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Natural Disasters – Disease module




Natural disasters greatly increase the probability of a disease outbreak.

World Health Organization, 2006

(Communicable diseases following natural disasters -- Risk assessment and priority interventions, WHO/CDS/NTD/DCE/2006.4, Retrieved 9-11-2006 from http://www.who.int/diseasecontrol_emergencies/en/)



Natural disasters are catastrophic events with atmospheric, geologic and hydrologic origins. They include earthquakes, volcanic eruptions, landslides, tsunamis, floods and drought. Natural disasters can have rapid or slow onset, and serious health, social and economic consequences. During the past two decades, natural disasters have killed millions of people, adversely affecting the lives of at least one billion more people and resulting in substantial economic damage (1). Developing countries are disproportionately affected because of their lack of resources, infrastructure and disaster preparedness systems.

The potential impact of communicable diseases is often presumed to be very high in the chaos that follows natural disasters. Increases in endemic diseases and the risk of outbreaks, however, are dependent upon many factors that must be systematically evaluated with a comprehensive risk assessment. This allows the prioritization of interventions to reduce the impact of communicable diseases post-disaster.

EMERGING INFECTIOUS DISEASES THREATEN PLANETARY EXTINCTION

The Toronto Sun, October 16, 1994, Pg. M6 (MHHARV4837)

Nor did the media go beyond Surat and explain how this largely inconsequential epidemic, a kind of false alarm in a much larger microbial saga, was another sharp warning of our species' growing vulnerability to infectious disease. Imagine, for a moment, if Surat had aroused a different airborne microbe, a so-called "emerging virus," beyond the waning reach of antibiotics. Suppose that the headliner germ had been a new strain of Ebola that dissolves internal organs into a bloody tar or the mysterious "X" virus that killed thousands in the Sudan last year. Had such a microbe been unleashed, the final death toll might have been millions, and the world might now be mourning a "new Black Death." The planet, in fact, might be an entirely different and emptier place altogether.



DISEASE IMPACTS OUTWEIGH WAR

Lauren Z. Asher, Law Student, Cardozo Journal of International and Comparative Law, Spring, 2001, 9 Cardozo J. Int'l & Comp. L. 135, p. 135



The spread of infectious disease is surging and as it spreads, the need for international regulation also expands. Throughout history epidemics have been responsible for millions of deaths and the number will undoubtedly rise, due in part to the increasing ease and speed of international travel. Statistically, disease is a more formidable killer than war, with the power to completely destabilize governments.

Disease internals


Crowed and unclean living conditions post a natural disaster increase the chances of epidemic disease transmission.

World Health Organization, 2006

(Communicable diseases following natural disasters -- Risk assessment and priority interventions, WHO/CDS/NTD/DCE/2006.4, Retrieved 9-11-2006 from http://www.who.int/diseasecontrol_emergencies/en/)

The sudden presence of large numbers of dead bodies in disaster-affected areas can heighten expectations of disease outbreaks (2), despite the fact that dead bodies do not pose a risk of outbreaks following natural disasters (3). Rather, the risk of outbreaks is associated with the size, health status and living conditions of the population displaced by the natural disaster. Crowding, inadequate water and sanitation, and poor access to health services, often characteristic of sudden population displacement, increase the risk of communicable disease transmission (4). Although the overall risk of communicable disease outbreaks is lower than often perceived, the risk of transmission of certain endemic and epidemic-prone diseases can increase following natural disasters.

Natural disasters increase the risk of waterborne disease outbreak like diarrhea disease and hepatitis.

World Health Organization, 2006

(Communicable diseases following natural disasters -- Risk assessment and priority interventions, WHO/CDS/NTD/DCE/2006.4, Retrieved 9-11-2006 from http://www.who.int/diseasecontrol_emergencies/en/)

