Infectious Diseases & Natural Disasters

Introduction
Historically, infectious disease epidemics have high mortality rate Natural disasters have potential for social disruption and death Epidemics are compounded when local infrastructure breaks down Can a natural disaster lead to an epidemic of an infectious disease? Are there infectious diseases that emerge after a natural disaster?

What is an emerging infectious disease?

In 1991, Institute of Medicine attempted to define the term: new, re-emerging, or drug resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future.

Phases of a Natural Disaster

1.Impact Phase (0-4 days) Extrication and initial treatment Immediate soft tissue infections 2.Post-Impact Phase (4 days-4 weeks) Airborne, foodborne, waterborne and vector diseases (next two slides) 3.Recovery Phase (after 4 weeks) Those with long incubation and of chronic disease, vectorborne

Post-Impact Phase Infections

Crush and penetrating trauma Skin and soft tissue disruption (MRSA) Muscle/tissue necrosis Toxin production disease Burns Waterborne Gastroenteritis Cholera Non-cholera dysentery Hepatitis Rare diseases

Post-Impact Phase Infections

Vectorborne Malaria West Nile Virus, other viral encephalitis Dengue and Yellow fever Typhus Respiratory Viral CAP Rare disease Other Blood transfusions

Recovery Phase Infections

These agents need a longer incubation period Tuberculosis Schistosomiasis Lieshmaniasis Leptospirosis Nosocomial infections of chronic disease

Factors for Transmission of Disease After a Disaster

1. 2. 3. 4. 5. Environmental considerations Endemic organisms Population characteristics Pre-event resources Type and magnitude of the disaster

1.Environmental considerations
Climate Cold - airborne Warm - waterborne Season (Canada) Winter - influenza Summer - enterovirus Rainfall El Nio years increase malaria Drought malnutrition disease Geography Isolation from resources

2.Endemic organisms
Infectious organisms endemic to a region will be present after the disaster Agents not endemic before the event are UNLIKELY to be present after Rare disease may be more common Unlikely a new or changed disease will occur Deliberate introduction could change this factor

3.Population characteristics
Density Displaced populations Refugee camps Age Increased elderly or children Chronic Disease Malnutrition Heart disease Transplantation

3.Population characteristics
Education Less responsive to disaster teams Religion People practicing certain religions cant accept medical attention Hygiene Underlying health education of public

4.Pre-event resources
Sanitation Primary health care and nutrition Disaster preparedness Disease surveillance Equipment and medications Transportation Roads Medical infrastructure

5.Type and magnitude of the disaster

Earthquake Crush and penetrating injuries Hurricane, Monsoon, Typhoon and Flooding Water contamination, vector borne diseases Tornado Crush Volcano Water contamination, airway diseases
Magnitude Bigger can mean more likelihood for epidemics

Example: Dominican Republic

Hurricane David and Frederic on August 31 and September 5th 1979 > 2,300 dead immediately Marked increase in all diseases measured six months after the hurricane Typhoid fever Gastroenteritis Measles Viral hepatitis

More examples: Epidemics after Disasters

San Francisco, 1907 Fires; plague resulting from Quarantine failure Duluth, MN, 1918 Forest Fire; influenza resulting from crowding and epidemic Italy, 1976 Earthquake; Salmonella carriers due to sanitation stoppage

Summary of Factors
Many factors play a role in disease development and outbreaks Change and/or closing of public health measures play a big role

General disaster reminders

Vaccinations are the mainstay of outbreak control in many situations Dead bodies pose little to no infectious disease risk; however this is debated Early surveillance and hygiene can prevent outbreaks

Conclusions
Infectious diseases may play a role in the post disaster period These diseases will vary depending on many factors If the disease is not present before the disaster, unlikely to be there after

Conclusions
Early recognition of certain diseases in disaster setting important Poor infrastructure and response has led to most increases in infectious diseases Know where you are going and what is endemic