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How infectious are dead bodies?

Wednesday, January 05, 2005

Transmission of infection requires the presence of an infectious agent, exposure to that agent, and a susceptible host. It is, therefore, possible to characterise the infectious risk from dead bodies following a natural disaster by considering these elements.

The human body is host to many organisms, only some of which are pathogenic. When the body dies, the environment in which pathogens live can no longer sustain them. However, this does not happen immediately, and transmission of infectious agents from a cadaver to a living person may occur.

Infectious hazards for individuals who routinely handle cadavers include tuberculosis, group A streptococcal infection, gastroenteritis, transmissible spongiform encephalopathies (such as Creutzfeldt-Jakob disease), hepatitis B, hepatitis C, HIV infection, and possibly meningitis and septicemia (especially meningococcal). Micro-organisms involved in the decay process (putrefaction) are not pathogenic.

Do victims of natural disasters have these infections when they die? Usually disaster victims die from trauma, burns, or drowning, and they are no more likely than the local population to have acute infections (meningitis and septicemia) or rare diseases (eg Creutzfeldt-Jakob disease).

Instead, where disease is present, it is far more likely to be due to chronic infections with blood-borne viruses (hepatitis B virus, hepatitis C virus, and HIV), enteric pathogens, and possibly Mycobacterium tuberculosis.

Historically, epidemics resulting in mass casualties have only occurred from a few diseases, including plague, cholera, typhoid, tuberculosis, anthrax, and smallpox. As previously noted, such infections are no more likely to be present in disaster victims than in the general population.

Furthermore, although some of these diseases are highly contagious, their causative agents are unable to survive long in the human body following death. It is, therefore, unlikely that such epidemics will result from contact with a cadaver.

Indeed, survivors present a much more important reservoir for disease. Where dead bodies have contaminated water supplies, gastroenteritis has been the most notable problem, although communities will rarely use a water supply where they know it to be contaminated by dead bodies.

Source: PAHO 

Thursday Edition: Do Dead Bodies Really Create Disease Risk?
By Al Tompkins (more by author)

As I read and watched the tsunami coverage, I wanted to know more about the risk of disease that thousands of unburied bodies might create. I have read press accounts of natural disasters stretching back several years now, and many report about the need to bury the dead because of a risk of spreading disease. But even the World Health Organization says that is not true. In a December 27 update, WHO said: "Dead bodies do not pose any health threat, but they feed fears and can divert precious attention and resources from effective relief efforts."

The WHO statement is one of a growing number of reports that say that bodies of people killed by trauma pose no overwhelming health risk unless the dead were infected with disease before they died. Here is a 1999 Slate story on the topic, after a devastating earthquake in Turkey.

The New York Times' coverage Wednesday included a passage that indicated there should be no rush to bury.

Even as local health officials out in the field were racing to create mass graves or pyres to deal with the rising tide of bodies, saying the bodies posed immediate health risks, officials of the World Health Organization emphasized that the biggest risk of an outbreak was posed by survivors.

The agency's officials said Tuesday that because there was little danger of epidemics from unburied bodies, immediate mass burials and cremations were not necessary. Instead, they said, family members and friends should be given time, where possible, to identify the bodies first.

I have seen similar articles elsewhere. This is from

"There is no evidence that, following a natural disaster, dead bodies pose a risk of epidemics," says Oliver Morgan, at the London School of Hygiene and Tropical Medicine, who is author of the article and who has worked with the disaster-assistance groups Oxfam and Médecins Sans Frontières (Doctors Without Borders) in Latin America, India, Africa, and the Balkans.

Historically, epidemics resulting in mass casualties have only occurred from a few diseases, including plague, cholera, typhoid, tuberculosis, anthrax, and smallpox. However, such infections are no more likely to be present in disaster victims than in the general population. In addition, while some of these diseases are highly infectious, they are unable to survive for long in the human body after death occurs. It is therefore unlikely that such epidemics will result from contact with a cadaver. Instead, notes the article, "it is far more likely that survivors will be a source of disease outbreaks."

That article said:

While the risks for rescue workers who handle dead bodies are higher than for the survivors of a disaster, they can be limited through a set of simple measures. Appropriate precautions include training military personnel and others who might have to provide assistance after a disaster, vaccinating those persons against hepatitis B and tuberculosis, using body bags and disposable gloves, washing hands after handling cadavers, and disinfecting stretchers and vehicles that have been used to transport bodies. published a story about what American disaster officials learned about body disposal after the September 11, 2001 attacks.

The Real Risks

Make no mistake about it. The health problems in the tsunami areas are overwhelming. Experts are now warning that as many people could die of diseases as from the actual tsunami. The World Health Organization says these are currently the biggest problems:

South East Asia is endemic for malaria and dengue fever. Flooding and stagnant water create favorable conditions for the mosquito vector. Overcrowding facilitates mosquito bites and therefore transmission ...
Poor quality and quantity of water and insufficient sanitation, overcrowding, and poor hygiene in temporary camps will bring forward the risk for outbreaks of different diarrheal diseases. Thorough and sustained water purification is an absolute priority ...
Apart from biological pollution, the possibility that the environment may be polluted by leaks or overflows from flooded chemical factories and warehouses must also be taken into consideration. Water can be contaminated by gasoline and oil leaking from damaged vehicles