title: Assessment of reportable disease incidence after Hurricane Sandy, New York City, 2012.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Greene
authors.forename: Elisha L
authors.initials: EL
authors.lastname: Wilson
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Konty
authors.forename: Annie D
authors.initials: AD
authors.lastname: Fine
mesh_terms: D003141:Communicable Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D055867:Cyclonic Storms; D004190:Disasters; D018563:Disease Notification / Q000706:statistics & numerical data*; D005260:Female; D055868:Floods; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality / Q000639:trends*; D009519:New York City; D011159:Population Surveillance; D018570:Risk Assessment; D012308:Risk Management