Risk of Dead Bodies Associated with an

Epidemic
One of the issues raised by the pandemic (H1N1) 2009 has been the management of the
bodies of people who have died as a result of epidemics. PAHO has prepared guidelines to
help the public in general regarding measures to be taken, and the risks presented by dead
bodies that have resulted from an epidemic.

Summary

Epidemics that have generated a large number of victims have been caused by diseases such
as plague, cholera, typhoid fever, tuberculosis, anthrax, small pox, and influenza. Even
though these are highly contagious diseases, their causing agents do not survive long in the
human body after death, making it unlikely that these epidemics can be transmitted by dead
bodies.

HIV remains active in dead bodies kept at two degrees Celsius between 6-15 days, and
influenza remains active in the environment for only one day.(1) Therefore, if the necessary
basic hygiene and biosecurity measures are taken, dead bodies will not transmit diseases,
even when the cause of death is related to infectious diseases.

An epidemic can diminish the operative capacity of the human resources and the external
services necessary for the efficient running of government and health sector agencies. The
following steps should be taken:

 Avoid taking dead bodies to hospitals, as these institutions do not have enough
storage space for this purpose. Therefore, it is important to have plans that assign
other spaces and entities willing to be used in these cases.
 Define clear procedures to remove victims from homes, elderly homes, and other
places. It is also important to make sure that those bodies are included in the analysis
of confirmed cases and to decide their final resting place.
 Ensure that a plan is in place so that there are enough human and transportation
resources for the previous actions to be carried out. It is important that voluntary or
new personnel are trained, aware of procedures, properly supervised and have all the
necessary items needed for their protection.

Dead Bodies and Infection

 There are diseases, such as Hepatitis B and HIV, that have a greater capacity for
transmission than other pathogens (Hepatitis B's risk of transmission is between 6%-
30%, while HIV's is 0.5%).(2) Transmission can happen due to accidents with sharp
contaminated objects, such as fragmented bones, needles, or other objects related to
the dead body; or accidents involving skin lesions during surgical procedures or by
contact with mucous or ocular secretions. It is, therefore, imperative to follow the
usual protection or biosecurity measures: masks, goggles and double rubber gloves.
 During epidemics it is important to establish a protocol for showing the adequate use
of the personal protection equipment (PPE) to relatives coming to identify bodies, and
 to personnel from morgues, funeral homes and transportation vehicles, the way it is
done with assistance personnel.
 As a rule, it is not necessary to keep bodies in bags. The exception would be bodies
leaking secretions or blood (such as those from people who have died from
hemorrhagic diseases, cholera, etc.), or those with numerous open wounds caused by
a traumatic event.
 If personnel are protected against the high-risk agents, they will also be protected
from the lower risk ones.

Coordination

 The plan for the management of dead bodies is not exclusive to the health sector, and
it requires previous planning and coordination with civil, governmental, military, and
police authorities, at the national and regional level, to speed up decision-making and
allocation of resources.
 The plan should also include coordination activities with the civil society, religious
entities, and the mass media to ensure an effective dissemination of the measures
taken to preserve public health during the epidemics.

Religious Services and Final Disposition of the Bodies

 The main risk for transmission is exposure to sick people-who are still alive-
particularly getting close to them without protection.
 Religious services present the risk of conglomeration, which also increase the risk of
transmission. It is therefore recommended that funeral services are regulated by civil
authorities, and suggest that services are quick and private.
 Hurried cremations, mass burials, or inadequate disposal of dead bodies should be
avoided. Experts from public health and management of dead bodies can advise on
this regard. Environmental health experts should define the adequate places for burial
and administrative mechanisms required to designate an area as a cemetery. It is also
important to preserve water and environmental sources.
 In general, PAHO's recommendations for the management of dead bodies in disaster
situations should be followed.

Bibliography

1. Morgan, Oliver. "Infectious disease risks from dead bodies following natural
disasters." Rev Panam Salud Pública, May 2004, vol.15, no.5, p.307-312. ISSN 1020-
4989.
2. Morgan, Oliver - ed. Management of Dead Bodies alter Disasters-A Field Manual for
First Responders. Washington. D.C. PAHO, 2006.

Contact

Department of Emergency Preparedness and Disaster Relief

Tel: (202) 974-3434

Email: disaster@paho.org