As water levels recede in flood hit Gujarat,
Maharashtra, Andhra Pradesh, Madhya Pradesh, Chhattisgarh, and Orissa,
rotting animal carcasses, issues of sanitation, and problems of sewage
from sewers, septic tanks, cesspools, and pit privies contaminating wells
following eight days of flooding, raise fears of disease.
Preventing outbreaks if diseases like
typhoid, dysentery, infectious hepatitis, and other diseases associated
with flood waters should now be thye major objective of all relief work.
We urge all organizations involved in flood relief operations to ensure that the following precautions are followed by ALL in order to avoid outbreak of epidemics of disease
General Considerations:
Overall precautions include:
- avoidance flood waters contaminated by sewage, and remains of animals especially by children
- using safe water and food,
- always using good hand washing practices before eating, drinking or touching face areas.
- Avoiding water from wells until it has been sampled and found to be safe.
Water safety:
All water should be treated.
Many normally safe water sources may have been compromised by disruption of treatment facilities or breaks in water lines. Even if it does not have a bad odor and taste, water may be contaminated by a variety of microorganisms, including bacteria and parasites that can cause diseases such as dysentery, cholera, typhoid and hepatitis.
To treat water:
- Filter the water using a piece of clean cloth to remove solid particles.
- Bring it to a rolling boil for about one full minute.
- Let it cool at least 30 minutes before using
OR, if there are no facilities to boil water:
Add 4 drops of liquid laundry bleach per liter of water. (Sodium hypochlorite of the concentration of 5.25% to 6% should be the only active ingredient in the bleach. Choose bleach with no added soap or fragrances.) Double the amount of bleach added to the water if the water is colored or turbid.
OR
Add one teaspoonful of bleaching powder to 25 liters of water
OR
Add 1O drops of povidone iodine to each liter of water, mix thoroughly and let stand 30 minutes before using.
OR
Use Iodine or Chlorine Tablets: Follow instructions on package.
Let treated clear water stand for 30 minutes. If the mixture smells of chlorine, it is safe to use. If it does not smell of chlorine, add 4 more drops of chlorine bleach per liter of water and let stand for a further 30 minutes, and smell it again. If it smells of chlorine, you can use it. If it does not smell of chlorine, discard it and find another source of water.
Waste Disposal:
Do not throw household garbage into the street.
Put it into bags and dispose of the bags through a proper disposal as soon as possible.
Use toilets and other plumbing fixtures only if they drain properly. Make sure that the sewage does not drain into the flood waters or into areas of drinking water.
Food safety:
Throw away food that may have come in contact with flood water regardless of whether it remained in a closed refrigerator or freezer. Discard any food that has been at room temperature for two hours or more, and any food that has an unusual odor, color, or texture. Discard any food without a waterproof container if there is any chance that it has come into contact with flood water.
Throw away food in cans that are bulging, opened or damaged. Undamaged, commercially canned foods can be saved if you remove labels, wash the cans and dip them in a solution of 1 cup of bleach in 20 liters of water. Relabel the cans with a marker.
Food containers with screwcaps, snaplids, crimped caps (soda bottles), twist caps, flip tops, and homecanned foods should be discarded if they have come into contact with flood water because they cannot be disinfected.
Personal Precautions
- Wash hands before drinking and eating
- Wash frequently using soap especially disinfecting soap
- Limit direct contact with contaminated flood water
- Treat cuts or open wounds and limit exposure
- Report all symptoms
- Make use of vaccination facilities
Bathe regularly if possible, and especially after cleaning flood contaminated areas and objects. After handling materials contaminated by flood water, wash hands thoroughly with soap and water before touching the body particularly face, mouth, eyes, or nose or members of the family. Using an antibacterial soap gives added protection from the organisms that may be present in flood waters.
Do not touch or handle food, eating, or cooking utensils until you have thoroughly washed your hands.
Immediately seek treatment for and report to public health professional any diarrhea, stomach upset, sudden illness, or infection observed.
Wounds open the way for tetanus and other infections that can lead to serious, even lifethreatening consequences. Clean a shallow wound with clean water and soap, apply an antiseptic and cover with waterproof bandaging. For a deep wound, seek medical attention. For a puncture wound or a wound contaminated with flood water, feces, soil, or saliva, immediately seek medical care and tetanus vaccination.
Mosquito control:
How much effort toward mosquito control is practical in the aftermath of the flood? This is a difficult question with no single, correct answer. Eliminating mosquito breeding sites is always desirable and is usually accomplished by filling
or draining standing water sources. However, with such an over abundance of breeding sites, it may not be possible to eliminate enough standing water to make a difference in the mosquito population, especially in the next week when other, higher priority activities are commanding the attention of relief workers, district health authorities and communities impacted by the flood. Also mosquitoes can migrate several miles after they emerge from their breeding site, and a wide area puddle elimination project would be required. Mosquito repellents remain the most effective way to cope with the mosquitoes menace after immediately after the flood and these should form part of relief kits.
