Personal Hygiene and Handwashing After a Disaster or Emergency 1.docx

8/10/2019 Personal Hygiene and Handwashing After a Disaster or Emergency 1.docx

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Personal Hygiene and Handwashing After a Disaster or

Emergency

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Disaster Kit

Handwashing

When to Wash Hands

Bathing

Dental Hygiene

Wound Care

Good basic personal hygiene and handwashing are critical to help prevent the spread of illness

and disease. Clean, safe running water is essential for proper hygiene and handwashing.

Hygiene is especially important in an emergency such as a flood, hurricane, or earthquake, but

finding clean, safe running water can sometimes be difficult. The following information will help to

ensure good hygiene and handwashing in the event of an emergency.

Disaster Supplies Kit (Hygiene Supplies)

Before an emergency, make sure you have created a Disaster Supplies Kit.

Handwashing

Keeping hands clean during an emergency helps prevent the spread of germs. If your tap water

is not safe to use, wash your hands with soap and water that has beenboiled or disinfected.

Follow these steps to make sure you wash your hands properly:

Wet your hands with clean, running water (warm or cold) and apply soap.

Rub your hands together to make a lather and scrub them well; be sure to scrub the backs

of your hands, between your fingers, and under your nails.
http://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/es/disasters/floods/sanitation.asphttp://www.addthis.com/bookmark.phphttp://www.addthis.com/bookmark.phphttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#kithttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#kithttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#handwashinghttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#handwashinghttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#whenwashhttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#whenwashhttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#bathinghttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#bathinghttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#dentalhttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#dentalhttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#woundhttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#woundhttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#make_safe_boilinghttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#make_safe_boilinghttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#make_safe_boilinghttp://www.addthis.com/bookmark.phphttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#make_safe_boilinghttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#woundhttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#dentalhttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#bathinghttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#whenwashhttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#handwashinghttp://www.bt.cdc.gov/disasters/floods/sanitation.asp#kithttp://www.addthis.com/bookmark.phphttp://www.bt.cdc.gov/es/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asp


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Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy

Birthday" song from beginning to end twice.

Rinse your hands well under running water.

Dry your hands using a clean towel or air dry them.

A temporaryhand washing stationcan be created by using a large water jug that contains clean

water (for example, boiled or disinfected).

Washing hands with soap and water is the best way to reduce the number of germs on them. If

soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60%

alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in

some situations, but sanitizers do noteliminate all types of germs.

Hand sanitizers are not effective when hands are visibly dirty.

Top of Page

When to Wash Hands

Wash hands with soap and clean, running water (if available):

Before, during, and after preparing food

Before eating food

After using the toilet

After changing diapers or cleaning up a child who has used the toilet

Before and after caring for someone who is sick

After blowing your nose, coughing, or sneezing

After touching an animal or animal waste

After touching garbage

Before and after treating a cut or wound

Other Hand Hygiene Resources

Food and Water Safety and Hand Hygiene Resources

Handwashing: Clean Hands Save Lives
http://www.dec.alaska.gov/eh/fss/Food/Docs/HANDWASHING_STATION.pdfhttp://www.dec.alaska.gov/eh/fss/Food/Docs/HANDWASHING_STATION.pdfhttp://www.dec.alaska.gov/eh/fss/Food/Docs/HANDWASHING_STATION.pdfhttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.cdc.gov/handwashing/http://www.cdc.gov/handwashing/http://www.cdc.gov/handwashing/http://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.dec.alaska.gov/eh/fss/Food/Docs/HANDWASHING_STATION.pdf


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Do not use contaminated water to wash dishes, brush your teeth, wash and prepare food,

or make ice.

Top of Page

Bathing

Bathing after a water-related emergency should only be done with clean, safe water. Listen to

local authorities for further instructions. Sometimes water that is not safe to drink can be used for

bathing.

Dental Hygiene

Brushing your teeth after a water-related emergency should only be done with clean, safe

water. Listen to local authorities to find out if tap water is safe to use.

Visit theSafe Drinking Water for Personal Use page for more information about making

your water safe for brushing your teeth.

You may visitCDC's Oral HealthWeb site for complete dental hygiene information.

Wound Care

Keeping wounds clean and covered is crucial during an emergency. If you have open cuts or

sores, keep them as clean as possible by washing well with soap and clean, safe water to controlinfection. If a wound develops redness, swelling, or drainage, seek immediate medical attention.

When providing first aid for a wound,clean handscan help prevent infection (see Handwashing

on this page). VisitEmergency Wound Care After a Natural Disasterto find complete information

on caring for wounds.

Healthcare professionals should visitEmergency Wound Management for Healthcare

ProfessionalsandManagement of Vibrio vulnificus Wound Infections After a Disaster.

Top of Page

Additional Hygiene Information

Cleaning and Sanitizing With Bleach after an Emergency

Flood Water After a Disaster or Emergency

Guidelines for the Management of Acute Diarrhea After a Disaster

Water-Related Emergencies & Outbreaks

Guidance on Microbial Contamination in Previously Flooded Outdoor Areas
http://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.cdc.gov/healthywater/emergency/safe_water/http://www.cdc.gov/healthywater/emergency/safe_water/http://www.cdc.gov/oralhealth/http://www.cdc.gov/oralhealth/http://www.cdc.gov/oralhealth/http://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/woundcare.asphttp://www.bt.cdc.gov/disasters/woundcare.asphttp://www.bt.cdc.gov/disasters/woundcare.asphttp://www.bt.cdc.gov/disasters/emergwoundhcp.asphttp://www.bt.cdc.gov/disasters/emergwoundhcp.asphttp://www.bt.cdc.gov/disasters/emergwoundhcp.asphttp://www.bt.cdc.gov/disasters/emergwoundhcp.asphttp://www.bt.cdc.gov/disasters/disease/vibriofaq.asphttp://www.bt.cdc.gov/disasters/disease/vibriofaq.asphttp://www.bt.cdc.gov/disasters/disease/vibriofaq.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/bleach.asphttp://www.bt.cdc.gov/disasters/bleach.asphttp://www.bt.cdc.gov/disasters/floods/cleanupwater.asphttp://www.bt.cdc.gov/disasters/floods/cleanupwater.asphttp://www.bt.cdc.gov/disasters/disease/diarrheaguidelines.asphttp://www.bt.cdc.gov/disasters/disease/diarrheaguidelines.asphttp://www.cdc.gov/healthywater/emergency/http://www.cdc.gov/healthywater/emergency/http://www.cdc.gov/nceh/ehs/Publications/Guidance_Flooding.htmhttp://www.cdc.gov/nceh/ehs/Publications/Guidance_Flooding.htmhttp://www.cdc.gov/nceh/ehs/Publications/Guidance_Flooding.htmhttp://www.cdc.gov/healthywater/emergency/http://www.bt.cdc.gov/disasters/disease/diarrheaguidelines.asphttp://www.bt.cdc.gov/disasters/floods/cleanupwater.asphttp://www.bt.cdc.gov/disasters/bleach.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/disease/vibriofaq.asphttp://www.bt.cdc.gov/disasters/emergwoundhcp.asphttp://www.bt.cdc.gov/disasters/emergwoundhcp.asphttp://www.bt.cdc.gov/disasters/woundcare.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.cdc.gov/oralhealth/http://www.cdc.gov/healthywater/emergency/safe_water/http://www.bt.cdc.gov/disasters/floods/sanitation.asp


