Disaster epidemiology Professor Vilius Grabauskas Kaunas University of Medicine, Kaunas, Lithuania NATO supported advanced research workshop, Kaunas, Lithuania, 8-10 August 2005

Task of the presentation To overview basic principles of epidemiology in disasters Vilius Grabauskas

The key concepts: Definitions Disaster epidemiology vs epidemiology in disasters Vilius Grabauskas

Definitions A disaster is a destructive event that causes a discrepancy between the number of casualties and their treatment capacity. In health and medical care, disaster means a situation in which the need of medical care exceeds the immediately available resources and in which extraordinary and coordinated measures are necessary if normal quality standards are to be maintained Vilius Grabauskas

To maintain the normal quality standards… we need to: attend to and treat injured persons within a injury area transport the injured and give treatment during transport attend to and treat injured persons in hospital take preventive measures against psychological sequelae in the injured, relatives and staff involved in rescue work. Vilius Grabauskas

How we reache our goals? Epidemiology is the study of the causes and distribution of disease in human populations Disaster epidemiology – the use of epidemiology in disaster situations. Epidemiologic methods can be used to measure and describe the adverse health effects of natural and human-caused disasters. Vilius Grabauskas

Phases of a Disaster PREIMPACT IMPACT POSTIMPACT disaster prevention and education IMPACT information collection and disaster mitigation POSTIMPACT rehabillitation Vilius Grabauskas

Epidemiology of disasters Natural (35% of all disasters and 94% of all deaths in the last 15 years) Man made Vilius Grabauskas

Role of Epidemiology in Disasters To identify the priority health problems in the affected community. To determine the extent of disease existing within a community. To identify the causes of disease and the risk factors. To determine the priority health interventions. To determine the extent of damage and the capacity of the local infrastructure. To monitor health trends of the community. To evaluate the impact of health programs. Vilius Grabauskas

Constraints of Epidemiology in Emergencies Poor understanding of basic epidemiological principles and measurement techniques. Rapid turnover of skilled staff. Lack of access to a significant fraction of the affected population due to chaos or insecurity. Limited resources for processing information. Difficulty in estimating the population size. Survey samples may not represent the total affected population. Vilius Grabauskas

Key Epidemiological Indicators Awareness of the value of immunisation Compliance to universal precautions against HIV/AIDS Equity in distribution of resources Incidence Prevalence Morbidity rate Mortality rate access coverage quality of services availability Vilius Grabauskas

Rapid Needs Assessment To determine the magnitude of the emergency. To define the specific health needs of the affected population. To establish priorities and objectives for action. To identify existing and potential public health problems. To evaluate the capacity of the local response including resources and logistics. To determine external resource needs for priority actions. To set up the basis for a health information system. Vilius Grabauskas

Surveillance To monitor the health of a population and identify the priority health needs To follow disease trends for early detection and control of outbreaks To assist in planning and implementing health programs To ensure resources are targeted to the most vulnerable groups To monitor the quality of health care To evaluate the coverage and effectiveness of program interventions Vilius Grabauskas

Outbreak Investigation Reportable Diseases Diseases of Public Health Importance • Measles • Cholera • Meningitis • Hepatitis • Tuberculosis • Yellow fever • Haemorrhagic fever • Rabies • Tetanus • Sexually transmitted infections (gonorrhoea, syphilis, chlamydia, genital ulcer disease, chancroid) HIV/AIDS Vilius Grabauskas

Data Analysis To identify the possible root causes of problems. To investigate further to verify the actual causes of a problem. To define needs that have not been met. To develop an action plan for dealing with problems. To improve the quality of programs. Vilius Grabauskas

Conclusions It is necessary… It is useful… It is helpful… as any tool if used professionally Vilius Grabauskas