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Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
Wolters Kluwer -- Medknow Publications
Prevention of communicable diseases after disaster: A review
Najmeh Jafari, Armindokht Shahsanai, [...], and Amir Loghmani
Additional article information
Abstract
Natural disasters are tragic incidents originating from atmospheric, geologic and hydrologic changes. In
recent decades, millions of people have been killed by natural disasters, resulting in economic damages.
Natural and complex disasters dramatically increase the mortality and morbidity due to communicable
diseases. The major causes of communicable disease in disasters are categorized into four sections:
Infections due to contaminated food and water, respiratory infections, vector and insect-borne diseases,
and infections due to wounds and injuries. With appropriate intervention, high morbidity and mortality
resulting from communicable diseases can be avoided to a great deal.
This review article tries to provide the best recommendations for planning and preparing to prevent
communicable disease after disaster in two phases: before disaster and after disaster.
KEYWORDS: Natural Disasters, Communicable Diseases, Prevention
Disasters can be seen as sudden and terrible events causing great damage, loss or destruction. Disasters
have been defined as ecologic troubles or severe and high-magnitude emergencies resulting in deaths,
injuries, illnesses, and profound damages that cannot be successfully managed using ordinary
procedures or resources and require external support.1 Disasters include earthquakes, floods, volcanic
eruptions, tsunamis, drought and landslides. These disasters may begin acutely or insidiously with
dramatic health, social, and economic sequels.2 In recent decades, millions of people have been killed
by natural disasters, adversely influenced the lives of more than one billion people, and caused
significant economic compensations. Due to the latest report of International Federation of Red Cross
and Red Crescent Society in the last decade (1999-2008), over 7100 disasters happened in the world
that caused 1,243,480 deaths and over one billion US dollars damage.3 In 2005, 246 (42%) out of 650
severe natural hazard events recorded globally occurred in Asia killing over 97,000 (90% of the global
total of 110,000 individuals) and affecting more than 150 million people. In 2006, 174 disasters affected
28 million people in Asia and the Pacific.
In 2008, from top 10 countries with the highest amount of disaster-related deaths in the world, 9 of
them were in Asia. In fact, it is estimated the average $39.5 billion physical losses from disasters
throughout Asia annually.4 Terrific earthquake in Marmara region in Turkey that caused more than
17,000 deaths in 1999 or the devastating flood in Central Europe occurred in 2002, resulted in economic
damages estimated more than $15 billion are only some examples.5
The Bam earthquake was the most catastrophic event in the last decade in Iran. On 26 December 2003,
a tragic earthquake measured 5.6 on the Richter scale, struck the ancient and agricultural city of Bam in
the south-east of Iran. In this devastating event more than 30,000 people were killed, around 80 percent
of the houses in the area were ruined and more than 100,000 became homeless.6
Natural and complex disasters such as earthquakes dramatically increase the mortality and morbidity
resulting from communicable diseases.7 Although the epidemics of infectious diseases after the natural
disaster are rare,8–10 63% of the morbidity among Nicaraguan refugees in Costa Rica in 1989 was due
to acute respiratory infections.11 In 1993, acute respiratory infections caused 30% of deaths in dwellers
of Kabul, Afghanistan and 23% of deaths in unsettled people.12 In addition, after the earthquakes in El
Salvador in 2001, 30% of infections were upper respiratory infections.13,14 The top five causes of death
in emergencies and disasters include diarrhea, acute respiratory infection, measles, malnutrition and, in
endemic zones, malaria.15 With appropriate intervention, high morbidity and mortality resulting from
communicable diseases can be avoided to a great deal.16
Communicable disease after disaster
The major causes of communicable disease in disasters can be categorized into four areas: Infections
due to contaminated food and water, respiratory infections, vector and insectborne diseases, and
infections due to wounds and injuries.17 The most common causes of morbidity and mortality in this
situation are diarrheal disease and acute respiratory infections.18
■ Waterborne diseases:
Diarrheal disease: Diarrheal disease outbreaks can arise subsequent to drinking-water contamination,
and have been reported after flooding and related movement. Vibrio cholera (O1 Ogawa and O1 Inaba)
and enterotoxigenic Escherichia coli are the major causes of this type.19–22
Hepatitis A and E: Hepatitis A and E have also fecal-oral transmission, especially in poor water
sanitation.23,24
Leptospirosis: Leptospirosis is a bacterial zoonosis transmitted through contact of mucous membranes

and skin with water, moist vegetation, or dirt contaminated with rodent urine.25–28
■ Diseases associated with crowding: Acute respiratory infections (ARI) as the main cause of morbidity
and mortality among unsettled people are seen predominantly in children less than 5 years old.2
Furthermore, meningitis and measles are transmitted from person to person, especially in crowded
circumstances.29
■ Vector-borne diseases: Malaria, cutaneous leishmaniasis30 and rabies17 are transmitted by vectors. In
1991, an earthquake in Costa Rica's Atlantic region was accompanied with1a high increase in malaria
cases.31 Furthermore, intermittent flooding associated with El Niño–Southern Oscillation has been
correlated with malaria epidemics in Peru.32
■ Infections due to wounds and injuries: The potentially significant threats to persons suffering a wound
are tetanus, staphylococci and streptococci.33
This review article tries to provide the best recommendations for planning and preparing to prevent
communicable disease after disaster in two phases: before disaster and after disaster.
Strategies for prevention of communicable disease
Before Disaster
The first phase of disaster policy making is to clarify our needs. For primary prevention, the most
important risk factors of communicable diseases should be determined. The most significant risk factors
in disasters are population movement and displacement.2 Additionally, overpopulation, economic and
environmental devastation, poverty, lack of sanitary water, poor waste management, lack of shelter,
malnutrition as a consequence of food shortages, and poor access to health care cause a dramatic
increase in the rates of communicable diseases after disaster.16,34–37
Furthermore the breakdown or overwhelming of public health organizations and deficiency of health
services obstruct prevention and control programs.38 With emphasizing on these risk factors, preparing
and policy making before disasters are a critical need. The response to the disaster is a multifaceted
operation requiring persistent review and modification of preparedness missions at the local,
nationwide, and global level.39
The Aim of this phase is to decrease vulnerability to communicable diseases through reducing causalities
and exposure to risk factors that provide passive protection during disaster. It needs some national
regulations that reduce hazard exposure through constructing evidence-based guidelines for protecting
individuals.40 Emergency response plans before disasters should include training in identifying and
management of specific potentially threatening diseases; preparing needed equipment, supplies and
materials, making local backups of supplies and tools for diagnosis and treatment, and environmental
health measures for disease outbreaks.
Furthermore, reinforcement of health-surveillance systems and practicing guidelines for managing

information on specific diseases; increasing the awareness of potentially affected population about
communicable diseases and the prerequisites for quick referral to a health facility are critical.15,40–42
Prepositioning of emergency supplies is one mechanism of increasing preparedness for natural
disasters.43 Additionally, in countries with potential threat of disasters, providing fully operational field
hospitals providing effective and efficient health care services to the damaged people in the probable
forthcoming disasters, seems critical; this plan has an important role to reduce mortality and morbidity
of communicable diseases.44 Such strategies are significantly facilitated by continuing support of
government, academic and private organizations in terms of assigning programs designed to offer up-to-
date education and training.
Post disaster Phase
In this phase, the emergency response for controlling communicable disease includes: Emergency
medical care, provision of shelter and site planning, water and sanitation, safe food preparation,
nutrition, case management, medical supplies and vector control. Moreover, health education and
providing the health of humanitarian workers is a critical point.
• Select and plan sites
providing appropriate shelters and site planning at the start of an emergency can decrease the incidence
of communicable disease especially diarrheal diseases, acute respiratory infections, meningitis,
tuberculosis, measles and vector-borne diseases.47 Shelters should have sufficient space according to
the needs of victims. Furthermore, access to the water, fuel, and transport, solid waste management,
and safety of food stores are essential.16,48 The new methods of GIS (Geographic Information System)
application is useful for finding the proper place for shelter settlement.49
• Ensure adequate water and sanitation facilities.
As mentioned before, water borne diseases are a main cause of communicable disease after disaster.
Ensuring constant delivery of safe drinking-water is the major preventive measure to be applied after a
natural disaster.
According to WHO guidelines, Chlorine is broadly obtainable, low-cost, easily used and effective against
almost all waterborne pathogens.15 The sphere project proposes the following minimum standards for
the water supply in disasters: (1) sufficient access to safe water, (2) water quality should be maintained
based on international guidelines, and (3) water consumption facilities and goods should be safe. People
should have sufficient facilities and provisions to collect, save and use adequate quantities of water for
drinking, cooking and personal hygiene, and to certify that drinking water remains safe until
consumption.45,50–52
Additionally, personal hygiene is an important issue in health promotion during disasters. Personal
hygiene habits will influence the general health status of the population. The importance of soap and
hand washing as a protection against fecal-oral disease should be emphasized in educational programs.
Soap and water should be provided to all disaster victims and rescue personnel.53–55
• Ensure safety of food:
Food safety is crucial for disease prevention in natural disasters. The World Health Organization
recommends five keys for ensuring the safety of food supplements following a disaster event;
Key 1: Preserve clean - (prevents the growth and spread of hazardous microorganisms)
Key 2: Separate cooked and raw food (microorganisms transfer prevention)
Key 3: Cook thoroughly (kills dangerous microorganisms)
Key 4: Preserve food at harmless temperatures (microorganisms growth prevention)

Key 5: Consuming safe water and raw materials (contamination prevention)56
• Control vectors
Natural disasters can influence transmission of vector-borne disease. The crowding of infected and
vulnerable hosts, a debilitated public health infrastructure and disruptions of ongoing control processes
are entirely risk factors for transmission of vector-borne disease.57 Major diseases frequently spread by
vectors are malaria, dengue, Japanese encephalitis, yellow fever, typhus, and trypanosomiasis. For
prevention, vector control interventions based on the local context and epidemiology of diseases are
essential. Examples of some useful interventions are indoor residual spraying for malaria, insecticide-
treated nets, and traps for tsetse flies as the vectors of trypanosomiasis.58
• Implement vaccination campaigns (e.g. measles)
Campaigns for measles immunization are one of the most cost-effective interventions in public
health.16 Mass measles immunization, as well as vitamin A supplementation is an immediate health
priority after natural disasters in regions with poor coverage levels. Mass immunization should be
fulfilled as soon as possible in areas with baseline coverage rates below 90% among individuals under 15
years old.
Furthermore, immediate provision of Tetanus Diphtheria (TD) vaccine and tetanus antitoxin to persons
injured during the earthquake and those undergoing emergency surgeries, is essential.59
• Provide essential clinical services
Access to the primary care services is critical to prevention, early diagnosis and treatment of a variety of
diseases, as well as providing secondary and tertiary care.60 Effective diagnosis and treatment of
communicable diseases, prevents excess mortality and morbidity.61
Furthermore, standardized guidelines for diagnosis and treatment of the most common infectious
diseases are needed. The Inter-agency Emergency Health Kit 2006 (IEHK 2006) which is designed by
world health organization to meet the initial primary health care needs of a displaced population is
useful in disaster scene. It can be set in immediate aftermath of a natural disaster or during an
emergency and includes essential medicines, medical facilities and also clinical protocols needed in the
context of emergency situations.62
• Provide basic laboratory facilities
Establishing a clinical laboratory is not a priority during the initial phase of most disasters. The diagnosis
of most common communicable diseases can usually be done by clinical diagnosis. Laboratory testing is
remained useful for confirming during a supposed epidemic event for which mass immunization may be
indicated (e.g. meningococcal meningitis) or where culture and antibiotic sensitivity testing is effective
in clinical decisions (e.g. dysentery).63
Consclusion
An important key to diminish adverse health effects due to natural disasters is a multidisciplinary
approach with a wide range of proficiency which is useful in prevention and also immediate treatment
of communicable diseases.
The establishment, implementation, and continuous monitoring of minimum standards for water safety
security, sanitation, shelter, and personal hygiene is critical for health promotion after disasters.
Awareness of the emergence of water and food born disease is of importance to the health of the
victims. Furthermore by establishment of a surveillance system and monitoring the trend of disease
carefully, the threat of outbreaks will be assessed. In addition, some strategic guidelines for controlling
outbreaks are needed.
This approach needs extensive continuing preparation, planning, education and also policy development.
The ultimate goal is better awareness and response for natural disaster or other complex emergency
circumstances to minimize the morbidity and mortality of such ominous events.
Author's Contributions
NJ conceived and designed the experiment. NJ, AS, MM and AL developed the review protocol. AS and
MM conducted the literature review and did the initial screening based on titles and abstracts. Data
extraction and quality appraisal was conducted by either NJ and AS or MM and AL. The first draft of the
paper was produced by NJ and AL, with subsequent drafts developed by all four authors. All authors
have read and approved the manuscript
Footnotes
Conflict of Interests Authors have no conflict of interests.
Article information
J Res Med Sci. 2011 Jul; 16(7): 956–962.
PMCID: PMC3263111
PMID: 22279466
Najmeh Jafari,1 Armindokht Shahsanai,2 Mehrdad Memarzadeh,3 and Amir Loghmani4
1- Resident of Community Medicine, Department of Community Medicine, School of Medicine, Isfahan

University of Medical Sciences, Isfahan, Iran.
2- Associate professor, Department of Community Medicine, School of Medicine, Isfahan University of

