Enhancing the response outcome of infectious disease treatment following natural disasters

Abstract

Response to: Arya SC, Agarwal N. Prevention and control of infections after natural disasters. Expert Rev. Anti Infect. Ther. 10(5), 529–530 (2012).

We appreciate Arya and Agarwal’s compliments on our article and thank them for the important contributions on the response to potential infectious diseases resulting from secondary effects of major natural disasters (2001–2011) [1]. Arya and Agarwal were addressing the challenges of meeting basic storage requirements of therapeutic, prophylactic and diagnostic agents, which can have a negative impact on the outcome of the treatment response. The development of drug resistance as well as the inefficiency or vaccine failure from poor cold chain infrastructure, especially in developing countries [2] has frequently been reported in post-disaster settings.

Not only clinicians and public health personnel but also drug suppliers, pharmacists and drug storage agents in disaster-affected regions have to consider these issues to ensure an effective response. As mentioned by the author, the disaster-affected areas may be subject to various environmental changes (e.g., temperature, humidity and radiation) and the collapse of health facilities. These situations may create a need for promoting innovative approaches such as rapid diagnostics (e.g., Rapid Malaria Test or Rapid Dengue test) [3] and insecticide-treated material (e.g., blankets and plastic sheeting). Furthermore, new approaches for storage of therapeutic, prophylactic and diagnostic agents in post-disaster settings are needed in addition to new heat-stable vaccines [2]. A compact microbiology laboratory will be important for medical personnel in areas where laboratory facilities may have been destroyed by a natural disaster. Equipment such as basic strain and culture media with an incubator or sensitivity discs may help in these situations. Some technically easier tests, such as a rapid assay for streptococcal or rotavirus infections, can be useful in disaster settings [4]. However, all of these need a minimum electricity supply to function. Powercuts related to disasters may disrupt water treatment and supply plants, as well as refrigeration facilities, increasing the risk of food-borne diseases, such as diarrhea [5]. They can also affect the proper functioning of health facilities, such as the preservation of the vaccine cold chain and therapeutics.

A rapid assessment of the health needs is important for appropriate resource allocation. In the context of disasters, therapeutic, prophylactic and diagnostic agents must be conserved and stored in accordance with the challenging international recommendations.

Another important issue will be to address the problems related to the donation of expired or unidentifiable drugs in a disaster response. For instance, in the Hurricane Mitch recovery efforts, a huge number of donated drugs were unusable. Medical personnel took critical time to sort this and it caused a medical waste disposal problem [101].

As described in the WHO guideline for drug donation [102], on arriving in the recipient country, all donated drugs should have a remaining shelf life of at least 1 year and should also be labeled in a language that is easily understood by the health professionals in that country.

In conclusion, beyond health risk assessments and adequate resource allocation, basic storage of therapeutic, prophylactic and diagnostic agents must follow international requirements, which are extremely challenging in disasters settings, especially in developing countries. As mentioned by the author, new studies and technology approaches that could improve the stability of vaccines and the therapeutic and diagnostic agents at extremes of temperature are needed. Education and awareness on the harm that can be caused by the donation of expired and unidentified drugs should also be raised.

Disclaimer

This work is the opinion of the authors and does not represent the views of Expert Reviews Ltd or its employees.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.