COMMUNICABLE DISEASES IN DISASTERS

1. COMMUNICABLE DISEASES
AND DISASTERS
By: Doaa Habib
Under supervision of:
Dr. Mona Aboserea
ZAGAZIG UNIVERSITY

2. Contents
 Disaster definition
 Types
 Biological disasters
 Communicable diseases spreading after
disasters
 Disaster management

3. Disaster definition
 Any occurrence that causes damage,
ecological disruption, loss of human life or
deterioration of health and health services on
a scale sufficient to warrant an extraordinary
response from outside the affected community
or area.
Emergency:
Any occurrence which requires immediate
response
(community is capable of coping)

4. Complex emergency
 A state where the normal social order has
collapsed to the extent that national authorities
are no longer able to cope with the
administration of their country.
Examples
 wars and civil strife
 Armed aggression
 Other actions resulting in displaced persons
and refugees

5. Types
 Atmospheric:
• Storms, hurricanes,
tornados
 Geologic:
• Earthquake,
landslides
 Hydrologic:
Flooding, tsunamis
 Biological:
• Epidemics of
communicable
 Accidents:
• Transportation accidents
• Collapse of buildings, dams
and other structures,
• Mine disasters
 Technological failures
• nuclear power station or
leak at a chemical plant
 Civil disturbances, terrorism:
 War and refugee
Natural Man made

7. Classification by time
Sudden,
acute onset
• Geological and Climatic hazards
• Epidemics of diseases
Chronic,
creeping
• drought, famine
• environmental degradation, deforestation
• chronic exposure to toxic substances

8. Communicable disease AND
disasters
Communicab
le disease
Epidemic
Disaster
Disaster
Spread of
diseases
Epidemic
Cause
Biological disaster
Result
Epidemic after
disaster

9. Biological disaster

10. Biological disaster
 Biological disasters define the devastating
effects caused by an enormous spread of a
certain kind of living organism-that may spread
a disease or infestations in human, plant,
animal or insect life on an epidemic or
pandemic level.
Communit
y
Country
World wide

11. Causes
 Biological agents bacteria, virus, fungi,
parasites.
A. Already present ( antigenic shift or genetic
drift, altered immunity)
B. new emerging
 Biological toxins
 Bioterrorism

12. Categories of biological hazards
(Biosafety level)
BSL1
• canine hepatitis, Escherichia coli, varicella
• Precautions are minimal, most likely involving gloves and some
sort of facial protection
BSL 2
• hepatitis A, B and C, some influenza A strains, Lyme disease, salmonella,
mumps, measles, dengue fever, HIV.
• cause only mild disease to humans, Require more extreme precautions,
the use of autoclaves for sterilizing.
BSL 3
• anthrax, West Nile virus, , SARS, MERS, yellow fever, and malaria
• It requires much more safety protocols including the use of respirators to
prevent airborne infection. Biological hazards in this group generally
have known vaccines or treatments.
BSL 4
• Marburg virus, Ebola virus, Lassa fever virus, small pox
• fatal to humans for which there is no known treatment or vaccine
• Drastic measures

13. Communicable diseases
spreading after disasters

14. Risk factors of communicable diseases
spread
Presence of pathogens
Displacement of population
Change in environment
Lack of basic health services
Disruption of basic public facilities
Food shortage
Altered individual resistance to diseases

15. Displacement: Primary
Concern
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
 the access to healthcare services
 The breakdown in living conditions following disasters may
increase the exposure to vectors and transmission of
plague, louse borne typhus and relapsing fever other vector
borne like malaria and dengue.
 The incidence of dog bite and risk of rabies may increase
as neglected strays come in close contact with persons
living in temporary shelters

16. Dead Bodies and Disease
 The sudden presence of large numbers of
dead bodies due to the natural disaster in the
does not a risk for epidemics.
 Dead bodies only pose health risks in a few
situations that require specific precautions,
such as deaths from cholera, anthrax or
hemorrhagic fevers

