualitative Study

OBJECTIVE

In 2011, the Japanese government issued nutritional reference values for energy; protein; vitamins B1, B2, and C; and salt to deal with poor meal quality in evacuation shelters. Because they were not widely used owing to their impracticality, the authors had examined the values according to the experience-based opinions of public health dietitians. Furthermore, we developed a usage tool containing a model menu that meets these values. This study aimed to confirm the usability of these revised values and model menus and collect ideas for improvement.

METHODS

We conducted 8 semi-structured group interviews with 12 dietitians, 9 disaster management officers, and 2 public health nurses in local governments supposed to have been affected by a large-scale disaster.

RESULTS

New reference values were highly evaluated by most participants. Interviewees said that model menus were helpful for evacuees or disaster officers who are unfamiliar with nutrition because they show combinations of food items that meet the reference values instead of the amounts of energy and nutrients. To improve their understanding, it was suggested that food items be categorized by staples, main dishes, and side dishes, encouraging them to complete these three components of a balanced diet. Because it was difficult to meet all the reference values in the immediate aftermath of the disaster, it was suggested that the time-dependent priority of each nutrient and model menus that supply the nutrient should be shown by disaster phases along with the assumed availability of utility for cooking in each phase.

CONCLUSION

The new reference values were feasible to meet during emergencies. Although model menus were also appreciated, further improvements were necessary for better understanding.

Reviewing the Health Care Impacts of Attacks on Critical Infrastructure

INTRODUCTION

Health care provision depends on reliable critical infrastructure (CI) to power equipment and to provide water for medication and sanitation. Attacks on CI limiting such functions can have a profound and prolonged influence on delivery of care.

METHODS

A retrospective analysis of the Global Terrorism Database (GTD) was performed of all attacks occurring from 1970-2020. Data were filtered using the internal database search function for all events where the primary target was "Utilities," "Food or Water Supply," and "Telecommunications." For the purposes of this study, the subtype "Food Supply" was excluded. Events were collated based on year, country, region, and numbers killed and wounded.

RESULTS

The GTD listed 7,813 attacks on CI, with 6,280 of those attacks targeting utilities, leading to 1,917 persons directly killed and 1,377 persons wounded. In total, there were 1,265 attacks targeting telecommunications causing 205 direct deaths and 510 wounded. Lastly, 268 attacks targeted the water supply with 318 directly killed and 261 wounded. Regionally, South America had the most attacks with 2,236, followed by Central America and the Caribbean with 1,390. Based on infrastructure type, the most attacks on utilities occurred in El Salvador (1,061), and the most attacks on telecommunications were in India (140). Peru (46) had the most attacks on its water supply.

CONCLUSION

The regions with the highest number of total attacks targeting CI have historically been in South America, with more attacks against power and utilities than other infrastructure. Although the numbers of persons directly killed and wounded in these attacks were lower than with other target types, the true impacts on lack of health care delivery are not accounted for in these numbers. By understanding the pattern and scope of these attacks, Counter-Terrorism Medicine (CTM) initiatives can be created to target-harden health care-related infrastructure.

Hospitals as disaster victims: Lessons not learned?

OBJECTIVE

Hospitals are a key component to disaster response but are susceptible to the effects of disasters as well, including infrastructure damage that disrupts patient care. These events offer an opportunity for evaluation and improvement of preparedness and response efforts when hospitals are affected directly by a disaster. The objective of this structured review was to evaluate the existing literature on hospitals as disaster victims.

METHODS

A structured and scoping review of peer-reviewed literature, gray literature, and news reports related to hospitals as disaster victims was completed to identify and analyze themes and lessons observed from disasters in which hospitals are victims, to aid in future emergency operations planning and disaster response.

RESULTS

The literature search and secondary search of referenes identified 366 records in English. A variety of common barriers to successful disaster response include loss of power, water, heating and ventilation, communications, health information technology, staffing, supplies, safety and security, and structural and non-structural damage.

CONCLUSIONS

There are common weaknesses in disaster preparedness that we can learn from and account for in future planning with the aim of improving resilience in the face of future disasters.

