Developing an International Standard for Disaster Epidemiology

In the aftermath of Hurricane Katrina, the Northern Armenian earthquake and the Indian Ocean Tsunami, regular epidemiologists stood by to help the cause, to save lives and prevent disability. Disaster epidemiology is a reactive school of public health in which only past experience, education and present colleagues serve as your guide and textbook for decision-making (Armenian, 2009). Disaster epidemiology is the often-unplanned application of epidemiological principles to the aftermath of natural disasters and war. Because disaster epidemiologists are traditionally recruited by the chance of their mere presence in ground zero, there are very few full time professional disaster epidemiologists.

Epidemiology provides as framework for effectively dealing with the resulting damages created by natural disasters. This framework includes the development of surveillance systems, which are intended to keep track of diseases incidence, deaths and general health data in the wake of disasters (Armenian, 2009). An additional part of this framework is the development of disease control strategies in response to health issues resulting from the event (Armenian). Assessment is a major epidemiological method that is used in disasters to determine the efficacy of health services administered throughout the event’s aftermath (Armenian). To determine the root of diseases and disasters, research on the etiologic causes should be conducted in an epidemiological review (Armenian). Finally, epidemiology serves as a valuable tool in the wake disasters as surveillance and investigation systems are developed for the long-term usage (Armenian).

An interesting event to look at within the framework of disaster epidemiology is the Indian Ocean Tsunami of 2004. The Indian Ocean Tsunami was considered one of the worst disasters ever to occur. The tsunami was created by a massive earthquake with energy the equivalent of 23,000 Hiroshima-type atomic bombs according to the US Geological Survey (National Geographic News, 2005).

Because these events, like infection, can lead to specific diseases and health conditions, systems for managing events must be designed in the interest of prevention and control. Due to the sudden nature of disasters, it is essential to collect initial data in order to better inform actions that can potentially head off disability and decrease the rate of mortality (Armenian, 2009). One of the early issues officials discovered in the wreckage of the tsunami was the hesitancy with which victims would speak to public health representatives (The International Labour Organization, 2005). Because of a fear of distressing victims, officials decided to refrain from asking them questions about the event, psychological data was not collected (Miller, 2005). The International Labour Organization replaced the representatives with young volunteers whose demeanor was received as relaxed and approachable by victims. These volunteers were then able to collect data through questionnaires to establish a baseline of prior economic and health status.

This ability to accommodate the delicate, and often-varied states of victims is essential in tailoring emergency response. This is because one of the results of living through a disaster can include resulting psychological. This psychological damage can result from forced isolation, personal injury, or the injury and death of others. To assess the psychological impact of the tsunami, mobile clinics administered mental health surveys, antidepressant and anti-anxiety medications throughout affected regions (Miller, 2005).

One of the differences between the psychological damage inflicted in this disaster, versus those that occurred in previous times is the use of the Internet. Immediately after the tsunami, many survivors used the Internet to communicate with friends and family. In addition, many of the survivors of the tsunami turned to the use of blogs where they dealt with the psychological stress created by the disaster (Handwerk, 2005). Blogs also serves as a massive source of news as eyewitnesses, known as “citizen journalists” were able to publish their own stories. The psychological benefits gained by producing these blogs resulted in enhanced feelings of camaraderie, social support as victims disclosed fears and shared experiences. Not only did these blogs provide a forum for psychological support and growth, but also they became a proper, up to date news source for the victims and their families.

The development of emergency monitoring systems and public health decision-making processes are some of the only ways to prepare for the unexpected. These systems can be designed based on experience from disasters elsewhere or relevant disasters that happened locally in the past (Armenian, 2009). One of the faults of this method is if the interval between disastrous events is too long or a natural disaster had never occurred in that region before. Lack of prior experience, resulting from lengthy disaster intervals or the absence of previous events, make it difficult to prepare a community for the potential occurrence of a disaster and even more difficult to prepare an action plan (Armenian).

An example of extreme intervals between events can be seen in the history of earthquakes in Armenia (Armenian, 2009). The first recorded earthquake was the destruction of Moz in which 10,000 died in the year 735 (Armenian). Over the next century, there were 7 more earthquakes throughout the country that resulted in the destruction of thousands of houses and villages. The most recent earthquakes occurred in 1859 and 1924 before the major earthquake in 1988. The length of these intervals gives evidence to the difficulty of learning from previous local events.

