The Infectious Hazards of Dead Bodies
The bodies of people who die with a communicable disease are a hazard to people who
handle or have contact with them. Occupations that have extensive contact with dead
bodies are most at risk. Except for a few communicable diseases, infected bodies can be
safely embalmed, and viewed by the bereaved. The infectious hazards of dead bodies can
be minimised by the use of appropriate infection control procedures.
Living persons with communicable diseases are thought generally to pose a greater risk of
transmitting infection than the dead. Most people have little, if any, contact with a dead body,
except perhaps following the death of a family member or friend. However, some
occupations have frequent and extensive contact with dead bodies. These occupations
include pathologists and mortuary attendants, medical and nursing staff, embalmers and
funeral directors, members of emergency services, and forensic scientists. The risks of
infection from contact with dead bodies were reviewed by the Public Health Laboratory
Service in the United Kingdom. This report is largely based on that review.
Infection risks from dead bodies
Table 1 lists the communicable diseases that occur in New Zealand that could potentially be
transmitted from a dead body. The diseases are categorised according to degree of risk,
although the risk may depend on the procedures being performed on, or the type of contact
with, the body. For each disease, Table 1 also indicates whether the body needs to be
transported in a body bag, and whether the body can be safely embalmed and safely viewed
by the bereaved.
Tuberculosis, Hepatitis B and C, HIV/AIDS, Creutzfeldt-Jakob disease, meningococcal
disease, and Group A streptococcal disease are considered to pose the greatest risks for
those handling or in contact with recently dead bodies.
Tuberculosis-infected cadavers present a real danger to persons performing autopsies,
especially when power saws are used. Five healthcare workers in the United States were
reported to have been infected with tuberculosis during an autopsy.
Hepatitis B and C viruses, and HIV, as bloodborne viruses, pose a particular risk for those in
contact with the blood of the deceased. Healthcare workers performing autopsies,
embalmers, emergency service workers, and forensic scientists are the occupations most at
risk. Skin penetration in the autopsy room can occur through contact with damaged bones
and bone spicules, as well as sharp instruments. Needle stick injuries are common among
embalmers.2
With the recent high rates of meningococcal disease in New Zealand, and a rate among
Mäori much higher that among Europeans, the risk of disease transmission during funeral
(tangi) practices needed to be considered. It is very unlikely that meningococci would
survive in a body, including the nasopharynx, for long after death, especially if the body is
embalmed. Transmission of meningococci through hongi (pressing noses), kissing, or other
close contact with the body is extremely unlikely. Therefore, there is no justification to alter
customary practices at a tangi when the deceased has died from meningococcal disease.
Control of the infection risks
Healthcare facilities should have documented infection control procedures for their autopsy
units, and for other services and staff handling dead bodies. These procedures should
include the principles of universal precautions. Autopsy staff and embalmers should wear
protective clothing, gloves, masks and eyewear. In addition, a recent report from the United
States has recommended that, because of the risk of aerosolisation when power-driven tools
are used, autopsy workers should wear respirators and work in rooms that have ultraviolet
lights and negative air pressure. Autopsy staff and embalmers should be vaccinated against
hepatitis B. While vaccination against tuberculosis is available, this is not recommended
because of the low effectiveness of BCG in adults. Even if vaccinated against tuberculosis,
autopsy staff and embalmers should take appropriate precautions if working with any
deceased who may have died with tuberculosis (or any other infectious disease).
Table 1: Guidelines for handling human cadavers with communicable diseases
Infection and degree of risk Bagging Viewing Embalming
required 1 safe 1 safe 1
Low risk
Chicken pox/shingles No Yes Yes
Influenza types (seasonal and non-seasonal) No Yes Yes
Legionellosis No Yes Yes
Leprosy No Yes Yes
Measles No Yes Yes
Meningitis (except meningococcal) No Yes Yes
Methicillin-resistant staphylococcus aureus No Yes Yes
Mumps No Yes Yes
Psittacosis No Yes Yes
Rubella No Yes Yes
Tetanus No Yes Yes
Whooping cough No Yes Yes
Medium risk
Cholera No Yes Yes
Food poisoning No Yes Yes
Diphtheria Advisable Yes Yes2
Hepatitis A No Yes Yes
HIV/AIDS Advisable Yes No
Leptospirosis No Yes Yes
Malaria No Yes Yes
Meningococcal disease Advisable Yes Yes2
Middle Eastern Respiratory Syndrome (MERS) Yes Yes No
Severe Acute Respiratory Syndrome (SARS) Yes Yes No
Scarlet fever Advisable Yes Yes2
Tuberculosis Advisable Yes Yes
Typhoid fever Advisable Yes Yes
Viral haemorrhagic fevers (not transmissible Advisable Yes Yes2
between people)
Infection and degree of risk Bagging Viewing Embalming safe
required 1 safe 1 1
High risk
Creutzfeldt-Jakob disease and other
transmissible spongiform encephalopathies Yes Yes3 No
Hepatitis B, C Yes Yes No
Invasive Group A streptococcal disease Yes Yes No
Viral haemorrhagic fevers (transmissible
between people) Yes Yes No
1
Definitions Bagging: placing body in an impervious plastic body bag
Viewing: bereaved seeing, touching, and spending time with the body; if the deceased has
been bagged the bag must be left unopened and intact
Embalming: injecting chemical preservatives into the body to slow the process of decay
2
Requires particular care during embalming
3
Unless autopsy has been performed, in which case viewing with no physical contact with the deceased
(ie no touching or kissing the body) should not be prohibited