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Food, Water, Sanitation, and Hygiene Information for

Use Before and After a Disaster or EmergencyShare

Before a Disaster or Emergency

Food and Water Needs: Preparing for a Disaster or Emergency

After a Disaster or Emergency

Safe Food

Keep Food and Water Safe After a Disaster or Emergency

Food & Water Safety and Hand Hygiene Resources(flyers, posters, stickers, PSAs)

Safe Drinking Water

Water Testing

Private Well Testing

EPA: Fecal Coliform and E. coli0157: H7

Water for Personal Use

Keep Food and Water Safe After a Disaster or Emergency

Personal Preparation and Storage of Safe Water

EPA: Emergency Disinfection of Drinking Water

Make Water Safe

Finding Emergency Water Sources

Water from Community Drinking Water Systems

Community Drinking Water Use

Water from Private Wells

Emergency Disinfection of Bored or Dug Wells
http://www.addthis.com/bookmark.phphttp://www.addthis.com/bookmark.phphttp://www.bt.cdc.gov/disasters/foodwater/prepare.asphttp://www.bt.cdc.gov/disasters/foodwater/prepare.asphttp://www.bt.cdc.gov/disasters/foodwater/facts.asphttp://www.bt.cdc.gov/disasters/foodwater/facts.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.cdc.gov/healthywater/drinking/private/wells/testing.htmlhttp://www.cdc.gov/healthywater/drinking/private/wells/testing.htmlhttp://www.epa.gov/katrina/fecal.htmlhttp://www.epa.gov/katrina/fecal.htmlhttp://www.epa.gov/katrina/fecal.htmlhttp://www.epa.gov/katrina/fecal.htmlhttp://www.bt.cdc.gov/disasters/foodwater/facts.asphttp://www.bt.cdc.gov/disasters/foodwater/facts.asphttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#treatinghttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#treatinghttp://www.epa.gov/safewater/faq/pdfs/fs_emergency-disinfection-drinkingwater-2006.pdfhttp://www.epa.gov/safewater/faq/pdfs/fs_emergency-disinfection-drinkingwater-2006.pdfhttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#make_safehttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#make_safehttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#finding_water_sourceshttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#finding_water_sourceshttp://www.cdc.gov/healthywater/emergency/safe_water/community.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/community.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/wells/disinfection_wells_bored.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/wells/disinfection_wells_bored.htmlhttp://www.addthis.com/bookmark.phphttp://www.cdc.gov/healthywater/emergency/safe_water/wells/disinfection_wells_bored.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/community.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#finding_water_sourceshttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#make_safehttp://www.epa.gov/safewater/faq/pdfs/fs_emergency-disinfection-drinkingwater-2006.pdfhttp://www.cdc.gov/healthywater/emergency/safe_water/personal.html#treatinghttp://www.bt.cdc.gov/disasters/foodwater/facts.asphttp://www.epa.gov/katrina/fecal.htmlhttp://www.cdc.gov/healthywater/drinking/private/wells/testing.htmlhttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/foodwater/facts.asphttp://www.bt.cdc.gov/disasters/foodwater/prepare.asphttp://www.addthis.com/bookmark.php


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Emergency Disinfection of Drilled or Driven Wells

EPA: Private Drinking Water Wells: What to Do After the Flood

Water from Cisterns, Storage Tanks, Tankers, and Rain-Catchment

Systems

Emergency Disinfection of Cisterns and other Rain-Catchment Systems

WHO: Cleaning and Disinfecting Water Storage Tanks and Tankers

Sanitation and Hygiene

Personal Hygiene and Handwashing After a Disaster or Emergency


Septic and Wastewater Concerns

Septic Systems

NASD: Flooded Private Sewage Systems: Safety, Sanitation And Clean-Up Concerns

Community Wastewater Treatment Systems

Water-related Diseases and Illnesses

Water-related Diseases, Contaminants, and Injuries

Water-related Diseases and Contaminants in Private Wells

Cryptosporidiosis and Boil Water Advisories

Guidelines for the Management of Acute Diarrhea (for Healthcare Providers)

Educational Materials


food & Water Safety and Hand Hygiene Resources
http://www.cdc.gov/healthywater/emergency/safe_water/wells/disinfection_wells_drilled.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/wells/disinfection_wells_drilled.htmlhttp://www.epa.gov/safewater/privatewells/whatdo.htmlhttp://www.epa.gov/safewater/privatewells/whatdo.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/cisterns/disinfection_cisterns.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/cisterns/disinfection_cisterns.htmlhttp://www.who.int/water_sanitation_health/publications/2011/tn3_cleaning_disinfecting_tanks_en.pdfhttp://www.who.int/water_sanitation_health/publications/2011/tn3_cleaning_disinfecting_tanks_en.pdfhttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.cdc.gov/healthywater/emergency/septic/septic.htmlhttp://www.cdc.gov/healthywater/emergency/septic/septic.htmlhttp://nasdonline.org/document/2028/d001564/flooded-private-sewage-systems-safety-sanitation-and-clean.htmlhttp://nasdonline.org/document/2028/d001564/flooded-private-sewage-systems-safety-sanitation-and-clean.htmlhttp://www.cdc.gov/healthywater/emergency/septic/wastewater.htmlhttp://www.cdc.gov/healthywater/emergency/septic/wastewater.htmlhttp://www.cdc.gov/healthywater/disease/type.htmlhttp://www.cdc.gov/healthywater/disease/type.htmlhttp://www.cdc.gov/healthywater/drinking/private/wells/diseases.htmlhttp://www.cdc.gov/healthywater/drinking/private/wells/diseases.htmlhttp://www.cdc.gov/crypto/health_professionals/bwa/http://www.cdc.gov/crypto/health_professionals/bwa/http://www.bt.cdc.gov/disasters/disease/diarrheaguidelines.asphttp://www.bt.cdc.gov/disasters/disease/diarrheaguidelines.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/disease/diarrheaguidelines.asphttp://www.cdc.gov/crypto/health_professionals/bwa/http://www.cdc.gov/healthywater/drinking/private/wells/diseases.htmlhttp://www.cdc.gov/healthywater/disease/type.htmlhttp://www.cdc.gov/healthywater/emergency/septic/wastewater.htmlhttp://nasdonline.org/document/2028/d001564/flooded-private-sewage-systems-safety-sanitation-and-clean.htmlhttp://www.cdc.gov/healthywater/emergency/septic/septic.htmlhttp://www.bt.cdc.gov/disasters/handhygiene.asphttp://www.bt.cdc.gov/disasters/floods/sanitation.asphttp://www.who.int/water_sanitation_health/publications/2011/tn3_cleaning_disinfecting_tanks_en.pdfhttp://www.cdc.gov/healthywater/emergency/safe_water/cisterns/disinfection_cisterns.htmlhttp://www.epa.gov/safewater/privatewells/whatdo.htmlhttp://www.cdc.gov/healthywater/emergency/safe_water/wells/disinfection_wells_drilled.html


