Communicable Disease

Progress in Disaster Science 23 (2024) 100334
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Progress in Disaster Science

journal homepage: www.elsevier.com/locate/pdisas
Review Article
Communicable diseases outbreaks after natural disasters: A systematic

scoping review for incidence, risk factors and recommendations
Mohammad Saatchi a, b, Hamid Reza Khankeh b, c, Javad Shojafard b, Arvin Barzanji b,
Maryam Ranjbar b, Narges Nazari b, Mohammad Azim Mahmodi b, Shokoufeh Ahmadi b,
Mehrdad Farrokhi b, d, *
a
Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran
b
Health in Emergency and Disaster Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
c
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
d
Department of Management of Health Safety and Environment, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
A R T I C L E I N F O A B S T R A C T
Keywords: Background: Natural hazards can play a considerable role in the emergence and spread of infectious diseases (ID).
Infections There are various risk factors associated with disease outbreaks following disasters.
Dieases outbreaks Objective: This study aimed to conduct a comprehensive systematic analysis of communicable disease epidemic
Disasters
and their associated risk factors following disasters worldwide.
Health ipmacts
Risk factors
Method: This is a systematic review adhering to the PRISMA Scoping Review criteria, encompassing various types
of descriptive and analytical research, such as cross-sectional, case-control, cohort, and ecological studies.
Published articles to the end of March 2022 were searched on the Web of Science, PubMed, and Scopus. The
primary objective of this review was to examine the incidence and/or prevalence of ID following natural
disasters.
Results: After screening 12,151 titles, 72 articles were included in the final analysis. Increased ID incidence rates
and outbreaks after floods, earthquakes, tsunamis, tropical storms, heavy rainfall, hurricanes and tornadoes,
extreme heat waves, and drought have been reported. Most commonly, outbreaks of diarrhea were reported after
floods, followed by leptospirosis and malaria. After earthquakes, an increased incidence of upper and lower
respiratory infections was recorded. Outbreaks of gastrointestinal infections and cutaneous leishmaniasis were
noted after earthquakes. Tetanus, measles, and malaria epidemics occurred post-tsunami, while cholera and
dengue fever were predominant after cyclonic events and monsoons. Socio-economic status, poor water supply,
low sanitation & hygiene, poor food security, sex, age, occupation, and co-existing disease are important risk
factors of epidemics after disasters.
Conclusion: This review outlines the important ID and major risk factors in the population exposed to natural
disasters, providing valuable insights for policymakers and disaster risk managers.
1. Introduction and damage to properties, and disrupt the normal routines of the
affected communities [3,4]. During the past three decades, the number
According to the classification provided by the Emergency Events and intensity of natural hazards have reached unprecedented levels,
Database (EM-DAT), natural hazards can be classified into various cat whereas annually about 500 disasters happen worldwide [5]. In addi
egories, including geophysical (earthquakes), hydrological (floods), tion to the aforementioned consequences, natural hazards have the
meteorological (extreme temperatures), climatological (droughts), bio potential of leading to widespread infectious epidemics depending on
logical (epidemics) and extraterrestrial (i.e. comet collisions) [1,2]. the type of disaster and the modes of disease transmission [6]. Hence,
However, it is important to note that all types, despite the variety of their the outbreak of contagious diseases is regarded as one of the possible
characteristics, have the potential to cause casualties, injuries to people adverse consequences after disasters. According to the Centers for
* Corresponding author.
E-mail address: me.farrokhi@uswr.ac.ir (M. Farrokhi).
https://doi.org/10.1016/j.pdisas.2024.100334
Received 7 March 2024; Received in revised form 7 May 2024; Accepted 30 May 2024
Available online 1 June 2024
2590-0617/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
M. Saatchi et al. Progress in Disaster Science 23 (2024) 100334
Disease Control and Prevention (CDC), an epidemic is characterized as 2.3. Data extraction
an unforeseen escalation in the incidence of cases within a particular
geographical region in a specific timeframe [7]. All the ultimate selected articles were transferred to End-Note. Three
There are several risk factors associated with disease outbreaks researchers (A.B., N⋅N, and MH.M) independently reviewed all the titles
following disasters: overcrowding, food insecurity, lack of clean water, and abstracts after eliminating duplicate entries. The irrelevant studies
poor sanitation, alteration in vectors’ distribution, housing and shelter that could not meet the inclusion criteria were excluded. The full text of
issues, limited access to healthcare services, population displacement, the remaining items in the list was provided and studied.
disruptions in basic infrastructure and transportation networks [8,9]. Any paper with inconsistencies in the methodology or findings and
Infections caused by contaminated water and food, respiratory in not in line with the study’s objectives was removed. Then, the re
fections, vector-borne diseases, and wound infections are among the searchers individually obtained the pertinent details from the articles
most prevalent communicable diseases based on the type of disaster and (title, first author, and publication year). They also collected informa
the existing infrastructures in the affected area. These pathogens have tion on the study’s location, duration, design, sample size, baseline
the capacity to induce an outbreak and result in high mortality rate in variables (mean age and gender diversity), the specific types of natural
some cases like diarrheal and respiratory diseases [10–12]. disasters and infectious diseases, mortality and infection rates (inci
Climate change is happening faster than ever, affecting both society dence, assessment, casualties), association indicators (relative risk and
and environment. This leads to more frequent and severe natural di odds ratio), and the key findings. During each screening process, in case
sasters. [13,14]. The integration and rational classification of the most of a disagreement regarding the inclusion/exclusion, the title or full text
contingent epidemics, their spatial distribution, and the identification of was referred to another researcher (M.S or SH.A) for the final decision.
factors that contribute to their occurrence, as well as the rapid pro The diseases were mentioned by their specific names and in the form of
gression of disease outbreaks following each disaster, are crucial con frequency and relative risk indicators [relative risk (RR), odds ratio
siderations in disaster policy making and risk management. Therefore, (OR)], with a confidence interval of 95%. Fig. 1 illustrates the process of
this study aimed to conduct a comprehensive systematic analysis of selecting the ultimate 72 articles.
communicable disease epidemics and the associated risk factors in the
aftermath of disasters, worldwide. 2.4. Ethical considerations
2. Method This study did not involve human participants, human participant
research ethics, or related secondary analyses; therefore, ethics approval
2.1. Eligibility criteria and consent to participate were not required.
The present study is a systematic scoping review that adheres to the 3. Results
criteria of the PRISMA Scoping Review [15] which encompasses various
types of descriptive and analytical research, including cross-sectional, 3.1. Searching results
case-control, cohort, and ecological studies. The primary objective or
component of these studies was to examine the incidence and/or prev In the initial search of the mentioned keywords yielded 12,151 titles
alence of infectious/ contagious epidemics following natural disasters. in ISI, PubMed, and Scopus databases. After removing duplicates,
Systematic review and meta-analysis, experimental (trial), time series, 10,679 articles were included in the first screening from which 9941
and single case studies, lectures, congress and conference reports, non- titles and abstracts did not meet the inclusion criteria. Then, in the final
English papers were excluded. The articles without full text were also analysis, from 339 evaluated full texts, 267 papers were excluded due to
removed because the team could not reach and review their findings and their thematic irrelevance to the main subject of the present study.
methodology that considered as a limitation. Finally, 72 articles were verified for this systematic review.
2.2. Search strategy 3.2. Characteristics of the included articles
Published articles from 1928 to the end of March 2022 in the The selected articles (published 1991–2022) that reported post-
reference databases: Web of Science, PubMed, and Scopus were disaster epidemics from 1988 to 2018 were included. These articles
considered as the main sources of data collection. Syntaxes in line with evaluated the epidemics incidence after floods in 31 papers [16–46],
the research topic and keywords in Medical Subject headings (Mesh) following an earthquake in 21 papers [47–67], in four papers after a
were searched in title, abstract, and text; both individually and in the tsunami [68–71], in six papers after tropical storms and heavy rainfall
form of using AND/OR operators. To optimize the search process within [72–77], following hurricanes and tornadoes in five papers [78–82], in
the databases, a thorough reassessment of the reference list was con one article following an extreme heat wave [83], and in four articles
ducted on the finally selected papers. The keywords searched in data after drought [84–87]. China published most of the articles 13, followed
bases were: Droughts; Wildfires; Natural Disasters; Floods; Heat wave; Cold by India 7, Pakistan 6, the Philippines 5, Bangladesh and Iran with 4
wave; Extreme temperature; Tornadoes; Lava flow; Cyclonic Storms; Tsu each, Nepal and Japan with 3 each, Brazil, Ecuador, Turkey, Indonesia,
namis; Earthquakes; rock fall; Landslides; Pyroclastic flow; Lahar; Ash fall; Haiti, and the United States with 2 each, and Laos, Guyana, Australia, Sri
Volcanic Eruptions; Diarrhea; Plague; Scrub Typhus; dysentery; bacillary; Lanka, Uganda, Mozambique, Sudan, Malaysia, Ghana, Nigeria,
Measles; Typhoid Fever; Leptospirosis; Hepatitis; Rift Valley Fever; West Nile Ethiopia, Central Africa, Vietnam, Italy, and Tuvalu with 1 each (Fig. 2).
virus; Dengue; Malaria; Cholera; Arboviruses; Vector-Borne Diseases; Dis A total of 1,831,959 cases of communicable disease after disasters were
ease Outbreaks; Epidemics; Communicable Diseases. reported in this study (Fig. 3).
To ensure thorough synonym inclusion in our search strategy, we
first identified key terms from the research objectives. We then con 3.3. Hydrological disasters (Table 1)
sulted various thesauri and field-specific databases for related terms,
and engaged with subject experts for their insights. Lastly, reviewing 3.3.1. Floods
some literatures helped us identify additional terms used in the field. Diarrhea as the most common epidemic after the flood was
mentioned in 14 articles [16,19,23,26,29–31,34,37,39,40,42,44,45]
(Fig. 4) followed by leptospirosis and malaria. According to the results, a
higher prevalence of diarrheal diseases was reported in men
2
Fig. 1. Flow diagram of the systematic literature search.
Fig. 2. Distribution of published articles by country of origin.
[16,19,24,29–31,39,40,45], except for one study that the incidence of to the healthy people with a confidence interval of 95%
cholera was 10% higher in women [42]. The highest frequency of [24,26,44,45,88].
diarrheal and food-borne diseases was related to dysentery Improper water reservoir (OR: 3.68, 95% CI:2.16–6.27), low eco
[24,30,31,34,37,39,44,45] and cholera [34,39,42]. Also, a higher ratio nomic status (OR: 2.73, 95% CI:1.54–4.82) [23], aged younger than 7
of patients suffering from dysentery, acute and bacterial diarrhea was years (OR: 2.0, 95% CI:1.12–3.54), and being old (OR: 1.87, CI:
reported (OR: 1.17–6.74, 95% CI: (1.03–1.33)-(1.95–23.34)) compared (1.06–3.30)) caused more diarrheal infection in the affected people
3
epidemics after the floods [20,22,29,35,36,38,40,42,46], Cholera with

