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The public health planners' perfect storm: Hurricane Matthew and Zika virus
Abstract
Hurricane Matthew threatened to be one of the most powerful Hurricanes to hit the United States in a century. Fortunately, it avoided making landfall on Florida, the eye of the Hurricane remaining centered 40 miles off the Florida coast. Even so it has resulted in over $7 Billion USD in damage according to initial estimates with much of the damage ongoing in severe flooding. Response to and recovery from Hurricane Matthew challenged Florida's public health services and resources just as emergency Zika-specific congressional funding to combat Zika outbreaks in Florida had become available. Hurricanes can disrupt the urban environment in a way that increases the likelihood of vector-borne illnesses and their aftermath can severely strain the very infectious disease and infection control academe needed to combat vector-borne outbreaks. This commentary attempts to examine the challenges posed by Hurricane Matthew in Florida's efforts to contain Zika.
... Hurricane Matthew-associated deaths across four states (Florida, Georgia, North and South Carolina) totaled to 43, the majority of which occurred in North Carolina (n = 26, 60%) and were directly associated with drowning in a motor vehicle (n = 18, 69%) (e.g., vehicle driven into standing water, vehicle swept away by water) [95]. Delayed outbreaks of vector-borne diseases are typically observed about 8 weeks post-hurricane [96] and the threat of a Zika outbreak was of particular concern for Florida after Matthew [97]. Disruptions in vector control measures and public awareness campaigns around Zika recently appropriated by Congress ($1.1 billion US dollars) were diverted to deal with the acute public health response to the storm. ...
... Disruptions in vector control measures and public awareness campaigns around Zika recently appropriated by Congress ($1.1 billion US dollars) were diverted to deal with the acute public health response to the storm. In future events, public health authorities should consider implementing pre-planned mosquito-control measures combined with public awareness messaging campaigns to mitigate the potential for a surge in incident vector-borne disease cases [97]. ...
Purpose of Review
Recent changes in our planetary climate have and will continue to challenge historical knowledge and risk assumptions for weather-related disasters. While the public health community is rapidly working to develop epidemiological approaches and tools to mitigate and adapt to these weather-related disasters, recent high-profile events have exposed gaps in knowledge and response efforts. Limited work has been done to assess the climate readiness of the local public health and healthcare community as it pertains to local response planning and adaptation measures in the event of a weather-related disaster. The purpose of this paper is to review the existing literature related to climate change, weather-related disasters, and population health approaches to adapt to climate-related changes in weather-related disasters at the local level. We highlight a brief case study to illustrate an example of a local approach to adaptation planning in a coastal community.
Recent Findings
Few studies have put forth quantitative disaster epidemiology tools to aid public health officials in preparing for and responding to these weather-related disaster events. There is a general lack of understanding within the public health community about the epidemiological tools which are available to assist local communities in their preparation for, response to, and recovery from weather-related disasters.
Summary
Cities around the nation are already working to assess their vulnerability and resilience to weather-related disasters by including climate change in emergency preparedness plans and developing adaptation strategies, as well as equipping local hospitals, health departments and other critical public health systems with climate information. But more work is needed and public health funding is lagging to support local and state-level efforts in preparing for and adapting to weather-related disasters in the context of a changing climate. Our population health disaster preparedness programs need to be adapted to address the increasing risks to local public health resulting from our changing climate.
... These infrastructure issues must be addressed quickly to optimize the emergency response. Furthermore, it is important to protect emergency workers from mosquitoes, as these workers are essential for restoring electrical power and telephone operations, relocating residents from damaged homes, and assisting injured people (Ahmed & Memish, 2017). ...
Preparation for post-hurricane mosquito control is essential for an effective emergency response to protect public health and promote recovery efforts. Effective pre-hurricane planning includes laying the groundwork for a successful reimbursement application to the Federal Emergency Management Agency. The critical and overlapping need to sustain funding for mosquito control programs is highlighted here in the context of both normal and emergency responses. Community support is an integral component of an effective integrated pest management program and is established over time with appropriate communication and engagement. Experienced mosquito control operators who are familiar with treatment areas are an essential component of successful operations. Here, practical advice is provided to plan, prepare, and implement a successful ground- and aerial-based mosquito control response.
... La complexité de la crise et la gestion des partenaires dans un contexte diplomatique tentant de s'ajuster aux leçons du séisme de 2010 étaient riches d'enseignement (11). Certaines orientations dans le domaine de la santé ont semblé étonnantes, notamment par un ancrage qui semblait être trop dans le présent en délaissant des éléments prospectifs majeurs principalement dans la veille épidémiologique et les menaces sanitaires prévisibles (3,19,20) : les déshydratations infantiles, l'émergence du paludisme à trois semaines de l'ouragan (21), la majoration des diarrhées aiguës infectieuses sévères par rapport à l'endémie de choléra (14,22), la possibilité d'infections à veiller du fait du péril fécal majeur, enfin le risque d'amputation sur plaies traitées tardivement. Expert pour emploi de l'UE, certaines recommandations de l'UE étaient à pondérer par ailleurs au regard des accords bilatéraux réalisés entre la France, l'OMS et l'État haïtien. ...
Ce nouveau numéro de « Médecine et Armées » s’intéresse aux soignants en situation de crise. Il convient donc de chercher à définir la crise, notion à l’usage florissant et galvaudé. Il faut le souligner d’emblée : la notion de crise échappe à toute définition répondant aux canons de la rigueur analytique habituelle. Relisons ici Uriel Rosenthal : « Les scientifiques ne se sentent guère à l’aise avec ces phénomènes qui semblent hors du champ des théories bien nettes et ciselées qu’ils ont développées à partir des circonstances et événements inscrits dans la normalité. Les crises semblent être en opposition absolue avec la base même des sciences ». Aussi, la « gestion » de la crise doit être enseignée comme un savoir créatif permettant de prendre en charge les exceptions aux règles, rapidement et sous pression. Le succès peut dépendre de la capacité à s’écarter des règles qui fonctionnent habituellement et de l’enseignement tiré des habitudes. Dans la médecine hippocratique, le terme de crise – krisis – désigne l’instant crucial ou la maladie touche à son terme, pour le meilleur ou pour le pire. La crise est un paroxysme d’incertitude ou tout est en suspens. À cette vision hippocratique, la pensée médicale du XIXe siècle adjoint le caractère inaugural, purement réactionnel, positif ou négatif.
