For this Case Assignment you are to select two general factors that may promote the occurrence of an infectious disease outbreak following a natural disaster.
1. Discuss the manner in which these factors impact communicable disease transmission.
2. What general control measure(s) can be applied to mitigate the effects of these factors?
Provide citations for all your resources. The use of peer-reviewed articles is encouraged whenever possible.
The Case Assignment should be 3 pages. Case Assignments are due on the first Monday following the end of this module.
1. Discuss the manner in which these factors impact communicable disease transmission.
Communicable disease refers to the “transmission of a disease by a causative organism from one person to another either directly or indirectly through a carrier or a vector” (Lemonick, 2011, p.3). Observations from previous natural disasters imply that skin, diarrheal, and respiratory infections are the most common infectious diseases in the effected population (Lemonick, 2011). The two primary factors that contribute to communicable disease are the environmental conditions and population overcrowding. Population characteristics include the concentration and age of the personnel and the type of communicable diseases associated with them. Habitually, relocated evacuees are crowded due to restrictions associated with relocation camps or emergency shelters following a natural disaster. Environmental factors include climate, with warm conditions favoring waterborne pathogens. Similarly, rainfall during El Nino contributes to malaria and diarrhoeal while drought leads to malnutrition-related disease (Lemonick, 2011). The potential impact of communicable diseases is often very high following natural disasters. The communicable disease outbreak itself can also create an epidemic within the affected area. An epidemic is defined as “the occurrence in a community or region of a group of diseases of similar nature, clearly in excess of normal expectancy, and derived from a common or propagated source” (Lemonick, 2011, p. 3). Topography and/or geographical locations may also play a role in epidemics by isolating the victims from much needed resources (Lemonick, 2011). Other factors that contribute to communicable disease transmission after disasters are the type of public health systems, facilities and levels of immunization available, dependent upon the magnitude of the disaster (Lemonick, 2011).
Waterborne disease
Flooding constitutes approximately 40 percent of all natural disasters, and it fuels both waterborne and vectorborne diseases. Waterborne disease is the most common communicable transmitted disease following a natural disaster (Lemonick, 2011). One of the most common waterborne communicable is Diarrhoeal. Diarrhoeal disease outbreaks often occur as a result of contaminated drinking-water, and have been reported following floods and related aqua natural disasters. For example, an outbreak of diarrhoeal disease after the reported flooding in Bangladesh in 2004, affected more than 17 000 people (World Health Organization, 2006). In the recent Tsunami of 2004, it was noted by World Health Organization, (2006) that 85 percent of the residence in Aceh Province, Indonesia, reported to have contracted diarrhoeal disease by drinking form unprotected wells. In Muzaffarabad, Pakistan, following the 2005 earthquake, an outbreak of severe diarrhoeal occurred in poorly established camps. The outbreak itself involved over 750 cases, mostly adults, and was finally controlled by supplying adequate water and sanitation facilities (World Health Organization, 2006). Additionally, it was noted by World Health Organization (2006) that in the United States, diarrhoeal was also revealed following hurricanes Allison and Katrina.
Hepatitis A and E are also transmitted in association with lack of access to safe water and sanitation facilities. Hepatitis A is prevailing in most developing countries; however, children are exposed and develop immunity at an early age. As a result, the risk of large outbreaks is usually low in most countries. In known endemic areas, hepatitis E outbreaks frequently follow heavy rains and floods and are generally a mild, but in pregnant women reportable fatality rates have been documented up to 25 percent (World Health Organization, 2006).
Although transmitted through mosquitoes, Malaria is considered a waterborne communicable disease (World Health Organization, 2012). Malaria is transmitted exclusively through mosquito bites. The intensity of transmission depends on factors related to the actual insect, the vector, the population, and the environment. Transmission also depends on the climatic conditions that may affect the mosquitoes, such as rainfall patterns, temperature and humidity (World Health Organization, 2012). Natural disasters, particularly meteorological events such as cyclones, hurricanes and flooding, can affect vector breeding sites and vector-borne disease transmission. Malaria outbreaks in the awakening of flooding are a well-known trend after a natural aquatic disaster (World Health Organization, 2012). World Health Organization (2012) also emphasized that the flooding linked to El Nino-Southern Oscillation has had a direct impact associated with malaria epidemics.
