Infectious Diseases and Disasters

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Infectious Diseases and Disasters
Dr. Eric Goedecke Asst. Professor of Emergency
Medicine
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Learning Objectives

• Focus on infectious disease as a consequence of
  disaster
• Clarification of risks
• Discuss misconceptions
• Concepts in disease prevention and mitigation

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Epidemic Risk

• Full disease outbreaks are rare
• Post impact or recovery phases
• Risk threats to the locality
• Drought
• Famine
• Population clusters/displacement
• Length of threat
• Mortality rates

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Risk and Hazard Analysis

• Man-made Hazards
• Chemicals
• Production, storage and transport
• Biologic hazards
• Terrorism
• Transportation Hazards
• Materials
• Mass transit centers

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Emerging Diseases

• Almost always from endemic disease
• Increased frequency
• Waterborne illness
• Preexisting health infrastructure

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Deaths following Disaster

• Measles, diarrheal disease, respiratory
  infections
• Mt. Pinatubo, Philippines
• Refugee camps
• Unsanitary living conditions
• Food shortages

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Dead Bodies

• Do not pose serious health risk
• Not a reservoir
• Proper burial and respect
• Psychological stress

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Risk Factors

• Population displacement
• Disruption water supplies
• Disruption of sanitation
• Loss basic health infrastructure
• Loss primary medical infrastructure

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Risk Factors

• Public health and medical officers must be
  knowledgeable about endemic diseases!
• Disruption of infrastructure
• Rapid assessment of any breakdown
• Quick intervention of weaknesses
• Hurricane Andrew Surveillance
• Rash, diarrhea, cough, animal bites, other
  infections

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Modes of Transmission

• Susceptibility
• Malnutrition
• Environmental extremes
• No access to medications
• Migration of large populations
• Modes
• Airborne
• Water
• Vectors

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Disease Transmission

• Overcrowding
• Measles
• Immunizations
• Upper Respiratory Infections
• Mortality increased children lt 5 years old
• Dominican Republic Hurricane Georges
• Tuberculosis and HIV
• Not a direct result

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Disease Vectors

• Standing water
• Haiti Hurricane Flora 1962
• Drought
• Southwestern United States - 1993

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Other Factors

• Climate Impact
• Disruption of prevention programs

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Disruption in Water Supplies

• Vibrio cholerae, Shigella dysenteriae, and
  Salmonella typhii
• Hepatitis A E
• Leptospirosis

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• Entamoeba histolytica E. histolytica

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Public Health Programs

• Routine vaccinations
• Special populations young and old
• Sexually transmitted diseases HIV Risks

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Disaster Induced Injuries

• Soft tissue injuries
• Secondary wound infections
• Staph, Strep, others

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Increases in Susceptibility

• Malnutrition
• Higher mortality rates
• Cyclical process
• Contamination of food supplies
• Lack of daily medicines
• Mass migration of populations
• Sanitation
• Malnutrition
• Overcrowding exposures

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Field Management of Infectious Diseases

• Environmental considerations
• Geographic variables
• Endemic organisms
• Population characteristics
• Disaster type
• Disaster magnitude
• Resource availability

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Field Management of Infectious DiseasesEnvironme
ntal Considerations

• Climate
• Vectors and organisms vary
• Colder seasons, crowding together
• Degree of isolation
• Remote areas
• Higher elevations-mountain/volcano

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Field Management of Infectious DiseasesPopulatio
n Characteristics

• Age

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Field Management of Infectious DiseasesDisaster
Type Magnitude

• Earthquakes
• Crush injuries
• Floods
• Waterborne problems

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Field Management of Infectious DiseasesResource
Availability

• Local, regional and national aid?
• Healthcare facilities
• Supply line and routes
• Transportation mechanisms
• Public Health information/instruction

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Prevention

• Repairing points of breakdown
• Needs assessment
• Restoring/Providing basic needs
• Surveillance

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Surveillance

• ongoing systematic collection, analysis, and
  interpretation of health data
• Timely
• Simple
• Accurate
• Universally understood
• Sustainable

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Surveillance

• Helps guide
• Prevent waste
• Specifics
• Dispel rumors
• Italy Earthquake 1980

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Surveillance

• Coordinated by single agency
• Standardized form
• Symptom based
• Information regularly released
• Death rates and population size

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Vaccines

• More protection lower cost
• Measles vaccine
• Tetanus
• Routine or with injury

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Measles
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Measles

• Highly contagious viral illness
• First described in 7th century
• Near universal infection of childhood in
  prevaccination era
• Common and often fatal in developing areas

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Measles Virus

• Paramyxovirus
• Hemagglutinin important surface antigen
• One antigenic type
• Rapidly inactivated by heat and light

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Measles Clinical Features

• Incubation period 10-12 days
• Prodrome
• Stepwise increase in fever to 103F or higher
• Cough, coryza, conjunctivitis
• Koplik spots

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Measles Complications
Percent reported 8 7 6 0.1 18 0.2

• Condition
• Diarrhea
• Otitis media
• Pneumonia
• Encephalitis
• Hospitalization
• Death

Based on 1985-1992 surveillance data
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Measles Clinical Features

• 2-4 days after prodrome, 14 days after exposure
• Maculopapular, becomes confluent
• Begins on face and head
• Persists 5-6 days
• Fades in order of appearance

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Water and Sanitation

• Shortage of water
• Hygiene
• QuantitygtQuality
• United Nations High Commissioner for Refugees
  recommendation 20 liters/day

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Diagnosis and Management

• Case confirmation
• Mode of transmission
• Active case finding
• Treatment

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Principles of Treatment

• Standardized protocols
• Diarrheal illness
• Oral rehydration
• Measles
• Vitamin A supplements
• Immunization

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Principles of Treatment

• Malaria
• Lower elevations
• Prevention
• Chemoprophylaxis-locally
• 31,127
• Meningitis
• Most feared 15/100,000
• Pneumonia
• Sexually transmitted diseases
• Skin infections

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• Emergency Medical Services

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Role of Emergency Departments

• Surveillance points
• Source of healthcare
• Personnel must be familiar with protocols
• Protective measures
• Treatment
• Transfer

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Summary

• Experience is growing
• Outbreaks are relatively uncommon
• Basic public health measures
• Endemic diseases

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