|Natural Disasters - Protecting the Public's Health (PAHO-OPS, 2000, 133 p.)|
|Chapter 7. Epidemiologic Surveillance and Disease Control|
Health authorities are often under considerable public and political pressure to begin mass vaccination programs, usually against typhoid, cholera, and tetanus. This pressure may be increased by exaggerated reports of the risk of such diseases in the local or international press, and by the offer of vaccines from abroad.
Typhoid and Cholera
Rapidly improvised mass vaccination campaigns against typhoid and cholera should be avoided in Latin America and the Caribbean for several reasons:
1. The World Health Organization does not recommend typhoid and cholera vaccines for routine use in endemic areas. The newer typhoid and cholera vaccines have increased efficacy, but because they are multi-dose vaccines, compliance is likely to be poor. They have not yet been proven effective as a large-scale public health measure. In a disaster situation, vaccination might, however, be recommended for health workers. Good medical control must rely on effective case identification and treatment and effective environmental sanitation measures.
2. Vaccination programs require large numbers of workers who could be better employed elsewhere.
3. Supervision of sterilization and injection techniques may be impossible, resulting in more harm than good being done.
4. Mass vaccination programs may lead to a false sense of security about the risk of diseases and to the neglect of effective control measures.
Supplying safe drinking water and the proper disposal of excreta continue to be the most practical and effective strategy to prevent cholera and typhoid fever and should be given the highest priority after a disaster.
Significant increases in tetanus have not occurred after natural disasters. The mass vaccination of populations against tetanus is usually unnecessary. The best protection against tetanus is maintenance of a high level of immunity in the general population by routine vaccination before a disaster occurs, and adequate and early wound cleansing and treatment.
If tetanus immunization was received more than 5 years ago in a patient who has sustained an open wound, a tetanus toxoid booster is an effective preventive measure. In previously unimmunized injured patients, tetanus antitoxin should be administered only at the discretion of a physician.
If routine vaccination programs are being conducted in camps or other densely populated areas with large numbers of children, it is prudent to include vaccination against tetanus, as indicated by public health guidelines, along with the other components of the vaccination program.
Measles, Polio, and Other Diseases Targeted for Eradication
Natural disasters may negatively affect the maintenance of ongoing national or regional eradication programs against measles and polio. Disruption of those programs should be closely monitored and prevented. Prevention and control programs for urban yellow fever, bubonic plague, or other vector-borne diseases should also be maintained to prevent the possible emergence or reemergence of diseases.
Vaccine Importation and Storage
Most vaccines - particularly measles vaccine - require refrigeration and careful handling if they are to remain effective. If cold-chain facilities are inadequate, they should be requested at the same time as the vaccines. Vaccine donors should ensure that adequate refrigeration facilities exist in the country before dispatching vaccines. During the emergency period it may be advisable for all imported vaccines, including those going to voluntary agencies, to be consigned to government stocks if cold-chain facilities are adequate.
The vaccination policy to be adopted should be decided at the national level only. Individual voluntary agencies should not decide to vaccinate on their own. Ideally, a national policy should be included in the disaster plan.