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Disaster-Related Surveillance Among US Virgin Islands (USVI) Shelters During the Hurricanes Irma and Maria Response

  • Amy Helene Schnall (a1), Joseph (Jay) Roth (a2), Lisa LaPlace Ekpo (a3), Irene Guendel (a3), Michelle Davis (a3) and Esther M. Ellis (a3)...



Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts.


Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter’s health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria.


Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%).


Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43)


Corresponding author

Correspondence and reprint requests to Amy Helene Schnall, 4770 Buford Highway MS F60, Chamblee, GA 30341 (e-mail:


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1. Dwyer, C. The Virgin Islands, after Irma: “It was like stepping onto another planet.” NPR: Breaking News. Published September 14, 2017. Accessed November 21, 2017.
2. Federal Emergency Management Agency (FEMA). Coordinated federal support continues for U.S. Virgin Islands and Puerto Rico following hurricanes Irma and Maria. Published October 11, 2017. Accessed November 21, 2017.
3. Federal Emergency Management Agency (FEMA). Daily operations briefing. Published October 2, 2017. Accessed November 21, 2017.
4. Centers for Disease Control and Prevention (CDC). Public health preparedness capabilities: national standards for state and local planning. Atlanta, GA: CDC; 2011.
5. Schnall, AH, Hanchey, A, Nakata, N, et al. Disaster-related American Red Cross shelter morbidity surveillance during Hurricane Harvey compared to previous hurricanes. 2018 [unpublished article].
6. Noe, RS, Schnall, AH, Wolkin, AF, et al. Disaster-related injuries and illnesses treated by American Red Cross disaster health services during Hurricanes Gustav and Ike. South Med J. 2013;106(1):102.



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