Even in very poor developing countries, serious outbreaks of communicable disease very rarely occur after natural disasters which do not involve the encampment of populations (21). Known exceptions to this include cases of leptospirosis, which increased in Brazil after flooding (23), the aggravation of an ongoing typhoid fever problem following hurricanes in Mauritius (24), and cases of food poisoning in both Dominica and the Dominican Republic (25). It is probably more likely that the diversion of scarce resources from normal public health activities to disaster relief, or subsequent economic problems aggravated by a disaster, will lead to epidemic long after the acute event, such as in the resurgence and subsequent failure to eradicate malaria from Haiti (26).
With this in mind, in the thirteenth (1981) edition of the American Public Health Association handbook entitled Control of Communicable Diseases in Man (27) there is a consensus described that was reached by specialists in communicable disease, liaison representatives, and Pan American Health Organization/World Health Organization officials about the relative risk of individual communicable disease after disaster. This information is presented in a simplified form in Table 2. For a further discussion of each disease, the reader should consult the thirteenth edition or a tropical medicine text (28).
Disease
|
Disaster Potential
|
Geographic Areas at Risk
|
|
Qualitative/Quantitative*
|
|
Amebiasis
|
contamination water/food
|
?
|
cosmopolitan
|
Chickenpox- Herpes Zoster
|
overcrowding in emergency situations
|
3 +
|
worldwide (infection nearly universal)
|
Cholera
|
contamination water/food, crowding in primitive conditions
|
1 +
|
none
|
Diarrhea, nonspecific
|
contamination water/food, crowding
|
4 +
|
universal
|
Diphtheria
|
crowding of susceptible groups
|
2 +
|
universal
|
Ebola/Marburg Virus
|
direct contact with infected blood secretions, organs or semen. Possible by vector-borne/aerosol routes
|
?
|
Rhodesia, Kenya, Sudan, Zaire
|
Food Poisoning—Staphylococcal
|
mass feeding and inadequate refrigeration/cooking facilities
|
4+
|
universal
|
—Bacillus cereus
|
mass feeding and inadequate refrigeration/cooking facilities
|
3+
|
universal
|
Gastroenteritis
|
—Epidemic Viral Gastroenteritis
|
contamination water/food crowding
|
?
|
universal
|
—Rotavirus Gastroenteritis
|
contamination of water/food, crowding
|
?
|
universal
|
Hemorrhagic Fevers of Argentinian and Bolivian Types
|
contamination of food
|
?
|
Argentina, Bolivia
|
Hepatitides Viral
|
—Viral Hepatitis A
|
contamination of water/food, inadequate sanitary facilities
|
4+
|
universal
|
—Viral Hepatitis B
|
improper sterilization procedures
|
4+
|
universal
|
—Viral Hepatitis, Non-A, Non-B
|
?
|
?
|
universal
|
Influenza
|
crowding
|
4+
|
universal (pandemics, epidemics, localized and sporadic outbreaks)
|
Leprosy
|
interruption of case detection and therapy
|
?
|
endemic
|
Leptospirosis
|
contamination of water/food, flooding of areas with high water table
|
?
|
worldwide
|
Malaria
|
availability of water for mosquito breeding
|
?
|
Tropical South America, Panama, and Haiti
|
Measles
|
introduction of measles to susceptible isolated population
|
?
|
universal
|
Meningitis, Meningococcal
|
crowding
|
?
|
endemic
|
Pediculosis
|
crowding, clothing
|
?
|
endemic worldwide
|
Plague
|
crowding, inappropriate rodent control, unhygienic conditions
|
?
|
endemic in certain areas of North and South America
|
Poliomyelitis
|
crowding nonimmune groups, contaminated food, inadequate sewage disposal
|
?
|
worldwide
|
Rabies
|
stray dogs
|
2+
|
worldwide
|
Relapsing Fever
|
overcrowding. malnournishment, poor personal hygiene
|
2+
|
endemic
|
Salmonellosis
|
overcrowding, contamination of food in mass feeding, poor sanitation
|
3 +
|
worldwide
|
Scabies
|
overcrowding
|
2 +
|
endemic
|
Shigellosis
|
crowding, poor sanitation, malnournishment
|
4 +
|
worldwide
|
Streptococcal Diseases caused by Group A (Beta Hemolytic streptococci)
|
contamination of food
|
2+
|
common in temperate zones and semitropical areas
|
Tetanus
|
flood, hurricanes, earthquakes
|
3 +
|
worldwide
|
Tuberculosis
|
crowding
|
1 +
|
worldwide
|
Typhoid Fever
|
disruption of usual sanitary control of food and water
|
2+
|
worldwide
|
Typhus Fever (Endemic Louse- Borne)
|
unhygienic conditions , crowding
|
2+
|
endemic foci
|
Yellow Fever
|
availability of infected mosquitoes
|
?
|
enzootic in Northern South America and parts of Africa
|
Whooping Cough
|
crowding
|
2+
|
worldwide
|