Leptospirosis’ Presence in the Population Subsequent to Hurricane Maria

Disasters can leave a path of destruction in their wake and in that aftermath, infectious diseases have the opportunity to affect individuals at a vulnerable point in their lives. Disaster management plans would ideally address these multifaceted aspects, including effective prevention of an influx of infectious diseases or outbreaks within the afflicted population. In respect to the most recent hurricane season of 2017, leptospirosis had an increased presence in Puerto Rico after the occurrence of Hurricane Maria. “Leptospirosis is an epidemic- prone zoonotic bacterial disease that can be transmitted by direct contact with contaminated water.

” (Watson, Gayer, & Connolly, 2010, para.13) When purified water, such as bottled water, becomes scarce, individuals resort to finding other sources that could be contaminated with bacteria, increasing the individual’s chance of exposure to infectious disease.

Immediately before, during, and after disasters there is a lack of readily available resources that are accessible to the individuals within the population. Those already limited resources, become even more limited when the location is remote, like Puerto Rico.

Lack of access to clean and safe water, as reported in Puerto Rico after Hurricane Maria, can increase the risk of Leptospirosis, because people may use natural or untreated water sources for drinking water, and potentially contaminated natural water for bathing. (p. 12)

As each week passed after Hurricane Maria initially impacted Puerto Rico, cases of leptospirosis began to surface, but it is important to recognize that leptospirosis, prior to Hurricane Maria, was already “endemic in Puerto Rico,” where “Puerto Rico reported about 45-75 cases of leptospirosis a year from 2014 to 2016, about half of the total annual cases for the United States” (Hurricane Key Messages, 2017, p.

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12).

It appears difficult to establish the correlation of whether the deaths were subsequent to the storm, or if the deaths would have occurred on their own accord, especially in the case of leptospirosis. “A Puerto Rico mortality database, which CNN and Centro de Peridoismo Investigativo sued the island’s Demographic Registry to obtain, lists 26 deaths in the six months after Hurricane Maria that were labeled by clinicians as “caused” by leptospirosis…” (Sutter & Pascual, 2018, para. 2). The spike in mortality rate for deaths caused by leptospirosis related to Hurricane Maria vary significantly from source to source, which brings to question why are there significant differences? This was addressed by, The Growing Risk of Leptospirosis in Puerto Rico, noting several reasons to why leptospirosis cases may be underreported, one reason being that “there is a ‘lack of timely diagnostic services,’ with current methods generally considered time consuming and requiring advanced laboratory services not typically available in remote or underdeveloped locations.”(Hurtado, 2017, para. 5). Underreporting or not reporting incidences at all, is extremely concerning and frustrating, because there could be severe repercussions if this happened with a more contagious infectious disease or diseases that transmit from person to person.

Being unable to accurately track the incidence rate of leptospirosis or any infectious disease during a disaster is problematic, but can also contribute to the distress and panic of the whole population. During my research there was little mention on the response or action taken to address leptospirosis, or how to handle the damage from the hurricane in general. In my opinion, due to the complexity of the disasters the multilevel approach of the social ecological model (SEM) could assist in analyzing and designing more thorough and effective disaster management plans. By developing a disaster management plan that incorporated SEM, this could potentially affect the severity of health outcomes that follow a disaster. For example, ensuring there is no price gouging on limited resources that are necessary for a disaster. A policy addressing this, would allow an individual, who may have social determinants present, such as poverty, to purchase a commodity that may have been unavailable to them before preventing their chance of exposure.

The research I found for leptospirosis’ presence in Puerto Rico appeared down played and misinterpreted by multiple resources, which not only causes public confusion, but directly effects the priority that is placed on addressing the outbreak of the infectious disease. Reducing the errors in collecting data, in this situation, is a key component, and would hopefully allow for proper prevention and preparation corresponding to infectious diseases. Ultimately, disasters are unpredictable often resulting in a massive amount of unimaginable devastation to population, but the severity of the crisis does not have to be layered in unpredictability, confusion, or prolonged by inaction.