Epidemic suppression packages in disasters: A public health viewpoint

Communicable disease outbreaks may emerge several days after a sudden large disaster in which there has been disruption and contamination of water and food supply, breaking of sewer lines, garbage accumulation, loss and destruction of housing and breakdown of personal sanitation. Water-borne diseases (typhoid, cholera, hepatitis) and "Dirt" diseases (impetigo, shigella) are targets of public health strategies of suppression. Restoration of the water supply for drinking and for washing is probably the most important step in aborting spread of communicable disease. For diarrhoea and enteritis, case detection and immediate antibiotic treatment of affected cases and close contacts are sensible temporary measures for suppressing morbidity and spread. Post-disaster mass immunization campaigns are the "golden calf" of disaster medicine. Pre-disaster education of the public should emphasize this point. Measures to restore the sanitary infrastructure (water supply, garbage disposal, sewage disposal, vector and rodent control) remain basic to infectious disease control in the post-disaster recovery period. Anticipating the need for those measures remains basic to pre-disaster planning.