276 deceased cases was regarded as the main lethal cause among diar
rheal diseases [42].
3.4. Geophysical disasters (Table 2)
3.4.1. Earthquake
The most frequent epidemics reported after earthquakes consisted of
respiratory, digestive, and diarrheal diseases, cutaneous Leishmaniasis,
Malaria, Zika, and Scabies, urinary, parasitic, and ear infections, Hep
atitis A, E, and C, coccidioidomycosis, skin infections, Jaundice Wounds,
and fungal infections.
The incidence of upper and lower respiratory infections explained in
ten articles [48–50,53–55,58,59,61,63], among which pneumonia was
reported in three [49,53,59] and influenza type A in one [54]. Coccid
ioidomycosis spread was mentioned in an article from America that
showed the attack rate of 30/105 and the risk of infection in the affected
people if older than 40 years was (OR: 2.80, 95% CI: 2.10–3.70). The risk
was even more than the healthy unaffected group (OR: 3.00, 95% CI:
1.6–5.4) where they had longer contact with the dust after the disaster
[61].
Gastrointestinal infections and diarrhea were also investigated in 9
articles [48,50,51,53,55,58–60,63]; where gastroenteritis
Fig. 3. Cases distribution of communicable disease after disasters by country
[53,55,58,59], and acute diarrhea [48,50,63] salmonellosis [60] and
of origin.
cholera [51] were the most common epidemics.
Cutaneous leishmaniasis was another infection that was reported in
[45]. four articles from Iran [47,52,64,65]. The average incidence had
In one study, the relative risk of dysentery and typhoid fever was increased 4.4 times in 5 year interval after Bam earthquake compared to
1.29 (95% CI:1.15–1.46), and 1.21 (95% 95% CI:1.17–1.26), respec the same period before the disaster. The highest incidence rate (88%)
tively. This relative risk in 0–4-year-old children was 1.37 (95% was seen in 6-year-old children [64]. Also, the incidence of the infection
CI:1.24–1.52) times more compared to the other ages, in men was 1.08 increased from 58/105 cases in the year before the Fars earthquake to
(95% CI:1.01–1.14) times more, and in farmers was 0.89 (95% 864/105 cases in the year after, that about 70% of infected patients were
CI:0.82–0.97) higher than the other people who did not face floods [30]. 10-year-old children and younger [52].
Eight studies reported the outbreak of leptospirosis Hepatitis A and E outbreaks in Turkey [56,62] and hepatitis C in
[18,20,22,28,34,36,38,41]. One of the most common causes of lepto Pakistan [57] were reported. One study suggested that the prevalence of
spirosis is exposure to floods, swallowing contaminated water, and hepatitis A and E in individuals younger than 17 years was related to
direct contact with water in the presence of wounds in the body socioeconomic conditions, crowded living environments, and family
[22,28,41] as well as contact with animals or their wastes [22,34]. The education levels that would increase in elderly patients [56].
incidence of disease was reported higher in women only in one article Two vector-transmitted diseases were also reported; malaria in Haiti
[20] whereas it was reported to be highly prevalent (OR: 1.92, 95% [66] and Zika in Ecuador [67]. Post-earthquake rising number of Zika
CI:1.24–2.98) in men [28]. Also, in most of the studies, the mean age of cases in affected areas and pregnant women was (OR: 8.0, CI:
the affected population was above 30 [18,20,28,38,41] except for one in (4.4–14.60)) and (OR: 30.0, 95% CI: 3.30–60.50), respectively [67].
which the average between 15 and 29 years old was noted [36]. Scabies was considered in two studies [59,63]. After the earthquake in
Leptospirosis was reported to a greater extent in people who worked in Pakistan, the disease was observed in 31.2% of 12,016 hospital admis
farming and rice cultivation [12,35]. In a study, 60% of patients were sions [63].
housewives or unemployed [36]. Other post-earthquake contagious diseases were urinary [59,63],
The outbreak of malaria was investigated in seven articles parasitic [63], skin [48,59], tetanus [49], jaundice, fungal [59], and
[17,21,23,25,26,34,35]. The highest rate of patients were under 15 conjunctivitis [59,63] infections.
years old and mostly contaminated with P.Vivax species [17]. The The highest rate of infection and mortality was linked to the outbreak
possibility of infection in the affected group was more (OR:3.67, 95% of cholera after the earthquake in Haiti (7436 deaths) of which 580
CI:1.77–7.61) tham unaffected people [26]. deaths were children younger than 5 years old [51].
Except for the aforementioned three common epidemics, some other
outbreaks were also reported: a) respiratory tract infection [19,29,40]; 3.4.2. Tsunami
b) Typhoid fever in general was 1.46 times higher (95% CI: 1.10–1.92) Tetanus, measles, and malaria epidemics after tsunami were studied
in the afflicted population [30,33]. It was significantly more prevalent in in four articles [68–71]. In India, 85 measles cases were reported in
men (OR: 1.61, 95% CI: 1.18–2.22), 0–4-year-old children (OR: 2.39, children younger than 8 years old in the affected areas [69,71]. After
95% CI: 1.02–5.60), individuals aged between 15 and 64 years old (OR: tsunami in Indonesia, 106 tetanus cases were identified resulting to 20
1.57, 95% CI: 1.17–2.11), and farmers (OR: 1.57, 95% CI: 1.12–2.20) deaths, of which 40% aged ≥50 [68]. The number of confirmed malaria
[33]; c) skin infection [29,40]; d) Japanese encephalitis cases [26,46] cases in the Nicobar Islands has increased from 1093 in 3 years before to
that significantly increased from the day 23rd(OR: 2.00, 95% 2562 3 years after the tsunami. Also mentioned was a substantial in
CI:1.14–3.52) after facing the floods [46]; e) higher infection risk of crease in Plasmodium falciparum species from 23% to 53% [70].
hepatitis type A [26,34] (OR:6.11, 95% CI:1.04–35.84) [26], and Hep
atitis E [34,43]; f) eye infections [40] like hemorrhagic conjunctivitis 3.5. Meteorological disasters (Table 3)
(OR: 2.00, 95% CI:1.14–3.52) [26]; g) ear infection [40]; and h) Rift
Valley fever [27]. 3.5.1. Cyclone and heavy monsoon rains
Among all the mortality rates (500 deaths in 10 articles) of infectious Diarrhea, cholera, and dengue fever have been identified as the
4
Table 1
Summary results of included studies (Hydrological disaster and communicable disease epidemic).
1st Author/ Location/ Year Study Design Type of Cases Death Main Result
Pub. Year Disaster Rate
Siddique et al., Bangladesh/1988 Survey Flood 46,740 84 Diarrhea: 34.7%; Respiratory infection:17.4%; Intestinal worm:
1991 10.1%; Skin infection: 5.8%; Eye and ear infection: 4%.
[40] Male: 56.2%; Patients <5 years: 27.5%
Sur et al., 2000 India/1998 Survey Flood 16,590 276 Cholera (V. cholerae O1); Male:45%; Patients <5 years:28%
[42] Attributable Risk (AR): 1.1%; Case Fatality Rate (CFR): 1.7%;
Highest death rate among <5 years (in 12 h: 45%, in 24 h: 55%, in
3 days: 5%)
Kunii et al., Bangladesh/1998 Survey Flood 517 2 Respiratory infection: 46.8%; Diarrhea: 44.3%; Skin infections:
2002 41.0%.
[29] Economic status: (OR) = 2.73 (95% CI: 1.54–4.82, p < 0.001)
Water storage: OR = 3.68 (95% CI: 2.16–6.27, p < 0.001)
Schwartz Bangladesh/ Survey Flood 20,395 6 Diarrhea (Cholera, shigellosis, salmonellosis, rotavirus)
