Health Recommendations for Relief Workers Responding to Disasters
This notice provides advice specific to the needs of relief workers responding
to disasters internationally or domestically. Because of their potential
exposures, relief workers are at increased risk for illness and injuries. In
addition, they should be aware of potential hazards, such as downed power lines
and security measures that may be imposed (e.g., curfews to prevent looting).
Those who provide assistance should also pay attention to their mental health
needs before, during, and after their time in the field. Moreover, because
relief workers' services are desperately needed, it is essential that workers
remain healthy during their trip. In addition to this notice, relief workers
should refer to the general regional travel recommendations for their specific
travel destination.
Prior to Travel
Risks and Health Recommendations
Although, relief workers should be assessed by a health-care professional at
least 4-6 weeks before travel so recommended vaccines can be completed and
provide maximum benefit, there is value in seeking care even if travel is
imminent. Those who know they may potentially do relief work in the future
would receive the most benefit by visiting a travel health professional early
and completing the relevant vaccine series, if needed, well in advance of any
future mission.
Travelers who are pregnant should consider other ways to be of assistance.
Pregnant women are especially advised to avoid areas where malaria exists
because of increased health risks to both the mother and unborn child; see "Preconceptional Planning, Pregnancy and Travel" in Health
Information for International Travel.
Immunizations
All travelers should be sure their routine immunizations are up to date
(tetanus/diphtheria, polio, measles, influenza). Some of the vaccines listed
below (polio, influenza, typhoid, and measles) require a single dose and can be
given at the same visit. Others require a series of injections for full benefit
(hepatitis, rabies, Japanese encephalitis). Some vaccine schedules can be
accelerated.
Immunizations for All Travelers
-
Tetanus/diphtheria vaccine or booster, if the most recent
vaccine or booster was 5 years ago or more.
-
Polio booster, for those who have completed a primary series
with either inactivated polio vaccine (IPV) or oral polio and will be traveling
to a polio-endemic or -epidemic area; see
http://www.polioeradication.org/.
-
Measles for those who are not immune. Immunity can be assumed
if there is documentation of measles diagnosed by a physician, laboratory
evidence of measles immunity, proof of receipt of two doses of live measles
vaccine on or after the first birthday, or the year of birth was before 1957.
However, measles or MMR vaccine can be given to travelers who might be
susceptible.
-
Influenza injectable vaccine if working directly with affected
populations. If work is not directly with affected populations, live attenuated
nasal influenza vaccine can be administered. Live vaccine is available for most
healthy persons 5-49 years of age who are not pregnant; injectable is available
for all age groups. See http://www.cdc.gov/vaccines/pubs/ACIP-list.htm.
-
Hepatitis B. For optimal protection, ideally vaccination
should begin at least 6 months before travel so that the full vaccine series
can be completed. Because some protection is provided by one or two doses, the
vaccine series should be initiated, even if it cannot be completed.
-
Hepatitis A. For optimal protection, the first dose of vaccine
should be given at least 30 days prior to travel; however, vaccine can be given
even if travel is imminent.
Immunizations for Travelers Going to Select Areas
-
Japanese encephalitis (JE), if traveling to an area where JE
is endemic; see "Japanese Encephalitis" in Health Information for
International Travel. A full 3-dose vaccination series requires 2-4
weeks to complete (days 0, 7, 14 or 30). However, an abbreviated schedule of 2
doses (days 0, 7) has been shown to protect 80% of vaccinees. Because serious
adverse reactions to the vaccine (generalized itching, respiratory distress,
angioedema, anaphylaxis) can occur in some individuals up to 1 week after
vaccination, the full course of immunization should be completed at least 10
days before departure, and vaccinees should remain in areas with access to
medical care during this 10-day period.
JE vaccination is not recommended for imminent travel; such travelers should
take measures to prevent mosquito bites, such as using insect repellent and
sleeping under insecticide-treated bed nets (see "Protection Against Mosquitoes and Other Arthropods" in Health
Information for International Travel). For travelers scheduled to
depart in 2 weeks or more, JE vaccine should be administered.
-
Rabies if traveling to areas where rabies is endemic, see "Rabies" in Health Information for International Travel.
