Natural Disasters

Infectious Diseases, Insect Plagues and Parasites

BackgroundBackground

Historically, infectious disease epidemics have high mortality (AIDS, SPANISH FLU 1918)

Disasters have potential for social disruption and death

Epidemics are worsened when infrastructure breaks down (NO HOSPITALS)

A natural disaster (Haiti hurricane) leads to an epidemic of an infectious disease (cholera)?

What is an emerging infectious disease?

In 1991, Institute of Medicine attempted to define:

– “new, re-emerging, or drug resistant infections whose incidence in humans has increased within the past 2 decades or whose incidence threatens to increase in the near future.”

Phases of Disaster Impact Phase (0-4 days)

– Extrication– Immediate soft tissue infections

Post impact Phase (4 days- 4 weeks)– Airborne, foodborne, waterborne and vector diseases

Recovery phase (after 4 weeks)– Those with long incubation and of chronic disease

Factors for Disease Transmission After a Disaster

Environmental considerations Endemic organisms Population characteristics-

pop.density, overall health, poverty Pre- event structure and public

health Type and magnitude of the disaster

Environmental Considerations Climate

– Cold- airborne– Warm- waterborne

Season (USA)– Winter- influenza YouTube - The H1N1 Swine Flu: A Look Inside

Rainfall– El Nino years increase malaria (more flooding) in South America (Eastern Pacific) and more Drought (western Pacific/Asia)-malnutrition-hunger diseases (more detail in food unit on drought and famine)

Population Characteristics Density

– Displaced populations– Refugee camps

Age– Increased elderly or children-more vulnerable

Chronic Diseases– Malnutrition– Heart disease

Population Characteristics Education

– Less responsive to disaster teams Religion-some don’t allow medicines Hygiene levels

– Underlying health education of public

Trauma to body from disasters– Penetrating, blunt, burns

Stress levels post disaster

A REFUGEE CAMP- Infectious diseases thrive

SHANTYTOWN- Poor PLACES IN LDC’s/ LLDC’S WHERE INFECTIONS SPREAD because of density and lack of health care

Pre-disaster resources: the level of these determine the extent the diseases thrive

Sanitation Primary health care and nutrition Disaster preparedness Disease surveillance Equipment and medications Transportation Roads Medical infrastructure

Type of disaster Earthquake

– Crush and penetrating injuries Hurricane (Monsoon, Typhoon) and

Flooding– Water contamination, vector borne diseases

Tornado– Crush

Volcano – Water contamination, airway diseases Magnitude

– Bigger can mean more likelihood for epidemics

Dominican Republic, 1979

Hurricane David and Fredrick on Aug 31 and Sept 5th 1979

>2,300 dead immediately Marked increase in all diseases measured

6 months after the hurricane– Thyphoid fever– Gastroenteritis– Measles– Viral hepatitis

Epidemics after DisastersSan Francisco, 1906 Fires; Plague resulting San Francisco, 1906 Fires; Plague resulting

from Quarantine failure from Quarantine failure

Duluth, MN, 1918 Forest Fire; Influenza Duluth, MN, 1918 Forest Fire; Influenza resulting from crowding and epidemicresulting from crowding and epidemic

Italy, 1976 Earthquake; Salmonella Carriers Italy, 1976 Earthquake; Salmonella Carriers due to sanitation stoppage due to sanitation stoppage

Haiti, 2010 Cholera after Earthquake Haiti, 2010 Cholera after Earthquake Devastated the country Devastated the country

U.N. says Haiti cholera protests may be politically motivated - CNN.com

Summary of Factors

Many factors play a role in disease development and outbreaks

Change of disease not likely to play role– Increase in rare diseases

Change and/or closing of public health measures play a big role

Post-Impact Phase Infections Crush and penetrating trauma

– Skin and soft tissue disruption – Muscle/tissue necrosis

– Toxin production disease– Burns

Waterborne illnesses– Gastroenteritis (stomach diseases)– Cholera U.N. says Haiti cholera protests may be politically motivated - CNN.com

– Non-cholera dysentery– Hepatitis (affect liver function)– Rare diseases like dengue (mosquito spread like malaria)

YouTube - Thailand battles Dengue fever - 17 Oct 08YouTube - The Ebola Virus Presentation

General disaster reminders

Vaccinations are the mainstay of outbreak control in many situations

Dead bodies pose little to no infectious disease risk; however this is debated

Early surveillance and hygiene can prevent outbreaks

Classification Classification SystemSystemBiological HazardsBiological Hazards

-Infectious Disease (-Infectious Disease (AIDS,AIDS, H1N1) H1N1)

-Parasitic Disease -Parasitic Disease (river blindness,(river blindness, tape tape worm, ring worm)worm, ring worm)

-Insect Infestation (-Insect Infestation (plague of locustsplague of locusts))

-Plant Disease -Plant Disease

(Irish potato famine due to blight)(Irish potato famine due to blight)

The Black PlagueThe Black Plague

The Bubonic Plague of Medieval Europe

The cause of the plagueThe cause of the plague It was caused by infected rodents that were carrying It was caused by infected rodents that were carrying

“Pasteurella pestis." It’s an infectious disease that is “Pasteurella pestis." It’s an infectious disease that is transmitted when the infected rodent comes in contact with transmitted when the infected rodent comes in contact with human beings. The plague was brought on usually by a rat or human beings. The plague was brought on usually by a rat or flea bite. flea bite.

