On September 16, 1999, Hurricane Floyd, a storm extending 300 miles with sustained winds of 96–110 miles per hour, made landfall in North Carolina, dropping up to 20 inches of rain in eastern regions of the state. Rain from Hurricane Floyd, combined with rains from Hurricane Dennis beginning on August 30 and Hurricane Irene on October 17, caused extensive flooding along the Neuse, Tar, Roanoke, Lumbar, and Cape Fear rivers, affecting an estimated 2.1 million persons. This report presents data about injuries, illnesses, and deaths during and following Hurricane Floyd in North Carolina and identifies the leading cause of death as drowning involving occupants of motor vehicles trapped in flood waters.

Epidemiologic information about deaths related to Hurricane Floyd were provided to CDC by the state medical examiner’s office. To monitor illness and injury related to the hurricane and subsequent flood, emergency department (ED) surveillance was established at 20 hospitals in 18 flood-affected counties in eastern North Carolina. Standardized illness and injury classifications were developed and applied by a disaster response team and ED staff during the surveillance period for comparison with similar periods in 1998. Diagnosis or chief symptoms for each patient visit was abstracted from daily ED logs to monitor trends during September 16–October 27, 1999. The 1999 illness and injury data were compared with data from 4 days in September 1998 (September 13 [Sunday], 15 [Tuesday], 17 [Thursday], and 19 [Saturday]) and 4 days in October 1998 (October 11 [Sunday], 13 [Tuesday], 15 [Thursday], and 17 [Saturday]). To compare a complete week of 1998 data with 1999 data, the September 1998 weekdays were weighted by multiplying by 2.5 and added to the weekend days; the same methods were applied to October 1998 data. Analysis of variance was used to compare the number of ED visits for each weekday during the 1999 surveillance period.

The medical examiner determined that 52 deaths were associated directly with the storm. Decedents ranged in age from 1 to 96 years (median: 43 years); 38 (73%) were males. Twenty counties reported at least one death; 40% of all deaths occurred in three counties. Of the 52 deaths, 35 (67%) occurred on September 16. The leading cause of death was drowning (Table 1); 24 (67%) deaths involved occupants of motor vehicles trapped in flood waters. Seven deaths occurred during transport by boat; flotation devices were not worn by any of the decedents. Five (10%) of the 52 decedents were rescue workers.

During September 16–October 27, 59,398 ED visits were reported; 67% related to illnesses and 33% to injuries. Four conditions accounted for 63% of all visits: orthopedic and soft tissue injury (28%), respiratory illness (15%), gastrointestinal illness (11%), and cardiovascular disease (9%); 19 cases of hypothermia occurred following the hurricane, including one death. EDs reported no hypothermia cases during the 1998 reference period. During the 1999 surveillance period, 10 cases of carbon monoxide poisoning were reported, compared with none during the 1998 reference period.

No statistical differences were found when comparing the number of ED visits with different days of the week during the surveillance period in 1999. Comparing the first week following Hurricane Floyd with the first week of September 1998, significant increases were reported in suicide attempts (relative risk [RR]=5.0; 95% confidence interval [CI]=1.4–17.1), dog bites (RR=4.1; 95% CI=2.0–8.1), febrile illnesses (RR=1.5; 95% CI=1.3–1.9), basic medical needs (e.g., oxygen, medication refills, dialysis, and vaccines) (RR=1.4; 95% CI=1.2–1.8), and dermatitis (RR=1.4; 95% CI=1.2–1.6). Comparing a week 1 month after Hurricane Floyd with the same period in 1998, significant increases were reported in 1999 for arthropod bites (RR=2.2; 95% CI=1.4–3.4), diarrhea (RR=2.0; 95% CI=1.4–2.8), violence (i.e., assault, gunshot wounds, and rape) (RR=1.5; 95% CI=1.1–2.2), and asthma (RR=1.4; 95% CI=1.2–1.7). Routine surveillance by local public health workers following Hurricane Floyd identified outbreaks in shelters of self-limiting gastrointestinal disease and respiratory disease.