... For instance, the containerbreeder Ae. albopictus frequently uses artificial habitats, such as flowerpots and vases, that are independent of precipitation [66]. In addition, although precipitation is generally considered beneficial, heavy rainfall events can have adverse effects on larval mosquito populations [67,68]. Hence, we considered a variable set without any precipitation-related variables. ...
Chikungunya virus disease (chikungunya) is a mosquito-borne infectious disease reported in at least 50 countries, mostly in the tropics. It has spread around the globe within the last two decades, with local outbreaks in Europe. The vector mosquito Aedes albopictus (Diptera, Culicidae) has already widely established itself in southern Europe and is spreading towards central parts of the continent. Public health authorities and policymakers need to be informed about where and when a chikungunya transmission is likely to take place. Here, we adapted a previously published global ecological niche model (ENM) by including only non-tropical chikungunya occurrence records and selecting bioclimatic variables that can reflect the temperate and sub-tropical conditions in Europe with greater accuracy. Additionally, we applied an epidemiological model to capture the temporal outbreak risk of chikungunya in six selected European cities. Overall, the non-tropical ENM captures all the previous outbreaks in Europe, whereas the global ENM had underestimated the risk. Highly suitable areas are more widespread than previously assumed. They are found in coastal areas of the Mediterranean Sea, in the western part of the Iberian Peninsula, and in Atlantic coastal areas of France. Under a worst-case scenario, even large areas of western Germany and the Benelux states are considered potential areas of transmission. For the six selected European cities, June–September (the 22th–38th week) is the most vulnerable time period, with the maximum continuous duration of a possible transmission period lasting up to 93 days (Ravenna, Italy).
... While it was originally believed that heavy rainfall and flooding would flush out mosquito larval habitats leading to overall decreases in mosquito populations and associated illness following EPEs, the opposite has been repeatedly observed. While flowing water during EPEs will wash away mosquito larvae and eggs, receding water after EPEs leaves behind new habitat for mosquitoes that quickly return and increase in numbers [56]. Due to the abundance of suitable breeding sites following heavy precipitation and flooding events, rates of mosquito-borne illness increase significantly, even in areas that typically experienced only low risk of disease at a typical lag of around 8 weeks after precipitation events [57]. ...
Extreme precipitation events (EPE) change the natural and built environments and alter human behavior in ways that facilitate infectious disease transmission. EPEs are expected with high confidence to increase in frequency and are thus of great public health importance. This scoping review seeks to summarize the mechanisms and severity of impacts of EPEs on infectious diseases, to provide a conceptual framework for the influence of EPEs on infectious respiratory diseases, and to define areas of future study currently lacking in this field. The effects of EPEs are well-studied with respect to enteric, vector-borne, and allergic illness where they are shown to moderately increase risk of illness, but not well-understood in relation to infectious respiratory illness. We propose a framework for a similar influence of EPEs on infectious respiratory viruses through several plausible pathways: decreased UV radiation, increased ambient relative humidity, and changes to human behavior (increased time indoors and use of heating and cooling systems). However, limited work has evaluated meteorologic risk factors for infectious respiratory diseases. Future research is needed to evaluate the effects of EPEs on infectious respiratory diseases using individual-level case surveillance, fine spatial scales, and lag periods suited to the incubation periods of the disease under study, as well as a full characterization of susceptible, vulnerable, and sensitive population characteristics.
... For instance, the containerbreeder Ae. albopictus frequently uses artificial habitats, such as flowerpots and vases, that are independent of precipitation [66]. In addition, although precipitation is generally considered beneficial, heavy rainfall events can have adverse effects on larval mosquito populations [67,68]. Hence, we considered a variable set without any precipitation-related variables. ...
Chikungunya virus disease (chikungunya) is a mosquito-borne infectious disease reported in at least 50 countries, mostly in the tropics. It has spread around the globe within the last two decades, with local outbreaks in Europe. The vector mosquito Aedes albopictus (Diptera, Culicidae) has already widely established itself in southern Europe and is spreading towards central parts of the continent. Public health authorities and policymakers need to be informed about where and when a chikungunya transmission is likely to take place. Here, we adapted a previously published global ecological niche model (ENM) by including only non-tropical chikungunya occurrence records and selecting bioclimatic variables that can reflect the temperate and sub-tropical conditions in Europe with greater accuracy. Additionally, we applied an epidemiological model to capture the temporal outbreak risk of chikungunya in six selected European cities. Overall, the non-tropical ENM captures all the previous outbreaks in Europe, whereas the global ENM had underestimated the risk. Highly suitable areas are more widespread than previously assumed. They are found in coastal areas of the Mediterranean Sea, in the western part of the Iberian Peninsula, and in Atlantic coastal areas of France. Under a worst-case scenario, even large areas of western Germany and the Benelux states are considered potential areas of transmission. For the six selected European cities, June–September (the 22th–38th week) is the most vulnerable time period, with the maximum continuous duration of a possible transmission period lasting up to 93 days (Ravenna, Italy).
... Relief workers from other areas may be present in the hurricane zone, and they may be subject to very high biting pressure while trying to restore services such as electrical power (O'Leary et al. 2002). Although in the USA increases in mosquito-borne diseases generally have not been noted after hurricanes, the possibility exists, and mosquito control is needed to reduce vector populations (Nasci andMoore 1998, Ahmed andMemish 2017). ...
The hurricane plan developed by the Florida Keys Mosquito Control District and approved by vote of the Board of Commissioners is presented. The plan is intended to facilitate prompt resumption of services after a tropical cyclone (tropical storm or hurricane) and to give direction and instructions to District staff who evacuate before a storm makes landfall. Specific procedures are documented for before and after storms, including communication, preparation of buildings and vehicles, and evacuation. The need for food and water for staff immediately after a storm is specifically mentioned in the plan. The plan is composed of five main sections: general preparedness, Lower Keys procedures, Middle Keys procedures, Upper Keys procedures, and aerial operations procedures. Also included is a section covering satellite telephone operation and a list of telephone contacts for local government and law enforcement agencies. An addendum details the District's policy for compensation for public emergency response work so all employees are aware of how they will be paid during the storm recovery period.
... Hurricane impacts on vector populations appear to be variable with respect to time since landfall and damage dependent. It is widely hypothesized, but not documented, that adult mosquitoes suffer significant direct mortality from hurricane strength winds (Ahmed andMemish 2017, CDC 2019). Hurricane winds can also expand aquatic larval habitats with the creation of water-holding root ball voids from knocked down trees (Caillouët, personal observation 2006). ...