Health hazards after floods (1):
Floods can potentially increase the transmission of waterborne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis A and vectorborne diseases, such as malaria, dengue and dengue haemorrhagic fever, chicunguya fever.
The major risk factor for outbreaks associated with flooding is the contamination of drinkingwater facilities. There is an increased risk of infection of waterborne diseases contracted through direct contact with polluted waters, such as wound infections, dermatitis, conjunctivitis, and ear, nose and throat infections. However, these diseases are not epidemicprone.
The only epidemicprone
infection which can be transmitted directly from contaminated water is leptospirosis. Transmission occurs through contact of the skin and mucous membranes with water, damp soil or vegetation (such as sugarcane) or mud contaminated with rodent urine. The occurrence of flooding after heavy rainfall facilitates the spread of the organism due to the proliferation of rodents which shed large amounts of leptospires in their urine.
Stagnant water provides breeding sites for mosquitoes, and therefore enhances the potential for exposure of the disasteraffected population and emergency workers to infections such as dengue, malaria etc. Flooding may initially flush out mosquito breeding, but it comes back when the waters recede. The lag time is usually around 68 weeks before the onset of a malaria epidemic. Malaria epidemics in the wake of flooding are a wellknown phenomenon in malariaendemic areas worldwide. The risk of outbreaks is greatly increased by complicating factors, such as increased exposure to mosquitoes while sleeping outside, a temporary pause in disease control activities, overcrowding.
Contrary to common belief, there is no evidence that corpses pose a risk of disease "epidemics" after natural disasters. Most agents do not survive long in the human body after death (with the exception of HIV which can be up to 6 days) and the source of acute infections is more likely to be the survivors. Human remains only pose health risks in a few special cases requiring specific precautions, such as deaths from cholera or haemorrhagic fevers. However, workers who routinely handle corpses may have a risk of contracting tuberculosis, bloodborne viruses (such as Hepatitis B/C and HIV), and gastrointestinal infections (such as rotavirus diarrhoea, salmonellosis, E. coli, typhoid/paratyphoid fevers, hepatitis A, shigellosis and cholera). Tuberculosis can be acquired if the bacillus is aerosolized (residual air in lungs exhaled, fluid from lungs spurted up through nose/ mouth during handling of the corpse). Exposure to bloodborne viruses occurs due to direct contact with nonintact skin of blood or body fluid, injury from bone fragments and needles, or exposure to the mucous membranes from splashing of blood or body fluid. Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faecooral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections.
Tetanus is not common after injury from flooding, and mass tetanus vaccination programs are not indicated. However, tetanus boosters may be indicated for previously vaccinated people who sustain open wounds or for other injured people depending on their tetanus immunization history. Passive vaccination with tetanus immune globulin (Hypertet) is useful in treating wounded people who have not been actively vaccinated and those whose wounds are highly contaminated, as well as those with tetanus.
There is an increased risk of respiratory tract infections due to exposure (loss of shelter, exposure to flood waters and rain).
A note on Surat:
In Surat residents have begun to throw out rotting food and soggy mattresses and piling all their garbage on the roads. Here the specter of the 1994 plague looms large.
Floods in early August 1994 resulted in human waste and refuse mixed with slush and mud being washed up and left on the riverbank creating ideal conditions for the spread of infection. People returning home dumped high piles of garbage in the street creating an environment for rats to thrive in. Villagers moved to new homes constructed by the government and converted their old, damaged homes into granaries to store food aid, thereby increasing numbers of rats in the area. With the outbreak of plague, broad spectrum antibiotics, required to curb the disease, were exhausted by panicbuying of the overthecounter antibiotics in response to media suggestions. Physicians and pharmacists escaping the city carried large amounts of treatment drugs away with them for their families and friends.
Active steps have to be taken to prevent this from happening again this year. The following measures must be taken to prevent the risk of plague (2)
- Effective environmental sanitation reduces the risk of persons being bitten by infectious fleas of rodents and other animals in places where people live, work, and recreate.
- Remove food sources used by rats and make homes, buildings, warehouses, or feed sheds rat proof.
- Report any observations of sick or dead rats animals to the local health department
- Eliminate sources of food and nesting places for rats around homes, work places, and recreation areas;
- remove heaps of garbage, debris, and other potentialfood supplies for rats, such as pet and wild animal food
- Apply insect repellents to clothing and skin.
- Do not allow dogs and other animals to roam freely.
- Use flea powders on per animals.
Hantavirus pulmonary syndrome (HPS) is a deadly disease transmitted by infected rodents through urine, droppings, or saliva. Humans can contract the disease when they breathe in aerosolized virus. To prevent Hantavirus infection (2)
- safely clean up rodentinfested areas;
- Air out infested spaces before cleanup;
- Spray areas of infestation and all excreta, nesting, and other materials with household disinfectant or 10% bleach solution then clean up, seal in bags, and dispose;
- Avoid sweeping, or stirring dust until the area is thoroughly wet with disinfectant;
- Wash hands after cleaning
Notes
(1) Based on the WHO Flooding and communicable diseases fact sheet
(2) Based on CDC guidelines