Disease Aftershocks—The Health Effects of Natural Disasters

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  • This article was downloaded by: [Tufts University]On: 16 October 2014, At: 12:19Publisher: Taylor & FrancisInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

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    Disease AftershocksThe Health Effectsof Natural DisastersStephen C. Guptill aa S21 National Center , U.S. Geological Survey , Reston, Virginia,20192Published online: 18 Aug 2010.

    To cite this article: Stephen C. Guptill (2001) Disease AftershocksThe Health Effects of NaturalDisasters, International Geology Review, 43:5, 419-423, DOI: 10.1080/00206810109465023

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  • International Geology Review, Vol. 43, 2001 , p. 419-423 Copyright 2001 by V. H. Winston & Son, Inc. All rights reserved.

    Disease AftershocksThe Health Effects of Natural Disasters STEPHEN C. GUPTILL

    S21 National Center, U.S. Geological Survey, Reston, Virginia 20192

    Abstract

    While the initial activity of a natural disaster event may directly injure or kill a number of peo-ple, it is possible that a significant number of individuals will be affected by disease outbreaks that occur after the first effects of the disaster have passed. Coupling the epidemiologist's knowledge of disease outbreaks with geographic information systems and remote sensing technology could help natural disaster relief workers to prevent additional victims from disease aftershocks.

    Introduct ion

    FOLLOWING A NATURAL disaster, such as an earth-quake, the media often report the number of injuries and fatalities. This reporting may go on for a week or two, then fade from the public stage. Less commonly noted, either in the popular press or official govern-ment reports, is the possibility that more individuals are being affected by disease outbreaks that occur after the initial effects of the disaster have passed. There are a number of causes of these disease after-shocks. It is possible that many of these could be mitigated by careful planning with the assistance of geographic information system (GIS) and remote sensing (RS) technology.

    Natural Disasters

    While natural disasters (such as earthquakes, volcanic eruptions, hurricanes, floods, and land-slides) are common around the planet, the occur-rence of major events that take a large toll in terms of loss of human life or property are relatively rare. The most deadly events are ones that cover a large geographic area, in particular tropical storms and floods. Table 1 presents a listing of events that have killed or affected the largest number of people. The frequency of such disasters can be seen by studying yearly statistics of selected disaster events. As examples, Tables 2 and 3 show the number of events, along with the number of people killed and affected, for the years of 1998 and 1991.

    Contributing Causes o f I l lness and Death:

    The cause of illness and death follows a rela-tively simple timeline after the initial event. Most immedia te dea ths and injuries are caused by

    trauma, asphyxia, or exposure. Soon after the event, contaminated food and/or water can cause such ill-nesses as cholera, typhoid fever, dysentery, and lep-tospi ros is . A week or two later , vec tor -borne diseases can infect an exposed population with malaria, Rift Valley fever, or assorted arboviral encephalitides. Concentrated settlements of evacu-ees can create conditions whereby viral hemor-rhagic fevers, meningi t i s , meas les , and acute respiratory infections are easily transmitted from one person to another. The various Internet-based disease and disaster reporting systems such as DisasterRelief.org (Turk, 1998), and ProMED-mail (ProMED-mail, 2001) contain numerous references to such post-disaster disease outbreaks. A few of these outbreaks have been the subject of more detailed epidemiological studies (Weekly Epidemio-logical Record, 2000).

    Many of these disease outbreaks, such as cholera or typhoid, are caused by contaminated water sup-plies. The lack of potable water and adequate sani-tary facilities pose the most immediate threat to human health. Relief workers must first locate all of the disaster victims and then ensure that these needs are satisfied. The problem is compounded if a large number of people have relocated, either delib-erately or through necessity, to areas without a via-ble supply of potable water. In addi t ion , the relocation of displaced persons into refugee camps often creates conditions that make the population highly susceptible to an outbreak of infectious dis-ease. If the camps are located in areas where diseases such as dengue, malaria, typhus, lep-tospirosis. Rift Valley fever, hantavirus, or viral hemorrhagic fevers are endemic, large numbers of people may become ill. People fearful of building collapse because of an earthquake aftershock may sleep outdoors, without shelter, leaving themselves