Insights and decision support for home health care services in times of disasters

Home health care (HHC) services are of vital importance for the health care system of many countries. Further increases in their demand must be expected and with it grows the need to sustain these services in times of disasters. Existing risk assessment tools and guides support HHC service providers to secure their services. However, they do not provide insights on interdependencies of complex systems like HHC. Causal-Loop-Diagrams (CLDs) are generated to visualize the impacts of epidemics, blackouts, heatwaves, and floods on the HHC system. CLDs help to understand the system design as well as cascading effects. Additionally, they simplify the process of identifying points of action in order to mitigate the impacts of disasters. In a case study, the course of the COVID-19 pandemic and its effects on HHC in Austria in spring 2020 are shown. A decision support system (DSS) to support the daily scheduling of HHC nurses is presented and applied to numerically analyze the impacts of the COVID-19 pandemic, using real-world data from a HHC service provider in Vienna. The DSS is based on a Tabu Search metaheuristic that specifically aims to deal with the peculiarities of urban regions. Various transport modes are considered, including time-dependent public transport.

[Knowledge gained from a 31-h power outage in Berlin Köpenick-medical problems and challenges]

On 19 February 2019 the severance of a 110kW cable caused an extensive electrical power cut in the Treptow-Köpenick district of Berlin. Subsequently, ca. 30,000 households were without electricity and ca. 70,000 people were affected. The power cut lasted more than 24h and all those involved were faced with a multitude of challenges. An operational command post was set up in which medical problems had to be continuously identified and re-evaluated. These included the identification of patients particularly at risk, such as home-ventilated patients and patients with artificial hearts. Furthermore, individual nursing homes had to be evacuated. During the procedure it was necessary to evacuate an intensive care ward or intermediate care ward with 23 patients due to the loss of power supply in the affected area. Hospitals must be prepared for such scenarios within the framework of preliminary planning. Furthermore, preliminary planning containing the special needs of vulnerable groups must be carried out on the part of the responsible authorities.

Health care during electricity failure: The hidden costs

Background

Surgery risks increase when electricity is accessible but unreliable. During unreliable electricity events and without data on increased risk to patients, medical professionals base their decisions on anecdotal experience. Decisions should be made based on a cost-benefit analysis, but no methodology exists to quantify these risks, the associated hidden costs, nor risk charts to compare alternatives.

Methods

Two methodologies were created to quantify these hidden costs. In the first methodology through research literature and/or measurements, the authors obtained and analyzed a year’s worth of hour-by-hour energy failures for four energy healthcare system (EHS) types in four regions (SolarPV in Iraq, Hydroelectric in Ghana, SolarPV+Wind in Bangladesh, and Grid+Diesel in Uganda). In the second methodology, additional patient risks were calculated according to time and duration of electricity failure and medical procedure impact type. Combining these methodologies, the cost from the Value of Statistical Lives lost divided by Energy shortage ($/kWh) is calculated for EHS type and region specifically. The authors define hidden costs due to electricity failure as VSL/E ($/kWh) and compare this to traditional electricity costs (always defined in $/kWh units), including Levelized Cost of Electricity (LCOE also in $/kWh). This is quantified into a fundamentally new energy healthcare system risk chart (EHS-Risk Chart) based on severity of event (probability of deaths) and likelihood of event (probability of electricity failure).

Results

VSL/E costs were found to be 10 to 10,000 times traditional electricity costs (electric utility or LCOE based). The single power source EHS types have higher risks than hybridized EHS types (especially as power loads increase over time), but all EHS types have additional risks to patients due to electricity failure (between 3 to 105 deaths per 1,000 patients).

Conclusions

These electricity failure risks and hidden healthcare costs can now be calculated and charted to make medical decisions based on a risk chart instead of anecdotal experience. This risk chart connects public health and electricity failure using this adaptable, scalable, and verifiable model.