17. Common communicable
diseases
Water
borne
Air borne
Vector
borne
Contact

18. Water borne diseases
TreatmentDiagnosisIncubation
Period
Clinical FeaturesDisease
rehydration
therapy;
antimicrobials
direct
microscopic
observation of
V. cholera in
stool
2 hrs - 5 daysprofuse watery
diarrhea, vomiting
Cholera
penicillin,
doxyxycline,
erythromycin,
cephalosporins
leptospira-
specific IgM
serological
assay
2 - 28 dayssudden onset fever,
headache, chills,
vomiting, severe
myalgia
Leptospiro
sis
supportive care;
hospitalize/
barrier nursing
for severe
cases;
monitoring of
detecting
anti- HAV of
anti-HEV IgM
Antibodies
15 - 50 daysjaundice, abdominal
pain, nausea,
diarrhea,
fever, fatigue and
loss of Appetite
Hepatitis

19. Water borne diseases
TreatmentDiagnosisIncubation
Period
Clinical
Features
Disease
ampicillin;
hospitalize
seriously ill or
malnourished;
rehydration
suspect if
bloody
diarrhea,
confirm by
isolation of
organism
12 - 96 hrsmalaise, fever,
vomiting,
blood and
mucous in
stool
Bacillary
dysentery
ampicillin,
trimethoprim
sulfate,
ciprofloxacin
culture from
blood, bone
marrow, bowel
fluids; rapid
antibody tests
3 - 14 dayssustained
fever,
headache,
constipation
Typhoid fever
ORSclinical1- 4 daysDiarrhea,
vomiting
Viral
Gastroenteritis

20. Vector borne diseases
TreatmentDiagnosisIncubatio
n
Period
Clinical
Features
Disease
chloroquineparasites on
blood
smear observed
using a
microscope; rapid
diagnostic
assays
7 - 30
days
fever, chills,
sweats, head
and body aches,
nausea
and vomiting
Malaria
intensive
supportive
therapy
Serum antibody
testing with
ELISA or rapid
dot-blot
technique
4 - 7 dayssudden onset
severe flu- like
illness, high
fever,
severe
headache, retro
orbital pain
Dengue

21. Vector borne diseases
TreatmentDiagnosisIncubation
Period
Clinical
Features
Disease
intensive
supportive
therapy
serological
assay for JE
virus IgM
specific
antibodies in
CSF or blood
(acute phase)
5 - 15 daysQuick onset,
headache, high
fever, neck
stiffness, stupor,
disorientation,
tremors
Japanese
encephalitis
intensive
supportive
therapy
serological
assay for
yellow
fever virus
antibodies
3 - 6 daysfever, backache,
headache,
nausea,
vomiting; toxic
phase jaundice,
abdominal pain,
kidney failure
Yellow fever

22. Air borne diseases
TreatmentDiagnosisIncubatio
n
Period
Clinical FeaturesDisease
co-
trimoxazole,
chlorampheni
col
ampicillin
Clinical, culture
respiratory
secretions
1 - 3 dayscough, difficulty breathing,
fast breathing, chest
indrawing
Pneumon
ia
supportive
care; vitamin
A; antibiotics
in
complicated
cases
generally made
by clinical
observation
10 - 12
days
rash, high fever, cough,
runny nose, red eyes;
serious post measles
complications (5-
10% of cases) - diarrhea,
pneumonia
Measles
Penicillin,
chlorampheni
col,
ceftriaxone,
Examination of
CSF, elevated
WCC, protein;
gram negative
5 - 15
days
Sudden onset fever, rash,
neck stiffness; altered
consciousness; bulging
fontanel in <1 yrs of age
Bacterial
meningiti
s

