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Background

Enbridge Oil Spill: Public Health Surveillance Investigation of Acute Health Effects Kim Hekman, MPH Michigan Department of Community Health CSTE/CDC Epidemiology Fellow. Background. July 26, 2010 Enbridge reported burst pipeline in Marshall, MI Pipeline extends from Indiana to Ontario

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  1. Enbridge Oil Spill: Public Health Surveillance Investigation of Acute Health EffectsKim Hekman, MPHMichigan Department of Community HealthCSTE/CDC Epidemiology Fellow

  2. Background July 26, 2010 Enbridge reported burst pipeline in Marshall, MI Pipeline extends from Indiana to Ontario Transported 283,000 barrels crude oil/day

  3. July 27, 2010

  4. Background 843,000 gallons of crude oil spilled Contamination affected 40 miles Recreational river

  5. Background • Incident command structure • EPA – lead agency • Calhoun County Public Health Department • Participating agencies • Enbridge • State and other health departments • Other state and federal agencies (e.g. Police, DEQ, ATSDR, US Fish & Wildlife)

  6. Background • End of first week • Rumors – residents sick and flooding EDs • Anecdotal reports – noxious odors • Health Officer requested epidemiologic support

  7. Background • State and local health departments developed an epi response and surveillance plan • Objective: Characterize the acute health impact of the oil spill on exposed communities • No focus on long-term health effects

  8. Methods Epi response included four data sources: • Health care provider reports • Monitoring of public calls to Children’s Hospital of Michigan Poison Control Center (PCC) • Syndromic surveillance • Door-to-door health surveys

  9. Methods: (1) Health care provider reports • Hospital counts • Medical providers in Calhoun and Kalamazoo counties required to report patients • Reporting required under R 333.2631-2635 • Notified via blast fax • PCC designated agent of state for data • Medical charts abstracted

  10. Methods: (1) Health care provider reports & (2) PCC public calls • Reports/calls entered into database • Categorized: • Major effect • Moderate effect • Minor effect • Lost to follow-up • Confirmed non-exposure • Daily count sent to incident command center

  11. Methods: (3) Syndromic surveillance • Calhoun and Kalamazoo counties • Syndromes: rash, neurological, respiratory, and gastrointestinal • Limited ED coverage of Calhoun County • Over the counter pharmaceutical sales examined

  12. Methods: (4) Community surveys • Four communities identified as clusters of interest • Location to spill • Calls from residents

  13. Methods: (4) Community surveys • Survey instrument created to obtain information: • Pre-existing chronic conditions • Oil spill related health symptoms • Relocation status • Odor intensity & duration

  14. Methods: (4) Community surveys • Administered 11 to 25 days after spill • Door-to-door • Single respondent answered for household • Packet of information • Comparison community upstream surveyed • Similar sociodemographics • Symptoms in last month

  15. Results:(1) Health care provider reports

  16. Demographics of Patients Visiting Heath Care Provider (n=145)

  17. Symptoms of Patients Visiting Health Care Provider

  18. Results:(2) PCC Monitoring of Public Calls

  19. Results:(3) Syndromic Surveillance System

  20. One alert was recorded in Kalamazoo County for rash several days after the spill No alerts in Calhoun County Limited coverage in Calhoun County Over-the-counter pharmaceutical sales No irregularities Syndromic Surveillance System

  21. Results:(4) Community Surveys

  22. Survey Completion

  23. Demographic Comparison

  24. Percent of Residents with Any Symptom by Community

  25. Symptom Types: Exposed vs. Comparison

  26. Results • 98% of exposed households reported odors on/after July 26 • 12% of exposed residents with symptoms said they went to a doctor • 72% of exposed residents with symptoms relocated compared to 51% without symptoms

  27. Discussion • Epi response • Multiple components • Comprehensive and timely • Served purpose in incident command center • PCC • Efficient method for collecting data

  28. Discussion • Neurological, respiratory, and gastrointestinal symptoms were predominantly reported • Symptoms significantly higher in exposed communities • Consistent with other oil spill studies • Ex. Headache prevalence • Shetland, Scotland: 32% • Wales, Great Britain: 38% • Enbridge Oil Spill: 35%

  29. Limitations: Survey • Recall bias • Over reporting of symptoms • Publicity/media • Under reporting of symptoms • Respondent: incomplete knowledge • Temporality • Surveys administered between August 6 – 17

  30. Limitations: Other • Health care reporting • Under-reporting • Syndromic Surveillance • Nearby hospitals not in system • Workers • Other surveillance system • MIOSHA, Enbridge, EPA • Tracked all work-related injuries/illness

  31. Lessons Learned • Value of epidemiologists being on-site early • Responding to needs in command center • Dispel rumors • Collaboration between state and local health departments • Provided information for MDCH epidemiology and toxicology response plans

  32. Acknowledgements • Calhoun County Public Health Department • Children’s Hospital of Michigan Poison Control Center • MDCH – Bureau of Epidemiology

  33. Thank you! • Any questions? • Kim Hekman HekmanK@michigan.gov • Full report: www.michigan.gov

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