Deadbody disposal

CATTLE MANAGEMENT IN DISASTER

DISPOSAL OF DEAD BODIES

(24TH & 25TH JANUARY 2008)

DR. S. J. GANDHIDEPUTY DIRECTOR

(EPIDEMIC BRANCH)COMMISSIONER OF HEALTH

MEDICAL SERVICES & MEDICAL EDUCATION

GANDHINAGAR

ANTHRAX

AFTER CONFIRMATION OF BEING A CASE OF ANTHRAX, A CARCASS SHOULD NOT BE OPENED AND SHOULD BE DISPOSED OF BY INCINERATION OR RENDERING

DEEP BURIAL AFTER DISINFECTION IS A LESS FAVORURED OPTION.

BLOOD FROM THE DEAD ANIMAL SHOULD BE COLLECTED BY FOLLOWING STRICT ASEPTIC PRECAUTIONS FOR CONFIRMATION OF DIAGNOSIS.

NECROPSY SHOULD NOT BE DONE, AS THIS HAS THE RISK OF SPREAD OF INFECTION.

EDUCATION

EDUCATE EMPLOYEES ABOUT MODES OF ANTHRAX TRANSMISSION.

CONTROL DUST AND PROPERLY VENTILATE ALL HAZARDOUS INDUSTRIES PARTICULARLY WHICH ARE HANDELING RAW ANIMAL MATERIALS

DO NOT USE /SELL HIDES OF ANIMALS EXPOSED TO ANTHRAX NOR USE THEIR CARACASSES AS FOOD OR FEED SUPPLEMENTS

TREAT PROPERLY THE EFFLUENTS FROM HAZARDOUS INDUSTRIES HANDELING ANIMALS,ETC.

MEASSURES IN OUTBREAKS

INVESTIGATE CONFIRM WITH LABORATORY DIAGNOSIS SEARCH FOR THE SOURCE

IN THE AFFACTED AREA: - THE CARACASSES OF INFECTED CATTEL ARE TO BE EITHER BURNT AT THE

SITE OF DEATH THE ASHES BURIED DEEPLY,OR WRAPPED IN DOUBLE THICKNESS PLASTIC

BAG TO PREVENT SPILLING OF BODY FLUIDS AND REMOVED TO A MORE SUITABLE SITE WHERE THEY ARE BURNT AND THE ASHES BURIED

THE SITE WHERE THE ANIMAL DIED IS TO BE DISINFECTED WITH 5% FORMALDEHYDE AFTERE DISPOSAL OF CARACASS

ALL OTHER ANIMALS IN THE AFFACTED AREA ARE TO BE VACCINATED

QUARNTINE & OTHER PRECAUTIONS

AFFACTED PREMISSES ARE TO BE QUARANTINED FOR AT LEAST 20 DAYS AFTER THE LAST CASE OR 6 WEEKS AFTER VACCINATION, WHICHEVER IS LATER

ANY MILK COLLECTED FROM A COW, BUFFALO OR GOAT SHOWING SIGNS OF ANTHRAX WITHIN 8 HOURS OF MILKING IS TO BE DESTROYED, ALONG WITH ANY OTHER MILK THAT MAY HAVE BEEN MIXED WITH SUSPECTED MILK

PEOPLE ENTERRING INFECTED PREMISES ARE REQUIRRED TO WEAR PROTECTIVE CLOTHING, WHICH ARE DISINFECTED BEFORE LEAVING THE PREMISES

ALL CATTLE ON NEIGHBOURING PREMISES SHOULD ALSO BE VACCINATED

QUARNTINE & OTHER PRECAUTIONS

A BUFFER ZONE, 20-30 KM WIDE, IS TO BE ESTABLISHED AROUND THE INFECTED AREA, WITHIN WHICH ALL CATTLE AND EXPOSED SHEEP ARE VACCINATED AND QUARANNTIED

PERSONS WHO HAVE HANDELED INFECTED ANIMALS OR THEIR CARACASSES SHOULD BE VACCINATED AGAINST ANTHRAX, IF THEIR EXPOSURE IS FREQUENT & IF HUMAN VCCINE IS AVAILABLE

SUCH PERSONS SHOULD AVOID ANY CONTACT WITH OTHER PERSONS OR ANIMALS WITHOUT FIRST CHANGING CLOTHING, WASHING HANDS AND TAKING APPROPRIATE MEASSURES

WHERE THERE IS A RISK OF AEROSOLIZATION OF SPORES

CONSIDER DAMPING DOWN OF MATERIAL WITH 5% FORMALIN, WEARING OF FACE MASKS ETC

DISPOSAL OF DEAD BODIES PLAGUE

RISK SIGNALS TO START IMMEDIATE FIELD INVESTIGATIONS: EVIDENCE OF RAT FALL SUSPECTED HUMAN CASE FLEA NUISANCE/ HIGH FLEA INDEX POSITIVE PLAGUE SEROLOGY IN RODENTS / CANNINES

