地震后遇难者的尸体处置与传染病预防的系统评价

Management of Dead Bodies and Epidemic Control after Earthquake——An Evidence-Based Approach

背景与目的全球近20年因地震死亡数十万人,震后大量遇难者尸体是否会造成大面积传染病爆发一直是全球关注的热点问题。本研究旨在通过全面检索、收集相关文献,系统评价全球近20年重大地震灾害后有关遇难者尸体处理及传染病控制的方法及效果,以期为遇难者尸体的科学处置提供当前最佳证据。方法制定检索策略,在MEDLINE、Cochrane图书馆、CNKI与WHO网站上检索并纳入1988～2007年期间地震后尸体处置与传染病控制的中英文全文文献。采用临床流行病学方法严格评价纳入文献。结果有关地震后遇难者尸体处理与传染病爆发的研究文献数量少,且多为描述性研究。本次评价共纳入10篇文献,包括2篇述评、4篇综述和4个技术报告。文献分析结果表明,灾后传染病爆发主要与灾民异地安置的卫生条件、人口密度、饮水与食品安全及基本卫生设施有关,尚无证据表明传染病爆发与尸体有关。现场尸体处置人员应做好自身防护措施。结论"地震后遇难者尸体会成为疾病的传染源"是一误区,建议政府部门应将尸体处置原则、模式纳入应急机制与现场救助手册。同时应强化对媒体、公众的健康教育,消除误区。

Background and Objective Nearly half of million have been reported dead after earthquakes in recent 20 years, and many people always concern seriously about whether those corpses pose a risk to epidemics after earthquakes. An evidence-based approach was conducted to assess the relationship between dead bodies and epidemic disease outbreak systematically. Methods We searched PubMed, The Cochrane Library （Issue 1, 2008）, CNKI and WHO website and screened the references of eligible studies. Results A total of 10 papers published beween 1988 to 2007 were included for final analysis, including 2 editorials, 4 reviews and 4 technical reports （technical note or manual）. The risk factors for epidemic outbreak after earthquakes were associated primarily with safe water, food and sanitation facilities, as well as the density of population, and no evidence was found that those corpses would pose a risk to the outbreak. But standard infection control precautions should be observed when human corpses were handled. Conclusion Management of dead bodies should be brought into the emergency preparedness system, disaster manuals and guidelines. A community-centered approach to informing communities about the management of the dead following earthquake is also needed. Meanwhile, the myth of about dead bodies and disease outbreak should be dispelled.