The plague originated on the northern coast of the Black Sea The plague originated on the northern coast of the Black Sea where Indians had trading colonies. Often in the winter the where Indians had trading colonies. Often in the winter the plague came about because small rodents were looking for plague came about because small rodents were looking for warm places to live and they chose peoples home. That warm places to live and they chose peoples home. That whole family would be infected with the plague, and sooner whole family would be infected with the plague, and sooner or later the whole village or town would be infected. or later the whole village or town would be infected.

The Black Plague was responsible for millions of deaths. The Black Plague was responsible for millions of deaths. Most of the deaths recorded were in Europe.Most of the deaths recorded were in Europe.

Who or what was effected Who or what was effected by the plague?by the plague? The plague affected people on the northern coast of the Black sea. The plague affected people on the northern coast of the Black sea.

In 1346 it had reached Crimea near Turkey. Once the disease had In 1346 it had reached Crimea near Turkey. Once the disease had reached Turkey and the Mediterranean it then went into the rest of reached Turkey and the Mediterranean it then went into the rest of Europe, but it had taken on a more aggressive form. Europe, but it had taken on a more aggressive form.

It reached Sicily in 1346, Italy in early 1347, and towards the end It reached Sicily in 1346, Italy in early 1347, and towards the end of 1347 was in Marseilles, France. In 1348 it attacked Spain and of 1347 was in Marseilles, France. In 1348 it attacked Spain and spread throughout Germany and France. Early that same year the spread throughout Germany and France. Early that same year the disease came to London, by 1349 was in Oxford and spread disease came to London, by 1349 was in Oxford and spread throughout England where it was present until 1359. Scotland was throughout England where it was present until 1359. Scotland was affected somewhat later. It was carried by rats on ships.affected somewhat later. It was carried by rats on ships.

It is estimated the roughly about 25 million people died from the It is estimated the roughly about 25 million people died from the Black plague.Black plague.

Symptoms of the plagueSymptoms of the plague The symptoms were described as: convulsions followed by a rise The symptoms were described as: convulsions followed by a rise

of temperature, with vomiting, headache, giddiness, intolerance to of temperature, with vomiting, headache, giddiness, intolerance to light, pain in the lower abdomen, back and limbs, sleeplessness, light, pain in the lower abdomen, back and limbs, sleeplessness, apathy and delirium. The body temperature varied greatly from apathy and delirium. The body temperature varied greatly from 101º-107º but fell two or three degrees on the second or third day.101º-107º but fell two or three degrees on the second or third day.

The headache was described as splitting and the deliriousness The headache was described as splitting and the deliriousness similar to the DTs (delirium tremens), resulting from extreme similar to the DTs (delirium tremens), resulting from extreme drunkenness. The eyes became red; the tongue swelled and drunkenness. The eyes became red; the tongue swelled and became covered with a white fur except on the tip. Later the became covered with a white fur except on the tip. Later the tongue became dry and the fur turned yellow or brown. tongue became dry and the fur turned yellow or brown.

Constipation was the rule but there might be diarrhea — an even Constipation was the rule but there might be diarrhea — an even worse sign. A characteristic symptom in severe cases was that worse sign. A characteristic symptom in severe cases was that the patient appeared dazed and stupid, staggered and had slurred the patient appeared dazed and stupid, staggered and had slurred speech. speech.

The patient might die within 24 hours, but more commonly death The patient might die within 24 hours, but more commonly death occurred on the second or third day. Recovery was very rareoccurred on the second or third day. Recovery was very rare. .

The effectsThe effects

In Europe is plague was known In Europe is plague was known as “the black death", because as “the black death", because of the discoloration of the skin, of the discoloration of the skin, and the black tumors that and the black tumors that occurred on the second day of occurred on the second day of the plague. The tumors were the plague. The tumors were mostly in the groin area, in mostly in the groin area, in most cases the person would most cases the person would die with in 24 hours. die with in 24 hours.

The plague was also know as The plague was also know as the “poor plague” because the the “poor plague” because the first ones occurred in poorer first ones occurred in poorer parts of the towns.parts of the towns.

