Interim Health Recommendations for Workers who Handle Human Remains After a Disaster

There is no direct risk of contagion or infectious disease from being near human remains for people who are not directly involved in recovery or other efforts that require handling dead bodies.

Individuals in affected areas should instead exercise caution to avoid well documented threats to health and safety, such as injury hazards from sharp debris and from unidentified structural damage to buildings, power lines, roads, and industrial facilities.

Loss of sanitary infrastructure may result in exposure to raw sewage, loss of local drinking water treatment capacity, and inability to maintain refrigeration for food and medical supplies.

Recommendations for individuals who must have direct contact with human remains

Human remains may contain blood-borne viruses such as hepatitis viruses and HIV, and bacteria that cause diarrheal diseases, such as shigella and salmonella. These viruses and bacteria do not pose a risk to someone walking nearby, nor do they cause significant environmental contamination.

Bacteria and viruses from human remains in flood water are a minor part of the overall contamination that can include uncontrolled sewerage, a variety of soil and water organisms, and household and industrial chemicals. There are no additional practices or precautions for flood water related to human remains, beyond what is normally required for safe food and drinking water, standard hygiene and first aid.

However, for people who must directly handle remains, such as recovery personnel, or persons identifying remains or preparing the remains for burial or cremation, there can be a risk of exposure to such viruses or bacteria.

Workers who handle human remains should use the following precautions:

1. Protect your face from splashes of body fluids and fecal material. You can use a plastic face-shield or a combination of eye protection (indirectly vented safety goggles are a good choice if available; safety glasses will only provide limited protection) and a surgical mask. In extreme situations, a cloth tied over the nose and mouth can be used to block splashes.
2. Protect your hands from direct contact with body fluids, and also from cuts, puncture wounds, or other injuries that break the skin that might be caused by sharp environmental debris or bone fragments. A combination of a cut-proof inner layer glove and a latex or similar outer layer is preferable. Footwear should similarly protect against sharp debris.
3. Maintain hand hygiene to prevent transmission of diarrheal and other diseases from fecal materials on your hands. Wash your hands with soap and water or with an alcohol-based hand cleaner immediately after you remove your gloves.
4. Give prompt care--including immediate cleansing with soap and clean water, and a tetanus booster if indicated--to any wounds sustained during work with human remains.
5. In addition to guarding physical safety, participate in available programs to provide psychological and emotional support for workers handling human remains. Agencies coordinating the management of human remains are encouraged to develop programs providing psychological and emotional support and care for workers during and after recovery activities.

Other Considerations

From the public health perspective of lowering the risk of possible infectious disease transmission, there is no requirement for mass burials or cremation. Response workers should assist local communities to identify a safe location for holding remains awaiting identification. This location should be shielded from public view if possible, and remains should be protected from scavenging animals.

If available, use body bags to contain remains. If available, refrigeration can reduce the rate of decay and facilitate identification.

The sight and smell of decay are unpleasant, but they do not create a public health hazard.

Additional Information

• Pan American Health Organization (PAHO): In Natural Disasters, Cadavers Pose No Threat of Disease
• World Health Organization (WHO): Flooding and communicable diseases fact sheet