Because of the intrinsically unexpected nature of disasters, there should be a global approach to disaster management. This approach could be manifested as a global treaty designed in the image of the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC). Like the WHO FCTC, the evidence-based treaty could legally bind contracting countries to employ and tailor relevant disaster management systems. The treaty, entitled the World Health Organization’s Framework Convention on Disaster Management, could include a variety of pre-approved, effective surveillance, evaluation and disease control strategies and methods that could be applied in a matter of hours.

Disaster preparedness should be a necessary governmental practice internationally. Rather than accepting the haphazard approach to disaster control and disaster epidemiology, local governments should institute teams of academics who serve as specialized disaster epidemiologists and disaster management experts consistently on call in the event of an emergency. This conceptual system is reminiscent of the Southern California Earthquake Center whose central office is located beneath Los Angeles City Hall and remains in service 24 hours a day (Southern California Disaster Center, 2009).

Disaster management is a method of dealing with the unexpected that is frequently unorganized and slapdash. The institution of formal disaster management methodology will normalize disaster counteraction and enhance the efficacy of first and last responders.

References

Armenian, H. (2009). "Epidemiology in War and Disasters."

Handwerk, B. (2005 January 28). Tsunami blogs help redefine news and relief
effort. National Geographic News Retrieved March 3, 2009 from
http://news.nationalgeographic.com/news/2005/01/0126_0
50126_tv_tsunami_blogs.html.

Miller, G. (2005). The tsunami’s psychological aftermath. Science, 309(5737),
1030-4.

National Geographic News. (2005 January 7). The deadliest tsunami in history?
National Geographic News. Retrieved March 3 2009 from
http://news.nationalgeographic.com/news/2004/12/1227_041226_tsunami.html.

Southern California Earthquake Center. (2009). Major products and publications.
Southern California Earthquake Center. Retrieved March 28, 2009 from
http://www.scec.org/.

The International Labour Organization. (2005 March 23). After the
tsunami rebuilding lives: A first step to rebuilding a
community. The International Labour Organization. Retrieved
March 7, 2009 from http://www.ilo.org/global/About_the_ILO/Media
_and_public_information/Feature_stories/lang--en/WCMS_075556/index.htm.

Prioritizing the crowded Global Health Agenda

Prioritizing the crowded Global Health Agenda

The subject of the following paragraphs is the prioritizing the crowded global health agenda. I am going to use the nature of “blogging”, which is to share the most relevant information, to discuss the urgent priority of the current global health agenda, the Swine Flu.

First, it seems that not everyone around the world is happy with the name. Pork producers question whether the term “swine flu” is appropriate, given that the new virus has not yet been isolated in samples taken from pigs in Mexico or elsewhere. While the new virus seems to be most heavily composed of genetic sequences from swine influenza virus material, it also has human and avian influenza genetic sequences as well, according to the CDC. Some officials around the world have already started naming the virus by its so-called place of origin. Government officials in Thailand, one of the world’s largest meat exporters, have started referring to the disease as “Mexican flu.” An Israeli deputy health minister, an ultra-Orthodox Jew, said his country would do the same, to keep Jews from having to say the word “swine.” But it seems that hopefully the WHO will have the final say on this. On the 25^th of April, the organization issued a statement suggesting that the virus should be called the “North America Influenza”. It seems that there is a medical tradition of naming influenza pandemics for the regions where they were first identified. This has included the Spanish flu of 1918 to 1919, the Asian flu of 1957 to 1958 and the Hong Kong flu of 1967 to 1968. The debate is likely to continue as scientists and health authorities try to trace the disease. While all signs now point to Mexico as the epicenter, the genetic material in the virus there includes part of a swine influenza virus of Eurasian origin. And influenza viruses tend to emerge from Asia. Many medical historians believe that the Asian and Hong Kong flus started in southeastern China near Hong Kong, where very high densities of people live in close proximity to hogs and chickens in rural areas and can share their viruses. Some historians also suggest that the Spanish flu also started in southeastern China. Those who are trying to relate the virus origin to the southeast Asia have come up with some evidence as well. For instance, Millions of pigs died in China two years ago in an epidemic so severe that it pushed pork prices up 90 percent. Veterinarians attributed the deaths at the time mainly to blue-ear disease, which does not affect humans, but also to swine flu. The Chinese government did not issue a public report assessing the outbreak and provided very few details to international organizations.

