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Assessment of reportable disease incidence after Hurricane Sandy, New York City, 2012.
[legionellosis]
Hurricane
Sandy
's
October
29
,
2012
arrival
in
New
York
City
caused
flooding
,
power
disruption
,
and
population
displacement
.
Infectious
disease
risk
may
have
been
affected
by
floodwater
exposure
,
residence
in
emergency
shelters
,
overcrowding
,
and
lack
of
refrigeration
or
heating
.
For
42
reportable
diseases
that
could
have
been
affected
by
hurricane-related
exposures
,
we
developed
methods
to
assess
whether
hurricane-affected
areas
had
higher
disease
incidence
than
other
areas
of
NYC
.
We
identified
post-hurricane
cases
as
confirmed
,
probable
,
or
suspected
cases
with
onset
or
diagnosis
between
October
30
and
November
26
that
were
reported
via
routine
passive
surveillance
.
Pre-hurricane
cases
for
the
same
4
-
week
period
were
identified
in
5
prior
years
,
2007
-
2011
.
Cases
were
geocoded
to
the
census
tract
of
residence
.
Using
data
compiled
by
the
NYC
Office
of
Emergency
Management
,
we
determined
(
1
)
the
proportion
of
the
population
in
each
census
tract
living
in
a
flooded
block
and
(
2
)
the
subset
of
flooded
tracts
severely
"
impacted
"
,
e
.
g
.
,
by
prolonged
service
outages
or
physical
damage
.
A
separate
multivariable
regression
model
was
constructed
for
each
disease
,
modeling
the
outcome
of
case
counts
using
a
negative
binomial
distribution
.
Independent
variables
were
:
neighborhood
poverty
;
whether
cases
were
pre-
or
post-hurricane
(
time
)
;
the
proportion
of
the
population
flooded
in
impacted
and
not
impacted
tracts
;
and
interaction
terms
between
the
flood
/
impact
variables
and
time
.
Models
used
repeated
measures
to
adjust
for
correlated
observations
from
the
same
tract
and
an
offset
term
of
the
log
of
the
population
size
.
Sensitivity
analyses
assessed
the
effects
of
case
count
fluctuations
and
accounted
for
variations
in
reporting
volume
by
using
an
offset
term
of
the
log
of
total
cases
.
Only
legionellosis
was
statistically
significantly
associated
with
increased
occurrence
in
flooded
/
impacted
areas
post-hurricane
,
adjusting
for
baseline
differences
(
P
=
.
04
)
.
However
,
there
was
only
1
legionellosis
case
post-hurricane
in
a
flooded
/
impacted
area
.
Hurricane
Sandy
did
not
appear
to
elevate
reportable
disease
incidence
in
NYC
.
Defining
and
acquiring
reliable
data
and
meta
-data
regarding
hurricane-affected
areas
was
a
challenge
in
the
weeks
post-storm
.
Relevant
metrics
could
be
developed
during
disaster
preparedness
planning
.
These
methods
to
detect
excess
disease
can
be
adapted
for
future
emergencies
.
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"heating"
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legionellosis
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