Exposure to animal bites, most notably from dogs in resource-poor countries,
poses a risk for rabies. Proper administration of the rabies pre-exposure
series (days 0, 7 and 21 or 28) requires at least 3 weeks to complete. Although
risk of exposure to stray animals and thus increased risk of exposure to rabies
may be increased in countries affected by disasters, there would be little to
no value in administering incomplete pre-exposure prophylaxis.
In the event of an animal bite, the partially immunized individual would be
considered unimmunized and should receive full postexposure
prophylaxis (i.e., rabies immune globulin (RIG) + 5 doses of vaccine). If
either rabies immune globulin or rabies vaccine is not available in the country
of destination, the exposed person should either return home or travel to the
closest major city where these biologics are available to initiate rabies
postexposure prophylaxis as soon as possible.
-
Yellow fever if travel is to endemic areas or if proof of
vaccination is required for entry based on travel itinerary; see "Yellow Fever Vaccine Requirements" in Health Information for
International Travel.
-
Typhoid (oral or injectable)
-
Cholera vaccine is not available in the U.S. If the traveler
will be working in areas where outbreaks of cholera are being reported, the
vaccine would have to be obtained at an intermediate destination.
Malaria Prophylaxis
If traveling to an area where malaria is endemic; see "
Malaria" in Health Information for International Travel. There is no immunization against malaria. Although no antimalarial drug is 100% protective, taking antimalarial drugs correctly and consistently is the most important factor in preventing this debilitating and potentially fatal condition, see "
Malaria Prescription Drugs: Information for the Public."
Malaria symptoms can include fever and flu-like illness, including chills,
headache, muscle aches, and fatigue. Malaria may also cause low red blood cell
counts (anemia) and yellowing of the skin and whites of the eye (jaundice). If
not promptly treated, infection with Plasmodium falciparum, the most harmful
malaria parasite, may cause coma, kidney failure, and death.
Travelers who become ill with a fever or flu-like illness either while
traveling in a malaria-risk area or after returning home (for up to 1 year)
should seek immediate medical attention and should be sure to tell the
physician their travel history.
Risks from Food and Water
Natural disasters often disrupt water supplies and sewage systems. If a trusted
source of bottled water is not available, water should be boiled or
disinfected. For more details, see
http://www.cdc.gov/travel/foodwater.htm.
Food should be selected with care to reduce the risk of acquiring any
gastrointestinal illness. Salads, uncooked vegetables, and unpasteurized milk
and milk products, such as cheese, should be avoided. Undercooked and raw meat,
fish, and shellfish can carry various intestinal pathogens. Cooked food that
has been allowed to stand for several hours at ambient temperature can provide
a fertile medium for bacterial growth and should be thoroughly reheated before
serving. Consumption of food and beverages obtained from street vendors has
been associated with an increased risk of illness. Therefore, food that has
been cooked and is still hot or fruit that has been washed in clean water and
then peeled by the traveler personally are safer to eat.
Travelers' Diarrhea
Diarrheal disease is a common complaint of travelers in normal circumstances
and may be exacerabated in areas where clean water is either not available or
the systems have been disrupted by disaster. An antibiotic for self-treatment
of acute diarrhea, such as a fluoroquinolone (e.g., ciprofloxacin), can be
given. Azithromycin can be used as an alternative. This medication should be
taken until symptoms subside (typically 3 days). Anti-motility agents, such as
loperamide and diphenoxylate and/or bismuth subsalicylate (Pepto-Bismol), can
reduce bowel movement frequency.
Medical attention should be sought for diarrhea accompanied by a high fever or
blood. Additionally, replacement of lost fluids by drinking clean water is the
most important means of maintaining wellness, although oral rehydration
solutions are ideal for the treatment of severe diarrhea.
Risks from Insect Bites
A variety of diseases can be spread by the bite of infected mosquitoes or
arthropods, from West Nile in the United States to malaria and dengue in much
of the tropics; check the region to which you will be traveling for specific
risks. Bites can be prevented through combined use of insect repellent and
barrier methods such as wearing long-sleeved shirts and long pants when
outdoors or sleeping under a bed net (malaria). Repellent containing DEET
should be used if travel is abroad; picaridin can be used if travel is
domestic; see "
What You Need to Know about Mosquito Repellent."
Risks from Snake Bites
Displaced reptiles, such as snakes, are likely to be found following flooding
and other natural disasters. The venom of a small or immature snake can be even
more concentrated than that of larger ones; therefore, all snakes should be
left alone. Fewer than half of all snakebite wounds actually contain venom;
however, medical attention should be immediately sought any time a bite wound
breaks the skin.
