One of the issues raised by the pandemic (H1N1) 2009 has been the management of the bodies of people who have died as a result of epidemics. PAHO has prepared guidelines to help the public in general regarding measures to be taken, and the risks presented by dead bodies that have resulted from an epidemic.
Summary
Epidemics that have generated a large number of victims have been caused by diseases such as plague, cholera, typhoid fever, tuberculosis, anthrax, small pox, and influenza. Even though these are highly contagious diseases, their causing agents do not survive long in the human body after death, making it unlikely that these epidemics can be transmitted by dead bodies.
HIV remains active in dead bodies kept at two degrees Celsius between 6-15 days, and influenza remains active in the environment for only one day.(1) Therefore, if the necessary basic hygiene and biosecurity measures are taken, dead bodies will not transmit diseases, even when the cause of death is related to infectious diseases.
An epidemic can diminish the operative capacity of the human resources and the external services necessary for the efficient running of government and health sector agencies. The following steps should be taken:
- Avoid taking dead bodies to hospitals, as these institutions do not have enough storage space for this purpose. Therefore, it is important to have plans that assign other spaces and entities willing to be used in these cases.
- Define clear procedures to remove victims from homes, elderly homes, and other places. It is also important to make sure that those bodies are included in the analysis of confirmed cases and to decide their final resting place.
- Ensure that a plan is in place so that there are enough human and transportation resources for the previous actions to be carried out. It is important that voluntary or new personnel are trained, aware of procedures, properly supervised and have all the necessary items needed for their protection.
Dead Bodies and Infection
- There are diseases, such as Hepatitis B and HIV, that have a greater capacity for transmission than other pathogens (Hepatitis B's risk of transmission is between 6%-30%, while HIV's is 0.5%).(2) Transmission can happen due to accidents with sharp contaminated objects, such as fragmented bones, needles, or other objects related to the dead body; or accidents involving skin lesions during surgical procedures or by contact with mucous or ocular secretions. It is, therefore, imperative to follow the usual protection or biosecurity measures: masks, goggles and double rubber gloves.
- During epidemics it is important to establish a protocol for showing the adequate use of the personal protection equipment (PPE) to relatives coming to identify bodies, and to personnel from morgues, funeral homes and transportation vehicles, the way it is done with assistance personnel.
- As a rule, it is not necessary to keep bodies in bags. The exception would be bodies leaking secretions or blood (such as those from people who have died from hemorrhagic diseases, cholera, etc.), or those with numerous open wounds caused by a traumatic event.
- If personnel are protected against the high-risk agents, they will also be protected from the lower risk ones.
Coordination
- The plan for the management of dead bodies is not exclusive to the health sector, and it requires previous planning and coordination with civil, governmental, military, and police authorities, at the national and regional level, to speed up decision-making and allocation of resources.
- The plan should also include coordination activities with the civil society, religious entities, and the mass media to ensure an effective dissemination of the measures taken to preserve public health during the epidemics.
Religious Services and Final Disposition of the Bodies
- The main risk for transmission is exposure to sick people-who are still alive-particularly getting close to them without protection.
- Religious services present the risk of conglomeration, which also increase the risk of transmission. It is therefore recommended that funeral services are regulated by civil authorities, and suggest that services are quick and private.
- Hurried cremations, mass burials, or inadequate disposal of dead bodies should be avoided. Experts from public health and management of dead bodies can advise on this regard. Environmental health experts should define the adequate places for burial and administrative mechanisms required to designate an area as a cemetery. It is also important to preserve water and environmental sources.
- In general, PAHO's recommendations for the management of dead bodies in disaster situations should be followed.
Bibliography
- Morgan, Oliver. "Infectious disease risks from dead bodies following natural disasters." Rev Panam Salud Pública, May 2004, vol.15, no.5, p.307-312. ISSN 1020-4989.
- Morgan, Oliver - ed. Management of Dead Bodies alter Disasters-A Field Manual for First Responders. Washington. D.C. PAHO, 2006.
Contact
Department of Emergency Preparedness and Disaster Relief
Tel: (202) 974-3434
Email: disaster@paho.org