Piogge intense/inondazione e rischi
per la salute: sintesi delle conoscenze,
prospettive di ricerca
P. Michelozzi
Fattori di rischio/
fattori di protezione
• Cambiamenti Climatici/ aumento della
frequenza ed intensità di piogge in alcune aree
• l’assetto idrogeologico
• l’uso del suolo
• L’assenza di sensibilizzazione e di
preparazione di fronte al rischio di inondazioni
• Le misure strutturali di difesa contro le
inondazioni
• Sistemi di previsione e allarme
• Informazione per la popolazione
Tra i paesei Europei, durante il periodo 19802002, le alluvioni sono state piu’ frequenti in
Francia , Italia e nel Regno Unito. Il maggior
numero di vittime e’ stato registrato in Italia (38
%), seguita da Spagna (20%) e Francia (17%).
In termini di perdite economiche, Germania e
Italia hanno subito il danno piu’ elevato pari a 11
miliardi di Euro, seguite da Spagna e Regno
Unito per circa 6 miliardi di Euro .
Fonte: Ministero dell’Ambiente
Fonte dei dati:
Ministero
dell'Ambiente
e Tutela
del Territorio,
2003)
Comuni ritenuti ad elevato rischio
idrogeologico in Italia (Fonte: Ministero Ambiente)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Calabria
Umbria
Valle d’Aosta
Marche
Toscana
Lazio
Basilicata
Emilia Romagna
Molise
Piemonte
Campania
Liguria
Sicilia
Friuli Venezia Giulia
Lombardia
Abruzzo
Trentino Alto Adige
Veneto
Puglia
Sardegna
Italia 5.581
409
92
74
243
280
366
123
302
121
1.046
474
188
272
137
914
178
111
161
48
42
100%
100%
100%
99%
98%
97%
94%
89%
89%
87%
86%
80%
70%
63%
59%
58%
33%
28%
19%
11%
70%
Alluvioni e Inondazioni in Italia dal 1994 al 1998
12 Settembre 1995:
Lombardia
5 Novembre 1994: Piemonte
(70 decessi)
30 Settembre 1998: Imperia
19 Giugno 1996: Versilia
(13 decessi)
5 Maggio 1998: Sarno e
Quindici (159 decessi)
14 Ottobre 1996: Crotone
13 Marzo 1995: Giarre
Alluvioni e Inondazioni in Italia dal 2000 al 2003
29 Agosto 2003: Val
Canale e Canal del
Ferro
Dal 13 al 16 Ottobre
2000: Piemonte, Valle
d’Aosta, Lombardia e
Liguria
23 Settembre 2003: Massa
Carrara
(23 decessi)
6 e 23 Novembre 2000:
Imperia e Savona
(7 decessi)
9 Settembre 2000:
Soverato
Alluvioni e Inondazioni in Italia dal 2008 al 2011
18 Luglio 2009:
Belluno
29 Maggio 2008:
Torino
1 e 2 Novembre 2010:
Padova, Vicenza e
Verona
4 Novembre 2011:Genova
(6 decessi)
4 Ottobre 2010: Genova e
Savona
25 Ottobre 2011:La
Spezia e Lunigiana (12
decessi)
3 Marzo 2011:
Marche,Romagna e il
teramano
5 Ottobre 2010: Prato
7 Novembre 2011:Isola d’Elba
20 Ottobre 2011: Roma
6 Novembre
2011: Napoli,
Salerno,
Avellino
9 Settembre 2010:
Salerno
22 Ottobre 2008:
Capoterra
1 Ottobre 2009:
Messina
(36 decessi)
Effetti sulla salute
Immediate, mid-term, and long-term direct and indirect
health consequences of floods (Du 2009)
Immediate
Health
Impacts
directs
indirect
Strategies
Mid-term
Health Impacts
Strategies
Long-term
Health
Impacts
Strategies
Drowning
Public
awareness
Rescue
Complications of injury
Early medical
care
Mental health
(Loss and
grief)
Support and
counseling
Injury
- Trauma
Injury—
debris,
collapsed
building, car
crash, etc.