Medical Sciences, Isfahan, Iran.
3- Associate professor, Department of Surgery, School of Medicine, Isfahan University of Medical

Sciences, Isfahan, Iran.
4- Resident of Community Medicine, Department of Community Medicine, School of Medicine, Isfahan

University of Medical Sciences, Isfahan, Iran.
Corresponding Author: Amir Loghmani, E-mail: ri.ca.ium.tnediser@inamhgol_a
Received 2011 Jan 31; Accepted 2011 May 28.
Copyright : © Journal of Research in Medical Sciences
This is an open-access article distributed under the terms of the Creative Commons Attribution-
Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC.
Articles from Journal of Research in Medical Sciences : The Official Journal of Isfahan University of
Medical Sciences are provided here courtesy of Wolters Kluwer -- Medknow Publications
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Bencana alam adalah insiden tragis yang berasal dari perubahan atmosfer, geologis, dan hidrologi.
Dalam beberapa dekade terakhir, jutaan orang telah terbunuh oleh bencana alam, yang mengakibatkan
kerusakan ekonomi.
Bencana alam dan kompleks secara dramatis meningkatkan mortalitas dan morbiditas akibat penyakit
menular. Penyebab utama penyakit menular dalam bencana dikategorikan ke dalam empat bagian:
Infeksi karena makanan dan air yang terkontaminasi, infeksi pernapasan, vektor dan penyakit yang
ditularkan serangga, dan infeksi karena luka dan cedera. Dengan intervensi yang tepat, morbiditas dan
mortalitas yang tinggi akibat penyakit menular dapat dihindari.
Artikel ulasan ini mencoba untuk memberikan rekomendasi terbaik untuk perencanaan dan persiapan
untuk mencegah penyakit menular setelah bencana dalam dua fase: sebelum bencana dan setelah
bencana.
KATA KUNCI: Bencana Alam, Penyakit Menular, Pencegahan
Bencana dapat dilihat sebagai peristiwa mendadak dan mengerikan yang menyebabkan kerusakan,
kehilangan, atau kehancuran besar. Bencana telah didefinisikan sebagai masalah ekologis atau keadaan
darurat yang parah dan berkekuatan tinggi yang mengakibatkan kematian, cedera, penyakit, dan
kerusakan parah yang tidak dapat dikelola dengan sukses menggunakan prosedur atau sumber daya
biasa dan memerlukan dukungan eksternal.1 Bencana meliputi gempa bumi, banjir, letusan gunung
berapi, tsunami, kekeringan dan tanah longsor. Bencana-bencana ini dapat dimulai secara akut atau
tidak langsung dengan sekuel kesehatan, sosial, dan ekonomi yang dramatis.2 Dalam beberapa dekade
terakhir, jutaan orang telah terbunuh oleh bencana alam, memengaruhi kehidupan lebih dari satu miliar
orang, dan menyebabkan kompensasi ekonomi yang signifikan. Karena laporan terbaru Federasi
Internasional Palang Merah dan Bulan Sabit Merah pada dekade terakhir (1999-2008), lebih dari 7.100
bencana terjadi di dunia yang menyebabkan 1.243.480 kematian dan kerusakan lebih dari satu miliar
dolar AS.3 Pada tahun 2005, 246 ( 42%) dari 650 peristiwa bahaya alam parah yang dicatat secara global
terjadi di Asia menewaskan lebih dari 97.000 (90% dari total global 110.000 individu) dan
mempengaruhi lebih dari 150 juta orang. Pada tahun 2006, 174 bencana mempengaruhi 28 juta orang di
Asia dan Pasifik.
Pada tahun 2008, dari 10 negara teratas dengan jumlah kematian terkait bencana tertinggi di dunia, 9 di
antaranya berada di Asia. Bahkan, diperkirakan kerugian fisik rata-rata $ 39,5 miliar dari bencana di
seluruh Asia setiap tahunnya.4 Gempa hebat di wilayah Marmara di Turki yang menyebabkan lebih dari
17.000 kematian pada tahun 1999 atau banjir dahsyat di Eropa Tengah terjadi pada tahun 2002,
mengakibatkan kerusakan ekonomi yang diperkirakan lebih dari $ 15 miliar hanyalah beberapa contoh.5
Gempa bumi Bam adalah peristiwa paling dahsyat dalam dekade terakhir di Iran. Pada 26 Desember
2003, gempa bumi tragis berkekuatan 5,6 pada skala Richter, menghantam kota kuno dan pertanian
Bam di tenggara Iran. Dalam peristiwa yang menghancurkan ini, lebih dari 30.000 orang tewas, sekitar
80 persen rumah di daerah itu hancur dan lebih dari 100.000 menjadi tunawisma.6
Bencana alam dan kompleks seperti gempa bumi secara dramatis meningkatkan mortalitas dan
morbiditas akibat penyakit menular.7 Meskipun epidemi penyakit menular setelah bencana alam jarang
terjadi, 8-10% 63% morbiditas di antara pengungsi Nikaragua di Kosta Rika pada tahun 1989 disebabkan
terhadap infeksi saluran pernapasan akut.11 Pada tahun 1993, infeksi saluran pernapasan akut
menyebabkan 30% kematian di penduduk Kabul, Afghanistan, dan 23% kematian pada orang yang tidak
tenang.12 Selain itu, setelah gempa bumi di El Salvador pada tahun 2001, 30% infeksi terjadi pada
infeksi saluran pernapasan atas.13,14 Lima penyebab utama kematian dalam keadaan darurat dan
bencana meliputi diare, infeksi saluran pernapasan akut, campak, malnutrisi dan, di zona endemis,
malaria.15 Dengan intervensi yang tepat, angka kesakitan dan kematian yang tinggi akibat penyakit
menular dapat dihindari untuk banyak.16
Penyakit menular setelah bencana
Penyebab utama penyakit menular dalam bencana dapat dikategorikan ke dalam empat bidang: Infeksi
karena makanan dan air yang terkontaminasi, infeksi pernapasan, vektor dan penyakit yang disebabkan
oleh serangga, dan infeksi karena luka dan cedera.17 Penyebab paling umum morbiditas dan mortalitas
dalam hal ini situasinya adalah penyakit diare dan infeksi saluran pernapasan akut.
Penyakit yang ditularkan melalui air:

Penyakit diare: Wabah penyakit diare dapat timbul setelah kontaminasi air minum, dan telah dilaporkan
setelah banjir dan pergerakan terkait. Vibrio cholera (O1 Ogawa dan O1 Inaba) dan enterotoxigenic
Escherichia coli adalah penyebab utama dari jenis ini. 19-22
Hepatitis A dan E: Hepatitis A dan E juga memiliki penularan tinja-oral, terutama dalam sanitasi air yang
buruk. 23,24
Leptospirosis: Leptospirosis adalah zoonosis bakteri yang ditularkan melalui kontak selaput lendir dan
kulit dengan air, vegetasi yang lembab, atau kotoran yang terkontaminasi dengan urin hewan
pengerat.25–28
■ Penyakit yang berkaitan dengan crowding: Infeksi saluran pernafasan akut (ISPA) sebagai penyebab
utama morbiditas dan mortalitas di antara orang-orang yang tidak tenang terlihat terutama pada anak-
anak berusia kurang dari 5 tahun.2 Selanjutnya, meningitis dan campak ditularkan dari satu orang ke
orang lain, terutama dalam kepadatan keadaan.29
■ Penyakit yang ditularkan melalui vektor: Malaria, leishmaniasis kulit, dan rabies17 ditularkan oleh
vektor. Pada tahun 1991, gempa bumi di wilayah Atlantik Kosta Rika disertai dengan1 peningkatan kasus
malaria yang tinggi.31 Selanjutnya, banjir intermiten yang terkait dengan El Nino-Osilasi Selatan telah
berkorelasi dengan epidemi malaria di Peru.32
■ Infeksi akibat luka dan cedera: Ancaman yang berpotensi signifikan terhadap orang yang menderita
luka adalah tetanus, stafilokokus, dan streptokokus.33
Artikel ulasan ini mencoba untuk memberikan rekomendasi terbaik untuk perencanaan dan persiapan
untuk mencegah penyakit menular setelah bencana dalam dua fase: sebelum bencana dan setelah
bencana.
Strategi untuk pencegahan penyakit menular
Sebelum Bencana
Tahap pertama pembuatan kebijakan bencana adalah mengklarifikasi kebutuhan kita. Untuk
pencegahan primer, faktor risiko terpenting dari penyakit menular harus ditentukan. Faktor risiko paling
signifikan dalam bencana adalah perpindahan dan perpindahan penduduk.2 Selain itu, populasi yang
berlebihan, kehancuran ekonomi dan lingkungan, kemiskinan, kurangnya air sanitasi, pengelolaan
limbah yang buruk, kurangnya tempat tinggal, kekurangan gizi sebagai akibat dari kekurangan makanan,
dan akses yang buruk ke perawatan kesehatan menyebabkan peningkatan dramatis dalam tingkat
penyakit menular setelah bencana.16,34-37
Lebih jauh, gangguan atau kewalahan organisasi kesehatan masyarakat dan kurangnya layanan
kesehatan menghambat program pencegahan dan pengendalian.38 Dengan menekankan pada faktor-
faktor risiko ini, persiapan dan pembuatan kebijakan sebelum bencana merupakan kebutuhan yang
sangat penting. Respons terhadap bencana adalah operasi beragam aspek yang membutuhkan tinjauan
dan modifikasi yang berkesinambungan dari misi kesiapsiagaan di tingkat lokal, nasional, dan global.39
Tujuan fase ini adalah untuk mengurangi kerentanan terhadap penyakit menular melalui pengurangan
kausalitas dan paparan faktor-faktor risiko yang memberikan perlindungan pasif selama bencana.
Diperlukan beberapa peraturan nasional yang mengurangi paparan bahaya melalui pembuatan
pedoman berbasis bukti untuk melindungi individu.40 Rencana tanggap darurat sebelum bencana harus
mencakup pelatihan dalam mengidentifikasi dan mengelola penyakit spesifik yang berpotensi
mengancam; menyiapkan peralatan, persediaan, dan bahan yang diperlukan, membuat cadangan
persediaan dan alat untuk diagnosis dan perawatan setempat, dan langkah-langkah kesehatan
lingkungan untuk wabah penyakit.
Selain itu, penguatan sistem pengawasan kesehatan dan pedoman praktik untuk mengelola informasi
tentang penyakit tertentu; meningkatkan kesadaran populasi yang berpotensi terkena penyakit menular
dan prasyarat untuk rujukan cepat ke fasilitas kesehatan sangat penting.15,40-42 Penyiapan persediaan
darurat adalah salah satu mekanisme untuk meningkatkan kesiapsiagaan terhadap bencana alam.43
Selain itu, di negara-negara dengan potensi ancaman tentang bencana, menyediakan rumah sakit
lapangan yang beroperasi penuh yang menyediakan layanan perawatan kesehatan yang efektif dan
efisien bagi orang-orang yang rusak dalam kemungkinan bencana yang akan datang, tampaknya penting;
rencana ini memiliki peran penting untuk mengurangi mortalitas dan morbiditas penyakit menular.44
Strategi tersebut secara signifikan difasilitasi oleh dukungan berkelanjutan dari pemerintah, organisasi
akademik dan swasta dalam hal menetapkan program yang dirancang untuk menawarkan pendidikan
dan pelatihan terkini.
Fase Pasca Bencana
Dalam fase ini, respons darurat untuk mengendalikan penyakit menular meliputi: Perawatan medis
darurat, penyediaan tempat tinggal dan perencanaan lokasi, air dan sanitasi, persiapan makanan yang
aman, nutrisi, manajemen kasus, persediaan medis, dan pengendalian vektor. Selain itu, pendidikan
kesehatan dan menyediakan kesehatan pekerja kemanusiaan adalah titik kritis.• Pilih dan rencanakan
situsmenyediakan tempat berlindung yang tepat dan perencanaan lokasi pada awal keadaan darurat
dapat mengurangi kejadian penyakit menular terutama penyakit diare, infeksi saluran pernapasan akut,
meningitis, tuberkulosis, campak dan penyakit yang ditularkan melalui vektor.47
Tempat penampungan harus memiliki ruang yang cukup sesuai dengan kebutuhan para korban . Selain
itu, akses ke air, bahan bakar, dan transportasi, pengelolaan limbah padat, dan keamanan toko makanan
sangat penting.16,48 Metode baru aplikasi GIS (Sistem Informasi Geografis) berguna untuk menemukan
tempat yang tepat untuk pemukiman hunian.49
• Pastikan fasilitas air dan sanitasi memadai.Seperti disebutkan sebelumnya, penyakit yang terbawa air
adalah penyebab utama penyakit menular setelah bencana. Memastikan pengiriman air minum yang
aman secara konstan adalah tindakan pencegahan utama yang diterapkan setelah bencana
alam.Menurut pedoman WHO, Klorin secara luas dapat diperoleh, murah, mudah digunakan dan efektif
terhadap hampir semua patogen yang ditularkan melalui air.15
Proyek lingkup mengusulkan standar minimum berikut untuk pasokan air dalam bencana: (1) akses yang
cukup ke air bersih, ( 2) kualitas air harus dijaga berdasarkan pedoman internasional, dan (3) fasilitas
dan barang konsumsi air harus aman. Orang harus memiliki fasilitas dan ketentuan yang memadai untuk
mengumpulkan, menyimpan, dan menggunakan air dalam jumlah yang cukup untuk minum, memasak,
dan kebersihan pribadi, dan untuk menyatakan bahwa air minum tetap aman sampai dikonsumsi.45,50–
52
Selain itu, kebersihan pribadi adalah masalah penting dalam promosi kesehatan selama bencana.
Kebiasaan kebersihan pribadi akan memengaruhi status kesehatan umum populasi. Pentingnya sabun
dan mencuci tangan sebagai perlindungan terhadap penyakit fecal-oral harus ditekankan dalam
program pendidikan. Sabun dan air harus diberikan kepada semua korban bencana dan petugas
penyelamat.53–55
• Pastikan keamanan makanan:Keamanan pangan sangat penting untuk pencegahan penyakit dalam
bencana alam. Organisasi Kesehatan Dunia merekomendasikan lima kunci untuk memastikan keamanan
suplemen makanan setelah kejadian bencana;
Kunci 1: Menjaga kebersihan - (mencegah pertumbuhan dan penyebaran mikroorganisme berbahaya)K
unci 2: Pisahkan makanan yang dimasak dan mentah (pencegahan transfer mikroorganisme)
Kunci 3: Masak sampai matang (bunuh mikroorganisme berbahaya)
Kunci 4: Simpan makanan pada suhu yang tidak berbahaya (pencegahan pertumbuhan mikroorganisme)
Kunci 5: Mengkonsumsi air bersih dan bahan baku (pencegahan kontaminasi) 56• Kontrol
vektorBencana alam dapat memengaruhi penularan penyakit yang ditularkan melalui vektor.
Kerumunan host yang terinfeksi dan rentan, infrastruktur kesehatan masyarakat yang lemah dan
gangguan proses pengendalian yang sedang berlangsung sepenuhnya merupakan faktor risiko
penularan penyakit yang ditularkan melalui vektor.57
Penyakit utama yang sering disebarkan oleh vektor adalah malaria, demam berdarah, ensefalitis Jepang,
demam kuning, penyakit tipus , dan trypanosomiasis. Untuk pencegahan, intervensi pengendalian
vektor berdasarkan konteks lokal dan epidemiologi penyakit sangat penting. Contoh dari beberapa
intervensi yang berguna adalah penyemprotan residu dalam ruangan untuk malaria, kelambu
berinsektisida, dan perangkap untuk lalat tsetse sebagai vektor trypanosomiasis.58
• Melaksanakan kampanye vaksinasi (mis. Campak)Kampanye untuk imunisasi campak adalah salah satu
intervensi yang paling hemat biaya dalam kesehatan masyarakat.16 Imunisasi campak massal, serta
suplementasi vitamin A merupakan prioritas kesehatan segera setelah bencana alam di daerah dengan
tingkat cakupan yang buruk. Imunisasi massal harus dipenuhi sesegera mungkin di daerah dengan
tingkat cakupan dasar di bawah 90% di antara individu di bawah 15 tahun.Selain itu, pemberian segera
vaksin Tetanus Diphtheria (TD) dan tetanus antitoxin kepada orang-orang yang terluka akibat gempa
bumi dan mereka yang menjalani operasi darurat, sangat penting.59
• Memberikan layanan klinis yang pentingAkses ke layanan perawatan primer sangat penting untuk
pencegahan, diagnosis dini dan pengobatan berbagai penyakit, serta memberikan perawatan sekunder
dan tersier.60 Diagnosis dan pengobatan penyakit menular yang efektif, mencegah kelebihan mortalitas
dan morbiditas.61Lebih lanjut, pedoman standar untuk diagnosis dan pengobatan penyakit menular
yang paling umum diperlukan. Inter-agency Emergency Health Kit 2006 (IEHK 2006) yang dirancang oleh
organisasi kesehatan dunia untuk memenuhi kebutuhan perawatan kesehatan primer awal dari populasi
yang dipindahkan berguna di lokasi bencana. Ini dapat ditetapkan segera setelah bencana alam atau
selama keadaan darurat dan termasuk obat-obatan penting, fasilitas medis dan juga protokol klinis yang
diperlukan dalam konteks situasi darurat.62
• Menyediakan fasilitas laboratorium dasar
Membangun laboratorium klinis bukanlah prioritas selama fase awal sebagian besar bencana. Diagnosis
penyakit menular yang paling umum biasanya dapat dilakukan dengan diagnosis klinis. Pengujian
laboratorium tetap berguna untuk mengkonfirmasi selama kejadian epidemi yang seharusnya di mana
imunisasi massal dapat diindikasikan (mis. Meningitis meningokokus) atau di mana pengujian kultur dan
sensitivitas antibiotik efektif dalam keputusan klinis (mis. Disentri) .63
Consclusion
Kunci penting untuk mengurangi dampak kesehatan yang merugikan akibat bencana alam adalah
pendekatan multidisiplin dengan berbagai kecakapan yang berguna dalam pencegahan dan juga
pengobatan segera penyakit menular.
Pembentukan, implementasi, dan pemantauan berkelanjutan standar minimum untuk keamanan
keselamatan air, sanitasi, tempat tinggal, dan kebersihan pribadi sangat penting untuk promosi
kesehatan setelah bencana. Kesadaran akan munculnya air dan penyakit bawaan makanan sangat
penting bagi kesehatan para korban. Selanjutnya dengan menetapkan sistem pengawasan dan
memantau kecenderungan penyakit dengan hati-hati, ancaman wabah akan dinilai. Selain itu, beberapa
pedoman strategis untuk mengendalikan wabah diperlukan.
Pendekatan ini membutuhkan persiapan, perencanaan, pendidikan, dan juga pengembangan kebijakan
yang berkelanjutan. Tujuan utamanya adalah kesadaran dan respon yang lebih baik untuk bencana alam
atau keadaan darurat kompleks lainnya untuk meminimalkan morbiditas dan mortalitas dari kejadian-
kejadian yang tidak menyenangkan tersebut.
Kontribusi Penulis
NJ menyusun dan merancang percobaan. NJ, AS, MM dan AL mengembangkan protokol peninjauan. AS
dan MM melakukan tinjauan literatur dan melakukan penyaringan awal berdasarkan judul dan abstrak.
Ekstraksi data dan penilaian kualitas dilakukan oleh NJ dan AS atau MM dan AL. Draf pertama makalah
ini diproduksi oleh NJ dan AL, dengan draf selanjutnya dikembangkan oleh keempat penulis. Semua
penulis telah membaca dan menyetujui naskah
Catatan kaki
Konflik Kepentingan Penulis tidak memiliki konflik kepentingan.
Informasi artikel
J Res Med Sci. 2011 Juli; 16 (7): 956–962.
PMCID: PMC3263111
PMID: 22279466
Najmeh Jafari, 1 Armindokht Shahsanai, 2 Mehrdad Memarzadeh, 3 dan Amir Loghmani4
1- Residen Kedokteran Komunitas, Departemen Kedokteran Komunitas, Fakultas Kedokteran,

