Emerging Disease During Disasters and Emergencies

Disasters are major events which occur with little prior human awareness of the time and place of occurrence. Atmospheric, geologic and hydrological factors contribute to natural disasters. Hydrological factors include floods, storms, typhoons, wave surges, hurricanes, and tornadoes. Geological factors that result in catastrophe are landslides and avalanches while earthquakes, tsunamis and, volcanic eruptions make up the atmospheric sources of natural disasters (Kouadio, Aljunid, Kamigaki, Hammad, & Oshitani, 2012). A complex interplay between these factors results in catastrophic events that require emergency responses to mitigate their negative impacts on people and the environment.

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Natural disasters have been part of human history for centuries. When disasters happen, they result in death and destruction -people are killed and others injured, property and the physical environment gets destroyed. However, it is the high number of deaths, injuries and widespread destruction which have been witnessed in the recent years that continue to cause great concern for emergency responders. According to Kouadio et al. (2012), world population growth, poverty, urbanization, and land shortage have increased the number of inhabitants in areas that are prone to natural disasters. A higher frequency of disasters has created a new challenge for rescue teams and health worker in the form of emerging diseases. One such disaster-related emerging disease is dengue fever. Given the new operating climate for rescuers and medical teams, understanding the relationship of dengue fever and disasters can help stakeholders design appropriate response strategies to mitigate the effects of damage as well as prevent disease transmission after disasters.

The Relationship Between Disasters and Disease

An occurrence of disaster causes deaths and injuries. The deaths and injuries that occur during or immediately after natural disasters are related to trauma such as lacerations, fractures, blunt trauma, crush injuries, burn injuries and drowning (Kouadio et al., 2012). The scene of dead people has often created the belief that the dead cause disease outbreaks. Despite the ubiquity of this belief, scientific evidence suggests that the presence of corpses and injured persons do not cause disease outbreaks during or shortly after natural disasters. For instance, dead bodies do not create the risk of an outbreak of an infectious disease except for isolated cases such as poor handling of cholera victims after a disaster (Watson, Gayer, & Connolly, 2007).

Research indicates that the emergence of infectious diseases results from prolonged after-effects of the disaster. These effects alter the pattern of behaviors of populations which predisposes them to infections (Watson et al., 2007). The prolonged after-effects may include population displacements, overcrowding, and poor water and sanitation conditions. Other predisposing factors are high exposure to disease vectors such as mosquitoes, poor personal hygiene, and a decline in immunity of the affected populations (Kouadio et al., 2012). For instance, when an earthquake occurs, it destroys water supply systems. Destruction of water systems (e.g., pipes) can increase the risk of contamination of water used for drinking. Contamination spreads pathogens to unsuspecting water users, triggering disease outbreaks.

Due to extensive research on disaster-related epidemics, emergency responders and medical workers have shown a greater ability to deal with disaster-related disease outbreaks. This has led to a significant reduction in the social and economic costs of infectious disease outbreaks during disasters (Rebmann, 2014). However, it has become challenging for disaster response stakeholders to handle cases of new or rare diseases. The challenges arise from the inadequate experience and knowledge on how to deal with cases of disease outbreaks which are emergent.

Emerging infections have been defined as those infections that have newly appeared in a given population or have been reported previously but are rapidly increasing in terms of geographical range or incidence (Rebmann, 2014; Morens, Folkers, & Fauci, 2004). Thus, the case of HIV/AIDS can be regarded as emerging when the incidence continues to increase since it was first reported in 1981. Similarly, an outbreak resulting from a biological attack such as the anthrax bacteria attack on the US in 2001 can as well be termed as an emerging infection. Therefore, newly emerging and reemerging infections after disasters can be referred to as emerging diseases (Rebmann, 2014).

The Case of Dengue Fever as a Disaster Related Emerging Disease in the US

Dengue fever is a mosquito-borne infection. It is the most prevalent and fastest-growing mosquito-borne virus worldwide with research findings suggesting that the spread of the virus has increased dramatically in tropical and subtropical regions in the world in recent decades (Bouri et al., 2012). The incidence of dengue fever has increased 30-fold over the last half a century, with an estimated 50 to 100 million infections occurring each year (Bouri et al., 2012; Cheong, Burkart, Leitao, & Lakes, 2013). The recent incidence rate and nature of its spread pose a serious health threat to millions of people with estimates indicating that about 2.5 billion people globally face the risk of being infected by the virus (Cheong et al., 2013).

Dengue is a virus with four serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). The DEN-1, DEN-2 and DEN-3 strains have been responsible for dengue outbreaks in the US. Dengue fever manifests itself in the form of influenza-like symptoms within a period of 4 to 5 days after a bite from the infecting mosquito bite. The patients may experience vomiting, musculoskeletal pain, joint pain, nausea and rash (Bouri et al., 2012). The occurrence of disasters creates new breeding grounds for dengue vectors as well as increases exposure to mosquitoes and rodents which further worsens the incidence of the disease (Kouadio et al., 2012). The risk of infections is compounded further by the destruction of healthcare infrastructures such as hospitals and roads.

