Risks posed by dead bodies after disasters (source WHO)

Contrary to common belief, there is no evidence that corpses pose a risk of epidemic disease after a natural disaster. Most agents do not survive long in the human body after death. Human remains only pose a substantial risk to health in a few special cases, such as deaths from cholera or haemorrhagic fevers.

Workers who routinely handle corpses may however risk contracting tuberculosis, bloodborne viruses (eg hepatitis B and C and HIV) and gastrointestinal infections (e.g. cholera, E. coli, hepatitis A, rotavirus diarrhoea, salmonellosis, shigellosis and typhoid/paratyphoid fevers):

ƒ Tuberculosis can be acquired if the bacillus is aerosolized – residual air in lungs exhaled, fluid from lungs spurted up through the nose or mouth during handling of the corpse. ƒ Bloodborne viruses can be transmitted via direct contact of non-intact skin or mucous membrane from splashing of blood or body fluid or from injury from bone fragments and needles. ƒ Gastrointestinal (GI) infections can easily be transmitted from faeces leaked from dead bodies. Transmission occurs via the faecal–oral route through direct contact with the body, soiled clothes or contaminated vehicles or equipment. GI infections can also be spread as a result of contamination of the water supply with dead bodies.

Information on these risks should be provided to both emergency workers and the general public to ensure adequate disposal of bodies, appropriate precautions when handling bodies and to avoid panic and misunderstanding.

General advice ƒ In the case of mass casualties and where identification of victims is no longer possible, burial is preferable to cremation. ƒ Burial in mass graves is not a recommended public health measure. It can violate important social norms and waste scarce resources. ƒ The families’ needs and social customs for funerals should be respected. If customs vary, each social group should be provided with a designated area, with the relevant materials, to be able to exercise their own traditions with dignity. ƒ Where existing facilities such as graveyards or crematoria are inadequate, alternative facilities should be provided.

Specific advice for workers handling corpses ƒ Graveyards should be at least 30 m from groundwater sources used for drinking-water. ƒ Grave floors must be at least 1.5 m above the water table, with a 0.7 m unsaturated zone. ƒ Surface water from graveyards must not enter inhabited areas. ƒ Exercise universal precautions taken when handling blood and body fluids. ƒ Use gloves once only and dispose of correctly. ƒ Use body bags. ƒ Wash hands with soap after handling bodies and before eating. ƒ Disinfect vehicles and equipment. ƒ Be vaccinated against hepatitis B. ƒ There is no need to disinfect bodies before disposal (except in case of cholera)

©World Health Organization. Extract from WER No. 3, 2005, 80, 21–28, published by WHO Unit on Disease Control in Humanitarian Emergencies. References: 1. Morgan, Oliver. Infectious disease risks from dead bodies following natural disasters. Pan American Journal of Public Health, 15(5):307–312.; 2. PAHO. Management of dead bodies after disasters: a field manual for first responders. Washington, D.C: PAHO, 2009.