Universitas Ilmu Kedokteran Isfahan, Isfahan, Iran.
2- Profesor Rekanan, Departemen Kedokteran Komunitas, Fakultas Kedokteran, Universitas Ilmu

Kedokteran Isfahan, Isfahan, Iran.
3 - Associate professor, Departemen Bedah, Fakultas Kedokteran, Universitas Ilmu Kedokteran Isfahan,
Isfahan, Iran.
4- Penduduk Kedokteran Komunitas, Departemen Kedokteran Komunitas, Fakultas Kedokteran,

Universitas Ilmu Kedokteran Isfahan, Isfahan, Iran.
Penulis Korespondensi: Amir Loghmani, E-mail: ri.ca.ium.tnediser@inamhgol_a
Menerima 2011 Jan 31; Diterima 2011 28 Mei.
Hak Cipta: © Jurnal Penelitian Ilmu Kedokteran
Ini adalah artikel akses terbuka yang didistribusikan di bawah ketentuan Creative Commons Attribution-
Noncommercial-Share Alike 3.0 Unported, yang mengizinkan penggunaan, distribusi, dan reproduksi
tanpa batasan dalam media apa pun, asalkan karya aslinya dikutip dengan benar.
Artikel ini telah dikutip oleh artikel lain di PMC.
Artikel dari Jurnal Penelitian Ilmu Kedokteran: Jurnal Resmi Universitas Ilmu Kedokteran Isfahan
disediakan di sini milik Wolters Kluwer - Medknow Publications
Epidemics after Natural Disasters
John T. Watson, Michelle Gayer, and Maire A. Connolly
Additional article information
Associated Data
Supplementary Materials
Abstract
The relationship between natural disasters and communicable diseases is frequently misconstrued. The
risk for outbreaks is often presumed to be very high in the chaos that follows natural disasters, a fear
likely derived from a perceived association between dead bodies and epidemics. However, the risk
factors for outbreaks after disasters are associated primarily with population displacement. The
availability of safe water and sanitation facilities, the degree of crowding, the underlying health status of
the population, and the availability of healthcare services all interact within the context of the local
disease ecology to influence the risk for communicable diseases and death in the affected population.
We outline the risk factors for outbreaks after a disaster, review the communicable diseases likely to be
important, and establish priorities to address communicable diseases in disaster settings.
Keywords: Disasters, epidemiology, outbreaks, surveillance, risk assessment, communicable diseases,

perspective
Natural disasters are catastrophic events with atmospheric, geologic, and hydrologic origins. Disasters
include earthquakes, volcanic eruptions, landslides, tsunamis, floods, and drought. Natural disasters can
have rapid or slow onset, with serious health, social, and economic consequences. During the past 2
decades, natural disasters have killed millions of people, adversely affected the lives of at least 1 billion
more people, and resulted in substantial economic damages (1). Developing countries are
disproportionately affected because they lack resources, infrastructure, and disaster-preparedness
systems.
Deaths associated with natural disasters, particularly rapid-onset disasters, are overwhelmingly due to
blunt trauma, crush-related injuries, or drowning. Deaths from communicable diseases after natural
disasters are less common.
Dead Bodies and Disease
The sudden presence of large numbers of dead bodies in the disaster-affected area may heighten
concerns of disease outbreaks (2), despite the absence of evidence that dead bodies pose a risk for
epidemics after natural disasters (3). When death is directly due to the natural disaster, human remains
do not pose a risk for outbreaks (4). Dead bodies only pose health risks in a few situations that require
specific precautions, such as deaths from cholera (5) or hemorrhagic fevers (6). Recommendations for
management of dead bodies are summarized in the Table.
Table
Table
Principles for management of dead bodies*

Despite these facts, the risk for outbreaks after disasters is frequently exaggerated by both health
officials and the media. Imminent threats of epidemics remain a recurring theme of media reports from
areas recently affected by disasters, regardless of attempts to dispel these myths (2,3,7).
Displacement: Primary Concern
The risk for communicable disease transmission after disasters is associated primarily with the size and
characteristics of the population displaced, specifically the proximity of safe water and functioning
latrines, the nutritional status of the displaced population, the level of immunity to vaccine-preventable
diseases such as measles, and the access to healthcare services (8). Outbreaks are less frequently
reported in disaster-affected populations than in conflict-affected populations, where two thirds of
deaths may be from communicable diseases (9). Malnutrition increases the risk for death from
communicable diseases and is more common in conflict-affected populations, particularly if their
displacement is related to long-term conflict (10).
Although outbreaks after flooding (11) have been better documented than those after earthquakes,
volcanic eruptions, or tsunamis (12), natural disasters (regardless of type) that do not result in
population displacement are rarely associated with outbreaks (8). Historically, the large-scale
displacement of populations as a result of natural disasters is not common (8), which likely contributes
to the low risk for outbreaks overall and to the variability in risk among disasters of different types.
Risk Factors for Communicable Disease Transmission
Responding effectively to the needs of the disaster-affected population requires an accurate

communicable disease risk assessment. The efficient use of humanitarian funds depends on
implementing priority interventions on the basis of this risk assessment.
A systematic and comprehensive evaluation should identify 1) endemic and epidemic diseases that are
common in the affected area; 2) living conditions of the affected population, including number, size,
location, and density of settlements; 3) availability of safe water and adequate sanitation facilities; 4)
underlying nutritional status and immunization coverage among the population; and 5) degree of access
to healthcare and to effective case management.
Communicable Diseases Associated with Natural Disasters

