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Infectious disease risks from dead bodies following ...

Rev Panam Salud Publica/Pan Am J Public Health15(5), 2004307 Infectious disease risks from dead bodiesfollowing natural disastersOliver review existing literature to assess the risks of infection from dead bodiesafter a natural disaster occurs, including who is most at risk, what precautions should betaken, and how to safely dispose of the bodies . transmission requires the presence of an Infectious agent, exposure to thatagent, and a susceptible host. These elements were considered to characterize the Infectious dis-ease risk from dead bodies . Using the PubMed on-line databases of the National Library ofMedicine of the United States of America, searching was done for relevant literature on the in-fection risks for public safety workers and funeral workers as well as for guidelines for the man-agement of the dead and prevention of infection.

Rev Panam Salud Publica/Pan Am J Public Health15(5), 2004 307 Infectious disease risks from dead bodies following natural disasters Oliver Morgan1 Objective. To review existing literature to assess the risks of infection from dead bodies

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1 Rev Panam Salud Publica/Pan Am J Public Health15(5), 2004307 Infectious disease risks from dead bodiesfollowing natural disastersOliver review existing literature to assess the risks of infection from dead bodiesafter a natural disaster occurs, including who is most at risk, what precautions should betaken, and how to safely dispose of the bodies . transmission requires the presence of an Infectious agent, exposure to thatagent, and a susceptible host. These elements were considered to characterize the Infectious dis-ease risk from dead bodies . Using the PubMed on-line databases of the National Library ofMedicine of the United States of America, searching was done for relevant literature on the in-fection risks for public safety workers and funeral workers as well as for guidelines for the man-agement of the dead and prevention of infection.

2 A small but significant literature was also re-viewed regarding the disposal of the dead and the contamination of groundwater by cemeteries. of natural disasters usually die from trauma and are unlikely to have acuteor epidemic-causing infections. This indicates that the risk that dead bodies pose for the pub-lic is extremely small. However, persons who are involved in close contact with the dead suchas military personnel, rescue workers, volunteers, and others may be exposed to chronic in-fectious hazards, including hepatitis B virus, hepatitis C virus, HIV, enteric pathogens, andMycobacterium tuberculosis.

3 Suitable precautions for these persons include training, use ofbody bags and disposable gloves, good hygiene practice, and vaccination for hepatitis B and tu-berculosis. Disposal of bodies should respect local custom and practice where possible. Whenthere are large numbers of victims, burial is likely to be the most appropriate method of dis-posal. There is little evidence of microbiological contamination of groundwater from burial. that dead bodies are Infectious can be considered a natural reac-tion by persons wanting to protect themselves from disease . However, clear information aboutthe risks is needed so that responsible local authorities ensure that the bodies of disaster vic-tims are handled appropriately and with due respect.

4 This paper provides a source of informa-tion for those who are in the unfortunate position of managing those bodies . Natural disasters, disaster planning, cadaver, disease outbreaks, natural disasters, there isoften concern that the bodies of victimscan cause epidemics amongst surviv-ing populations (1, 2). This sometimesleads to inappropriate burial of thedead without proper identification ofthe victims. Recent examples of suchdisasters include Hurricane Mitch inCentral America in 1998; a cyclone inOrissa, India, in 1999; and earthquakesin El Salvador in 2001 and in Turkey in 2003.

5 Although empirical evidencesuggests otherwise (2), strong aversionto the dead may represent a natural instinct to protect ourselves againstdisease (3). following large natural dis-asters, these instinctive uncertaintiesare compounded by the lack of clearinformation about how to manage thedead, and these uncertainties result inKey wordsRevisi n bibliogr fica / literature reviewMorgan O. Infectious disease risks from dead bodies following natural disasters. Rev Panam SaludPublica. 2004;15(5):307 citation1 London School of Hygiene and Tropical Medicine,Public and Environmental Health Research Unit,London, United Kingdom.

6 Send correspondenceto: Oliver Morgan, London School of Hygiene andTropical Medicine, Public and EnvironmentalHealth Research Unit, London WC1E 7HT, UnitedKingdom; email among humanitarian work-ers, health organizations, and govern-ment authorities. Many individualsand organizations are still unclearabout what the Infectious risks asso-ciated with dead bodies really are, who is most at risk, what precautionsshould be taken, and how to safely dis-pose of the bodies . This paper reviewsthe risks for both the general publicand for those who may be more inti-mately involved in managing the article also addresses the infec-tious disease risks associated with thedisposal of the dead, an area that oftencauses particular problems.

7 Relevant literature was identifiedfrom the PubMed on-line database of the National Library of Medicine of the United States of America. Keywords included relief work, disasterplanning, natural disasters, diseaseoutbreaks, emergency medicine, mortuary practice, burial, and cadaver. Bibliographies of all rele-vant papers were searched to identifyfurther papers. Studies were selected if they addressed the handling anddisposal of dead Infectious ARE DEAD bodies ?Transmission of infection requiresthe presence of an Infectious agent, ex-posure to that agent, and a susceptiblehost.

8 It is therefore possible to charac-terize the Infectious risks from deadbodies following a natural disaster byconsidering these elements. This sec-tion considers the presence of infec-tious agents in cadavers; the followingsections make estimates of exposure. The human body is host to many or-ganisms, only some of which are patho-genic. When the body dies, the envi-ronment in which pathogens live canno longer sustain them. However, thisdoes not happen immediately, andtransmission of Infectious agents froma cadaver to a living person mayoccur. Infectious hazards for individ-uals who routinely handle cadaversinclude tuberculosis, group A strep-tococcal infection, gastroenteritis,transmissible spongiform encephalop-athies (such as Creutzfeldt-Jakob dis-ease), hepatitis B, hepatitis C, HIV in-fection, and possibly meningitis andsepticemia (especially meningococcal)(4).

9 Microorganisms involved in thedecay process (putrefaction) are notpathogenic (5). Do victims of natural disasters havethese infections when they die? Usu-ally disaster victims die from trauma,burns, or drowning (2, 6), and they areno more likely than the local popula-tion to have acute infections (meningi-tis and septicemia) or rare diseases( , Creutzfeldt-Jakob disease ). In-stead, where disease is present, it is farmore likely to be due to chronic infec-tions with bloodborne viruses (hep-atitis B virus, hepatitis C virus, andHIV), enteric pathogens, and possiblyMycobacterium tuberculosis(Table 1).

10 RISK TO THE GENERAL PUBLICH istorically, epidemics resulting inmass casualties have only occurredfrom a few diseases, including plague,cholera, typhoid, tuberculosis, anthrax,and smallpox (2). As previously noted,such infections are no more likely to be present in disaster victims than inthe general population. Furthermore,although some of these diseases arehighly contagious, their causativeagents are unable to survive long in thehuman body following death (4). It istherefore unlikely that such epidemicswill result from contact with a , survivors present a much moreimportant reservoir for disease (2).


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