Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 21;10(3):ofad093.
doi: 10.1093/ofid/ofad093. eCollection 2023 Mar.

Invasive Mold Infections Following Hurricane Harvey-Houston, Texas

Mitsuru Toda  1 , Samantha Williams  1 , Brendan R Jackson  1 , Sebastian Wurster  2 , Jose A Serpa  3 , Masayuki Nigo  4 , Carolyn Z Grimes  4 , Robert L Atmar  3 , Tom M Chiller  1 , Luis Ostrosky-Zeichner  4 , Dimitrios P Kontoyiannis  2
Affiliations

Invasive Mold Infections Following Hurricane Harvey-Houston, Texas

Mitsuru Toda et al. Open Forum Infect Dis. .

Abstract

Background: Characterizing invasive mold infection (IMI) epidemiology in the context of large flooding events is important for public health planning and clinical decision making.

Methods: We assessed IMI incidence (per 10 000 healthcare encounters) 1 year before and after Hurricane Harvey at 4 hospitals in Houston, Texas. Potential IMI cases were assigned as proven or probable cases using established definitions, and surveillance cases using a novel definition. We used rate ratios to describe IMI incidence and multivariable logistic regression to examine patient characteristics associated with IMI case status.

Results: IMI incidence was significantly higher posthurricane (3.69 cases) than prehurricane (2.50 cases) (rate ratio, 1.48 [95% confidence interval, 1.10-2.00]), largely driven by surveillance IMI cases. Aspergillus was the most common species cultured (33.5% prehurricane and 39.9% posthurricane). About one-quarter (25.8%) of IMI patients lacked classical IMI risk factors such as hematologic malignancy and transplantations. Overall, 45.1% of IMI patients received intensive care, and in-hospital all-cause mortality was 24.2%.

Conclusions: IMI incidence likely increased following Hurricane Harvey and outcomes for IMI patients were severe. Patient and clinician education on IMI prevention and identification is warranted, particularly as the frequency of extreme weather events increases due to climate change.

Keywords: aspergillosis; hurricane; invasive mold infections; surveillance.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. S. Wu. is a coinvestigator on an active Astellas-sponsored investigator-initiated research grant, and a coinvestigator on an active Gilead-sponsored investigator-initiated research grant. L. O.-Z. received institutional payments from CDC, institutional grants from Pfizer, Cidara, Scynexis, and Astellas, and consulting fees from Pfizer, Cidara, Merck, F2G, Astellas, Gilead, Octapharma, Viracor, and Appilli. R. L. A. received institutional payments from CDC. M. N. received institutional payments from CDC, grants from the National Institutes of Health and Gilead, and honoraria from University of Fukui, Japan. D. P. K. received institutional payments from CDC. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Flow diagram showing screening, chart abstraction, and analyses process for patients with invasive mold infections (IMIs) before and after Hurricane Harvey—4 medical centers, Houston, Texas, 2016–2018.
Figure 2.
Figure 2.
Invasive mold infections before and after Hurricane Harvey by month and invasive mold infection case status—4 medical centers, Houston, Texas, 2016–2018. Abbreviation: EORTC/MSG, European Organization for Research and Treatment of Cancer/Mycoses Study Group.
Figure 3.
Figure 3.
Interrupted time series of invasive mold infection case trends before and after Hurricane Harvey by month—4 medical centers, Houston, Texas, 2016–2018. Interrupted time series model was used to examine linear trends in monthly overall counts and changes between 12 months before and after hurricane landfall, controlling for seasonality and autocorrelation.
See this image and copyright information in PMC

References

    1. Masson-Delmotte V, Zhai P, Pirani A, et al. . Climate change 2021: the physical science basis. Contribution of Working Group I to the sixth assessment report of the Intergovernmental Panel on Climate Change. Cambridge, UK: Cambridge University Press; 2021.
    1. US Global Change Research Program . National climate assessment. Available at: https://nca2014.globalchange.gov/downloads. Accessed 7 January 2023.
    1. Papalexiou SM, Montanari A. Global and regional increase of precipitation extremes under global warming. Water Resour Res 2019; 55:4901–14.
    1. US Global Change Research Program . Climate science special report. Chapter 7: precipitation change in the United States.2017:1–470. Available at: https://science2017.globalchange.gov/chapter/7/. Accessed 7 January 2023.
    1. National Weather Service. Major Hurricane Harvey—August 25–29, 2017. Available at: https://www.weather.gov/crp/hurricane_harvey. Accessed 26 October 2021.