Epidemiology of tropical cyclones: the dynamics of disaster, disease, and development.

Tropical cyclones—variously defined as hurricanes, typhoons, and cyclones—regularly impact human populations and periodically produce devastating weather-related natural disasters. The epidemiology of tropical cyclones is fundamentally determined by the physical forces of massive cyclonic systems intersecting with patterns of human behavior. The destructive forces of cyclonic winds, inundating rains, and storm surge are frequently accompanied by floods, tornadoes, and landslides (1, 2). Human factors include land use and settlement patterns, building design and construction, forecasting and warning systems, risk perception, evacuation, and sheltering. Preparedness and mitigation strategies for minimizing harm include family disaster planning, stocking of hurricane supplies, protection of home sites, timely response to public warnings, and alertness to poststorm hazards. Public health consequences associated with tropical cyclones include storm-related mortality, injury, infectious disease, psychosocial effects, displacement and homelessness, damage to the health-care infrastructure, disruption of public health services, transformation of ecosystems, social dislocation, loss of jobs and livelihood, and economic crisis. These outcomes disproportionately befall developing nations, and human factors strongly influence the observed disparities (3). We conducted a review of the epidemiologic literature on the public health consequences of tropical cyclones. For the purpose of this review, we performed a keyword search on the Internet using a variety of academic search engines and websites, including MEDLINE, PubMed, the National Center for PTSD PILOTS database, the National Hazards Center database, and the National Oceanic and Atmospheric Administration/National Hurricane Center website, using combinations of the terms ‘‘tropical cyclone,’’ ‘‘cyclone,’’ ‘‘hurricane,’’ ‘‘typhoon,’’ ‘‘natural disasters,’’ and ‘‘epidemiology.’’ We also conducted keyword searches directly on the websites of Morbidity and Mortality Weekly Report and major medical and emergency medicine journals. Checks of the bibliographies of key references in the psychosocial and sociologic literature expanded the search. We conducted analyses of windstorm data using the Emergency Disasters Database (EM-DAT) of the Center for Research on the Epidemiology of Disasters (Brussels, Belgium) (4).