Background: In the setting of global warming, natural disasters are increasing in pace and scope. Although natural disasters themselves do not cause outbreaks, the breakdowns in sanitary infrastructure and the displacement of populations, often to crowded shelters, have caused outbreaks. On August 26, 2017, category 4 hurricane Harvey made landfall near Corpus Christi, Texas, causing catastrophic flooding and displacing >30,000 residents from the Southern Gulf Coast region. Dallas accepted >3,800 evacuees at the Kay Bailey Hutchison Convention Center mega-shelter for 23 days, where a medical clinic was erected in the convention center parking garage. The medical clinic uniquely included a dedicated infection prevention team composed of local volunteer infection preventionists, healthcare epidemiologists, infectious diseases providers, and health department personnel. Methods: Evacuees were housed at the Dallas mega-shelter from August 29 through September 20. The infection prevention team maintained a presence of 3–4 members during clinical operations in shifts. The team conducted an initial needs assessment upon opening of the shelter medical clinic, facilitated acquisition of adequate numbers of hand sanitizer stations, sinks with running water, portable hand-washing stations, portable toilets and showers, and cleaning products. The infection prevention team coordinated and oversaw environmental cleaning services (EVS) carried out by local hospital EVS staff. Protocols for cleaning, disinfection, communicable disease testing, isolation, and treatment were created. In addition, education and training materials for the implementation of these protocols were distributed to volunteer staff. The infection preventionists created and provided oversight of the designated isolation units for respiratory, gastrointestinal and dermatologic infections of outbreak potential. Infection prevention rounding tools were developed and executed daily in the clinic, at the on-site daycare center, dining area, and the general shelter dormitory. Vaccination for influenza was formalized under a protocol and administered at the clinic and via mobile vaccination teams in the chronic illness section of the dormitory. Results: In tota3,829 residents were housed at the mega-shelter for 23 days. Moreover, 1,560 patients were seen in 2,654 clinic visits at the shelter medical clinic. In total, 48 (19%) clinic visits were for respiratory symptoms, 228 (9%) were for dermatologic problems, and 215 (8%) were for gastrointestinal symptoms. Also, 32 patients were referred to the isolation unit within the clinic. Overall, 98 influenza vaccines were administered. There was 1 confirmed case of influenza and 1 confirmed case of norovirus. Conclusions: No known transmission of communicable diseases occurred in this long-term, natural disaster–related mega-shelter, likely attributed to having a comprehensive infection prevention team of on-site volunteers available throughout the shelter operation. This model should be considered in future large-scale shelter settings to prevent disease transmission.

Disclosures: None

Funding: None

Understanding the clinical risk factors for COVID-19 disease severity and outcomes requires a combination of data from electronic health records and patient reports. To facilitate the collection of patient-reported data, as well as accelerate and standardize the collection of data about host factors, we have constructed a COVID-19 survey. This survey is freely available to the scientific community to send electronically for patients to complete online. This patient survey is designed to be comprehensive, yet not overly burdensome, to gather data useful for a range of clinical investigations, and to accommodate a wide variety of implementation settings including at a COVID-19 testing site, at home during infection or after recovery, and/or for individuals while they are hospitalized. A widely adopted standardized survey that can be implemented online with minimal resources can serve as a critical tool for combining and comparing data across studies to improve our understanding of COVID-19 disease.

On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with “mega-sheltering,” beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33–37)

Acromelic dysplasias are a group of skeletal dysplasias characterised by short-limbed short stature with other distinctive phenotypic features including small hands and feet and stiff joints. Geleophysic dysplasia is an acromelic dysplasia that is associated with characteristic facial features, progressive cardiac valvular thickening, and tracheal stenosis. Owing to overlapping clinical features with other types of short-limbed skeletal dysplasias, it is important to make a precise diagnosis as they have different cardiac morbidity and mortality. We present the cases of three patients with geleophysic dysplasia and progressive mitral valve disease to emphasise the natural history of this disorder and provide guidance regarding cardiac health supervision in these individuals.

Dilated cardiomyopathy is characterised by dilation and impaired systolic function. We present the case of a child with dilated cardiomyopathy caused by a 624 kb duplication of 6q22.31, which includes the phospholamban gene. The patient also has failure to thrive and developmental delay due to complex cytogenetic abnormalities including a 5p15 deletion associated with Cri du Chat and an 11p15 duplication associated with Russell–Silver syndrome.

Long-chain n-3 PUFA can lower blood pressure (BP) but their acute effects on cardiac output, BP and systemic vascular resistance (SVR) in response to dynamic exercise are uncertain. We compared the effects of high-fat meals rich in EPA (20 : 5n-3), DHA (22 : 6n-3) or oleic acid (control) on cardiac output, BP and SVR in response to exercise stress testing. High-fat meals (50 g fat) containing high-oleic sunflower oil enriched with 4·7 g of either EPA or DHA v. control (high-oleic sunflower oil only) were fed to twenty-two healthy males using a randomised cross-over design. Resting measurements of cardiac output, heart rate and BP were made before and hourly over 5 h following the meal. A standardised 12 min exercise test was then conducted with further measurements made during and post-exercise. Blood samples were collected at fasting, 5 h postprandially and immediately post-exercise for the analysis of lipid, glucose and 8-isoprostane-F2α (8-iso-PGF2α). Plasma concentrations of EPA and DHA increased by 0·22 mmol/l 5 h following the EPA and DHA meals, respectively, compared with the control (P < 0·001). Resting cardiac output and 8-iso-PGF2α increased similarly following all meals and there were no significant differences in cardiac output during exercise between the meals. SVR was lower at 5 h and during exercise following the DHA but not EPA meal, compared with the control meal, by 4·9 % (95 % CI 1·3, 8·4; P < 0·01). Meals containing DHA appear to differ from EPA with regard to their effects on cardiovascular haemodynamics during exercise.

This retrospective cohort study found that syringes prefilled with heparin flush solution caused an outbreak of Serratia marcescens bloodstream infection at an outpatient treatment center in Texas in 2007. The epidemiologic study supported this conclusion, despite the lack of microbiologic evidence of contamination from environmental and product testing. This report underscores the crucial contributions that epidemiologic studies can make to investigations of outbreaks that are possibly product related.