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Dead bodies, disasters, and the myths about them: Is public health law misinformed?

Thomas M. Gionis, MD, JD, LLM, MBA, MHA, FCLM, Cyril H. Wecht, MD, JD, FCLM, Lewis W. Marshall, Jr., MS, MD, JD, FAAEP, Fred A. Hagigi, DrPH, MBA, MPH


While the mission of public health is to fulfill society’s interest in ensuring a healthy society as “public health is what we, as a society, do collectively to assure the conditions for people to be healthy,” the mission of public health law is to assist in the creation of those conditions. However, at times of disaster, threats or risks caused by dead bodies often cause dramatic media coverage and public panic, which incite the passage of emergency public health laws. The unfortunate result of such emergency public health laws mandating immediate dead body disposal, often through mass burial, is that proper identification of the deceased is severely hampered, and families are frequently precluded from experiencing the grieving process and are unable to bring closure to such a traumatic event. Are such emergency public health laws misinformed? Are the threats of dead bodies of disasters a threat to the public’s health? Are the perceived public health threats of dead bodies merely a myth—or is their cause for justified concern? Such a rush to burial not only may add to the psychological distress of survivors but it also forbids them the opportunity of seeing their loved ones being treated with dignity and respect. Additional consequence of “emergency” mass burial legislation without proper identification include legal problems associated with inheritance, life insurance, remarriage of spouses, parenting of surviving children, and even the threat of diplomatic tensions between nation states resulting from burial of foreign tourists.
Disaster medicine specialists are often called upon to comment to the media, advise governmental agencies, and console families, as to the disposition of dead bodies and to the existence of any public health threats caused by the accumulation of human cadavers. Because disaster medicine specialists play a vital role in preserving the public’s health, and because public fears of spread of infectious disease often escalate paralleling the accumulation of dead bodies, disaster medicine specialists must be properly informed of the epidemiologic risks and public health issues that dead bodies of disasters may pose. The purpose of this article is to provide a foundation for disaster medicine specialists in properly advising governments, the public, media, and families regarding the risks and fears concerning the health hazards of human cadavers resulting from disasters.


dead bodies, disasters, myths, infectious diseases, public health law, infectious epidemiology, media panic, postdisaster human cadavers, natural disaster epidemics, burial, pathogens, ground water, cemetery, universal precautions, tuberculosis, blood-bor

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Morgan O, de Ville de Goyet C: Dispelling disaster myths about dead bodies and disease: The role of scientific evidence and the media. Rev Panam Salud Publica. 2005; 18(1): 33-36. Threat of health epidemic looms after quake, tsunamis [news report]. Available at: 4029138/detail.html. Accessed May 12, 2007.

de Ville de Goyet C: Epidemics caused by dead bodies: A disaster myth that does not want to die. Rev Panam Salud Publica/Pan Am J Public Health. 2004; 15(5):297-299.

Sumathipala S, Siribaddana S, Perera C: Management of dead bodies as a component of intervention after the tsunami: A view from Sri Lanka. Int. Rev. Psychiatry. 2006; 18(3): 249-257.

Baxter PJ: Individual and community responses to trauma and disasters: The structure of human chaos. Brit. Med. J. 1995; 310: 269.

Clark A: Working with grieving adults. Adv. Psychiatr. Treat. 2004; 10: 164-170.

Ommeren MV, Saxena S, Saraceneo B: Mental and social health during and after acute emergencies: Emerging consensus. Bull. World Health Organisat. 2005; 83: 71-75.

Malilay J: Public health assessments in disaster settings: Recommendations for a multidisciplinary approach. Prehospital Disaster Med. 2000; 15: 167-172.

Binder S, Sanderson LM: The role of the epdidemiologists in natural disasters. Ann. Emerg. Med. 1987; 16(9): 1081-1084.

Velimirovic B: Non-natural disasters—An epidemiologic review. Disasters. 1980; 4: 28-32.

Morgan O, Sribanditmongkol P, Perera C, et al.: Mass fatality management following the South Asian tsunami disaster: Case studies in Thailand, Indonesia, and Sri Lanka. PLoS Med. 2006; 3(6): 809-815.

