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An Outbreak Investigation in New Orleans, Louisiana

Rebecca Noe, MPH; Adam L. Cohen, MD; Edith Lederman, MD; L. Hannah Gould, PhD; Hannah Alsdurf, MPH; Peter Vranken, DPH; Rauol Ratard, MD; Juliette Morgan, MD; Scott A. Norton, MD, MPH; Joshua Mott, PhD

Arch Dermatol. 2007;143(11):1393-1398.

Objectives  To determine the extent and scope of the outbreak of skin eruptions, to identify the causes of the acute skin diseases, to identify risk factors for the conditions, and to reduce the dermatologic morbidity among workers repairing buildings damaged by Hurricane Katrina and Hurricane Rita.

Design  Retrospective cohort study.

Setting  Military base in New Orleans, Louisiana.

Participants  Civilian construction workers living and working at a New Orleans military base between August 30, 2005, and October 3, 2005. Living conditions were mainly wooden huts and tents with limited sanitation facilities.

Main Outcome Measures  Survey of risk factors, physical examination, skin biopsy specimens, and environmental investigation of the occupational and domiciliary exposures.

Results  Of 136 workers, 58 reported rash, yielding an attack rate of 42.6%. The following 4 clinical entities were diagnosed among 41 workers who had a physical examination (some had >1 diagnosis): 27 (65.9%) having papular urticaria, 8 (19.5%) having bacterial folliculitis, 6 (14.6%) having fiberglass dermatitis, and 2 (4.9%) having brachioradial photodermatitis. All diagnoses except brachioradial photodermatitis were confirmed by histopathologic examination. After adjusting for race/ethnicity and occupation, sleeping in previously flooded huts was statistically significantly (adjusted odds ratio, 20.4; 95% confidence interval, 5.9-70.2) associated with developing papular urticaria, the most common cause of rash in this cluster.

Conclusions  We identified 4 distinct clinical entities, although most workers were diagnosed as having papular urticaria. Huts previously flooded as a result of the hurricanes and used for sleeping may have harbored mites, a likely source of papular urticaria. To reduce the morbidity of hurricane-related skin diseases, we suggest avoiding flooded areas, fumigating with an acaricide, and wearing protective clothing.

Author Affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Noe and Drs Cohen, Lederman, Gould, Vranken, Morgan, and Mott); Tulane University School of Public Health and Tropical Medicine, New Orleans (Ms Alsdurf), and Louisiana Department of Health and Hospitals, Baton Rouge (Drs Vranken and Ratard); and Dermatology Department, Uniformed Services University of the Health Sciences, and United States Army, Bethesda, Maryland (Dr Norton).

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