Infectious disease risks from dead bodies following natural disasters

Objective. To review existing literature to assess the risks of infection from dead bodies
after a natural disaster occurs, including who is most at risk, what precautions should be
taken, and how to safely dispose of the bodies.
Methods. Disease transmission requires the presence of an infectious agent, exposure to that
agent, and a susceptible host. These elements were considered to characterize the infectious disease
risk from dead bodies. Using the PubMed on-line databases of the National Library of
Medicine of the United States of America, searching was done for relevant literature on the infection
risks for public safety workers and funeral workers as well as for guidelines for the management
of the dead and prevention of infection. A small but significant literature was also reviewed
regarding the disposal of the dead and the contamination of groundwater by cemeteries.
Results. Victims of natural disasters usually die from trauma and are unlikely to have acute
or “epidemic-causing” infections. This indicates that the risk that dead bodies pose for the public
is extremely small. However, persons who are involved in close contact with the dead—such
as military personnel, rescue workers, volunteers, and others—may be exposed to chronic infectious
hazards, including hepatitis B virus, hepatitis C virus, HIV, enteric pathogens, and
Mycobacterium tuberculosis. Suitable precautions for these persons include training, use of
body bags and disposable gloves, good hygiene practice, and vaccination for hepatitis B and tuberculosis.
Disposal of bodies should respect local custom and practice where possible. When
there are large numbers of victims, burial is likely to be the most appropriate method of disposal.
There is little evidence of microbiological contamination of groundwater from burial.
Conclusions. Concern that dead bodies are infectious can be considered a “natural” reaction
by persons wanting to protect themselves from disease. However, clear information about
the risks is needed so that responsible local authorities ensure that the bodies of disaster victims
are handled appropriately and with due respect. This paper provides a source of information
for those who are in the unfortunate position of managing those bodies.