Outbreaks of disease following natural disasters Paragraph 1 ‘Natural disasters are defined as catastrophic events with atmospheric, geologic and hydrologic origins that have serious health, social and economic consequences. They may have rapid or slow onset and include earthquakes, volcanic eruptions, landslides, tsunamis, floods and drought. Over the past two decades, natural disasters have killed millions of people worldwide, adversely affected the lives of at Jeast a billion more and resulted in massive economic damage. Alarmingly, many environmental experts predict increases in both their incidence and severity in the future. It is often developing countries that are most affected because they may lack the resources, infrastructure and disaster-preparedness systems to deal with the initial impact of the disaster and its after-effects. Paragraph 2 ‘When reporting on a natural disaster, be it an earthquake in Pakistan, a flood in Bangladesh or a cyclone in Australia, it is common for media organisations to direct their focus towards the likelihood of disease outbreaks shortly afterwards. More often than not, however, such reports are based on a perceived connection between dead bodies and epidemics, as opposed to being based on facts or sound medical information. In truth, outbreaks of communicable diseases in the aftermath of natural disasters are relatively uncommon and it is the initial trauma of the disaster itself that is far more likely to have the greater impact on populations, certainly with regard to deaths caused. Paragraph 3 This is not to say that the risks of communicable disease transmission in disaster-stricken areas are not real, just that they are often overstated. 1f communicable diseases are to take hold after a cataclysmic event, this is more likely to occur when large numbers of people have been displaced and resettled in ‘temporary locations. Although the large-scale displacement of populations is relatively uncommon, when it does occur, the sudden crowding of survivors, often with inadequate food and shelter, unsafe wat and poor sanitation, can allow communicable diseases, either alone or in combination with malnutrition, to emerge as potential killers. There are also other factors that may contribute to communicable disease outbreaks after disasters. These include the underlying health status of the population, levels of ‘vaccination coverage for preventable diseases, the availability of healthcare services, and the existing local disease ecology.Paragraph 4 Diarrhoeal diseases are the most common water-related diseases and can occur as a result of widespread consumption of contaminated drinking water. An outbreak of diarthoeal disease after flooding in Bangladesh in 2004 involved more than 17,000 cases. After the 2005 earthquake in Muzaffarabad, Pakistan, over half the adult population of an unplanned, poorly equipped camp of 1,800 persons were affected by an outbreak of acute watery diarrhoea, which was only controlled after adequate water and sanitation facilities were provided. It is important to note that in both cases the sources of the outbreaks were bacteria endemic to the area, not the presence of human remains. Paragraph & Probably the most important factor in controlling the secondary effects of natural disasters and population displacement is the response of those in authority. It is vital that the risks, such as those previously outlined, are assessed immediately and addressed initially with the rapid reinstatement of basic services. Ensuring access to safe water and primary healthcare Services is crucial, as are surveillance and early warning to detect epidemic-prone diseases known to occur in the disaster-affected area. A comprehensive communicable disease risk assessment can determine priority diseases for inclusion in the surveillance system, and prioritise the need for immunisation campaigns. Paragraph 6 It is not always easy, of course, Depending on the location and scale of the disaster, and the affected area's government, obtaining relevant information in these contexts is frequently challenging, Healthcare during the emergency phase is often delivered by a wide range of national and international personnel which creates coordination challenges. Also, a lack of pre~disaster baseline surveillance information can lead to difficulties in accurately differentiating epidemic from background endemic disease transmission. ‘The priority in these settings, then, is the rapid implementation of control measures when cases of epidemic-prone diseases are detected. Paragraph 7 Following a natural disaster, it is clear that the continued detection of and response to communicable diseases are essential to monitor the incidence of diseases, to document their effects, to respond with control measures when needed, and to better quantify the risk of outbreaks. It is the systematic gathering of relevant and accurate information that is vital to the disaster-management effort, rather than the often sensationalist reports of the world’s media organisations that purport to ‘war’ communities of disease outbreaks. TURN OVERQuestions. Part B - Text B1: Questions 1-10 1 In paragraph 1, the word ‘infrastructure’ refers to ‘A preparedness systems. B services and faciities. buildings and factories. D_ government agencies. 