Risk for Invasive Mold Infections in People with Immunosuppression After Hurricane Harvey

An investigation into mold exposures after Hurricane Harvey demonstrated that immunosuppressed adult residents were exposed to mold and water-damaged areas and many did not wear respiratory protection equipment or other personal protective equipment (PPE), according to a report published in the Morbidity and Mortality Weekly Report.

Researchers conducted interviews with a convenience sample of residents from 3 hospital systems in the metropolitan area of Houston, Texas, where hospital-wide recommendations about avoiding mold exposure had not been disseminated before Hurricane Harvey. Using a modified questionnaire developed by the United States Centers for Disease Control and Prevention after Hurricanes Katrina and Rita, researchers conducted telephone interviews between October 21, 2017, and November 8, 2017, of 103 persons who had immunosuppression and who had stayed in the Houston metropolitan area during or after Hurricane Harvey.

Of the 102 participants, 92 reported living in their homes at the time of the interview. Water was reported in the homes of 46 of participants; 37 of these participants reported a median of 3 inches of water in the first floor of their homes for a median of 3 days, and 28 of these 37 participants reported that they had either seen or smelled mold in their homes. Thirty-two homes were cleaned for water damage/mold, 17 participants reported living in the house during cleanup, and 17 participants performed the cleanup themselves.

Participation in cleanup activities was assessed with cleanup categorized as either heavy (removing furniture, drywall, or carpeting) or light (sweeping, wiping off counters or walls, or retrieving personal items).

Overall, 49% (n=50) engaged in any type of cleanup activity, including 23 who engaged in heavy cleanup activities (median of 7 days) and 27 who engaged in light cleanup activities (median of 4 days). Of the 23 people who engaged in heavy cleanup, 57% reported not wearing respiratory protection, and 87% reported not wearing any PPE. Similarly, of the 27 people who engaged in light cleanup, 85% reported not wearing respiratory protection. The most frequently used PPE were gloves. In addition, although a total of 40 of these 50 participants reported wearing any PPE, only 7 participants reported wearing a mask at all times.

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Although federal agencies currently recommend that immunosuppressed persons avoid flooded and mold-contaminated buildings because of a high risk for invasive mold infections, the findings from this study “might help prompt future studies on the knowledge, attitudes, and practices of [PPE] use among immunosuppressed persons in post-hurricane settings and other locations experiencing flooding when complete avoidance of mold-contaminated sites is difficult,” concluded the study authors.

Disclosures: Luis Ostrosky-Zeichner, MD, reports grants and/or personal fees from Astellas, Merck & Co., Pfizer, Cidara, Scynexis, F2G, Amplyx, Mayne, Gilead, NovaDigm, United Medical, and Stendhal outside the submitted work. Dimitrios P. Kontoyiannis, MD, reports honoraria for lectures from Merck & Co., Gilead, and United Medicine. He also reports consulting fees from Merck & Co., Astellas, Cidara, Amplyx, and Mayne.


Chow NA, Toda M, Pennington AF, et al. Hurricane-associated mold exposures among patients at risk for invasive mold infections after Hurricane Harvey – Houston, Texas, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(21):469-473.