DURING AN OUTBREAK OF BUBONIC PLAGUE ,RODENT CONTROL MEASURES WOULD FURTHER AGGREVATE THE PLAGUE TRANSMISSION BECAUSE LARGE NUMBER OF FLEAS WOULD LEAVE THEIR DEAD RODENT HOST AND WOULD FEED ON MAN AND OTHER DOMESTIC AND PERIDOMESTIC RODENTS AND

MAINTAIN DISEASE TRANSMISSION

SAFE DISPOSAL OF THE BODIES OF PERSONS DYING DUE TO PLAGUE AND DEAD RODENTS DURING RAT FALL: -

IN FATAL CASES OCCURRING DUE TO SUSPECTED PLAGUE POST MORTEM SHOULD BE DISCOURAGED.

CREMATION OR BURIAL OF THE DEAD BODY AS PER THE LOCAL CUSTOMS SHOULD BE UNDERTAKEN.

FUNERAL CEREMONIES IN THE HOUSES OF PLAGUE VICTIMS WHICH MAY INVOLVE ASSEMBLY OF PEOPLE SHOULD BE DISCOURAGED.

THE DEAD BODIES OF PLAGUE VICTIMS SHOULD NOT BE HANDLED AND ENCOFFINED BY THE RELATIVES AND FRIENDS OF THE DECEASED.

THE BURIAL STAFF SHOULD USE MASKS, PROTECTIVE CLOTHINGS, BOOTS & THICK RUBBER GLOVES.

OTHER NECESSARY PRECAUTIONS

PROFESSIONALS HANDLING THE DEAD BODIES SHOULD RECIEVE CHEMOPROPHYLAXIS IN RECOMMENDED DOSAGE AS PER THE ADVICE OF THE DOCTOR.

A LAYER OF LIME AS AN ABSORBENT MATERIAL TO BE KEPT ON THE COFFINS BEFORE THE DEAD BODIES ARE PUT IN IT.

THE DEAD BODY SHOULD BE PACKED IN AN IMPERVIOUS BODY BAG FOR TRANSPORT FROM THE PLACE OF DEATH AND SHOULD NOT BE EXTRACTED FROM THE BAG, AND SHOULD NOT BE BATHED BEFORE CREMATION/ BURIAL.

OTHER NECESSARY PRECAUTIONS

THE BAGGED BODY SHOULD BE PLACED IN A HERMETICALLY SEALED COFFIN AND BURIED WITHOUT RE-OPENING.

DEAD BODY SHOULD BE BURIED IN SUFFICIENT DEEP GRAVES TO PREVENT ACCESS TO RODENTS AND OTHER ANIMALS.

THE GARMENTS AND OTHER BELONGINGS OF A PATIENT DYING DUE TO BUBONIC PLAGUE IN THE HOUSE MUST BE GOT RID OF THE RAT-FLEAS BY THE APPLICATION OF 10% DUST FORMULATION OF MALATHION.

THE SOILED ARTICLES OF PNEUMONIC –PLAGUE VICTIMS SHOULD BE PACKED IN A BAG, INCINERATED, AUTOCLAVED OR FUMIGARED AND PROPERLY DISPOSED OF BY BURNING

GUIDELINES FOR DISPOSAL OF DEAD RODENTS DURING RAT FALL:-

USE DOUBLE FOLDED CLOTH TO COVER YOUR

FACE

DEAD RATS SHOULD NOT BE TOUCHED WITH

BARE HANDS

DISPSABLE HAND GLOVES OR POLYTHENE

SHEET SHOULD BE WRAPED AROUND THE HAND

TO HANDLE DEAD RATS

GUIDELINES TO DISPOSE OF DEAD RATS

SPRAY INSECTICIDE DUST OVER THE DEAD RAT AND SUBSEQUENTLY BURRY IT IN A DEEP PIT.

PICK UP THE DEAD RAT BY MEANS OF LONG FORCEPS, LONG TONG ETC. AND PUT IT IN A CONTAINER CONTAINING COTTON WOOL SOAKED IN INSECTICIDE FOR FINAL DISPOSAL

THE DISPOSABLE ITEMS SHOULD BE BURNT OR BURRIED AND OTHER ITEMS SHOULD BE DISINFECTED

RABIES

THE TREATMENT SHOULD BE STARTED IMMEDIATELY AFTER THE BITE. THE TREATMENT MAY BE MODIFIED IF ANIMAL INVOLVED (DOG OR CAT)

REMAINS HEALTHY THROUGHOUT THE OBSERVATION PERIOD OF 10 DAYS .