Hurricanes have profound impacts on zoonotic pathogen ecosystems that exhibit spatial and temporal waves in both distance from and time since the event. Wind, rain, and storm surge directly affect mosquito vectors and animal hosts of these pathogens. In this analysis, we apply a West Nile virus transmission model parameterized for the Northern coast of the Gulf of Mexico to explore the effect of event timing of hurricane landfall, time since the event, and damage extent on human West Nile virus neuro-invasive disease (WNV-NID) risk. Early-season hurricanes, which make landfall prior to the peak of baseline WNV transmission activity, increase the average total WNV-infectious mosquitoes for the year by 7.8% and human WNV-NID incidence by 94.3% across all areas with hurricane damage. The indirect effects on human exposure to mosquito bites in the immediate aftermath and long-term recovery from the event have strong impacts on the risk of infection. The resultant interactive direct and indirect storm effects on the pathogen system are spatially and temporally heterogenous among the generalized time and space categories modeled.
... In this study, the 20 most likely public health risks after the typhoon disaster occurred in Guangxi Zhuang Autonomous Region were selected, and the risk degree was evaluated and ranked. The top five are trauma, typhoid or paratyphoid, cholera, infectious diarrhea, and hepatitis a, which is consistent with the results of studies at home and abroad that the most likely public health risks caused by typhoon disasters are trauma, gastrointestinal diseases, skin diseases and insect-borne infectious diseases [4][5][6][7][8]. However, the United States conducted field epidemiological studies after the hurricane in 2004 and found that psychological damage after the typhoon crisis should not be ignored. ...
... La complexité de la crise et la gestion des partenaires dans un contexte diplomatique tentant de s'ajuster aux leçons du séisme de 2010 étaient riches d'enseignement (11). Certaines orientations dans le domaine de la santé ont semblé étonnantes, notamment par un ancrage qui semblait être trop dans le présent en délaissant des éléments prospectifs majeurs principalement dans la veille épidémiologique et les menaces sanitaires prévisibles (3,19,20) : les déshydratations infantiles, l'émergence du paludisme à trois semaines de l'ouragan (21), la majoration des diarrhées aiguës infectieuses sévères par rapport à l'endémie de choléra (14,22), la possibilité d'infections à veiller du fait du péril fécal majeur, enfin le risque d'amputation sur plaies traitées tardivement. Expert pour emploi de l'UE, certaines recommandations de l'UE étaient à pondérer par ailleurs au regard des accords bilatéraux réalisés entre la France, l'OMS et l'État haïtien. ...
Situation générale : la protection civile est une aide d’origine gouvernementale permettant à une nation de répondre au mieux pendant ou après une catastrophe pour la protection des personnes et des biens. Elle peut être en nature, par l’envoi d’équipes spécialisées dans la gestion de crises spécifiques ou pour l’évaluation et la coordination sur site. Le « Mécanisme » européen de protection civile (EUCPM), créé en 2001, a pour but de permettre la coopération et la mise en commun des moteurs de résilience nationaux afin d’augmenter la pertinence et l’efficience de la réponse à la crise entre 32 pays participants. Il peut être activé sur demande par tout pays dans le monde. Les missions sont d’une grande complexité, à haute responsabilité en milieu international à l’instar de leurs intensités, dans l’incertitude des premiers instants de la crise, des hommes et des institutions participantes. Mission : l’ouragan « Matthew » dévastait la partie ouest de Haïti le 4 octobre 2016, le gouvernement demandant d’emblée à l’Union européenne d’activer le Mécanisme. Une équipe de cinq experts, dont un expert santé, était mise en place du 7 au 26 octobre pour la Commission européenne. Les missions étaient notamment de faciliter la coordination, le déploiement, la mise en place et le retrait de l’aide reçue par Haïti de la part des états membres de l’Union européenne, d’appuyer les autorités nationales et les Nations unies pour évaluer la situation et faciliter la coordination, d’identifier les besoins et le type d’assistance nécessaire en protection civile et formuler les recommandations. Ce fut notamment au profit de la plus grosse unité d’épuration d’eau d’origine française des Unités d’instruction et d’intervention de la sécurité civile, l’acheminement des kits adaptés aux stocks nationaux dans la lutte contre l’épidémie de diarrhées aiguës sévères en collaboration étroite avec l’Organisation mondiale de la santé ayant le mandat gouvernemental pour les questions sanitaires. Discussion : l’expertise santé a été originale dans l’évaluation et l’anticipation des différents aspects de la crise sanitaire, la formalisation des offres de santé de l’Union européenne au plus proche des besoins et pour une mise à profit immédiate, l’expertise de l’hôpital régional de la ville de Jeremie pour une reprise de son activité chirurgicale immédiate. Les ajustements de l’expert santé doivent être d’une grande dynamique face à la gestion de la crise en collaboration avec les différents partenaires locaux, français, européens et internationaux.
General situation: Civil protection consists in governmental aid given in support of a nation to best adjust to the immediate aftermath of a disaster for the protection of people and property. It can be in-kind, and consist in sending teams specialized in crisis management or concern on-site assessment and coordination. The European Union (EU) Civil Protection Mechanism (EUCPM) was established in 2001; it aims is to facilitate the cooperation and pooling of national resilience drivers in order to increase the relevance and efficiency of the response to crises between 32 European countries. It can be activated upon the request of any country in the world. The selection of specialists is national, and is accredited by the EU. The missions are very complex, and involve high degree of responsibility at the international level, as much as the uncertainty and intensity of the first moments of the crisis, of the people and institutions involved. Mission: On October 4th 2016, hurricane Matthew devastated the western part of Haiti, and the government urged the EU to activate the EUCPM. A team of five experts, including one health expert, was put in place from October 7th to 26th for the European Commission. The missions mainly aimed at facilitating the coordination, deployment, provision and withdrawal of aid received by Haiti from EU member states, supporting national authorities and the United Nations in assessing the situation and facilitating coordination, identifying needs and the type of assistance needed in civil protection and formulating recommendations. This was particularly in favor of the largest water treatment unit of French origin, the Civil Protection Training and Response Units (UIISC), distributing kits tailored to national stocks in the fight against severe acute diarrhea outbreaks in close collaboration with the World Health Organization having government mandate pertaining to health issues. Discussion: The health expertise was unique in assessing and anticipating the different aspects of the health crisis, formalizing EU health offers as closely as possible to the needs and making immediate use of them, the expertise of the regional hospital of the city of Jeremy for an immediate resumption of its surgical activity. The adjustments of the health experts must be very dynamic in regards to the crisis management, in collaboration with the various local, French, European and international partners.