Associations between Green Building Design Strategies and Community Health Resilience to Extreme Heat Events: A Systematic Review of the Evidence

This project examined evidence linking green building design strategies with the potential to enhance community resilience to extreme heat events. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method for a systematic review, it assessed the strength of the evidence supporting the potential for Leadership in Energy and Environmental Design (LEED®) credit requirements to reduce the adverse effects of extreme heat events and/or enhance a building’s passive survivability (i.e., the ability to continue to function during utility outages) during those events. The PRISMA Flow Diagram resulted in the selection of 12 LEED for New Construction (LEED NC) credits for inclusion in the review. Following a preliminary scan of evidence supporting public health co-benefits of the LEED for Neighborhood Development rating system, queries were submitted in PubMed using National Library of Medicine Medical Subject Headings Terms. Queries identified links between LEED credit requirements and risk of exposure to extreme heat, environmental determinants of health, co-benefits to public health outcomes, and co-benefits to built environment outcomes. Public health co-benefits included reducing the risk of vulnerability to heat stress and reducing heat-related morbidity and mortality. The results lay the groundwork for collaboration across the public health, civil society, climate change, and green building sectors.

Power Outage Preparedness and Concern among Vulnerable New York City Residents

Power outages can impact health, and certain populations may be more at risk. Personal preparedness may reduce impacts, but information on power outage preparedness and risk perception among vulnerable populations is limited. We examined power outage preparedness and concern among New York City residents, including vulnerable populations defined as older adults (≥ 65 years), and respondents with household members who require assistance with daily activities or depend on electric medical devices. A random sample telephone survey was conducted during November-December 2016. Preparedness was defined as having a three-day supply of drinking water, non-perishable food, and a working flashlight. Among all respondents (n = 887), 58% were prepared and 46% expressed concern about health. Respondents with electric-dependent household members (9% of all respondents) tended to have higher preparedness (70 vs. 56% of respondents without electric-dependent household members). Among this group, only 40% reported being registered with a utility company to receive early notification of outages. While the subgroup sample was small, respondents with registered electric-dependent household members had lower preparedness than those with non-registered users (59 vs. 76%). Respondents with household members who needed assistance had comparable levels of preparedness to respondents without someone who needed assistance (59 vs. 57%). Older adults had greater preparedness than younger adults (65 vs. 56%). Health concerns were greater among all vulnerable groups than the general population. Levels of preparedness varied among vulnerable respondents, and awareness of power outage notification programs was low. Our findings highlight the need to increase awareness and preparedness among at-risk people.

Sustainable Model for Public Health Emergency Operations Centers for Global Settings

Capacity to receive, verify, analyze, assess, and investigate public health events is essential for epidemic intelligence. Public health Emergency Operations Centers (PHEOCs) can be epidemic intelligence hubs by 1) having the capacity to receive, analyze, and visualize multiple data streams, including surveillance and 2) maintaining a trained workforce that can analyze and interpret data from real-time emerging events. Such PHEOCs could be physically located within a ministry of health epidemiology, surveillance, or equivalent department rather than exist as a stand-alone space and serve as operational hubs during nonoutbreak times but in emergencies can scale up according to the traditional Incident Command System structure.

Health Impacts of Citywide and Localized Power Outages in New York City

BACKGROUND

Previous studies investigated potential health effects of large-scale power outages, including the massive power failure that affected the northeastern United States and Ontario, Canada, in August 2003, and outages associated with major storms. However, information on localized outages is limited.

OBJECTIVE

The study sought to examine potential health impacts of citywide and localized outages in New York City (NYC).

METHODS

Along with the citywide 2003 outage, localized outages in July 1999 and July 2006 were identified. We additionally investigated localized, warm- and cold-weather outages that occurred in any of 66 NYC electric-grid networks during 2002–2014 using New York State Public Service Commission data. Mortality and hospitalizations were geocoded and linked to the networks. Associations were estimated using Poisson time-series regression, including examining distributed lags and adjusting for temperature and temporal trends. Network-specific estimates were pooled by season.

RESULTS

Respiratory disease hospitalizations were associated with the 2006 localized outage [cumulative relative risk [CRR] over 0–1 lag day, lag₀₁=2.26 (95% confidence interval [CI]: 1.08, 4.74)] and the 2003 citywide outage, but not with other localized, warm-weather outages. Renal disease hospitalizations were associated with the 2003 citywide outage, and with localized, warm-weather outages, pooled across networks [RR at lag₃=1.16 (95% CI: 1.00, 1.34)], but not the 2006 localized outage. All-cause mortality was positively associated with the 1999, 2003, and 2006 outages (significant for the 2003 outage only), but not with other localized, warm-weather outages. Localized, cold-weather outages were associated with all-cause mortality [lag₀₁ CRR=1.06 (95% CI: 1.01, 1.12)] and cardiovascular disease hospitalizations [lag₀₁ CRR=1.14 (95% CI: 1.03, 1.26)], and fewer respiratory disease hospitalizations [lag₀₃ CRR=0.77 (95% CI: 0.61, 0.97)].

