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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.
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. 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. 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.
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 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. 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.
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. 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.
In a large study undertaken in Indonesia in —, flooding was identified as a significant risk factor for diarrheal illnesses caused by Salmonella enterica serotype Paratyphi A paratyphoid fever The risk for diarrheal disease outbreaks following natural disasters is higher in developing countries than in industrialized countries 8 , In Muzaffarabad, Pakistan, an outbreak of acute watery diarrhea occurred in an unplanned, poorly equipped camp of 1, persons after the earthquake.
In the United States, diarrheal illness was noted after Hurricanes Allison 20 and Katrina 21 — 23 , and norovirus, Salmonella , and toxigenic and nontoxigenic V. 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.
After the earthquake in Pakistan, sporadic hepatitis E cases and clusters were common in areas with poor access to safe water. Over 1, cases of acute jaundice, many confirmed as hepatitis E, occurred among the displaced Clusters of both hepatitis A and hepatitis E were noted in Aceh after the December tsunami 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 27 ; in Mumbai, India, after flooding in 28 ; in Argentina after flooding in 29 ; and in the Krasnodar region of the Russian Federation in After a flooding-related outbreak of leptospirosis in Brazil in , spatial analysis indicated that incidence rates of leptospirosis doubled inside the flood-prone areas of Rio de Janeiro Crowding is common in populations displaced by natural disasters and can facilitate the transmission of communicable diseases.
Crowded living conditions facilitate measles transmission and necessitate even higher immunization coverage levels to prevent outbreaks A measles outbreak in the Philippines in among persons displaced by the eruption of Mt.
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 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 , 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 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 35 , and ARI accounted for the highest number of cases and deaths among those displaced by the tsunami in Aceh in 26 and by the earthquake in Pakistan 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. 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 Malaria outbreaks in the wake of flooding are a well-known phenomenon.
Dengue transmission is influenced by meteorologic conditions, including rainfall and humidity, and often exhibits strong seasonality. However, transmission is not directly associated with flooding. 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.
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. Cases were also reported in Pakistan following the earthquake An unusual outbreak of coccidiomycosis occurred after the January 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 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 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 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 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.
Priority measures to reduce the risk for communicable diseases after natural disasters. The program provides technical and operational support for control of communicable diseases in humanitarian emergencies.
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Epidemics after Natural Disasters
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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.
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On 19 February at Member States. Specialised Centers. EUR-OPA specialised centres develop projects aiming to improve the awareness and resilience to major risks within the population. Browse Centre's projects. More on the BeSafeNet project. BeSafeNet website.
It includes a summarized review of key concepts and policy issues and of selected project formulation and appraisal methods which can be used to incorporate natural hazard information into investment project preparation. A review of existing investment projects in Latin America and the Caribbean indicates that those in the agricultural sector are generally undertaken with little or no consideration of natural hazards. Hazards affect agricultural projects more than any other sector. A combination of geographic location, climatic conditions, and limited capabilities for natural hazard assessment and disaster mitigation makes Third World nations more susceptible to the disasters natural hazard events pose than post-industrialized nations. Furthermore, the agricultural sector in these countries is often the most vulnerable and least able to cope with natural hazards in terms of infrastructure and institutional support. In the following discussion, emphasis is placed on the need to apply the methods described in the formulation stage of new investment projects, rather than in the review of already prepared projects.
A natural disaster is defined as an event of nature, which overwhelms local resources and threatens the This report will attempt to catalogue and briefly discuss the immediate medical and long-term health effects disaster situation as opposed to anticipating the next one. On the other Manual For Disaster Relief Work.
Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. It is recognized that many significant nonmarket effects result from natural disasters, including environmental impacts. Though our committee had a keen interest in these topics, it became clear that these impacts—though often significant—did not fit easily with this study's main report and conclusions for the following reasons: 1 not all disasters result in significant ecosystem impacts e. Though there are emerging efforts in quantifying and monetizing ecosystem services e. Nonetheless, the magnitude of the environmental impacts of many disasters compelled the committee to discuss them and we do so in this Appendix.
Need emergency housing assistance? After a natural disaster e. If the property is unliveable or damaged, they will need to work out if any action needs to be taken. Are you a property manager? A tenancy does not automatically end when a property becomes unliveable after a natural disaster. A tenancy agreement will only end if one of the following occurs:.
Floods were the deadliest type of disaster accounting for In comparison to the previous decade , in there were more disasters compared to the annual average of events, fewer deaths compared to the annual average of 45,, fewer number of people affected compared to the annual average of The deadliest events recorded in were the summer heat waves that affected Europe, more specifically France, Belgium and the Netherlands, with over deaths. In general, the impact of heat waves remains grossly underestimated. This is primarily due to underreporting in developing countries, where temperatures often exceed European values by a large margin and local populations have limited possibilities to protect themselves from heat wave exposure. The following most deadly event consisted of the flood in India due to the high monsoon rains, which lasted from July to October and affected 13 states mainly in the North and caused nearly dead. We recorded more than twice as many floods as storms 91 this year, both types affecting nearly 64 million people worldwide.
A natural disaster is a major adverse event resulting from natural processes of the Earth ; examples include floods , hurricanes , tornadoes , volcanic eruptions , earthquakes , tsunamis , storms , and other geologic processes. A natural disaster can cause loss of life or damage property,  and typically leaves some economic damage in its wake, the severity of which depends on the affected population's resilience and on the infrastructure available. In modern times, the divide between natural, man-made and man-accelerated is quite difficult to draw    with human choices like architecture,  fire,   resource management   or even climate change  potentially playing a role. An adverse event will not rise to the level of a disaster if it occurs in an area without vulnerable population.
In order to do so the, project is divided in two components:. Component 2: to provide Capacity Building to effectively react to regional epidemics and natural disasters. Outcomes of the C-RED project pdf Standard operating procedures for receiving international emergency relief consignments and equipment imported for humanitarian purposes in Liberia pdf
For decades sections of the academic community have been emphasizing that disasters are not natural. The implications of continuing to use this expression, while explicitly researching human vulnerability, are wide-ranging, and we explore what this means for us and our peers. The Gorkha Earthquake struck Nepal, resulting in over deaths and over USD 10 billion in damages not to mention months of disruption and psychological impacts. But one can argue that despite the huge financial, structural, and human toll, the earthquake was not unusual or unexpected. Moreover, stronger earthquakes often occur around the world causing less damage.
On 19 February at EUR-OPA specialised centres develop projects aiming to improve the awareness and resilience to major risks within the population. Browse Centre's projects. More on the BeSafeNet project.
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