Table 3.

Selected EIDs/REIDs outbreaks associated with natural disasters.

Year	Continent/Region	Natural Disaster	EID/REID	Summary
Africa
1987–1988	South Africa	Flood	Poliomyelitis	An outbreak of type 1 poliomyelitis with 23 cases reported triggered by the massive floods, experienced in the area 2 months earlier in the eastern part of South Africa between December 1987 and November 1988. The cases were most probably due to temporary breakdown in vaccination services and considerable surface pollution, including ‘wild’ poliovirus as a result of flooding (47).
2000	Mozambique	Flood	Malaria	After the heavy rain in Mozambique in 2000 the incidence of malaria increased by four to five times compared to the same period in other years (48).
America
1991	Costa Rica	22 April 1991 Earthquake	Malaria	After the earthquake on 22 April 1991, measuring 7.4 on the Richter scale, statistically significant increases in the incidence of malaria were reported during the months immediately after the earthquake in Limon Province. The number of registered malaria cases for 1 June through 31 May period dramatically increased from 681 in the 1990–1991 period to 3,597 on 1 June 1991 through 31 May 1992 in the same region (49).
1991	USA	Drought	Leptospirosis	Five leptospirosis cases associated with swimming in a rural swimming pond were reported from a small town in rural Illinois between July 7 and 18 in 1991. The outbreak was attributed to the drought conditions creating an environment in the pond facilitating transmission of the organism from area animals to humans (50).
1993	USA	Flood	Leptospirosis	Following the floods in 1993, leptospirosis cases exposed to extensive flood water were reported in Iowa (51).
1994	USA	1994 Northridge, California Earthquake	Coccidioidomycosis	A coccidioidomycosis outbreak between 24 January and 15 March was reported in Ventura County following the January 1994 earthquake, centered in Northridge, California. It is suggested that the outbreak was caused by arthrospores spread in dust clouds generated by the earthquake (52).
1996	Brazil	Flood	Leptospirosis	An increase in the number of leptospirosis cases was reported during the subsequent weeks, after the heavy rainfall caused persistent flooding in several areas of Rio de Janeiro accounting for the largest epidemics in the city’s history. The incidence of leptospirosis was around 1 case per 100,000 inhabitants in the city of Rio de Janeiro yearly before the outbreak. The disease incidence fluctuated to 42.05 per 100,000 inside the flood-risk area (53).
1998	Nicaragua and Guatemala	Hurricane Mitch	Cholera, Leptospirosis and Malaria	Hurricane Mitch in 1998 affected several countries in Central America which damaged health services, wate,r and sanitation networks, and caused population movements between neighboring countries. Thirty-eight cholera outbreaks with 33 deaths in Guatemala, and a leptospirosis outbreak in Nicaragua with 7 seven deaths were seen. Also, the number of reported malaria cases was much higher than the weekly average reported during the pre-Mitch period in Nicaragua and Guatemala (during the second and third weeks) (54).
2001–2003	USA	Drought	West Nile virus	Sporadic and focal transmission of West Nile Virus (WNV) in humans and sentinel chickens has been reported from Florida between 2001–2003. Transmission of WNV was associated with drought 2–6 months prior and land surface wetting 0.5–1.5 months prior probably due to drought that brought avian hosts and vector mosquitoes into close contact facilitating the epizootic cycling and amplification of the arboviruses within these populations (55).
2003–2011	USA	Drought	West Nile virus	Analysis of the field surveys of local mosquito communities and the prevalence of WNV within Culex spp. populations for transmission seasons of 2012 and 2011, and the WNV infection rates and climate data from nine transmission seasons (2003–2011) in New Jersey showed drought conditions (i.e., increased temperatures and decreased precipitation totals), were associated with increases in the prevalence of WNV and confirmed that climatic conditions have a strong impact on the prevalence of vector-borne diseases (56).
2004	Dominican Republic	Flood	Malaria	After the Hurricane struck the Dominican Republic, the east coast of the country received heavy rains and flooding resulting in increased mosquito breeding sites. The number of malaria cases increased sharply, and 2,012 cases had been reported within one month in 2004, which was approximately 1,500–2,500 cases annually in the country (57, 58).
2004	USA	Flood	Leptospirosis	After a flood in a university campus, two leptospirosis cases, of which one was a professor cleaning his flooded laboratory in sandals, were diagnosed (59).
2005	Guyana	Flood	Leptospirosis	The widespread flooding following the unusually high rainfall in January along the Atlantic coast led to conditions favorable for epidemic leptospirosis. An outbreak of leptospirosis associated with flooding was confirmed via laboratory testing (60, 61).
2010	Haiti	Earthquake on January 12, 2010	Malaria	After the great earthquake, 11 laboratory-confirmed cases of whom seven of them were emergency responder U.S. residents, of P. falciparum malaria acquired in Haiti reported (62). By enhanced surveillance conducted between 4 March and 9 April, 2010, 317 more malaria cases were diagnosed most probably due to displaced persons living outdoors or in temporary shelters, putting them at increased risk for acquiring malaria (63).
2011	USA	Tornado	Mucormycosis	After the tornado on 22 May, 2011, a large cluster of cases of mucormycosis, with 13 A. trapeziformis infections in persons injured during a tornado reported, suggesting environmental fungi be considered as potential agents of soft-tissue infections in injured patients after disasters (64).