    0020-6814/01/525/419-5 $10.00 419

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    http://DisasterRelief.org

  • 4 2 0 STEPHEN C. GUPTILL

    TABLE 1. Effects of Natural Disasters

    Disaster

    Epidemic

    Famine

    Flood

    Epidemic

    Drought

    Drought

    Flood

    Flood

    Drought

    Flood

    Year

    1917

    1932

    July 1931

    July 1914

    1928

    1987

    August 1998

    May 1991

    November 1979

    July 1993

    Country

    Worldwide

    Soviet Union

    People's Republic of China

    Serbia/Poland/Soviet Union

    People's Republic of China

    India

    People's Republic of China

    People's Republic of China

    India

    India

    Killed

    20.000,000

    5,000,000

    3,700,000

    3.000,000

    3,000,000

    300

    3.656

    1.729

    -827

    Affected

    --

    28,500,000

    --

    300,000,000

    238,973,000

    210,232,227

    190,000,000

    128.000,000

    Source: EM-DAT: the OFDA/CRED International Disaster Database, Universit Catholique de Louvain. Brussels. Belgium.

    TABLE 2. Selected Natural Disaster Statistics, 1998

    Disaster type

    Landslides

    Earthquakes

    Floods

    Tropical storms

    Volcanoes

    No. of events

    23

    17

    92

    72

    4

    No. of people killed

    1,044

    7,423

    13,554

    14,866

    0

    No. of people affected

    230,110

    1,827.021

    306,917.299

    29,394,098

    7.808

    Source: EM-DAT: the OFDA/CRED International Disaster Database, Universit Catholique de Louvain. Brussels. Belgium.

    susceptible to mosquito bites and infection. These and other public health consequences of disasters have been examined in detail in Noji (1997).

    R o l e o f R e m o t e S e n s i n g and Geographic In format ion S y s t e m s

    Remotely sensed imagery, either from aircraft or spacecraft, can enable a rapid assessment of an area that has been impacted by a natural disaster. Com-bining these data with other geospatial data in a geo-graphic information system can provide disaster relief specialists with the information they need to find sites that minimize the risks of exposing the population to disease. In general, disaster response officials can use remote sensing systems and geo-

    graphic information systems technology for the fol-lowing types of tasks: (1) disaster assessment; (2) emergency response; (3) distribution of relief ser-vices; (4) settlement location, and (5) infrastructure reconstruction.

    Immediately following a disaster, location of and access tothe affected population may be lim-ited or impossible. High-resolution remote sensing imagery taken soon after the event can enable offi-cials to assess the extent of the damage and to direct response personnel and relief supplies to the most needy areas. If survivors are geographically dis-placed from their homes, the sites for relief/refugee camps should not place them further at risk from disease. Emergency response teams and relocation experts should consider not only the facilities infra-

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  • DISEASE AFTERSHOCKS 4 2 1

    TABLE 3. Selected Natural Disaster Statistics, 1991

    Disaster

    Landslides

    Earthquakes

    Floods

    Tropical storms

    Volcanoes

    No. of events

    11

    30

    89

    68

    11

    No. of people killed

    821

    4.959

    8,504

    146,061

    715

    No. of people affected

    35,971

    1,107,914

    285,867,966

    27,845,246

    865.002

    Source: EM-DAT: the OFDA/CRED International Disaster Database. Universit Catholique de Louvain, Brussels, Belgium.

    structure of a site (for the prevention of enteric ill-nesses), but also its geographic setting with respect to risks of other infectious disease outbreaks. A GIS could help pinpoint appropriate camp sites. These concepts are being examined, for example, by the Government of India in creating a disaster manage-ment system (Gupta, 2000; Srivastava et. al., 2000).

