JDR Vol.7 No.6 pp. 746-753
doi: 10.20965/jdr.2012.p0746


Communicable Diseases After the Disasters: with the Special Reference to the Great East Japan Earthquake

Kentaro Iwata*1, Goh Ohji*1, Hideaki Oka*2,
Yoshihiro Takayama*3, Tetsuji Aoyagi*4, Yoshiaki Gu*4,
Masumitsu Hatta*4, Koichi Tokuda*4, and Mitsuo Kaku*4

*1Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
*2Department of General Medicine, Kanto Rosai Hospital, Kawasaki, Kanagawa 211-8510, Japan
*3Department of Infectious Diseases, Okinawa Chubu Hospital, Uruma, Okinawa 904-2293, Japan
*4Department of Infection Control and Laboratory Diagnosis, Tohoku University School of Medicine, Sendai, Miyagi 980-8575, Japan

July 26, 2012
October 10, 2012
Online released:
December 1, 2012
December 1, 2012
the Great East Japan Earthquake, communicable diseases

On March 11, 2011, the Great East Japan Earthquake – a massive temblor followed by a gigantic tsunami was associated with significant morbidity and mortality. Among many health problems such as trauma, drowning, and mental illnesses, infectious diseases may place significant burden on survivors of such disasters. Wound infections including tetanus, leptospirosis, legionellosis, rickettsiosis, respiratory infections, and diarrheal illness among other infections had been considered to be associated with earthquake and tsunami. Overall, the impact of infectious diseases after the Great East Japan Earthquake was relatively small, with only sporadic outbreaks observed. The incidence of serious infections such as tetanus, legionellosis, and tsunami lung, was also low, considering the overall impact of the earthquake and tsunami per se. This review discusses the impact of infectious diseases after the Great East Japan Earthquake, and reviews past disaster-related infections as reference.