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Share

Educational Materials

Posters and Flyers

Keep Food Safe

English

Eat Safe Food

English

Spanish

Make Water Safe

EnglishSpanish

Drink Safe Water

English

Spanish

Wash Your Hands

English

Spanish

Haitian Creole

Sticker for

Clean Hands Save Lives

Stickers


Stickers for printing on 8.5" x 11" sticky-tac paper

English

Spanish

Haitian Creole

Handout Cards
http://www.addthis.com/bookmark.phphttp://www.addthis.com/bookmark.phphttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-keepfoodsafe.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-keepfoodsafe.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-eatsafefood.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-eatsafefood.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/flyer-eatsafefood.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/flyer-eatsafefood.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-B_Make_Water_Safe_Flyer_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-B_Make_Water_Safe_Flyer_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-B_Make_Water_Safe_Flyer_es_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-B_Make_Water_Safe_Flyer_es_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-A_Drink_Safe_Water_Flyer_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-A_Drink_Safe_Water_Flyer_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-A_Drink_Safe_Water_Flyer_es_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-A_Drink_Safe_Water_Flyer_es_508.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-wash-your-hands.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-wash-your-hands.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/flyer-wash-your-hands.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/flyer-wash-your-hands.pdfhttp://emergency.cdc.gov/hcr/disasters/pdf/cleanhandssavelives_emergency_situations.pdfhttp://emergency.cdc.gov/hcr/disasters/pdf/cleanhandssavelives_emergency_situations.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/cleanhands_stickers.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/cleanhands_stickers.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/cleanhands_stickers.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/cleanhands_stickers.pdfhttp://emergency.cdc.gov/hcr/disasters/hurricanes/pdf/cleanhands-stickers.pdfhttp://emergency.cdc.gov/hcr/disasters/hurricanes/pdf/cleanhands-stickers.pdfhttp://www.addthis.com/bookmark.phphttp://www.addthis.com/bookmark.phphttp://emergency.cdc.gov/hcr/disasters/hurricanes/pdf/cleanhands-stickers.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/cleanhands_stickers.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/cleanhands_stickers.pdfhttp://emergency.cdc.gov/hcr/disasters/pdf/cleanhandssavelives_emergency_situations.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/flyer-wash-your-hands.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-wash-your-hands.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-A_Drink_Safe_Water_Flyer_es_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-A_Drink_Safe_Water_Flyer_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-B_Make_Water_Safe_Flyer_es_508.pdfhttp://www.cdc.gov/healthywater/pdf/emergency/09_202278-B_Make_Water_Safe_Flyer_508.pdfhttp://emergency.cdc.gov/es/disasters/hurricanes/pdf/flyer-eatsafefood.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-eatsafefood.pdfhttp://emergency.cdc.gov/disasters/hurricanes/pdf/flyer-keepfoodsafe.pdfhttp://www.addthis.com/bookmark.php


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Hand Hygiene

For use when distributing hand sanitizer

English

Slide Sets


English

Public Service Announcements

Handwashing After a Disaster

Script, Audio, Video, Text Messages, and TV Crawls

Additional Resources

Personal Hygiene and Handwashing After a Disaster or Emergency

HomePublicationsArticle

Preventing and controlling infectious diseases

after natural disasters

Health,Risk & Vulnerabilities,Water

ARTICLE

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Flooding in Nowshera, Pakistan. Photo: UN Photo/WFP/Amjad Jamal

Beyond damaging and destroying physical infrastructure, natural disasters can lead to outbreaks of

infectious disease. In this article, two UNU-IIGH researchers and colleagues review risk factors and

potential infectious diseases resulting from the secondary effects of major natural disasters that occurred

from 2000 to 2011, classify possible diseases, and give recommendations on prevention, control measures

and primary healthcare delivery improvements.

Over the past few decades, the incidence and magnitude of natural disasters has grown, resulting in

substantial economic damages and affecting or killing millions of people. Recent disasters have shown that

even the most developed countries are vulnerable to natural disasters, such as Hurricane Katrina in the

United States in 2005 and the Great Eastern Japan Earthquake and tsunami in 2011. Global population

growth, poverty, land shortages and urbanization in many countries have increased the number of people

living in areas prone to natural disasters and multiplied the public health impacts.

Natural disasters can be split in three categories: hydro-meteorological disasters, geophysical disasters and

geomorphologic disasters.

Hydro-meteorological disasters, like floods, are the most common (40 percent) natural disasters worldwide

and are widely documented. The public health consequences of flooding are disease outbreaks mostly

resulting from the displacement of people into overcrowded camps and cross-contamination of water

sources with faecal material and toxic chemicals. Flooding also is usually followed by the proliferation of

mosquitoes, resulting in an upsurgence of mosquito-borne diseases such as malaria. Documentation of

disease outbreaks and the public health after-effects of tropical cyclones (hurricanes and typhoons) and

tornadoes, however, is lacking.

Geophysical disasters are the second-most reported type of natural disaster, and earthquakes are the

majority of disasters in this category. Outbreaks of infectious diseases may be reported when earthquakedisasters result in substantial population displacement into unplanned and overcrowded shelters, with


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limited access to food and safe water. Disease outbreaks may also result from the destruction of

water/sanitation systems and the degradation of sanitary conditions directly caused by the earthquake.

Tsunamis are commonly associated with earthquakes, but can also be caused by powerful volcanic

eruptions or underwater landslides. Although classified as geophysical disasters, they have a similar

clinical and threat profile (water-related consequences) to that of tropical cyclones (e.g., typhoon or

hurricane).

Geomorphologic disasters, such as avalanches and landslides, also are associated with infectious disease

transmissions and outbreaks, but documentation is generally lacking.