2016	Ecuador	Earthquake on April 16, 2016	ZIKV	A significant increase in the number of Zika Virus (ZIKV) cases was seen in the affected areas after the 7.8 magnitude earthquake in Ecuador on 16 April, 2016 (65, 66). The total number of ZIKV cases in the country rapidly escalated from 92 to 1,106 in just 3 months. Eighty percent of the cases were reported from the region most affected by the earthquake (67).
Asia
1997–1998	Indonesia	Drought	Malaria	A dramatic increase in malaria and an associated 550 deaths were reported beginning in late August 1997 due to the prolonged and severe drought created by the prevailing 1997–98 El Niño Southern Oscillation (ENSO) in Irian Jaya, Indonesia. Drought conditions resulting in numerous, transient pools of standing water permitting a rapid increase in vector populations and movement and exposure of the population to high-risk malaria endemic lowlands were the main drivers of the outbreaks (68).
1999	Japan	Heavy rainfall	Leptospirosis	After the heavy rainfall in 1999, an outbreak of leptospirosis in the Yaeyama Islands was reported. Fourteen people who were exposed to contaminated soil or water were diagnosed with leptospirosis and required hospitalization (69).
2000	India	Flood	Leptospirosis	Two weeks after heavy rains led to floods in Mumbai in July 2000, an outbreak of leptospirosis was reported in adults admitted to public hospitals. Additionally, leptospirosis was diagnosed in 18 children who were admitted to one hospital between 24 July and 14 September 2000. All of them had contact with flood water (70).
2003	Iran	December 2003 Bam city Earthquake	Cutaneous leishmaniasis	After an earthquake created 10 million tons of rubble, creating suitable conditions for the propagation of sand fly vectors in Bam city of Kerman province in Iran, 2003, a new Anthroponotic Cutaneous Leishmaniasis (ACL) focus in the villages of Dehbakry county, of which there had not previously been any record of CL, was established and an outbreak reported in November 2004 (71).
2003	Iran	July 2003 Fars Earthquake	Cutaneous leishmaniasis	The annual incidence of CL in Fars, Zarindasht, increased from 58.6 cases/ 100,000 in 2002 to 864/100,000 in 2004 after the two earthquakes on 10 July 2003. The cases were predominantly Zoonotic CL (65).
2003	Iran	December 2003 Bam city Earthquake	Cutaneous leishmaniasis	Creating various risk factors; the earthquake caused a sharp increase in the incidence of anthroponotic cutaneous leishmaniasis (ACL) cases in Bam. The mean annual incidence of ACL increased from 1.9 per 1,000 for the period of 1999–2003 to 7.6 per 1,000 for the period of 2004–2008 (66).
2004	Indonesia	Tsunami	Melioidosis	Ten patients with pneumonia of whom four were with culture-confirmed melioidosis, were diagnosed among tsunami survivors as a result of immersion in contaminated saltwater during the tsunami (72).
2007	China	Flood	Malaria	Several floods occurred following the persistent and heavy rain in June and July in the Huaihe River Basin in 2007. The monthly mean monthly malaria incidence fluctuated from 13.76/10 to 95.78/10 in the area. Increased risk of malaria was significantly associated with flooding (73).
2009	Taiwan	Typhoon	Leptospirosis, melioidosis	After Typhoon Morakot in 2009, unusual epidemics of leptospirosis and melioidosis cases were reported. Incidences of leptospirosis and melioidosis cases after the typhoon were significantly higher than those before the typhoon (74).
2011	Sri Lanka	Flood	Leptospirosis	In 2011, a large outbreak of leptospirosis with 32 cases was observed in Anuradhapura district, which was not previously classified as a leptospirosis endemic area, after two weeks of massive flooding (75).
2015	Nepal	Earthquake	Scrub typhus	Three months after the devastating earthquake in April 2015 in Nepal; the first and most significant fatal scrub typhus outbreak was reported in the country with 141 cases in 2015, and lasted for three years (76–78).
Europe
1997 and 2002	Czech Republic	Flood	Leptospirosis	Leptospirosis has been reported rather sporadically, with an incidence rate of about 0.3% per 100,000 population in the Czech Republic. After vast floods in 1997 and 2002, the incidence of leptospirosis increased to 0.9 per 100,000 population (79).
1999	Türkiye	17 August 1999 Earthquake	Tularemia	After the 1999 earthquake, an oropharyngeal tularemia outbreak was reported from the Golcuk-Kocaeli region beginning with 5 cases followed by 129 more cases. This was the first outbreak in the region and most of the cases were from the houses located around natural springs in the new settlement constructed after the earthquake. The outbreak was probably due to pollution of natural springs infected by wild rodents or other infected animals (80).
2004	Finland	Tsunami	Melioidosis	Melioidosis cases were reported in survivors of tsunami that occurred in coastal areas of the Indian Ocean rim in December 2004. Burkholderia pseudomallei was isolated from three Finnish patients in January 2005 whom were visiting Thailand when the tsunami struck in December 2004 (81).
2010	Austria	Flood	Leptospirosis	Four leptospirosis cases were reported in athletes after a triathlon held in Langau, a village in Austria, due to intense rain on the eve of the triathlon that had caused flooding and “unusual turbidity” of the lake (82).