Morgan O: Infectious disease risks from dead bodies following natural disasters. Rev Panam Salud Publica. 2004; 15(5): 307-312.

Fineberg H: The population approach to public health. Available at Accessed May 12, 2007.

Institute of Medicine: The future of the public’s health in the 21st centruy. Washington DC: National Academies Press; 2003.

Gostin LO: Public health law: A renaissance. J Law Med Ethics. 2002; 30: 136-137.

Weiss M, Saraceno B, Saxena S, et al.: Mental health in the aftermath of disasters: Consensus and controversy. J Nerv Ment Dis. 2003; 191: 611-615.

Perera C: After the tsunami: Legal implications of mass burials of unidentified victims in Sri Lanka. PLoS Med. 2005; 2: e185.

Seaman J: Epidemiology of natural disasters. Contrib. Epidemiol. Biostat. 1984; 5: 1-77.

Armenian HK, Noji EK, Oganessian AP: Case control study of injuries due to the earthquake in Soviet Armenia. Bull World Health Organisat. 1992; 70: 251-257.

Universite’ Catholique de Louvain: EM-DAT: The international disaster database. Available at Accessed May 12, 2007.

de Ville de Goyet C: Maladies transmissibles et surveillance épidémiologique lors de désastres naturels. Bull World Health Organisat. 1979; 57(2): 153-165.

de Ville de Goyet C: Stop propagating disaster myths. Lancet. 2000; 356: 762-764.

Webb P, Bain C, Pirozzo S: Essential Epidemiology. New York: Cambridge University Press, 2005.

Aschengrau A, Seage GR: Essentials of Epidemiology in Public Health. Sudbury, MA: Jones and Bartlett, 2003.

Noji EK: The public health consequences of disaster. Prehospital Disaster Med. 2000; 15(4): 147-157.

Noji EK: Disaster epidemiology and disease monitoring. J Med Syst. 1995; 19(2): 171-174.

Guha-Sapir D, Joshi PC, Parry LV: Risk Factors for Mortality and Injury: Post-Tsunami Epidemiological Findings from Tamil Nadu. Brussels, Belgium: Center for Research on the Epidemiology of Disasters (CRED), School of Public Health, Catholic University of Louvain, 2006.

DeBruyker M, Greco D, Lechat MF, et al.: The 1980 earthquake in Southern Italy—Morbidity and mortality. Int J Epidemiol. 1985; 14(1): 113-117.

Jonkman SN, Kelman I: An analysis of the causes and circumstances of flood disaster deaths. Disasters. 2005; 29(1): 75-97.

Calder J, Mannion S: Orthopaedics in Sri Lanka post-tsunami. J Bone Joint Surg Brit. 2005; 87B(6): 759-761.

Fan SW: Clinical cases in tsunami hit banda aceh—From a primary health care perspective. Ann Acad Med Singapore. 2006; 35(1): 54-56.

Malilay J, Henderson A, McGeehin M, et al.: Estimating health risks from natural hazards using risk assessment and epidemiology. Risk Anal. 1997; 17(3): 353-358.

de Ville de Goyet C: Las enfermedades transmisibles y la vigilancia epidemiológica en situaciones de desastres naturales. Bol Oficina Sanit Panam. 1980; 89(4): 353-359.

Healing TD, Hoffman PN, Young SE: The infectious hazards of human cadavers. Commun Dis Rep CDR Rev. 1995; 5(5): R618- R619.

Sterling T, Bishai W, Harrington S, et al.: Transmission of Mycobacterium tuberculosis from a cadaver to an embalmer. N Engl J Med. 2000; 342(4): 2468-2469.

McKenna M, Hutton M, Cauthen G, et al.: The association between occupation and tuberculosis. Am J Respir Crit Care Med. 1996; 154: 87-93.

United States, Centers for Disease Control and Prevention. Proportionate mortality from pulmonary tuberculosis associated with occupations—28 states, 1979-1990. MMWR Morb Mortal Wkly Rep. 1995; 44(1): 14-19.