After a natural disaster

The overwhelming majority of deaths immediately after a natural disaster are directly associated with

blunt trauma, crush-related injuries and burn injuries. The risk of infectious disease outbreaks in the

aftermath of natural disasters has usually been overemphasized by health officials and the media, leading

to panic, confusion and sometimes to unnecessary public health activities.

The prolonged health impact of natural disasters on a community may be the consequence of the collapse

of health facilities and healthcare systems, the disruption of surveillance and health programmes

(immunization and vector control programmes), the limitation or destruction of farming activities (scarcity

of food/food insecurity), or the interruption of ongoing treatments and use of unprescribed medications.

The risk factors for increased infectious diseases transmission and outbreaks are mainly associated with

the after-effects of the disasters rather than to the primary disaster itself or to the corpses of those killed.

These after-effects include displacement of populations (internally displaced persons and refugees),

environmental changes and increased vector breeding sites. Unplanned and overcrowded shelters, poor

water and sanitation conditions, poor nutritional status or insufficient personal hygiene are often the case.

Consequently, there are low levels of immunity to vaccine-preventable diseases, or insufficient vaccinationcoverage and limited access to health care services.

Phases of outbreak and classification of infectious disease

Infectious disease transmission or outbreaks may be seen days, weeks or even months after the onset of the

disaster. Three clinical phases of natural disasters summarize the chronological public health effects on

injured people and survivors:

Phase (1), the impact phase (lasting up to to 4 days), is usually the period when victims are

extricated and initial treatment of disaster-related injuries is provided.

Phase (2), the post-impact phase (4 days to 4 weeks), is the period when the first waves ofinfectious diseases (air-borne, food-borne, and/or water-borne infections) might emerge.

Phase (3), the recovery phase (after 4 weeks), is the period when symptoms of victims who have

contracted infections with long incubation periods or those with latent-type infections may become

clinically apparent. During this period, infectious diseases that are already endemic in the area, as

well as newly imported ones among the affected community, may grow into an epidemic.

It is common to see the international community, NGOs, volunteers, experts and the media leaving a

disaster-affected zone usually within three months, when in reality basic sanitation facilities and access to

basic hygiene may still be unavailable or worsen due to the economic burden of the disasters.

Although it is not possible to predict with accuracy which diseases will occur following certain types of

disasters, diseases can be distinguished as either water-borne, air-borne/droplet or vector-borne diseases,

and contamination from wounded injuries.


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Diarrhoeal diseases

The most documented and commonly occurring diseases are water-borne diseases (diarrhoeal diseases and

Leptospirosis). Diarrhoeal diseases cause over 40 percent of the deaths in disaster and refugee camp

settings. Epidemics among victims are commonly related to polluted water sources (faecal contamination),

or contamination of water during transportation and storage. Outbreaks have also been related to shared

water containers and cooking pots, scarcity of soap and contaminated food, as well as pre-existing poorsanitary infrastructures, water supply and sewerage systems.

Diarrhoeal epidemics are frequently reported following natural disasters in developing countries. Floods

are recurrent in many African countries, such as Mozambique, and usually lead to a significant increase in

diarrhoeal disease incidences.

Following the 2005 earthquake in Pakistan, an estimated 42 percent increase in diarrhoeal infections was

reported. In Iran, 1.6 percent of the 75,586 persons displaced by the Bam earthquake in 2003 were infected

with diarrhoeal diseases. A rapid assessment conducted in Indonesia after the 2004 tsunami showed that 85

percent of the survivors in the town of Calang experienced diarrhoeal illness after drinking from

contaminated wells. In Thailand, the 2004 Indian tsunami also contributed to a significant increase indiarrhoeal disease incidences.

An investigation conducted in 100 households after the 2001 earthquake in El Salvador showed that 137

persons out of 594 (22 percent) experienced diarrhoeal infections. An evolving cholera epidemic was

reported 9 months after the earthquake in Haiti, with a high fatality rate of 6.4 percent among the victims

(of the 4,722 documented affected, 303 died).

Only a small cluster of Norovirus cases was reported in evacuation centres some weeks after the Great

Eastern Japanese Earthquake and tsunami, while various pathogens were confirmed among the populations

displaced by Hurricanes Allison (2001) and Katrina in the US.

Leptospirosis, the other frequently occurring water-borne disease, can be transmitted through contact with

contaminated water or food, or with soil containing contaminated urine (Leptospires) from infected

animals (e.g., rodents). Floods facilitate the proliferation of rodents and the spread of Leptospires in a

human community. Investigations conducted in populations affected by flood disasters in 2000 in India

and Thailand reported Leptospirosis epidemics. Increased risk factors and outbreaks were also reported

after Typhoon Nali in China and Taiwan in 2001.


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The following table shows a breakdown of the occurrence of communicable diseases. (This is described in

detail in the original paper, which is available for downloading in the the right sidebar.)

On the topic of outbreak and classification, one final note regarding the myth of infectious disease

transmission from dead bodies: Still controversial and frequently overstated is the assumption that dead

bodies pose a significant risk for the transmission of infectious diseases after a natural disaster. Despite thevast number of deaths resulting from major disasters, no outbreaks resulting from corpses have been


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documented. The environment in which pathogens live in a dead body can no longer sustain them, since

the microorganisms involved in putrefaction (decay processes) are not disease causing. There are a few

situations, such as deaths from cholera or hemorrhagic fever epidemics, that require specific precautions,

but families should not be deprived of appropriate identification and burial ceremonies for their dead

relatives from disasters. Survivors of disaster present a much more substantial reservoir for potential

infectious diseases.

Prevention and control measures

We recommend re-establishing and improving the delivery of primary health care. Medical supply should

be provided, and training of healthcare workers and medical personnel on appropriate case management

should be conducted. Public health responders should set up a rapid disease risk assessment within the first

week of the disaster in order to identify disaster impacts and health needs. Practically, prompt and

adequate prevention and control measures, and appropriate case management and surveillance systems are

essential for minimizing infectious disease burdens. The prevention and control checklist provided in our

paper shows the measures to be undertaken in order to avoid infectious diseases following natural

disasters.

Natural disasters and infectious disease outbreaks represent global challenges towards the achievement of

the Millennium Development Goals. It is important for the public, policymakers and health officials to

understand the concept that disaster does not transmit infectious diseases; that the primary cause of death

in the aftermath of a disaster is non-infectious; that dead bodies (from disasters) are not a source of

epidemic; and that infectious disease outbreaks result secondarily from exacerbation of disease risk

factors.

National surveillance systems and the establishment of continual practices of protocol for health

information management have to be strengthened. In disasters, education on hygiene and hand washing,

and provision of an adequate quantity of safe water, sanitation facilities and appropriate shelter are veryimportant for prevention of infectious diseases. The assessment and response activities described above

should be properly coordinated.

