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Volume 27, Issue 4

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Prevention of Communicable Diseases after Disaster

Written by  Ammara Muneer, Arshad Ali, Shahid Iqbal, Norman Akbar Khan Tuesday, 15 April 2014 14:22

Atmospheric, geological, and hydrological changes are the main causes of natural disasters. In recent decades natural disasters have increased, causing loss of life, physical damages, and economic loss. Developing countries are most affected by the disasters because they don’t have the required resources, infrastructure, and disaster preparedness system. Although the deaths after a disaster are mainly caused by the initial traumatic impact of the disaster, outbreak of infectious disease in the aftermath of the disaster is the result of population displacement and change in environment. Disaster preparedness plans should be designed in such way to consider the health needs of the population surviving the disaster. Due to displacement of large numbers of people and sudden crowds in camps, lack of safe water and sanitation facilities have adverse health impacts on the population affected. This requires therapeutic and preventative interventions.

Disasters results in changes in the physical environment in which we live. These changes introduce new pathogens to the population, or the already present pathogens get an increased opportunity to infect humans. The communicable diseases are easily transmitted by use of unsafe water for drinking and sanitary purposes and deteriorated health conditions of the affected population. If proper interventions are not made on time, the communicable disease will increase rapidly and have a devastating impact on the already-affected community hit by disaster. In the U.S. and many other countries, adequate attention has been given to these issues. This has resulted in low post-disaster disease transmission, but still the spread of communicable diseases should be carefully monitored.

It should be the first priority to establish health facilities in the disaster-hit area to provide first aid and treat emergency cases. The health personnel on site for the control of outbreak of communicable diseases should be knowing how to carry out primary investigation and then on the basis of that investigation confirm the presence of pathogens and then with the treatment and prevention procedures.

For the prevention of communicable diseases after disaster, it is important to know the factors causing them, modes of transmission, management of the infectious diseases, and then different preventative interventions to control the spread of communicable diseases.

CAUSES OF COMMUNICABLE DISEASES

  1. Presence of pathogens
    If pathogens are already present in an area hit by a disaster, then the chances of disease caused by that pathogen is likely to occur because the conditions become ideal for transmission after the disaster because of the reduced vulnerability of the population affected.
  2. Displacement of population
    Disasters may result in massive population displacement from one place to another which may lead to increase in transmission of disease. People may move to an area where certain pathogens may exist to which people may not have the required immunity. Migration of people and high population density in camps provide ideal conditions for the passage of communicable diseases.
  3. Change in environment
    The change in environment after disaster causes an increase in infectious diseases such as contamination of water after earthquakes or floods because of the cross connection between water and sewage lines.
  4. Disruption of basic public utilities
    After a disaster, the public utilities are damaged. These utilities include water pipelines, sewage systems, electricity, and gas pipelines. These can cause contamination in water sources which then causes diseases such as typhoid fever, gastroenteritis, hepatitis A, cholera, etc.
  5. Lack of basic health services
    After a disaster, the health services are disrupted. This causes an increase in the transmission of communicable diseases. Because of the lack of health facilities, the infections can’t be treated on time, giving opportunity for the disease to spread. The longer the disruption means the greater the risk of communicable diseases to spread.
  6. Food Shortage
    Disasters like floods destroys the crops, resulting in food shortages which causes malnutrition of the population affected. This increases vulnerability and reduces people’s immunity to diseases. Malnutrition also causes high mortality rates.

MODES OF TRANSMISSION OF COMMUNICABLE DISEASES

  • direct person-to-person contact
  • water-borne diseases that are spread by using the contaminated water like gastroenteritis, cholera, etc.
  • air-borne large-population density at a particular area helps in transmission of infection through droplets
  • vector-borne diseases such as malaria or dengue are transmitted by different insects and animals like such as mosquitoes and the plague caused by rats and rabies by dogs or bats

STRATEGIES FOR PREVENTION OF COMMUNICABLE DISEASES

PRE-DISASTER PHASE

In the pre-disaster phase for the prevention of communicable diseases, we have to emphasize making relevant policy to clarify our needs.

  • Identification of important risk factors
    For primary prevention, we have to first identify the most important risk factors responsible for the outbreak of disease after a disaster. The most significant factors are the displacement of a population and their movement to some other place. In addition to this overcrowding of the population in one place, lack of food and shelter, lack of safe water for drinking and sanitation, improper waste management, disruption of public health organizations which result in lack of medical facilities, and more contribute to an increase in the transmission of communicable diseases after a disaster.
  • Emphasizing risk factors in policies and preparedness plans In creating policies and disaster preparedness plans, the need is to emphasize these risk factors. In disaster preparedness, plan both pre-disaster and post-disaster preventative measures so they are clarified at local, national, and global levels.
  • Preparation of pre-disaster emergency response plan.
    The aim of these pre-disaster preventative measures are to decrease the vulnerability of the people to communicable diseases by reducing their exposure to risk factors that will provide passive protection to them during disaster. Emergency response plans before disaster must include training of the health workers in identifying the threatening disease and to effectively manage and provide treatment on spot. It should also include acquiring the required equipment, supplies, materials, and tools needed for the diagnosis and treatment of disease on the field to control the spread of communicable diseases.
  • Establishment of health surveillance systems
    Health surveillance systems should be reinforced, and guidelines should be given on how to manage the information about potential diseases. The population should be educated about the potential threats of the communicable diseases.
  • Arrangement for emergency supplies and field hospital
    One way to increase preparedness to deal with communicable diseases after disasters is to keep in-stock emergency supplies. Countries which are more prone to disasters should have arrangements for fully operative field hospitals to deal with emergency cases effectively if a probable disaster was to occur.

