Global Health Impacts of Floods: Epidemiologic Evidence

The objective of this paper is to investigate and to improve understanding of the causes and circumstances of flood disaster deaths. A standardised method of classifying flood deaths is proposed and the difficulties associated with comparing and assessing existing information on flood deaths are discussed. Thirteen flood cases from Europe and the United States, resulting in 247 flood disaster fatalities, were analysed and taken as indicative of flood disaster deaths. Approximately two-thirds of the deaths occurred through drowning. Thus, a substantial number of flood disaster fatalities are not related to drowning. Furthermore, males are highly vulnerable to dying in floods and unnecessary risk-taking behaviour contributes significantly to flood disaster deaths. Based on these results, recommendations are made to prevent loss of life in floods. To provide a more solid basis for the formulation of prevention strategies, better systematic recording of flood fatalities is suggested, especially those caused by different types of floods in all countries.

In October 1995, epidemic "hemorrhagic fever," without jaundice or renal manifestations, was reported in rural Nicaragua following heavy flooding; 2259 residents were evaluated for nonmalarial febrile illnesses (cumulative incidence, 6.1%) and 15 (0.7%) died with pulmonary hemorrhage. A case-control study found that case-patients were more likely than controls to have ever walked in creeks (matched odds ratio [MOR], 15.0; 95% confidence interval [CI], 1.7-132.3), have household rodents (MOR, 10.4; 95% CI, 1.1-97.1), or own dogs with titers >/=400 to Leptospira species (MOR, 23.4; 95% CI, 3.6-infinity). Twenty-six of 51 case-patients had serologic or postmortem evidence of acute leptospirosis. Leptospira species were isolated from case-patients and potential animal reservoirs. This leptospirosis epidemic likely resulted from exposure to flood waters contaminated by urine from infected animals, particularly dogs. Leptospirosis should be included in the differential diagnosis for nonmalarial febrile illness, particularly during periods of flooding or when pulmonary hemorrhage occurs.