- Electrical
Injury
- Burns and
Explosions
Injury
Hypothermia
Building
construction
standards
Evacuation
Public awareness
Infection—skin
and eye
infections, fecaloral
injections
Early medical
care
Chronic
diseases
Effective health
care
Rescue
Awareness
Poisoning—
Chemical
contamination
Risk
management
Decontamination
Disability
Early intervention
Rehabilitation
Animal Bites
Rescue
Health risks
associated with
the
displacement of
patients,
disabled
persons,
seniors,
children, etc.
(e.g., heart
attack, illness,
deterioration)
Rescue
Safe health
services
Mental health—
shock
Communicable
diseases—
- Overcrowding
- Vector
- Exposure to
infectious
diseases
- Animal bites
Support and
counseling
Clean food and
water
Safe waste
disposal
Refugee care
Immunization
program
Malnutrition—
poverty,
damage of
property
Economic
recovery
Aid and
assistance
programs
Key studies that assess the relation between flooding and
health (Ahern 2005)
Authors, year
Location and year of
flood
Design
Main results
Reacher et al. 2004
Lewes, United Kingdom
Telephone interviews of 227 cases
(house flooded) and 240 controls
(nonmatched), 9 months postflood
Fourfold higher risk of psychological
distress in flooded group (RRz 5 4.1,
95% CIz: 2.6, 6.4); flood also associated
with earache in all age groups (RR 5
2.2, 95% CI: 1.1, 4.1); association for
gastroenteritis less marked (RR 5 1.7,
95% CI: 0.9, 3.0)
Duclos et al.,
1991
Nimes, France,
1988
108 questionnaire interviews
1–2 months postflood; review
of medical care delivery data
for Nýˆmes area; active surveillance
in GPz clinics instigated 1 week
after flood
Nine flood-related drownings, but death
certificates did not reveal increased
mortality; 6% of interviewees reported
mild injuries, but no specific increase in
infectious disease observed
Handmer and
Smith, 1983
Lismore, Australia,
1974
Comparison of patients
from flooded and
nonflooded areas
No flood-related increase in hospital
admissions, and this holds for all classes
of flood severity; no significant overall
change in total number of deaths
Han et al.,
1999
Bucharest,
Romaniay
Compared asymptomatically
infected persons (n 5 38) with
uninfected persons (n 5 50)
identified in serosurvey
Among apartment dwellers, 63% (15/24)
of
infected
persons
had
flooded
basements;30% (11/37) for uninfected
persons (OR 5 3.94, 95% CI: 1.16, 13.7;
p < 0.01)
Summary of the epidemiological evidence for adverse
health effects following chemical contamination resulting
from floods (modified from Euripidou 2004)
Flooding type and
country
Study design and
period
Pollutant and
source(s)
Public health
outcomes
observed
Subject selection
criteria
Type of
environmental
sampling
undertaken and
results
Unprecedented rains,
Iowa, USA, 1993
Telephone survey of 99
county PH officers in the
state to assess PH
impact of flood
Carbon monoxide
poisoning reported by
seven counties
representing 14% of
the state population
(±2.7 million)
Seven counties
reported carbon
monoxide poisoning
showing evidence of
risk associated with
indoor use of
generators
All health counties within None?
the State (n =14)
Flooded canals, river,
Rotherham, UK, 2000
MAFF, NRA surveys
pre2000; British
waterway survey
Dioxin
None?