  1. [1] PG Greenough, “Infectious Diseases and Disasters,” DE Hogan and JL Burstein (Ed.), Disaster Medicine 2nd ed. Lippincott Williams & Wilkins, a Wolters Kluwer business, Philadelphia, USA, pp. 44-55, 2007.
  2. [2] B. Lindtjørn, “Disaster epidemiology,” The Lancet, Vol.337, No.8733, pp. 116-117, Jan. 1991.
  3. [3] N. Takayama, History of Rabies in Japan, [accessed July 2, 2012, in Japanese]
  4. [4] H. Spencer, A. Romero, R. Feldman, C. Campbell, O. Zeissig, E. Boostrom, and E. Croft Long, “DISEASE SURVEILLANCE AND DECISION-MAKING AFTER THE 1976 GUATEMALA EARTHQUAKE,” The Lancet, Vol.310, No.8030, pp. 181-184, Jul. 1977.
  5. [5] S. Yamamoto, C. Iwasaki, H. Oono, K. Ninomiya, and T. Matsumura, “The first imported case of rabies into Japan in 36 years: a forgotten life-threatening disease,” J. Travel Med., Vol.15, No.5, pp. 372-374, Oct. 2008.
  6. [6] H. Tamashiro, G. C. Matibag, R. A. Ditangco, K. Kanda, and Y. Ohbayashi, “Revisiting rabies in Japan: is there cause for alarm?,” Travel Med. Infect. Dis., Vol.5, No.5, pp. 263-275, Sep. 2007.
  7. [7] M. R. Surmieda, J. M. Lopez, G. Abad-Viola, M. E. Miranda, I. P. Abellanosa, R. A. Sadang, F. P. Magboo, N. S. Zacarias, R. L. Magpantay, and F. M. White, “Surveillance in evacuation camps after the eruption of Mt. Pinatubo, Philippines,” MMWR CDC Surveill Summ, Vol.41, No.4, pp. 9-12, Aug. 1992.
  8. [8] R. Shimazawa and M. Ikeda, “The vaccine gap between Japan and the UK,” Health Policy, No.0.
  9. [9] “Progress toward measles elimination-Japan, 1999-2008,” MMWR Morb. Mortal. Wkly. Rep., Vol.57, No.38, pp. 1049-1052, Sep. 2008.
  10. [10] “A foreign journalist developed measles, while covering the Great East Japan Earthquake,” Asahi Shinbun morning edition, April 20, 2011 (in Japanese).
  11. [11] K. Lee, “Infectious diseases management from the perspective of disaster medicine,” The Journal of Ambulatory and General Pediatrics, Vol.14, No.3, pp. 288-292, 2011 (in Japanese).
  12. [12] K. Nomura, H. Murai, T. Nakahashi, S. Mashiba, Y. Watoh, T. Takahashi, and S. Morimoto, “Outbreak of norovirus gastroenteritis in elderly evacuees after the 2007 Noto Peninsula earthquake in Japan,” J. Am. Geriatr. Soc., Vol.56, No.2, pp. 361-363, 2008.
  13. [13] U.S. Geological Survey, “Magnitude 7.0 – Haiti region,” 2011, [accessed July 3, 2012]
  14. [14] World Health Organization, “Fighting the rise in cholera cases in Haiti,” [accessed July 3, 2012]
  15. [15] C.-S. Chin, J. Sorenson, J. B. Harris, W. P. Robins, R. C. Charles, R. R. Jean-Charles, J. Bullard, D. R. Webster, A. Kasarskis, P. Peluso, E. E. Paxinos, Y. Yamaichi, S. B. Calderwood, J. J. Mekalanos, E. E. Schadt, and M. K.Waldor, “The Origin of the Haitian Cholera Outbreak Strain,” New England Journal of Medicine, Vol.364, No.1, pp. 33-42, Jan. 2011.
  16. [16] Infectious Agents Surveillance Report (IASR), “An outbreak of vomiting and diarrheal illness at an evacuation center in Koriyama, Fukushima,” Vol.32, pp. S8-S9, 2011, [accessed July 4, 2012, in Japanese]
  17. [17] News coverage from on July 21, 2008, [accessed July 3, 2012, in Chinese]
  18. [18] Y. Wang, P. Hao, B. Lu, H. Yu, W. Huang, H. Hou, and K. Dai, “Causes of infection after earthquake, China, 2008,” Emerging Infect. Dis., Vol.16, No.6, pp. 974-975, Jun. 2010.
  19. [19] E. Chen, L. Deng, Z. Liu, X. Zhu, X. Chen, and H. Tang, “Management of gas gangrene in Wenchuan earthquake victims,” J. Huazhong Univ. Sci. Technol. Med. Sci., Vol.31, No.1, pp. 83-87, Feb. 2011.
  20. [20] T. Shimazu, “Trauma and severe soft tissue infections of the limbs with particular emphasis on tetanus and gas gangrene, and with special considerations for post-disaster infections,” J. Jpn. Soc. Surg. Infect., Vol.8, No.4, pp. 359-366, Aug. 2011 (in Japanese).
  21. [21] S.-R. Chiang and Y.-C. Chuang, “Vibrio vulnificus infection: clinical manifestations, pathogenesis, and antimicrobial therapy,” J. Microbiol Immunol Infect, Vol.36, No.2, pp. 81-88, Jun. 2003.
  22. [22] “Vibrio illnesses after Hurricane Katrina-multiple states, August-September 2005,” MMWR Morb. Mortal. Wkly. Rep., Vol.54, No.37, pp. 928-931, Sep. 2005.