A HISTORY OF RABIES VACCINATION IN AN ANIMAL IS NOT ALWAYS A GUARANTEE THAT THE BITING ANIMAL IS NOT RABID.

ONE VACCINE DOSE IN THE ANIMAL DOES NOT ALWAYS PROVIDE LONG LASTING PROTECTION AGAINST INFECTION WITH RABIES.

THE NATURAL HISTORY OF RABIES IN MAMMALS OTHER THAN DOGS AND CATS IS NOT FULLY UNDERSTOOD AND THEREFORE THE 10 DAY OBSERVATION PERIOD MAY NOT BE APPLICABLE

GUIDELINES FOR TREATMENT

BITE BY ALL WILD ANIMALS: TREAT AS CATEGORY 3 EXPOSURE FOR RABIES

BITE BY RODENTS: BITES BY DOMESTIC RATS, MICE, SQUIRREL, HARE AND RABBITS SELDOM REQUIRE TREATMENT

BAT RABIES: BAT RABIES HAS NOT BEEN CONCLUSIVELY PROVED IN INDIA AND HENCE EXPOSURE TO BATS DOES NOT WARRANT TREATMENT

VACCINE SCHEDULES

(A) INTRA-MUSCULAR VACCINE SCHEDULE: HUMAN DIPLOID CELL VACCINE PURIFIED CHICK EMBRYO CELL VACCINE PURIFIED VERO CELL RABIES VACCINE PURIFIED DUCK EMBRYO VACCINE SCHEDULE OF DOSAGE: 0, 3, 7, 14 & 28 DAYS SIXTH (D90) INJECTION, OPTIONAL IN-IMMUNOLOGICALLY

DEFICIENT, ARE AT THE EXTREMES OF AGE AND ON STEROID THERAPY.

VACCINE SCHEDULES

(B) INTRA –DERMAL REGIMENS:

IN THIS METHOD SMALL AMOUNT OF RABIES

VACCINE/ANTIGEN IS DEPOSITED IN THE LAYERS OF

THE SKIN AT MULTIPLE SITES

THIS RESULTS IN A STRONGER IMMUNE RESPONSE

RABIES IN DOGS

CLINICAL PICTURE: FURIOUS RABIES: CHANGE IN BEHAVIOUR, RUNNING AMUCK,

CHANGE IN VOICE, EXCESSIVE SALIVATION, PARALYTIC STAGE DUMB RABIES

LABORATORY DIAGNOSIS: HEAD OF THE ANIMAL IS CUT OFF DULY PACKED IN ICE IN AIR TIGHT CONTAINER

OR BRAIN MAY BE REMOVED WITH ANTI-SEPTIC PRECAUTIONS SENT IN 50% GLYCEROL –SALINE FOR EXAMINATION

JAPANESE ENCEPHALITIS

JAPANESE ENCEPHALITIS IS A MOSQUITO BORNE ZOONOTIC VIRAL DISEASE. PIGS AND BIRDS (CATTLE EGRETS, POND HERONS) ARE THE NATURAL HOSTS AND MAN AND HORSE ARE “ DEAD END” HOSTS.

AFFECTED STATES IN INDIA ARE ANDHRA PRADESH, BIHAR, KARNATAKA, TAMILNADU, UTTAR PRADESH AND WEST BENGAL.

JE OUTBREAKS USUALLY COINCIDE WITH MONSOON & POST MONSOON PERIOD, WHEN THE VECTOR DENSITY IS HIGH.

CASE FATALITY IN NEWLY AFFECTED AREAS IS TO THE EXTENT OF 30-40%

CHILDREN BELOW 15 YEARS OF AGE ARE ESPECIALLY HIGH RISK GROUP.

CAUSATIVE AGENT & TRANSMISSION

JAPANESE ENCEPHALITIS VIRUS WHICH IS ANTIGENICALLY RELATED TO OTHER FLAVIVIRUSES LIKE DENGUE, WEST NILE AND YELLOW FEVER.

TRANSMISSION BY:

MOSQUITO-BORN -CULEX TRITANEORHYNCHUS GROUP THE VIRUS DOES NOT CAUSE ANY DISEASE AMONG IT’S

NATURAL HOSTS AND THE TRANSMISSION GOES UN-NOTICED THROUGH MOSQUITOES PRIMARILY BELONGING TO THE GENUS CULEX.

THERE IS NO SPECIFIC TREATMENT.

CLINICAL PICTURE

ACUTE ENCEPHALITIS WHICH CAN PROGRESS TO

PARALYSIS

SEIZURES

COMA AND DEATH

MAJORITY OF CASES ARE SUB-CLINICAL.

SERIOUS NEUROLOGICAL SEQUELAE LIKE MENTAL

IMPAIRMENT, SEVERE NEUROLOGICAL INSTABILITY,

PERSONALITY CHANGE AND PARALYSIS MAY OCCUR IN

AROUND 10-30% OF CASES.

