The destruction of the Kakhovka Hydroelectric Power Plant by the occupiers has led to catastrophic consequences, including the death of people (the exact number of casualties is currently impossible to determine), animals, the decimation of fish in the drained areas, destruction of ecosystems, and contamination of water sources and soil. In the disaster zone, a number of epidemic risks arise, the first of which is a possible outbreak of acute gastrointestinal and other infectious diseases due to limited access to clean water. Mind investigated the extent of these risks and how to avoid them.
What is the mechanism of infection spread after the dam explosion? Massive flooding destroys infrastructure and results in the washing away of septic tanks, rubbish dumps, cemeteries, and animal burial sites, where natural foci of infectious diseases can concentrate. Water itself becomes a vector for the spread of dangerous causative agents, and the summer heat acts as a catalyst for the proliferation of some of them.
In addition to water, the causative agents of gastrointestinal infections can spread through contaminated food products, dirty hands, and household objects, as well as insects that contaminate food. Although infection primarily occurs after the ingestion of contaminated water or products, the pathogens can survive relatively long periods outside the human body.
Another potential factor in the spread of diseases is the mass death of fish, which is currently occurring in the shallow waters of the Kherson, Mykolaiv, Zaporizhia, and Dnipropetrovsk oblasts. Tens of thousands of fish have already perished in these areas. Dead or decaying fish pose a threat of botulism, and parasites, and may contain hazardous chemicals. The risk remains whether the fish is consumed in dried, smoked, boiled, or fried form, and it is also a risk for animals.
Which specific diseases threaten the residents of the flooded areas? In addition to botulism, flooding carries the risk of spreading pathogens of diseases such as cholera, salmonellosis, hepatitis A, enteric typhus, helminthiasis, shigellosis, and others. These are primarily transmitted through the faecal-oral route (due to the contamination of water with the contents of septic tanks and sewage).
As for cholera, the epidemic of which has been actively frightening Ukrainians in recent days by media, the Ministry of Health of Ukraine (MoH) does not rule out cases of cholera but emphasises that they are likely to be isolated.
"We do not exclude the possibility of sporadic cases of cholera among infectious diseases after the water recedes. We have intensified the appropriate control measures and done everything possible to prevent such cases," assured the Chief State Sanitary Doctor and Deputy Head of the MoH, Igor Kuzin.
Hope is also expressed by infectious disease specialist Yevgen Dubrovsky, who believes that due to the large volume of water released from the Kakhovka reservoir, all pathogens of infectious diseases in it will be diluted and present at a relatively low concentration (i.e., less than the minimum infectious dose).
Those affected in the flooded areas may also be at risk of anthrax (due to the erosion of animal burial sites) and leptospirosis (through the flooding of rodent burrows, as the pathogen enters the body, including through damaged skin). However, these diseases are not transmitted from person to person and can be effectively treated with antibiotics, so there is no expectation of corresponding epidemics.
There is also a risk that the number of mosquito-borne diseases, such as fevers or skin infections, may increase as a result of the marshy conditions once the water recedes.
It should be noted that the water may not only be contaminated with pathogenic microorganisms but also toxic substances due to the leaching of pesticides, vehicle depots, and industrial facilities.
What is the epidemiological situation in the affected regions? According to the MoH, as of June 13, no outbreaks of infectious diseases or increased levels of infectious illnesses have been reported in the Kherson Oblast.
However, according to the Chief State Sanitary Doctor of Ukraine, there has already been a significant exceedance of microbiological indicators in surface water bodies. Therefore, it is prohibited to swim or use such water for domestic purposes and food processing.
How to prevent infection in flooded areas? First and foremost, it is necessary to adhere to sanitary rules and guidelines from the Ministry of Health. We have compiled all the recommendations from the body and the Public Health Centre:
If there are signs of acute gastrointestinal infection or any other illness, seek immediate medical attention.
What is the Ministry of Health doing to prevent epidemics? The Ministry of Health (MoH) has announced the implementation of an emergency response plan to address potential epidemiological threats. The "Response Readiness" package is operational within the Medical Guarantees Programme. Hospitals in the Kherson, Mykolaiv, and Dnipropetrovsk oblasts, which are going to serve as hubs in case of potential outbreaks of infectious diseases, are mostly prepared to receive patients and provide them with all necessary medical assistance if needed.
Necessary stocks of medications, including antibiotics and sorbents for the treatment of acute gastrointestinal infections, have been assembled in the affected oblasts. Mykolaiv and Kherson oblasts have prepared a supply of water disinfection tablets. The MoH assures that these provisions will be sufficient to meet the needs of Kherson oblast residents for at least several months.
On June 11, the ministry also prohibited bathing in open water bodies in the affected regions. Strict control measures have been implemented to prevent the informal sale of aquatic resources such as fish and crayfish.
As of June 13, monitoring and epidemiological control are being conducted in the flooded areas by 84 groups of experts from disease control and prevention centres in six oblasts. Among other tasks, specialists collect water samples from rivers and wells and assist in the disinfection of wells in flooded areas.
Operational reserve brigades from the Centre for Disease Control and Prevention have been formed in the Mykolaiv Oblast. These teams will be dispatched to Kherson to strengthen the control of the epidemiological situation in the flooded areas once the water levels recede.