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close this bookEpidemiologic Surveillance after Natural Disaster (PAHO - OPS; 1982; 105 pages) [FR] [ES]
close this folderPart 1 : Epidemiologic surveillance and disease control after natural disaster
close this folderChapter 4 : Operational aspects of disease surveillance after disaster
View the documentField investigation of rumors and reports of communicable disease
View the documentGaining access to laboratories to obtain definitive diagnoses and support for epidemiologic investigations
View the documentPresenting epidemiologic information to decision makers
View the documentSurveillance during and after the recovery phase

Field investigation of rumors and reports of communicable disease

Rumors and unconfirmed reports frequently circulate after a major disaster, but until recently epidemiologists were not asked to take part in relief' efforts except when there was need to investigate the more serious of these. Political issues and the nature of public outcry, rather than public health priorities, often determined the perceived severity of a rumor or report. Rumors of increase in snake-bites after flooding, or the discovery of patients with residual poliomyelitis would, for example, lead invariably to an official government request for scarce antivenom or polio vaccine.

Following the Nigerian Civil War, a major bilateral agency initiated the sending of medical epidemiologists to evaluate the substance of such reports before responding to requests for assistance. This practice rapidly expanded to one in which requests for massive supplies of drugs and supplies for health services, and the long term impact of disaster on health services and nutritional status, are now routinely evaluated (44-46). Immediately consulting the medical epidemiologists of major relief agencies has become a definite feature in decision making. Now, epidemiologists are sent to affected areas to organize surveillance before rumors and unconfirmed reports are even generated.

In recent major disasters the appropriate evaluation of rumors has been made possible through this increasingly earlier involvement of epidemiologists in the relief response. This can be attributed to two factors. The most obvious is that prompt investigation can take place before a situation gets out of hand. Perhaps more important, however, has been the existence of the opportunity to educate members of disaster agencies, the media and national health authorities about appropriate ways to interpret and respond to rumor.

Epidemiology staff members who participate in relief should expect the appearance of rumors and unconfirmed reports and should be prepared to deal with them. Rumors from many sources may come to the epidemiologist's attention. Perhaps easiest to handle are reports communicated to field relief workers and visitors to the field from relief headquarters. Of the most frequent and difficult to handle are reports promulgated in the media, and reports directly brought to the attention of national leaders.

The most efficient and effective way of handling rumors of any origin is to undertake surveillance. To confirm and/or quantify the magnitude of a problem indicated by rumor, the epidemiology staff should try to canvass reporting units in the area by radio. Negative responses will frequently satisfy the need for information on the part of media, political authorities and participating agencies. This is particularly true when negative results are coupled with the promise of repealing the survey and of sharing surveillance information. Sources should also be encouraged to report any rumors they might hear in the future to the epidemiology unit or the relief coordinator for investigation. In general, maintaining a positive attitude toward receiving rumors instills trust in the source, as well as in the public. When convinced that efforts to substantiate the reports are underway, responsible persons of the media will delay publication of rumors until after discussion with relief' authorities.

Reports of disease in the media originate at local, regional, or national levels. It is common in this age of satellite communications for a television or newspaper item to have directly reached the international services from the area affected by the disaster, thus bypassing authorities in the capital. Although estimates of death and disease are not usually reported in the media, so that sensationalism is minimized and panic and anxiety are prevented, breakdowns of respect of such a policy do occur. Reporters often assume that information provided by a doctor or nurse on the scene is more accurate and reliable than that in releases from official, central sources. Inexperienced and tired health personnel have on occasion locally released information, subsequently shown to be mistaken or exaggerated, to members of the media. The likelihood of such an occurrence will be reduced if seasoned health workers lead relief teams, there are briefings about the policy of dealing with the media, and an open relationship is developed between the media and the relief coordinator.

It is always possible that individual reporters may be more concerned with publicity than accuracy and that precautions do not prevent the publication of rumor. Also, the extent of disaster or of an epidemic may be exaggerated in order to embarrass authorities or to seek political advantage. The only recourse to take under these circumstances is to provide the relief coordinator the most accurate information available.

When influential local citizens or authorities report a rumor, it can be difficult to convince decision makers to wait for the results of an epidemiologic investigation before taking unnecessary or counterproductive action. Fortunately, it is usually possible to convince policy makers that immediately dispatching a team to look into the report is the quickest and most visible and effective response available. A potentially more serious operational problem exists when local or national authorities deny rumors which have not been investigated.

The majority of rumors of epidemic communicable disease after a disaster will not be confirmed. Nevertheless, the epidemiology team should not discount rumors without canvassing reporting units and/or undertaking field investigations. It may be necessary to exercise selectivity in investigating rumors, based on public health implications and/ or political sensitivity, since lack of manpower is a frequently limiting factor. When the central epidemiologist is not satisfied with the field staff's ability to investigate a rumor, one or more epidemiologists should be sent to the field. In international relief efforts, national epidemiologists and members of their staff should be responsible for investigations.

The principles involved in investigating rumors are very similar to those of any other epidemic investigation. These are discussed by Langmuir (47). Western (48), Sommer (1), and Blake (44) have demonstrated how to adapt these principles to disaster situations.

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