Durban - The National Institute for Communicable Diseases (NICD) has indicated 12 health risks associated with flood disasters after parts of South Africa, particularly KwaZulu-Natal, have recently experienced heavy rains and flooding.
The NICD, its in April communiqué, said flood disasters result in five categories of health risks:
- Acute events: drowning and trauma.
- Non-communicable diseases: floods impact significantly on chronic health conditions due to medication non-compliance and lack of access to health service.
- Health-care infrastructure: damage or disruption to health-care infrastructure and systems.
- Mental health: anxiety, depression and PTSD (post-traumatic stress disorder) are potential mental health consequences for flood victims.
- Infection.
The NICD said flood disasters resulted in an increased risk of a range of infections.
“Damage to or disruption of environmental health infrastructure and services (water supply and sewage systems) increases the risk of water- and food-borne disease,” the NICD said.
“The displacement of people and overcrowding that often results from flooding provides optimal conditions for outbreaks of respiratory and gastrointestinal illness; contributing factors in such settings include poor standards of hygiene, close contact among flood victims, poor sanitation, poor nutrition, and poor food safety.”
The NICD said the provision of safe drinking water to affected communities was critical. It said uninterrupted safe water supply, safe wastewater disposal and solid waste handling were key to preventing large outbreaks of waterborne disease.
Health education for victims of flood disasters was an important preventive measure. Health messaging should focus on the use of safe water, hand hygiene, and food safety practice, the NICD said.
Advice for those affected by the floods includes:
- Always use safe water. If you are concerned about the quality of water you are using for drinking and cooking, then treat the water first by boiling it (place water in a clean container and bring to a boil for one minute); or treat it using household bleach (add one teaspoon of household bleach (containing 5% chlorine) to 20-25 litres of water, mix well and leave it to stand for at least 30 minutes before use).
- Practise good hand hygiene. Wash hands with soap and safe water before, during, and after preparing food; before and after eating food; before and after caring for someone at home who is sick (especially if they have diarrhoea); after using the toilet; and after changing nappies or cleaning up a child who has used the toilet.
- Make sure your food is safe! Follow the World Health Organization’s five keys to safer food: keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; and use safe water and raw materials. Washing hands with soap and water before, during and after preparing food and before eating is especially important.
12 health risks associated with flood disasters:
1. Cutaneous infections
Skin and soft tissue infections can follow trauma. These are often caused by typical bacterial causes of skin and soft tissue infections (Staphylococcus aureus and Streptococcus pyogenes) as well as less common water-dwelling organisms (Aeromonas spp, Vibrio spp). Fungal infections also occur, and may be polymicrobial; these may present as rapidly progressing necrotising fasciitis. Non-tuberculous mycobacteria (M chelonae, M fortuitum and M abscessus) can also cause infections after exposure to flood water.
2. Respiratory infections
Acute respiratory infections are common following flood disasters. Disruption of housing and overcrowding increase the risk of transmission of respiratory viral pathogens.
Gastrointestinal disease:
3. Cholera
Cholera is an acute diarrhoeal illness caused by infection with Vibrio cholerae bacteria following the ingestion of food or water contaminated with faeces of an infected person. Although most people infected with V cholerae don’t develop symptoms, about 10% will develop severe disease with acute profuse watery diarrhoea that can rapidly lead to severe dehydration. If left untreated, cholera can result in death. Mild cases are treated with oral fluids, while more severe cases may require intravenous fluids and appropriate antibiotics.
4. Shigellosis
Shigella spp are a group of bacteria that cause shigellosis. Transmission to humans occurs via the faecal-oral route, from person to person and through the ingestion of contaminated water or food. Symptoms include watery or bloody diarrhoea (dysentery), fever, nausea and sometimes vomiting and abdominal cramps. Severe infection with high fever may be associated with seizures in young children, and other possible complications include bloodstream infections, post-infectious arthritis and haemolytic-uraemic syndrome.
5. Enteric fever
Enteric fever is a bacterial infection caused by Salmonella typhi or S paratyphi A, B or C. It is transmitted by the ingestion of water or food that has been contaminated by faeces of an infected person. Symptoms of the disease are non-specific, and include fever, headache and gastrointestinal symptoms (such as abdominal pain, nausea, constipation and/or diarrhoea).
6. Other diarrhoeal disease
Transmission of other pathogens (bacteria, viruses and parasites) that cause diarrhoeal disease can result from contaminated water sources. These include E coli (particularly enterotoxigenic E coli), rotavirus and norovirus. Children are typically at increased risk of these infections. Symptoms include diarrhoea, vomiting and fever.
7. Hepatitis A
Hepatitis A is caused by hepatitis A virus. This virus is transmitted through the faecal-oral route, through ingestion of contaminated food and water or through close person-to- person contact with an infectious individual. Symptoms include fever, malaise, nausea, vomiting, diarrhoea, abdominal discomfort, dark urine and jaundice.
8. Zoonoses and vector-borne diseases
Flood disasters can result in changes in the physical environment that favour an increase in the breeding of some animals and vectors, which can lead to an increase in zoonoses and vector-borne diseases. Flood waters that remain stagnant after the flood provide breeding sites for mosquitoes.
9. Leptospirosis
Leptospirosis is a bacterial disease caused by Leptospira spp and is transmitted to humans through direct contact with animal hosts (rodents, domestic pets and livestock) or through an environment contaminated by animal urine. It is increasingly recognised as an important infection associated with flood disasters. People who come into direct contact with flood water (for example, by swimming or wading) that is contaminated with the urine of infected animals are at high risk of being infected. Symptoms are non-specific and include fever, headaches, muscle aches, chills, conjunctival suffusion (redness), abdominal pain, jaundice, vomiting, diarrhoea and sometimes a rash.
10. Malaria
Malaria is caused by Plasmodium spp parasites transmitted to humans through the bites of infected female Anopheles mosquitoes. Symptoms are non-specific and mimic many other febrile illnesses; common symptoms include fever, sweats, cold shivers, headache, muscle/joint aches, malaise, loss of appetite, nausea and vomiting. Urgent diagnosis and treatment according to national guidelines is important to prevent complications and death. Malaria transmission areas in South Africa include north-eastern KwaZulu-Natal and low altitude areas of Mpumalanga and Limpopo, particularly those bordering Zimbabwe, Mozambique and Swaziland.
11. Rift Valley fever
Rift Valley fever (RVF) is an infection that primarily affects domestic animals, but infection can be transmitted to humans through the bites of the Aedes mosquito. It can also be transmitted through the consumption of unpasteurised milk or the meat of infected dead animals, or contact with the blood or tissues of these animals. Heavy rains and floods can trigger outbreaks of RVF among animals, leading to infections in humans. Most human RVF infections are mild or do not present with any symptoms. Most affected people present with a flu-like illness; common symptoms include fever, headache, muscle or joint aches, neck stiffness, sensitivity to light, loss of appetite and/or vomiting.
12. West Nile virus disease
West Nile virus disease is caused by West Nile virus which is transmitted to humans through the bites of Culex mosquitoes. Infection with West Nile virus is asymptomatic in most (70-80%) of patients. Persons who develop symptoms usually present with a non-specific flu-like illness; common symptoms include fever, headache, fatigue, nausea, vomiting, muscle or joint aches, diarrhoea and a rash. Severe illness can occur, manifesting as encephalitis or meningitis.
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