Diseases associated with crowding
Amongst the illness mentioned above population overcrowding itself can cause an outbreak of certain communicable diseases. For example, Meningitis is transmitted from person to person, particularly in situations of crowding. Cases and deaths from meningitis among those displaced, particularly in such geographical locations such as Aceh and Pakistan have been substantially documented (World Health Organization, 2006). Another well-known overcrowding communicable disease is acute respiratory infections (ARI). ARI are a major cause of disease and mortality among displaced populations, particularly in children ages five and under. Lack of access to adequate health services and to antibiotics further increases the risk of death from ARI. Other risk factors associated with ARI also include indoor cooking and poor nutrition (World Health Organization, 2006). It was noted by World Health Organization (2006) that the reportable ARI cases increased in Nicaragua 30 days following Hurricane Mitch in 1998. Additionally, the 2004 tsunami accounted for the highest number of ARI cases and deaths ever recorded (World Health Organization, 2006).
2. What general control measure(s) can be applied to mitigate the effects of these factors? Provide citations for all your resources. The use of peer-reviewed articles is encouraged whenever possible.
Ensuring constant and uninterrupted supply of safe drinking-water is up most important as the first line of defense and preventive measure that should be immediately implemented. Additionally, it is important to identify and predetermine the adequate stock required for all facilities that undergo initial triage responsibilities (World Health Organization, 2006). For general consideration of all communicable disease, access to primary care is critical for prevention, early detection, and treatment, as well as establishing secondary and tertiary care. Furthermore, chlorine can also be implemented and added to kill waterborne pathogens and is widely available, easy to use, and relatively inexpensive (World Health Organization, 2006). After a natural disaster the immediate impact of communicable diseases can be further mitigated with the following interventions: Ensure early diagnosis and treatment of diarrhoeal diseases and ARI; ensure early diagnosis and treatment for malaria; and ensure the availability and application of treatment protocols for the main communicable disease threats. Additionally, a surveillance and early warning system should be quickly established to detect outbreaks and monitor priority endemic diseases (Lemonick, 2011). For example, periodic laboratory confirmation of rapid test-positive fever cases should be documented to identify and track the positive test rate. Furthermore, disaster managers and health organizations can utilize a comprehensive communicable disease risk assessment created by the World Health Organization (WHO), which can help identify and prioritize threats, such as ensuring health-care workers are properly trained to detect diseases and that proper reporting to health agency occurs. Trained health care providers must also be able to ensure proper sampling protocols are in place as well as transporting materials for investigation. Additionally, appropriate stockpiles such as cholera need to be readily available for rapid response to outbreaks (World Health Organization, 2006). Moreover, for some communicable diseases such as dengue and malaria, the main preventive efforts should be vector control. Two forms of vector control are effective and preferred in a wide range of circumstances, which are Insecticide-treated mosquito nets (ITNs) and Long-lasting insecticidal nets (LLINs). Additionally, it is noted by World Health Organization, (2006) that indoor residual spraying (IRS) with insecticides is a very powerful way to rapidly reduce malaria transmission. Furthermore, indoor spraying can be effective for up to 6 months, depending on the insecticide used and the type of surface on which it is sprayed (World Health Organization, 2006). The first line of defense against communicable diseases will always be proper disaster management, which enables, education, and proper preventative measures prior to natural disasters.
References
Lemonick, D. M. (2011). Epidemics after natural disasters. Tysons Corner, VA: American Journal of Clinical Medicine. Retrieved from http://www.aapsus.org/wp-content/uploads/ajcmsix.pdf
World Health Organization. (2006). Communicable diseases following natural disasters: Risk assessment and priority interventions. Geneva: NTD Information Resource Centre. Retrieved from http://www.who.int/diseasecontrol_emergencies/guidelines/CD_Disasters_26_06.pdf
World Health Organization. (2012). Malaria. WHO Media centre. Retrieved from http://www.who.int/mediacentre/factsheets/fs094/en/
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