National Institute of Allergy and Infectious Diseases, National Institutes of Health. Tuberculosis Fact Sheet, March 2006. Available at Accessed May 1, 2007.

Gershon RR, Vlahov D, Escamilla JA, et al.: Tuberculosis risk in funeral home employees. J Occup Environ Med. 1998; 40(5):497- 503.

United States, Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities. MMWR Recomm Rep. 1994; 43(RR-13): 1-132.

United States Centers for Disease Control and Prevention, National Center for HIV/AIDS, STD and TB Prevention: hepatitis B—Frequently asked questions. Available at: diseases/hepatitis/common_faqs.htm#5. Accessed May 12, 2007.

Demiryürek D, Bayramoglu A, Ustaçelebi S: Infective agents in fixed human cadavers: A brief review and suggested guidelines. Anat Rec. 2002; 269: 194-197.

World Health Organization: AIDS Epidemic Update, December 2006. Geneva: World Health Organization, 2006.

World Health Organization: Hepatitis B Fact Sheet. Geneva: WHO, 2007. Available at fs204/en/. Accessed May 12, 2007.

Chisari FV, Ferrari C: Viral hepatitis. In Nathanson N, et al. (eds.): Viral Pathogenesis. Philadelphia: Lippincott-Raven, 1997: 745-778.

Ganem D, Schneider RJ: Hepadnaviridae: The viruses and their replication. In Knipe DM (ed.): Field Virology. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2001: 2923-2969.

Mahoney FJ, Kane M: Hepatits B vaccine. In Plotkin SA, Orenstein WA (eds.): Vaccines. 3rd ed. Philadelphia, W.B. Saunders, 1999: 158-182.

Robinson WS: Hepatitis B virus and hepatitis D virus. In Mandell GL, Bennett JE, Dolin R (eds.): Principles and Practice of Infectious Diseases. 4th ed. New York: Churchill Livingstone, 1995: 1406-1439.

Hollinger FB, Liang TJ: Hepatitis B virus. In Knipe DM (ed.): Field Virology. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2001: 2971-3036.

Robinson WS: Hepatitis B viruses. General features (human). In Webster RG, Granoff A (eds.): Encyclopedia of Virology. London: Academic Press, 1994: 554-569.

World Health Organization, Department of Communicable Disease Surveillance and Response: Hepatitis B. Geneva: World Health Organization, 2002.

United States Centers for Disease Control and Prevention, National Center for HIV/AIDS, STD and TB Prevention: Viral Hepatitis B Fact Sheet. Available at diseases/hepatitis/b/fact.htm. Accessed May 12, 2007.

Simmonds P: Viral heterogeneity of the hepatitis C virus. J Hepatol. 1999; 31: 54-60.

United States Centers for Disease Control and Prevention, National Center for HIV/AIDS, STD and TB Prevention: Viral Hepatitis C Fact Sheet. Available at diseases/hepatitis/c/fact.htm. Accessed May 12, 2007.

World Health Organization: Hepatitis C Fact Sheet. Geneva: WHO, 2006. Available at factsheets/fs164/en/. Accessed May 12, 2007.

EASL International Consensus Conference on Hepatitis C. Consensus statement. J Hepatol. 1999; 31: 3-8.

World Health Organization: Hepatitis B Fact Sheet. Geneva: WHO, 2006. Available at factsheets/fs164/en/. Accessed May 12, 2007.

Gershon RR, Vlahov D, Farzadegan H, et al.: Occupational risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infections among funeral service practitioners in Maryland. Infect Control Hosp Epidemiol. 1995; 16(4): 194-197.

World Health Organization: Three months after the Indian Ocean earthquake-tsunami. Available at: international/asia_tsunami/3months/report/en/print.htm. Accessed May 12, 2007.

World Health Organization: Epidemic-prone disease surveillance and response after the tsunami in Aceh Province, Indonesia. Wkly Epidemiol Rec. 2005; 80: 160-163.

