South Asia: Tsunami & Health Situation Report # 37

Report
from World Health Organization
Published on 18 Feb 2005
While most tsunami-affected countries are now concentrating on rehabilitation and rebuilding their health infrastructure, the emergency relief phase continues in some areas, particularly Aceh. There are reports of cases of various communicable diseases but no outbreaks. The mental health and nutritional status of many tsunami survivors remain serious concerns.
Summary
  • Five new cases of bloody diarrhea have been reported from Meulaboh, Indonesia.

  • 34 of 115 suspected cases of malaria reported from Car Nicobar, India, have tested positive.

  • In Sri Lanka, 3 suspected cases of meningitis have been reported from Ampara.

  • A team of trainers have arrived in Sri Lanka from the Philippines to provide training for child-to-child methodology for psychosocial programs.

  • Hospital infection control is a serious concern in Aceh.

  • A Health Information Unit has been set up at the Provincial Health Office, Banda Aceh, to improve health information flow.

  • The harassment of women, domestic and alcohol abuse are becoming concerns in affected areas of Sri Lanka
Health Priorities

Communicable Diseases

Indonesia: Five new cases of bloody diarrhea due to Shigella flexneri have been identified in Meulaboh Hospital (Aceh Barat). Isolates of S. flexneri have demonstrated antibiotic sensitivity to ciprofloxacin and ceftriaxone, but resistance to amoxicillin, co-trimoxazole, and chloramphenicol.

A new case of measles in an unvaccinated child was reported in Samudera sub-district, Aceh Utara. Efforts to locate further cases are ongoing. Vaccination coverage for measles in Banda Aceh is now at 60%. Health officials from all districts will gather in Banda Aceh to develop a plan to accelerate measles vaccination for the whole province.

A new laboratory confirmed case of hepatitis A was reported in Aceh Besar. A previously reported case of hepatitis A from Lan Lhom (Aceh Besar), who also tested positive for hepatitis E (rapid diagnostic test), has recovered. HEV ELISA test results are pending. Control measures have been implemented, including sanitary and hygiene measures such as soap distribution, health education, and heightened surveillance.

Results of a field investigation involving a previously reported fatal case of acute jaundice in Suak Beukah (Aceh Jaya) revealed that one of her asymptomatic family members tested positive for hepatitis E virus by rapid testing. Confirmatory (HEV ELISA) test results are pending. No further cases have been reported.

A fatal case of malaria was reported in a remote village in Wayla Timur, Aceh Barat. In addition, 90% of febrile patients have reportedly tested positive for P. falciparum from a clinic in the same sub-district. These reports are in the process of verification. Two insecticide treated net (ITN) meetings have been held to identify high risk groups, ITN needs in target districts, and types of nets that are both currently available and need to be ordered. NGOs in the respective districts will support mobilization and distribution of nets.

A fatal case of neonatal tetanus was reported from Sinabang Hospital, Simeulue Island. Investigation is ongoing. An urgent need to re-establish routine tetanus vaccinations has been recognized.

Two previously reported cases of typhoid fever from Meulaboh Hospital, Aceh Barat, have recovered or are recovering.

Environmental control measures for dengue have been implemented at the residence of a previously confirmed case in Banda Aceh.

Investigations of a previously reported outbreak of food poisoning in Blang Nebung (Aceh Utara), found that approximately 258 persons developed acute vomiting within a 3 hour period. 138 cases were hospitalized for rehydration but have recovered. Illness was initially attributed to the consumption of instant noodles, and a few clinical samples have tested positive for S. aureus. However, epidemiologic and laboratory studies have not been able to definitively identify the source (vehicle) of the outbreak.

India: The National Institute of Communicable Diseases (NICD) surveillance team reported 115 suspected cases of malaria in Car Nicobar. 34 of the cases were found to be positive. Madras Medical College has been involved in strengthening disease surveillance capacity in the Kancheepuram district of Tamil Nadu through its Community Medicine and Microbiology departments. Medical officers and health workers were recently trained in Guntur (Andhra Pradesh).

Sri Lanka: Three suspected case of meningitis have been reported from Ampara. All were clinically diagnosed by physicians from the U.S.A., and have demonstrated clinical improvement after being administered antibiotics. A few cases of diarrhea have been reported from Kalimunai district. An investigation by WHO team is currently ongoing.

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