et al., 2006 1988,1998,2004 (2229 V.cholerae from dry season to flood peak: 1988: 25% from 15% (P
[39] patients) ≤ 0.01), 1998: 42% from 20% (P ≤ 0.001); 2004 first epidemic:
23% from 11% (P ≤ 0.001); second epidemic: 41% from 32% (P =
0.03).
Kawaguchi Laos/2006 Cross sectional survey Flood 97 Leptospirosis, prevalence among 406 subjects: OR = 23.9 (95%
et al., 2008 CI: 19.70–28.0, P < 0.001).
[28] 15 serogroups tested: 12 detected
Independent risk factors: male: OR = 1.92 (95% CI: 1.24–2.98);
Median (age): 35 years
Ahmed et al., Pakistan/2010 Cross sectional study Flood 7814 Acute Diarrhea: 30%; Skin and Soft tissue infection: 33%;
2011 Conjunctivitis: 7%; Nose and Throat Infection: 5%; Respiratory
[19] Tract Infection: 21%; Suspected Malaria: 4%.
Males: 60%; Age (16 to 45 years): 48%.
Dechet et al., Guyana/2005 Survey Flood 236 34 236 patients with suspected leptospirosis:
2012 Of the 236 patients, 105 (44%) tested: 2 confirmed, 53 probable,
[22] 50 suspected.
Median age: 32 years; male: 43%
201 patients interviewed:direct contact with flood waters (89%)
Amilasan Philippines/2009 Retrospective Flood 471 51 Leptospirosis:
et al., 2012 Causes of death = pulmonary hemorrhage: 35%; ARDS/SRF: 24%;
[20] Acute Renal Failure: 20%; multiple organ failure/DIC:16%.
Afzal and Pakistan/2010–11 Cross Sectional Flood 2406 Malaria (in children aged ≤15 years)
Sultan, 2013 P. vivax:1562(65%); P. falciparum: 759 (31%); co-infection in 85,
[17] 27 cases of P; falciparum malaria: cerebral malaria.
The most affected age group (5–9 years.): 41%.
Ding et al., China/2007 A time-stratified case- Flood 197 Infectious diarrhea: 64.7% bloody; other type: 29.3%
2013 crossover analysis Male: 63.96%; aged (< 14 years): 59.90%.
[24] Incidence rates (in Fuyang): 2.048/105 and Bozhou: 4.609/105;
The highest incidence rates (in children <4 years): 5.257/105 in
Fuyang and 38.541/105 in Bozhou.
The strongest effect on lag days (lag 2 days in Fuyang): OR = 3.77
(95% CI: 1.65–8.59); lag 5 days in Bozhou: OR = 5.859 (95% CI:
1.44–26.17).
infectious diarrhea after adjusting for other meteorological
factors: OR = 3.17 (95% CI: 1.12–8.95) in Fuyang: OR = 6.75
(95% CI: 1.95–23.34) in Bozhou.
Smith et al., Australia/2010–11 Surveillance Flood 9 Leptospirosis: Median age: 37 years; Male:100%; 2/3 cases:
2013 employed within the agricultural sector; Resident on farms.
[41]
Ding et al., China/2007 Mix-Method study Flood 3683 Malaria: increased risk with flooding alone adjusted hazard ratio
2014 (AHR) = 1.467 (95% CI = 1.257, 1.713), waterlogging alone AHR
[23] = 1.879 (95% CI = 1.696, 2.121), flooding and waterlogging
AHR = 2.926 (95% CI = 2.576, 3.325). Male:58.2%; Age:(<14
years): 22.7%; age (15–59 years):55.4%.
Memon et al., Pakistan/2011 Prospective Flood 74 14 Malaria: 74 (8.38%) diagnosed from 883 patients with symptoms
2014 observational study Overall mortality (18.9%).
[35] High mortality rate in pregnant women and in patients with
complications: pneumonia (P = 0.04); renal failure (P = 0.04);
Unconsciousness (P = 0.001); Septicemia (P = 0.001).
Ni et al., 2014 China/2004–09 Prospective Flood NA Dysentery: significantly different between non-flooded and
[37] flooded months (p < 0.05); in the whole region: Relative Risk (RR)
=1.66 (95% CI: 1.52–1.82).
Agampodi Srilanka/2011 Cross-sectional Flood 32 Leptospirosis: Age: 40 ± 12; gender: Male: 61(63.5%) engaged in
et al., 2014 paddy farming activities: 27 (84.4%).
[18]
Boyce et al., Uganda/2013 Quasi-experimental Flood 1285 Malaria: approximately 30% increased risk of positive test results
2016 design in villages bordering an affected river vs. farther villages
[21]
Zhang et al., China/2007 Symmetric Flood 902 Bacillary dysentery: Median age: 7 years.
2016 bidirectional case- increased risk: OR = 1.84 (95% CI: 1.22–2.78) at 2-day lag;
[45] crossover study
(continued on next page)
5
Table 1 (continued )
1st Author/ Location/ Year Study Design Type of Cases Death Main Result
Pub. Year Disaster Rate
(<7 years: ORs >1 from lag 1 to lag 3); (>7 years: ORs >1 at lag 1
and lag 3)
Gao et al., China/2007 A spatial and temporal Flood 8689 Malaria: 5904 cases, OR = 3.67 (95% CI: 1.77–7.61), Lag days:
2016 analysis OR = 4.62 (95% CI: 2.83–6.41); Diarrhea: 2681cases, OR = 2.16
[89] (95% CI: 1.24–3.78), Lag days: OR = 1.70 (95% CI: 1.29–2.10);
Hepatitis A: 104 cases, OR = 6.11 (95% CI: 1.04–35.84) Huai
River flood (2007), Lag days: OR = 3.75 (95% CI: 1.78–5.72).
Liu et al., 2016 China/2012 Survey Flood 184 Bacillary dysentery: increased risk of infection: OR = 3.27 (95%
[31] CI: 1.299–8.228) in Jishou; OR = 2.21 (95% CI: 1.05–4.65) in
Huaihua
Zhang et al., China / 2007–2012 A time-stratified case- Flood 370 26 Japanese Encephalitis (JE): Median age: 4.2 years; Male/Female:
2016 crossover study 1.3/1
[46] Increased number of JE cases from lag 23–24, the strongest effect
at lag 23: OR = 2.00 (95% CI: 1.14–3.52).
Gudo et al., Southern Cross sectional Flood 20 Rift valley fever Virus:10% case;
2016 Mozambique/2013 Age: 21–36 years; Male:56.7%
[27]
Xu et al., 2017 China/2004–10 Prospective study Flood 18,976 Bacillary dysentery: Two weeks’ lagged effect of flood impact: RR
[44] = 1.17 (95% CI: 1.03–1.33). Weekly numbers of bacillary
dysentery cases: 7–211
Elsanousi Sudan/2013 Observational Flood 7262 Malaria cases and Incidence rate: [(2013:7262 and 8.24), (2012:
et al., 2018 retrospective study 5549 and 6.48)]/105; (2011/5069 and 6.09). Incidence of malaria
[25] increased in both age groups (<5 years and > 5 years) in the 12-
week period of the flood year (P < 0.0001)
Mohd Radi Malaysia/2014 Observational Flood 872 5 Leptospirosis: 12% occurred during and 59% post flood; Age
et al., 2018 ecological study group (15–29 years.): about 1/3 of all; male, Malaysians and/or
[36] Malay race group: 60%; Unemployed/homemaker occupation
category:60%
Liu et al., 2018 China/2005–12 Survey Flood 1682 Typhoid fever: Male/female: 1.44/1; Aged (15–64 years): 69%;
[33] Increased risk (at lag 1 week): RR = 1.46 (95% CI: 1.10–1.92).
Abu and Ghana/2012 Survey Flood 119 Mean Perceived Risk of Diarrhea in Household with at least one
Codjoe, case: 22.94 ± 23.05; Male: 13.28 (20.01%); Female: 8.62
2018 (13.63%); Age: (28.96 ± 12.53); gender: Male: 227 (56.6%);
[16] Female:174 (43.4%).
Louw et al., Nigeria/2012 Mix method Flood 280 Diarrheal outbreak (cholera and dysentery): 47.1%; Typhoid
2019 fever: 21.7%; Malaria fever: 17.5%; Skin rashes: 4.3%; Hepatitis
[34] A: 3.6%; Hepatitis E: 1.1%; Leptospirosis: 1.8%; Schistosomiasis:
0.4%; Other water-related infections: 2.5%.
Interview: Devastating effects on people’s well-being and
derailing the community’s economic development.
Tricou et al., Central African Retrospective Study Flood 745 Hepatitis E: Male:56%; Median age: 23 years.
2020 Republic/2008–12 Seasonal pattern with correlation between HEV incidence and
[43] rainfall in Bangui (~70% positive test in rainy season)
Liao et al., China/2016 A quasi-experimental Flood 359,580 Diarrhea: Dysentery, Typhoid, Other infection
2020 study All-cause daily diarrhea during-flood period, 18 June - 31 Aug
[30] 2016: 7.81/106; post-flood period, 1 Sep; 2016–31 Aug. 2017:
6.10/106; During-flood: increased risk of dysentery; Post-flood:
increased risk of all diarrheal infections.
Rajendran India/2018 Survey Flood 133 2 Leptospirosis: Males: 79 (59.4%); Females: 54 (40.6%).