The following types of communicable diseases have been associated with populations displaced by
natural disasters. These diseases should be considered when postdisaster risk assessments are
performed.
Water-related Communicable Diseases
Access to safe water can be jeopardized by a natural disaster. Diarrheal disease outbreaks can occur
after drinking water has been contaminated and have been reported after flooding and related
displacement. An outbreak of diarrheal disease after flooding in Bangladesh in 2004 involved >17,000
cases; Vibrio cholerae (O1 Ogawa and O1 Inaba) and enterotoxigenic Escherichia coli were isolated (13).
A large (>16,000 cases) cholera epidemic (O1 Ogawa) in West Bengal in 1998 was attributed to
preceding floods (14), and floods in Mozambique in January–March 2000 led to an increase in the
incidence of diarrhea (15).
In a large study undertaken in Indonesia in 1992–1993, flooding was identified as a significant risk factor
for diarrheal illnesses caused by Salmonella enterica serotype Paratyphi A (paratyphoid fever) (16). In a
separate evaluation of risk factors for infection with Cryptosporidium parvum in Indonesia in 2001–2003,
case-patients were >4× more likely than controls to have been exposed to flooding (17).
The risk for diarrheal disease outbreaks following natural disasters is higher in developing countries than
in industrialized countries (8,11). In Aceh Province, Indonesia, a rapid health assessment in the town of
Calang 2 weeks after the December 2004 tsunami found that 100% of the survivors drank from
unprotected wells and that 85% of residents reported diarrhea in the previous 2 weeks (18). In
Muzaffarabad, Pakistan, an outbreak of acute watery diarrhea occurred in an unplanned, poorly
equipped camp of 1,800 persons after the 2005 earthquake. The outbreak involved >750 cases, mostly
in adults, and was controlled after adequate water and sanitation facilities were provided (19). In the
United States, diarrheal illness was noted after Hurricanes Allison (20) and Katrina (21–23), and
norovirus, Salmonella, and toxigenic and nontoxigenic V. cholerae were confirmed among Katrina
evacuees.
Hepatitis A and E are also transmitted by the fecal-oral route, in association with lack of access to safe
water and sanitation. Hepatitis A is endemic in most developing countries, and most children are
exposed and develop immunity at an early age. As a result, the risk for large outbreaks is usually low in
these settings. In hepatitis E–endemic areas, outbreaks frequently follow heavy rains and floods; the
illness is generally mild and self-limited, but in pregnant women case-fatality rates can reach 25% (24).
After the 2005 earthquake in Pakistan, sporadic hepatitis E cases and clusters were common in areas
with poor access to safe water. Over 1,200 cases of acute jaundice, many confirmed as hepatitis E,
occurred among the displaced (25). Clusters of both hepatitis A and hepatitis E were noted in Aceh after
the December 2004 tsunami (26).
Leptospirosis is an epidemic-prone zoonotic bacterial disease that can be transmitted by direct contact
with contaminated water. Rodents shed large amounts of leptospires in their urine, and transmission
occurs through contact of the skin and mucous membranes with water, damp soil or vegetation (such as
sugar cane), or mud contaminated with rodent urine. Flooding facilitates spread of the organism
because of the proliferation of rodents and the proximity of rodents to humans on shared high ground.
Outbreaks of leptospirosis occurred in Taiwan, Republic of China, associated with Typhoon Nali in 2001
(27); in Mumbai, India, after flooding in 2000 (28); in Argentina after flooding in 1998 (29); and in the
Krasnodar region of the Russian Federation in 1997 (30). After a flooding-related outbreak of
leptospirosis in Brazil in 1996, spatial analysis indicated that incidence rates of leptospirosis doubled
inside the flood-prone areas of Rio de Janeiro (31).
Diseases Associated with Crowding
Crowding is common in populations displaced by natural disasters and can facilitate the transmission of
communicable diseases. Measles and the risk for transmission after a natural disaster are dependent on
baseline immunization coverage among the affected population, and in particular among children <15
years of age. Crowded living conditions facilitate measles transmission and necessitate even higher
immunization coverage levels to prevent outbreaks (32). A measles outbreak in the Philippines in 1991
among persons displaced by the eruption of Mt. Pinatubo involved >18,000 cases (33). After the tsunami
in Aceh, a cluster of measles involving 35 cases occurred in Aceh Utara district, and continuing sporadic
cases and clusters were common despite mass vaccination campaigns (26). In Pakistan, after the 2005
South Asia earthquake, sporadic cases and clusters of measles (>400 clinical cases in the 6 months after
the earthquake) also occurred (25).
Neisseria meningitidis meningitis is transmitted from person to person, particularly in situations of

crowding. Cases and deaths from meningitis among those displaced in Aceh and Pakistan have been
documented (25,26). Prompt response with antimicrobial prophylaxis, as occurred in Aceh and Pakistan,
can interrupt transmission. Large outbreaks have not been recently reported in disaster-affected
populations but are well-documented in populations displaced by conflict (34).
Acute respiratory infections (ARI) are a major cause of illness and death among displaced populations,
particularly in children <5 years of age. Lack of access to health services and to antimicrobial agents for
treatment further increases the risk for death from ARI. Risk factors among displaced persons include
crowding, exposure to indoor cooking using open flame, and poor nutrition. The reported incidence of
ARI increased 4-fold in Nicaragua in the 30 days after Hurricane Mitch in 1998 (35), and ARI accounted
for the highest number of cases and deaths among those displaced by the tsunami in Aceh in 2004 (26)
and by the 2005 earthquake in Pakistan (25).
Vectorborne Diseases
Natural disasters, particularly meteorologic events such as cyclones, hurricanes, and flooding, can affect
vector-breeding sites and vectorborne disease transmission. While initial flooding may wash away
existing mosquito-breeding sites, standing water caused by heavy rainfall or overflow of rivers can
create new breeding sites. This situation can result (with typically some weeks’ delay) in an increase of
the vector population and potential for disease transmission, depending on the local mosquito vector
species and its preferred habitat. The crowding of infected and susceptible hosts, a weakened public
health infrastructure, and interruptions of ongoing control programs are all risk factors for vectorborne
disease transmission (36).
Malaria outbreaks in the wake of flooding are a well-known phenomenon. An earthquake in Costa Rica’s
Atlantic Region in 1991 was associated with changes in habitat that were beneficial for breeding and
preceded an extreme rise in malaria cases (37). Additionally, periodic flooding linked to El Niño–
Southern Oscillation has been associated with malaria epidemics in the dry coastal region of northern
Peru (38).
Dengue transmission is influenced by meteorologic conditions, including rainfall and humidity, and often
exhibits strong seasonality. However, transmission is not directly associated with flooding. Such events
may coincide with periods of high risk for transmission and may be exacerbated by increased availability
of the vector’s breeding sites (mostly artificial containers) caused by disruption of basic water supply
and solid waste disposal services. The risk for outbreaks can be influenced by other complicating factors,
such as changes in human behavior (increased exposure to mosquitoes while sleeping outside,
movement from dengue-nonendemic to -endemic areas, a pause in disease control activities,
overcrowding) or changes in the habitat that promote mosquito breeding (landslide, deforestation, river
damming, and rerouting of water).
Other Diseases Associated with Natural Disasters
Tetanus is not transmitted person to person but is caused by a toxin released by the anaerobic tetanus
bacillus Clostridium tetani. Contaminated wounds, particularly in populations where vaccination
coverage levels are low, are associated with illness and death from tetanus. A cluster of 106 cases of
tetanus, including 20 deaths, occurred in Aceh and peaked 2-1/2 weeks after the tsunami (26). Cases
were also reported in Pakistan following the 2005 earthquake (25).
An unusual outbreak of coccidiomycosis occurred after the January 1994 Southern California earthquake.
The infection is not transmitted person to person and is caused by the fungus Coccidioides immitis,
which is found in soil in certain semiarid areas of North and South America. This outbreak was
associated with exposure to increased levels of airborne dust subsequent to landslides in the aftermath
of the earthquake (39).
Disaster-Related Interruption of Services
Power cuts related to disasters may disrupt water treatment and supply plants, thereby increasing the
risk for waterborne diseases. Lack of power may also affect proper functioning of health facilities,
including preservation of the vaccine cold chain. An increase in diarrheal illness in New York City
followed a massive power outage in 2003. The blackout left 9 million people in the area without power
for several hours to 2 days. Diarrhea cases were widely dispersed and detected by using nontraditional
surveillance techniques. A case-control study performed as part of the outbreak investigation linked
diarrheal illness with the consumption of meat and seafood after the onset of the power outage, when
refrigeration facilities were widely interrupted (40).
Discussion
Historically, fears of major disease outbreaks in the aftermath of natural disasters have shaped the
perceptions of the public and policymakers. These expectations, misinformed by associations of disease
with dead bodies, can create fear and panic in the affected population and lead to confusion in the
media and elsewhere.
The risk for outbreaks after natural disasters is low, particularly when the disaster does not result in
substantial population displacement. Communicable diseases are common in displaced populations that
have poor access to basic needs such as safe water and sanitation, adequate shelter, and primary
healthcare services. These conditions, many favorable for disease transmission, must be addressed
immediately with the rapid reinstatement of basic services. Assuring access to safe water and primary
healthcare services is crucial, as are surveillance and early warning to detect epidemic-prone diseases
known to occur in the disaster-affected area. A comprehensive communicable disease risk assessment
can determine priority diseases for inclusion in the surveillance system and prioritize the need for
immunization and vector-control campaigns. Five basic steps that can reduce the risk for communicable
disease transmission in populations affected by natural disasters are summarized in an (Appendix Table).
Disaster-related deaths are overwhelmingly caused by the initial traumatic impact of the event. Disaster-
preparedness plans, appropriately focused on trauma and mass casualty management, should also take
into account the health needs of the surviving disaster-affected populations. The health effects
associated with the sudden crowding of large numbers of survivors, often with inadequate access to
safe water and sanitation facilities, will require planning for both therapeutic and preventive
interventions, such as the rapid delivery of safe water and the provision of rehydration materials,
antimicrobial agents, and measles vaccination materials.
Surveillance in areas affected by disasters is fundamental to understanding the impact of natural

disasters on communicable disease illness and death. Obtaining relevant surveillance information in
these contexts, however, is frequently challenging. The destruction of the preexisting public health
infrastructure can aggravate (or eliminate) what may have been weak predisaster systems of
surveillance and response. Surveillance officers and public health workers may be killed or missing, as in
Aceh in 2004. Population displacement can distort census information, which makes the calculation of
rates for comparison difficult. Healthcare during the emergency phase is often delivered by a wide range
of national and international actors, which creates coordination challenges. Also, a lack of predisaster
baseline surveillance information can lead to difficulties in accurately differentiating epidemic from
background endemic disease transmission.
Although postdisaster surveillance systems are designed to rapidly detect cases of epidemic-prone
diseases, interpreting this information can be hampered by the absence of baseline surveillance data
and accurate denominator values. Detecting cases of diseases that occur endemically may be
interpreted (because of absence of background data) as an early epidemic. The priority in these settings,
however, is rapid implementation of control measures when cases of epidemic-prone diseases are
detected. Despite these challenges, continued detection of and response to communicable diseases are
essential to monitor the incidence of diseases, to document their effect, to respond with control
measures when needed, and to better quantify the risk for outbreaks after disasters.
Supplementary Material
Appendix Table:
Priority measures to reduce the risk for communicable diseases after natural disasters
Click here to view.(18K, pdf)

Acknowledgments
We thank Pamela Mbabazi, Jorge Castilla, Andre Griekspoor, José Hueb, Dominique Legros, David
Meddings, Mike Nathan, Aafje Rietveld, and Peter Strebel for their support and assistance with the
preparation of this manuscript.
Biography
Dr Watson is a medical epidemiologist with the Disease Control in Emergencies Program at the World
Health Organization in Geneva. The program provides technical and operational support for control of
communicable diseases in humanitarian emergencies.
Footnotes
Suggested citation for this article: Watson JT, Gayer M, Connolly MA. Epidemics after natural disasters.
Emerg Infect Dis [serial on the Internet]. 2007 Jan [date cited]. Available from
http://www.cdc.gov/ncidod/EID/13/1/1.htm
Article information
Emerg Infect Dis. 2007 Jan; 13(1): 1–5.
doi: 10.3201/eid1301.060779
PMCID: PMC2725828
PMID: 17370508
John T. Watson,corresponding author* Michelle Gayer,* and Maire A. Connolly*
*World Health Organization, Geneva, Switzerland
corresponding authorCorresponding author.
Address for correspondence: John T Watson, Disease Control in Humanitarian Emergencies,

Communicable Diseases Cluster, World Health Organization, 1211 Geneva, Switzerland; email:
tni.ohw@jnostaw
Copyright notice
This article has been cited by other articles in PMC.

