Invasive Mold Infections Following Hurricane Harvey-Houston, Texas
Mitsuru Toda1, Samantha Williams1, Brendan R Jackson1
1Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Background:
Characterizing invasive mold infection (IMI) epidemiology in the context of large flooding events is important for public health planning and clinical decision making.
Methods:
We assessed IMI incidence (per 10 000 healthcare encounters) 1 year before and after Hurricane Harvey at 4 hospitals in Houston, Texas. Potential IMI cases were assigned as proven or probable cases using established definitions, and surveillance cases using a novel definition. We used rate ratios to describe IMI incidence and multivariable logistic regression to examine patient characteristics associated with IMI case status.
Results:
IMI incidence was significantly higher posthurricane (3.69 cases) than prehurricane (2.50 cases) (rate ratio, 1.48 [95% confidence interval, 1.10-2.00]), largely driven by surveillance IMI cases. Aspergillus was the most common species cultured (33.5% prehurricane and 39.9% posthurricane). About one-quarter (25.8%) of IMI patients lacked classical IMI risk factors such as hematologic malignancy and transplantations. Overall, 45.1% of IMI patients received intensive care, and in-hospital all-cause mortality was 24.2%.
Conclusions:
IMI incidence likely increased following Hurricane Harvey and outcomes for IMI patients were severe. Patient and clinician education on IMI prevention and identification is warranted, particularly as the frequency of extreme weather events increases due to climate change.
Insights
Invasive mold infection (IMI) incidence increased significantly after Hurricane Harvey, with severe outcomes for affected patients. Education on IMI prevention is crucial, especially with rising extreme weather events.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Large-scale flooding events, such as hurricanes, can impact public health by altering the epidemiology of infections.
- Understanding invasive mold infection (IMI) patterns after extreme weather is vital for healthcare planning.
Purpose of the Study:
- To assess the incidence of invasive mold infections (IMI) in Houston hospitals before and after Hurricane Harvey.
- To identify patient characteristics associated with IMI and analyze outcomes.
Main Methods:
- Retrospective analysis of IMI cases (proven, probable, and surveillance) at four Houston hospitals.
- Comparison of IMI incidence rates (per 10,000 healthcare encounters) one year pre- and post-hurricane.
- Multivariable logistic regression to examine factors associated with IMI.
Main Results:
- IMI incidence was significantly higher post-hurricane (3.69 cases/10,000 encounters) compared to pre-hurricane (2.50 cases/10,000 encounters).
- Aspergillus species were the most common molds identified.
- A significant proportion of IMI patients (25.8%) lacked typical risk factors; 45.1% required intensive care, with a 24.2% in-hospital mortality rate.
Conclusions:
- Hurricane Harvey was associated with an increased incidence of IMI, characterized by severe patient outcomes.
- There is a need for enhanced clinician and patient education regarding IMI prevention and recognition, particularly in light of increasing climate-related extreme weather events.
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