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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 5 : The control of communicable disease after disaster
View the documentImmunization
View the documentChemotherapy
View the documentQuarantine and isolation

Chapter 5 : The control of communicable disease after disaster

The activities of communicable disease control which are effective in normal times are usually also appropriate and effective in postdisaster periods. The twelfth and thirteenth editions of Control of Communicable Diseases in Man (2, 27) are very useful compendia in which these procedures are summarized disease by disease. Situations precipitated by disaster are often characterized by unique features, however, which warrant discussion in this final chapter. Comments will be divided for purposes of simplicity into sections on environmental health management, immunization, chemotherapy, and quarantine and isolation.

Environmental health management

The management of environmental health after disaster consists of activities related to basic sanitation—the disposal of excrete, the maintenance of water supply, personal hygiene, food supply and vector control, the burial of the dead, and the provision of shelter. Disaster relief administrators appreciate that limitations of time, manpower and resources demand establishing priorities. The factors brought into consideration for this purpose include the nature of preexisting conditions, cultural acceptability, creature comfort and risk to public health such as the occurrence of epidemics of communicable disease.

In general, the amount of disaster relief activity that is devoted to environmental health management is proportional to the sufficiency of sanitation facilities which existed beforehand. The limited duration of disaster relief activity renders it impractical to try to establish permanent sanitary facilities and safe sources of water and food if these were severely damaged by the disaster or were previously nonexistent. Populations in which there were low levels of personal hygiene and which lacked these amenities will not, in a short time period, be educated about the proper use of latrines, wells or bathing facilities. Previous exposure and the development of immunity to disease frequently means that rural populations without sanitary facilities are at lower risk than affected urban dwellers and relief workers of acquiring communicable diseases. In contrast, the interruption of water or electrical service in an industrialized community can cause severe disruption of social and sanitary services and thus facilitate the transmission of disease. Encamped populations in both poor and less poor nations always require that meticulous attention be paid to environmental health management.

It is important for epidemiologists to realize that the environmental measures to which relief administrators give priority are frequently not those most associated with the risk of communicable disease transmission. Among the first concerns of environmental health managers are the existence of shelter and potable water, the burial of the dead and the disposal of excrete. Vector control, food protection and promoting personal hygiene are invariably assigned lower priority. These latter activities are, however, extremely important in terms of the transmission of communicable disease. In major disasters, particularly in poorer countries, the availability at all levels of persons trained and available to practice environmental health management is the factor which limits the promotion of these measures of high priority.

Human and animal carcasses have rarely, if ever, been associated with epidemics of communicable diseases, but even though the problems related to health are not at issue, in most societies the acceptable disposal of corpses is extremely important for cultural reasons. In most circumstances, the stench of unburied or improperly buried animal carcasses will not be tolerated for long.

Environmental intervention also frequently fails to prevent the transmission of communicable disease because of limitations in existing techniques and/or misapplication. Chlorination and/or filtration of water, for example, may not destroy protozoa such as Giardia lamblia. Water disinfection tablets (such as Globaline and Halazone) will destroy enteric bacteria, amoebae, and some, but not all, enteric viruses. Massive distribution of water purification tablets following disasters has not been effective in poorly educated populations unfamiliar with proper usage and thus is not a recommended routine measure. Indeed, if such tablets are ingested whole like pills, fatality may result. The tablets may be useful, however, among well educated and motivated groups such as relief workers, military, civil servants, and so forth.

Such measures as vector control are too often directed at nuisance insects rather than vectors of human disease. Pesticides may be applied to outdoor vegetation in order to reduce populations of biting mosquitoes (e.g., Culex), instead of the vectors of malaria (Anopheles) or dengue and yellow fever (Aedes aegypti). Resistant housefly populations may also be treated with excessive amounts of pesticides when improved excreta and solid waste collection and disposal would be much more effective.

The Pan American Health Organization's manual, Emergency Vector Control after Natural Disaster (53), and the World Health Organization's Guide to Sanitation in Natural Disasters (22) provide a thorough review of the principles of environmental health management.

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