Articles from Emerging Infectious Diseases are provided here courtesy of Centers for Disease Control
and Prevention
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Epidemi setelah Bencana Alam
Abstrak
Hubungan antara bencana alam dan penyakit menular sering disalahartikan. Risiko wabah sering
dianggap sangat tinggi dalam kekacauan yang terjadi setelah bencana alam, rasa takut yang
kemungkinan besar berasal dari hubungan yang dirasakan antara mayat dan epidemi. Namun, faktor
risiko untuk wabah setelah bencana dikaitkan terutama dengan perpindahan penduduk. Ketersediaan
air bersih dan fasilitas sanitasi, tingkat kepadatan, status kesehatan yang mendasari populasi, dan
ketersediaan layanan kesehatan semuanya berinteraksi dalam konteks ekologi penyakit lokal untuk
mempengaruhi risiko penyakit menular dan kematian pada orang yang terkena dampak. populasi. Kami
menguraikan faktor risiko untuk wabah setelah bencana, meninjau penyakit menular yang mungkin
penting, dan menetapkan prioritas untuk mengatasi penyakit menular dalam pengaturan bencana.
Kata kunci: Bencana, epidemiologi, wabah, surveilans, penilaian risiko, penyakit menular, perspektif
Bencana alam adalah peristiwa bencana dengan asal atmosfer, geologi, dan hidrologi. Bencana termasuk
gempa bumi, letusan gunung berapi, tanah longsor, tsunami, banjir, dan kekeringan. Bencana alam
dapat memiliki onset yang cepat atau lambat, dengan konsekuensi kesehatan, sosial, dan ekonomi yang
serius. Selama 2 dekade terakhir, bencana alam telah menewaskan jutaan orang, berdampak buruk
terhadap kehidupan setidaknya 1 miliar orang, dan mengakibatkan kerusakan ekonomi yang substansial
(1). Negara-negara berkembang terkena dampak yang tidak proporsional karena mereka kekurangan
sumber daya, infrastruktur, dan sistem kesiapsiagaan bencana.
Kematian yang terkait dengan bencana alam, khususnya bencana yang timbul cepat, sebagian besar
disebabkan oleh trauma tumpul, cedera yang berkaitan dengan himpitan, atau tenggelam. Kematian
akibat penyakit menular setelah bencana alam jarang terjadi.
Mayat dan Penyakit
Kehadiran tiba-tiba sejumlah besar mayat di daerah yang terkena bencana dapat meningkatkan
kekhawatiran wabah penyakit (2), meskipun tidak ada bukti bahwa mayat menimbulkan risiko epidemi
setelah bencana alam (3). Ketika kematian secara langsung disebabkan oleh bencana alam, sisa-sisa
manusia tidak menimbulkan risiko wabah (4). Mayat hanya menimbulkan risiko kesehatan dalam
beberapa situasi yang memerlukan tindakan pencegahan khusus, seperti kematian akibat kolera (5) atau
demam berdarah (6). Rekomendasi untuk pengelolaan jenazah dirangkum dalam Tabel.
Tabel
Prinsip-prinsip untuk pengelolaan mayat *
• Pengelolaan massal mayat sering didasarkan pada kepercayaan keliru bahwa mereka mewakili bahaya
epidemi jika tidak segera dikubur atau dibakar.
• Pemakaman lebih disukai daripada kremasi dalam situasi korban massal.
• Setiap upaya harus dilakukan untuk mengidentifikasi mayat. Pemakaman massal harus dihindari jika
memungkinkan.
• Keluarga harus memiliki kesempatan (dan akses ke bahan) untuk melakukan pemakaman dan
pemakaman yang sesuai dengan budaya sesuai dengan kebiasaan sosial.
• Jika fasilitas yang ada seperti kuburan atau krematori tidak memadai, lokasi atau fasilitas alternatif
harus disediakan.
• Untuk pekerja yang secara rutin menangani badan, pastikan
• Tindakan pencegahan universal untuk darah dan cairan tubuh
• Gunakan dan perbaiki sarung tangan dengan benar
• Gunakan kantong mayat jika tersedia

• Mencuci tangan dengan sabun setelah memegang tubuh dan sebelum makan
• Desinfeksi kendaraan dan peralatan
• Badan tidak perlu disinfeksi sebelum dibuang (kecuali dalam kasus kolera, shigellosis, atau demam
berdarah)
• Dasar dari setiap kuburan adalah> 1,5 m di atas muka air, dengan zona tak jenuh 0,7 m
* Diadaptasi dari Morgan (3).
Prinsip-prinsip untuk pengelolaan mayat *Terlepas dari fakta-fakta ini, risiko wabah setelah bencana
sering kali dibesar-besarkan oleh pejabat kesehatan dan media. Ancaman epidemi yang akan terjadi
tetap menjadi tema berulang dari laporan media dari daerah yang baru-baru ini terkena bencana,
terlepas dari upaya untuk menghilangkan mitos-mitos ini (2,3,7).Perpindahan: Kepedulian UtamaRisiko
penularan penyakit menular setelah bencana dikaitkan terutama dengan ukuran dan karakteristik
populasi yang dipindahkan, khususnya kedekatan air yang aman dan jamban yang berfungsi, status gizi
dari populasi yang dipindahkan, tingkat kekebalan terhadap penyakit yang dapat dicegah dengan vaksin
seperti campak, dan akses ke layanan kesehatan (8). Wabah lebih jarang dilaporkan pada populasi yang
terkena dampak bencana daripada populasi yang terkena dampak konflik, di mana dua pertiga kematian
mungkin disebabkan oleh penyakit menular (9). Malnutrisi meningkatkan risiko kematian akibat
penyakit menular dan lebih sering terjadi pada populasi yang terpengaruh konflik, terutama jika
perpindahan mereka terkait dengan konflik jangka panjang (10).Meskipun wabah setelah banjir (11)
telah didokumentasikan dengan lebih baik daripada yang setelah gempa bumi, letusan gunung berapi,
atau tsunami (12), bencana alam (terlepas dari jenisnya) yang tidak mengakibatkan perpindahan
penduduk jarang dikaitkan dengan wabah (8). Secara historis, perpindahan populasi dalam skala besar
sebagai akibat dari bencana alam tidak umum terjadi (8), yang kemungkinan berkontribusi pada risiko
rendah untuk wabah secara keseluruhan dan pada variabilitas risiko di antara bencana dari berbagai
jenis.Faktor Risiko untuk Penularan Penyakit MenularMenanggapi secara efektif kebutuhan populasi
yang terkena bencana memerlukan penilaian risiko penyakit menular yang akurat. Penggunaan dana
kemanusiaan yang efisien tergantung pada pelaksanaan intervensi prioritas berdasarkan penilaian risiko
ini.Evaluasi yang sistematis dan komprehensif harus mengidentifikasi 1) penyakit endemik dan epidemi
yang umum di daerah yang terkena dampak; 2) kondisi kehidupan populasi yang terkena dampak,
termasuk jumlah, ukuran, lokasi, dan kepadatan permukiman; 3) ketersediaan air bersih dan fasilitas
sanitasi yang memadai; 4) status gizi dasar dan cakupan imunisasi di antara populasi; dan 5) tingkat
akses ke layanan kesehatan dan manajemen kasus yang efektif.Penyakit Menular yang Terkait dengan
Bencana AlamJenis penyakit menular berikut ini telah dikaitkan dengan populasi yang mengungsi akibat
bencana alam. Penyakit-penyakit ini harus dipertimbangkan ketika penilaian risiko pascabencana
dilakukan.Penyakit Menular terkait AirAkses ke air yang aman dapat terancam oleh bencana alam.
Wabah penyakit diare dapat terjadi setelah air minum terkontaminasi dan telah dilaporkan setelah
banjir dan perpindahan terkait. Wabah penyakit diare setelah banjir di Bangladesh pada tahun 2004
melibatkan> 17.000 kasus; Vibrio cholerae (O1 Ogawa dan O1 Inaba) dan enterotoksigenik Escherichia
coli diisolasi (13). Epidemi kolera yang besar (> 16.000) (O1 Ogawa) di Benggala Barat pada tahun 1998
disebabkan oleh banjir sebelumnya (14), dan banjir di Mozambik pada Januari-Maret 2000
menyebabkan peningkatan kejadian diare (15).Dalam sebuah penelitian besar yang dilakukan di
Indonesia pada tahun 1992-1993, banjir diidentifikasi sebagai faktor risiko yang signifikan untuk penyakit
diare yang disebabkan oleh Salmonella enterica serotipe Paratyphi A (demam paratyphoid) (16). Dalam
evaluasi terpisah dari faktor-faktor risiko untuk infeksi Cryptosporidium parvum di Indonesia pada tahun
2001-2003, pasien kasus lebih besar kemungkinannya dibandingkan kontrol untuk terkena banjir
(17).Risiko wabah penyakit diare setelah bencana alam lebih tinggi di negara-negara berkembang
daripada di negara-negara industri (8,11). Di Provinsi Aceh, Indonesia, penilaian kesehatan cepat di kota
Calang 2 minggu setelah tsunami Desember 2004 menemukan bahwa 100% korban selamat minum dari
sumur yang tidak terlindungi dan bahwa 85% penduduk melaporkan diare dalam 2 minggu sebelumnya
(18). Di Muzaffarabad, Pakistan, wabah diare berair akut terjadi di sebuah kamp yang tidak terencana
dan tidak lengkap dengan 1.800 orang setelah gempa bumi tahun 2005. Wabah ini melibatkan> 750
kasus, kebanyakan pada orang dewasa, dan dikendalikan setelah fasilitas air dan sanitasi yang memadai
disediakan (19). Di Amerika Serikat, penyakit diare tercatat setelah Hurricanes Allison (20) dan Katrina
(21-23), dan norovirus, Salmonella, dan V. cholerae toksigenik dan nontoksigenik dikonfirmasi di antara
para pengungsi Katrina.Hepatitis A dan E juga ditularkan melalui rute fecal-oral, terkait dengan
kurangnya akses ke air bersih dan sanitasi. Hepatitis A bersifat endemik di sebagian besar negara
berkembang, dan sebagian besar anak terpapar dan mengembangkan kekebalan pada usia dini.
Akibatnya, risiko untuk wabah besar biasanya rendah di pengaturan ini. Di daerah endemis hepatitis E,
wabah sering terjadi
Di daerah endemis hepatitis E, wabah sering terjadi setelah hujan lebat dan banjir; penyakitnya
umumnya ringan dan sembuh sendiri, tetapi pada wanita hamil tingkat fatalitas kasus dapat mencapai
25% (24). Setelah gempa bumi tahun 2005 di Pakistan, kasus dan kluster hepatitis E sporadis umum
terjadi di daerah dengan akses air bersih yang buruk. Lebih dari 1.200 kasus penyakit kuning akut,
banyak yang dikonfirmasi sebagai hepatitis E, terjadi di antara pengungsi (25). Cluster hepatitis A dan
hepatitis E tercatat di Aceh setelah tsunami Desember 2004 (26).Leptospirosis adalah penyakit bakteri
zoonosis yang rentan terhadap epidemi yang dapat ditularkan melalui kontak langsung dengan air yang
terkontaminasi. Hewan pengerat mengeluarkan banyak leptospira dalam urin mereka, dan penularan
terjadi melalui kontak kulit dan selaput lendir dengan air, tanah lembab atau tumbuh-tumbuhan (seperti
tebu), atau lumpur yang terkontaminasi dengan urin hewan pengerat. Banjir memfasilitasi penyebaran
organisme karena proliferasi hewan pengerat dan kedekatan hewan pengerat dengan manusia di
dataran tinggi bersama. Wabah leptospirosis terjadi di Taiwan, Republik Cina, terkait dengan Topan Nali
pada tahun 2001 (27); di Mumbai, India, setelah banjir pada tahun 2000 (28); di Argentina setelah banjir
pada tahun 1998 (29); dan di wilayah Krasnodar Federasi Rusia pada tahun 1997 (30). Setelah wabah
terkait leptospirosis yang terkait dengan banjir di Brasil pada tahun 1996, analisis spasial menunjukkan
bahwa tingkat kejadian leptospirosis berlipat dua di dalam wilayah rawan banjir di Rio de Janeiro
(31).Penyakit Terkait dengan CrowdingKerumunan biasa terjadi pada populasi yang mengungsi akibat
bencana alam dan dapat memfasilitasi penularan penyakit menular. Campak dan risiko penularan
setelah bencana alam tergantung pada cakupan imunisasi dasar di antara populasi yang terkena dampak,
dan khususnya di antara anak-anak <15 tahun. Kondisi hidup yang padat memfasilitasi penularan
campak dan bahkan memerlukan tingkat cakupan imunisasi yang lebih tinggi untuk mencegah wabah
(32). Wabah campak di Filipina pada tahun 1991 di antara orang-orang terlantar akibat letusan Mt.
Pinatubo melibatkan> 18.000 kasus (33). Setelah tsunami di Aceh, sekelompok campak yang melibatkan
35 kasus terjadi di kabupaten Aceh Utara, dan kasus sporadis dan cluster yang terus-menerus adalah
umum terjadi meskipun ada kampanye vaksinasi massal (26). Di Pakistan, setelah gempa bumi Asia
Selatan 2005, kasus sporadis dan kelompok campak (> 400 kasus klinis dalam 6 bulan setelah gempa
bumi) juga terjadi (25).Meningitis Neisseria meningitidis ditularkan dari orang ke orang, terutama dalam
situasi berkerumun. Kasus dan kematian akibat meningitis di antara mereka yang mengungsi di Aceh
dan Pakistan telah didokumentasikan (25,26). Respons segera dengan profilaksis antimikroba, seperti
yang terjadi di Aceh dan Pakistan, dapat mengganggu transmisi. Wabah besar belum dilaporkan baru-
baru ini pada populasi yang terkena bencana tetapi didokumentasikan dengan baik pada populasi yang
dipindahkan oleh konflik (34).Infeksi saluran pernafasan akut (ISPA) adalah penyebab utama penyakit
dan kematian di antara populasi pengungsi, terutama pada anak-anak <5 tahun. Kurangnya akses ke
layanan kesehatan dan agen antimikroba untuk perawatan semakin meningkatkan risiko kematian
akibat ISPA. Faktor-faktor risiko di antara para pengungsi termasuk crowding, paparan terhadap
memasak di dalam ruangan menggunakan api terbuka, dan nutrisi yang buruk. Insiden ARI yang
dilaporkan meningkat 4 kali lipat di Nikaragua dalam 30 hari setelah Badai Mitch pada tahun 1998 (35),
dan ARI merupakan jumlah kasus dan kematian tertinggi di antara mereka yang kehilangan tempat
tinggal akibat tsunami di Aceh pada tahun 2004 (26) dan oleh gempa 2005 di Pakistan (25).Penyakit
vectorborneBencana alam, terutama peristiwa meteorologis seperti topan, badai, dan banjir, dapat
memengaruhi situs pemuliaan vektor dan penularan penyakit melalui vektor. Sementara banjir awal
mungkin menghanyutkan tempat-tempat perkembangbiakan nyamuk yang ada, genangan air yang
disebabkan oleh curah hujan yang tinggi atau meluapnya sungai-sungai dapat menciptakan tempat-
tempat berkembang biak baru. Situasi ini dapat mengakibatkan (dengan penundaan beberapa minggu)
dalam peningkatan populasi vektor dan potensi penularan penyakit, tergantung pada spesies vektor
nyamuk lokal dan habitat yang disukai. Kerumunan host yang terinfeksi dan rentan, infrastruktur
kesehatan masyarakat yang lemah, dan gangguan dari program pengendalian yang sedang berlangsung
adalah semua faktor risiko untuk penularan penyakit yang ditularkan melalui vektor (36).Wabah malaria
setelah banjir adalah fenomena yang terkenal. Gempa bumi di Wilayah Atlantik Kosta Rika pada tahun
1991 dikaitkan dengan perubahan habitat yang bermanfaat untuk berkembang biak dan mendahului
peningkatan kasus malaria yang ekstrem (37). Selain itu, banjir periodik yang dikaitkan dengan El Niño-
Osilasi Selatan telah dikaitkan dengan epidemi malaria di wilayah pesisir kering Peru utara (38).
Penularan demam berdarah dipengaruhi oleh kondisi meteorologi, termasuk curah hujan dan
kelembaban, dan sering menunjukkan musim yang kuat. Namun, transmisi tidak secara langsung
dikaitkan dengan banjir. Peristiwa semacam itu mungkin bertepatan dengan periode-periode risiko
tinggi untuk penularan dan dapat diperburuk oleh peningkatan ketersediaan tempat-tempat pemuliaan
vektor (kebanyakan wadah buatan) yang disebabkan oleh gangguan pasokan air dasar dan layanan
pembuangan limbah padat. Risiko wabah dapat dipengaruhi oleh faktor-faktor rumit lainnya, seperti
perubahan perilaku manusia (peningkatan paparan nyamuk saat tidur di luar, perpindahan dari daerah
dengue-nonendemik ke-endemik, jeda dalam kegiatan pengendalian penyakit, kepadatan penduduk)
atau perubahan dalam habitat yang mempromosikan perkembangbiakan nyamuk (tanah longsor,
deforestasi, perusakan sungai, dan pengalihan rute air).Penyakit Lain yang Terkait dengan Bencana
AlamTetanus bukan ditularkan dari orang ke orang tetapi disebabkan oleh racun yang dilepaskan oleh
anaerob tetanus bacillus Clostridium tetani. Luka yang terkontaminasi, terutama pada populasi di mana
tingkat cakupan vaksinasi rendah, berhubungan dengan penyakit dan kematian akibat tetanus.
Sekelompok 106 kasus tetanus, termasuk 20 kematian, terjadi di Aceh dan memuncak 2-1 / 2 minggu
setelah tsunami (26). Kasus-kasus juga dilaporkan di Pakistan setelah gempa bumi tahun 2005
(25).Wabah coccidiomycosis yang tidak biasa terjadi setelah gempa bumi California Selatan Januari 1994.
Infeksi ini tidak menular dari orang ke orang dan disebabkan oleh jamur Coccidioides immitis, yang
ditemukan di tanah di daerah semi kering tertentu di Amerika Utara dan Selatan. Wabah ini dikaitkan
dengan paparan peningkatan kadar debu di udara setelah tanah longsor setelah gempa bumi
(39).Gangguan Layanan Terkait BencanaPemadaman listrik yang terkait dengan bencana dapat
mengganggu pengolahan air dan memasok pabrik, sehingga meningkatkan risiko penyakit yang
ditularkan melalui air. Kurangnya daya juga dapat mempengaruhi berfungsinya fasilitas kesehatan,
termasuk pelestarian rantai dingin vaksin. Peningkatan penyakit diare di New York City mengikuti
pemadaman listrik besar-besaran pada tahun 2003. Pemadaman listrik menyebabkan 9 juta orang di
daerah itu tidak memiliki listrik selama beberapa jam hingga 2 hari. Kasus diare tersebar luas dan
terdeteksi dengan menggunakan teknik pengawasan nontradisional. Sebuah studi kasus-kontrol
dilakukan sebagai bagian dari penyelidikan wabah terkait penyakit diare dengan konsumsi daging dan
makanan laut setelah dimulainya pemadaman listrik, ketika fasilitas pendingin terganggu secara luas
(40).
Diskusi
Secara historis, kekhawatiran wabah penyakit besar setelah bencana alam telah membentuk persepsi
masyarakat dan pembuat kebijakan. Harapan-harapan ini, salah informasi oleh asosiasi penyakit dengan
mayat, dapat menciptakan ketakutan dan kepanikan pada populasi yang terkena dampak dan
menyebabkan kebingungan di media dan di tempat lain.Risiko wabah setelah bencana alam rendah,
terutama ketika bencana tidak mengakibatkan perpindahan populasi yang besar. Penyakit menular
sering terjadi pada populasi pengungsi yang memiliki akses yang buruk ke kebutuhan dasar seperti air
bersih dan sanitasi, tempat tinggal yang memadai, dan layanan kesehatan primer. Kondisi-kondisi ini,
yang banyak menguntungkan untuk penularan penyakit, harus segera ditangani dengan pemulihan
cepat layanan dasar. Memastikan akses ke air bersih dan layanan kesehatan primer sangat penting,
demikian juga pengawasan dan peringatan dini untuk mendeteksi penyakit rawan epidemi yang
diketahui terjadi di daerah yang terkena bencana. Penilaian risiko penyakit menular yang komprehensif
dapat menentukan penyakit prioritas untuk dimasukkan dalam sistem pengawasan dan
memprioritaskan kebutuhan untuk imunisasi dan kampanye pengendalian vektor. Lima langkah dasar
yang dapat mengurangi risiko penularan penyakit menular pada populasi yang terkena bencana alam
dirangkum dalam (Tabel Lampiran).
Kematian terkait bencana sangat disebabkan oleh dampak traumatis awal dari peristiwa tersebut.
Rencana kesiapsiagaan bencana, dengan fokus yang tepat pada trauma dan manajemen korban massal,
juga harus mempertimbangkan kebutuhan kesehatan dari populasi yang selamat dari bencana yang
selamat. Efek kesehatan yang terkait dengan kerumunan tiba-tiba dari sejumlah besar korban, seringkali
dengan akses yang tidak memadai ke air bersih dan fasilitas sanitasi, akan memerlukan perencanaan
untuk intervensi terapeutik dan pencegahan, seperti pengiriman cepat air yang aman dan penyediaan
bahan rehidrasi, agen antimikroba, dan bahan vaksinasi campak.Pengawasan di daerah-daerah yang
terkena dampak bencana merupakan hal mendasar untuk memahami dampak bencana alam terhadap
penyakit dan kematian akibat penyakit menular. Namun, mendapatkan informasi pengawasan yang
relevan dalam konteks ini sering kali menantang.
Penghancuran infrastruktur kesehatan publik yang sudah ada sebelumnya dapat memperburuk (atau
menghilangkan) apa yang mungkin merupakan sistem pengawasan dan tanggapan predisaster yang
lemah. Petugas survailen dan petugas kesehatan masyarakat dapat terbunuh atau hilang, seperti di Aceh
pada tahun 2004. Pemindahan penduduk dapat mengubah informasi sensus, yang mempersulit
perhitungan angka perbandingan. Perawatan kesehatan selama fase darurat sering disampaikan oleh
berbagai aktor nasional dan internasional, yang menciptakan tantangan koordinasi. Juga, kurangnya
informasi pengawasan baseline predisaster dapat menyebabkan kesulitan dalam membedakan epidemi
secara akurat dari penularan penyakit endemik latar belakang.
Meskipun sistem surveilans pascabencana dirancang untuk secara cepat mendeteksi kasus-kasus
penyakit yang rentan terhadap epidemi, menafsirkan informasi ini dapat terhambat oleh tidak adanya
data pengawasan dasar dan nilai-nilai penyebut yang akurat. Mendeteksi kasus penyakit yang terjadi
secara endemis dapat ditafsirkan (karena tidak adanya data latar belakang) sebagai epidemi awal.
Prioritas dalam pengaturan ini, bagaimanapun, adalah implementasi yang cepat dari tindakan
pengendalian ketika kasus-kasus penyakit yang rentan terhadap epidemi terdeteksi. Terlepas dari
tantangan-tantangan ini, deteksi dan respons berkelanjutan terhadap penyakit menular sangat penting
untuk memantau timbulnya penyakit, untuk mendokumentasikan efeknya, untuk merespons dengan
langkah-langkah pengendalian bila diperlukan, dan untuk mengukur risiko wabah setelah bencana
dengan lebih baik.
Materi tambahan
Tabel Lampiran:
Langkah-langkah prioritas untuk mengurangi risiko penyakit menular setelah bencana alam
Klik di sini untuk melihat. (18K, pdf)
Ucapan Terima Kasih