Environmental samples
of affected area
Overflowed sewerage
system, Greater London,
UK, 1998
Biological and
environmental
VOCs, heavy metals
Sore throat (OR 11,
Households affected by
95% CI=2.22–60), eye sewerage ingress,
irritation (p=0.04)
control sample and
clean-up team
(1994–1997) Elevated
levels of dioxin in river
sediment. (2000)
Sediment samples
elevated concentrations
of dioxin observed
Soil, water and air bag
samples for VOCs and
heavy metals
Summary of the epidemiological evidence for adverse
health effects following chemical contamination resulting
from floods (modified from Euripidou 2004)
Flooding type and
country
Study design and
period
Pollutant and
source(s)
Mine dam flood, Baia
Mare,Romania 2000
Environmental
sampling
Cyanide, heavy
metals
Mine dam flood,
Aznalcóllar Mine,
Spain, 1998
Environmental
sampling
Mine flood, Truro,
Cornwall, UK, 1992
Environmental
sampling
Public health
outcomes
observed
To be determined,
massive fish kill
Subject selection
criteria
Type of
environmental
sampling
undertaken and
results
Environmental
samples and
community samples
Water samples for
cyanide and heavy
metals
Acidic waste water, Fish kill, gross soil
heavy metals,
contamination of
sulphides
farm land
Environmental
samples of area
Soil samples for heavy
metals, water samples
Heavy metals
Environmental
samples of affected
area
Water samples for
heavy metals
Contamination of
river
Ratio of observed to expected deaths by week
from date of onset of flooding (from Milojevic 2011)
from Milojevic 2011. Same data shown by fourweek blocks
Association between mental health outcomes and sociodemographics, previous medical problems and water level
(Paranjothy et al, 2011)
Psychological distress
(cases = 584, total =
2,113)
Anxiety
(cases =297, total=
2,037)
Depression
(cases = 280,total =
2,113)
Probable PTSD
(cases = 138,total
= 2,019)
Univariate
Adjusted*
Univariate
Adjusted*
Univariate
Adjusted*
Univariate
Adjusted*
Not affected
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
Outside the
house
1.8
(1.4, 2.3)
1.8
(1.3, 2.4)
2.0
(1.3, 3.1)
1.7
(1.1, 2,7)
1.2
(0.8, 1.8)
1.1
(0.7, 1.7)
2.6
(1.4, 4.8)
2.6
(1.4, 4.9)
Below floor
level
3.0
(2.0, 4.6)
3.0
(1.9, 4.6)
2.4
(1.3, 4.5)
2.1
(1.1, 4.0)
3.1
(1.8, 5.3)
2.9
(1.6, 5.0)
2.8
(1.1, 7.0)
2.6
(1.0, 6.7)
Above floor
level
13.4
(10.0, 17.9)
12.8
(9.3, 17.6)
17.8
(12.2, 26.0)
13.9
(9.3, 20.8)
9.5
(6.7, 13.5)
7.7
(5.2, 11.4)
14.3
(8.2, 24.9)
11.9
(6.6, 21.5)
Explanatory
variable: Water
level
*Odds ratios and 95%CI. Adjusted odds ratios are adjusted for age, sex, prior health status, employment,
gender, area and data collection method
Indicazioni per la ricerca futura:
PROSPETTIVE DI STUDIO
Effetti sulla salute:
quale lag dell’effetto?
• effetti che si verificano durante o
immediatamente a seguito dell’evento;
• effetti che si osservano nei giorni o nelle
settimane successive all’evento;
• effetti a lungo termine che potrebbero
manifestarsi e/o durare per mesi o anni dopo
un’inondazione.
Effetti diretti:
• mortalità per annegamento, infarto e ferite
• traumi (es. distorsioni/storte, lacerazioni,
contusioni, etc.)
Effetti indiretti :
- malattie infettive (malattie gastrointestinali,
dermatiti, congiuntiviti) e rari casi di malattie
trasmesse da vettori o da roditori.
- aumento della mortalità/incidenza di
patologie cardiovascolari/respiratorie a breve,
medio termine
- avvelenamento, causato dalla rottura di
condotti sotterranei, dallo straripamento di
scorie tossiche, e dal rilascio di sostanze
chimiche conservate nel terreno
- disturbo post-traumatico (PTSD), include
ansia, depressione, disturbi psicosociali e
suicidi (a medio e lungo termine)
Effetti indiretti :
(L'eccesso di umidità e di acqua stagnante
associata a sviluppo di muffe all'interno di
abitazioni o di altri edifici.)
