Examining the relationship between infectious diseases and flooding in Europe: A systematic literature review and summary of possible public health interventions

Brown, Lisa; Murray, Virginia

Despite a considerable amount of research on the relationship between infectious diseases and flooding, globally and in Summary of possible public health interventions Public health interventions include those made before, during, and after flooding to reduce vulnerability to infectious diseases. Interventions need to take place at a variety of levels: individual, household, community, regional, national, and international. 51 The public health measures cited in the literature to reduce the risk of infectious diseases as a result of flooding focus on: risk assessments, enhanced surveillance systems, and specific prevention and control measures depending upon the type of infectious disease risk. 62, 63 A rapid disease risk assessment should be conducted by a representative multi-agency group within the first week of the flood including: data on the flooded region and displaced persons, the main disease threats for the enhanced surveillance system, baseline data collection, and identification of priority interventions. 62, 63 During a flood event, hand-held devices that allow workers to enter and analyze data in the field can assist the rapid risk assessment. 64 Existing disease surveillance systems can be enhanced to target specific diseases or syndromes and to support timely response actions to reduce disease impact and risk of transmission. 62, 63 Public health teams need to establish adequate disease surveillance systems which take into account the inherent disruption of the public health infrastructure that may occur during flooding. An enhanced surveillance system should be adaptable and context-specific, monitor key epidemiological data and compare with baseline data, monitor vulnerable groups, identify any emerging outbreaks, and result in timely public health action. In high-income countries, risk assessments and surveillance systems need to be very refined to detect small differences from baseline incidence data. 51 Prevention of infectious diseases following flooding involves maintenance of health services, provision of shelter, clean water supplies, proper sanitation, regular and adequate food supply, and in some cases mass vaccination campaigns and control of disease vectors. 62, 63 Water and sanitation are vital elements in the transmission of water-borne diseases; hence, providing clean drinking water is a priority in the initial days following flooding. Clasen et al. 65 found that household interventions were more effective in preventing diarrhea than interventions at the water-source. Interventions at the household level reviewed included: chlorination, filtration, solar disinfection, and combined flocculation and disinfection. Ejemot-Nwadiaro et al. 66 found hand-washing interventions can reduce diarrhea episodes by one-third.