Infectious Diseases and Natural Disasters
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Transcript Infectious Diseases and Natural Disasters
Infectious Diseases
and
Natural Disasters
Background
Historically, infectious disease epidemics have
high mortality
Disasters have potential for social disruption
and death
Epidemics are compounded when
infrastructure breaks down
Can a natural disaster lead to an epidemic of
an infectious disease?
What is an emerging
infectious disease?
In 1991, Institute of Medicine attempted
to define:
– “new, re-emerging, or drug resistant
infections whose incidence in humans
has increased within the past 2 decades
or whose incidence threatens to increase
in the near future.”
Phases of Disaster
Impact Phase (0-4 days)
– Extrication (damage caused from removing
individuals from a wreckage)
– Immediate soft tissue infections
Post impact Phase (4 days- 4 weeks)
– Airborne, foodborne, waterborne and vector
diseases
Recovery phase (after 4 weeks)
– Those with long incubation and of chronic
disease
Factors for Disease
Transmission After a
Disaster
Environmental considerations
Endemic organisms (prevalent in that
location)
Population characteristics
Pre- event structure and public health
Type and magnitude of the disaster
Endemic organisms
(exclusively native to a place)
Infectious organisms endemic to a region will
be present after the disaster
Agents not endemic before the event are
UNLIKELY to be present after
Rare disease may be more common
Unlikely a new or changed disease will occur
Population Characteristics
Density
– Displaced populations
– Refugee camps
Age
– Increased elderly or children
Chronic Disease
– Malnutrition
– Heart disease
– Transplantation
Population Characteristics
Education
– Less responsive to disaster teams
Religion
Hygiene
– Underlying health education of public
Trauma
– Penetrating, blunt, burns
Stress
Pre-event resources
Sanitation
Primary health care and nutrition
Disaster preparedness
Disease surveillance
Equipment and medications
Transportation
Roads
Medical infrastructure
Type of disaster
Earthquake
– Crush and penetrating injuries
Hurricane and Flooding
– Water contamination, vector borne diseases
(ex. Transmitted by mosquitos)
Tornado
– Crush
Volcano
– Water contamination, airway diseases
Magnitude
– Bigger can mean more likelihood for
epidemics
Dominican Republic, 1979
Hurricane David and Fredrick on Aug 31 and
Sept 5th 1979
>2,300 dead immediately
Marked increase in all diseases measured
6 months after the hurricane
– Thyphoid fever
– Gastroenteritis
– Measles
– Viral hepatitis
Epidemics after Disasters
San Francisco, 1907 Fires; Plague
resulting from Quarantine failure
Duluth, MN, 1918 Forest Fire; Influenza
resulting from crowding and epidemic
Italy, 1976 Earthquake; Salmonella Carriers
due to sanitation stoppage
Summary of Factors
Many factors play a role in disease
development and outbreaks
Change and/or closing of public health
measures play a big role
What infections would we
see today?
Endemic organisms
Post-impact phase
Recovery Phase
Post-Impact Phase Infections
Crush and penetrating trauma
– Skin and soft tissue disruption
– Muscle/tissue necrosis (when groups of cells
die or degrade)
– Toxin production disease
– Burns
Waterborne
– Gastroenteritis
– Cholera (infection in the small intestine)
– Non-cholera dysentery(inflamed intestine)
– Hepatitis
– Rare diseases
Post-Impact Phase Infections
Vector borne
– Malaria
– Dengue and Yellow fever
Respiratory
– Caused by a virus
– Rare disease
Other
– Blood transfusions
Recovery Phase Infections
These agents need a longer incubation
period
– TB
General disaster reminders
Vaccinations are the mainstay of
outbreak control in many situations
Dead bodies pose little to no infectious
disease risk; however this is debated
Early surveillance and hygiene can
prevent outbreaks
Conclusions
Infectious diseases may play a role in the
post disaster period
These diseases will vary depending on
many factors
If the disease is not present before the
disaster, unlikely to be there after
Conclusions
Early recognition of certain diseases in
disaster setting important
Poor infrastructure and response has led
to most increases in infectious diseases
know where you are going and what is
endemic