But whatever the virus is called and wherever it has been originated from, people must know what they are dealing with. Swine influenza is originally referred to influenza caused by any strain of influenza virus endemic in pigs. Strains endemic in swine are called Swine Influenza Virus (SIV). Of the three human influenza viruses, two are endemic in swine as well; type A is very common, type C is rare, and type B has not been reported in Swine. Before the 2009 flu outbreak in humans, swine flu was very rare among humans, and those who are very closely exposed to pigs, such as the pig farm workers, used to be the only group at risk. The original virus is non-lethal, and not transmittable from human to human either. The symptoms of the swine flu in humans are similar to those of influenza, or influenza-like illness, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness, and general discomfort. The 2009 flu outbreak in humans that is widely known as "swine flu" apparently is not due to a swine influenza virus. It is due to a new strain of influenza A subtype H1N1 that is derived from one strain of human influenza virus, one strain of avian influenza virus, and two separate strains of swine influenza viruses. The origins of this new strain are unknown, and the World Organization for Animal Health reports that this strain has not been isolated in swine. Unlike the original strain, it passes with apparent ease from human to human, an ability attributed to an as-yet unidentified mutation.

It is interesting to know that the common human H1N1 influenza virus affects millions of people every year. In yearly influenza epidemics 5-15% of the world population are affected with upper respiratory tract infections. This results 250000-500000 deaths around the world. However, most certainly, this flu epidemic started after the flu season, and is on the verge of becoming a worldwide pandemic. The outbreak is believed to have started in March. Local outbreaks of an influenza-like illness were first detected in three areas of Mexico, but the virus responsible was not clinically identified as a new strain until April 24^th. Following the identification, its presence was soon confirmed in various Mexican states and in Mexico City. Within days, isolated cases were identified elsewhere in Mexico, the U.S and several other northern hemisphere countries. By April 28^th, the new strain was confirmed to have spread to Spain, the UK, New Zealand, and Israel, and the virus was suspected in many other nations, with a total of over 3000 candidate cases, with 152 attributed deaths. As of now, there are 14 cases identified in California.

On April 27^th, the WHO raised their alertness level from 3 to 4 (on a scale of 6) worldwide in response to sustained human-to-human transfer of the virus. The situation was raised to level 5 on April 29^th. Here is a quick look at the WHO’s pandemic alert phases. Phase 1: A virus in animals has caused no known infections in humans. Phase 2: An animal flu virus has caused infection in humans. Phase 3: Sporadic cases or small clusters of disease occur in humans. Human-to-human transmission, if any, is insufficient to cause community-level outbreaks. Phase 4: The risk for a pandemic is greatly increased but not certain. The disease-causing virus is able to cause community-level outbreaks. Phase 5: Still not a pandemic, but spread of disease between humans is occurring in more than one country of one WHO region. Phase 6: This is the pandemic level. Community-level outbreaks are in at least one additional country in a different WHO region from phase 5.

Despite the scale of the alert, the WHO stated on April 29^th that the majority of people infected with the virus have made a full recovery without need of medical attention or antiviral drugs. But there are ways both to prevent and to treat the disease. The CDC reports that the swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. In addition, the Federal Government and manufacturers have begun the process of developing a vaccine against this new virus. As far as prevention, the CDC suggests that Personal hygiene measures, such as avoiding people who are coughing or sneezing and frequent hand-washing, may prevent flu infection. Those who aren’t health professionals should avoid contact with sick people. People who get sick with flu symptoms should stay home. Studies have suggested that closing schools, theaters, and canceling gatherings in the early stages of a pandemic can limit its spread. Such measures would likely take place if health officials determine that the virus is spreading quickly enough and is deadly enough to cause a pandemic.

 

Resources

http://www.cdc.gov/h1n1flu/index.htm

http://www.nytimes.com/2009/04/29/world/asia/29swine.html?_r=1&scp=6&sq=swine%20flu&st=cse

http://www.bloomberg.com/apps/news?pid=20601087&sid=aLdy2aZer5fM&refer=home

http://www.nytimes.com/2009/04/27/world/27flu.html?scp=16&sq=swine%20flu&st=cse

http://www.webmd.com/cold-and-flu/news/20090429/swine-flu-one-step-closer-to-pandemic?ecd=wnl_nal_042909

http://www.nytimes.com/2009/04/29/opinion/l29flu.html?scp=12&sq=swine%20flu&st=cse