2 According to paragraph 1, natural disasters ‘Aare responsibie for failing economies. B occur more often in developing countries. are forecast to become more common. D__ have killed billions of people in the past 20 years. a According to paragraph 2, .. ‘A most deaths from natural disasters are due to the disaster itso. B__ sensationalist reporting on disasters is relatively uncommon. the media exaggerate the number of deaths caused by disasters. D___ media organisations rely on medical experts for stories. 4 According to paragraph 3, communicable disease transmission following disasters is A only amatter of time. Ba result of malnutrition. © byno means a certainty. D most likely water-related, 5 According to paragraph 3, which one of the following is NOT a factor that may contribute to disease outbreaks after natural disasters? ‘A the general health of the community before the disaster struck B to the area by means of the disaster itself vaccination levels and the availabilty of healthcare services Diseases that were present in the area prior to the disaster bacteria brought itQuestions. 10 According to paragraph 4, diarrhoeal disease outbreaks are .. A often due to existing bacteria, B easy to control. most common in flooded areas. D unlikely to affect children. According to paragraph 4, which of the following statements about post-disaster diarrhoea outbreaks is TRUE? A They can be prevented by fast removal of human remains. B They are more likely if ving conditions are unhygienic. Their severity is often greater among the adult population D They are particularly acute after earthquakes and floods, In paragraph 5, what is meant by ‘the secondary effects of natural disasters’? ‘A population displacement B disease outbreaks © immunisation programs D tisk assessment According to paragraph 6, A. id organisations do not work together effectively in disaster situations. B absence of local data makes it harder to detect epidemic-prone diseases. C the control of local diseases means epidemics are unlikely to occur. D endemic diseases are more difficult to identity than epidemic diseases. ‘Which one of the following statements is NOT supported by information in paragraph 7? ‘A \Nigilance is important in ensuring disease risks are contained. B Effective outbreak management depends on systematic surveillance. © World media organisations are unimportant in disaster management. D Accurate appraisals of disease threats are critical for disaster management. END OF PART B- TEXT 1 TURN OVER FOR PART B~ TEXT 2Macular degeneration Paragraph 1 Age-related macular degeneration (AMD) is the most common form of blindness in developed countries. While many of the other major causes of blindness are now treated successfully, macular degeneration remains a considerable threat to the vision of people aged over 50. It is a progressive disease, and as yet there is no cure. AMD refers to the deterioration of an area of the retina — the light-sensitive lining of the inner eye ~ known as the macula. The macula is composed of a high concentration of light receptors, and is strategically positioned at the back of the eyeball to receive the light from the centre of the field of vision. When this part of the eye is damaged or begins to degenerate, the person will experience a loss of ‘their central vision, but will often retain their peripheral vision. Paragraph 2 ‘There are a number of factors that may contribute to the onset of AMD. Advanced age is the major known predisposing factor. AMD is also believed to be the result of an interaction between a person's genetic disposition and their environment. Indeed, AMD tends to run in families, with a 50% probability of developing the condition if there is a family history of the disease. As for environmental factors, smoking is the strongest risk factor. Some studies have also found that there is a significant association with leisure time spent outdoors in the sun and the development of AMD. Obesity and a lack of regular exercise have also been identified as major risk factors for increasing the progression of the discase. Diet can play an important preventative role, with fruit and vegetables high in beta-carotene (such as leafy greens) and vitamins A, C and E found to help slow down deterioration in the eye. Paragraph 3 ‘There are two types of AMD. The most common (around 