Myths and reality: Communicable disease following natural disasters

Human corpses must be disposed of immediately to avoid epidemics.

REALITY: Unless the victims died of a highly contagious disease and persons handling them immediately after death ignore basic sanitary precautions, the health risk from corpses is negligible. Acceptable disposal of human remains should be accorded extremely high priority for social, not health, reasons.

To prevent epidemics of cholera and typhoid fever, health officials should initiate mass immunizations, as a first priority following the advent of a catastrophe.

REALITY: Cholera and typhoid epidemics rarely occur as a consequence of disasters. Immunization of selected groups, such as children under 2 years of age who are expected to be encamped for over 30 days, should be encouraged. Primary immunization with presently available vaccines, however, requires two or three injections at intervals of two to four weeks, and it confers only partial protection, which lasts a few months. Furthermore, mass efforts at vaccination in the relief phase are an extensive drain on limited manpower, communication facilities and transportation. Improvised mass vaccinations can therefore not be justified.

Drawing courtesy Radio Times Hulton Picture Library

The population of rural areas without adequate water treatment facilities is the group at highest risk of waterborne disease epidemics.

REALITY: The groups most vulnerable to waterborne diseases are populations migrating to congested areas and relief workers from other zones who have not developed immunity to the diseases endemic to the area.

The main risk to the rural populations arises more often from disruption of normal public health programs caused by the disaster or by the diversion of relief efforts to unnecessary activities.

When disaster strikes, the affected area should order stocks of intravenous fluids in anticipation of epidemics of diarrheal disease.

REALITY: No epidemics of diarrheal disease have been documented as a result of disasters. Increases have been observed, however, in temporary settlements and other areas of high population density where sanitary measures are inadequate. When properly used, oral rehydration therapy provides a much cheaper means of treating diarrhea than IV fluids. Ninety-five percent of all cases, regardless of etiology, can be treated effectively with a case-fatality rate of less than one percent, by nonphysicians with minimum training. PAHO has stockpiles of ORS in Trinidad (CAREC), Barbados and Peru.