Ring around the rosy Ring around the rosy connected to the plague?connected to the plague? The child’s song “Ring around the rosy” is said The child’s song “Ring around the rosy” is said

to have a connection to the plague:to have a connection to the plague: ““Ring around the rosy” – Rose-colored areas of Ring around the rosy” – Rose-colored areas of

skin.skin. ““Pocket full of posies”- Sweet-smelling flowers Pocket full of posies”- Sweet-smelling flowers

that those tending the sick would carry to ward that those tending the sick would carry to ward off the stench of disease.off the stench of disease.

Ashes ashes”- Impending death (or the sneezing Ashes ashes”- Impending death (or the sneezing and coughing of the plague).and coughing of the plague).

““All fall down”- Death.All fall down”- Death.

What was done to help What was done to help stop it?stop it?

Efforts were made to stop the plague from spreading; Efforts were made to stop the plague from spreading; towns blockaded themselves, turning away travelers towns blockaded themselves, turning away travelers and refugees, but all it took for it to spread was one and refugees, but all it took for it to spread was one person to slip by. person to slip by.

In the countryside it tended to work in pockets, missing In the countryside it tended to work in pockets, missing some villages altogether and wiping out most of the some villages altogether and wiping out most of the population of others. population of others.

In the towns the death rate ran at about 30%, whilst In the towns the death rate ran at about 30%, whilst some villages were abandoned, the survivors fleeing, some villages were abandoned, the survivors fleeing, creating "deserted villages". creating "deserted villages".

Outlandish curesOutlandish cures 1. Sit next to a blazing hot fire (as the Pope did) right through the hot 1. Sit next to a blazing hot fire (as the Pope did) right through the hot

summer of 1348.summer of 1348.

2. Live in a house sheltered from the wind, and close all the doors and 2. Live in a house sheltered from the wind, and close all the doors and windows.windows.

3. "The swellings should be softened with figs and cooked onions 3. "The swellings should be softened with figs and cooked onions mixed with yeast and butter." Guy de Chaulliacmixed with yeast and butter." Guy de Chaulliac

4. "Toads should be thoroughly dried in the sun, then laid on the boil. 4. "Toads should be thoroughly dried in the sun, then laid on the boil. The toad will swell and draw the poison into its own body. When it is The toad will swell and draw the poison into its own body. When it is full, it should be thrown away and a new one applied." (A doctor's full, it should be thrown away and a new one applied." (A doctor's advice)advice)5. "All human excrement and other filth lying in the city is to be 5. "All human excrement and other filth lying in the city is to be removed." Letter from Edward III to the Lord Mayor of London, 1349.removed." Letter from Edward III to the Lord Mayor of London, 1349.6. "Consume a medicine made from boiled onions and the gall bladder 6. "Consume a medicine made from boiled onions and the gall bladder of a hare." (Another doctor's advice) of a hare." (Another doctor's advice)

What could have been What could have been done to prevent this?done to prevent this?

If the countries that were effected had any idea that the Black If the countries that were effected had any idea that the Black Plague would be moving their way, and how it was contracted Plague would be moving their way, and how it was contracted the could have been a few things they could of done to prevent the could have been a few things they could of done to prevent it. They could’ve tried to keep the rodent population down, have it. They could’ve tried to keep the rodent population down, have tighter security from the effected places not letting the people tighter security from the effected places not letting the people effected into other places that had yet to experience the plague.effected into other places that had yet to experience the plague.

Even today there is no real cure for the black plague. Even today there is no real cure for the black plague.

Who could help those Who could help those who were effected?who were effected?

For the people who were struck by this disease there For the people who were struck by this disease there really wasn’t much that could be done for them, since really wasn’t much that could be done for them, since there was no real cure for it. there was no real cure for it.

For the family and friends that had a loved one that had For the family and friends that had a loved one that had been stricken with the plague all they could do is wait, been stricken with the plague all they could do is wait, and pray that their loved one would hopefully pull and pray that their loved one would hopefully pull through it.through it.

Conclusions Infectious diseases play a role in the

post natural disaster period These diseases will vary depending

on many factors like wealth, climate, geography, etc.

Conclusions Early recognition of certain diseases in disaster

setting is important to “nip it in the bud” Travellers should know where they are going

and what is endemic in that area. Make sure you get all proper medical needles before travel to areas with these diseases.

http://www.powershow.com/view/5646a-NGVlM/Insectshttp://www.powershow.com/view/5646a-NGVlM/Insects_as_Disease_Vectors_powerpoint_ppt_presentation_as_Disease_Vectors_powerpoint_ppt_presentation

HowStuffWorksHowStuffWorks Videos " Videos "SuperswarmSuperswarm: Locust Plagues": Locust Plagues"