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Infectious Diseases and Disasters

Infectious Diseases and Disasters. Dr. Eric Goedecke Asst. Professor of Emergency Medicine. Learning Objectives. Focus on infectious disease as a consequence of disaster Clarification of risks Discuss misconceptions Concepts in disease prevention and mitigation. Epidemic Risk.

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Infectious Diseases and Disasters

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  1. Infectious Diseases and Disasters Dr. Eric Goedecke Asst. Professor of Emergency Medicine

  2. Learning Objectives • Focus on infectious disease as a consequence of disaster • Clarification of risks • Discuss misconceptions • Concepts in disease prevention and mitigation Quetzaltenango, Guatemala, August 2008.

  3. Epidemic Risk • Full disease outbreaks are rare • Post impact or recovery phases • Risk threats to the locality • Drought • Famine • Population clusters/displacement • Length of threat • Mortality rates Quetzaltenango, Guatemala, August 2008.

  4. Quetzaltenango, Guatemala, August 2008.

  5. Risk and Hazard Analysis Man-made Hazards • Chemicals • Production, storage and transport • Biologic hazards • Terrorism Transportation Hazards • Materials • Mass transit centers Quetzaltenango, Guatemala, August 2008.

  6. Emerging Diseases • Almost always from endemic disease • Increased frequency • Waterborne illness • Preexisting health infrastructure Quetzaltenango, Guatemala, August 2008.

  7. Deaths following Disaster • Measles, diarrheal disease, respiratory infections • Mt. Pinatubo, Philippines • Refugee camps • Unsanitary living conditions • Food shortages Quetzaltenango, Guatemala, August 2008.

  8. Dead Bodies • Do not pose serious health risk • Not a reservoir • Proper burial and respect • Psychological stress Quetzaltenango, Guatemala, August 2008.

  9. Risk Factors • Population displacement • Disruption water supplies • Disruption of sanitation • Loss basic health infrastructure • Loss primary medical infrastructure Quetzaltenango, Guatemala, August 2008.

  10. Risk Factors • Public health and medical officers must be knowledgeable about endemic diseases! • Disruption of infrastructure • Rapid assessment of any breakdown • Quick intervention of weaknesses • Hurricane Andrew Surveillance • Rash, diarrhea, cough, animal bites, other infections Quetzaltenango, Guatemala, August 2008.

  11. Quetzaltenango, Guatemala, August 2008.

  12. Modes of Transmission • Susceptibility • Malnutrition • Environmental extremes • No access to medications • Migration of large populations • Modes • Airborne • Water • Vectors Quetzaltenango, Guatemala, August 2008.

  13. Disease Transmission • Overcrowding • Measles • Immunizations • Upper Respiratory Infections • Mortality increased children < 5 years old • Dominican Republic Hurricane Georges • Tuberculosis and HIV • Not a direct result Quetzaltenango, Guatemala, August 2008.

  14. Disease Vectors • Standing water • Haiti – Hurricane Flora 1962 • Drought • Southwestern United States - 1993 Quetzaltenango, Guatemala, August 2008.

  15. Other Factors • Climate Impact • Disruption of prevention programs Quetzaltenango, Guatemala, August 2008.

  16. Disruption in Water Supplies • Vibrio cholerae, Shigella dysenteriae, and Salmonella typhii • Hepatitis A + E • Leptospirosis Quetzaltenango, Guatemala, August 2008.

  17. Entamoeba histolytica [E. histolytica ] Quetzaltenango, Guatemala, August 2008.

  18. Public Health Programs • Routine vaccinations • Special populations: young and old • Sexually transmitted diseases & HIV Risks Quetzaltenango, Guatemala, August 2008.

  19. Quetzaltenango, Guatemala, August 2008.

  20. Disaster Induced Injuries • Soft tissue injuries • Secondary wound infections • Staph, Strep, others Quetzaltenango, Guatemala, August 2008.

  21. Increases in Susceptibility • Malnutrition • Higher mortality rates • Cyclical process • Contamination of food supplies • Lack of daily medicines • Mass migration of populations • Sanitation • Malnutrition • Overcrowding exposures Quetzaltenango, Guatemala, August 2008.

