Infectious Diseases and Natural Disasters. Background Historically, infectious disease epidemics...

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Infectious Diseases and Natural Disasters

Transcript of Infectious Diseases and Natural Disasters. Background Historically, infectious disease epidemics...

Infectious Diseases andNatural Disasters

BackgroundBackground

Historically, infectious disease epidemics have high mortality

Disasters have potential for social disruption and death

Epidemics compounded when infrastructure breaks down

Can a natural disaster lead to an epidemic of an infectious disease?

Are there emerging infectious diseases after a natural disaster?

What is an emerging infectious disease?

In 1991, Institute of Medicine attempted to define:

– “new, re-emerging, or drug resistant infections whose incidence in humans has increased within the past 2 decades or whose incidence threatens to increase in the near future.”

Phases of Disaster Impact Phase (0-4 days)

– Extrication– Immediate soft tissue infections

Post impact Phase (4 days- 4 weeks)– Airborne, foodborne, waterborne and vector diseases

Recovery phase (after 4 weeks)– Those with long incubation and of chronic disease, vectorborne

Factors for Disease Transmission After a Disaster

Environmental considerations Endemic organisms Population characteristics Pre- event structure and public

health Type and magnitude of the disaster

Environmental Considerations Climate

– Cold- airborne– Warm- waterborne

Season (USA)– Winter- influenza– Summer- enterovirus

Rainfall– El Nino years increase malaria– Drought-malnutrition-disease

Geography– Isolation from resources

Endemic organisms(exclusively native to a place) Infectious organisms endemic to a region

will be present after the disaster Agents not endemic before the event

are UNLIKELY to be present after Rare disease may be more common Unlikely a new or changed disease will

occur Deliberate introduction could change this

factor

Population Characteristics Density

– Displaced populations– Refugee camps

Age– Increased elderly or children

Chronic Disease– Malnutrition– Heart disease– Transplantation

Population Characteristics Education

– Less responsive to disaster teams Religion Hygiene

– Underlying health education of public

Trauma– Penetrating, blunt, burns

Stress

What infections would we see today?

Endemic organisms Post-impact phase Recovery Phase

Pre-event resources

Sanitation Primary health care and nutrition Disaster preparedness Disease surveillance Equipment and medications Transportation Roads Medical infrastructure

Type of disaster Earthquake

– Crush and penetrating injuries (Skin and soft tissue disruption, Muscle/tissue necrosis, Toxin production disease, Burns).

Hurricane (Monsoon, Typhoon) and Flooding– Water contamination(Gastroenteritis, Cholera, Non-cholera dysentery, Hepatitis)

– Vector borne diseases(Malaria, viral encephalitis, Dengue and Yellow fever,

Typhus)

Tornado– Crush (see earthquake)

Volcano– Water contamination (see Hurricane)– Airway diseases (Viral, CAP (phenomena))

Epidemics after DisastersSan Francisco, 1907 Fires; Plague San Francisco, 1907 Fires; Plague

resulting from Quarantine failure resulting from Quarantine failure

Duluth, MN, 1918 Forest Fire; Duluth, MN, 1918 Forest Fire; Influenza resulting from crowding Influenza resulting from crowding and epidemicand epidemic

Italy, 1976 Earthquake; Salmonella Italy, 1976 Earthquake; Salmonella Carriers due to sanitation Carriers due to sanitation stoppage stoppage

Summary of Factors

Many factors play a role in disease development and outbreaks

Change of disease not likely to play role– Increase in rare diseases

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 Halting infrastructure and response

has led to most increases in infectious diseases

know where you are going and what is endemic