Townsville flooding - "The health response has been quite remarkable"

28 February 2019

Recent flooding in North and North West Queensland has focused attention on the dangerous soil-borne bacteria and disease organisms that floodwaters harbour, posing serious health risks in affected regions. Indeed there has been two confirmed deaths and several people admitted to hospital as a result of melioidosis in the wake of flooding. CKN spoke with Townsville’s Public Health Unit acting director, Dr Julie Mudd, about the health effects that recent flooding have had on the region, and how her team in Townsville have responded to the crisis.

Flooding brings with it long-lasting health effects through exposure to environmental bacterium in mud and polluted surface water, such as melioidosis and leptospirosis, as well as vector borne diseases with standing water acting as breeding sites for mosquitoes.

Dr Julie Mudd, Townsville Public Health Unit

Dr Julie Mudd, Townsville Public Health Unit

The floods have had a significant impact on the town and will continue to do so for some time to come. The hospital has been busy from the start of the flooding through to end of February with a very high volume of patients continuing through ED.

We are always alert during wet season. Locally our awareness of soil borne illnesses is fairly good as diseases like melioidosis occur more often here than elsewhere. January is of course “change-over” month for health staff, so we needed to ensure that all our new arrivals knew what to look for and how to test appropriately. It can be quite daunting for staff that trained elsewhere to get up to speed with tropical diseases and more quick read resources to assist newcomers to the tropics would be helpful.

In the initial phase we saw a large volume of injuries from people fleeing the flood waters and later clean up attempts. Our messaging from day one was about avoid contact with flood waters where possible and cleaning and covering any wounds. This was followed by an increase in infections, particularly wound infections, with both common and exotic tropical or waterborne bacteria. These included Staph and Strep infections, Pseudomonas and Aeromonas and Burkholderia pseudomallei (melioidosis).

We initially avoided disease specific messaging as this can dissuade people from considering all the options (like Staph, Strep and Pseudomonas). When we started seeing melioidosis cases we responded to the alarm with resources that continued the same messages, linked to that disease in particular. At the same time we increased our messages to GPs and hospital staff.

Some of these potentially flood related conditions, like melioidosis and leptospirosis, can be diagnostically challenging. An increase in summer flu across the state has compounded the problem by making differential diagnosis even more difficult. We utilised doctor letters in conjunction with the Infectious Diseases team at Townsville Hospital to assist GPs with detection and management of potential flood related diseases.

In an event like this we know people can’t always avoid the floodwaters and many had to cross floodwater to save their life, but messaging about unnecessary exposure and the management of exposed wounds is really important. Even very minor wounds, like insect bites and blisters, were getting infected and causing people strife. Adequate early management of wounds will prevent a lot of ED presentations and hospitalisations. Knowing what tests to perform is also really important, including ensuring that wound swabs were taken for flood exposed wounds and that specimens for culture (blood, urine, sputum or wound depending on symptoms) were tested for suspected melioidosis cases.

We have a significant number of people systemically unwell as a result of these infections. Many elderly, disabled, frail or chronically unwell residents found their home based care disrupted by the flooding, either through damage to their own homes or through flooding having impacted their carers. This resulted in a number of people requiring admission to hospital or respite in aged care facilities. It also made discharging people with complex needs more challenging. The increased housing density that results from having so many people displaced, mostly living with friends and family, also increases the risks of respiratory and gastrointestinal outbreaks. Additionally the water and heat made ideal mosquito breeding conditions which increased our chances of mosquito borne illnesses spreading through town.

The health response has been quite remarkable. The hospital has remained open throughout the emergency. The public health unit worked tirelessly to ensure food businesses were able to reopen; pharmacies were functioning; evacuation centres were food-safe and had adequate hygiene standards; community messaging was accurate, timely and consistent; potential mosquito vectors were minimised and disease surveillance and monitoring was fast, reliable and responsive. Deployed staff from Cairns and Brisbane assisted in ensuring a timely response, and all agencies worked together really well to protect the health of the town. Our little public health unit put in over 2,800 hours of work across the 18 days of the incident response.