Personal Hygiene After a Flood or Storm

Natural Disasters and Severe Weather Currently selected Maintaining Health During Bushfires Maintaining Health During and After Floods and Storms Water Quality Treat all floodwater as potentially contaminated with sewage

Keep children away from flood-affected areas and avoid unnecessary contact with mud and floodwaters. Ensure feet are

covered if they are likely to come into contact with mud and always wear gloves when handling flood-affected items or

mud.

Always wash your hands thoroughly with soap and clean water or with an alcohol-based hand cleanser:
http://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/default.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/default.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/bushfire.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/bushfire.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/storms-and-floods.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/storms-and-floods.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/water-quality.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/water-quality.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/water-quality.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/storms-and-floods.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/bushfire.aspxhttp://www.health.nsw.gov.au/emergency_preparedness/weather/Pages/default.aspx


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after handling flood-affected items;

when participating in flood clean-up activities;

immediately after going to the toilet; and

before handling or eating food.

Only use clean eating utensils, toothbrushes, towels or handkerchiefs.

All cuts and abrasions should be cleaned, treated with antiseptic and coveredimmediately. Seek immediate medical attention if you have deep or puncture wounds, or if

any wounds develop redness or swelling. Check whether you are up-to-date with your

tetanus vaccinations.

To avoid being bitten by mosquitoes, use an insect repellent on exposed skin areas

and reapply every two hours. Cover up as much as possible with light-coloured loose-fitting

clothing.

Epidemics after Natural Disasters

John T. Watson, *Michelle Gayer,*andMaire A. Connolly*

Author informationCopyright and License information

This article has beencited byother articles in PMC.

Abstract

Natural disasters are catastrophic events with atmospheric, geologic, and hydrologic origins.

Disasters include earthquakes, volcanic eruptions, landslides, tsunamis, floods, and drought.

Natural disasters can have rapid or slow onset, with serious health, social, and economic

consequences. During the past 2 decades, natural disasters have killed millions of people,

adversely affected the lives of at least 1 billion more people, and resulted in substantial

economic damages (1). Developing countries are disproportionately affected because they

lack resources, infrastructure, and disaster-preparedness systems.

Deaths associated with natural disasters, particularly rapid-onset disasters, are

overwhelmingly due to blunt trauma, crush-related injuries, or drowning. Deaths from

communicable diseases after natural disasters are less common.

Go to:

Dead Bodies and Disease

The sudden presence of large numbers of dead bodies in the disaster-affected area may

heighten concerns of disease outbreaks (2), despite the absence of evidence that dead bodiespose a risk for epidemics after natural disasters (3). When death is directly due to the natural
http://www.ncbi.nlm.nih.gov/pubmed/?term=Watson%20JT%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Watson%20JT%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Gayer%20M%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Gayer%20M%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Gayer%20M%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Connolly%20MA%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Connolly%20MA%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Connolly%20MA%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/#R1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725828/http://www.ncbi.nlm.nih.gov/pubmed/?term=Connolly%20MA%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Gayer%20M%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Watson%20JT%5Bauth%5D


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disaster, human remains do not pose a risk for outbreaks (4). Dead bodies only pose health

risks in a few situations that require specific precautions, such as deaths from cholera (5)or

hemorrhagic fevers (6). Recommendations for management of dead bodies are summarized in

theTable.

Table

Principles for management of dead bodies*

Despite these facts, the risk for outbreaks after disasters is frequently exaggerated by both

health officials and the media. Imminent threats of epidemics remain a recurring theme of

media reports from areas recently affected by disasters, regardless of attempts to dispel these

myths (2,3,7).

Go to:

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, and the access to healthcare

services (8). Outbreaks are less frequently reported in disaster-affected populations than in

conflict-affected populations, where two thirds of deaths may be from communicable

diseases (9). Malnutrition increases the risk for death from communicable diseases and is

more common in conflict-affected populations, particularly if their displacement is related to

long-term conflict (10).

Although outbreaks after flooding (11)have been better documented than those after

earthquakes, volcanic eruptions, or tsunamis (12), natural disasters (regardless of type) that

do not result in population displacement are rarely associated with outbreaks (8). Historically,

the large-scale displacement of populations as a result of natural disasters is not common (8),

which likely contributes to the low risk for outbreaks overall and to the variability in risk

among disasters of different types.

Go to:
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Risk Factors for Communicable Disease Transmission

Responding effectively to the needs of the disaster-affected population requires an accurate

communicable disease risk assessment. The efficient use of humanitarian funds depends on

implementing priority interventions on the basis of this risk assessment.

A systematic and comprehensive evaluation should identify 1) endemic and epidemic

diseases that are common in the affected area; 2) living conditions of the affected population,

including number, size, location, and density of settlements; 3) availability of safe water and

adequate sanitation facilities; 4) underlying nutritional status and immunization coverage

among the population; and 5) degree of access to healthcare and to effective case

management.

Go to:

Communicable Diseases Associated with Natural Disasters

The following types of communicable diseases have been associated with populations

displaced by natural disasters. These diseases should be considered when postdisaster risk

assessments are performed.

Water-related Communicable Diseases

Access to safe water can be jeopardized by a natural disaster. Diarrheal disease outbreaks can

occur after drinking water has been contaminated and have been reported after flooding and

related displacement. An outbreak of diarrheal disease after flooding in Bangladesh in 2004involved >17,000 cases; Vibrio cholerae(O1 Ogawa and O1 Inaba) and

enterotoxigenicEscherichia coliwere isolated (13). A large (>16,000 cases) cholera

epidemic (O1 Ogawa) in West Bengal in 1998 was attributed to preceding floods (14), and

floods in Mozambique in JanuaryMarch 2000 led to an increase in the incidence of diarrhea

(15).

In a large study undertaken in Indonesia in 19921993, flooding was identified as a

significant risk factor for diarrheal illnesses caused by Salmonella entericaserotype

Paratyphi A (paratyphoid fever) (16). In a separate evaluation of risk factors for infection

with Cryptosporidium parvumin Indonesia in 20012003, case-patients were >4 more

likely than controls to have been exposed to flooding (17).

The risk for diarrheal disease outbreaks following natural disasters is higher in developing

countries than in industrialized countries (8,11). In Aceh Province, Indonesia, a rapid health

assessment in the town of Calang 2 weeks after the December 2004 tsunami found that 100%

of the survivors drank from unprotected wells and that 85% of residents reported diarrhea in

the previous 2 weeks (18). In Muzaffarabad, Pakistan, an outbreak of acute watery diarrhea

occurred in an unplanned, poorly equipped camp of 1,800 persons after the 2005 earthquake.

The outbreak involved >750 cases, mostly in adults, and was controlled after adequate waterand sanitation facilities were provided (19). In the United States, diarrheal illness was noted
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after Hurricanes Allison (20)and Katrina (2123), and norovirus, Salmonella, and toxigenic

and nontoxigenic V. choleraewere confirmed among Katrina evacuees.

