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Chapter 2 The Pre-Travel Consultation Counseling & Advice for Travelers

Natural Disasters

Amy F. Wolkin, Josephine Malilay

Travelers should be aware of the potential for natural disasters such as hurricanes, floods, tsunamis, tornadoes, or earthquakes. Natural disasters can contribute to the transmission of some diseases, especially since water supplies and sewage systems may be disrupted; sanitation and hygiene may be compromised by population displacement and overcrowding; and normal public health services may be interrupted.


Travelers can better prepare themselves for disasters by staying well informed and planning ahead. Travelers should know how to recognize impending hazards and know what to do to protect themselves before the disaster occurs. When arriving at a destination, travelers should be familiar with local risks for earthquakes, floods, landslides, tsunamis, and other hazards, as well as warning systems, evacuation routes, and shelters in areas of high risk. Travelers can find information on travel alerts and disaster threats from the Department of State website (, as well as CDC’s Travelers Health website ( Recommendations from these sites may include specific immunizations or cautions about unique hazards in the area. The Department of State’s Smart Traveler Enrollment Program offers a free service to US travelers to register upcoming trips abroad so that the Department of State can send alerts (

Travelers should have access to a first aid kit and an adequate supply of prescription medication in the event of an emergency. They also should develop a family emergency plan (see for more information), which should include how travelers will locate separated family members or contact family members back at home during a disaster. Domestic or overseas travelers can connect to missing family members through American Red Cross Family Linking Services (


During a disaster and when recovering from a disaster, travelers should consider safety as well as mental and physical well-being. The risk for outbreaks of an infectious disease is minimal unless a disease is endemic in an area before the disaster. Although typhoid can be endemic in developing countries, natural disasters have seldom led to epidemic levels of disease. Floods can prompt outbreaks of leptospirosis and cholera in endemic areas.

When water and sewage systems have been disrupted, safe water and food supplies are necessary to prevent enteric disease transmission. If contamination is suspected, water should be boiled or disinfected (see Water Disinfection for Travelers in this chapter). Travelers who are injured during a natural disaster should have a medical evaluation to determine what additional care may be required for wounds potentially contaminated with feces, soil, or saliva, or that have been exposed to fresh or sea water that may contain parasites or bacteria. Tetanus booster status always should be kept current.

During a natural disaster, deaths are rarely due to infectious diseases. Rather, they are most often due to blunt trauma, crush-related injuries, or drowning. Therefore, travelers should be aware of the risks for injury during and after a natural disaster. In floods, people should avoid driving through swiftly moving water. Travelers should exercise caution during clean-up, particularly when encountering downed power lines, water-affected electrical outlets, interrupted gas lines, and stray or frightened animals. Travelers should also be aware of hazards from alternative sources of fuel and electricity for heating or cooking during power outages (such as carbon monoxide poisoning from an improperly used generator). During natural disasters, technological malfunctions may release hazardous materials (such as release of toxic chemicals from a point source displaced by strong winds, seismic motion, or rapidly moving water).

Natural disasters can lead to wide-ranging air pollution. For example, wildfires have caused widespread pollution over vast expanses, worsening symptoms of chronic heart and lung diseases and other respiratory conditions (such as asthma). Natural disasters resulting in massive structural collapse or dust clouds can release chemical or biologic contaminants (such as asbestos). Health risks associated with these environmental occurrences have not been fully studied. Travelers with chronic pulmonary disease, pregnant, or who are immunocompromised may be more susceptible to adverse effects from these types of exposures; if advised, travelers should evacuate the affected area.


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