Kami berterima kasih kepada Pamela Mbabazi, Jorge Castilla, Andre Griekspoor, José Hueb, Dominique
Legros, David Meddings, Mike Nathan, Aafje Rietveld, dan Peter Strebel atas dukungan dan bantuan
mereka dengan persiapan naskah ini.
Biografi
Dr Watson adalah ahli epidemiologi medis dengan Program Pengendalian Penyakit dalam Keadaan
Darurat di Organisasi Kesehatan Dunia di Jenewa. Program ini menyediakan dukungan teknis dan
operasional untuk pengendalian penyakit menular dalam keadaan darurat kemanusiaan.
Catatan kaki
Kutipan yang disarankan untuk artikel ini: Watson JT, Gayer M, Connolly MA. Epidemi setelah bencana
alam. Emerg Infect Dis [serial di Internet]. 2007 Jan [tanggal dikutip]. Tersedia dari
http://www.cdc.gov/ncidod/EID/13/1/1.htm
Informasi artikel
Emerg Infect Dis. 2007 Jan; 13 (1): 1–5.
doi: 10.3201 / eid1301.060779
PMCID: PMC2725828
PMID: 17370508
John T. Watson, penulis yang sesuai * Michelle Gayer, * dan Maire A. Connolly *
* Organisasi Kesehatan Dunia, Jenewa, Swiss
author yang sesuai. Penulis yang sesuai.
Alamat korespondensi: John T Watson, Pengendalian Penyakit dalam Keadaan Darurat Kemanusiaan,
Cluster Penyakit Menular, Organisasi Kesehatan Dunia, 1211 Jenewa, Swiss; email: tni.ohw@jnostaw
Pemberitahuan hak cipta
Artikel ini telah dikutip oleh artikel lain di PMC.
Artikel-artikel dari Emerging Infectious Diseases disediakan di sini atas izin Pusat Pengendalian dan
Pencegahan Penyakit
Preventing and controlling infectious diseases after natural disasters
Mencegah dan mengendalikan penyakit menular setelah bencana alam
Beyond damaging and destroying physical infrastructure, natural disasters can lead to outbreaks of
infectious disease. In this article, two UNU-IIGH researchers and colleagues review risk factors and
potential infectious diseases resulting from the secondary effects of major natural disasters that
occurred from 2000 to 2011, classify possible diseases, and give recommendations on prevention,
control measures and primary healthcare delivery improvements.
♦♦♦
Over the past few decades, the incidence and magnitude of natural disasters has grown, resulting in
substantial economic damages and affecting or killing millions of people. Recent disasters have shown
that even the most developed countries are vulnerable to natural disasters, such as Hurricane Katrina in
the United States in 2005 and the Great Eastern Japan Earthquake and tsunami in 2011. Global
population growth, poverty, land shortages and urbanization in many countries have increased the
number of people living in areas prone to natural disasters and multiplied the public health impacts.
Natural disasters can be split in three categories: hydro-meteorological disasters, geophysical disasters
and geomorphologic disasters.
Hydro-meteorological disasters, like floods, are the most common (40 percent) natural disasters
worldwide and are widely documented. The public health consequences of flooding are disease
outbreaks mostly resulting from the displacement of people into overcrowded camps and cross-
contamination of water sources with faecal material and toxic chemicals. Flooding also is usually
followed by the proliferation of mosquitoes, resulting in an upsurgence of mosquito-borne diseases such
as malaria. Documentation of disease outbreaks and the public health after-effects of tropical cyclones
(hurricanes and typhoons) and tornadoes, however, is lacking.
Geophysical disasters are the second-most reported type of natural disaster, and earthquakes are the
majority of disasters in this category. Outbreaks of infectious diseases may be reported when
earthquake disasters result in substantial population displacement into unplanned and overcrowded
shelters, with limited access to food and safe water. Disease outbreaks may also result from the
destruction of water/sanitation systems and the degradation of sanitary conditions directly caused by
the earthquake. Tsunamis are commonly associated with earthquakes, but can also be caused by
powerful volcanic eruptions or underwater landslides. Although classified as geophysical disasters, they
have a similar clinical and threat profile (water-related consequences) to that of tropical cyclones (e.g.,
typhoon or hurricane).
Geomorphologic disasters, such as avalanches and landslides, also are associated with infectious disease
transmissions and outbreaks, but documentation is generally lacking.
Beyond damaging and destroying physical infrastructure, natural disasters can lead to outbreaks of
infectious disease. In this article, two UNU-IIGH researchers and colleagues review risk factors and
potential infectious diseases resulting from the secondary effects of major natural disasters that
occurred from 2000 to 2011, classify possible diseases, and give recommendations on prevention,
control measures and primary healthcare delivery improvements.
♦♦♦
Over the past few decades, the incidence and magnitude of natural disasters has grown, resulting in
substantial economic damages and affecting or killing millions of people. Recent disasters have shown
that even the most developed countries are vulnerable to natural disasters, such as Hurricane Katrina in
the United States in 2005 and the Great Eastern Japan Earthquake and tsunami in 2011. Global
population growth, poverty, land shortages and urbanization in many countries have increased the
number of people living in areas prone to natural disasters and multiplied the public health impacts.
Natural disasters can be split in three categories: hydro-meteorological disasters, geophysical disasters
and geomorphologic disasters.
Hydro-meteorological disasters, like floods, are the most common (40 percent) natural disasters
worldwide and are widely documented. The public health consequences of flooding are disease
outbreaks mostly resulting from the displacement of people into overcrowded camps and cross-
contamination of water sources with faecal material and toxic chemicals. Flooding also is usually
followed by the proliferation of mosquitoes, resulting in an upsurgence of mosquito-borne diseases such
as malaria. Documentation of disease outbreaks and the public health after-effects of tropical cyclones
(hurricanes and typhoons) and tornadoes, however, is lacking.
Geophysical disasters are the second-most reported type of natural disaster, and earthquakes are the
majority of disasters in this category. Outbreaks of infectious diseases may be reported when
earthquake disasters result in substantial population displacement into unplanned and overcrowded
shelters, with limited access to food and safe water. Disease outbreaks may also result from the
destruction of water/sanitation systems and the degradation of sanitary conditions directly caused by
the earthquake. Tsunamis are commonly associated with earthquakes, but can also be caused by
powerful volcanic eruptions or underwater landslides. Although classified as geophysical disasters, they
have a similar clinical and threat profile (water-related consequences) to that of tropical cyclones (e.g.,
typhoon or hurricane).
Geomorphologic disasters, such as avalanches and landslides, also are associated with infectious disease
transmissions and outbreaks, but documentation is generally lacking.
Selain merusak dan menghancurkan infrastruktur fisik, bencana alam dapat menyebabkan berjangkitnya
penyakit menular. Dalam artikel ini, dua peneliti dan rekan UNU-IIGH meninjau faktor risiko dan
penyakit menular potensial yang dihasilkan dari efek sekunder dari bencana alam besar yang terjadi dari
tahun 2000 hingga 2011, mengklasifikasikan kemungkinan penyakit, dan memberikan rekomendasi
tentang pencegahan, tindakan pengendalian, dan pemberian layanan kesehatan primer perbaikan.
♦♦♦
Selama beberapa dekade terakhir, insiden dan besarnya bencana alam telah berkembang, menghasilkan
kerusakan ekonomi yang substansial dan mempengaruhi atau membunuh jutaan orang. Bencana baru-
baru ini menunjukkan bahwa bahkan negara-negara yang paling maju pun rentan terhadap bencana
alam, seperti Badai Katrina di Amerika Serikat pada 2005 dan Gempa Bumi dan Tsunami Jepang Timur
Besar pada 2011. Pertumbuhan populasi global, kemiskinan, kekurangan lahan, dan urbanisasi di banyak
negara telah meningkatkan jumlah orang yang tinggal di daerah rawan bencana alam dan
melipatgandakan dampak kesehatan masyarakat.
Bencana alam dapat dibagi menjadi tiga kategori: bencana hidro-meteorologi, bencana geofisika dan
bencana geomorfologi.
Bencana hidro-meteorologi, seperti banjir, adalah bencana alam yang paling umum (40 persen) di
seluruh dunia dan didokumentasikan secara luas. Konsekuensi kesehatan masyarakat akibat banjir
adalah wabah penyakit yang sebagian besar disebabkan oleh perpindahan orang ke kamp-kamp yang
penuh sesak dan kontaminasi silang dari sumber air dengan bahan feses dan bahan kimia beracun.
Banjir juga biasanya diikuti oleh perkembangbiakan nyamuk, yang berakibat pada meningkatnya
penyakit yang ditularkan oleh nyamuk seperti malaria. Dokumentasi wabah penyakit dan kesehatan
masyarakat setelah efek siklon tropis (angin topan dan topan) dan tornado, bagaimanapun, masih
kurang.
Bencana geofisika adalah jenis bencana alam yang paling banyak dilaporkan kedua, dan gempa bumi
adalah sebagian besar bencana dalam kategori ini. Wabah penyakit menular dapat dilaporkan ketika
bencana gempa bumi mengakibatkan perpindahan penduduk dalam jumlah besar ke tempat
penampungan yang tidak direncanakan dan penuh sesak, dengan akses terbatas ke makanan dan air
bersih. Wabah penyakit juga dapat disebabkan oleh rusaknya sistem air / sanitasi dan penurunan kondisi
sanitasi yang secara langsung disebabkan oleh gempa bumi. Tsunami umumnya dikaitkan dengan gempa
bumi, tetapi juga dapat disebabkan oleh letusan gunung berapi yang kuat atau tanah longsor di bawah
air. Meskipun diklasifikasikan sebagai bencana geofisika, mereka memiliki profil klinis dan ancaman yang
serupa (konsekuensi terkait air) dengan siklon tropis (mis., Topan atau badai).
Bencana geomorfologis, seperti longsoran dan tanah longsor, juga terkait dengan penularan dan
penyebaran penyakit menular, tetapi dokumentasi umumnya kurang.
After a natural disaster

