Disasters And Diseases

Question 1

Learning Objectives

Answer 1

• The health effects of disasters, groups particularly at risk and the communicable disease risks involved
• The communicable diseases most commonly associated with disasters
• Being aware of The essentials of the control of communicable disease in disasters (Assessment, Prevention, Surveillance, Outbreak control, Management of
  cases)

Question 2

What does the nature of disasters determine?

Answer 2

• The patterns of morbidity & mortality
• Subsequent health problems

Question 3

List other factors that can influence the health effects of disasters

Answer 3

• Multi factorial
• Nature of the disaster, Duration, Location, Affected population, Access, Effects on infrastructure, Security, Endemic/epidemic diseases
• These will in turn affect the nature of the response needed

Question 4

Describe the features of an Earthquake/Tsunami

Answer 4

• Release of vast amounts of energy
• Wide areas affected
• Earthquakes >Force 7 on Richter Scale causes:
• Extensive destruction
• Many fatalities
• Population displacement

Question 5

List the effects of an Earthquake/tsunami

Answer 5

• Trauma: many with minor cuts & bruises! smaller group with simple fractures, a minority need surgery / other intensive treatment. Serious multiple fractures, internal injuries & crush syndrome
• Drowning
• Asphyxia
• Dust inhalation
• Burns and electric shock
• Environmental exposure (hypothermia)

Question 6

State one human made disaster and their features

Answer 6

• Terrorism:
• May be many casualties
• Access to casualties may be difficult
• Terrorist attacks frequently in built-up areas
• Security of responders
• Not just explosives: Gunshot/knifing, Vehicle as weapon, Biological agents, Poison gas

Question 7

List the range of injuries caused by terrorism attacks

Answer 7

• Wide range of injuries
• Blast
• Ballistic
• Trauma
• Crush

Question 8

Describe the features of disasters & communicable diseases

Answer 8

• Natural disasters: Acute onset
• Trauma is usually the main immediate cause of morbidity & mortality,
• Communicable diseases (CD) occur later
• Outbreaks of CD less frequent in natural disasters than in conflicts
• Long term: Morbidity & mortality often related to malnutrition

Question 9

Describe the features of conflicts

Answer 9

• In many wars more people die from illness than trauma
• Estimates of mortality:
• Darfur (2004 – 8): > 80% of ca. 300,000 deaths due to disease*
• Yemen (to end 2021) 60% of deaths [227,000/377,000] due to indirect causes (famine, disease) (UNDP Nov 2021)

Question 10

List the Factors increasing risk of disease outbreaks in
disasters

Answer 10

• Breakdown of control measures
• Damage to: Health facilities, Infrastructure (e.g. water, sewage, power supplies etc.)
• Loss of staff
• Damage to or loss of programmes: immunisation, vector control, WASH
• Contamination of water & food
• Breakdown of long term treatment programmes: Infectious agents (e.g.TB), Non infectious illnesses
• Increased susceptibility
• Displacement
• Crowding

Question 11

What are the risk factors for communicable diseases commonly associated with?

Answer 11

Associated primarily with population displacement

Question 12

Which groups are at high risk following a disaster?

Answer 12

• Displaced people
• Children (especially <5Y & unaccompanied)
• Women (especially pregnant women & nursing
  mothers): >75% of refugees & IDPs at risk are women & children, ~25% of these are women of reproductive age, 20% of these likely to be pregnant
• Elderly people
• Disabled people

Question 13

List the risks to displaced individuals?

Answer 13

• Health status of displaced population
• Access to healthcare
• Increased susceptibility
• Reduced immune competence due to: Stress, Poor diet, Malnutrition
• “New” organisms
• Water & Sanitation
• Contaminated food
• Crowding

Question 14

List the risks to the host population

Answer 14

• Imported organisms
• Malnutrition: overexploitation of resources

Question 15

Using Gaza as an example, how many people have been killed or displaced?

Answer 15

• Nearly 42,000 people have been killed in Gaza since the start of the war on Oct 7th 2023
• Around 1.9 million people (9/10Gazans) have been displaced at least once
• They also have a soaring rate of infectious diseases such as diarrhoea and upper respiratory infection

Question 16

Describe the situation in Ukraine due to the conflict occurring (PART 1)

Answer 16

• Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in Ukraine
• Disruptions in treatment for chronic cardiovascular & respiratory diseases likely to increase morbidity & mortality
• Low immunization rates for all vaccine-preventable diseases
• High HIV & resistant TB rates
• The war has weakened TB surveillance capacity & interrupted treatment.
• Risk of an increased spread of drug-resistant TB.

Question 17

Describe the situation in Ukraine due to the conflict occurring (PART 2)

Answer 17

• Overcrowded shelters, population displacement, infrastructure damage, lack of adequate WASH, nutritional stress & exposure to cold weather during winter, could increase the risk of respiratory & diarrhoeal diseases, including cholera
• Critical to strengthen the early warning and alert component of the disease surveillance system to capture the various hazards.

Question 18

What are the common diseases occurring to displaced individuals?

Answer 18

• The Communicable Diseases facing displaced persons
  will generally be those:
• In the areas through which they have moved
• n the areas to which they have moved
• They brought with them from home

Question 19

What diseases are more likely to cause immediate problems than others?