Infection from the dengue virus has been traditionally considered a health problem in developing countries with highly tropical climates. However, there has been an increase in the cases of dengue virus in the high-income countries, including the United States. In the last 20 years, for instance, outbreaks have been reported in Hawaii, Texas and recently Florida (Bouri et al., 2012). This shows that there are favorable conditions in subtropical countries for the transmission of dengue virus.

Previous Outbreaks in the United States

The Pre-1850 Period

Although the virus had not been identified as known today, medical reports indicate that there were several outbreaks of dengue in 19th century America. For instance, dengue outbreaks were reported in Philadelphia and Pennsylvania in the 1820s. Other regions that reported the outbreak of the virus during this period included Charleston, South Carolina; Savannah, Georgia; Pensacola, Florida; and New Orleans, Louisiana(Bouri et al., 2012).

1850-1945

During the period between 1850 and 1945, regular cases of dengue outbreaks occurred in the US. The period is important in the history of the disease as it witnessed great medical development in control of the disease. Specifically, the proposition of the vector theory revealed the role of mosquitoes in the transmission of the virus (Bouri et al., 2012). This discovery informs much of the control measures against dengue fever today.

Dengue Incidences after World War 2

After the Second World War, dengue fever was not a significant health concern for health stakeholders in the US. The suppression of the virus resulted from aggressive efforts made by the department of health in eradicating the disease. In the 1980s, however, dengue fever reemerged. The reemergence of the virus was attributed to overcrowding as a result of urbanization (Bouri et al., 2012).

Since the 1980s, regular movements of people from high-risk areas into the US have been the primary source of dengue outbreaks. Recent evidence suggests that at least 100 cases of dengue are reported in the US each year. A majority of these cases are travel-related though a few outbreaks have been linked to the autochthonous transmission within domestic populations (Bouri et al., 2012). According to Bouri et al. (2012), the outbreaks have been mainly reported in the regions that border Mexico with evidence suggesting that areas hit by natural disasters are a major source of infection in the US. Therefore, whatever location natural disasters strike, it is possible that such effects increase the risk of an outbreak in the US depending on the connectivity of the populations of the region/country of the epidemic to America.

Recent occurrences have been reported in Hawaii, Texas, and Florida in 2001, 2005 and 2009 respectively. In Hawaii, 1644 suspected cases were investigated and the results confirmed122 cases. In the 2005 dengue outbreak in Brownsville, Texas, 3 cases of autochthonous dengue were confirmed while 24 cases of the disease were confirmed in people who had traveled to neighboring Mexico. Reports at the time indicated that Tamaulipas, Mexico, also experienced an outbreak of dengue fever. In 2009, 29 locally acquired cases of dengue were confirmed in Key West County. Further investigations revealed that 5 percent of the residents of the county had been affected by the virus (Bouri et al., 2012). From the highlighted cases, it can be observed that the susceptibility of local populations to dengue infections and globalization increases the vulnerability of US populations to outbreaks despite the effectiveness of the health care system in preventing and controlling the disease outbreaks.

Dengue Fever Outbreaks in Other Parts of the World

Many parts of the world, especially tropical regions, are more vulnerable to the occurrence of dengue as a result of disasters. Warm temperatures positively affect the feeding behaviors of dengue vectors, their gonotrophic cycle, larval development and replication (Cheong et al., 2013). When disasters strike, they create favorable conditions for the transmission of the virus. As the effects of climate change continue to alter weather patterns across the world, more regions are being exposed to the occurrence of natural disasters. Some of the countries that have been worst hit by dengue fever resulting from disasters in the recent past are Indonesia and Brazil.

Dengue Fever in Indonesia

In September 2009, an earthquake of magnitude 7.6 hit the outskirts of the city of Pandang, a highly populated area in the West Sumatra region of Indonesia. The outbreak was the worst in years and resulted in at least 1000 deaths, 2400 injuries; more than 200, 0000 people were directly affected by the aftermath of the quake (Beaumont, 2009). Besides several people dying and thousands sustaining injuries, the earthquake led to widespread destruction across the city. Roads, hospitals, schools, power lines, and other facilities were destroyed (Fanany, 2012; Beaumont, 2009). These outcomes created significant challenges to the health care system in Indonesia.

Warmer climate and rainfall are considered as the primary conditions for the persistent outbreak of dengue fever in Indonesia. In areas such as the city of Makassar, humidity is used as the principal factor for determining the occurrence of dengue fever in the country (Fanany, 2012). Research has shown that many cases of dengue fever in Asia occur during the rainy season and warmer temperatures (Cheong et al., 2013). However, studies have shown as well that the propensity of earthquake occurrence in Indonesia...