CONCLUSIONS

Localized outages may affect health. This information can inform preparedness efforts and underscores the public health importance of ensuring electric grid resiliency to climate change. https://doi.org/10.1289/EHP2154.

Changes in extreme events and the potential impacts on human health

Extreme weather and climate-related events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity, and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, dust storms, flooding rains, coastal flooding, storm surges, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden. More information is needed about the impacts of climate change on public health and economies to effectively plan for and adapt to climate change. This paper describes some of the ways extreme events are changing and provides examples of the potential impacts on human health and infrastructure. It also identifies key research gaps to be addressed to improve the resilience of public health to extreme events in the future.

IMPLICATIONS

Extreme weather and climate events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity, and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, flooding rains, coastal flooding, surges, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden.

Public Health Concerns Associated with the New York City Blackout of 1977

The 1977 New York City blackout began at 9:36 p.m. on 13 July and lasted some 25 h until 10:39 p.m. on 14 July. The New York City Department of Health rapidly set up a Blackout Contingency Plan, established priorities, and mobilized its staff to address remedial interventions. Top priorities included water supplies, sewage disposal, perishable food supplies, hospital and emergency room services, solid waste disposal, beach contamination with untreated sewage , and assisting those on electrically powered home life support systems. The 1977 blackout occurred during an extended heat wave. An analysis of total deaths and deaths due to pulmonary and cardiovascular/renal diseases by day correlated with temperatures. However, there was no direct correlation with the blackout itself, in part perhaps because of the confounding influence of high temperatures. The increase of deaths on very hot days outside of the blackout period lends strong support to the relationship between increased deaths and high ambient temperatures. The 1977 New York City blackout was distinguished from those of 1965 and 2003 by violence, arson, and looting that occurred in several areas. These acts resulted in 204 civilian injuries, 436 police injuries, 80 firefighter injuries, and 1037 fires. The violence, arson, and looting caused extensive long-term physical and functional damage to certain areas of two boroughs of the city, Brooklyn and the Bronx. Although the New York City Department of Health had not previously established a disaster preparedness plan, its professionals quickly rose to the occasion because they were able to draw upon vast public health practice experience and ingenuity.

Food selection criteria for disaster response planning in urban societies

Background

Nutrition professionals that have menu planning and disaster management responsibilities should consider factors that have transcended from ancient to current times, in addition to recognizing societal trends that have led to our current increased vulnerability in the event of a disaster. Hence, we proceeded to develop a set of “Disaster Response Diets” (DRDs) for use in urban societies inclusive of the aforementioned considerations.

Methods

A three-phase multidimensional approach was used to identify food groups suitable for creating a set of DRDs. Phase One consisted of calculating the percent daily nutrient intake and Drewnowski’s naturally nutrient rich (NNR) score for an individual or mean composite for one serving of food from 11 specific food groups. In Phase Two, in addition to nutrient density, the 11 food groups were evaluated and scored based on the following DRD planning criteria: storage and handling properties, preparation ease and, cultural acceptance/individual tolerance. During Phase Three, three DRDs were developed based upon the data retrieved from Phases one and two.

Results

In Phase One, the NNR scores ranged from 2.1 for fresh fruits to 28.1 for dry cereals, a higher score indicating a higher nutrient density. During Phase Two, a maximum score of 12 was possible based on appropriateness for a disaster situation. Five plant-based food groups (dry cereals, nuts, dried fruits, grains and legumes) achieved a score ranging between 7 and 12, whereas the five fresh food groups were deemed ineligible due to sanitation and perishability concerns. During Phase Three, three DRDs (milk-inclusive, milk-free and Grab-and-Go) were developed as benchmarks for disaster response planning.