Rischio di infezioni polmonari in
sottogruppi di suscettibili:
•
asmatici, persone che soffrono di allergie
•
persone con disturbi e malattie
respiratorie croniche (es. BPCO)
•
soggetti immunodepressi (es. soggetti
Temporali e incremento di asma-rinite
allergica
Author
D'Amato G
1994
Place and population
Study period
Napoli, Italy
04-Jun-04
6 adults and 1 11
yrs old
England, 29
Jun-94
healthcall offices
All ages
Typpe of studyOutcome
Case-series
Asthma ED visits
Ecological
study
Telephone calls for
asthma
Newson R
1997
England, 14
Jan 1990Regional Health
March 1994
Authorities
Age: 0-14; ?15 yrs
Time series
Asthma Hospital
Admission
Marks GB
2001
6 cities SE
Australia
All ages
Canada, Eastern
Ontario
Children
Higham J
1997
Dales RE
2003
Pulimood TB England,
2007
Cambridge
All ages
Main results
All patients were sensitized to Parietaria
pollen. No air pollution peaks associated with
thunderstorm
Significant increased risk of calls for asthma
during storm nights vs control nights (OR=6.4)
in the 17 areas affected by the storm
High level of sferic densities associated with a
25% excess in both ages class
Thunderstorm+high pollen count vs
tunderstorms with low pollen count: 16%
excess in children; 50% excess in adults
Thunderstorms within 80 km OR: 5.0
Thunderstorm outflows OR: 15.0
Jan 1995- Dec Case-control
1998
Asthma ED visits
1993-1997
Time series
Asthma ED visits
During thunderstorm days compared to
control days, daily asthma visits increased
from 8.6 to 10, and air concentration of fungal
spores doubled
Jul-02
Case-control
Asthma admissions
Subjects sensitive to Alternaria species
(OR=9.31) Subjects sensitive to Alternaria plus
Cladosporium species (OR=63.9)
Associazione tra temporali e asma:
meccanismo biologico
Changes in the weather, such as rain or humidity, may
induce hydration of pollen grains and their fragmentation,
which generate atmospheric biological aerosols carrying
allergens
Pollen grains ruptures by osmotic shock (also as a
consequence of strong electric fields development) during
thunderstorms result in the release of respirable, allergencarrying cytoplasmic starch granules (0.5-2.5 μm) that can
reach lower airways inducing asthma reactions in pollinosis
patients
Marks GB et al. Thorax 2001, 56:468
D’Amato G et al. Allergy 2007, 62:11
Fonti dei dati
Dati su precipitazioni (mm/h)
Serie storiche disponibili al DEP (fonte: Aeronautica
Militare – Servizio Meteorologico)
Dati su scariche elettriche (densità e conteggio)
numero di scariche per unità di superficie
(10Km×10Km)
Dati da acquisire: fonte Aeronautica Militare – Servizio
Meteorologico
Studi di serie temporale
• Effetti associati ad eventi di piogge intense e temporali
• Effetti associati ad eventi di inondazioni
Rischio di patologie cardiovascolari (es. eventi coronarici
acuti), patologie respiratorie, disturbi psicologici
(ricoveri per causa/ accessi pronto soccorso)
Fonte dei dati: SDO nazionali periodo disponibile
2001-2010
Studi di analisi geografica
• Variazione dell’incidenza di patologie
ricoveri/mortalità per causa nelle aree
colpite da eventi di piogge
intense/inondazioni
• Unità in studio: Comune
Surveys in popolazioni interessate da
inondazioni
• Studio di altri outcomes (es.SPT)
• Identificazione di fattori di rischio
• Fattori di protezione della popolazione