If medical care is rapidly available, then initial treatment should include
immobilization of the affected limb and minimizing physical activity as much as
possible (ideally of the entire patient) during transport to a medical
facility. If care is delayed, then a loose-fitting pressure bandage that does
not restrict arterial and venous flow (but does limit lymphatic flow) is the
recommended first-aid measure while the victim is moved as quickly as possible
to a medical facility. Tourniquets that impair blood flow to the affected limb
are generally contraindicated.
Specific therapy for snakebites is controversial and should be left to the
judgment of local emergency medical personnel. Snakes tend to be active at
night and in warm weather. As a precaution, boots and long pants should be worn
when walking outdoors at night in areas possibly inhabited by venomous snakes.
Proper protection such as the aforementioned clothing, careful attention to
one's surroundings, and overall avoidance of contact are the best measures that
can be taken to avoid injury.
Injuries
The risk of injury during and after a natural disaster is high. Injuries are
also one of the most common hazards of travel. Persons who anticipate the need
to travel to disaster areas should wear sturdy footwear to protect their feet
from widespread debris in these areas. Tetanus is a potential health threat for persons who
sustain wound injuries. Any wound or rash has the potential for becoming
infected, and such wounds or rashes should be assessed by a health-care
provider as soon as possible. Any wounds, cuts, or animal bites, (see "
Rabies" in
Health Information for International Travel)
should be immediately cleansed with soap and clean water. Familiarity with
basic first aid is advised to self-treat any injury until medical attention can
be obtained.
Preventing Electrocutions
Relief workers should be careful to avoid downed power lines. During power
outages, many people use portable electrical generators
(
http://www.bt.cdc.gov/poweroutage/workersafety.asp). If the portable generator
is improperly sized, installed, or operated, it can send power back to the
electrical lines. This problem is called backfeed or feedback in the electrical
energy in power lines. Backfeed can kill or seriously injure repair workers or
people in neighboring buildings. In addition, electrical power and natural gas
or propane tanks should be shut off to avoid fire, electrocution, or
explosions. Battery-powered flashlights and lanterns, rather than candles, gas
lanterns, or torches, should be used.
Environmental Hazards
During natural disasters, technological malfunctions may release hazardous
materials (e.g., toxic chemicals from a point source displaced by winds or
rapidly moving water). Natural disasters may also lead to air pollution. Lung
infections may occur after inhalation of sea water. Disasters resulting in
massive structural collapse can cause the release of chemical or biologic
contaminants (e.g., asbestos or arthrospores leading to fungal infections).
Persons with chronic pulmonary disease may be more susceptible to adverse
effects from these exposures.
Travelers should be familiar with the temperature range in the intended
destination, noting that there may be severe fluctuations between daytime and
nighttime temperatures. There are health risks related to extreme temperatures
(e.g., heatstroke, hypothermia) and to sun exposure in the tropics or at high
altitude on the eyes (cataracts) and skin (skin cancer, sunburn); see
http://www.cdc.gov/cancer/skin/chooseyourcover/. Wraparound
sunglasses that provide 100 percent UV ray protection should be worn for eye
protection. A broad-spectrum (protection against both UVA and UVB rays)
sunscreen and lip screen with at least SPF 15 should be used. Travelers should
be familiar with the signs of illness related to extreme heat and what to do;
see "
What
Is Extreme Heat?" in "Extreme Heat: A Prevention Guide to Promote Your
Personal Health and Safety."
Extremes in Environmental Temperatures
Both hot and cold extremes in temperature can pose a danger to health.
Heat-related illness, such as heat stroke, can even be fatal. In addition,
sunburn, skin cancer, and eye cataracts are linked to overexposure to dangerous
UV (ultraviolet) rays of the sun.
Exposure to extreme cold temperatures can lead to frostbite and hypothermia
(low body temperature), a condition that can also be fatal. For information on
how to prevent temperature and sun-related illnesses, see "
Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety" and "
Temperature Extremes" and "
Sunburn" in
Health Information for International Travel.
Psychological/Emotional
Because of the tremendous loss of life, serious injuries, missing and separated
families, and destruction of whole areas often associated with disasters, it is
important that relief workers recognize the situation they encounter may be
extremely stressful. Keeping an item of comfort nearby, such as a family photo,
favorite music, or religious material, can often offer comfort in such
situations. Checking in with family members and close friends from time to time
is another means of support. For additional mental health resources, see "
Coping with a Traumatic Event."