On August 24, 2005, Tropical Depression 12 became Tropical Storm Katrina, the 11th named storm of the 2005 Atlantic hurricane season. Late on August 25, Katrina made initial landfall in south Florida as a category 1 hurricane on the Saffir-Simpson Hurricane Scale. Katrina strengthened rapidly upon reaching the Gulf of Mexico, attaining category 5 intensity. On August 29, Hurricane Katrina struck the Gulf Coast near the Louisiana-Mississippi border as category 3 hurricanes. The effect of earlier category 5 wind speeds on Gulf waters and the massive size of the storm combined to create devastating storm-surge conditions for coastal Mississippi, Louisiana, and Alabama and damage as far east as the Florida panhandle . Storm-induced breeches in the New Orleans levee system resulted in the catastrophic flooding of approximately 80% of that city. Hurricane Katrina was the deadliest hurricane to strike the United States since 1928. Preliminary mortality reports indicate approximately 1,000 Katrina-related deaths in Louisiana, 200 in Mississippi, and 20 in Florida, Alabama, and Georgia.

When hurricanes move onto land, the resulting storm surges, violent winds, heavy rains, and flooding can cause extensive damage. Before 1990, the majority of hurricane-related deaths in the United States resulted from drowning caused by sudden storm surges. Advances in warning technology and timely evacuation have decreased hurricane-related mortality. Since 1990, indirect causes of death and injury from hurricanes, such as electrocutions, clean-up injuries, and carbon monoxide poisonings, have become more prominent (2,4–6). During and after Hurricane Katrina, the majority of deaths resulted from storm surges along the Mississippi and Louisiana coastlines and flooding in the New Orleans area. The destructive force of the hurricane was magnified by the particular vulnerability of New Orleans, a city largely located below the surface of surrounding bodies of water. The resultant flooding closed New Orleans, the major population and commercial center of Louisiana and the hub of the state’s public health infrastructure.

Hurricane Katrina disrupted basic utilities, food-distribution systems, health-care services, and communications in large portions of Louisiana and Mississippi. In the days after the hurricane struck, displacement of persons living in these areas resulted in the congregation of more than 200,000 persons in evacuation centers in at least 18 states. Massive local, state, and federal responses ensued. The situation was compounded on September 24 when a second category 3 hurricane, Rita, forced the cessation of response activities in New Orleans and the evacuation of Louisiana and Texas cities near the Gulf. As the region moves into the reconstruction phase of this disaster, heavily affected states will need continued support to rebuild the public health infrastructure.

MMWR is highlighting the public health response to Hurricanes Katrina and Rita with two special issues. This issue focuses on public health activities in Louisiana 1–2 months after Hurricane Katrina, during which time local authorities reopened portions of New Orleans and the pre-disaster population began to return. Reports in this issue describe a range of public health disaster-response activities, including morbidity surveillance, shelter-based surveillance, and community health and needs assessment, environmental assessment, and infectious-disease case investigation. A second special issue, scheduled for March, will focus on the broader impact of Hurricanes Katrina and Rita, including public health activities in Mississippi, Texas, Alabama, and Florida.

Following less than a month after Hurricane Katrina devastated large parts of the central Gulf Coast region, Hurricane Rita was the second hurricane of the season to reach Category 5 status (on the Saffir-Simpson scale) in the Gulf of Mexico. This marked the first time on record that two hurricanes reached Category 5 strength in the Gulf of Mexico in the same season. Additionally, it was only the third time that two Category 5 storms formed in the Atlantic Basic in the same year.

One of the strongest storms on record for the Atlantic Basin, peak sustained winds reached 175 mph as the storm tracked west and northwest through the Gulf. Weakening occurred during the 36 hours prior to landfall but Rita brought hurricane strength winds more than 150 miles inland and caused significant damage along the coast. Hurricane Rita made landfall with windspeeds of 120 mph along the Texas/Louisiana border early on September 24th.

At its peak intensity, Rita’s minimum central pressure reached 897 mb. Only two other storms in recorded history have had lower pressures in the Atlantic:

Hurricane Gilbert, Cozumel, Mexico, September 14th 1988, 888mb, category 5, near 185 mph
The Labor Day Hurricane, Florida Keys, September 2, 1935, 892 mb, Category 5, approaching 200 mph

Although the region was well-prepared for the storm, the devastation across the Louisiana/Texas border region was widespread. While there are currently few reports of injuries or deaths as a direct result of the storm, unlike the large loss of life from Hurricane Katrina, a massive evacuation effort likely saved much loss of life. The most deadly hurricane to strike the U.S. made landfall in Galveston, Texas on September 8, 1900. This was also the greatest natural disaster ever to strike the U.S., claiming more than 8000 lives when the storm surge caught the residents of this island city by surprise.