Earthquakes are unpredictable natural disasters with devastating consequences for human life and infrastructure. While not as frequent as floods or storms, earthquakes rank third in economic losses and are among the deadliest events, causing significant casualties and displacement. High mortality and morbidity rates are attributed to factors such as building collapse, tsunamis, fires, and landslides. These events create conditions conducive to the emergence of infectious diseases, causing further suffering and hindering the emergency response and recovery process. This study aims to comprehensively review the scientific literature on earthquake-triggered infectious diseases, encompassing their causative agents, symptoms, risk factors, and vulnerable populations, ultimately proposing prevention strategies to minimize public health risks following earthquakes.

The review comprehensively surveyed major medical and scientific databases (PubMed, Scopus, ScienceDirect, Google Scholar) using keywords based on WHO guidelines on communicable diseases following natural disasters. The search encompassed documented sporadic cases, outbreaks, and epidemics of infectious diseases associated with earthquakes and related phenomena like landslides and tsunamis worldwide, from 1980 to 2016. No specific time period or study design filters were applied to ensure comprehensive coverage.

This narrative review analyzed existing literature on infectious diseases following earthquakes globally. The search strategy included major databases (PubMed, Scopus, ScienceDirect) and online resources (Google, Google Scholar) using keywords related to earthquake-associated infectious diseases. The search terms were derived from the World Health Organization (WHO) document "Communicable diseases following natural disasters: risk assessment and priority interventions." Published articles and official reports in English were included, with no restrictions on study design. The review encompassed a broad timeframe from 1980 to 2016, examining various parameters of the earthquakes, such as magnitude, intensity, and human impact (casualties, injuries, affected population), extracted from the International Disaster Database (EM-DAT). The review categorized infectious diseases as waterborne, airborne, vector-borne, or wound/skin infections.

The review documented a substantial increase in infectious diseases following earthquakes of Mw 5.6 or greater. The most frequent infections included respiratory, gastrointestinal, and skin infections, along with wound infections. Specific findings detailed various infectious diseases linked to particular earthquakes: **Respiratory Infections:** Outbreaks of pneumonia, influenza, and coccidioidomycosis were observed following several major earthquakes worldwide. Overcrowding and poor sanitation in evacuation shelters were significant contributors to the spread of respiratory infections. The 1994 Northridge earthquake led to a coccidioidomycosis outbreak, linked to dust clouds from landslides. The 2011 Tōhoku earthquake-induced tsunami also resulted in increased respiratory infections due to overcrowding in evacuation centers. **Gastrointestinal Diseases:** Outbreaks of waterborne and foodborne diseases, including shigellosis, salmonellosis, cholera, giardiasis, and hepatitis A and E, were reported after numerous earthquakes. Damaged water and sanitation systems, inadequate hygiene practices, and overcrowding in shelters played crucial roles in transmission. The 2010 Haiti earthquake resulted in a major cholera outbreak. **Vector-Borne Diseases:** Increased incidence of malaria, leishmaniasis, and scrub typhus followed earthquakes in various regions. Ecological changes due to earthquakes, such as deforestation and changes in water sources, created favorable environments for vector breeding. The 2015 Gorkha earthquake in Nepal saw a significant scrub typhus outbreak due to increased rodent and mite populations. **Wound and Skin Infections:** High rates of wound and skin infections were recorded after many earthquakes due to injuries from building collapse, poor access to medical care, and unsanitary conditions. Gram-negative bacteria were often the predominant pathogens isolated from wound samples, with high rates of multidrug-resistant bacteria. Tetanus outbreaks were also reported in several instances.

The findings highlight the significant public health consequences of earthquakes extending beyond immediate casualties. The post-disaster environment, characterized by damaged infrastructure, overcrowding, and compromised hygiene, creates a breeding ground for infectious diseases. The study emphasizes the importance of preparedness and a multi-hazard approach to disaster risk reduction. The high prevalence of Gram-negative bacteria in wound infections underscores the need for broad-spectrum antibiotic treatment strategies in the aftermath of earthquakes. The occurrence of outbreaks in areas with pre-existing vulnerabilities highlights the need for targeted interventions focusing on the most at-risk populations.

Earthquakes pose a substantial public health threat, not only through direct casualties but also through the subsequent emergence of infectious diseases. The establishment of effective disease surveillance systems, coupled with disaster preparedness strategies focusing on water and sanitation, hygiene promotion, and vaccination, are crucial for minimizing the public health burden. Future research should investigate the long-term health effects of earthquake-triggered infectious diseases and develop more refined risk assessment tools for informing public health interventions.

The study's reliance on existing literature limits the ability to account for underreported cases or outbreaks. The variable quality of data across different studies also introduces some uncertainty into the analysis. Further research is necessary to quantify the precise contribution of earthquakes to infectious disease outbreaks compared to other factors.