90% of cases) is known as “dry” AMD. In this form, the macula becomes thin through the natural process of ageing. The retinal pigment epithelium cells degenerate and atrophy, resulting in the loss of central vision. This usually occurs gradually. In the rarer form, known as ‘wet’ or neovascular AMD, blood vessels growing beneath the retina leak fluid and haemorthage into the macula, The macula then becomes scarred, affecting vision. ‘Wet’ AMD is more damaging to the eye than the dry form and usually results in a more rapid loss of vision.Paragraph 4 Due to the degenerative nature of ‘dry’ AMD, treatment is difficult. Antioxidant therapy, however, has ‘been shown to slow down the progression of the disease, and advances in retinal surgery may one day offer some hope. The ‘wet? form is more receptive to various forms of treatment. Thermal laser therapy was once used, but its practice is diminishing as it often results in damage of the surrounding tissue. Photodynamic therapy using a low-energy cool laser is more successful in slowing down or halting further loss of vision, but it can be an expensive procedure. Future avenues of research may involve the use of pharmacological treatment to block the action of vascular endothelial growth factor (VEGF), whose role is related to the growth of abnormal biood vessels, which affect vision in the ‘wet’ form of AMD. Paragraph § Aside from a loss of vision, AMD can also affect mental health. Symptoms of the discase often set in when a person is reaching retirement age, making the prospect of leisure activities, such as travel, more difficult, Studies have shown that people with vision loss are three times more likely to experience depression. Sufferers may also feel isolated and emotionally stressed. Often their overall physical health is very good, but the onset of vision loss substantially diminishes their quality of life, particularly as they experience a loss of independence. Furthermore, there are increased risks of falls and hip fractures for aged people with low vision. Studies have found, however, that contact with low-vision care services can reduce the emotional impact of a diagnosis of AMD. Paragraph 6 The prevalence of AMD also has a wider effect, especially on health services. Life expectancy has almost doubled in the last century in developed countries, and as the population ages the incidence of AMD will increase, There will therefore be a greater strain on health systems and an earlier need for nursing-home care. It is estimated that the cost of AMD in developed countries will triple within the next twenty years. Governments will need to develop strategies to ensure that health services will be able to cope with the growing number of people needing support and treatment for vision loss due to AMD. TURN OVERQuestions " 12 13 14 18 10 Part B - Text B2: Questions 11-19 According to paragraph 1, which one of the following statements is TRUE? ‘A AMD progresses very rapidly if left untreated. B People with AMD have impaired peripheral vision. C Once the macula starts to degenerate, it will not stop. D__ AMD only affects people who live in developed countries, According to paragraph 2, which one of the following statements is FALSE? ‘A Genetics can predispose a person to AMD. Environmental factors are largoly to blame for AMD. ‘There is often no single cause of AMD. ‘The elderly tend to be more susceptible to AMD. goa According to paragraph 3, ‘wet? AMD occurs when .. damage to the retina causes scarring of the macula the retina leaks fluid and haemorrhages into the macula. blood vessels discharge flu the macula haemorthages and leaks into the retina. into the macula. com> According to paragraph 4, for ‘wet’ AMD sufferers who require treatment, ‘A success is more likely than it is for ‘dry’ AMD sufferers. B photodynamic laser therapy is the most cost-effective option. thermal laser therapy will diminish the damaged eye tissue. advanced surgical procedures are a source of encouragement. According to paragraph 4, pharmacological treatment for AMD ‘A may harm tissue around the macula, B__is currently being used for ‘wet AMD. Cis more costly than other methods of treatment. D___ may limit abnormal blood vessel development.Questions 16 According to paragraph 5, AMD can affect sufferers’ mental health because A oe ' 5 ee c they worry about the increased risk of falls. 47 Ancor paar wh cow of oe lowing straront te TRY A cterl sree hs bean oud ger ym of on i B Those suffering depression or grief are more likely to develop AMD. Scere earerinan eee , 18 Which one of the following statements is NOT supported by information in paragraph 6? ine tne, ee | Se oo vanes essen mec | C cases of AMD will increase threefold throughout the world. | See ee rene emcees eens paren ene ee ee eg 5 = e) tae END OF PART B~ TEXT 2 END OF READING TEST "