Hepatitis A and E are also transmitted by the fecal-oral route, in association with lack of

access to safe water and sanitation. Hepatitis A is endemic in most developing countries, and

most children are exposed and develop immunity at an early age. As a result, the risk for

large outbreaks is usually low in these settings. In hepatitis Eendemic areas, outbreaks

frequently follow heavy rains and floods; the illness is generally mild and self-limited, but in

pregnant women case-fatality rates can reach 25% (24). After the 2005 earthquake in

Pakistan, sporadic hepatitis E cases and clusters were common in areas with poor access to

safe water. Over 1,200 cases of acute jaundice, many confirmed as hepatitis E, occurred

among the displaced (25). Clusters of both hepatitis A and hepatitis E were noted in Aceh

after the December 2004 tsunami (26).

Leptospirosis is an epidemic-prone zoonotic bacterial disease that can be transmitted bydirect contact with contaminated water. Rodents shed large amounts of leptospires in their

urine, and transmission occurs through contact of the skin and mucous membranes with

water, damp soil or vegetation (such as sugar cane), or mud contaminated with rodent urine.

Flooding facilitates spread of the organism because of the proliferation of rodents and the

proximity of rodents to humans on shared high ground. Outbreaks of leptospirosis occurred in

Taiwan, Republic of China, associated with Typhoon Nali in 2001 (27); in Mumbai, India,

after flooding in 2000 (28); in Argentina after flooding in 1998 (29); and in the Krasnodar

region of the Russian Federation in 1997 (30). After a flooding-related outbreak of

leptospirosis in Brazil in 1996, spatial analysis indicated that incidence rates of leptospirosisdoubled inside the flood-prone areas of Rio de Janeiro (31).

Diseases Associated with Crowding

Crowding is common in populations displaced by natural disasters and can facilitate the

transmission of communicable diseases. Measles and the risk for transmission after a natural

disaster are dependent on baseline immunization coverage among the affected population,

and in particular among children 18,000 cases (33). After the tsunami in Aceh, a

cluster of measles involving 35 cases occurred in Aceh Utara district, and continuing sporadic

cases and clusters were common despite mass vaccination campaigns (26). In Pakistan, after

the 2005 South Asia earthquake, sporadic cases and clusters of measles (>400 clinical cases

in the 6 months after the earthquake) also occurred (25).

Neisseria meningitidismeningitis 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 (25,26). Prompt response with antimicrobial prophylaxis, as

occurred in Aceh and Pakistan, can interrupt transmission. Large outbreaks have not been
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recently reported in disaster-affected populations but are well-documented in populations

displaced by conflict (34).

Acute respiratory infections (ARI) are a major cause of illness and death among displaced

populations, particularly in children


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vaccination coverage levels are low, are associated with illness and death from tetanus. A

cluster of 106 cases of tetanus, including 20 deaths, occurred in Aceh and peaked 2-1/2

weeks after the tsunami (26). Cases were also reported in Pakistan following the 2005

earthquake (25).

An unusual outbreak of coccidiomycosis occurred after the January 1994 Southern California

earthquake. The infection is not transmitted person to person and is caused by the

fungus Coccidioides immitis, which is found in soil in certain semiarid areas of North and

South America. This outbreak was associated with exposure to increased levels of airborne

dust subsequent to landslides in the aftermath of the earthquake (39).

Disaster-Related Interruption of Services

Power cuts related to disasters may disrupt water treatment and supply plants, thereby

increasing the risk for waterborne diseases. Lack of power may also affect proper functioning

of health facilities, including preservation of the vaccine cold chain. An increase in diarrheal

illness in New York City followed a massive power outage in 2003. The blackout left 9

million people in the area without power for several hours to 2 days. Diarrhea cases were

widely dispersed and detected by using nontraditional surveillance techniques. A case-control

study performed as part of the outbreak investigation linked diarrheal illness with the

consumption of meat and seafood after the onset of the power outage, when refrigeration

facilities were widely interrupted (40).

Go to:

Discussion

Historically, fears of major disease outbreaks in the aftermath of natural disasters have

shaped the perceptions of the public and policymakers. These expectations, misinformed by

associations of disease with dead bodies, can create fear and panic in the affected population

and lead to confusion in the media and elsewhere.

The risk for outbreaks after natural disasters is low, particularly when the disaster does not

result in substantial population displacement. Communicable diseases are common in

displaced populations that have poor access to basic needs such as safe water and sanitation,adequate shelter, and primary healthcare services. These conditions, many favorable for

disease transmission, must be addressed immediately with the rapid reinstatement of basic

services. Assuring access to safe water and primary healthcare services is crucial, as are

surveillance and early warning to detect epidemic-prone diseases known to occur in the

disaster-affected area. A comprehensive communicable disease risk assessment can

determine priority diseases for inclusion in the surveillance system and prioritize the need for

immunization and vector-control campaigns. Five basic steps that can reduce the risk for

communicable disease transmission in populations affected by natural disasters are

summarized in an (Appendix Table).
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Disaster-related deaths are overwhelmingly caused by the initial traumatic impact of the

event. Disaster-preparedness plans, appropriately focused on trauma and mass casualty

management, should also take into account the health needs of the surviving disaster-affected

populations. The health effects associated with the sudden crowding of large numbers of

survivors, often with inadequate access to safe water and sanitation facilities, will requireplanning for both therapeutic and preventive interventions, such as the rapid delivery of safe

water and the provision of rehydration materials, antimicrobial agents, and measles

vaccination materials.

Surveillance in areas affected by disasters is fundamental to understanding the impact of

natural disasters on communicable disease illness and death. Obtaining relevant surveillance

information in these contexts, however, is frequently challenging. The destruction of the

preexisting public health infrastructure can aggravate (or eliminate) what may have been

weak predisaster systems of surveillance and response. Surveillance officers and public

health workers may be killed or missing, as in Aceh in 2004. Population displacement can

distort census information, which makes the calculation of rates for comparison difficult.

Healthcare during the emergency phase is often delivered by a wide range of national and

international actors, which creates coordination challenges. Also, a lack of predisaster

baseline surveillance information can lead to difficulties in accurately differentiating

epidemic from background endemic disease transmission.

Although postdisaster surveillance systems are designed to rapidly detect cases of epidemic-

prone diseases, interpreting this information can be hampered by the absence of baseline

surveillance data and accurate denominator values. Detecting cases of diseases that occurendemically may be interpreted (because of absence of background data) as an early

epidemic. The priority in these settings, however, is rapid implementation of control

measures when cases of epidemic-prone diseases are detected. Despite these challenges,

continued detection of and response to communicable diseases are essential to monitor the

incidence of diseases, to document their effect, to respond with control measures when

needed, and to better quantify the risk for outbreaks after disasters.