  22. Field Management of Infectious Diseases • Environmental considerations • Geographic variables • Endemic organisms • Population characteristics • Disaster type • Disaster magnitude • Resource availability Quetzaltenango, Guatemala, August 2008.

  23. Field Management of Infectious Diseases:Environmental Considerations • Climate • Vectors and organisms vary • Colder seasons, crowding together • Degree of isolation • Remote areas • Higher elevations-mountain/volcano Quetzaltenango, Guatemala, August 2008.

  24. Field Management of Infectious Diseases:Population Characteristics • Age Quetzaltenango, Guatemala, August 2008.

  25. Field Management of Infectious Diseases:Disaster Type & Magnitude • Earthquakes • Crush injuries • Floods • Waterborne problems Quetzaltenango, Guatemala, August 2008.

  26. Field Management of Infectious Diseases:Resource Availability • Local, regional and national aid? • Healthcare facilities • Supply line and routes • Transportation mechanisms • Public Health & information/instruction Quetzaltenango, Guatemala, August 2008.

  27. Prevention • Repairing points of breakdown • Needs assessment • Restoring/Providing basic needs • Surveillance Quetzaltenango, Guatemala, August 2008.

  28. Surveillance • “ongoing systematic collection, analysis, and interpretation of health data” • Timely • Simple • Accurate • Universally understood • Sustainable Quetzaltenango, Guatemala, August 2008.

  29. Surveillance • Helps guide • Prevent waste • Specifics • Dispel rumors • Italy: Earthquake 1980 Quetzaltenango, Guatemala, August 2008.

  30. Surveillance • Coordinated by single agency • Standardized form • Symptom based • Information regularly released • Death rates and population size Quetzaltenango, Guatemala, August 2008.

  31. Vaccines • More protection & lower cost • Measles vaccine • Tetanus • Routine or with injury Quetzaltenango, Guatemala, August 2008.

  32. Measles Quetzaltenango, Guatemala, August 2008.

  33. Measles • Highly contagious viral illness • First described in 7th century • Near universal infection of childhood in prevaccination era • Common and often fatal in developing areas

  34. Measles Virus • Paramyxovirus • Hemagglutinin important surface antigen • One antigenic type • Rapidly inactivated by heat and light

  35. Measles Clinical Features • Incubation period 10-12 days • Prodrome: • Stepwise increase in fever to 103°F or higher • Cough, coryza, conjunctivitis • Koplik spots

  36. Condition Diarrhea Otitis media Pneumonia Encephalitis Hospitalization Death Measles Complications Percent reported 8 7 6 0.1 18 0.2 Based on 1985-1992 surveillance data

  37. Quetzaltenango, Guatemala, August 2008.

  38. Measles Clinical Features • 2-4 days after prodrome, 14 days after exposure • Maculopapular, becomes confluent • Begins on face and head • Persists 5-6 days • Fades in order of appearance

  39. Quetzaltenango, Guatemala, August 2008.

  40. Water and Sanitation • Shortage of water • Hygiene • Quantity>Quality • United Nations High Commissioner for Refugees recommendation: 20 liters/day Quetzaltenango, Guatemala, August 2008.

  41. Diagnosis and Management • Case confirmation • Mode of transmission • Active case finding • Treatment Quetzaltenango, Guatemala, August 2008.

  42. Principles of Treatment • Standardized protocols • Diarrheal illness • Oral rehydration • Measles • Vitamin A supplements • Immunization Quetzaltenango, Guatemala, August 2008.

  43. Principles of Treatment • Malaria • Lower elevations • Prevention • Chemoprophylaxis-locally • 31,127 • Meningitis • Most feared: 15/100,000 • Pneumonia • Sexually transmitted diseases • Skin infections Quetzaltenango, Guatemala, August 2008.

  44. Emergency Medical Services Quetzaltenango, Guatemala, August 2008.

  45. Role of Emergency Departments • Surveillance points • Source of healthcare • Personnel must be familiar with protocols • Protective measures • Treatment • Transfer Quetzaltenango, Guatemala, August 2008.

  46. Summary • Experience is growing • Outbreaks are relatively uncommon • Basic public health measures • Endemic diseases Quetzaltenango, Guatemala, August 2008.

  47. Quetzaltenango, Guatemala, August 2008.

  48. Quetzaltenango, Guatemala, August 2008.

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