23. Contact infections
TreatmentDiagnosisIncubation
Period
Clinical
Features
Disease
immune
globulin
Antibiotic
Muscle
relaxants
entirely clinical3 - 21 daysdifficulty
swallowing,
lockjaw,
muscle
rigidity,
spasms
Tetanus
Penicillin in
massive
doses
Sero therapy
in proper dose
Clinical,
culture of
discharge
3 - 21 daysFever, toxicity,
wound
infection,
tissue
necrosis
Gas gangrene
Post exposure
immunization,
serotherapy
History of biteAccording to
bite site
Hydrophobia,
aerophobia,
seizures
Rabies

24. Phases of disasters
• Most of deaths, injuries
• Extrication of victims
• Immediate soft tissue infections treatment
Impact Phase (0-4 days)
• Airborne, foodborne, waterborne and vector diseases
• Prevent more spread of infection, stabilization
Post impact phase (4 days – 4 weeks)
• Infections with long incubation (TB) and of chronic disease, vector
borne
• Reconstruction
Recovery phase ( after 4 weeks)

25. Diseases by disaster phases
Impact
Deaths
Injuries
Hypothermia
Dehydration
Injury site
infection
Post impact
Airborne, flu
Waterborne, GE
vector diseases
Tetanus
Recovery
TB
Schistosomiasis
Lieshmaniasis
Leptospirosis
Nosocomial
infections of
chronic disease

26. Disaster management
 Is more than just response and relief (i.e., it assumes
a more proactive approach)
 Is a systematic process is based on the key
management principles (planning, organizing,
coordinating and controlling)
 Aims to reduce the negative impact or consequences
of adverse events (i.e., disasters cannot always be
prevented, but the adverse effects can be minimized)

27. Disaster management cycle

28. Risk analysis
 Is a situation that
has the potential for
causing damage to
life, property and the
environment
 Is the probability
that an injury or
damage will occur.
Hazard Risk

29. Risk analysis
 Factors makes the
community more fragile
and less able to cope
with or recover from an
adverse event.
 It comprises poverty,
social exclusion, and
inequity, illiteracy,
inadequate or
inequitable access to
basic health and
development services.
 Is the susceptibility
of damage to life,
property and the
environment if a
hazard reaches its
full potential
Susceptibility Vulnerability

30. Response
 Response measures are those, which are
taken immediately, prior to and following
disasters.
 Such measures are directed towards saving
life and protecting property and dealing
with the immediate damage caused by the
disaster.
 Its success depends vitally on good
preparedness.

31. Response to biological
disaster Establishment of diagnosis, epidemic
 Risk and vulnerability analysis
 enhance public health surveillance
 seek national assistance/guidance to Set case definition, put
guidelines
 Control of epidemic
1. alert hospitals and healthcare providers of the threat
2. prepare alternative care facilities
3. prepare to distribute medications
4. triage, tagging, dealing with dead bodies
 Prevent spread:
1. Pharmacological: immunization, chemoprophylaxis
2. Non pharmacological: isolation, quarantine
3. Infection control precautions

32. Response to disasters
 Search, rescue and first‐aid:
Most immediate help come from uninjured survivors.
 Field care:
1. Availability of ambulatory health facilities
2. Bed availability in nearby hospitals
3. Medical & surgical services
 Triage
 tagging
 name, age, place of origin, triage category, diagnosis & initial
treatment
 Dealing with dead bodies
 Removal of the dead from the disaster scene, use of body bags if
badly damaged
 Identification
 Reception by relatives
 New burial areas sited at least 250 meters away from drinking
water sources

33. Triage
 Rapidly classify the injured on basis of Severity of
their injuries, and Likelihood of their survival with
prompt treatment
 At the site of disaster
 Four color code system:

35. Relief phase
 Assistance from outside starts to reach disaster area
(6- 24hs).
Type & quantity of relief supplies depends upon:
 Type of disaster
 Type and quantity of supplies available locally.
 Rapid damage assessment
 Surveillance and disease control
1. Implement as soon as possible all public health
measures to reduce the risk of disease transmission
2. Organize a reliable disease reporting system to
identify outbreaks and to promptly initiate control
measures

36. Role of vaccination
 Vaccination is recommended to health
care workers but not for population in
relief phase.
Why?
 Compliance, Sterilization, Human
workforce
 Cold‐chain should be maintained
 vaccination for general population have
role in recovery phase

37. Nutrition
 Infants, children, pregnant & lactating women, sick
persons.
 Steps to ensure food relief:
1. Assessing the food supplies after the disaster
2. Assessing the nutritional needs of the affected
population.
3. Calculating the daily food rations and need for large
population groups.
4. Monitoring the nutritional status of the affected
population.