Long-term Health Problems After

Natural Disasters Strike


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Health obstacles plague communities long after a natural disaster.

ByKatherine BeardJan. 6, 2014 | 7:00 a.m. EST+ More

It's been nearly two months since thestrongest stormever recorded slammed the Philippinesand the U.S. alone has contributed more than$37 millionto relief efforts in the devastatedcountry according to Time Magazine. Other countries and international organizations like theU.N. have donated just as much to help decimated communities in the badly damaged provinceof Leyte return to some sense of normalcy as they begin to rebuild their lives.

Whether it's Louisiana hit byHurricane Katrinain 2005, or Indonesia struck by thetsunami in2004,communities that suffer from natural disasters also suffer from the side effects of thedisaster long after the cameras have stopped rolling and the aid comes to a halt. Some of thegreatest challenges these people undergo is not the natural disaster itself but the residualproblems stemming from the disaster, namely the long-term health problems kindled from thecalamity.

Courtland Robinson, a professor at the Center for Refugee and Disaster Response at the JohnsHopkins Bloomberg School of Public Health, says that when communities deal with naturaldisasters they deal with the emergency phase first. These are typically the images flashed acrossthe TV screen immediately after a natural disaster has taken place.

This phase is all about rescue and recovery Robinson explained. Doctors and aid workers

"stabilize the health of the population with emergency interventions," he says.
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"You need people who have acute trauma care skills to come in, find and rescue those peoplewho are able to be saved," says Robinson. "It's really kind of a triage operation in many cases."Like doctors do in triage, first responders must decide who to save first based on their conditionand the resources the relief teams have to help the individuals.

The emergency phase requires "providing things for the community that are realities like cleanwater, food, temporary shelter, immediately followed by health services," says Ron Waldman,professor of global health at George Washington University and board president of the non-governmental organization Doctors of the World.

[READ:Aid Workers Settle In for Long Haul After Haiyan]

Peace Corps Response Volunteer Christy Grimsley assisted the Red Cross in Sri Lanka after anearthquake in southeastern Asia triggered the 2004 Boxing Day tsunami, which is known as oneof the deadliest natural disasters in history, when more than 230,000 people died. Grimsley saysthe redevelopment phase follows the emergency phase. While the emergency phase "is the bigsplash with all the aid and assistance coming in, the development phase is how the communitiesthen put themselves together," she said. This phase is where the less immediate healthconditions begin to be addressed.

The long-term health conditions typically addressed during the redevelopment phase includemental and psychological issues, vaccinating and eliminating the outbreak of communicablediseases like cholera, malaria, and measles and reinstating the infrastructure of the healthservices system.

Mental Health

Mental health problems have proven to be some of the most common side effects of naturaldisasters. The great loss and devastation disasters incur makes mental health problems likepost-traumatic stress disorder and depression, rampant among survivors of these horrific acts ofnature.

"Disasters cause a significant amount of stress; the death of loved ones can be particularlytraumatic but also the loss of jobs, material goods and livelihoods," Amanda McClelland, seniorofficer of Emergency Health at the International Federation of Red Cross wrote in an email.

But mental health problems rarely manifest themselves in the early stages of the emergency.

"Mental health and psycho social issues become more apparent as time goes on and can beoverlooked in emergencies," McClelland explained.

One reason these mental problems are not examined till later is because in fact the majority ofthe population will suffer from grief and shock following the event. "That's really normal,"Robinson said. "You almost hope to see it," he continued.

But then you hope and expect to see people returning to some kind of normalcy; picking up andtrying to dig out and get themselves into their houses and back to school or back to work. Andwhen that doesn't happen then that's a sign the individual is beginning to experience post-traumatic stress disorder, maybe depression, or maybe anxiety."
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It is for this reason health professionals urge people in natural disaster ridden communities toreturn to their daily routines as soon as possible.

[ALSO:A Year After Sandy, Research Focuses on the Social Impact of Disasters]

"Getting people back to work is really vital and is really a part of human dignity," says Waldman ."If these needs are not re-established soon there's bound to be an onset of depression that canhave a negative impact on individuals and the community," he said.

Communicable Diseases

Communities reeling from natural disasters also tend to become breeding grounds for outbreaksof communicable diseases, which are defined as diseases that easily transfer from person toperson or animal to person. "Continuing problems with hygiene and diseases related to hygieneare common in refugee camps," Grimsley says. "Maintaining hygiene levels in these camps iscritical to full recovery."

Prevention methods like washing hands and vaccinations are the key to combating these deadly,yet preventable outbreaks.

"Disasters change the environment, so they can also change the population [throughdisplacement], as well as the agents that create disease," McClelland said.

Creating new breeding environments can sometimes even mean new diseases are introduced topopulations that have not suffered from those diseases in the past.

"Disease that was present before the disaster can increase, and disease previously under controlcan become problematic," she said.

Though public health officials used to live by the rule that if a disease wasn't in a communitybefore the disaster it wouldn't be there after, they have come to find that like every rule, there areexceptions. "Following this rule without consideration can have dire consequences," McClellandexplained, noting that Haiti was one of thoseexceptions.Haiti suffered from a 7.0 earthquake inJanuary 2010. This catastrophic event destroyed what little structures and infrastructures thatexisted in the Western Hemisphere's poorest country. When CNN returned to Haiti in thesummer of 2010 to check up on the relief efforts, reporterIvan Watsonwrote in an article "Sixmonths later, not much appears to have changed. It still looks like a bomb just dropped on thiscity." In fact, the U.N. estimated 1.5 million individuals were homeless and living in the refugee

camps. Many criticized the relief organizations who were assisting with Haiti's recovery effortsand their lack of organization and effectiveness. Then in October 2010 a cholera epidemic brokeout. Later it was discovered the disease was brought over by foreign aid workers. The lack ofsanitation and cleanliness that are typical when large populations of people live in close quartersonly cultivated the epidemic in the already sub-par health conditions. "In Haiti, where they hadnot had cholera in 100 years, new imported cases caused an outbreak," McClelland said.Though the number of displaced Haitians has decreased to about 350,000 as of 2013, Haiti'sprogress is still few and far between,Time Magazinereported.

Health Service System

"The real damage in the long run is done to the health service infrastructure," Waldman says.
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On top of the physical damage done to the hospitals and health buildings, the loss of medicalequipment and medicines, "there's the issue of the dysfunction of health facilities."

Haiti is an example of where an already poor health infrastructure system was destroyed and hasyet to be rebuilt and improved. Waldman points out that the initial cholera epidemic that struck

Haiti following the earthquake actually had nothing to do with the actual earthquake andeverything to do with the health care system, more precisely the lack of an efficient one.

