Special Issue on Infectious Disease Control of Natural Disasters
Authors: Shinoda Sumio 
Published: April 2016

Large natural disasters such as earthquakes, tsunamis and typhoons often produce many refugees, forcing them to live inconvenient and unsanitary lives in temporary places of refuge. Even if they can remain in their homes, hygienic conditions may be worsened by interrupted electricity, water, fuel and other lifelines.
Winter disasters bring more concerns, such as influenza and cold weather, while those in summer raise problems of diarrhea-related disease.
Two of Japan’s largest recent earthquakes, the 1995 Great Hanshin-Awaji Earthquake and the 2011 Great East Japan Earthquake, did not cause large infectious disease outbreaks thanks to proper countermeasures. Even so, such outbreaks frequently occur worldwide.
One recent example is the 2010 cholera outbreak following an earthquake in Haiti. In an added complication, it is thought that the outbreak was from a foreign source – an Asian epidemic strain of cholera.
Many refugees have resulted from ethnic and tribal conflicts in Africa. In a visit to Kenya as a short-term expert for the Japan International Cooperation Agency (JICA), I observed a cholera outbreak in a Somali refugee camp. Health facilities at the camp were extremely bad, with the occurrence of drought adding to the suffering in these regions.
Many developing countries in tropical and subtropical regions have problems of insufficient food supplies due to recent population growth. Disasters breaking out in these areas leave an unwelcome legacy of undernourishment and malnutrition, especially among young children. In this situation, the number of fatalities due to diarrhea is very high. Such fatalities are fewer in developed countries, but diarrhea in children under 5 years of age in developing countries remains a serious problem. World Health Organization (WHO) statistics published this year show that the global number of deaths in 2010 of children under 5 was some 76 million, 10% of which suffered from diarrhea-related disease. Malaria, pneumonia, premature birth, birth asphyxia and neonatal sepsis are additional causes of these deaths.
This special issue details the countermeasures taken against infectious diseases in recent large disasters.
As stated above, no serious outbreaks of infection were observed in the Great East Japan Earthquake, but damage to a local atomic power plant was extensive, as reported by the mass media. In addition to refugees from the earthquake and tsunami, many residents near the atomic power plant were forced to move out of their homes and towns because of the possible release of radiation, even though their homes had not been destroyed or even damaged.
The lack of serious infectious disease outbreaks were more than made up for, however, by many problems with infectious disease. The subject of infectious disease risk and public health recovery is described by Dr. Hitoshi Oshitani of Tohoku University. Another article covers communicable diseases following the Great Earthquake described by Dr. Kentaro Iwata of Kobe University.
The Great Earthquake and resulting tsunami in Sumatra, Indonesia, in December 2005 left more than 2,300,000 victims. Because this happened in a tropical region, public health control, especially food sanitation, was the worst problem. Dr. Nasronudin of Airlangga University in Indonesia communicates his experiences in this situation.
The 2011 Haiti earthquake also involved a tropical region. As a Central American country, Haiti has had no experience with cholera in nearly a century and faces a cholera outbreak after the earthquake. Dr. G. B. Nair a cholera specialist at the Translational Health Science and Technology Institute of India, investigated the situation in Haiti and found that the causative strain was an Asian epidemic cholera. We therefore asked Dr. Nair to write about the Haiti cholera epidemic.
Global microbial culture collection facilities have many microbial stocks that, if somehow released by a disaster, would cause at least two serious problems – one of environmental pollution by pathogenic organisms triggering infectious disease and another of the loss of valuable microbial resources. This makes it vital to maintain safe, secure culture collections against disasters. Dr. Takayuki Ezaki, Gifu University, describes this subject.
Finally, we thank the authors for their contributions and the reviewers for their invaluable comments.