Diarrhoeal disease outbreaks can occur following contamination of drinking-water, and have been reported following flooding and related displacement. An outbreak of diarrhoeal disease post flooding in Bangladesh in 2004 involved more than 17 000 cases, with the isolation of Vibrio cholerae (O1 Ogawa and O1 Inaba) and enterotoxigenic Escherichia coli (5). A large (>16 000 cases) cholera epidemic (O1 Ogawa) in West Bengal in 1998 was attributed to preceding floods (6), and floods in Mozambique in January–March 2000 led to an increase in the incidence of diarrhoea (7). The risk of diarrhoeal disease outbreaks following natural disasters is higher in developing than in developed countries (8). In Aceh Province, Indonesia, a rapid health assessment performed in the town of Calang two weeks after the December 2004 tsunami found that 100% of the survivors drank from unprotected wells, and that 85% of residents reported diarrhoea in the previous two weeks (9). In Muzaffarabad, Pakistan, following the 2005 earthquake, an outbreak of acute watery diarrhoea occurred in an unplanned, poorly-equipped camp of 1800 persons. The outbreak involved over 750 cases, mostly adults, and was controlled following the provision of adequate water and sanitation facilities (10). In the United States, diarrhoeal illness was noted following hurricanes Allison (11) and Katrina (12–14), and norovirus, Salmonella, and toxigenic and nontoxigenic V. cholerae were confirmed among Katrina evacuees. Hepatitis A and E are also transmitted by the faecal–oral route, in association with lack of access to safe water and sanitation. Hepatitis A is endemic in most developing countries, and children are exposed and develop immunity at an early age. As a result, the risk of large outbreaks is usually low in these settings. In endemic areas, hepatitis E outbreaks frequently follow heavy rains and floods; it is generally a mild, self-limited illness, but in pregnant women case-fatality rates can be up to 25% (15). Clusters of both hepatitis A and hepatitis E were noted in Aceh following the December 2004 tsunami (16). Leptospirosis is a zoonotic bacterial disease that is transmitted through contact of the skin and mucous membranes with water, damp vegetation, or mud contaminated with rodent urine. Infected rodents shed large amounts of leptospires in their urine. Flooding facilitates the spread of the organism due to the proliferation of rodents and the proximity of rodents to humans on shared high ground. Outbreaks of leptospirosis occurred in Taiwan, China, associated with Typhoon
Natural disasters spread diseases due to crowding – prompt response is key.
World Health Organization, 2006

(Communicable diseases following natural disasters -- Risk assessment and priority interventions, WHO/CDS/NTD/DCE/2006.4, Retrieved 9-11-2006 from http://www.who.int/diseasecontrol_emergencies/en/)


Measles and the risk of transmission in the disaster-affected population is dependent on the baseline vaccination coverage rates among the affected population, and in particular among children aged <15 years. Crowded living conditions, as is common among people displaced by natural disasters, facilitate transmission and necessitate even higher immunization coverage levels to prevent outbreaks (19). A measles outbreak in the Philippines in 1991 among people displaced by the eruption of Mt. Pinatubo involved more than 18 000 cases (20). In Aceh following the tsunami, a cluster of measles involving 35 cases occurred in Aceh Utara district, and continuing sporadic cases were common despite mass vaccination campaigns (16). Sporadic cases and clusters of measles (>400 clinical cases in the six months following the earthquake) also occurred in Pakistan following the 2005 South Asia earthquake (21). Meningitis caused by Neisseria meningitidis 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 (16, 21). Prompt response with antibiotic prophylaxis, as occurred in Aceh and Pakistan, can interrupt transmission. Acute respiratory infections (ARI) are a major cause of morbidity and mortality among displaced populations, particularly in children aged <5 years. Lack of access to health services and to antibiotics for treatment further increases the risk of death from ARI. Risk factors among displaced persons include crowding, exposure to indoor cooking and poor nutrition. The reported incidence of ARI increased four-fold in Nicaragua in the 30 days following Hurricane Mitch in 1998 (22), and ARI accounted for the highest number of cases and deaths among those displaced by the tsunami in Aceh in 2004 (16) and by the 2005 earthquake in Pakistan (21).
Natural disasters like flooding are ripe for disease outbreak.

BBC 2006

(SURINAM FLOODING CAUSES SERIOUS HEALTH CONCERNS, 5-18-2006)

Paramaribo, Suriname: Health officials are on the lookout for a malaria epidemic in the aftermath of last week's severe flooding as the waters slowly subside in the interior of Suriname. These concerns are more acute in the east of the country where water levels are still rising in some areas even as weather forecasters are still expecting more rain. Several cases of diarrhoea and vomiting, linked to water-borne illness, have been confirmed, the National Coordination Centre for Disaster Management (NCCR) said in a statement.
As yet there is no epidemic, but the risk for outbreaks of malaria and diarrhoea remain and the lack of access to clean drinking water is a serious concern, the Centre said.The NCCR is transporting huge amounts of bottled water to the affected areas but officials were encountering serious logistical problems owing to the cost and space needed to transport it to the remote interior.
A small outbreak of malaria was detected in the village of Asigron, near the Brokopondo Lake, with 19 adults and 25 children, almost a fifth of the community's population, testing positive for the mosquito-borne disease, but the Director of Health, Dr Marthelise Eersel, said this outbreak was not directly linked to the flooding.She warned, however, that the risk of a wider spread of malaria was real and that prevention and early treatment measures were urgently needed.

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