Public Health Implications of Emergencies and Disasters Open Access

Abstract

Background: The last ten years have seen an unprecedented rise in the number of persons displaced from their home due to conflict or natural disasters. Loss of infrastructure and large population displacements often lead to environmental conditions ripe for infectious disease outbreaks. While it is widely acknowledged that infectious disease epidemics play a major role in morbidity and mortality in complex emergencies and natural disasters, there has been limited published literature comprehensively examining this relationship.

Methods: Events were collected for the years 2005-2014. Complex emergencies (CE) were identified using the Center for Research on the Epidemiology of Disasters (CRED) Complex Emergency Database and United Nations (UN) Flash and Consolidated Appeals archive. Natural disasters (ND) were identified using the CRED International Disaster Database and UN Flash and Consolidated Appeal archive. Infectious disease outbreaks were identified from the World Health Organization (WHO) outbreak archive. Individual databases were created for each type of event then compared for overlap. Descriptive and inferential statistics were performed.

Results: There were 169 unique complex emergencies, 913 natural disasters, 118 events linked to both complex emergency and natural disaster, and 384 outbreaks were identified for the specified years. 43% of CEs were linked to outbreaks, 24% of NDs were linked to outbreaks, and 36% of 'both' events were linked to outbreaks. The OR of a vaccine-preventable outbreak occurring in a CE setting versus an ND setting was 6.66.

Conclusions: Outbreaks were more likely to be linked to a CE event and more likely to occur in developing countries. When an outbreak was associated with a CE, it was much more likely to be a vaccine preventable disease. Focus on better vaccine coverage in developing countries could reduce the morbidity and mortality associated with CEs when they do occur.

Table of Contents

1. Introduction. 1

Background. 2

1.2 Literature Review. 4

1.3 Research Objectives. 4

2. Methods. 5

2.1 Complex Emergencies. 5

2.2 Natural Disasters. 7

2.3 Infectious Disease Outbreaks. 8

2.4 Data Organization and Statistics. 9

3. Results. 10

3.1 Complex Emergencies. 10

3.2 Natural Disasters. 13

3.3 Both. 14

3.4 Infectious Disease Outbreaks. 15

3.5 CEs, NDs, and Outbreaks. 17

4. Limitations. 19

5. Discussion. 21

Appendix 1: Tables. 28

Table 1. Populations affected by Complex Emergencies. 28

Table 2. Ten most affected countries from Complex Emergencies by number affected, 2005-2014. 28

Table 3. Ten most affected countries from Natural Disasters by number affected, 2005-2014. 28

Table 4. Ten most affected countries from Concurrent CE and ND by number affected, 2005-2014.29

Table 5. Ten most affected countries from Outbreak by numbers infected, 2005-2014. 29

Table 6. Ten most affected countries from Outbreak by highest case fatality rates, 2005-2014. 29

Table 7. Ten most affected countries from outbreak by case fatality rates, excluding H1N1, 2005-2014. 30

Table 8. Ten most affected countries from outbreak by case fatality rates in cases affecting 100 or greater persons. 30

Table 9. Ten most affected countries from Cholera by case numbers, 2005-2014. 30

Table 10. Ten most affected countries from cholera by case fatality rates, 2005-2014.31

Table 11. Ten most affected countries from measles by case numbers, 2005-2014. 31

Table 12. Two most affected countries from cholera by case fatality rates, 2005-2014. 31

Table 13. Ten most affected countries from meningococcal disease by case numbers, 2005-2014. 32

Table 14. Ten most affected countries from meningococcal disease by case fatality rates, 2005-2014. 32

Table 15. Ten most affected countries from poliomyelitis by case numbers, 2005-2014. 32

Table 16. Ten most affected countries from poliomyelitis by case fatality rates, 2005-2014. 33

Table 17. Ten most affected countries from poliomyelitis by case numbers, 2005-2014. 33

Table 18. Ten most affected countries from yellow fever by case fatality rates, 2005-2014.. 33

Table 19. Odds Statistics (H1N1 included). 34

Table 20. Odds Statistics (H1N1 excluded). 34

Appendix 2: Figures. 35

Figure 1. CE process diagram.. 35

Figure 2. CE regional distribution (n=169). 36

Figure 3. ND process diagram. 36

Figure 4. Natural Disasters regional distribution (n=913). 37

Figure 5. Natural Disasters by type and year. 37

Figure 6. Concurrent CE and ND - regional distribution. 38

Figure 7. Outbreak process diagram. 38

Figure 8. Outbreaks by Year. 39

Figure 9. Outbreaks regional distribution. 39

Figure 10. Types of Outbreaks. 40

Figure 11. Outbreaks VPD vs. NVPD by region. 40

Figure 12. Outbreaks VPD vs NVPD by region, excluding H1N1. 41

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Infectious Disease Natural Disaster Complex emergency Outbreak
Committee Chair / Thesis Advisor	Cookson, Susan Temporado, Emory University
Committee Members	Rochat, Roger, Emory University Caudle, William Michael, Emory University
Partnering Agencies	CDC

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