Watson JT, Gayer M, Connolly MA: Epidemics after natural disasters. Emerg Infect Dis. 2007; 13: 1-5.

Michel R, Demoncheaux JP, Boutin JP, et al.: Risk for epidemics after natural disasters (letter). Emerg Infect Dis. 2007; 13: 1-5. Available at Accessed May 12, 2007.

Rischetelli G, Harris J, McCauley L, et al.: The risk of acquiring hepatitis B or C among public safety workers. Am J Prev Med. 2001; 20(4): 299-306.

United States Centers for Disease Control and Prevention. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public safety workers. MMWR Morb Mortal Wkly Rep. 1989; 38(S-6): 3-37.

United States Centers for Disease Control and Prevention: Fact sheet: Universal precautions for prevention of transmission of HIV and other Bloodborne infections. Available at http:// Accessed May 12, 2007.

Lynch P, et al.: Rethinking the role of isolation precautions in the prevention of nosocomial infections. Ann Intern Med. 1987; 107: 243-246.

United States Centers for Disease Control and Prevention: Recommendations for prevention of HIV transmission in health-care settings. MMWR Morb Mortal Wkly Rep. 1987; 36 (Suppl 2S): S1-S18.

United States Centers for Disease Control and Prevention: Hepatitis C virus infection among firefighters, emergency medical technicians, and paramedics. MMWR Morb Mortal Wkly Rep. 2000; 49(29): 660-665.

Ucisik A, Rusbrook P: The impact of cemeteries on the environment and public health: An introductory briefing. Denmark: World Health Organization Regional Office for Europe, 1998.

Pan American Health Organization: Natural disasters. Protecting the public’s health. Washington, DC: PAHO, 2000.

Corry JEL: Post-mortem ethanol production. J Appl. Bacteriol. 1978; 44: 1-48.

Dent BB, Knight MJ: Cemeteries: A special kind of landfill. In Weaver TR, Lawrence CS (eds.): Proceedings of IAH Sustainable Solutions Conference, Melbourne, February 1998. Kenilworth: International Association of Hydrologists, 1998, 451-456..

Dent BB: Hydrogeological Studies at Botany Cemetery. Sydney: University of Technology, 1995. M.Sc. project report. 75. Knight MJ, Dent BB: Sustainability of waste and groundwater management. In Weaver TR, Lawrence CS (eds.): Proceedings of IAH Sustainable Solutions Conference, Melbourne, February 1998. Kenilworth: International Association of Hydrologists, 1998, 359-374.

Pedley S, Guy H: The public health implications of microbiological contamination of groundwater. Q J Eng Geol. 1996; 30: 179-188.

Reddy KR: Behavior and transport of microbial pathogens and indicator organisms in soils treated with organic wastes. J Environ Qual. 1981; 10: 255-267.

Lance JC, Gerba CP: Poliovirus movement during high rate land filtration of sewage water. J Environ Qual. 1989; 1: 31-34.

Duboise SM: Poliovirus survival and movement in a sandy forest soil. Appl Environ Microbiol. 1976; 31: 536-543.

O’Brien RT, Newman JS: Inactivation of polioviruses and coxsackrieviruses in surface water. Appl. Environ Microbiol. 1977; 33: 334-341.

Chan GS, Scate M, Emami S: Cemeteries and groundwater: An examination of the potential contamination of groundwater by preservatives containing formaldehyde. Toronto, ON: Water Resources Branch, Ontario Ministry of the Environment, 1992: 11.

Morgan O, Tidball-Binz M, Van Alphen D: Management of Dead Bodies After Disasters: A Field Manual for First Responders. Washington, DC: Pan American Health Organization, 2006.

Organización Panamericana de la Salud. Terremotos en El Salvador, 2001. Washington, DC: OPS (Crónicas de Desastres). 2002: No. 11.

Iserson KV: What happens to corpses? Death doesn’t have to be a mysterious subject. Emerg Med Serv. 1995; 24(6): 35-43.

Mather JD: The attenuation of the organic component of landfill leachate in the unsaturated zone: A review. Q J Eng Geol. 1989; 22: 241-246.



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