"Cholera will continue to outbreak because the infrastructure remains inadequate," Waldman

said.

The mass exodus of residents from the epicenter of any emergency is a common problem for

communities working to recover and rebuild. This exodus also contributes greatly to the lack of

health services that communities recovering from disasters tend to deal with.

"A lot of people leave and that means there are fewer resources available to help address these

long term problems," Waldman says. He used Hurricane Sandy and the communities hit in New

York and New Jersey as an example of an area that has experienced a lag in restoration on

account of this routine migration away from the initial point of the disaster, causing a scarcity of

health services.

[MORE: Cholera in Haiti Far Worse Than Predicted]

"If you look at places that were affected by HurricaneSandyfrom a health point of view, a lot of

doctors left the area," Waldman said. "So though much concern was expressed early on [the

communities affected by Hurricane Sandy] still haven't recovered because the doctors left, so

there are fewer facilities and resources available to the residents of the affected areas more than

a year a later."

This trend was evident in October as newspapers marked the first anniversary since Hurricane

Sandy killed an estimated 160 people, and destroyed massive amounts of property as it tore

through communities in New Jersey and New York.NBC News reporteda community that had

lost nearly 350 residents' homes, yet only 40 homes were being rebuilt.

Natural disasters are fleeting. Earthquakes tremor to stillness, tsunamis subside, and flood

waters recede. But the effects ripple long after the actual event. Robinson refers to these as

"chronic emergencies."

"It seems like a contradiction of terms," he says. "You have acute things and then you have

chronic things. But in fact a lot of these emergencies have these long tails where people aren't

back home again, their lives aren't normal again and the lot of the relief aid that comes in for 60,

90, 120 days maybe up to year, go away as we move onto the next emergency."
http://www.usnews.com/news/articles/2011/03/21/cholera-in-haiti-far-worse-than-predictedhttp://www.usnews.com/news/articles/2011/03/21/cholera-in-haiti-far-worse-than-predictedhttp://www.usnews.com/news/articles/2011/03/21/cholera-in-haiti-far-worse-than-predictedhttp://www.usnews.com/news/articles/2011/03/21/cholera-in-haiti-far-worse-than-predictedhttp://abcnews.go.com/US/jersey-residents-waiting-hurricane-sandy-rebuilding-money/story?id=20371933http://abcnews.go.com/US/jersey-residents-waiting-hurricane-sandy-rebuilding-money/story?id=20371933http://abcnews.go.com/US/jersey-residents-waiting-hurricane-sandy-rebuilding-money/story?id=20371933http://usnews.nbcnews.com/_news/2013/10/29/21215983-superstorm-sandy-anniversary-one-year-later-thousands-still-not-home?litehttp://usnews.nbcnews.com/_news/2013/10/29/21215983-superstorm-sandy-anniversary-one-year-later-thousands-still-not-home?litehttp://usnews.nbcnews.com/_news/2013/10/29/21215983-superstorm-sandy-anniversary-one-year-later-thousands-still-not-home?litehttp://usnews.nbcnews.com/_news/2013/10/29/21215983-superstorm-sandy-anniversary-one-year-later-thousands-still-not-home?litehttp://abcnews.go.com/US/jersey-residents-waiting-hurricane-sandy-rebuilding-money/story?id=20371933http://www.usnews.com/news/articles/2011/03/21/cholera-in-haiti-far-worse-than-predicted


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Grimsley applauded the Red Cross' pledge to stay in Indonesia's tsunami impacted areas six

years after it displaced more than1.5 millionpeople in Southeastern Asia. She says this

commitment is what has helped it not only recover but thrive. The World Bank says thanks to

nearly$7 billionin contributions and exceptional disaster response and reconstruction Aceh, the

capital of the Indonesian province which was destroyed in the tsunami, has been transformed toa robust city. In fact, the approaches initiated in response to Indonesia's tsunami are beginning to

be replicated in other emergency response areas. The World Bank is encouraging disaster

response organizations to use Aceh as a model for future communities devastated by calamity.

She says if there is any hope to see these communities repair and recuperate, governments,

international agencies and non-governmental organizations must maintain their commitment to

recovery.

"It's really important for government and international agencies to maintain their commitment andnot just move on to the next big disaster," Grimsley says.

atural Disasters & Environmental Hazards

Josephine Malilay, Dahna Batts, Armin Ansari, Charles W. Miller, Clive M. Brown

NATURAL DISASTERS

Travelers should be aware of the potential for natural phenomena such as hurricanes, floods,

tsunamis, tornadoes, or earthquakes. Natural disasters can contribute to the transmission of some

diseases, especially since water supplies and sewage systems may be disrupted; sanitation and

hygiene may be compromised by population displacement and overcrowding; and normal public

health services may be interrupted.

When arriving at a destination, travelers should be familiar with local risks for seismic, flood-

related, landslide-related, tsunami-related, and other hazards, as well as warning systems,

evacuation routes, and shelters in areas of high risk.

Disease Risks

The risk for infectious diseases among travelers to affected areas is minimal unless a disease is

endemic in an area before the disaster, because transmission cannot take place unless the

causative agent is present. Although typhoid can be endemic in developing countries, natural

disasters have seldom led to epidemic levels of disease. Floods have been known to prompt
http://www.theguardian.com/world/2009/dec/23/2004-tsunami-five-years-onhttp://www.theguardian.com/world/2009/dec/23/2004-tsunami-five-years-onhttp://www.theguardian.com/world/2009/dec/23/2004-tsunami-five-years-onhttp://www.worldbank.org/en/news/feature/2012/12/26/indonesia-reconstruction-chapter-ends-eight-years-after-the-tsunamihttp://www.worldbank.org/en/news/feature/2012/12/26/indonesia-reconstruction-chapter-ends-eight-years-after-the-tsunamihttp://www.worldbank.org/en/news/feature/2012/12/26/indonesia-reconstruction-chapter-ends-eight-years-after-the-tsunamihttp://www.worldbank.org/en/news/feature/2012/12/26/indonesia-reconstruction-chapter-ends-eight-years-after-the-tsunamihttp://www.theguardian.com/world/2009/dec/23/2004-tsunami-five-years-on


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outbreaks of leptospirosis and cholera in areas where the organism is found in water sources (see

theLeptospirosisandCholerasections in Chapter 3).

When water and sewage systems have been disrupted, safe water and food supplies are of great

importance in preventing enteric disease transmission. If contamination is suspected, water should

be boiled or disinfected (see theWater Disinfection for Travelerssection earlier in this chapter).Travelers who are injured during a natural disaster should have a medical evaluation to determine

what additional care may be required for wounds potentially contaminated with feces, soil, o

Documents

Personal Hygiene and Handwashing After a Disaster or Emergency 1.docx