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Transcript
Infectious Diseases and Natural Disasters Background 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 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 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