Such strategies, if supported by the government and other private organizations, can offer education, training, and other medical facilities can substantially reduce the rate of mortality and morbidity of communicable diseases.

POST-DISASTER PHASE

Measures to reduce the risk of communicable diseases

The following preventative and control measures should be undertaken on an immediate basis to avoid the spread of communicable diseases following a natural disaster.

  1. Water safety
  2. The most important is the supply of clean water for drinking after a disaster to prevent any disease. Chlorine is the best protectant against almost all water-borne pathogens, is easily available, and it is easy to use. However, international guidelines must be followed while establishing settlements in which the water is readily available for sanitation.
  3. Medical services
    Prevention accessibility to primary healthcare is very important. It allows for early diagnosis of a disease and treatment of that disease. Following the steps listed below can reduce the impact of diseases
    • early treatment and diagnosis
    • availability and use of appropriate treatment procedures for possible communicable diseases threats
    • proper training of health workers for appropriate case management
    • risk assessment of the disease should be carried out within one week to identify causes, impacts, and treatment
    • prompt and adequate drug supplies should be available for appropriate case treatment
    • dissemination of messages involving health education such as washing hands, water purification techniques, use of insecticides, and the use of protective and preventive measures according to the nature of the disease
    • disaster response teams should have updated guidelines for prevention and control of communicable diseases after disaster
  4. Early warning system
    Early warning systems should be established quickly to monitor the outbreak of infectious diseases, assess the risk, and to take measures to rapidly control it on basis of priority. Health workers must be trained to detect the diseases and provide on-spot treatment. First-aid kits must be available for early response.
  5. Vaccination and immunization
    Mass immunization of the population affected after disaster can be an efficient and effective way to stop the outbreak of communicable diseases, especially in children below the age of five.
  6. Ways to prevent malaria and dengue
    Preventative measures for malaria should be based on information and assessment of the local community and species of parasites prevalent in that area. Indoor spraying of insecticides and distribution of insecticide treated nets will stop the growth and development of mosquitoes. Monitoring the number of cases of malaria and early detection can be helpful in controlling the outbreak of malaria. For dengue, the efforts should be mobilized for the elimination of vector breeding sites. Communities should be educated about the preventative measures to control dengue such as covering all vessels containing water and removing or destroying any place or solid debris where water can collect.

MONITORING AND SURVEILLANCE OF DISEASE

The following tools can be utilized to prevent the outbreak of disease after a disaster:

  1. Disease present in the disaster area
    It is very important to get the information from the local health sources about the presence of diseases in the area affected by the disaster. Second, the diseases caused after a particular disaster must be given attention, and then the disease present in that area must be identified and confirmed.
  2. Method of collection and analysis of data established
    Data collection and analysis should be done by an experienced person at health services. The methods and record keeping for data collection and analysis should be standardized and reviewed on a daily basis to identify the trend of disease among patients.
  3. Communication of information about disease
    For uninterrupted flow of information from the area where the communicable disease has occurred, a viable route must be established.
  4. Early investigation
    If the surveillance system detects any unusual patterns of disease, then the investigation should be carried out as quickly as possible. For the investigation, the management team must be provided with a mobile-equipped laboratory and specified person to carry out the necessary clinical investigations. Any unconfirmed news about a disease from any other source or field worker must be promptly investigated to effectively control the disease before its outbreak.
  5. Procedures for the reporting of disease
    The disease should be reported on its onset and frequently updated about progress and preventative measures to control it. The data collected must be shared with the local health departments or its representatives to come up with better ideas to control it.
  6. Report analysis and evaluation
    Reports made about the disease should be analysed, evaluated, and then shared with the concerned authorities for a prompt and improved health response.
  7. Monitoring of disease
    Even when the emergency phase of the disaster is over, surveillance of some of the diseases with longer incubation periods such as Hepatitis A should be continued. Before leaving the site, the assigned medical officers should give the copy of all the collected data on a specific disease to the local authorities for further response and treatment.

CONCLUSION

Natural disasters and the outbreak of communicable diseases pose a challenge toward the achievement of the Millennium Development Goals. Disaster itself doesn’t result in transmission of infectious diseases, but the risk of outbreak of communicable diseases is related to size, health, and the living conditions of the displaced population in camps.

For efficient management to control the spread of infectious diseases, a natural surveillance system is important. People must be educated about the importance of hand washing and personal hygiene on site. Safe water and food must be provided for the people, and proper shelter and sanitation facilities are very important for prevention of infectious diseases. All the response activities should be well coordinated and integrated in policies by the policymakers.

Ammara Munir is a master research scholar of disaster management at NUST Islamabad, Pakistan. She has more than 10 years of professional experience in the field of disaster management.

Dr. Arshad Ali is a professional civil and environmental engineer. He has more than 15 years of research experience in the field of environmental and disaster management. He has more than 50 research publications in international reputed journals to his credit. Currently, he is working as an assistant professor at the NUST Islamabad, Pakistan.

Dr. Shahid Iqbal is a civil engineer with specialization in structural engineering. He has been working for the last 20 years in the field of disaster mitigation and reconstruction engineering. He has more than 10 research publications to his credit. Currently, he is head of the structural engineering department at NUST Islamabad, Pakistan.

Engr Noman Akber Khan, is a professional civil engineer, he has been working for the last 15 years in the field of disaster mitigation and reconstruction engineering. He is currently a master research scholar of disaster management at NUST Islamabad, Pakistan.