... While previous experience with disease outbreaks after hurricanes has spurred post-disaster education initiatives to prevent mosquito bites [7] and rapidly deployable vector control programs, such as aerial spraying [8], public funding for these programs is frequently strained, delays are not uncommon, and mosquitoes are becoming increasingly resistant to insecticides. These realities suggest that the spread of mosquito-borne Zika in the US will continue to be an area of concern as hurricanes continue to threaten the Atlantic coast in the coming years [9]. ...
Background
Outbreaks of mosquito-borne viral illnesses commonly occur after storms. As storms are predicted to worsen in intensity and frequency, mosquito-borne viruses, including the Zika virus are expected to spread, and with devastating consequences. While the disease is self-limited, pregnant women who contract Zika can transmit the virus to their fetuses, causing neurodevelopmental abnormalities, including microcephaly. An overlooked vector of the Zika virus, however, is men whose semen can transmit the virus at the time of sexual intercourse. Current recommendations for preventing the sexual transmission of Zika are inadequate and need to emphasize male reproductive responsibility, via expanding services for men’s family planning and developing novel male contraceptives.
Main body
To prevent the sexual transmission of Zika, the World Health Organization recommends that couples use condoms or abstain from sexual activity for at least 6 months when traveling in Zika-infected areas. Strict adherence to these recommendations is neither practical nor adequate to address Zika’s sexual transmission. As up to 13% of couples who use condoms experience unintended pregnancy, semen and consequent viral exposure is imminent. The use of contraception beyond just barrier methods is essential. However, the burden of contraception largely falls upon women and efforts to prevent vertical transmission are often aimed at educating women, when the outcome is equally undesirable among their male partners. These short-comings highlight the lack of attention to men’s options for family planning. Educating men about the full range of contraceptive options, correcting misconceptions about the efficacy of withdrawal and barrier contraceptive methods, increasing access to vasectomy, and developing novel male contraceptive options would allow shared responsibility for the prevention of unintended pregnancy and Zika-related morbidity.
Conclusion
Gaps in recommendations to prevent the sexual transmission of Zika provide an opportunity to develop men’s family planning initiatives and the range of accessible contraceptives to men.
... Arboviral disease transmission may also increase in the weeks to months following hurricanes due to pooled flood waters providing breeding ground for mosquito and other arthropod vectors [23]. Adult mosquitos typically cannot survive the storm surge and high winds associated with hurricanes leading to reduced cases of arboviral disease immediately following the storm [24]. ...
Purpose of Review
We aim to highlight the common infectious pathogens that affect evacuees, non-evacuees, and medical responders following hurricanes in the USA, in order to help clinicians quickly diagnose and treat patients and increase medical preparedness in hurricane affected areas.
Recent Findings
Hurricanes facilitate the spread of infectious pathogens through population displacement, flooding, and trauma. Hurricane shelters create conditions that lead to the spread of infectious pathogens due to overcrowding, resource limitation, and reduced hygiene. The pathogens that tend to spread during hurricanes are often endemic to the hurricane-affected area. Patients with chronic infections, such as HIV and tuberculosis, can experience disruption in medical care during hurricanes.
Summary
The Gulf and Atlantic Coasts of the USA have experienced many devastating and costly hurricanes in recent history. Hurricanes create conditions that facilitate the spread of endemic infectious pathogens, especially among evacuees and temporary residents of emergency shelters, and can also damage public health infrastructure which can disrupt medical care in patients with chronic infections. In order to mitigate the effects of hurricanes on the spread of infectious diseases, public health workers and clinicians should implement preparedness plans that ensure patients with chronic infections have sufficient supply of their medications in the event that their care is disrupted, patients have copies of their medical records, evacuation centers are appropriately staffed and supplied, infection control protocols are implemented in evacuation centers, and emergency responders are provided with education on potential infectious exposures and have access to protective equipment to minimize the spread of infectious pathogens.
... Increased precipitation could lead to increased habitat availability due to increased soil moisture, humidity, and availability of natural ponds. Extreme flooding can lead to the destruction of vectors' habitats, through flushing of stagnant water bodies, but at the same time it can create new breeding grounds when the water recedes [116]. Lower summer rainfall in the Mediterranean could make suitable breeding sites scarce À or have the opposite effect if it leads to more open containers being used for water supply and irrigation. 1 1. 25 smaller spatial scales, it may be feasible to conduct extensive field collections of species that allow for an estimate of abundance rather than just simple presence or absence. ...
Vector-borne diseases are on the rise globally. As the consequences of climate change are becoming evident, climate-based models of disease risk are of growing importance. Here, we review the current state-of-the-art in both mechanistic and correlative disease modelling, the data driving these models, the vectors and diseases covered, and climate models applied to assess future risk. We find that modelling techniques have advanced considerably, especially in terms of using ensembles of climate models and scenarios. Effects of extreme events, precipitation regimes, and seasonality on diseases are still poorly studied. Thorough validation of models is still a challenge and is complicated by a lack of field and laboratory data. On a larger scale, the main challenges today lie in cross-disciplinary and cross-sectoral transfer of data and methods.
... Furthermore, biological topics, as vector competence of local vectors (Gardner et al., 2016), vector competence between species (Camara et al., 2016), and the timing and location of vector or virus introduction (Robert et al., 2016;Walther et al., 2017) can change the probability and magnitude of transmission. Nevertheless, the anthropogenic factors usually are the main ones that trigger actual epidemics, even through climatic extreme events (Ahmed and Memish, 2017), and so some modeling in border areas includes also travel between borders and socioeconomic factors (Monaghan et al., 2016), while drivers of non-vectorial transmission still need better epidemiological elucidation (Guzzetta et al., 2016). ...
Zika is a viral disease transmitted mainly by mosquitoes of the genus Aedes. In recent years, it has expanded geographically, changing from an endemic mosquito-borne disease across equatorial Asia and Africa, to an epidemic disease causing large outbreaks in several areas of the world. With the recent Zika virus (ZIKV) outbreaks in the Americas, the disease has become a focus of attention of public health agencies and of the international research community, especially due to an association with neurological disorders in adults and to the severe neurological and ophthalmological abnormalities found in fetuses and newborns of mothers exposed to ZIKV during pregnancy. A large number of studies have been published in the last 3 years, revealing the structure of the virus, how it is transmitted and how it affects human cells. Many different animal models have been developed, which recapitulate several features of ZIKV disease and its neurological consequences. Moreover, several vaccine candidates are now in active preclinical development, and three of them have already entered phase I clinical trials. Likewise, many different compounds targeting viral and cellular components are being tested in in vitro and in experimental animal models. This review aims to discuss the current state of this rapidly growing literature from a multidisciplinary perspective, as well as to present an overview of the public health response to Zika and of the perspectives for the prevention and treatment of this disease.