The overwhelming majority of deaths immediately after a natural disaster are directly associated with
blunt trauma, crush-related injuries and burn injuries. The risk of infectious disease outbreaks in the
aftermath of natural disasters has usually been overemphasized by health officials and the media,
leading to panic, confusion and sometimes to unnecessary public health activities.
The prolonged health impact of natural disasters on a community may be the consequence of the
collapse of health facilities and healthcare systems, the disruption of surveillance and health
programmes (immunization and vector control programmes), the limitation or destruction of farming
activities (scarcity of food/food insecurity), or the interruption of ongoing treatments and use of
unprescribed medications.
The risk factors for increased infectious diseases transmission and outbreaks are mainly associated with
the after-effects of the disasters rather than to the primary disaster itself or to the corpses of those
killed. These after-effects include displacement of populations (internally displaced persons and
refugees), environmental changes and increased vector breeding sites. Unplanned and overcrowded
shelters, poor water and sanitation conditions, poor nutritional status or insufficient personal hygiene
are often the case. Consequently, there are low levels of immunity to vaccine-preventable diseases, or
insufficient vaccination coverage and limited access to health care services.
Phases of outbreak and classification of infectious disease
Infectious disease transmission or outbreaks may be seen days, weeks or even months after the onset of
the disaster. Three clinical phases of natural disasters summarize the chronological public health effects
on injured people and survivors:
Phase (1), the impact phase (lasting up to to 4 days), is usually the period when victims are extricated
and initial treatment of disaster-related injuries is provided.
Phase (2), the post-impact phase (4 days to 4 weeks), is the period when the first waves of infectious
diseases (air-borne, food-borne, and/or water-borne infections) might emerge.
Phase (3), the recovery phase (after 4 weeks), is the period when symptoms of victims who have
contracted infections with long incubation periods or those with latent-type infections may become
clinically apparent. During this period, infectious diseases that are already endemic in the area, as well
as newly imported ones among the affected community, may grow into an epidemic.
It is common to see the international community, NGOs, volunteers, experts and the media leaving a
disaster-affected zone usually within three months, when in reality basic sanitation facilities and access
to basic hygiene may still be unavailable or worsen due to the economic burden of the disasters.
Although it is not possible to predict with accuracy which diseases will occur following certain types of
disasters, diseases can be distinguished as either water-borne, air-borne/droplet or vector-borne
diseases, and contamination from wounded injuries.
Setelah bencana alam
Mayoritas kematian yang terjadi segera setelah bencana alam secara langsung dikaitkan dengan trauma
tumpul, cedera yang berkaitan dengan himpitan dan luka bakar. Risiko wabah penyakit menular setelah
bencana alam biasanya terlalu ditekankan oleh pejabat kesehatan dan media, yang menyebabkan
kepanikan, kebingungan dan kadang-kadang kegiatan kesehatan masyarakat yang tidak perlu.
Dampak kesehatan yang berkepanjangan dari bencana alam pada suatu masyarakat dapat menjadi
konsekuensi dari runtuhnya fasilitas kesehatan dan sistem perawatan kesehatan, gangguan program
pengawasan dan kesehatan (program imunisasi dan pengendalian vektor), keterbatasan atau perusakan
kegiatan pertanian (kelangkaan makanan). / kerawanan pangan), atau gangguan dari perawatan yang
sedang berlangsung dan penggunaan obat-obatan yang tidak diresepkan.
Faktor-faktor risiko untuk peningkatan penularan dan wabah penyakit menular terutama terkait dengan
dampak setelah bencana daripada dengan bencana primer itu sendiri atau pada mayat orang-orang
yang terbunuh. Ini setelah efek termasuk perpindahan populasi (pengungsi internal dan pengungsi),
perubahan lingkungan dan peningkatan vektor tempat berkembang biak. Tempat penampungan yang
tidak terencana dan penuh sesak, kondisi air dan sanitasi yang buruk, status gizi yang buruk atau
kebersihan pribadi yang tidak memadai sering terjadi. Akibatnya, ada tingkat kekebalan yang rendah
terhadap penyakit yang dapat dicegah dengan vaksin, atau tidak cukupnya cakupan vaksinasi dan
terbatasnya akses ke layanan perawatan kesehatan.
Tahapan wabah dan klasifikasi penyakit menular
Penularan atau penyebaran penyakit menular dapat dilihat berhari-hari, berminggu-minggu, atau
bahkan berbulan-bulan setelah awal bencana. Tiga fase klinis dari bencana alam merangkum efek
kronologis kesehatan masyarakat pada orang yang terluka dan yang selamat:
Fase (1), fase dampak (berlangsung hingga 4 hari), biasanya merupakan periode ketika korban
dibebaskan dan perawatan awal untuk cedera terkait bencana disediakan.
Fase (2), fase pasca-dampak (4 hari hingga 4 minggu), adalah periode ketika gelombang pertama
penyakit menular (yang terbawa melalui udara, yang terbawa oleh makanan, dan / atau infeksi yang
ditularkan melalui air) mungkin muncul.
Fase (3), fase pemulihan (setelah 4 minggu), adalah periode ketika gejala-gejala korban yang memiliki
infeksi dengan periode inkubasi yang lama atau mereka yang memiliki infeksi tipe laten dapat menjadi
jelas secara klinis. Selama periode ini, penyakit menular yang sudah endemik di daerah tersebut, serta
yang baru diimpor di antara masyarakat yang terkena dampak, dapat tumbuh menjadi epidemi.
Adalah umum untuk melihat komunitas internasional, LSM, sukarelawan, pakar dan media
meninggalkan zona yang terkena bencana biasanya dalam waktu tiga bulan, ketika pada kenyataannya
fasilitas sanitasi dasar dan akses ke kebersihan dasar mungkin masih tidak tersedia atau bertambah
buruk karena beban ekonomi bencana.
Meskipun tidak mungkin untuk memprediksi dengan akurat penyakit mana yang akan terjadi setelah
jenis bencana tertentu, penyakit dapat dibedakan sebagai penyakit yang ditularkan melalui air, penyakit
yang ditularkan melalui udara / tetesan atau penyakit yang ditularkan melalui vektor, dan kontaminasi
dari cedera yang terluka.
Diarrhoeal diseases
The most documented and commonly occurring diseases are water-borne diseases (diarrhoeal diseases
and Leptospirosis). Diarrhoeal diseases cause over 40 percent of the deaths in disaster and refugee
camp settings. Epidemics among victims are commonly related to polluted water sources (faecal
contamination), or contamination of water during transportation and storage. Outbreaks have also been
related to shared water containers and cooking pots, scarcity of soap and contaminated food, as well as
pre-existing poor sanitary infrastructures, water supply and sewerage systems.
Diarrhoeal epidemics are frequently reported following natural disasters in developing countries. Floods
are recurrent in many African countries, such as Mozambique, and usually lead to a significant increase
in diarrhoeal disease incidences.
Following the 2005 earthquake in Pakistan, an estimated 42 percent increase in diarrhoeal infections
was reported. In Iran, 1.6 percent of the 75,586 persons displaced by the Bam earthquake in 2003 were
infected with diarrhoeal diseases. A rapid assessment conducted in Indonesia after the 2004 tsunami
showed that 85 percent of the survivors in the town of Calang experienced diarrhoeal illness after
drinking from contaminated wells. In Thailand, the 2004 Indian tsunami also contributed to a significant
increase in diarrhoeal disease incidences.
An investigation conducted in 100 households after the 2001 earthquake in El Salvador showed that 137
persons out of 594 (22 percent) experienced diarrhoeal infections. An evolving cholera epidemic was
reported 9 months after the earthquake in Haiti, with a high fatality rate of 6.4 percent among the
victims (of the 4,722 documented affected, 303 died).
Only a small cluster of Norovirus cases was reported in evacuation centres some weeks after the Great
Eastern Japanese Earthquake and tsunami, while various pathogens were confirmed among the
populations displaced by Hurricanes Allison (2001) and Katrina in the US.
Leptospirosis, the other frequently occurring water-borne disease, can be transmitted through contact
with contaminated water or food, or with soil containing contaminated urine (Leptospires) from
infected animals (e.g., rodents). Floods facilitate the proliferation of rodents and the spread of
Leptospires in a human community. Investigations conducted in populations affected by flood disasters
in 2000 in India and Thailand reported Leptospirosis epidemics. Increased risk factors and outbreaks
were also reported after Typhoon Nali in China and Taiwan in 2001.
The following table shows a breakdown of the occurrence of communicable diseases. (This is described
in detail in the original paper, which is available for downloading in the the right sidebar.)
Penyakit diare
Penyakit yang paling banyak didokumentasikan dan paling sering terjadi adalah penyakit yang ditularkan
melalui air (penyakit diare dan Leptospirosis). Penyakit diare menyebabkan lebih dari 40 persen
kematian dalam pengaturan bencana dan kamp pengungsi. Epidemi di antara korban umumnya terkait
dengan sumber air yang tercemar (kontaminasi feses), atau kontaminasi air selama transportasi dan
penyimpanan. Wabah juga terkait dengan wadah air bersama dan panci masak, kelangkaan sabun dan
makanan yang terkontaminasi, serta prasarana sanitasi yang buruk, pasokan air, dan sistem
pembuangan air limbah yang sudah ada sebelumnya.
Epidemi diare sering dilaporkan setelah bencana alam di negara-negara berkembang. Banjir berulang di
banyak negara Afrika, seperti Mozambik, dan biasanya menyebabkan peningkatan yang signifikan dalam
insiden penyakit diare.
Menyusul gempa bumi 2005 di Pakistan, diperkirakan terjadi peningkatan infeksi diare sebesar 42
persen. Di Iran, 1,6 persen dari 75.586 orang yang mengungsi akibat gempa Bam pada tahun 2003
terinfeksi penyakit diare. Penilaian cepat yang dilakukan di Indonesia setelah tsunami 2004
menunjukkan bahwa 85 persen dari korban yang selamat di kota Calang mengalami penyakit diare
setelah minum dari sumur yang terkontaminasi. Di Thailand, tsunami India 2004 juga berkontribusi pada
peningkatan yang signifikan dalam insiden penyakit diare.
Investigasi yang dilakukan di 100 rumah tangga setelah gempa bumi tahun 2001 di El Salvador
menunjukkan bahwa 137 orang dari 594 (22 persen) mengalami infeksi diare. Epidemi kolera yang
berkembang dilaporkan 9 bulan setelah gempa bumi di Haiti, dengan tingkat kematian yang tinggi 6,4
persen di antara para korban (dari 4.722 terdokumentasi yang terkena dampak, 303 meninggal).
Hanya sekelompok kecil kasus Norovirus yang dilaporkan di pusat-pusat evakuasi beberapa minggu
setelah Gempa Besar dan Tsunami Jepang Timur Besar, sementara berbagai patogen dikonfirmasi di
antara populasi yang dipindahkan oleh Hurricanes Allison (2001) dan Katrina di AS.
Leptospirosis, penyakit bawaan air lainnya yang sering terjadi, dapat ditularkan melalui kontak dengan
air atau makanan yang terkontaminasi, atau dengan tanah yang mengandung urin yang terkontaminasi
(Leptospires) dari hewan yang terinfeksi (mis., Tikus). Banjir memfasilitasi penyebaran hewan pengerat
dan penyebaran Leptospira dalam komunitas manusia. Investigasi yang dilakukan pada populasi yang
terkena dampak bencana banjir pada tahun 2000 di India dan Thailand melaporkan epidemi
Leptospirosis. Peningkatan faktor risiko dan wabah juga dilaporkan setelah Topan Nali di Cina dan
Taiwan pada tahun 2001.
Tabel berikut menunjukkan rincian dari terjadinya penyakit menular. (Ini dijelaskan secara terperinci
dalam makalah asli, yang tersedia untuk diunduh di sidebar kanan.)
On the topic of outbreak and classification, one final note regarding the
myth of infectious disease transmission from dead bodies: Still
controversial and frequently overstated is the assumption that dead
bodies pose a significant risk for the transmission of infectious diseases
after a natural disaster. Despite the vast number of deaths resulting from
major disasters, no outbreaks resulting from corpses have been
documented. The environment in which pathogens live in a dead body
can no longer sustain them, since the microorganisms involved in putrefaction (decay processes) are not
disease causing. There are a few situations, such as deaths from cholera or hemorrhagic fever epidemics,
that require specific precautions, but families should not be deprived of appropriate identification and
burial ceremonies for their dead relatives from disasters. Survivors of disaster present a much more
substantial reservoir for potential infectious diseases.
Prevention and control measures
We recommend re-establishing and improving the delivery of primary health care. Medical supply
should be provided, and training of healthcare workers and medical personnel on appropriate case
management should be conducted. Public health responders should set up a rapid disease risk
assessment within the first week of the disaster in order to identify disaster impacts and health needs.
Practically, prompt and adequate prevention and control measures, and appropriate case management
and surveillance systems are essential for minimizing infectious disease burdens. The prevention and
control checklist provided in our paper shows the measures to be undertaken in order to avoid
infectious diseases following natural disasters.
Natural disasters and infectious disease outbreaks represent global challenges towards the achievement
of the Millennium Development Goals. It is important for the public, policymakers and health officials to
understand the concept that disaster does not transmit infectious diseases; that the primary cause of
death in the aftermath of a disaster is non-infectious; that dead bodies (from disasters) are not a source
of epidemic; and that infectious disease outbreaks result secondarily from exacerbation of disease risk
factors.
National surveillance systems and the establishment of continual practices of protocol for health
information management have to be strengthened. In disasters, education on hygiene and hand
washing, and provision of an adequate quantity of safe water, sanitation facilities and appropriate
shelter are very important for prevention of infectious diseases. The assessment and response activities
described above should be properly coordinated.
Pada topik wabah dan klasifikasi, satu catatan terakhir mengenai mitos penularan penyakit menular dari
mayat: Masih kontroversial dan sering dilebih-lebihkan adalah asumsi bahwa mayat meninggal
menimbulkan risiko yang signifikan untuk penularan penyakit menular setelah bencana alam. Meskipun
jumlah besar kematian akibat bencana besar, tidak ada wabah yang disebabkan oleh mayat telah
didokumentasikan. Lingkungan di mana patogen hidup dalam mayat tidak dapat lagi
mempertahankannya, karena mikroorganisme yang terlibat dalam pembusukan (proses pembusukan)
tidak menyebabkan penyakit. Ada beberapa situasi, seperti kematian akibat wabah kolera atau demam
berdarah, yang memerlukan tindakan pencegahan khusus, tetapi keluarga tidak boleh kehilangan
identifikasi yang tepat dan upacara pemakaman untuk kerabat mereka yang meninggal akibat bencana.
Orang yang selamat dari bencana menghadirkan reservoir yang jauh lebih besar untuk penyakit menular
yang potensial.
Tindakan pencegahan dan pengendalian
Kami merekomendasikan membangun kembali dan meningkatkan pengiriman perawatan kesehatan