Avian Influenza

Chingmeirong , Imphal

Control Room

The Nerve Centre

Quarantine: restrict access to infected premises; village; station and bus-stand

Physical survey of the area of operation

To determine nature and scope of operations.



Physical Survey To Know :

Cleaning of the farms Hygienic conditions on farms Quantities of solid, semi-solid, liquid fecal material, feathers and other waste material lying unattended Farmers participation in Culling Number of birds on the Farm Demarcation of Surveillance & Infected areas

Demarcation of Surveillance & Infected areas

5 km radius

Stamping Out

5 km radius Compulsory Vaccination / Surveillance

(High risk poultry areas)

3 km Culling area

Demarcation of Surveillance & Infected areas

Culling: use of sedatives mixed in water to reduce activity level in birds.

SodiumFenoBarbital,

Culling : Dislocation & Decapitation

Culling: culled birds on farms were packed in bags for disposal, which were carried to disposal sites

Culling:public announcement not to release birds in morning; Panchayat involved; common disposal ground identified in villages; birds collected by veterinarians in morning; cash for bird; tremendous response

Different StrategyForBackyardpoultry

Backyard poultry: sites for disposal identified by Panchayat

Disposal

Two methods: bury or burn Burning: bury ash, remains etc.; burn well;

material requirements higher; incinerators Burying: dig deep; dumped material be kept

below ground level; lime/earth layers; no scavenging. Rodent problem

Dispose: birds, eggs/trays, sacks, feathers, feed/feed ingredients, fecal material, manure etc.

Safe Disposal: Deep trenches dug by JCB’s

Disposal:more than 40 JCB’s deployed in

Navapur & Jalgaon I; requisitioned from deptts

Burial of Birds

Disposal:material carried out manually for disposal from farms/villages

Disposal: killed birds and infected material dumped into pits dug by JCB’s

Materials should be lower than ground level

Disposal:pits covered by earth and ‘limed’

Alternatelayers of earth and lime to pack it well

Disposal by Burning

PPE burnt on each farm on exit by each person from each farm

Disposal:eggs destroyed and buried with egg trays etc.

Disposal of feed and feed materials Infected material Feed manufacturing units within

poultry farm GOI to share cost of compensation

upto 50%

Disposal of feed and feed materials.



Major activity.Farms are largely two-tier structures.

Clean up:Commercial farms


Upper storey has bird cages and support systems

Lower storey is dump ground for fecal matter; ‘slurried’ due to water leakage from bird water systems




Physicallyimpossible to enter & clean up.Difficult to access lower storey due to low height


Jetting& suction machines

Liquid material pumped out


Discharged into pits which were covered withthick layer of lime and earth. Continuouswatch.



Covered with plastic sheets

Sheds cleaned manually thereafter


Clean up:Commercial farms : Use of labor

Specialized labor required. Availability an issue.

Farm owners: required to be involved; reluctant;

Reluctance to use PPE; Temiflu Difficult work conditions

Feather disposal

laborious work; not possible manually

Feather disposal

Flame guns purchased and used; operated by LPG

Feather disposal

Cage systems are to be opened up, cleaned and disinfected; water systems to be handled similarly

Disinfecting & Spraying

Foggers provided by GOI. Sprayers to be provided by State Govt.




Disinfecting & Spraying: Commercial Poultry

Wash floors and walls with calcium hydroxide (3% solution) Spray of bleaching powder & lime in floors of sheds and farm

area White-wash of concrete and bricked area with lime Spray 4% formalin over area Treat equipment with hypochlorite solution (2%) for 48 hours KMnO4 mixed in water tanks etc Close chamber fumigated with KMnO4 & formalin

Different strategy Heavily populated villages in Jalgaon Complete culling in village before starting clean-up Burn baskets/egg trays/litter/feed and all the poultry in

10 km radius Bury the eggs Remove, burn all litter from permanent cages and

clean the cages Burn garbage around poultry keeping area Whitewash the houses: 3km/10km

Disinfecting & Spraying :Backyard Poultry

Disinfecting & Spraying : Backyard Poultry Spray all houses in 0-3 km Spray poultry rearing houses and yards in 3-10 km

zone Spray all damp areas/drains with 4% formalin Formalin not to be used in inhabited areas due to

irritation to humans. Alternatives: Trilocid Concentrate, Virkon-S, Sodium

hypochlorite. Sprinkle lime on top Sprinkle lime on the roads, streets etc in all the

villages under the operation

Sanitized farms

Sanitized farms

Sanitized farms

Sanitized farms

Sanitized farms

Sanitized farms

Sealing of farms

Sealing of farms

THANK YOU

Health & Medicine

Deadbody disposal