Answer 19

• Respiratory / respiratory route (crowding)
• GI (impure water, contaminated food)
• Vector borne (breakdown of vector controls & possibly
  increase of breeding potential for vectors)

Question 20

List the conditions which consistently account for 60-95% of deaths in displaced individuals

Answer 20

• Acute respiratory infection (ARI), Malnutrition, Diarrhoea, Measles, Malaria
• Need to consider the long term as well as the
  short: TB, HIV/AIDS

Question 21

Describe respiratory diseases amongst displaced individuals

Answer 21

• ARI: major cause of illness & death in displaced populations
• Children <5Y especially at risk: #1 infectious disease killer of children <5Y
• Risk of death from ARI increased by lack of access to: health services, antimicrobial agents for treatment
• Risk factors among displaced persons
  include: crowding, exposure to indoor cooking using open fires, poor nutrition

Question 22

List other important diseases transmitted via the respiratory tract

Answer 22

• Measles
• Diphtheria
• Pneumonic plague
• Bacterial meningitis
• COVID-19 (& other Coronaviruses)
• All of these have disaster implications

Question 23

What are the problems when it comes to malnourished individuals?

Answer 23

• Malnourished individuals have an increased susceptibility to infection
• PEM & micronutrient deficiencies damage the immune system
• Malnutrition magnifies the effects of disease
• More severe disease episodes
• More complications
• Longer duration of illness

Question 24

Describe the features of diarrhoea diseases

Answer 24

• The big three: Cholera (acute watery diarrhoea)! Dysentery (bloody diarrhoea), Typhoid (Enteric fever)
• Many other causes of GI infections - usually endemic not
  epidemic - can cause much morbidity
• NB. Diarrhoea +/- vomiting +/- fever may be a symptom of
  another type of disease – not a GI infection!
• Treatment usually (initially) symptomatic

Question 25

Describe the features of measles in displaced individuals (PART 1)

Answer 25

- Very infectious & potentially fatal - Widespread despite vaccination programmes - Vaccination led to a 73% drop in measles deaths between 2000 & 2018 worldwide - Failure to vaccinate led to increases in the number of cases: 2016: 132,490 cases*. 2019: 869,770 cases*

Question 26

Describe the features of measles in displaced individuals (PART 2)

Answer 26

- Mortality: 207,500 measles deaths globally in 2019*. >95% in low-income countries. mostly children <5Y - Common in crowded emergency settings, large population displacements & high levels of malnutrition. - Worst single killer of children in some refugee situations - Vaccination & Vitamin A are vital components of initial control measures

Question 27

Describe the features of malaria

Answer 27

- Caused by protozoan parasites, Plasmodium spp. • Transmitted by female Anopheles mosquitoes • Widespread in tropical & subtropical regions - ca. 3.5 billion people at risk - 249 million cases of malaria in 2022 - 228 million in Africa (95%) - ca. 608,000 deaths from malaria in 2022: 95% in Africa, ca. 78% children <5Y - Vector control, protective measures, treatment

Question 28

State the correlation between Malaria and Disasters

Answer 28

Many countries affected by natural disasters or armed conflict are in malaria endemic areas

Question 29

Describe the long term problems of TB & HIV/AIDS

Answer 29

- Not acute short term problems - Potential long term problems - Risks of transmission due to: Overcrowding, Poor conditions, malnutrition, breakdown of social networks, economic vulnerability, sexual violence, Risks to aid workers - Difficult to treat in mobile (e.g. refugee/IDP) populations - Incomplete treatment risks development of resistance

Question 30

How can diseases be the cause of disasters?

Answer 30

- An important factor in the past - Black death began 1348: Probably reduced the world's population by 20% by 1400 - 1918-20 “Spanish” flu may have killed up to 100 million people (5% of the world’s population) - Remain so now: Ebola, Covid-19, HIV/AIDS

Question 31

How can we mitigate through diseases caused by disasters?

Answer 31

- aware of risks - Aware of & can undertake preventive measures - Non-pharmaceutical actions - Testing, tracing & surveillance - Good treatment methods: intensive care, development of drugs & vaccines - Improved diagnostics

Question 32

List some control measures that we can take towards communicable diseases

Answer 32

- Rapid Assessment - Prevention - Surveillance - Outbreak control - Disease management

Question 33

How can we carry out rapid assessment as a control measure towards communicable diseases?

Answer 33

- Identify the communicable disease threats faced by the population affected by a disaster - Define the health status of the population - Detect outbreaks - Determine the ability of the population & the responding agencies to control the various diseases - Determine needs

Question 34

How can we carry out prevention as a control measure towards communicable diseases?

Answer 34

- Maintain a healthy environment & good living conditions - Ensure a good nutritional status - Introduce measures to: - prevent person to person spread - control vectors - prevent contact with vectors - prevent spread via the environment - Public health education programmes - Vaccination

Question 35

How can we carry out Surveillance as a control measure towards communicable diseases?

Answer 35

- Set up or strengthen surveillance programmes with early warning mechanisms to: - Ensure early reporting of cases - Monitor disease trends - Facilitate prompt detection & response - Assessment of response

Question 36

How can we control outbreaks as a control measure against communicable diseases

Answer 36

- Preparedness: Stockpiles, Treatment protocols! Training - Rapid detection - Rapid response: Investigation, Confirmation, Treatment, Implement controls

Question 37

How can we carry out disease management as a control measure against communicable diseases?

Answer 37

- Prompt and accurate diagnosis: Syndromic! Laboratory - Case definitions - Treatment: Stockpiles, Effective treatment, Standard protocols, Training