Beginning on September 6, 2017, Hurricane Irma crossed the Caribbean, followed on September 16 by Hurricane Maria. These storms caused severe damage in a number of countries and territories, including Anguilla, Barbuda, the British Virgin Islands, Dominica, the Dominican Republic, Haiti, Puerto Rico, Saint Martin, Sint Maarten, and the US Virgin Islands.

The extent of destruction across these countries and territories varies, with many areas flooded and inaccessible. Significant damage from the hurricanes has caused problems with water supplies, sanitation, food supply, electricity, transportation, shelter, communications, security, medical care, and mosquito control. Post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among persons in or recently returned from hurricane-affected areas. Contaminated drinking water and reduced access to safe water, food, and shelter in some areas may create conditions for outbreaks of infectious diseases such as leptospirosis, dengue, hepatitis A, typhoid, vibriosis, Zika, and influenza.

Potential visitors should postpone travel to severely affected areas because serious health and safety risks may be present and medical care may be limited or unavailable. Postponing travel to these areas would also prevent further straining already limited local resources. Many of these areas also remain at risk of Zika, so pregnant women should not travel to these areas.

Those who must travel, including those who are traveling for humanitarian aid work, should adhere to the following recommendations:

Prevent illness and injury

• Wash your hands often with soap and clean water (if available) or with hand sanitizer (containing at least 60% alcohol). Proper hand hygiene will help you avoid illness from bacteria and viruses.
• Use caution around downed power lines, water-affected electrical outlets, and broken gas lines.
• Avoid driving through moving or standing water.
• Pay attention for signs of heat stress. Heat stress can result in heat stroke (a medical emergency), heat exhaustion, or heat cramps.
• Use caution around sources of carbon monoxide, an odorless, colorless gas that can cause sudden illness and death if inhaled. Carbon monoxide can cause sudden illness and death if inhaled. Do not stay in a building where a generator is running inside or within 20 feet of the building.
• Avoid stray or frightened animals. In addition to the risk of rabies, all animal bites carry a risk of bacterial infection. Seek medical help immediately if you are bitten or scratched by an animal.
• Avoid direct contact with human remains. (If you are a relief worker helping with human remains, see the Interim Health Recommendations for Workers Who Handle Human Remains After a Disaster.)

Avoid diseases spread by insects
Mosquito-borne illnesses such as Zika*, dengue, and chikungunya may be found in these areas. Travelers should take steps to prevent bug bites. Malaria is also a risk in Haiti and parts of the Dominican Republic, so travelers should talk to their doctor or health care provider about taking medicine to prevent it.

*Because Zika can cause serious birth defects and be spread through sex as well as mosquito bites, partners of pregnant women and couples considering pregnancy should take prevention steps during and after travel. Pregnant women should NOT travel to areas with risk of Zika.

Follow food and water safety guidelines
Contaminated water and food can cause travelers’ diarrhea and other, more serious, illnesses including leptospirosis, hepatitis A, typhoid fever, and vibriosis (see “Food and Water Safety”).

Avoid floodwater

• Avoid drinking floodwater or water from lakes, rivers, or swamps. During and after a disaster, tap or well water may become contaminated with sewage, agricultural or industrial waste, chemicals, and other things that can cause illness or death. Pay attention to drinking water advisories in your area.
• Avoid wading in flooded areas, especially if you have any cuts or abrasions. If a cut becomes red, swells, or oozes, seek immediate medical attention.
• Wear protective clothing, especially footwear, if you must wade in floodwater or other areas that might be contaminated.~

Get medical care if you are injured or sick

• If you get a cut or wound, clean it out as quickly as possible with soap and clean water (if available). See a doctor immediately if you notice any signs of an infection.
• Seek medical care immediately if you develop a high fever, headache, chills, vomiting, and diarrhea. Some diseases, like leptospirosis, are treatable with antibiotics but can lead to serious harm or death if left untreated.

More Information

• Prevent Illness and Injury After a Disaster
• Clean Up Safely After a Disaster
• What You Need to Know When the Power Goes Out
• Guidance for Emergency Responders in US Virgin Islands and Puerto Rico

Clinician Information

Health care providers treating patients in the continental United States who recently traveled in hurricane-affected areas should be aware of the increased risk for infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid, vibriosis, Zika, and influenza.

Health care providers should also consider less common diseases in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness.