Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 13, Number 1—January 2007

Epidemics after Natural Disasters

John T. Watson*Comments to Author , Michelle Gayer*, and Maire A. Connolly*
Author affiliations: *World Health Organization, Geneva, Switzerland;

Main Article


Principles for management of dead bodies*

• Mass management of dead bodies is often based on the false belief that they represent an epidemic hazard if not buried or burned immediately.
• Burial is preferable to cremation in mass casualty situations.
• Every effort should be made to identify the bodies. Mass burial should be avoided if at all possible.
• Families should have the opportunity (and access to materials) to conduct culturally appropriate funerals and burials according to social custom.
• Where existing facilities such as graveyards or crematoria are inadequate, alternative locations or facilities should be provided.
• For workers routinely handling bodies, ensure
  • Universal precautions for blood and body fluids
  • Use and correct disposal of gloves
  • Use of body bags if available
  • Hand-washing with soap after handling bodies and before eating
  • Disinfection of vehicles and equipment
  • Bodies do not need disinfection before disposal (except in cases of cholera, shigellosis, or hemorrhagic fever)
  • Bottom of any grave is >1.5 m above the water table, with a 0.7-m unsaturated zone

*Adapted from Morgan (3).

Main Article

  1. United Nations Cultural Scientific and Cultural Organization [homepage on the internet]. Paris. About natural disasters. [cited 2006 Aug 10]. Available from
  2. de Ville de Goyet C. Epidemics caused by dead bodies: a disaster myth that does not want to die.Rev Panam Salud Publica. 2004;15:2979.PubMed
  3. Morgan O. Infectious disease risks from dead bodies following natural disasters.Rev Panam Salud Publica. 2004;15:30711. DOIPubMed
  4. Management of dead bodies in disaster situations. (PAHO disaster manuals and guidelines on disaster series, no. 5).Washington: Pan American Health Organization; 2004.
  5. Sack RB, Siddique AK. Corpses and the spread of cholera.Lancet. 1998;352:1570. DOIPubMed
  6. Boumandouki P, Formenty P, Epelboin A, Campbell P, Atsangandoko C, Allarangar Y, Clinical management of patients and deceased during the Ebola outbreak from October to December 2003 in Republic of Congo[article in French]. Bull Soc Pathol Exot. 2005;98:21823.PubMed
  7. de Ville de Goyet C. Stop propagating disaster myths.Lancet. 2000;356:7624. DOIPubMed
  8. Noji E, ed. Public health consequences of disasters. New York: Oxford University Press; 1997.
  9. Noji EK. Public health in the aftermath of disasters.BMJ. 2005;330:137981. DOIPubMed
  10. Spiegel PB. Differences in world responses to natural disasters and complex emergencies.JAMA. 2005;293:19158. DOIPubMed
  11. Ahern M, Kovats RS, Wilkinson P, Few R, Matthies F. Global health impacts of floods: epidemiologic evidence.Epidemiol Rev. 2005;27:3646. DOIPubMed
  12. Floret N, Viel J-F, Mauny F, Hoen B, Piarroux R. Negligible risk for epidemics after geophysical disasters.[PMID: 16704799]. Emerg Infect Dis. 2006;12:5438.PubMed
  13. Qadri F, Khan AI, Faruque ASG, Begum YA, Chowdhury F, Nair GB, Enterotoxigenic Escherichia coli and Vibrio cholerae diarrhea, Bangladesh.[PMID: 16022790]. Emerg Infect Dis. 2005;11:11047.PubMed
  14. Sur D. Severe cholera outbreak following floods in a northern district of West Bengal.Indian J Med Res. 2000;112:17882.PubMed
  15. Kondo H, Seo N, Yasuda T, Hasizume M, Koido Y, Ninomiya N, Post-flood–infectious diseases in Mozambique.Prehosp Disaster Med. 2002;17:12633.PubMed
  16. Vollaard AM, Ali S, van Asten HA, Widjaja S, Visser LG, Surjadi C, Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia.JAMA. 2004;291:260715. DOIPubMed
  17. Katsumata T, Hosea D, Wasito EB, Kohno S, Hara K, Soeparto P, Cryptosporidiosis in Indonesia: a hospital-based study and a community-based survey.Am J Trop Med Hyg. 1998;59:62832.PubMed
  18. Brennan RJ, Kimba K. Rapid health assessment in Aceh Jaya District, Indonesia, following the December 26 tsunami.Emerg Med Australas. 2005;17:34150. DOIPubMed
  19. World Health Organization. Acute water diarrhea outbreak. Weekly Morbidity and Mortality Report. 2005;1:6. [cited 2006 Aug 10].Available from
  20. Waring SC, Reynolds KM, D'Souza G, Arafat RR. Rapid assessment of household needs in the Houston area after Tropical Storm Allison.Disaster Manag Response. 2002; (Sep):39.PubMed
  21. Centers for Disease Control and Prevention (CDC). Norovirus outbreak among evacuees from hurricane Katrina–Houston, Texas, September 2005.MMWR Morb Mortal Wkly Rep. 2005;54:10168.PubMed
  22. Centers for Disease Control and Prevention. Infectious disease and dermatologic conditions in evacuees and rescue workers after Hurricane Katrina—multiple states, August–September, 2005.MMWR Morb Mortal Wkly Rep. 2005;54:9614.PubMed
  23. Centers for Disease Control and Prevention. Two cases of toxigenic Vibrio cholerae O1 infection after Hurricanes Katrina and Rita—Louisiana, October 2005.MMWR Morb Mortal Wkly Rep. 2006;55:312.
  24. Aggarwal R, Krawczynski K. Hepatitis E: an overview and recent advances in clinical and laboratory research.J Gastroenterol Hepatol. 2000;15:920. DOIPubMed
  25. World Health Organization. Acute jaundice syndrome. Weekly Morbidity and Mortality Report. 2006;23:8. [cited 2006 Aug 10].Available from
  26. World Health Organization. Epidemic-prone disease surveillance and response after the tsunami in Aceh Province, Indonesia.Wkly Epidemiol Rec. 2005;80:1604.PubMed
  27. Yang HY, Hsu PY, Pan MJ, Wu MS, Lee CH, Yu CC, Clinical distinction and evaluation of leptospirosis in Taiwan—a case-control study.J Nephrol. 2005;18:4553.PubMed
  28. Karande S, Bhatt M, Kelkar A, Kulkarni M, De A, Varaiya A. An observational study to detect leptospirosis in Mumbai, India, 2000.Arch Dis Child. 2003;88:10705. DOIPubMed
  29. Vanasco NB, Fusco S, Zanuttini JC, Manattini S, Dalla Fontana ML, Prez J, Outbreak of human leptospirosis after a flood in Reconquista, Santa Fe, 1998[article in Spanish]. Rev Argent Microbiol. 2002;34:12431.PubMed
  30. Kalashnikov IA, Mezentsev VM, Mkrtchan MO, Grizhebovskii GM, Briukhanova GD. Features of leptospirosis in the Krasnodar Territory[article in Russian]. Zh Mikrobiol Epidemiol Immunobiol. 2003; (Nov-Dec):6871.PubMed
  31. Barcellos C, Sabroza PC. The place behind the case: leptospirosis risks and associated environmental conditions in a flood-related outbreak in Rio de Janeiro.Cad Saude Publica. 2001;17(Suppl):5967.PubMed
  32. Marin M, Nguyen HQ, Langidrik JR, Edwards R, Briand K, Papania MJ, Measles transmission and vaccine effectiveness during a large outbreak on a densely populated island: implications for vaccination policy.Clin Infect Dis. 2006;42:3159. DOIPubMed
  33. Surmieda MR, Lopez JM, Abad-Viola G, Miranda ME, Abellanosa IP, Sadang RA, Surveillance in evacuation camps after the eruption of Mt. Pinatubo, Philippines.MMWR CDC Surveill Summ. 1992;41:963.
  34. Gaspar M, Leite F, Brumana L, Felix B, Stella AA. Epidemiology of meningococcal meningitis in Angola, 1994–2000.Epidemiol Infect. 2001;127:4214. DOIPubMed
  35. Campanella N. Infectious diseases and natural disasters: the effects of Hurricane Mitch over Villanueva municipal area, Nicaragua.Public Health Rev. 1999;27:3119.PubMed
  36. Lifson AR. Mosquitoes, models, and dengue.Lancet. 1996;347:12012. DOIPubMed
  37. Saenz R, Bissell RA, Paniagua F. Post-disaster malaria in Costa Rica.Prehosp Disaster Med. 1995;10:15460.PubMed
  38. Gagnon AS, Smoyer-Tomic KE, Bush AB. The El Nino southern oscillation and malaria epidemics in South America.Int J Biometeorol. 2002;46:819. DOIPubMed
  39. Schneider E, Hajjeh RA, Spiegel RA, Jibson RW, Harp EL, Marshall GA, A coccidiomycosis outbreak following the Northridge, Calif, earthquake.JAMA. 1997;277:9048. DOIPubMed
  40. Marx MA, Rodriguez CV, Greenko J, Das D, Heffernan R, Karpati AM, Diarrheal illness detected through syndromic surveillance after a massive power outage: New York City, August 2003.Am J Public Health. 2006;96:54753. DOIPubMed

Main Article

Page created: June 28, 2010
Page updated: June 28, 2010
Page reviewed: June 28, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.