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.

The threat of a new tetanus outbreak due to urban flooding disaster requires vigilance: a narrative review

Vaccines for tetanus prevention have rapidly progressed, and the number of outbreaks, especially the incidence of tetanus in developed countries, has decreased dramatically. However, the mortality rate associated with severe tetanus remains high. Tetanus eradication is difficult owing to the widespread presence of the spores of tetanus bacteria in the environment, but tetanus can be prevented by acquired immunity from vaccines. Older people, intravenous drug users, and migrants are at a high risk of tetanus in developed countries owing to the lack of booster vaccination programs. Natural disasters, especially floods, often cause an increase in the prevalence of tetanus because of the associated injuries. Precautions should be taken to combat the threat of a new tetanus outbreak due to floods in urban areas owing to global warming. In particular, Japan is facing a high risk of urban flooding-induced tetanus, despite its status as a developed country. This review aims to highlight the data on the epidemiology, causes, treatment, and prevention of tetanus and problems associated with tetanus countermeasures during future floods.

Can we mitigate the effect of natural disasters on child health? Evidence from the Indian Ocean tsunami in Indonesia

The 2004 Indian Ocean tsunami was an international natural disaster unlike any seen before, killing 166,561 people in Aceh province, Indonesia. It prompted an unprecedented humanitarian response and was a catalyst in ending almost 30 years of civil conflict in Aceh. Since the tsunami was followed by a multitude of events, we first conduct a systematic review to identify those events in Indonesia. We then use a synthetic control method to estimate the combination of those effects on child mortality indicators in Aceh for the 13 years that followed the disaster using data from 258,918 children born between 1990 and 2017. The results show a significant increase in under-5 mortality only the year after the tsunami and no effect in the medium term. However, younger and older children were affected differently in the medium term. In fact, we show a decrease in child mortality among children aged 1-4 years. In contrast, we observe an increase in mortality among children under-1 in 2009 and 2010. Overall, the resilience of Aceh province points to the importance of coordinated international disaster responses after natural disasters.

Tetanus

Tetanus is a vaccine-preventable disease that still commonly occurs in many low-income and middle-income countries, although it is rare in high-income countries. The disease is caused by the toxin of the bacterium Clostridium tetani and is characterised by muscle spasms and autonomic nervous system dysfunction. Global vaccination initiatives have had considerable success but they continue to face many challenges. Treatment for tetanus aims to control spasms and reduce cardiovascular instability, and consists of wound debridement, antitoxin, antibiotics, and supportive care. Recent research has focused on intravenous magnesium sulphate and intrathecal antitoxin administration as methods of spasm control that can avoid the need for ventilatory support. Nevertheless, without access to mechanical ventilation, mortality from tetanus remains high. Even with such care, patients require several weeks of hospitalisation and are vulnerable to secondary problems, such as hospital-acquired infections.

Eradication of tetanus

INTRODUCTION

The causative agent of tetanus, Clostridium tetani is widespread in the environment throughout the world and cannot be eradicated. To reduce the number of cases of tetanus efforts are focussed on prevention using vaccination and post-exposure wound care.

SOURCES OF DATA

Medline, Pubmed and Cochrane databases; World Health Organization and United Nations Children's Fund publications.

AREAS OF AGREEMENT

The maternal and neonatal tetanus elimination initiative has resulted in significant reductions in mortality from neonatal tetanus throughout the world.

AREAS OF CONTROVERSY

Although there are few data available it is likely that large numbers of children and adults, particularly men, remain unprotected due to lack of booster immunization.

AREAS TIMELY FOR DEVELOPING RESEARCH

It remains unclear how HIV and malaria affect both responses to vaccination and transplacental transfer of antibodies or how this might affect timing of vaccination doses.

Two cases of severe pneumonia after the 2011 Great East Japan Earthquake

In 2011, during the Great East Japan Earthquake and tsunami, 90% of victims died from drowning. We report on two tsunami survivors with severe pneumonia potentially caused by Legionella pneumophila. Both victims aspirated a large quantity of contaminated water; sand, mud and a variety of microbes were thought to have entered into their lower respiratory tracts. One patient had a mycotic intracranial aneurysm; the other patient had co-infections with several organisms, including Scedosporium species. Although scedosporiosis is a relatively rare infectious disease, symptoms are progressive and prognosis is poor. These pathogens are not specific for tsunami lung, but are reported causative agents for pneumonia after near-drowning.

Skin and respiratory disorders following the identification of disaster victims in Thailand

The purpose was to assess disorders related to disaster victim identification (DVI) in a group of Danish forensic personnel that had performed disaster victim identification in Thailand after the 2004 tsunami. All individuals from the DVI team were screened using a questionnaire to identify disorders presenting in relation to DVI work in Thailand. All participants who had a positive screening result were examined clinically by an occupational physician and had a standard lung function test. Individuals with skin disorders were examined by a dermatologist and a skin patch was performed. Individuals with respiratory disorders were evaluated by a specialists in pulmonary medicine, based on the results of an extended lung function test and a skin prick test. Out of the 165 persons that worked with DVI in Thailand, 152 (92%) answered the questionnaire, and 24 underwent subsequent clinical examination. On examination, five persons were found to have skin disorders and four had airway disorders associated with the DVI work in Thailand. The allergy tests gave no support to the conditions being caused by exposure to disinfectants or other specific chemicals in any of the examined individuals. Working in disaster areas may cause or aggravate skin and airway disorders. It is suggested that an assessment of risk is performed before sending personnel abroad to challenging working conditions, and that a health check is carried out upon their return.

Characteristic tetanus infection in disaster-affected areas: case study of the Yogyakarta earthquakes in Indonesia

BACKGROUND

Tetanus is an infectious disease caused by the contamination of wounds from bacteria that live in soil. The tetanus mortality rate remains high in developing countries affected by natural disasters. Whether the socio-demography and geographical conditions may influence the tetanus treatment outcome on the earthquake situation in Yogyakarta, Indonesia has not been investigated.

FINDINGS

We present 26 tetanus patients who were admitted to eight hospitals following the earthquakes that occurred on May, 27, 2006, in Yogyakarta, Indonesia. The independent variables were age, gender, distance, admission, hospitalization, and type of hospital with the dependent variable surviving or perishing. Data were analyzed by logistic regression methods on SPSS 17.0. The distance from the patient's place of residence to the hospital were obtained and analyzed by using geospatial tools MapInfo 7.8 SCP and Global Mapper 7. Eight of the 26 patients were dead (30.8%) and statistical results showed that the distance (OR = 1.740, 95% CI = 1.068-2.835) and type of hospital (OR = 0.067, 95% CI = 0.001-3.520) were significant predictors of death.

CONCLUSION

Our findings show that in order to reduce the mortality rates, performing triage systems based on the distance and type of hospital priority for internally displaced persons could be proposed as well as making provisions for the generally old population in order to prevent an outbreak of tetanus following earthquakes in Yogyakarta, Indonesia.