primer. Pasokan medis harus disediakan, dan pelatihan petugas kesehatan dan tenaga medis tentang
manajemen kasus yang tepat harus dilakukan. Para responden kesehatan masyarakat harus membuat
penilaian risiko penyakit yang cepat dalam minggu pertama bencana untuk mengidentifikasi dampak
bencana dan kebutuhan kesehatan. Secara praktis, langkah-langkah pencegahan dan kontrol yang cepat
dan memadai, dan manajemen kasus yang tepat dan sistem pengawasan sangat penting untuk
meminimalkan beban penyakit menular. Daftar periksa pencegahan dan pengendalian yang disediakan
dalam makalah kami menunjukkan langkah-langkah yang harus dilakukan untuk menghindari penyakit
menular setelah bencana alam.
Bencana alam dan wabah penyakit menular merupakan tantangan global menuju pencapaian Tujuan
Pembangunan Milenium. Penting bagi publik, pembuat kebijakan dan pejabat kesehatan untuk
memahami konsep bahwa bencana tidak menularkan penyakit menular; bahwa penyebab utama
kematian setelah bencana adalah tidak menular; bahwa mayat (dari bencana) bukanlah sumber epidemi;
dan bahwa wabah penyakit menular terjadi sebagai akibat dari eksaserbasi faktor-faktor risiko penyakit.
Sistem pengawasan nasional dan penetapan praktik berkelanjutan dari protokol untuk manajemen
informasi kesehatan harus diperkuat. Dalam bencana, pendidikan tentang kebersihan dan mencuci
tangan, dan penyediaan air bersih yang memadai, fasilitas sanitasi dan tempat tinggal yang sesuai
sangat penting untuk pencegahan penyakit menular. Kegiatan penilaian dan respons yang dijelaskan di
atas harus dikoordinasikan dengan benar.
Sumber
https://unu.edu/publications/articles/preventing-and-controlling-infectious-diseases-after-natural-
disasters.html#info

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Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences

Wolters Kluwer -- Medknow Publications

Prevention of communicable diseases after disaster: A review

Najmeh Jafari, Armindokht Shahsanai, [...], and Amir Loghmani

Additional article information

KEYWORDS: Natural Disasters, Communicable Diseases, Prevention

Communicable disease after disaster

Leptospirosis: Leptospirosis is a bacterial zoonosis transmitted through contact of mucous membranes

Strategies for prevention of communicable disease

Furthermore, reinforcement of health-surveillance systems and practicing guidelines for managing

Post disaster Phase

• Select and plan sites

• Ensure safety of food:

Key 2: Separate cooked and raw food (microorganisms transfer prevention)

Key 3: Cook thoroughly (kills dangerous microorganisms)

Key 4: Preserve food at harmless temperatures (microorganisms growth prevention)

• Implement vaccination campaigns (e.g. measles)

• Provide essential clinical services

J Res Med Sci. 2011 Jul; 16(7): 956–962.

Najmeh Jafari,1 Armindokht Shahsanai,2 Mehrdad Memarzadeh,3 and Amir Loghmani4

1- Resident of Community Medicine, Department of Community Medicine, School of Medicine, Isfahan

2- Associate professor, Department of Community Medicine, School of Medicine, Isfahan University of

3- Associate professor, Department of Surgery, School of Medicine, Isfahan University of Medical

4- Resident of Community Medicine, Department of Community Medicine, School of Medicine, Isfahan

Corresponding Author: Amir Loghmani, E-mail: ri.ca.ium.tnediser@inamhgol_a

Received 2011 Jan 31; Accepted 2011 May 28.

Copyright : © Journal of Research in Medical Sciences

This article has been cited by other articles in PMC.

KATA KUNCI: Bencana Alam, Penyakit Menular, Pencegahan

Penyakit menular setelah bencana

Penyakit yang ditularkan melalui air:

Strategi untuk pencegahan penyakit menular

Fase Pasca Bencana

Kunci 1: Menjaga kebersihan - (mencegah pertumbuhan dan penyebaran mikroorganisme berbahaya)K

Kunci 3: Masak sampai matang (bunuh mikroorganisme berbahaya)

• Menyediakan fasilitas laboratorium dasar

Konflik Kepentingan Penulis tidak memiliki konflik kepentingan.

J Res Med Sci. 2011 Juli; 16 (7): 956–962.

Najmeh Jafari, 1 Armindokht Shahsanai, 2 Mehrdad Memarzadeh, 3 dan Amir Loghmani4

1- Residen Kedokteran Komunitas, Departemen Kedokteran Komunitas, Fakultas Kedokteran,

2- Profesor Rekanan, Departemen Kedokteran Komunitas, Fakultas Kedokteran, Universitas Ilmu

4- Penduduk Kedokteran Komunitas, Departemen Kedokteran Komunitas, Fakultas Kedokteran,

Penulis Korespondensi: Amir Loghmani, E-mail: ri.ca.ium.tnediser@inamhgol_a

Menerima 2011 Jan 31; Diterima 2011 28 Mei.

Hak Cipta: © Jurnal Penelitian Ilmu Kedokteran

Artikel ini telah dikutip oleh artikel lain di PMC.

Epidemics after Natural Disasters

John T. Watson, Michelle Gayer, and Maire A. Connolly

Additional article information

Keywords: Disasters, epidemiology, outbreaks, surveillance, risk assessment, communicable diseases,

Dead Bodies and Disease

Principles for management of dead bodies*

Displacement: Primary Concern

Risk Factors for Communicable Disease Transmission

Responding effectively to the needs of the disaster-affected population requires an accurate

Communicable Diseases Associated with Natural Disasters

Water-related Communicable Diseases

Diseases Associated with Crowding

Neisseria meningitidis meningitis is transmitted from person to person, particularly in situations of

Other Diseases Associated with Natural Disasters

Disaster-Related Interruption of Services

Surveillance in areas affected by disasters is fundamental to understanding the impact of natural

Click here to view.(18K, pdf)

Emerg Infect Dis. 2007 Jan; 13(1): 1–5.