Von Stechmücken übertragene Krankheiten stellen zunehmend eine Gefahr für die Gesundheit von Mensch und Tier dar. Im Laufe der letzten Jahrzehnte haben sich kompetente Vektoren wie die Asiatische Tigermücke (Aedes albopictus) und die Asiatische Buschmücke (Aedes japonicus) global energisch ausgebreitet. Es besteht Grund zu der Annahme, dass Klimawandel-bedingt zunehmende Temperaturen diesen Trend auch in Zukunft fördern werden. Gleichzeitig wurden weltweit große Ausbrüche von Krankheiten beobachtet, die von diesen und anderen Stechmückenarten übertragen werden (beispielsweise Zika, West-Nil-Fieber und Usutu). Entlang der Mittelmeerküste kam es wiederholt zu Ausbrüchen von Dengue und Chikungunya – Krankheiten die von vielen vormals als reine Tropenkrankheiten angesehen wurden. Auch das Usutu-Virus wurde, solange es nur sporadisch in Afrika gemeldet wurde, weitestgehend ignoriert. Das änderte sich erst, als es in Europas Vogelpopulationen zu großen Usutu-Ausbrüchen kam, die in Deutschland unter dem Namen „Amselsterben“ Bekanntheit erlangten. Es besteht daher ein offenkundiger Bedarf für räumliche Abschätzungen des mit diesen Krankheiten verbundenen Risikos. In dieser Dissertation verwende ich zwei etablierte Methoden (Ecological Niche Models und ein epidemiologisches Modell) zur räumlichen Risikobeurteilung einiger durch Stechmücken übertragener Viruserkrankungen. Ich erstelle Risikokarten für Chikungunya, Usutu, und die Vektorart Ae. albopictus auf unterschiedlichen räumlichen Skalen. Ich untersuche Stärken und Schwächen der unterschiedlichen Methoden und mache Vorschläge für zukünftige Verbesserungen. Ausnahmslos alle Modelle in dieser Dissertation deuten darauf hin, dass das Auftreten von durch Stechmücken übertragenen Viruserkrankungen in weiten Teilen des jeweiligen Untersuchungsgebiets weiternehmen wird. Auf globaler Ebene wird erwartet, dass sich die Präsenz von Chikungunya auf allen Kontinenten außer der Antarktis erhöht. Ausnahmen bilden einige Gebiete in Australien und Nordindien, in denen der Klimawandel zu Bedingungen führen wird, die das Überleben von Vektoren verhindern können. Auf kontinentaler Ebene deuten zwei grundlegend unterschiedliche Modelle für Usutu darauf hin, dass große Teile Europas günstige Umweltbedingungen für die Übertragung der Krankheit bieten. Allerdings unterscheiden sich die Ergebnisse der beiden Modelle auf lokaler Ebene teils erheblich. Auf nationaler Ebene werden Klimawandel-bedingt große Teile Westdeutschlands in naher Zukunft die klimatischen Anforderungen für eine Etablierung von Ae. albopictus erfüllen. Die meisten dieser Gebiete (einschließlich derjenigen, die bereits heute sehr gut geeignet sind) wiesen in der Vergangenheit auch erhöhte Inzidenzraten für reisebedingte Dengue- und Chikungunya-Infektionen auf, was auf ein erhöhtes Risiko für die Übertragung von Viren hinweist. Risikokarten sind ein wichtiges Instrument, das von Feldentomologen und Epidemiologen zur gezielteren Überwachung (sowohl surveillance als auch monitoring) verwendet werden kann. Und sie können dazu beitragen, Politikern und Entscheidungsträgern wichtige Informationen zu übermitteln, um den Aufbau der für diese Bemühungen erforderlichen Infrastruktur zu erleichtern. Sowohl epidemiologische Modelle als auch Ecological Niche Models leiden unter einem Mangel an wesentlichen Daten. Für epidemiologische Modelle fehlen für viele Krankheiten Laborstudien und Felddaten zu den zugrundeliegenden Übertragungsmechanismen. Dies wird in dieser Arbeit am Beispiel der extrinsischen Inkubationsperiode (EIP) von Dengue demonstriert. Es ist seit langem bekannt, dass die Dauer der EIP innerhalb des Mückenvektors stark von der Umgebungstemperatur abhängt. Unter den wenigen experimentellen Arbeiten, die diese Beziehung untersuchen, basieren einige auf fehlerhaften Methoden oder sind anderweitig stark veraltet. Der Bedarf an Grundlagenforschung in diesem Bereich ist hoch, da bei vielen weniger untersuchten Krankheiten (wie z.B. Usutu) noch viel erheblichere Wissenslücken bestehen. Ein Hauptproblem von Ecological Niche Models ist die Verfügbarkeit hochwertiger Aufzeichnungen über das Auftreten von Vektoren und Krankheiten. Die internationalen und interdisziplinären Bemühungen um ein zentrales, offenes Datenarchiv müssen intensiviert werden. Das zentralisierte Klimadatenarchiv der Earth System Grid Foundation (ESGF, https://esgf.llnl.gov) und die Datenbank für Vorkommensdaten von Arten in der Global Biodiversity Information Facility (GBIF, http://www.gbif.org) könnte als Inspiration dafür dienen. Die Übertragbarkeit von Modellergebnissen über verschiedene Klimazonen hinweg ist ein weiteres Problem, das weitere Untersuchungen erfordert. Letztendlich bieten unterschiedliche Modelle unterschiedliche Vor- und Nachteile, und unterschiedliche Fragen erfordern unterschiedliche Lösungsansätze. Ecological Niche Models erfordern nur ein begrenztes a-priori Wissen über die Umweltparameter, die die räumliche Verbreitung einer Art bestimmen. Selbst mit einer relativ geringen Anzahl von Vorkommensdaten können insbesondere sie für eine schnelle, räumlich grob aufgelöste Risikobewertung sehr nützlich sein. Epidemiologische Modelle bauen auf einem viel stärker theoretisch geprägten Hintergrund auf. Eine adäquate Parametrisierung vorausgesetzt, können sie wertvolle Informationen auf feinen räumlich-zeitlichen Skalen beitragen. Während Ecological Niche Models von Grund auf für räumliche Anwendungen gedacht sind, birgt die Anpassung epidemiologischer Modelle für die Erstellung räumlicher Risikokarten einige ungelöste Hürden, die das Objekt zukünftiger Arbeiten sein werden.