et al., 2021 Max. cases (41–50 years): 24.81%.
[38]
Liu et al., 2020 China/2005–12 Survey Flood 407 Acute Hemorrhagic Conjunctivitis (AHC): Attack rate: 198.461/
[32] 105; Increased morbidity risk of AHC: RR = 2.136 (95% CI:
2.109–2.163).
The attributable Years lived with disability (YLD) / 1000 of AHC:
0.0434 (95% CI: 0.0425–0.0442); The highest YLD/ 1000 of AHC:
ages 5 and 14 years; Females and youngsters; more vulnerable to
the flood-related disease
predominant communicable diseases after cyclonic events and Dengue fever was reported in China with the highest pathogenicity
monsoons. rate among 18 to 59-year-old patients. The risk of infection spread has
Five articles investigated diarrheal disease [72–74,76,77], where risen (OR: 1.62, CI: (1.45–1.80)) when exposed to tropical storms [75].
being a child (<5 yrs) [74], and rainfall >50 mm [73] were among the
risk factors. The infection risk was higher in the affected people after 25 3.5.2. Hurricanes and storms
(OR: 3.25, 95% CI: 1.45–7.27)) and 50 (OR: 3.05, 95% CI: 2.20–4.23)) Post-storm/hurricane epidemics encompassed gastroenteritis, infec
milimeters of monsoon rains [73]. The contingent diarrheal infection tious diarrhea, respiratory infection, Dengue fever, urinary tract infec
has augmented (OR: 1.35, CI: (1.14–1.60)) in the presence of heavy tion, soil-borne parasitic and helminth infections, leptospirosis, and
monsoon rains, as well [74]. The unavailability of hygienic clean water sexually transmitted diseases.
resulted to the Cholera epidemic in India [74,76]. Bacillary dysentery In the Philippines, the outbreak of gastroenteritis and diarrhea was
epidemics are also significantly more possible (OR: 2.30, 95% CI: described after Typhoon Haiyan [79,82] whereas 72% of patients used
1.81–2.93)) in people who encountered tropical storms and heavy rains unsterilized water sources. The risk of acute diarrhea and gastroenteritis
[73]. in the storm-affected areas was higher with no sanitized water sources
6
Fig. 4. Distribution of types of communicable diseases after disasters.
(OR: 18.2, 95% CI: 4.8–68.8), inappropriate drinking water (OR: 2.4, infections specifically gonorrhea and chlamydia cases have risen from
95% CI: 0.25–22.6), and toilets (OR: 0.6, 95% CI: 0.14–2.67)). Mean 2.3% up to 5.1% and from 12.4% up to 14.1%, respectively [81].
while, after the hurricane, several gastroenteritis cases rose up to 7 times
in adults and 4.5 times in children compared to the same period before 3.5.3. Heat waves
that disaster [82]. A study from Vietnam showed that the risk of Dengue fever has been
Pneumonia has intensified 3.6 times in adults and 2.7 times in dramatically increased up to 85% among people suffering from heat
children and Dengue fever boosted 7.6 and 20 times in adults and wave stroke. The risk of infection after exposure to the temperatures
children, respectively [79]. The most prevalent soil-borne parasitic and 22.6, 24.1, and 1.33 degrees would rise (OR: 1.85, 95% CI: 1.44–2.39),
helminth infections were caused by Ascaris, trichorrhiasis, and Ring (OR: 1.40, 95% CI: 1.22–1.61), and (OR: 1.83, 95% CI: 1.09–3.08),
worm which have been observed in 431 cases in the aftermath of storms respectively [83].
[78].
Leptospirosis was another post-hurricane contagious epidemic in
which 14 deaths and 259 patients who had skin wounds with direct 3.6. Climatological disasters (Table 4)
exposure to contaminated water and/or animal excrement were regis
tered [80]. In the United States after Hurricane Katrina in the New 3.6.1. Drought
Orleans area, it was also observed that the rate of sexually transmitted The epidemics of diarrhea [84], Scabies [85], Dengue fever [86], and
yellow fever [87] have been observed after the drought. The attack rate
7
Table 2
Summary results of included studies (Geological disasters and communicable disease epidemic).
1st author/Pub. year Location/year Study design Type of cases NO. Main Result
disaster Death
Schneider et al., 1997 USA/1994 Case control study. Earthquake 203 3 Coccidioidomycosis: RR (age ≥ 40 years) = 2.8 (95% CI:
[61] 2.1–3.7, P < 0.001) dust cloud exposure: OR = 3.0 (95% CI:
1.6–5.4, P < 0.001)
Total Attack Rate (AR): 30/ 105; AR: Race (Asian, Pacific): 43/
105; Race (White, non-Hispanic): 37/105; Age: (≥40 years):
52/105; Sex: (male) 34/105.
Sencan et al., 2004 Turkey/1999 Cross sectional study Earthquake 476 Hepatitis A (HAV) and hepatitis E (HEV) in children (2–15
[62] years.)
HAV prevalence (living in Düzce and Golyaka temporary
houses): 44.4 and 68.8% respectively, OR = 0.37 (95% CI:
0.22–0.61, p = 0.0005).
HEV prevalence: 4.7 and 17.2% respectively, OR = 0.24 (95%
CI: 0.11–0.51, p = 0.0007).
Kaya et al., 2008 Turkey/2003 A prospective study Earthquake 589 Hepatitis A and E in children (6 months to 17 years.)
[56] The sero-prevalence rates of hepatitis A: 63.8%; hepatitis E:
0.3%; both increased with age, no significant difference in
genders (P > 0.05).
Hepatitis A: crowded living environment and education level
of the family (P < 0.01), hepatitis E: not related to these
factors (P > 0.05)
Khan et al., 2008 Pakistan Cross sectional study Earthquake 24 Hepatitis C (HCV)
[57] 2005–06 1 round HCV antibody positive by ELISA)245 subjects): 8
(3.26%); Male: 155 (63.3%) from positive cases.
2 round (11 months after earthquake): 16 (5.51%); HCV
antibody positive from 290 subjects. Positive Males: 136
(46.9%).
Bai and Liu, 2009 Pakistan/2005 Cross sectional study Earthquake 423 Upper respiratory infection: 329 (14%); Diarrhea: 94 (4%);
[50] Wound infection among the injured patients; Adults:(Male:
72%; Female: 64%); children: 78%.
Shah et al., 2010 Pakistan/2005 Retrospective study Earthquake 12,016 Viral upper respiratory tract infection (URTI): 42%; Scabies:
[63] 31.2%; Urinary tract infection (UTI): 10%; Bacterial
URTI:4.2%; Diarrhea: 5.5%; Otitis media: 3.45%;
Conjunctivitis:1.95%; Parasitic infestation:1.7%; Male:
43.8%.
Fakoorziba et al., Iran/2003 Case-control Earthquake 836 Cutaneous Leishmaniosis:58 cases/105–864 /105
2011 (2002–2004) aged ≤10 years: 70%.
[52]
Sharifi et al., 2011 Iran/1999–2008 Survey Comparative Earthquake post-earthquake mean annual incidence of anthroponotic
[64] Evaluation of Pre- / Post- cutaneous leishmaniasis (ACL): 7.6/1000; pre-earthquake
Earthquake mean annual incidence of ACL: 1.9/1000; Most infected: Age
(<20 years); Males: 56.3%.
Sharifi et al., 2011 Iran/2008 Survey Earthquake 204 Cutaneous Leishmaniosis: 3884 examined
[65] Highest rate (P = 0.0001): Age (≤10 yrs.); overall prevalence
rate: 5.3%; Female: 6.3%; Male: 4.3%; face lesions: 47%; one
lesion: 77.9%.
Townes et al., 2012 Haiti/2010 Survey Earthquake 317 Malaria: 1629 suspected patients, (96%) rapid diagnostic tests
[66] (RDTs): positive result: 317 (20.3%).
Male: 55.2%; Age: 8.2% (< 5 years); 27.4% (5–14 years);
61.2% (>15 years); positive and pregnant: 3.5%.
Barzilay et al., 2013 Haiti/2010–12 Survey Earthquake 604,634 7436 Cholera (V. cholerae O1, serotype Ogawa, biotype El Tor)
[51] Hospitalization: 329,697; cumulative attack rate: 5.1% in first
and 6.1% in second year; Age (<5 years): 78,938 (13.1%);
hospital admission: 34,394 (10.4%); deaths: 580 (7.8%);
Cumulative fatality rates in 2-year: 0.6% - 4.6%.
Aoyagi et al., 2013 Japan/2011 Retrospective Earthquake 81 Pneumonia: (81.5%); skin and subcutaneous tissue infection
[49] (i.e. tetanus): 18.5%; Double number of hospitalizations after
the first week comparing to the same period in 2010; Highly
prevalent in elderly patients (median age: 78 years)
Aflatoonian et al., Iran/2010 Survey Earthquake 67 Cutaneous Leishmaniosis: interviewed and physically
2013 examined for active lesions or scars: 5544; infected: 1.2% of
[47] the inhabitants, active: 0.5%, scars: 0.7%; female: 1.7%,
males: 0.8% (P = 0.003); age groups: equally affected; face
lesions: 37%.
Kawano et al., 2014 Japan/ 2011 Retrospective Study Earthquake 418 Acute Respiratory Infection (ARI) (in 37 shelters)
[55] and tsunami Cumulative incidence rate of ARI:
Into the crowded shelters (mean space<5.5 m2/per person):
5⋅4/10000 person-days, interquartile range (IQR) 0–24⋅6, P =
0⋅04
Into the non-crowded shelters (mean space>5.5 m2/per
person): 3⋅5/10000 person-days, IQR 0–8⋅7
Daily incidence rate of ARI:
crowded vs. non-crowded shelters: 19⋅1/10000 person-days
(95% CI 5⋅9–32⋅4, P < 0⋅01)
(continued on next page)
8
Table 2 (continued )
1st author/Pub. year Location/year Study design Type of cases NO. Main Result
disaster Death
Kamigaki et al., 2014 Japan/2011 Survey Earthquake 105 Influenza A (H3N2) in 5 evacuation centers (ECs)
[54] Mean AR: 5.3% (range, 0.8%–11.1%); Male-to-female ratio of
confirmed cases: 0.88; Majority of cases: aged 15–64 years
Malla et al., 2016 Nepal/2015 Prospective Earthquake 122 Acute gastroenteritis: 23.7%; URTI: 20.6%, Impetigo: 16.5%,
[59] observational study UTI: 8.2%, Conjunctivitis: 6.5%, Pneumonia: 6.5%, Scabies:
6.5%, Tinea fungal infection: 9%, Chicken pox: 2.5%. Most
common infectious disease pattern: 82% in children
Nigro et al., 2016 Italy/2013 Survey Earthquake 155 Salmonellosis: Male: 47%; Age (1–15 years.); Children
[60] hospitalized: 28.4%
Lachish et al., 2016 Nepal/2015 Survey Earthquake 106 Gastroenteritis:73 (53%); Acute Respiratory Infection (ARI):
[58] 22 (16%); Fever: 11 (8%); Age: 35 ± 9.1; Male:109 (79%).
Vasquez et al., 2017 Ecuador/2016 Survey Earthquake 143 Zika: Male: 44%; Females: 67.8%.
[67] Cumulative incidence: 11.1/105 in affected vs. control area (P
< 0.01): 1.79/105; Living in the affected area + ZIKA: OR =
8.0 (95% CI: 4.4–14.6, P < 0.01); Pregnant women + ZIKV:
OR = 30.0 (95% CI: 3.3–60.5, P < 0.01) in the affected area
Giri et al., 2018 Nepal/2015 Earthquake 586 3 Pneumonia: 26.6%; Gastroenteritis: 2.6%; Respiratory
[53] Infections: 33.8% and other infections: 37%
Almira and Hidajah, Indonesia/2018 Cross sectional study Earthquake 450 89 ARI: 23%; Diarrhea: 15%; Skin infection: 6%; 1 Measles, 4
2020 Varicella suspects; Female patients: 52%
[48]
Aceh Epidemiology Indonesia/ Survey Tsunami 106 20 Tetanus
Group, 2006 2004 Male: 63.2%; median age:40 years; age < 5 years: 6.6%
[68] CFR: 18.9%; ≥50 years: 40.0%
Mohan et al., 2006 India/2004–05 Cross sectional study Tsunami 71 Measles attack rate:1.3 /1000; Onset date (14 days after
[71] tsunami): 42% of affected villages; Median age of patients: 54
months
Manimunda et al., Nicobar group of Retrospective Analysis Tsunami 2562 Malaria (2005–2008): large increase in the incidence of
2011 Islands/Dec. malaria/ Plasmodium falciparum: 23% to 53%;
[70] 2004 Endemic area: high transmission setting, high-risk area for
malaria. The significantly higher (P < 0.01) monthly
incidence of malaria during January, February and March
2008 among migrant laborers
Balasubramaniam and India/2005 Survey Tsunami 14 Measles = 51.85%
Roy, 2012 Age: 3–8 years
[69]
of 17.5% for diarrheal disease was seen in very young children (< 2 earthquakes cited the outbreak of respiratory diseases caused by bio
years). Children with diarrhea were significantly more (OR: 12.8, 95% logical factors, including upper respiratory system infection, pneu
CI: 9.3–17.7)) exposed to the drought crisis. The risk of infection in monia, influenza type A, and Coccidiomycosis-induced lung infection
adults with low personal hygiene was also (OR: 3.0, 95% CI: 1.5–6.1)) (the native disease of South America and Mexico). Inadequate physical
more than a healthy population with no exposure [84]. The risk of distance between people, overcrowding, living in camps, insufficient/
Dengue fever was also higher (OR: 1.60, 95% CI: 1.33–1.92) in affected inappropriate ventilation, and deficiencies in health care were the
urban areas [86]. triggering factors that have predominantly precipitated respiratory in
The results about yellow fever suggested that men (OR: 2.58, 95% CI: fections following a seismic event. Based on these findings, the affected
2.28–2.92), at working age (OR: 2.03, 95% CI: 1.76–2.35)), living in people, residents of emergency accommodation camps, and those living
urban areas (OR: 5.02, 95% CI: 3.76–6.69) would be more infected if in communal settings are recommended to keep adequate physical space
faced with drought [87]. The Scabies incidence rate also went up to 60% as part of preventive measures against the spread of communicable
in adolescents (<18 years) and 51.6% in women [85]. diseases in post-disaster situations.
Furthermore, Table 5 delineates the most significant risk factors Air ventilation and air circulation are essential for preventing the
influencing disease outbreaks following disasters, as determined by the increase in pathogen load and reducing the risk of disease transmission.
results and categorized by disease type. Additionally, distributing face masks among individuals is highly rec
ommended if necessary.
4. Discussion Active screening and the establishment of a syndromic surveillance
are essential to identify the patients, control or restrict contacting to the
The present study is a systematic scoping review of published articles individuals who have suspected symptoms, and provide immediate
to investigate the influencing factors and recommendations of the treatment for the infected ones. Educating people about personal hy
communicable diseases outbreak after natural disasters. The majority of giene practices, frequent handwashing, and reporting symptoms in
the reviewed papers have studied the epidemics following floods and themselves or their close contacts is emphasized. Additionally, health
earthquakes. The Incidence of gastrointestinal, all kinds of diarrhea, and authorities must plan and provide the necessary hygiene supplies for
respiratory infections were the most prevalent post-disaster outbreaks. individuals.
This study identified the significant risk factors as follows: the type and Another finding of this study is the outbreak of diarrheal diseases
nature of the hazard, the geographical location, the socioeconomic after the earthquake.When such disasters occur, the predisposing factors
status of the affected area, the age and gender of the afflicted population, to diarrhea infection could be the disruption in access to healthy clean
the state of disaster management, and the preparedness level. water, inadequate cleaning of dishes, improper hand washing after toilet
Earthquakes are the most common geophysical disasters; therefore, and before eating, decreased adherence to preventive and sanitary
their subsequent epidemics and the number of related publications were behavioral principles, having contaminated foods, insufficient cooking
considerable. About half of the studies on communicable diseases after of food, and so on.
