War Breeds Disease

10/31/2007 (When it first ran on People Port) An aspect of war rearely considered is given light in this issue, Emerging Infectious Diseases. CDC's online publication. The writers raise issues that war planners, observers, may expect to see. Michelle Gayer, Dominique Legros, Pierre Formenty, and Maire A. Connolly, authored the report. This story from excerpts of their article.

Revised International Health Regulations of 2005 provide a global legal framework to guide response to public health events of international concern. Conflict-affected countries represent one of the weakest links in global health security and should be prioritized by the international community in provision of technical and operational support to implement core capacities for detection and response to epidemics.

Military forces are increasingly implementing aid programs for conflict-affected populations. These programs have a crucial role and are a valuable resource. However, military aid can affect the neutrality of humanitarian aid. A consistent and transparent policy is needed for military humanitarian interventions, as well as extensive civil-military liaisons and close cooperation with other humanitarian agencies

1 million displaced persons crowded into camps with little access to safe water because of drought and inadequate sanitation. The outbreak subsequently spread into neighboring eastern Chad in June 2004 because of movement of Sudanese refugees fleeing Darfur.

The outbreak of Marburg hemorrhagic fever in Angola from October 2004 through July 2005 was the first outbreak in an African urban setting and the most lethal (374 cases, CFR 88%). Thirty years of civil war had destroyed infrastructure, left roads mined, and left medical services with untrained staff and a persistent lack of supplies. Healthcare centers were primarily responsible for amplification of the outbreak through reuse of needles and syringes and use of multidose vials in healthcare centers due to poor training in safe injection practice (WHO, unpub. data).

Years of war in Sierra Leone during the 1990s weakened health systems and led to a long-term deterioration in infection control practices. As a result, a nosocomial outbreak of Lassa fever occurred in Kenema District Hospital from January through April 2004. A total of 410 cases occurred with a CFR of 30% (Ministry of Health Sierra Leone and WHO, unpub. data). The outbreak started in the pediatric ward, where nosocomial transmission likely resulted from use of contaminated multiuse vials and reuse of contaminated needles and syringes.

Children discharged into the community were readmitted with suspected Lassa fever into the Lassa ward and comprised most of the pediatric cases in this outbreak. A total of 50% of the case-patients were

200,000 cases and 3,000–5,000 deaths occurred annually across this region. In disease-endemic areas of Sierra Leone and Liberia, Lassa fever causes an estimated 10%–16% of hospitalizations.

2 million displaced persons and is likely to have provided new opportunities for rodents to proliferate when persons were forced to abandon villages and relocate in overcrowded camps. However, numbers of new cases related to the conflict are unavailable. Emergence of Lassa fever in camps in non–disease-endemic areas has been documented (World Health Organization [WHO], unpub. data) and is probably related to the poor condition of dwellings and storage of grain rations..

Similarly, unsanitary environmental conditions led to the proliferation of rats in postwar Kosovo and resulted in a tularemia outbreak among the displaced population from August 1999 through April 2000, with 327 serologically confirmed cases in 21 of 29 municipalities. The population had fled their villages because of bombings, and on their return several weeks later, they found destroyed buildings, contaminated food stores and wells, and a greatly increased rodent population. Control measures included appropriate case management, improving water and waste management, health education on hygiene, and protection of food and water sources from rats.

Copyrighted, 2007, J John Swanko, All rights reserved. May be used with permission.