1. Enbridge Oil Spill: Public Health Surveillance Investigation of Acute Health Effects Enbridge Oil Spill: Public Health Surveillance Investigation of Acute Health Effects Kim Hekman, MPH Michigan Department of Community Health CSTE/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

8. July 27, 2010

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

10. 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)

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

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

14. Methods Epi response included four data sources: 1. 1. Health care provider reports 2. 2. Monitoring of public calls to Children’s Hospital of Michigan Poison Control Center (PCC) 3. 3. Syndromic surveillance 4. 4. Door-to-door health surveys

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

16. Methods: (1) H 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

17. Methods: (3) S 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

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

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

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

21. Results: (1) H Results: (1) Health care provider reports

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

24. Symptoms of Patients Visiting Health Care Provider

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

28. Results: (3) Results: (3) Syndromic Surveillance System

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

30. Results: (4) Results: (4) Community Surveys

31. Survey Completion

32. Demographic Comparison

33. Percent of Residents with Any Symptom by Community

34. Symptom Types: Exposed vs. Comparison

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

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

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

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

39. 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 Limitations: Other

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

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

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