    V e c t o r - B o r n e Di sease Mitigation Strategies

    Determining the specific risk of illness from a vector-borne disease is a difficult task. Research being conducted in the United States provides an example of the types of methods that could be applied on a broader scale.

    Natural disasters in the United States have rarely been accompanied by epidemics of mosquito-borne disease. However, disaster response policies should include provisions for monitoring increases in potentially infectious mosquitoes and the risk for arboviral disease (Nasci and Moore, 1998). Scien-tists at the United States Geological Survey (USGS) and the Centers for Disease Control and Prevention (CDC) are undertaking a study in the Mobile, Ala-bama area to determine if RS and GIS technology can be used in three phases of disaster response: (1) determination of the location and extent of a disaster event; (2) determination of areas that contain patho-gens or that might foster disease; and (3) location of populations at risk and intervention to reduce the likelihood of exposure to disease.

    Remote sensing technology can be very useful in helping to determine the geographic extent and sever-ity of a disaster. Comparison of contemporaneous imagery with archival data holdings helps to deter-mine the magnitude of the damage. In the case of this study, we are particularly interested in the extent of

    flooding (resulting from a Gulf Coast hurricane, for example). If clouds are not obscuring the ground, high-resolution images (ground resolution = pixels 15 m in size or smaller) from satellites or aircraft can detect the flood boundaries. Should cloud cover be a problem, radar sensors can penetrate the cloud cover and provide good discrimination of the land/water boundary despite their coarser spatial resolution.

    Determining the areas that contain the insect vec-tors or the vertebrate hosts of disease agents is a multi-faceted problem. The major post-disaster dis-ease risk in the Mobile study area is from eastern equine encephalomyelitis (EEE). The CDC informa-tion on arboviral encephalitides (CDC, 1999) noted that EEE is caused by a virus transmitted to humans and equities by the bite of an infected mosquito. EEE virus is an alphavirus that was first identified in the 1930s and currently occurs in focal locations along the eastern seaboard, the Gulf Coast, and some inland Midwestern locations. While small outbreaks of human disease have occurred in the United States, equine epizootics can be a common occurrence dur-ing the summer and fall.

    It takes from 4 to 10 days after the bite of an infected mosquito for an individual to develop symptoms of EEE. These symptoms begin with a sudden onset of fever, general muscle pains, and a headache of increasing severity. Many individuals will progress to more severe symptoms such as sei-zures and coma. Approximately one-third of all peo-ple with clinical encephalitis caused by EEE will die from the disease and of those who recover, roughly half will suffer permanent brain damage, with many of those requiring permanent institu-tional care.

    In addition to humans, EEE virus can produce severe disease or death in horses; some birds such

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  • 4 2 2 STEPHEN C. GUPTILL

    as the whooping crane, pheasants, quail, ostrich, and emu; and even puppies. Because horses are out-doors and attract hordes of biting mosquitoes, they are at high risk of contracting EEE when the virus is present in mosquitoes. Cases in horses usually pre-cede those in humans, so horse cases may be used as a surveillance tool; however, in some areas, a high rate of vaccination in horses reduces the utility of these animals as a surveillance tool.

    EEE virus occurs in natural cycles involving birds and the mosquito species Culiseta melanura, in some swampy areas nearly every year during the warm months. Where the virus resides or how it sur-vives in the winter is unknown. Migratory birds may introduce it in the spring or it may remain dormant in some yet undiscovered part of its life cycle. With the onset of spring, the virus reappears in the birds (many native bird species do not seem to be severely affected by the virus) and mosquitoes of the swamp. In this usual cycle of transmission, the virus does not escape from these areas because the mosquito involved prefers to feed upon birds and does not usually bite humans or other mammals.

    Following a flood event, the numbers of mosqui-toes may dramatically increase and the virus may escape from enzootic foci in swamp areas in birds or bridge vectors such as Coquillettidia perturbans and Aedes sollicitans. These species feed on both birds and mammals and can transmit the virus to humans, horses, an...

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