Other Health Risks
Leptospirosis may occur as a result of wading,
swimming, or bathing in waters contaminated by animal urine. In addition,
exposure to animal bites, most notably dogs in the developing world and bats or
skunks in the South Central U.S, poses a potential risk for rabies and other
infections. Individuals who sustain a bite should seek immediate medical
attention for both appropriate management of the wound and assessment regarding
post-exposure rabies propyhylaxis.
Illness Abroad
If fever, cough, unusual rash, or difficulty breathing develop while traveling,
medical attention should be sought as soon as possible. Because illness and
injury are a real possibility for people going to areas following a disaster,
the traveler should recognize that most functioning hospitals and clinics may
be busy caring for people who have been injured and therefore would be unable
to treat travelers. For seriously ill travelers, evacuation to other parts of a
country or outside the country to receive adequate medical care may be
necessary. A supplemental health insurance policy that includes evacuation
insurance should be considered. See the U.S. Department of State website for
additional information:
http://travel.state.gov/.
Handwashing
Frequent handwashing using soap and water removes potentially infectious
material from the skin and helps prevent transmission of both respiratory and
enteric diseases. Waterless alcohol-based hand rubs may be used when soap is
not available and hands are not visibly soiled.
Travel Health Kit
Relief workers should plan for travel with the knowledge that there may be
shortages of electricity, safe water, or food distribution systems in affected
areas. They should try to pack to be as self-sufficient as possible and bring
only those items necessary for their trip. In addition to a basic
travel health kit, relief workers should bring the
following items:
Toiletries
-
Alcohol-based hand sanitizer
-
Toilet paper
-
Sun block (spf 15 or higher)
-
Insect repellent containing DEET
-
Menstrual supplies
-
Extra pair of prescription glasses, copy of prescription
-
Eyeglasses repair kit
-
Contact lenses, lens cleaner, and eye glasses protective case
-
Toothbrush/toothpaste
-
Skin moisturizer
-
Soap, shampoo
-
Lip balm
-
Razor, extra blades *
-
Scissors *
-
Nail clippers/tweezers*
-
Q-tips, cotton swabs
-
Sewing kit
-
Laundry detergent
-
Small clothesline/pins
Clothing
-
Comfortable, light-weight clothing
-
Long pants
-
Long-sleeved shirts
-
Hat
-
Boots
-
Shower shoes
-
Rain gear
-
Bandana/handkerchief
-
Towel (highly absorbent, travel towels if possible)
-
Gloves (Leather gloves if physical labor will be performed; rubber gloves if
handling blood or body fluids).
Activities of Daily Living
-
Sunglasses
-
Water proof watch
-
Flashlight
-
Spare batteries
-
Knife, such as a Swiss Army Knife or Leatherman*
Security
-
Money belt
-
Cash
-
Cell phone (with charger)
-
Candles, matches, lighter in a ziplock bag
-
Ziplock bags
-
Safety goggles
-
An item of comfort (i.e., family photo, spiritual or religious material)
(* pack these items in checked baggage, they may be confiscated if packed in
carry-on bags on a commercial airliner.)
For International Travel
-
Extra passport-style photos
-
Photocopy of all important documents (bring copies and leave copies with
employer and next of kin)
-
Next-of-kin contact information, first page of passport, driver's license,
travelers checks, immunization schedule, birth certificate, credit cards,
diplomas/medical licenses, emergency telephone numbers, blood type, Social
Security number, travel tickets.
Food and Water
If traveling to an area where
food and water may be contaminated:
-
Bottled water or water filters/purification system/water purification tablets
-
Nonperishable food items
Post Travel
On return from one of the affected areas, relief workers who are unwell or who
have become injured for any reason should receive a medical evaluation, which
should include psychological support and counseling as necessary. Returning
relief workers should seek health care in the event of fever, rash, respiratory
illness or any other unusual symptoms.
Travelers returning from areas with malaria who become ill with a fever or
flu-like illness (for up to 1 year) should seek immediate medical attention and
should be sure to tell the physician their travel history.
Additional information about responding to a disaster can be found at the CDC
Emergency Preparedness and Response website;
http://www.bt.cdc.gov/.