title: Shelter crowding and increased incidence of acute respiratory infection in evacuees following the Great Eastern Japan Earthquake and tsunami.
abstract: Although outbreaks of acute respiratory infection (ARI) at shelters are hypothesized to be associated with shelter crowding, no studies have examined this relationship. We conducted a retrospective study by reviewing medical records of evacuees presenting to one of the 37 clinics at the shelters in Ishinomaki city, Japan, during the 3-week period after the Great Eastern Japan Earthquake and tsunami in 2011. On the basis of a locally weighted scatter-plot smoothing technique, we categorized 37 shelters into crowded (mean space <5·5 m2/per person) and non-crowded (⩾5·5 m2) shelters. Outcomes of interest were the cumulative and daily incidence rate of ARI/10 000 evacuees at each shelter. We found that the crowded shelters had a higher median cumulative incidence rate of ARI [5·4/10 000 person-days, interquartile range (IQR) 0-24·6, P = 0·04] compared to the non-crowded shelters (3·5/10 000 person-days, IQR 0-8·7) using Mann-Whitney U test. Similarly, the crowded shelters had an increased daily incidence rate of ARI of 19·1/10 000 person-days (95% confidence interval 5·9-32·4, P < 0·01) compared to the non-crowded shelters using quasi-least squares method. In sum, shelter crowding was associated with an increased incidence rate of ARI after the natural disaster.
authors.affiliation: Department of Emergency Medicine,University of Fukui Hospital,Fukui Prefecture,Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kawano
authors.affiliation: Harvard Interfaculty Initiative in Health Policy,Cambridge,MA,USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Tsugawa
authors.affiliation: Department of Primary Care and Emergency Medicine,Kyoto University Graduate School of Medicine,Kyoto Prefecture,Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nishiyama
authors.affiliation: Department of Emergency Medicine,University of Fukui Hospital,Fukui Prefecture,Japan.
authors.forename: H
authors.initials: H
authors.lastname: Morita
authors.affiliation: Department of Community Health Care Promotion,University of Fukui Hospital,Fukui Prefecture,Japan.
authors.forename: O
authors.initials: O
authors.lastname: Yamamura
authors.affiliation: Department of Emergency Medicine,Massachusetts General Hospital,Harvard Medical School,Boston,MA,USA.
authors.forename: K
authors.initials: K
authors.lastname: Hasegawa
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003441:Crowding; D004190:Disasters; D004196:Disease Outbreaks; D055866:Earthquakes; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010550:Personal Space; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D057192:Tsunamis; D055815:Young Adult
keywords: Community epidemics; epidemiology; infectious disease control; infectious disease epidemiology; respiratory infections