Epidemiological surveillance of diseases following the earthquake of 23rd November 1980 in Southern Italy

The Impact of Earthquakes on Public Health: A Narrative Review of Infectious Diseases in the Post-Disaster Period Aiming to Disaster Risk Reduction

Earthquakes are among the most impressive natural phenomena with very high potential to set off a chain of effects that significantly affects public health through casualties and injuries. Related disasters are attributed not only to the strong ground motion and coseismic phenomena but also to secondary effects, comprising mainly landslides and tsunamis, among others. All these can create harsh conditions favorable for the emergence of infectious diseases that are capable of causing additional human and economic losses and disruption of the emergency and recovery process. The present study comprises an extensive narrative review of the existing literature on the earthquake-triggered infectious diseases recorded worldwide, along with their symptoms, causative pathogens, associated risk factors, most vulnerable population groups, and prevention strategies. Respiratory, gastrointestinal, and vector-borne diseases, as well as wound and skin infections, are mainly recorded among the earthquake-affected population. Measures for effectively preventing earthquake-triggered infectious diseases are also proposed. One of the widely proposed measures is the establishment of a proper disease surveillance system in order to immediately and effectively identify the pre- and post-disaster occurrence of infectious diseases. This approach significantly contributes to disease trends monitoring, validation of early warning, and support of the emergency response and recovery actions.

Incidence of infectious diseases after earthquakes: a systematic review and meta-analysis

OBJECTIVES

Evaluation of the incidence of infectious diseases after natural disasters can help develop healthcare policies. This study provides a global review of the most prevalent infectious diseases observed after earthquakes.

STUDY DESIGN

A systematic review and meta-analysis were performed.

METHODS

A systematic review was performed on electronic databases, including PubMed, Scopus and Web of Science, up to March 2020 (with no time limitations). Studies addressing earthquakes and infectious diseases were collected based on specified inclusion and exclusion criteria. Subsequently, the quality of the studies was assessed by the Newcastle-Ottawa scale (NOS). Data analyses were carried out on six subgroups under five different disease categories using comprehensive meta-analysis software.

RESULTS

In total, 24 studies qualified for the systematic review and 18 were included in the meta-analysis. The incidences of gastrointestinal infections, dermal infections, respiratory infections, central nervous system infections and other infectious diseases were as follows: odds ratio (OR) 163.4 (95% confidence interval [CI]: 31.0-858.1), OR 84.5 (95% CI: 27.1-262.8), OR 9.9 (95% CI: 3.5-27.7), OR 0.5 (95% CI: 0.2-1.1) and OR 4.4 (95% CI: 1.9-9.9) cases per 100,000 people, respectively. The association between the incidences of infectious diseases before and after earthquakes was significant, namely, 1.561 (95% CI: 1.244-1.957) with a P-value <0.001.

CONCLUSIONS

The results show an increase in the prevalence of infectious diseases after earthquakes. Governments should take essential measures to be better prepared for such unpredictable catastrophes.

The Scientific Landscape of November 23rd, 1980 Irpinia-Basilicata Earthquake: Taking Stock of (Almost) 40 Years of Studies

The November 23rd, 1980 Irpinia-Basilicata (Southern Italy) earthquake is one of the strongest earthquakes ever occurred in Italy. The earthquake was a natural laboratory for the scientific community, which was engaged highly and promptly in investigating the event, thus publishing a flood of papers in different research areas over time. Just these research outputs are the focus of the article, which examines, with a tailored methodological approach, the international and national (Italian) studies started and advanced since the occurrence of the earthquake. First, we built and analyzed statistically two bibliographic databanks regarding the earthquake studies: (a) the international version of IRpinia Bibliographic databASE (IR_BASE_ENG), selecting and standardizing the pertinent scientific documents extracted from Scopus, Web of Science, and other databases and (b) the national version of the database (IR_BASE_IT) using the Google Scholar search engine to search for the most relevant papers in Italian. Second, IR_BASE_ENG was analyzed in a bibliometric perspective through the data mining VOSviewer software (Waltman et al., 2010) that builds co-occurrence term maps useful in perspective of investigating the wide-ranging studies on the earthquake. Third, taking a cue from this network analysis, we recognized the main research topics and performed a minireview of the related international studies, integrating in it a quick reference to the literature in Italian. Finally, we associated the scientific outputs to each cluster/topic, also performing the frequency analysis of the published documents for each subject, thus gaining information on the temporal trends of studies and getting a more exhaustive evidence of the scientific landscape on the earthquake over the last 40 years.

Pre-Earthquake Vulnerability Assessment

Health planning for disasters builds on an awareness of ways in which the disaster affects health and on anticipation of tasks to be performed by the health sector.

In view of the possibility of an earthquake of significant magnitude in Israel, and in the absence of previous earthquake experience, published data of earthquake health effects were studied, such as causes of death and injury, casualty rates and factors influencing these, distribution of injuries and their severity, effect on health care facilities and on physical, social and psychological environments. Implications of the studied data were applied to relevant conditions in Israel and to an earthquake there. A predisaster vulnerability assessment was thus obtained, pointing to the nature, size, and space and time distribution of tasks the health sector would be expected to perform should an earthquake occur in Israel.

On the basis of this assessment some recommendations for the preparation and preparedness of the health sector for such an occurrence are submitted.

Health response to a large and rapid influx of Albanian refugees in southern Italy, 1991

Over a two-day period in March 1991, more than 23,000 Albanian refugees arrived without warning in the southern Italian port of Brindisi. A simple surveillance system was established within days of their arrival to monitor health problems that were expected to have a high frequency, were of concern to the Italian health care system because of potential spread to the local population, and were susceptible to therapeutic or preventive measures. The most commonly encountered health problems were pediculosis and scabies. Despite poor sanitary conditions, only one outbreak of gastrointestinal disease was reported. Obstetric events were common, and many resulted in adverse outcomes. Hospitalization rates were high, although in the early weeks of the emergency, many were unwarranted. This experience demonstrates the value of a simple, rapid surveillance system in prioritizing health problems and preventing rumors. In future, greater emphasis should be placed on outpatient management of simple medical problems.

Disease epidemiology and earthquake disaster. The example of Southern Italy after the 23 November 1980 earthquake

This paper describes aspects of the epidemiological situation following the November 1980 earthquake disaster in Campania and Basilicata, southern Italy. First, population displacements and the fluctuating state of homelessness after the catastrophe are described. Secondly, the level of medical provision prior to the disaster is assessed and damage caused by the earthquake to the medical care and sanitation infrastructures is outlined. Thirdly, the publicity given by news media to the threat of disease is examined and compared with the official government reaction, which took the form of emergency medical provision and intervention against the supposed threat of disease. The national epidemiological surveillance system, which was set up during the aftermath of the disaster, is outlined and some of its results, describing the post-impact epidemiological situation in the disaster zone, are examined. Despite the chaotic situation following the earthquake and the publicity given to the threat of disease outbreaks, there were no serious epidemics and the hospital system was able to cope with the aftermath. The government program of vaccinating survivors and relief volunteers can therefore be seen as an over-reaction to the prevailing situation, although continuing disease surveillance was probably a wise precaution.