When Public Health Messaging Still is Not Enough: Post Disaster Carbon Monoxide Poisoning Outbreaks, Connecticut's Experience 1 Year Later — October 2012

Styles, Timothy S

BACKGROUND: During October 2011 a large carbon monoxide (CO) poisoning outbreak (133 cases and 5 deaths) occurred in Connecticut following a snowstorm-related power outage. In response, the Connecticut Department of Public Health (CDPH) sought to improve prevention messaging for future storms. On October 29, 2012, Hurricane Sandy caused extensive power outages and another CO poisoning outbreak in Connecticut. We characterized these cases.

METHODS: On October 26, CDPH launched an enhanced, multimedia CO-warning campaign that continued through November 7, including mass-media announcements, Facebook postings, tweets in multiple languages, alerts to local health departments, posters in high-traffic public areas, and household door hangers. Disaster-related CO poisoning cases were defined as carboxyhemoglobin levels ≥9% (physician- and laboratory-reportable in Connecticut) during October 29–November 7, in which CO exposure was related to the storm or power outage. We interviewed patients or proxies with a standardized questionnaire and reviewed medical records.

RESULTS: We identified 30 cases from 11 CO exposure incidents. Median patient age was 40 years (range: 9–92); 50% were foreign-born; 53% were non-Hispanic white, 37% Hispanic, and 10% other. One patient had heard CO-warning messaging during the previous year; no patients reported hearing or seeing warning messaging immediately before or during the 2012 storm. Although geographic areas affected by the 2011 and 2012 storms differed, the number of homes without power and most common CO exposure source (portable generators, 91%) were similar.

CONCLUSIONS: Despite attempts at well-targeted, well-timed warning messages and outreach to diverse populations, postdisaster CO poisonings occurred, albeit with fewer cases and no deaths. Foreign-born persons were disproportionately affected. In addition to public health messaging, other methods of CO poisoning prevention are needed.