According to Smith and Casadevall, which factor most significantly contributes to the spread of microbial infections during a disaster?

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Last updated: October 15, 2026 • View editorial policy

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Disaster infections: the key driver

The disruption of sanitation systems and access to clean water is the dominant factor driving the spread of microbial infections during disasters. 1

  • Rationale anchored in guideline evidence:

    • CDC MMWR (2025) links post-disaster outbreaks (e.g., tularemia) to disrupted water infrastructure and contamination of food/water by rodents after war and earthquakes, underscoring sanitation and safe water as the primary amplifiers of infection risk 1.
    • Broader disaster guidance consistently notes increased infections from contaminated water/food and crowding when sanitation is compromised 2.

  • Why the other options are not primary drivers:

    • Availability of medical professionals: affects care capacity but is not the main mechanism of microbial spread 3.
    • Widespread vaccination programs: mitigate specific vaccine-preventable diseases; their presence reduces, not increases, spread 4.
    • Introduction of new antimicrobial drugs: influences treatment and resistance patterns, not the immediate spread during disasters 5.

  • Practical caveat for morbidity, mortality, and quality of life:

    • Prioritize rapid restoration of safe water, sanitation, and hygiene (WASH) to prevent high-burden waterborne and zoonotic outbreaks that drive excess deaths and long-term disability post-disaster 1, 2.

References

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