  23. [23] “Outbreak of tetanus cases following the tsunami in Aceh Province, Indonesia,” Glob Public Health, Vol.1, No.2, pp. 173-177, 2006.
  24. [24] Infectious Disease Surveillance Center, National Institute of Infectious Diseases, “Reported cases of infections associated with the Great East Japan Earthquake as of April 13, 2012,” [accessed July 4, 2012, in Japanese]
  25. [25] Centers for Disease Control and Prevention, “Tetanus (lockjaw) vaccination,” [accessed July 9, 2012]
  26. [26] Y. Inoue, Y. Fujino, M. Onodera, S. Kikuchi, T. Shozushima, N. Ogino, K. Mori, H. Oikawa, Y. Koeda, H. Ueda, T. Takahashi, K. Terui, T. Nakadate, H. Aoki, and S. Endo, “Tsunami lung,” J. Anesth, Vol.26, No.2, pp. 246-249, Apr. 2012.
  27. [27] Y. Nakamura, Y. Utsumi, N. Suzuki, Y. Nakajima, O. Murata, N. Sasaki, H. Nitanai, H. Nagashima, S. Miyamoto, J. Yaegashi, T. Hatakeyama, Y. Shibano, K. Yarita, K. Kamei, T. Nakadate, S. Endo, Y. Terayama, and K. Yamauchi, “Multiple Scedosporium apiospermum abscesses in a woman survivor of a tsunami in northeastern Japan: a case report,” J. Med. Case Reports, Vol.5, p. 526, Oct. 2011.
  28. [28] K. Ebisawa, N. Yamada, S. Okada, Y. Suzuki, A. Satoh, M. Kobayashi, and N. Morikawa, “Combined legionella and Escherichia coli lung infection after a tsunami disaster,” Intern. Med., Vol.50, No.19, pp. 2233-2236, 2011.
  29. [29] National Police Agency, “Casualties due to the Great East Japan Earthquake”, [accessed July 3, 2012]
  30. [30] The Japanese Association for Infectious Diseases, “The Great East Japan Earthquake – Infections after earthquake and tsunami. version 2,” [accessed July 4, 2012, in Japanese]
  31. [31] Infectious Diseases Weekly Report, “Tsutsugamushi disease,” No.13, 2002, [accessed July 4, 2012, in Japanese]
  32. [32] M. Hatta, S. Endo, K. Tokuda, H. Kunishima, K. Arai, H. Yano, N. Ishibashi, T. Aoyagi, M. Yamada, S. Inomata, H. Kanamori, Y. Gu, M. Kitagawa, Y. Hirakata, and M. Kaku, “Post-Tsunami Outbreaks of Influenza in Evacuation Centers in Miyagi Prefecture, Japan,” Clin. Infect. Dis., Vol.54, No.1, pp. e5-e7, Jan. 2012.
  33. [33] Infectious Agents Surveillance Report (IASR), “Infection Control and Surveillance at evacuation centers in Iwate prefecture,” Vol.32, pp. S1-S3, 2011, [accessed July 4, 2012, in Japanese]
  34. [34] K. Haku, “Nutrition Management,” pp. 156-169, O. Kunii (Ed.), Public Health after Disasters, Nanzando, Tokyo, Japan, 2012.pp. 44-55, DE Hogan and JL Burstein (ed), Disaster Medicine 2nd ed. Lippincott Williams & Wilkins, a Wolters Kluwer business, Philadelphia, USA, 2007.
  35. [35] H. Kanamori, H. Kunishima, K. Tokuda, and M. Kaku, “Infection control campaign at evacuation centers in Miyagi prefecture after the Great East Japan Earthquake,” Infect Control Hosp Epidemiol, Vol.32, No.8, pp. 824-826, Aug. 2011.
  36. [36] I. N. Miskin, R. Nir-Paz, C. Block, O. Merin, S. Burshtein, S. Pirogovsky, T. Halperin, D. Schwartz, and M. J. Schwaber, “Antimicrobial therapy for wound infections after catastrophic earthquakes,” N. Engl. J. Med., Vol.363, No.26, pp. 2571-2573, Dec. 2010.
  37. [37] I. Uçkay, H. Sax, S. Harbarth, L. Bernard, and D. Pittet, “Multiresistant infections in repatriated patients after natural disasters: lessons learned from the 2004 tsunami for hospital infection control,” J. Hosp. Infect., Vol.68, No.1, pp. 1-8, Jan. 2008.
  38. [38] H. Kanamori, N. Aso, D. J.Weber, M. Koide, Y. Sasaki, K. Tokuda, and M. Kaku, “Latent Tuberculosis Infection in Nurses Exposed to Tuberculous Patients Cared for in Rooms without Negative Pressure after the 2011 Great East Japan Earthquake,” Infection Control and Hospital Epidemiology, Vol.33, No.2, pp. 204-206, Feb. 2012.
  39. [39] T. Butler, “Loperamide for the Treatment of Traveler’s Diarrhea: Broad or Narrow Usefulness?,” Clin Infect Dis., Vol.47, No.8, pp. 1015-1016, Oct. 2008.

*This site is desgined based on HTML5 and CSS3 for modern browsers, e.g. Chrome, Firefox, Safari, Edge, IE9,10,11, Opera.

Last updated on Feb. 24, 2017