Conclusions

Plant-based DRDs are universally acceptable and tolerated across cultures and religions. Therefore, we suggest nutrition professionals consider using a plant-based approach for creating DRDs for public health institutions and organizations.

Using Medicare data to identify individuals who are electricity dependent to improve disaster preparedness and response

During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity-dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity-dependent populations.

Health effects of coastal storms and flooding in urban areas: a review and vulnerability assessment

Coastal storms can take a devastating toll on the public's health. Urban areas like New York City (NYC) may be particularly at risk, given their dense population, reliance on transportation, energy infrastructure that is vulnerable to flood damage, and high-rise residential housing, which may be hard-hit by power and utility outages. Climate change will exacerbate these risks in the coming decades. Sea levels are rising due to global warming, which will intensify storm surge. These projections make preparing for the health impacts of storms even more important. We conducted a broad review of the health impacts of US coastal storms to inform climate adaptation planning efforts, with a focus on outcomes relevant to NYC and urban coastal areas, and incorporated some lessons learned from recent experience with Superstorm Sandy. Based on the literature, indicators of health vulnerability were selected and mapped within NYC neighborhoods. Preparing for the broad range of anticipated effects of coastal storms and floods may help reduce the public health burden from these events.

Lessons learned from a policy decision to coordinate a multijurisdiction H1N1 response with a single incident management team

This case review describes the creation of a single incident management team by 5 independent local public health agencies to respond to the 2009 H1N1 influenza pandemic. It focuses at the policy level, describing relationship building between local public health agency leaders and the conditions required to support such a response. Readers will understand the precursors that allowed for this regionalized response, how the response was implemented, the lessons learned, and recommendations for future responses. As local health jurisdictions and tribes review and update their emergency response plans, they should consider forming a regionalized public health incident management team to conserve overhead resources and to ensure coordinated policies and public messaging for public health incidents that cross geopolitical boundaries.

Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management

BACKGROUND The World Health Organisation's (WHO) sixty-fourth World Health Assembly in May 2011 adopted a resolution on 'strengthening national health emergency and disaster management capacities and resilience of health systems'. Disaster management is a topical issue globally and countries are being encouraged to improve their disaster preparedness, along with growing international commitment to strengthening health systems. Lessons identified from disasters have not been effectively collated; essential experience is forgotten. METHODS This paper describes the analysis of the worldwide experience of disasters through a health systems approach. A systematic search of the core literature from January 2000 to November 2011 was conducted. Components drawn from the WHO's Global assessment of national health sector emergency preparedness and response baseline survey were combined with WHO's six health system building blocks (or levers) to act as the initial analysis anchors, with a further grounded theory qualitative analysis of the literature allowing the identification of emerging themes and insights. The priority areas identified by this literature review were then compared with the topics covered by the new expert-consensus-derived Toolkit for assessing health-system capacity for crisis management developed by the WHO Regional Office for Europe. FINDINGS 143 publications identified from a literature search were analysed and appraised. Themes and examples from the literature demonstrate how health system strengthening should contribute to disaster management. Priority areas under-represented in the WHO Toolkit and identified by the qualitative analysis are discussed. INTERPRETATION Collation and analysis of the disaster management literature identifies how health system strengthening can promote resilience and efficient recovery in the face of disasters. These findings support and complement the WHO Toolkit. Countries can use the literature evidence with the WHO Toolkit to assess their disaster management capacities and identify priorities for strengthening their health system.

CITATION

Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/5028b6037259a.

Lights out: impact of the August 2003 power outage on mortality in New York, NY

BACKGROUND

Little is known about how power outages affect health. We investigated mortality effects of the largest US blackout to date, 14-15 August 2003 in New York, NY.

METHODS

We estimated mortality risk in New York, NY, using a generalized linear model with data from 1987-2005. We incorporated possible confounders, including weather and long-term and seasonal mortality trends.

RESULTS

During the blackout, mortality increased for accidental deaths (122% [95% confidence interval = 28%-287%]) and nonaccidental (ie, disease-related) deaths (25% [12%-41%]), resulting in approximately 90 excess deaths. Increased mortality was not from deaths being advanced by a few days; rather, mortality risk remained slightly elevated through August 2003.