9
Table 3
Summary results of included studies (Metrological disasters and communicable disease epidemic).
First author/ Location/year Study design Type of cases NO. Main Result
publication year disaster Death
Bhunia and Ghosh, India/2009 Case control study Cyclone & 1076 14 Cholera (AR / 104): <5 years: 54%; ≥45 years: 53%.
2011 rain fall Male: 54.8%, AR: 47%.
[72]
Deng et al., 2015 China/ Unidirectional Cyclone & Bacillary dysentery and other infectious diarrhea in seven tropical
[73] 2005–11 case-crossover typhoon cyclones.
Typhoons: the greatest impacts on bacillary dysentery on lag 6 days: OR
= 2.30 (95% CI: 1.81–2.93) and lag 5 days: OR = 3.56 (95% CI:
2.98–4.25).
Tropical storms: highest impacts on lag 2 days: OR = 2.47 (95% CI:
1.41–4.33) and lag 6 days: OR = 2.46 (95% CI: 1.69–3.56).
Tropical cyclone: a risk factor for both bacillary dysentery: daily
precipitation reached 25 mm and 50 mm with the largest: OR = 3.25
(95% CI: 1.45–7.27) and OR = 3.05 (95% CI: 2.20–4.23).
Mukhopadhyay India/2015 Survey Heavy 3003 Diarrhea: 164 cases under the surveillance; All age groups;(<5 yrs.):
et al., 2019 rainfall ≈25%. The most commonly isolated organism: V. cholerae O1
[76]
Rafa et al., 2021 Bangladesh/ Survey Cyclone – Diarrhea:42.5%; Skin infection: 42.5%; Dysentery: 7.5%; Eye irritation:
[77] 2020 10%; Jaundice: 2.5%; Other diseases: 22.5%.
No diseases after cyclone: 7.5%.
Li et al., 2021 China/ Case-crossover Tropical 47,784 – Dengue fever: (20 tropical cyclones) Increased risk: RR = 1.62 (95%
[75] 2013–18 study cyclones CI:1.45–1.80), lag 5 day. 18 and 59 yrs. old: 78.9%; No difference in effect
estimates between genders.
Deshpande et al., Ecuador/ Survey Heavy 33,927 – Diarrhea: Male: 49.9%; Patients: <5 years old: 61.4%; Heavy rainfall
2020 2013–14 rainfall events (HREs) with dry antecedent conditions: elevated incidence vs.
[74] Similar conditions without HREs: RR = 1.35 (95% CI:1.14–1.60);.
Ventura et al., 2015 Haiyan, Case-control Hurricane 105 Acute gastroenteritis
[82] Philippines &typhoon Male:51%; Median age: 2 years; The most affected age group: 1 to 5 years:
49%.
Factors associated with acute gastroenteritis: Untreated drinking-water
OR = 21.7 (95% CI:7.6–62.1); Toilet facility: OR = 6.4 (95% CI:
1.3–32.9); Water Source: OR = 5.0 (95% CI: 1.2–20.1).
Chang et al., 2016 Haiyan, Surveillance Hurricane 672 Gastroenteritis: 44%; Respiratory infection (Pneumonia, Tuberculosis):
[79] Philippines &typhoon 41.4%; Dengue Fever 6.4%; UTI 8.2%.
Belizario et al., 2021 Philippines Cross-sectional Hurricane 437 soil-transmitted helminth infections (Ascaris lumbricoides, Trichuris
[78] Study &typhoon trichiura, and the hookworms)
Schistosomiasis: preschool-age children: 166; school-age children: 271
Nsuami et al., 2009 New orlean, Screening Hurricane – Screened (346: 60.1% males; median age 17.0 years) before, (333: 54.1%
[81] USA &typhoon males; median age 17.0 years) after hurricane.
The prevalence of gonorrhea: 2.3% (8/346, 95% CI: 1.3% -4.6%) before;
5.1% (17/333, 95% CI: 3.1% - 8.2%) after Hurricane.
Gonorrhea in female: OR = 2.6 (95% CI 1.0–6.3; p = 0.04), with
chlamydia infection: OR = 9.2 (95% CI 3.9–21.7; p < 0.001).
Mendoza et al., Philippines/ Cross sectional Typhoon 259 14 Leptospirosis:591 probable cases; Mean age: 38.9 years; males: 82%;
2013 2009 Causes: Waded/Swam in flood waters, 253 (98.0%); Swallowed flood
[80] water: 58 (22.4%); Presence of wound: 95 (37.3%); Exposure to animal
carcass: 39 (15.0%).
Cheng et al., 2020 Vietnam/ Survey Heat waves 55,801 0 Average Dengue fever: 119 / week.
[83] 2008–16 large outbreak: 59.9%; medium: 22.9%; small: 12.7%,
The largest effect estimates: small outbreaks: 24.1 ◦ C, RR = 1.40 (95%CI:
1.22–1.61); medium outbreaks: 33.1 ◦ C, RR = 1.83 (95% CI: 1.09–3.08);
large outbreaks: 22.6 ◦ C, RR = 1.85 (95%CI: 1.44–2.39).
The impact of the disaster on the increased incidence of cutaneous reports of measles, malaria, and tetanus after tsunamis which has not
leishmaniasis in Iranwas reported [47,52,64,65] besides the environ been investigated in any previous review studies so far. Diaz’s study
mental factors like the weather conditions, temperature, rainfall, pre reported several infections (skin and systemic) in the tsunami survivors
cipitation, and humidity that have been explained to determine the and affected people [93]. Mavroli et al. explained the severely injured
severity of this skin infection [90]. Aflatoonian et al. explained that the survivors of earthquakes and tsunamis are exposed to a large number of
improper environmental and health conditions, individual and behav pathogens in soil and water which makes the preventive and protective
ioral changes, and entry of an unsafe population following the Bam measures necessary [94]. Reduced physical distance, staying in camps,
earthquake activated the old foci and induced new emerging foci of this and disrupting the common health routines in the affected people are
epidemic [91]. Rostamian et al. have also suggested the population considered the risk factors that increase the incidence of the afore
displacement caused by natural disasters could expose people to mentioned infections, as well as contact with contaminated soil or being
mosquitoes (leishmaniasis vector) and increase the incidence of the bitten by wild animals (in tetanus). Enhancing vaccination coverage,
infection. Therefore, it is essential to provide certain protocols to pre improving wound care treatment, and establishing a regular surveil
vent and control the risk of infection after natural disasters in countries lance system, in addition to competent disaster management, and
where the disease is endemic. These protocols should include practical providing supportive care according to the national guidelines could
instructions for using an appropriate mosquito net to prevent bites, prevent post-disaster Tetanus outbreaks, as Pascapurnama has also
constructing temporary safe shelters, educating the affected population, declared. Moreover, health education is required to inform the com
and treating the infected people [92]. munities how to reduce the risk of tetanus [95].
Despite the rare prevalence, we found and analyzed the outbreak It is indispensable that health policymakers and disaster risk
10
Table 4
Summary results of included studies (Climatological disasters and communicable disease epidemic).
First author/ Location/year Study design Type of disaster cases NO. Main Result
publication year Death
Emont et al., Tuvalu, South Epidemiological Drought 244 Diarrhea: Male: 51%; AR: 3.93% (from 1.5% for >65 years to
2017 Pacific Island, Investigation 17.5% for 0–2 years); Risk in children (0–2 yrs.): 12.8 (95% CI:
[84] 2011 9.3–17.7) times more than (> 15 yrs.) individuals.
Risk factors: Water tank level < 20% full, OR = 2.31 (95%
CI:1.16–4.60); Decreased frequency of handwashing: OR = 3.00
(95% CI:1.48–6.08).
Enbiale and Ethiopia/2015 A cross-sectional Drought 379,000 Scabies: screened 1,125,770 individuals; Male:48.4%; <18 years
Ayalew, 2018 house-to-house census of age: 60% of confirmed cases;
[85] Of the 474 subjects: 6 (98.3%) confirmed cases by a
dermatologist
Lowe et al., 2021 Brazil/2001–19 Spatiotemporal Drought (and 12,895,293 0 Dengue fever: increased risk 0–3 months after extremely wet