Every year, the Student Debates Subcommittee (SDS) of the Student Affairs Committee (SAC) for the annual Entomological Society of America (ESA) meeting organizes the Student Debates. This year, the SAC selected topics based on their synergistic effect or ability to ignite exponential positive change when addressed as a whole. For the 2019 Student Debates, the SAC SDS identified these topic areas for teams to debate and unbiased introduction speakers to address: 1) how to better communicate science to engage the public, particularly in the area of integrated pest management (IPM), 2) the influential impacts of climate change on agriculturally and medically relevant insect pests, and 3) sustainable agriculture techniques that promote the use of IPM to promote food security. Three unbiased introduction speakers gave a foundation for our audience to understand each debate topic, while each of six debate teams provided a strong case to support their stance or perspective on a topic. Debate teams submitted for a competitive spot for the annual ESA Student Debates and trained for the better part of a year to showcase their talents in presenting logical arguments for a particular topic. Both the debate teams and unbiased introduction speakers provided their insight toward a better understanding of the complexities of each topic and established a foundation to delve further into the topics of science advocacy and communication, climate change, and the many facets of integrated pest management.
World Health Organization (WHO), Centers for Disease Control (CDC), Florida Department of Health, News and Feature Articles, Pathology, Vaccine R&D (Companies Developing Vaccines), Diagnostics, Clinical Research, Mosquito Vectors, Peer Reviewed Literature (General Reviews and Clinical Discussion, Epidemiology / Transmission, Pathology, Immunology and Animal Models, Virology / Genomics / Structural Biology, Medical Countermeasures and Diagnostics)
During the first 6 months of 2016, large outbreaks of Zika virus disease caused by local mosquito-borne transmission occurred in Puerto Rico and other U.S. territories, but local mosquito-borne transmission was not identified in the continental United States (1,2). As of July 22, 2016, the Florida Department of Health had identified 321 Zika virus disease cases among Florida residents and visitors, all occurring in either travelers from other countries or territories with ongoing Zika virus transmission or sexual contacts of recent travelers.* During standard case investigation of persons with compatible illness and laboratory evidence of recent Zika virus infection (i.e., a specimen positive by real-time reverse transcription-polymerase chain reaction [rRT-PCR], or positive Zika immunoglobulin M [IgM] with supporting dengue serology [negative for dengue IgM antibodies and positive for dengue IgG antibodies], or confirmation of Zika virus neutralizing antibodies by plaque reduction neutralization testing [PRNT]) (3), four persons were identified in Broward and Miami-Dade counties whose infections were attributed to likely local mosquito-borne transmission. Two of these persons worked within 120 meters (131 yards) of each other but had no other epidemiologic connections, suggesting the possibility of a local community-based outbreak. Further epidemiologic and laboratory investigations of the worksites and surrounding neighborhood identified a total of 29 persons with laboratory evidence of recent Zika virus infection and likely exposure during late June to early August, most within an approximate 6-block area. In response to limited impact on the population of Aedes aegypti mosquito vectors from initial ground-based mosquito control efforts, aerial ultralow volume spraying with the organophosphate insecticide naled was applied over a 10 square-mile area beginning in early August and alternated with aerial larviciding with Bacillus thuringiensis subspecies israelensis (Bti), a group biologic control agent, in a central 2 square-mile area. No additional cases were identified after implementation of this mosquito control strategy. No increases in emergency department (ED) patient visits associated with aerial spraying were reported, including visits for asthma, reactive airway disease, wheezing, shortness of breath, nausea, vomiting, or diarrhea. Local and state health departments serving communities where Ae. aegypti, the primary vector of Zika virus, is found should continue to actively monitor for local transmission of the virus.(†).
The impacts of climate change on human health have been documented globally and in the United States. Numerous studies project greater morbidity and mortality as a result of extreme weather events and other climate-sensitive hazards. Public health impacts on the U.S. Gulf Coast may be severe as the region is expected to experience increases in extreme temperatures, sea level rise, and possibly fewer but more intense hurricanes. Through myriad pathways, climate change is likely to make the Gulf Coast less hospitable and more dangerous for its residents, and may prompt substantial migration from and into the region. Public health impacts may be further exacerbated by the concentration of people and infrastructure, as well as the region's coastal geography. Vulnerable populations, including the very young, elderly, and socioeconomically disadvantaged may face particularly high threats to their health and well-being. This paper provides an overview of potential public health impacts of climate variability and change on the Gulf Coast, with a focus on the region's unique vulnerabilities, and outlines recommendations for improving the region's ability to minimize the impacts of climate-sensitive hazards. Public health adaptation aimed at improving individual, public health system, and infrastructure resilience is urgently needed to meet the challenges climate change may pose to the Gulf Coast in the coming decades.
We briefly describe 2 systems that provided disaster-related mortality surveillance during and after Hurricane Sandy in New York City, namely, the New York City Health Department Electronic Death Registration System (EDRS) and the American Red Cross paper-based tracking system.
Red Cross fatality data were linked with New York City EDRS records by using decedent name and date of birth. We analyzed cases identified by both systems for completeness and agreement across selected variables and the time interval between death and reporting in the system.
Red Cross captured 93% (41/44) of all Sandy-related deaths; the completeness and quality varied by item, and timeliness was difficult to determine. The circumstances leading to death captured by Red Cross were particularly useful for identifying reasons individuals stayed in evacuation zones. EDRS variables were nearly 100% complete, and the median interval between date of death and reporting was 6 days (range: 0-43 days).
Our findings indicate that a number of steps have the potential to improve disaster-related mortality surveillance, including updating Red Cross surveillance forms and electronic databases to enhance timeliness assessments, greater collaboration across agencies to share and use data for public health preparedness, and continued expansion of electronic death registration systems. (Disaster Med Public Health Preparedness. 2014;8:489-491).