CONCLUSIONS

To our knowledge, this is the first analysis of power outages and nonaccidental mortality. Understanding the impact of power outages on human health is relevant, given that increased energy demand and climate change are likely to put added strain on power grids.

Health impact in New York City during the Northeastern blackout of 2003

OBJECTIVE

This study assessed the health effects of the 2003 Northeastern blackout, the largest one in history, on mortality and hospital admissions due to respiratory, cardiovascular, and renal diseases in New York City (NYC), and compared the disease patterns and sociodemographic profiles of cases during the blackout with those on control days.

METHOD

We investigated the effects of the blackout on health using incidence rate ratios to compare the disease on blackout days (August 14 and 15, 2003) with those on normal and comparably hot days (controls). Normal days were defined as summer days (June-August) between the 25th and 75th percentiles of maximum temperature during 1991-2004. Comparably hot days were days with maximum temperatures in the same range as that of the blackout days. We evaluated the interactive effects of demographics and the blackout using a case-only design.

RESULTS

We found that mortality and respiratory hospital admissions in NYC increased significantly (two- to eightfold) during the blackout, but cardiovascular and renal hospitalizations did not. The most striking increases occurred among elderly, female, and chronic bronchitis admissions. We identified stronger effects during the blackout than on comparably hot days. In contrast to the pattern observed for comparably hot days, higher socioeconomic status groups were more likely to be hospitalized during the blackout.

CONCLUSIONS

This study suggests that power outages may have important health impacts, even stronger than the effects of heat alone. The findings provide some direction for future emergency planning and public health preparedness.

Organizing emergency preparedness within United States public health departments

OBJECTIVES

We examined the manner in which state public health agencies have organized their operations to accomplish the goals associated with emergency preparedness (EP) funds. We also examined the leadership challenges associated with the effective utilization of preparedness funds.

METHODS

The websites of all 50 state public health organizations in the USA were examined in order to determine the different approaches that states have used to organize for preparedness. Thirty-eight states provided sufficient information to allow for classification of their organizational approach to EP. Telephone interviews were conducted with representatives in three model states to obtain deeper insights into the organizational approach.

RESULTS

Three predominant organizational models were identified as a means to address the challenge of organizing for preparedness. The results confirmed the equifinality principle of organization (there may be more than one equally effective way to organize) and demonstrated that, contrary to the prescription of early management thought, there is no 'one best way' to organize. Leadership rather than formal management emerged as the primary contributor to perceived EP. Specifically, interviews with preparedness professionals indicated that they believed expert power was more important than position power and the ability to negotiate and influence through persuasion was more important than formal authority.

CONCLUSIONS

All three models contained, to a greater or lesser degree, elements of matrix management with the associated leadership challenges for emergency preparedness (EP) directors. Recommendations were provided for successful leadership in the context of EP directors in state departments of public health.

Diarrheal illness detected through syndromic surveillance after a massive power outage: New York City, August 2003

OBJECTIVES

We investigated increases in diarrheal illness detected through syndromic surveillance after a power outage in New York City on August 14, 2003.

METHODS

The New York City Department of Health and Mental Hygiene uses emergency department, pharmacy, and absentee data to conduct syndromic surveillance for diarrhea. We conducted a case-control investigation among patients presenting during August 16 to 18, 2003, to emergency departments that participated in syndromic surveillance. We compared risk factors for diarrheal illness ascertained through structured telephone interviews for case patients presenting with diarrheal symptoms and control patients selected from a stratified random sample of nondiarrheal patients.

RESULTS

Increases in diarrhea were detected in all data streams. Of 758 patients selected for the investigation, 301 (40%) received the full interview. Among patients 13 years and older, consumption of meat (odds ratio [OR]=2.7, 95% confidence interval [CI]=1.2, 6.1) and seafood (OR=4.8; 95% CI=1.6, 14) between the power outage and symptom onset was associated with diarrheal illness.

CONCLUSIONS

Diarrhea may have resulted from consumption of meat or seafood that spoiled after the power outage. Syndromic surveillance enabled prompt detection and systematic investigation of citywide illness that would otherwise have gone undetected.