[86] modelling study wet condition) conditions (maximum RR at 1 month lag): RR = 1.56 (95% CI:
1.41–1.73) and 3–5 months after drought conditions (maximum
RR at 4 months lag): RR = 1⋅43 (95% CI:1.22–1.67)
Rosser et al., Brazil/2017–18 Survey Drought 2097 0 Yellow fever (YFV): Confirmed cases: increased in men: OR =
2022 2.58 (95% CI: 2.28–2.92); working age: OR = 2.03 (95% CI:
[87] 1.76–2.35); recent travel from an urban to a rural area: OR = 5.02
(95% CI: 3.76–6.69).
managers should be prepared enough and take the necessary measures mainly caused by Plasmodium vivax and then Falciparum. This is
to prevent respiratory, gastrointestinal, and vector-borne epidemics consistent with what Suhr et al. and Agunwamba et al. found about the
based on the existing standards and guidelines before geophysical di association of close physical distance to wetlands with an increase in
sasters happen. These measures include implementing strategies to Malaria [100,105]. According to Ding et al., climate variables in floods
control carriers, ensuring the maintenance of appropriate physical and inundation are important environmental drivers of transmission,
distancing, conducting active screening of individuals with symptoms, because they can affect the growth and reproduction rate of mosquitoes,
isolating people having respiratory and gastrointestinal symptoms from the activity time pattern of the population, and the life cycle of Plas
healthy ones, prompt diagnosing and treating patients, delivering health modium which leads to a higher burden of the disease. Therefore, public
education to affected populations, providing safe sanitary water and the health measures are necessary to prevent and control the potential risk
supplementary items and necessities for hygiene and washing, equip of malaria epidemic after these hydrological disasters [23]. The World
ping with nets and repellants for insects, improve the environment, and Health Organization has provided the following recommendations to
continuous monitoring of the health status of the affected community. control malaria in flooded areas: spraying camps with appropriate in
secticides, using mosquito nets impregnated with insecticides, covering
4.1. Hydrological disasters water storage containers, removing water from garbage, Larvicide in
areas with surface freshwater sources, proper garbage disposal and
Here, the reviewed articles on post-flood communicable diseases collection [106].
mainly showed the escalation in diarrheal epidemics: shigellosis, In general, disaster risk managers and health policymakers must
salmonellosis, and typhoid. These results are in line with the previous prioritize the implementation of preventive measures against gastroin
findings [95–100]. Disruption in the public access to healthy sources of testinal epidemics, Leptospirosis, and Malaria before hydrological di
drinking water, contaminated water ponds, mixed water with sewage, sasters occur. This is crucial because the disruption of water supply
using polluted surface water, reduced preventive hygiene measures such sources and the possibility of shuffling sewage, especially for drinking
as washing hands after toilet and before eating, biological contamina water in areas where people use natural water sources (wells, springs,
tion of food, and improper washing dishes were cited as the major causes rivers, etc.) and do not have access to piped water, will increase the
of diarrheal diseases after floods. Children and the elderly are more possibility of diarrheal diseases and infections that are transmitted
vulnerable to the aforementioned infections. Therefore, it is necessary to through orofecal route in the affected population. The strict imple
take preventive measures which entail providing sanitary water and mentation of WASH programs can be placed as the main priority in the
educating parents about adherence to health recommendations espe prevention of gastrointestinal diseases, specifically in hydrological di
cially frequent hand washing after defecation and before any eating sasters. Considering the possibility of leptospirosis spread, the necessary
and/or drinking, etc. to diminish or impede the infection spread in these preventive measures of WHO guidelines should be prioritized in makind
groups. Wolf et al., have also concluded that health interventions that health policies. Furthermore, it is recommended to identify the species
cover water sanitation improvement programs, hand washing with soap, that carry leptospirosis within the high-risk region before disasters. This
and other hygienic measures following the WASH program can reduce measure proactively aims to enhance the preventive efforts for post-
the risk of diarrheal diseases in low and middle-income countries [101]. disaster outbreaks through improved understanding and strategic
Our study indicated a notable rise in Leptospirosis outbreak after planning. The prohibitory recommendations of the WHO for malaria
floods which were in accordance with the results of previous review emphasize the implementation like drying the bogs, using larvicides,
studies [96,98,100,102,103]. Humans become infected through direct and appropriate window nets.
contact with animal hosts (rodents, domestic pets, and cattle) or through
an environment contaminated with animal urine. In floods, increased 4.2. Meteorological disasters
transmission is likely to be multifaceted, involving closer contact be
tween animal hosts and humans, direct contamination of floodwaters, The outbreaks of cholera, bacillary, and other diarrheal diseases
and impairment of water and sewage infrastructure [104]. Considering have been reported after storms and heavy rain. Kraay et al. showed that
the mechanism of transmission, it is recommended that providing clean heavy rains were associated with a rise in diarrheal cases. Inadequate
water in flood conditions and preventing contact with or drinking un sanitation infrastructure, unavailability of WASH program facilities,
clean water should be the priority for health service providers. along with no access to healthy water, direct exposure to and use the
Malaria is the other post-flood prevalent communicable disease contaminated water have been proposed as the most important risk
11
M. Saatchi et al.
Table 5
The most important risk factors of epidemics of communicable diseases after disasters.
Waterborne Diseases Airborne diseases Vector-borne disease Rodent borne Other infectious
Major risk Diarrhea Cholera Leptospirosis Hepatitis Typhoid Gastroenteritis ARI Measles Coccidiomycosis Malaria Dengue Zika Yellow Japanese Scabies Rift Leishmaniosis Tetanus Skin Urinary ENT
factor (Influenza, Fever Fever encephalitis Valley Infection Infection
following Pneumonia) Fever
natural
disasters
Socio- ✓ ✓
Economic
Status
Poor Water ✓ ✓ ✓
Supply
Low ✓ ✓ ✓
Sanitation
& hygiene
Poor food ✓ ✓
security
Sex ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Water ✓ ✓
Recession
Exposure to ✓
dust
Exposure to ✓ ✓
water
12
Exposure To ✓
Animal
Age ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Place ✓ ✓ ✓ ✓ ✓
Occupation ✓ ✓ ✓ ✓
Temperature ✓ ✓
Moisture ✓
Race ✓
Low ✓ ✓
Education
Poor ✓ ✓
Sanitation
Vaccines ✓
Coverage
Injury ✓
Co-Exist ✓
Disease
Precipitation
Progress in Disaster Science 23 (2024) 100334