Natural disasters such as hurricanes may contribute to mosquito abundance and, consequently, arbovirus transmission risk. In 2011, flooding from Hurricane Irene in eastern North Carolina (NC) resulted in increased mosquito populations that hindered recovery efforts. Budget shortfalls in NC have reduced the functionality of long-term mosquito surveillance and control programs; hence, many counties rely on the Federal Emergency Management Agency for post-disaster mosquito control. This pilot study examines mosquito abundance pre- and post-aerial insecticide spraying at eight study sites in Washington and Tyrrell Counties in rural eastern NC after Hurricane Irene. Percent change was calculated and compared for traps in areas that received aerial pesticide application and those that did not. Traps in spray zones show decreases in mosquito abundance when compared to control traps (treatment: -52.93%; control: 3.55%), although no significant differences (P = 0.286) were found in mosquito abundance between groups. Implications of reactive rather than proactive mosquito control responses are discussed.
Tropical cyclone damage potential, as currently defined by the Saffir-Simpson scale and the maximum sustained surface wind speed in the storm, fails to consider the area impact of winds likely to force surge and waves or cause particular levels of damage. Integrated kinetic energy represents a framework that captures the physical process of ocean surface stress forcing waves and surge while also taking into account structural wind loading and the spatial coverage of the wind. Integrated kinetic energy was computed from gridded, objectively analyzed surface wind fields of 23 hurricanes representing large and small storms. A wind destructive potential rating was constructed by weighting wind speed threshold contributions to the integrated kinetic energy, based on observed damage in Hurricanes Andrew, Hugo, and Opal. A combined storm surge and wave destructive potential rating was assigned according to the integrated kinetic energy contributed by winds greater than tropical storm force. The ratings are based on the familiar 1-5 range, with continuous fits to allow for storms as weak as 0.1 or as strong as 5.99.
The future health costs associated with predicted climate change-related events such as hurricanes, heat waves, and floods are projected to be enormous. This article estimates the health costs associated with six climate change-related events that struck the United States between 2000 and 2009. The six case studies came from categories of climate change-related events projected to worsen with continued global warming-ozone pollution, heat waves, hurricanes, infectious disease outbreaks, river flooding, and wildfires. We estimate that the health costs exceeded $14 billion, with 95 percent due to the value of lives lost prematurely. Actual health care costs were an estimated $740 million. This reflects more than 760,000 encounters with the health care system. Our analysis provides scientists and policy makers with a methodology to use in estimating future health costs related to climate change and highlights the growing need for public health preparedness.
Health risk assessment is important in the safe deployment of workers to tropical areas. We monitored dengue incidence in 204 of 222 North American relief workers visiting Puerto Rico after Hurricane Georges and during a dengue epidemic in 1998. We recorded information regarding participants' living conditions and any illness they experienced from arrival to 2 weeks after their departure. Virus isolation, polymerase chain reaction, and serological tests for anti-dengue immunoglobulin (Ig) M and IgG antibodies were used to diagnose dengue infection by means of departure and follow-up serum specimens. Among respondents, 82% (164 of 199) reported mosquito bites, 97% (156 of 161) reported having insect repellent available, and 41% (79 of 195) reported using repellent every day. Twelve participants reported a mild denguelike illness. No participants had laboratory evidence of dengue infection after 1.8 person-years of assessable exposure to areas with dengue transmission (upper 95% confidence limit of 1.67 cases per person-year). The risk of acquiring dengue among relief workers in this study appears low, possibly as a result of protective factors. Travelers to dengue-endemic areas should continue to be advised to protect themselves against mosquito bites.
After Hurricane Katrina, the number of reported cases of West Nile neuroinvasive disease (WNND) sharply increased in the hurricane-affected regions of Louisiana and Mississippi. In 2006, a >2-fold increase in WNND incidence was observed in the hurricane-affected areas than in previous years.
Various types of Ag plating technology along with the advantages and limitations of each plating approach are discussed. Potential issues with Ag as a packaging metallization, and some of the steps that need to be taken to mitigate risks, are also reviewed. The replacement of Au is driven by two clear advantages of Ag for the HBLED application: much lower material cost and higher reflectivity in the visible spectrum. Other advantages of Ag include higher electrical conductivity, higher thermal conductivity and no tendency to work-harden under repeated mechanical stress. There are two broad categories of plating technology: electrolytic and electroless plating. For electrolytic plating, the metal surface to be plated is biased as the cathode in an electrochemical cell which contains dissolved metal ions. The limitation of immersion plating is that the process stops or slows dramatically once the pad surface is covered with the depositing metal since corrosion of the underlying pad material can no longer occur.
Background: In the last decades, there have been several natural disasters and global catastrophies with a steady increase in humanitarian relief work. This has resulted in increased research in the field of humanitarian aid, however the focus is mostly on the victims of the disasters and not on the individuals and organisations providing aid. Objectives: The intent of this research is to review the information available on pre-deployment interventions and recommendations such as vaccinations and other health preserving measures in volunteers and professionals deploying abroad in humanitarian relief missions. Methods: We performed a systematic literature review of papers written in English, French, Italian or German. We searched the following databases: Cochrane, PubMed, CINAHL, EMBASE and also hand searched reference lists. The cut-off date for the publication search was November 20th, 2014. In addition to the literature search we also sent a questionnaire to 30 organisations to detail their approach to preparing relief workers. Results: We identified 163 papers of possible relevance and finally included 35 papers in the systematic review. Six organisations provided information on pre-deployment preparation of aid workers. Identified papers show that pre-deployment physical and mental fitness are paramount for success in humanitarian missions. However, in many settings, pre-travel medical and psychological assessments and/or training/education sessions are not mandatory. We identified high-risk hazards for aid workers (often location specific), these included: travellers' diarrhoea, vector-borne infections, accidents, violence, tuberculosis, HIV, hepatitis A, leptospirosis, typhoid fever, seasonal and H1N1 influenza. Conclusions: The medical evaluation can identify problems or risk factors, such as psychological frailty, that can be exacerbated by the stressful settings of humanitarian missions. In this pre-travel setting, the status of routine vaccinations can be controlled and completed, medication dispensed and targeted preventive advice provided. A mission specific first-aid kit can be recommended. There is a lack of evidence-based literature on the theme of pre-travel advice guidelines for humanitarian workers. We propose a shared database of literature on this topic as a resource and suggest that some standardization of guidelines would be useful for future planning.
Dengue is a mosquito-borne viral disease that has evolved from a sporadic infection to a major public health
problem in the Americas, Southeast Asia and thewestern Pacific, and Africa [1–4]. Its incidence has increased 30-fold over the past 50 years, and although the true disease burden is not well known, the annual incidence in some areas of the Americas may reach 5%–10% of all children when underreporting is considered [1].We recently analyzed the disease burden of dengue in Venezuela, and we found an overall decline in case numbers and mortality over the period of 1950–2011 [5].However, there were increases in case number and mortality during epidemic years, especially among children [5]. In this report, we focus on the most recent period of data, from 2000 to 2011, comparing pediatric and adult case numbers and mortality.