38. Recovery or Rehabilitation
 Recovery is the process by which communities and
the nations are assisted in returning to their proper
level of functioning following a disaster ( >4 days)
‘’Restoration of the pre‐disaster conditions’’.
 Priorities shift from health care needs towards
environmental measures.
 Long term recovery: reconstruction of damage after
disaster.

39. Recovery elements
• Survey of water sources and distribution system
• Chlorination. > 0.7ppmWater supply
• Kitchen sanitation
• Personal hygiene of individuals involved in food
preparation
Food safety
• Washing, cleaning and bathing facility
• Emergency latrines
Basic sanitation
and hygiene
• Intensified vector control programs.Vector control
• Reconstruction
• Reintegrate disaster survivors into the society
Long term
recovery

40. Disaster prevention
 Prevention: Measures aimed at impeding and preventing the
occurrence of a disaster event.
 Items:
1. Vulnerability Analysis and Risk Assessment
2. Environmental Management
 Safe Water supply and proper maintenance of sewage pipeline
3. Personal hygiene awareness, provision of washing, cleaning and
bathing facilities, and avoiding overcrowding.
4. Vector control
 Elimination of breeding places by water management, draining
of stagnant pools and not allowing water to collect.
 Outdoor fogging and control of vectors by regular spraying of
insecticides.
 Keeping a watch on the rodent population
5. Burial/disposal of the Dead bodies

41. Prevention
6. Integrated Disease Surveillance Systems
7. Immunization
8. Biosafety in the laboratories dealing with
bacteria, viruses or toxins
9. Prevention of Post-disaster Epidemics
10. Non-pharmaceutical Interventions for
Disease Containment by Isolation and
Quarantine

42. Mitigation
 Measures designed To lessen and reducing disaster
hazards on community.
 Vertical process in pre and post disaster.
Include:
1- Structural mitigation – construction projects which
reduce economic and social impacts
 Flood mitigation works
 Appropriate land use planning, ventilation
 Improved building codes
 Safety of health facilities and public health services
2- Non-structural activities – policies and practices which
raise
awareness of hazards or encourage developments to

43. Preparedness or preparation
 A program of long term development activities to strengthen the overall
capability and capacity of a country to manage efficiently all types of
emergencies.
 It require inter sectorial cooperation
Elements:
1. Evaluate the risk of the country or particular region to the disaster
2. Adopt standards and regulations
3. Organize communication, information and warning systems
4. Ensure coordination and response mechanisms
5. Adopt measure to ensure that financial and other resources are
available for increased readiness and can be mobilized in disaster
situation
6. Develop public education program, vaccinations
7. Coordinate information session with news media
8. Organize disaster simulation exercises that test response mechanisms.

44. Disaster management

45. Don’t forget
 Most commonly reported disease in post-disaster
phase is Gastroenteritis ( the first killer)
 Most practical and effective strategy of disease
prevention and control in post-disaster phase is
‘supplying safe drinking water and proper disposal
of excreta’
 Foremost step for disease prevention and control in
post-disaster phase is chlorination of all water bodies.
 Level of residual chlorine to be maintained in all water
bodies in post-disaster phase is (> 0.7 ppm)
 A common micronutrient deficiency in disasters is
Vitamin A deficiency: It occurs due to deficient relief
diets, measles and diarrhea (gastroenteritis)
 Other common deficiencies include scurvy (Vitamin

46. Thank you