Infectious Diseases in the aftermath of Floods in

Asia: A Literature Review

Jung, Yoomi, RN, Ph.D.Major, ROKA, NC

Associate professorHead, Military Health & Policy Research Center

Korea Armed Forces Nursing Academy

Contents

BackgroundPurposeMethodsResultsDiscussionConclusion

Background

We are living in an era of disaster

: 357 natural disasters worldwide in 2012

Asia is the most vulnerable region to flooding (UNU,

2014)

- 8 out of 13 natural disasters has been floods (61.5%) in 2012

- With an average of 82/year hydrological events between

2002-2011, 111mn victims & 13bn plus dollars damage

Heavy rainfall (55.2%) and flooding (52.9%) were the

most common events preceding outbreaks (Cann et al.,

2013)

Understanding possible infectious diseases regarding

floods in the region helps health workers to predict,

prepare, and respond more efficiently

Purpose

This study was to provide through a literature review

an insight into infectious diseases that could break out

after flooding disasters in Asian countries.

Identify flooding events and their features and impacts that

were reported over the past decade Explore whether there have been outbreaks of infectious

diseases in the aftermath of floods Investigate diagnostic tests and treatments used for the

epidemics

Methods 3-1

Study design

: Literature review following the steps of Cann, Thomas,

Salmon,

Wyn-Hones, and Kay (2013)

Search strategy

- Database: Pubmed

- Search period: Jan 16-17, 2014

- Search words

: infection, infectious disease, communicable disease, flood,

flooding

flood & communicable disease, flood & infectious disease,

flood &

infection, flooding & communicable disease, flooding & in-

fectious

disease, flooding & infection

- Additional conditions: studies to provide full text and abstract

studies published between 2004-2014

Methods 3-2

Selection criteria

- Literature type: not a review article

- Language: English

- Subject: human

- Disaster type: flood

- Region: Asia

- Data: primary data from affected population, surveillance

report, and others

Methods 3-3

<Fig. 1> The records selection process

Results 7-1

1. 12 floods from 8 countries

2. The most frequently hit

country: Bangladesh

(5 of 12, 41.7%)

3. Affected areas in Bangladesh

: Dhaka only (5 of 5, 100%)

4. Flooding years: 1988-2010

<Fig. 2> Regional distribution of floods

(unclear) India

Fuyang & Bozhou, China

Tainan,Taiwan

Metro Manila,

Philippines

Hanoi,Vietnam

Dhaka, Bangladesh

Beaufort,Malaysia

1988

1998

2004 A

2004 B

2007 1999

2008

2007

2005

2009

2009

(unclear) Pak-istan

2010

Main features of the floods (3-

1)

Results 7-2

5. Season: Jul-Sep (75 %)

6. Main cause

a. heavy rainfall (57.1%),

b. typhoon (28.6%)

c. unusual heavy monsoon rain

(14.3%)

7. Size of flooding

a. 87.6mm (2013, China)

~2,748mm (2009, Tai-

wan)

b. An average of 26 flood days

(Bangladesh)

Main features of the floods (3-2)

Frequency

Month

<Fig. 3> Seasonal distribution of floods

Results 7-3

Main features of the floods (3-3)

7. Impact or damages

a. 33.1mn affected and 1,722 died, combined

(Pakistan, China, and Viet-

nam)

b. 178 deaths among 2,999 patients visiting 15 hospitals

(Philippines)

Results 7-4

Infectious disease outbreaks

1. By number of reported outbreaks

a. Diarrhea (7 reports in 12 flooding events, 58%)

b. Leptospirosis (2 reports in 12 events, 17%)

c. Cellulitis, skin diseases, respiratory infections,

Dengue fever, Hantavirus infection, and pink eye

Results 7-5

Diarrhea

Category Findings

Countries Bangladesh, Pakistan, China

Number of cases

787,430 from 7 floods

Pathogen - Vibrio Cholerae O1 (most common) 4 times

increase

- Rota virus (second most common)

- 23-51% cases with no identifiable organism

Diagnostic test Rectal swab

Treatment Oral/ intravenous re-hydration, antibiotics

Results 7-6

Leptospirosis

※ CFR: Case Fatality Rate

Category Findings

Countries Philippines, Malaysia

Number of cases

517 from two events

CFR※ 10.8% & 2.2% each, 10.1% combinedPulmonary hemorrhage as main cause in both

Pathogen L. Borgpetersenii serovar Tarassovi (most preva-lent)

Diagnostic test Leptospira Serology Kit, PanBio IgM ELISA, Micro-scopic Agglutination Test (MAT)

Treatment Penicillin G (over 90%), Ceftriaxone, Doxycycline, Amoxicillin, IV D-Penicillin

Results 7-7

Category Findings

Countries Taiwan

Number of cases

- 344 from one event (88% increase in the lower extremity cases)- 10 times increase in number of W+ pts before flooding (31 vs. 3 per week)

Pathogen W+ vs. W-Gram-negative bacilli (GNB): 86% > 34% Enterococcus spp. : 16% > 3%Gram-positive cocci (GPC) : 43% < 80%Staphylococcus aureus : 16% < 51%

Diagnostic test Wound or pus culture

Treatment Not mentioned

Cellulitis

※ W+: Patients who had immersed their affected limbs in flood water

Discussion 3-1

Diarrheal epidemic

1. Poor water supply and sewage system

2. Water source contaminated by flood

☞ hand-washing, not sharing of water containers & cooking pots,

safe & palatable drinking water

V. cholerae serotype O1

1. The main cause of diarrheal epidemic after the 2010 Haiti

earthquake

2. The most common pathogen in waterborne outbreaks (Cann et

al., 2013)

: Vibrio spp. & leptospirosis spp.

3. One of three most useful vaccines post disasters

: Cholerae, Tetanus toxoid, and Hepatitis A (Wiwanitkit, 2010)

☞ Adequate reserve of vaccines and antibiotics of necessity

Fecal-oral transmission

↑

Infectious diarrhea

↑

Discussion 3-2

Redefining of vulnerable populations

1. Boys were dominant patients of leptospirosis

: active frequent skin wounds animal urine in outdoor activi-

ties

2. After floods, water can be main source of infection

: Pathogen in land flood creek, lake, river

☞ Need to understand possible environmental changes and infec-

tion

routes after disasters

Timely initiation of treatment

1. WHO recommends to start leptospirosis treatment within 5

days

☞ Need to primarily target the vulnerable populations of the

possible

epidemics for surveillance after a disaster

Discussion 3-3

Cellulitis after inundation

1. Also reported after tsunami (Maegele, 2006; Unahlekhaka & mehta,

2006)

a. Mainly Proteus spp., Klebsiella spp., Enterobacter spp., & E.

coli

2. Pathogens commonly existing soil, plants, animal feces, &

sewage

3. Flow into flood water

☞ Protection of limbs with broken skin integrity from flood water

Conclusion

Due to the climate change, weather is getting more

unpredictable and more flooding can be expected in

the region

The types of infectious disease vary depending on

types of disaster and endemic diseases of the area

Healthcare workers should study and continue to

update themselves with prevalent infectious dis-

eases in the region where they work, and accord-

ingly vaccines, treatments and other prevention

measures

Thank you

Jung, Y., Lee, M., & Kim, M. (2015). Infectious Dis-

eases in the Aftermath of Floods in Asia: A Litera-

ture Review. Journal of Military Nursing, 33 (1),

pp83-94