The effects of Hurricane Katrina have caused the long-term sequelae of a diminished patient base, of a reduced number of available health care professionals, and of closing hospitals in New Orleans, Louisiana. These changes have substantially impacted the academic infrastructure of New Orleans. This article outlines the post-Katrina response of the Louisiana State University Health Science Center (LSUHSC) Infectious Diseases Section and Health Care Services Division to maintain existing HIV and infectious diseases programs. Although several challenges delayed the immediate reopening of the New Orleans location of the HIV Outpatient Program clinic, the LSUHSC Infectious Diseases Section and Health Care Services Division established clinics outside New Orleans for the care of HOP patients immediately following the hurricane. The HOP clinic reopened in New Orleans ( in a temporary location) in early November 2005. Several recommendations for academic clinical, training, and research programs are outlined, to assist other centers that might face disaster aftermath challenges.
Deaths Associated with Hurricane Sandy OctoberNovember 2012 Noe R, Murti M, Casey-Lockyer M, Mertzlufft C, Heick R, Yard E, Wolkin A
On October 29, 2012, Hurricane Sandy hit the northeastern U.S. coastline. Based on storm surge predictions, mandatory evacuations were ordered on October 28, including for New York City's Evacuation Zone A, the coastal zone at risk for flooding from any hurricane. By October 31, the region had 612 inches of precipitation, 78 million customers without power, approximately 20,000 persons in shelters, and news reports of numerous fatalities. To characterize deaths related to Sandy, CDC analyzed data on 117 hurricane-related deaths captured by American Red Cross (Red Cross) mortality tracking during October 28November 30, 2012. This session will describe the results of Centers for Disease Control and Prevention (CDC) analysis, which found drowning to be the most common cause of death related to Sandy, with 45% of drowning deaths occurred in flooded homes in Evacuation Zone A.
Information on the Sandy-related deaths captured by Red Cross included the decedent's age, sex, race (white, black, Asian, other, or unknown), and date and location of death. Disaster-related deaths were categorized as direct or indirect. Directly related deaths are deaths caused by the environmental force of the disaster (e.g., wind or flood) or by the direct consequences of these forces (e.g., structural collapse). Indirectly related deaths are defined as deaths occurring in a situation in which the disaster led to unsafe conditions (e.g., hazardous roads) or caused a loss or disruption of usual services that contributed to the death (e.g., loss of electrical services). The characteristics of drowning deaths were compared with all deaths using chi-square tests of trend and t-tests. Home addresses of decedents whose drowning death occurred in the home were examined with respect to FEMA's hurricane storm surge area (field-verified as of November 11, 2012) and known, geographically defined areas under evacuation order (i.e., New York City's Evacuation Zone A).
A total of 117 deaths was reported by Red Cross occurring during October 28-November 29, 2012. The source of information for the mortality forms was a medical examiner/coroner for 94 (80.3%) cases and the family of the decedent for 10 (8.5%) cases. Most deaths occurred in New York (53 [45.3%]) and New Jersey (34 [29.1%]); the other deaths occurred in Pennsylvania, West Virginia, Connecticut, and Maryland.
Decedents ranged in age from 1 to 94 years (mean: 60 years, median: 65 years); 60.7% were male, and 53.8% were white. Of the 117 deaths, 67 (57.3%) were classified as directly related deaths, and 38 (32.5%) were indirectly related to the storm. Of the directly related deaths, the most common mechanism was drowning (40 [59.7%]), followed by trauma from being crushed, cut, or struck (19 [28.4%]). Poisoning was the most common indirectly related cause of death; of the 10 poisonings, nine were caused by carbon monoxide. Comparing the 40 drowning deaths to all Sandy-related deaths, the age, sex, and race distributions of decedents were similar. The majority of drowning deaths (29 [72.5%]) also occurred in the initial phase of the storm, during October 2931. Twenty-one (52.5%) drowning deaths occurred in the decedent's home, and 11 (27.5%) occurred outside; one person drowned in a flooded commercial building lobby, and another person drowned while intentionally swimming off a storm-affected beach. The location of drowning deaths by state was significantly different (p<0.05) compared with all Sandy-related deaths. The majority of drowning deaths (32 [80.0%]) occurred in New York, whereas deaths in New York accounted for only 27.3% of nondrowning deaths. Twenty decedents drowned in flooded homes in New York, and home addresses for 18 (90.0%) of them were located in Evacuation Zone A; the other two decedents' homes were in or near areas of flooding and near Evacuation Zone A. Notes written by Red Cross volunteers on these 20 deaths captured decedents' reasons for not evacuating, such as "afraid of looters," "thought Hurricane Irene was mild," and "unable to leave because did not have transportation."
Drowning is a leading cause of hurricane death but is preventable with advance warning systems and evacuation plans. Emergency plans should ensure that persons receive and comprehend evacuation messages and have the necessary resources to comply with them.
Natural disasters, such as the recent Indian Ocean tsunami, can have a rapid onset, broad impact, and produce many factors that work synergistically to increase the risk of morbidity and mortality caused by communicable diseases. The primary goal of emergency health interventions is to prevent epidemics and improve deteriorating health conditions among the population affected. Morbidity and mortality due to infectious diseases can be minimized providing these intervention efforts are implemented in a timely and coordinated fashion. This article presents a review of some of the major issues relevant to preparedness and response for natural disasters.
The present review will focus on some of the possible infectious disease consequences of disastrous natural phenomena and severe weather, with a particular emphasis on infections associated with floods and the destruction of infrastructure.
The risk of infectious diseases after weather or flood-related natural disasters is often specific to the event itself and is dependent on a number of factors, including the endemicity of specific pathogens in the affected region before the disaster, the type of disaster itself, the impact of the disaster on water and sanitation systems, the availability of shelter, the congregating of displaced persons, the functionality of the surviving public health infrastructure, the availability of healthcare services, and the rapidity, extent, and sustainability of the response after the disaster. Weather events and floods may also impact disease vectors and animal hosts in a complex system.
Weather or flood-related natural disasters may be associated with an increased risk of soft tissue, respiratory, diarrheal, and vector-borne infectious diseases among survivors and responders.
Infectious diseases of severe weather relayed and flood related natural disasters
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