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From the Centers for Disease Control and Prevention
November 25, 1998

Deaths Associated With Hurricane Georges—Puerto Rico, September 1998

JAMA. 1998;280(20):1736-1737. doi:10.1001/jama.280.20.1736-JWR1125-2-1

MMWR. 1998;47:897-898

ON THE EVENING of September 21, 1998, Hurricane Georges struck Puerto Rico with estimated maximum winds of 115 mph (Category 3). It made multiple landfalls throughout the Caribbean, including Antigua, the U.S. Virgin Islands, Hispaniola, and Cuba. On September 25, Hurricane Georges struck the U.S. mainland near Key West, Florida, and made final landfall on September 27 in Biloxi, Mississippi, as a Category 2 hurricane. This report presents preliminary data about deaths resulting from the hurricane in Puerto Rico.

On September 23, all 78 civil divisions in Puerto Rico reported damage to homes, and 416 government-run shelters were housing approximately 28,000 persons. Approximately 700,000 persons were without water, and 1 million had no electricity.

The medical examiner (ME) at the Institute of Forensic Sciences provided information about the number and causes of deaths associated with Hurricane Georges. The ME determined whether a death was hurricane-related, including deaths during the impact phase of the storm (i.e., associated with high winds, storm surge, or flash flooding), and during the post-impact phase (i.e., associated with hurricane-related effects such as structural damage, power outages, and injuries incurred during clean-up).

Case Reports
Case 1

On September 23, a 28-year-old woman from Ponce died inside her home from carbon monoxide (CO) poisoning. A gasoline-powered electric generator had been operating inside the home while she was sleeping. Two other family members were hospitalized because of CO poisoning.

Case 2

On September 24, a 46-year-old man from Bayamon was found dead from CO poisoning inside his family store. He had been cleaning the store the night after the hurricane, and a gasoline-powered electric generator was operating outside near an opening where fumes could enter the structure.

Cases 3-6

On September 25, a 27-year-old woman from Caguas and her three children (aged 4, 6, and 7 years) died in a fire in their home. They were using candles to light the home. The mother apparently was asleep when the house caught fire.

Case 7

On September 25, a 66-year-old man from Utuado died as a result of head trauma sustained on September 22. He was removing water that had entered his home during the hurricane when he fell and struck the back of his head.

Case 8

On September 28, a 49-year-old man in San Juan was electrocuted while repairing a cable damaged by the storm. He was an employee of the electrical company.

Public Health Response

Mortality surveillance in Puerto Rico after Hurricane Georges led directly to public health interventions by the Puerto Rico Department of Health. Public health alerts covering the sources, symptoms, diagnosis, and treatment of CO poisoning were issued to hospital emergency departments across the island. Community education efforts were initiated, and a CO fact sheet was prepared. Emergency departments of the largest hospital system in Puerto Rico instituted surveillance for cases of CO poisoning.

Reported by:

LA Alvarez, MD, Institute of Forensic Sciences; C Deseda, MD, State Epidemiologist, Div of Epidemiology, Puerto Rico Dept of Health. Emergency Response Coordination Group, Office of the Director; Environmental Hazards Epidemiology Section, Health Studies Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Div of Applied Public Health Training, Epidemiology Program Office; and an EIS Officer, CDC.

CDC Editorial Note:

Preliminary findings of the investigation of deaths in Puerto Rico associated with Hurricane Georges indicate that all deaths occurred during the post-impact phase. Because improvements in hurricane warning systems have greatly decreased deaths during the impact phase of such storms in many areas, additional intervention efforts in these localities should focus on adverse health events in a storm's aftermath, such as those associated with storm damage and clean-up. The two deaths caused by CO poisoning from generators illustrate the growing importance of this toxicant as a cause of morbidity and mortality in post-disaster situations.

These eight deaths, and deaths in similar circumstances after other hurricanes,1-3 suggest that public health authorities should emphasize worker safety during clean-up and power-restoration activities and the hazards of open flames in homes. In addition, to reduce the risk for CO poisoning, persons should be warned to place generators outside and away from homes and discouraged from operating gasoline-powered items in enclosed areas. In localities with large Spanish-speaking populations, these and other warnings should continue to be in English and Spanish. In the future, mortality surveillance should continue to be conducted during the immediate aftermath of hurricanes and other natural disasters to guide public health activities.

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