CHALMETTE, La. – Although health officials were preparing for outbreaks of deadly diseases in the wake of Hurricane Katrina, the federal Centers for Disease Control said Thursday that no epidemics had materialized so far.

Doctors are seeing some clusters of diarrhea, along with skin rashes and infected wounds. But the CDC said an epidemic of cholera or typhoid was “very unlikely.” Medical experts said the main concerns currently are potential outbreaks of gastrointestinal disease and flu-like illnesses in the shelters, where thousands of refugees from the New Orleans area are still living in cramped quarters.

“No disease outbreaks have been reported as of September 8, 2005 in areas affected by Hurricane Katrina,” the CDC said on its Web site.

News that at least four people along the Gulf Coast had died of a bacterial infection related to cholera fueled fears of a mass outbreak. The stench of New Orleans’ standing water, which contains high levels of lead and E coli bacteria, exacerbated the fears – as did a report that officials had prepared 25,000 body bags for victims of the hurricane and its aftermath.

But doctors said infection with the bacterium responsible for the four deaths, Vibrio vulnificus, is rare and appears to target people with compromised immune systems. They speculated that the victims might have had open sores that got infected when they were exposed to floodwater.

V. vulnificus is not transmitted from person to person, according to the CDC.

Public health officials continued to stress that people who came in contact with the floodwater should scrub with soap and water.

Dr. Janis Tupesis, who teaches emergency medicine at the University of Chicago, said the strain of E. coli in the floodwater – which EPA officials said was at least 10 times the safe limit – was “really, really common,” and illness caused by the bug usually clear up on its own. He compared it to “normal travelers’ diarrhea – maybe you need a few days of antibiotics.”

The kind of E. coli that causes bloody diarrhea and kidney failure is a much more virulent strain that usually comes from eating contaminated meat, Tupesis said. That strain has not been reported in the floodwater.

Tupesis said most of the health problems in the first week after the hurricane hit had to do with “the basic infrastructure breaking down – the lack of access to medications and electricity.” Many diabetics who couldn’t take their insulin, heart patients who couldn’t take their blood-pressure medication and kidney patients who couldn’t get dialysis became critically ill, he said.

Then there were people who couldn’t get prompt treatment for existing medical conditions, such as asthma or infections, because the system was overwhelmed; their problems may have become more serious.

“Now what we’re starting to see are diseases of large groups of people in the same place,” said Tupesis. “We’re seeing upper respiratory infections, pneumonias. There’s a concern about tuberculosis.”

In addition to the overcrowding, he said, the lack of clean water, clean food and sanitation are causing small outbreaks of vomiting and diarrhea, mostly in the very young and the elderly.

Another potential health problem, Tupesis said, is mosquito-borne illnesses, such as encephalitis and West Nile virus.

“Mosquitoes breed in standing water,” he said. “Most of the Southeast is standing water, and it’s hot.”

The CDC recommends that anyone traveling to the Gulf Coast get inoculated against tetanus, diphtheria and hepatitis B.

Emergency responders who had not been immunized were doing so as late as Thursday.

At the beleaguered St. Bernard’s Parish emergency operations center in Chalmette, La., more than 100 responders got shots for hepatitis A and B and tetanus. Fire crews of 25 at a time showed up at one point, said Craig Steinberg, a pharmacist with the Disaster Medical Assistance Team sent to the parish.

“We had a line going out the building,” Steinberg said. “These are all responders – firefighters, people doing clean-up.”

Among them was Jeff McClain, 43, director of operations for the St. Bernard Port Harbor and Terminal District, who got two hepatitis vaccinations in his right shoulder Thursday.

“They got the left one yesterday,” he said. That was for tetanus.

In Chicago, Tupesis said he was leaving Sunday to volunteer at a makeshift hospital set up by the Red Cross. He said he’s gotten the recommended inoculations and also plans to take mosquito netting, repellant with a high concentration of Deet, and a hand sanitizer, “Purell – because you won’t have access to a sink.”

Outside of that, he said, you have to use common sense and be very aware of what you eat and drink.

“If it’s not boiled or peeled,” he said, “don’t eat it.”

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