✓
Rate
Poor health ✓
services
Increase of ✓ ✓ ✓ ✓ ✓
lag days
factors [98]. Based on Saulnier et al., gastrointestinal infections increase conditions increase the proliferation and also the capabilities of vectors
after the storm [99]. A higher risk of Dengue fever has also been re in the remaining water ponds [114] like Sugg et al. that also noted it as
ported [75,107] Which was in line with what Viana et al. declared with one of the risk factors for the infections that are transmitted through
strong relation to meteorological variables (rainfall and temperature) water, food, and vectors in such natural disasters [115].
[108]. Velu et al. also explained the role of various factors such as the
amount and pattern of rainfall in the outbreak of mosquito-borne dis 5. Conclusion
eases (Dengue fever transmitted by Aedes mosquito) in Zambi [109].
The outbreaks of gastroenteritis and diarrheal diseases, respiratory The significant risk factors in the outbreak of communicable diseases
infections, yellow fever, urinary infections, parasitic disorders, and after natural disasters that should be considered by policymakers and
Dengue fever following hurricanes and typhoons have also been docu disaster risk managers were presented as follow: the destruction of vital
mented. The transportation of dust and dirt particles, as well as frequent and sensitive infrastructures such as sanitary water supply and collec
and prolonged exposure to them, might be regarded as notable risk tion and disposal of sewage and waste, disruption in supply and access to
factors for the mentioned diseases. According to Saulnier et al., the healthy food, using unsafe and unhealthy sources of water and food,
transmission of infectious diseases is primarily associated with the in reduced air quality due to dust and other pollutants, gatherings, and
direct consequences of floods or storms. The reported epidemics have overcrowding in small places and shelters without proper ventilation
been attributed to water contamination, overcrowding in shelters, facilities, shortage of physical distance between people, using shared
displacement of population, and poor sanitation. Hence, public health dishes and equipment, disruption in providing health services and care,
interventions should be directed towards preventing the spread of these decreased level of compliance with health behaviors and preventive
infectious outcomes [99]. measures in the affected population. This could help prevent post-
Considering the oral-fecal transmission of diarrheal diseases, neces disaster contagious disease epidemics and the subsequent creation of
sary prohibitory measures should be taken such as controlling trans secondary crises.
mission routes, ensuring sanitary water and healthy food supply, Based on the results of this research, it is recommended to accurately
preventing consumption or contact with unsanitary water, providing identify the region’s health problems, environmental conditions and
hygiene items and detergents like soap, educating to wash hands after endemic diseases in preventive planning before disasters occur, and get
using the toilet and before eating or drinking, and using fast and effec prepared as much as possible to deal with their outbreaks during
tive treatments such as oral rehydration therapy. disasters.
Health planners and policymakers should consider the existence of
vector-borne diseases like Dengue fever, yellow fever, and chikungunya CRediT authorship contribution statement
(Aedes mosquito) in the region before the meteorological disasters
occur; therefore, the measures that control the mosquito population Mohammad Saatchi: Writing – review & editing, Supervision,
(spraying insecticides, improving the environment, etc.), as well as the Project administration, Methodology, Conceptualization. Hamid Reza
important preventions to reduce the exposure and bites (using suitable Khankeh: Writing – review & editing, Supervision, Conceptualization.
nets and insect repellants and lotions), should carefully be attended. Javad Shojafard: Writing – original draft, Investigation. Arvin Bar
zanji: Writing – original draft, Investigation. Maryam Ranjbar: Writing
4.3. Climatological disasters – original draft, Investigation. Narges Nazari: Writing – original draft,
Investigation. Mohammad Azim Mahmodi: Writing – original draft,
This category includes extreme temperature changes (heat wave, Investigation. Shokoufeh Ahmadi: Writing – original draft, Investiga
cold wave, and extreme winter conditions), drought, and fire (forest, tion. Mehrdad Farrokhi: Writing – review & editing, Supervision,
land). Only one study was found that reported the outbreak of Dengue Conceptualization.
cases following the heat wave [83]. Alteration in the mosquito popu
lation due to changes in temperature and humidity and the access to Declaration of competing interest
water sources for insects can be considered as noteworthy risk factors.
Jia et al. reported that a heat wave event facilitates population growth in There is no conflict of interest and the authors declare that they have
the initial stage, but tends to have an overall inhibitory effect which is no financial or personal ties that may have biased the research presented
affected by two main factors associated with the rise in the mosquito in this paper.
population: the time of an unusual heat wave onset and a relatively high
temperature in a long period [110]. Data availability
The outbreak of communicable diseases after drought (diarrheal
diseases, dengue fever, yellow fever, and scabies) was described. Malik Review article.
et al. found a relation between temperature, climate, and weather with
the prevalence of diarrheal diseases, but not as the main cause. The References
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Progress in Disaster Science 23 (2024) 100334

Contents lists available at ScienceDirect

Progress in Disaster Science

Communicable diseases outbreaks after natural disasters: A systematic

2.2. Search strategy 3.2. Characteristics of the included articles

Fig. 1. Flow diagram of the systematic literature search.

Fig. 2. Distribution of published articles by country of origin.

epidemics after the floods [20,22,29,35,36,38,40,42,46], Cholera with

3.4. Geophysical disasters (Table 2)

Fig. 4. Distribution of types of communicable diseases after disasters.

Progress in Disaster Science 23 (2024) 100334

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