Prehospital and Disaster Medicine

Special Report

Mississippi's Infectious Disease Hotline: A Surveillance and Education Model for Future Disasters

Andrew M. J. Caveya1 c1, Jonathan M. Spectora1, Derek Ehrhardta2, Theresa Kittlea3, Mills McNeilla3, P. Gregg Greenougha4 and Thomas D. Kirscha2

a1 Harvard School of Public Health, Boston, Massachusetts, USA

a2 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

a3 Mississippi Department of Health, Jackson, Mississippi, USA

a4 Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA


Introduction: The potential for outbreaks of epidemic disease among displaced residents was a significant public health concern in the aftermath of Hurricane Katrina. In response, the Mississippi Department of Health (MDH) and the American Red Cross (ARC) implemented a novel infectious disease surveillance system, in the form of a telephone “hotline”, to detect and rapidly respond to health threats in shelters.

Methods: All ARC-managed shelters in Mississippi were included in the surveillance system. A symptom-based, case reporting method was developed and distributed to shelter staff, who were linked with MDH and ARC professionals by a toll-free telephone service. Hotline staff investigated potential infectious disease outbreaks, provided assistance to shelter staff regarding optimal patient care, and helped facilitate the evaluation of ill evacuees by local medical personnel.

Results: Forty-three shelters sheltering 3,520 evacuees participated in the program. Seventeen shelters made 29 calls notifying the hotline of the following cases: (1) fever (6 cases); (2) respiratory infections (37 cases); (3) bloody diarrhea (2 cases); (4) watery diarrhea (15 cases); and (5) other, including rashes (33 cases). Thirty-four of these patients were referred to a local physician or hospital for further diagnosis and disease management. Three cases of chickenpox were identified. No significant infectious disease outbreaks occurred and no deaths were reported.

Conclusions: The surveillance system used direct verbal communication between shelter staff and hotline managers to enable more rapid reporting, mapping, investigation, and intervention, far beyond the capabilities of a more passive or paper-based system. It also allowed for immediate feedback and education for staff unfamiliar with the diseases and reporting process. Replication of this program should be considered during future disasters when health surveillance of a large, disseminated shelter population is necessary.

(Received April 14 2008)

(Accepted April 30 2008)


c1 50b Cambridge Road London SW11 4RR United Kingdom E-mail:

Cavey AMJ, Spector JM, MD, Ehrhardt D, Kittle T, McNeill M, Greenough PG, Kirsch TD: Mississippi's infectious disease hotline: A surveillance and education model for future natural disasters. Prehospital Disast Med 2009;24(1):11–17.