Expert Commentary

Infectious Disease in Areas Where Normal Infrastructure Has Been Disrupted

Kentaro Iwata, MD

Professor, Division of Infectious Disease
Kobe Medical University
Kobe, Japan


Infectious disease can rapidly become a serious concern in the aftermath of a disaster like the recent earthquake and tsunami in Japan. Respiratory problems can be common in disrupted settings, especially among children and the elderly. The spread of viral and bacterial respiratory infections is particularly worrisome when survivors are crowded together in refuge centers where treatment facilities may be incomplete. Following a tsunami there are particularly serious risks of exposure to soil and seawater-borne pathogens like Legionella. Steps that can be taken to avoid infection include hand washing and use of masks. Patients who are found to be coughing should be isolated at least 3 meters from other patients. Patients should also be encouraged to cover their coughing with hand or sleeve. Coughing may also be induced by increased particulate matter in the air. This condition is not necessarily reflective of infection however it is likely to be disturbing and frequently chronic. Antibiotics should not be given for coughs of this nature. Among other infectious disorders commonly present in evacuees is diarrhea. This commonly follows ingestion of spoiled food and contaminated water in disrupted environments. This is frequently exacerbated by loss of sanitary facilities. Patients with diarrhea face dehydration issues and so procuring sources of clean water is essential. Although anti-diarrheals like Imodium are not recommended in general practice they may have utility in disaster settings for preserving quality of life. Finally, tetanus becomes a very serious problem following disasters and prevention is critical because case care involves a major consumption of medical resources. Prophylactic immunizations should be pursued, especially when not booster has been received within a 10-year period.


  1. Ebisawa K. et al (2011) Combined legionella and Escherichia coli lung infection after a tsunami disaster. Intern Med. 50(19):2233-6.
  2. Iijima K et al and Members of JGS Disaster Supportive Center. (2011) Actions of the Japan Geriatric Society in response to the 2011 off the Pacific Coast of Tohoku Earthquake: First report. Geriatr Gerontol Int. Oct;11(4):525-6.
  3. Grossman L, and Bird W. (2011) Chemical contamination in Tohoku. Environ Health Perspect. Jul;119(7)
View AllPublications
Integrating Bipolar Disorder Management in Primary Care
Kilbourne AM, Goodrich DE, O'Donnell AN, Miller CJ. Curr Psychiatry Rep. 2012 Sep 22....

Management of sleep apnea in the cleft population
Muntz HR.  Curr Opin Otolaryngol Head Neck Surg. 2012 Sep 20. [Epub ahead of print] ...

A systematic review of the psychosocial difficulties relevant to patients with migraine
Raggi A, Giovannetti AM, Quintas R, D'Amico D, Cieza A, Sabariego C, Bickenbach JE, Leonardi...

Physical activity promotion in primary care targeting the older adult.
Neidrick TJ, Fick DM, Loeb SJ. J Am Acad Nurse Pract. 2012;24:405-16.
Purpose: This...

The Direct and Indirect Costs among U.S. Privately Insured Employees with Hypogonadism.
Kaltenboeck A, Foster S, Ivanova J, Diener M, Bergman R, Birnbaum H, Kinchen K, Swindle R. J...