Cholera Handling Bodies

For official guidelines, please follow all local guidelines and instructions from officials in the local area impacted.   Below are some standard recommendations excerpted for the disposal of the dead published by World Health Organization WHO more information can be accessed here (source)

Give priority to the living over the dead (provide sanitation facilities for the survivors first)

Contamination of water sources and the resulting transmission of infection may occur in a very limited number of cases when bodies are in contact with the water system and transmit gastro-enteritis.

Promote the identification and tagging of corpses

Provide Accurate Information concerning the risks associated with corpses

Do not promote mass cremation of bodies

Do not support Mass burial of unidentified bodies in large graves

Conserve fuel and resources

Respect the wishes and social customs of the families

Observation of the dead can be deeply disturbing and the odours produced by decomposing corpses may be even more so, it is therefore important that corpses are collected quickly and morgue facilities are provided if bodies can not be buried or cremated fairly rapidly.

More information on how to dress the body, disinfect, burial and cremation from the World Health Organization can be read in Chapter 9 of their manual here

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DISINFECTING CLOTHING AND DISPOSING OF BODIES:  (SOURCE)

· Prompt and thorough disinfection of a patient’s clothing, personal articles and immediate environment can help to control spread of infection within a family. Effective and inexpensive disinfectants include: chlorinated lime powder, 2% chlorine solution, and a 1-2% solution of phenol.

· Clothes should be washed thoroughly with soap and water, and then boiled or soaked in disinfectant solution. Sun-drying of clothes is also helpful since direct sunlight will kill bacteria.

· Utensils may be washed with boiling water or disinfectant solution.

· The washing of contaminated articles, particularly clothes, in rivers and ponds which might be sources of drinking-water, or near wells, must be prohibited. 

Funerals for people who die of cholera or of any other cause in a community affected by cholera, can contribute to the spread of an epidemic. To reduce the spread of infection, funerals should be held quickly and near the place of death. Those who prepare the body for burial can be exposed to high concentrations of bacterial contamination. Those who wash the body should never prepare the food. If funeral feasts cannot be cancelled, and if other people are not available to prepare the food, meticulous hand washing with soap and clean water is essential before food is handled. A designated health worker, present at the funeral gathering, can be helpful in supervising the use of hygienic practices.

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BODY RECOVERY

 Many different people or groups will be involved in body recovery. This process must be done rapidly to correctly identify the dead and reduce the mental stress on the survivors.

Bodies should be placed in body bags if available; plastic sheets, shrouds, or bed sheets may also be used. Identification of the deceased, and the place and date of recovery (removal) should be recorded, if known.

CONTROL MEASURES

The World Health Organization (WHO) has developed some general cholera management measures to reduce the possibility of disease transmission, which can also be used for an influenza pandemic. These are:

• Disinfect the body (cadaver) with 0.5% bleach solution. (For dealing with influenza victims, disinfection with soap and water will be sufficient.)

• Reduce physical contact by family members.

• Wash hands with soap and water after touching a corpse.

• Disinfect the equipment and bedding.

STORAGE

While refrigerated storage between 2 and 4 degrees Celsius is an ideal, it is not always feasible to find existing facilities large enough to accommodate all those who have died. As an option, refrigerated sea-land cargo containers have been suggested and some communities have made arrangements to purchase or lease these. If such an option is not possible, any large, well-ventilated space, such as a warehouse or empty building, can serve as a temporary mortuary. If refrigeration is not available, temporary facilities should be set up away from residential areas but easily accessible to vehicles and the public.

Other considerations for storage of bodies:

• Storage space should be refrigerated to 2 to 4 degrees Celsius, if possible.

• Dry ice (the solid form of carbon dioxide) may be used. Regular ice (frozen water) should be avoided due to problems with transportation, storage, disposal, and sanitation.

• Bodies should be placed in a body bag or wrapped in a sheet before storage.

• Waterproof labels with a unique identification numbers should be used.

• Temporary burial may be necessary for immediate storage if other means are not available.

IDENTIFICATION

Most of the people who die in a pandemic are likely to die at home or in a health care facility. It is unlikely that there will be large numbers of people whose identities cannot be easily confirmed (as in the case of a massive landslide or tsunami).

A lead agency or individual such as the local governor, police chief, military commander, or mayor should be assigned full authority over the management of dead bodies. A team will be required to assist in identifying the deceased, securing the remains, and notifying family or friends. The team may include members from law enforcement, forensic sciences, health authorities, and social services.

Cholera outbreak: assessing the outbreak response and improving preparedness.WHO/CDS/CPE/ZFK/2004.4 http://www.who.int/cholera/publications/cholera_outbreak/en/index.html  (available also in French and Portuguese)

First steps for managing an outbreak of acute diarrhoea. WHO/CDS/NCS/2003.7.Rev.1
http://www.who.int/cholera/publications/first_steps/en/index.html  (available also in Arabic, French and Portuguese)

Acute diarrhoeal diseases in complex emergencies: critical steps WHO/CDS/CPE/ZFK/2004.6 http://www.who.int/cholera/publications/critical_steps/en/index.html  (available also in Arabic, French and Portuguese)

Oral cholera vaccine use in complex emergencies: What next? Report of a WHO meeting. Cairo, Egypt, 14–16 December 2005. WHO/CDS/NTD/IDM/2006.2 http://www.who.int/cholera/publications/cholera_vaccines_emergencies_2005.pdf

Source: http://www.paho.org/english/dd/ped/DeadBodiesBook.pdf

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