EINet Alert ~ Jan 04, 2005

*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:

1. Updates
- APEC EINet Alert

2. APEC EINet activities
- What APEC EINet is Doing to Help

1. Updates
APEC EINet Alert
* Earthquake and Tsunami Disaster in South and South-East Asia *

India and Sri Lanka: First disease outbreaks reported
The first outbreaks of communicable diseases were now being seen in areas hit by the tsunami in Asia, a senior WHO official said 2 Jan 2005. "There are increasing reports of diarrheal disease outbreaks coming from displaced persons' settlements in Sri Lanka (and) in India," said David Nabarro, the top official at the WHO dealing with humanitarian crises. However, he said the initial signs were not cause for alarm, although preventive measures and treatments must continue. "They are not causing us alarm because we expect this," he said. "What we need to do is to make sure that we continue to distribute all rehydration salts and treatment for diarrhea and we continue to do our work in sanitation and water supplies." This is likely the first of many reports regarding infectious diseases emerging in the wake of the disastrous tsunamis. Although much will be contaminated water-associated enteric disease including cholera and typhoid, mosquito-transmitted diseases such as malaria, and non-enteric water-linked diseases such as melioidosis and leptospirosis will also occur. (Promed 1/2/05)

WHO Southeast Asia earthquake and tsunami updates
Economy-specific data (Indonesia, Sri Lanka, India, Thailand, Maldives, and Myanmar) on numbers of deaths, injuries, and displaced, along with special reports, are now provided at: http://www.who.int/hac/crises/international/asia_tsunami/sitrep/05/en/ . Key issues include:
- Ensuring access to adequate supplies of clean drinking water. This is essential to prevent disease outbreaks, particularly waterborne diseases. Millions of water purification tablets have been sent to the South East Asia region along with technical expertise (sanitation engineers) in efforts to re-build water and sanitation infrastructures.

- Treating the injured and casualties. WHO estimates that more than 500,000 are injured due to this catastrophe. Basic medical supplies to treat over half a million people for three months have been mobilized.

- Improving sanitation and hygiene needs in temporary shelters. Overcrowded living conditions propagate respiratory diseases (such as pneumonia). There is an increased risk of measles, influenza and meningitis outbreaks as well as increased incidence of acute respiratory infection. Diarrhoeal diseases and vector-borne diseases are also increased in overcrowded conditions. Good camp/settlement management is essential to ensure relief reaches all people in a timely manner.

- To ensure the right aid assistance reaches the right people at the right time, a coordinated assessment and response with local governments, other UN agencies, NGOs, donors, private sector and - most importantly - local communities is required. WHO continues to work closely at country, regional and global levels with all stakeholders to ensure adequate coordination efforts and adequate surveillance systems.

Mass vaccination against cholera and typhoid fever is NOT recommended. The most practical and effective strategy to prevent cholera and typhoid is to provide clean water in adequate quantities and adequate sanitation.

The following data are being verified by WHO:
- Thailand: Health problems are being reported, including: acute diarrhoea (167), wound infections (163), food poisoning (33), pneumonia (20), malaria (8), Dengue (7).
- Maldives: Health problems are being reported, including: acute diarrhoea (225), viral fever (124), injuries (552), anxiety /shock (152).
- Sri Lanka: Cases of diarrhea are reported in some districts but are very much the expected norm. No evidence of outbreaks yet. Plans for rapid diagnosis of diarrhoea to exclude cholera have been carried out.
http://www.who.int/hac/crises/international/asia_tsunami/en/ (WHO 1/3/04)

WHO Director-General arrives in Indonesia; WHO key assistance areas
The Director-General of the World Health Organization (WHO), Dr LEE Jong-wook, has arrived in Jakarta at the start of a five-day visit to Indonesia and Sri Lanka. During the visit, Dr Lee will take part in the Special ASEAN Leaders' meeting on the Aftermath of the Tsunami, to be held in Jakarta 6 Jan 2004. WHO's assistance is focused in five key areas:

- Disease surveillance and response: tracking patterns of life-threatening diseases and establishing an early warning system;
- Coordinated action with the health system and other health actors locally, nationally and internationally;
- Providing public health guidance on responding to disease outbreaks, water quality, sanitation, chronic disease management and mental health;
- Ensuring access to essential health care together with all partners and the local health system
- Helping to coordinate medical supplies to ensure that supply chains work well and that people get the medicines they need when and where they need them. http://www.who.int/mediacentre/news/notes/2005/np01/en/
(WHO 1/3/04)

WHO Regional Office for South-East Asia
Links to:
- Situational Reports
- Economy Information
- Guidelines for health emergency
- What is WHO doing?
- General Information
(WHO SEAR 1/3/04)

CDC updated tsunami-related public health issues
CDC has updated their information on public health consequences that can result from tsunamis. The following information is provided: Notice for Travelers, Health Information for Humanitarian Workers, Interim Vaccination & Malaria Prophylaxis Recommendations for Persons Traveling to Areas Affected by the Tsunami, Interim Health Recommendations for Workers who Handle Human Remains, Health Effects of Tsunamis, Infectious Disease Concerns, WHO South Asia earthquakes & tsunamis website, Related Health Issues, and Other Websites. (CDC, http://www.bt.cdc.gov/disasters/tsunamis/ )

Japan raises aid to $500 million; US raises to $350 million
Japanese Prime Minister Junichiro Koizumi has announced his nation would offer $500 million in grant aid for the tsunami-stricken regions of southern Asia. The decision to increase Japan's aid comes one day after the US increased its aid to the region to $350 million. More than $2 billion has now been pledged by the international community. Aid has begun to reach tsunami victims in remote areas of Indonesia as a United Nations official says the death toll could grow from 138,000 to 150,000.
http://www.cnn.com/2005/WORLD/asiapcf/01/01/japan.relief.pledge/index.html CNN 1/3/04)

Comprehensive BBC coverage of the Tsunami Disaster http://news.bbc.co.uk/1/hi/in_depth/world/2004/asia_quake_disaster/default.stm

Comprehensive CNN coverage of the Tsunami Disaster http://www.cnn.com/SPECIALS/2004/tsunami.disaster/


2. APEC EINet activities
What APEC EINet is Doing to Help
APEC EINet is on heightened alert mode and is monitoring the media and relevant sources for a rise in infectious disease incidence in the tsunami-affected region. Surveillance systems are being established by the WHO and disease reports are being verified by WHO workers. We will continue to provide you with special updates to keep you informed about infectious disease news in the area. Currently we are also discussing other ways in which we can be of assistance by communicating with our partners at Hawaii's Tripler Army Medical Center (TAMC). The activities of the US Pacific Command post can be viewed at http://www.pacom.mil/special/0412asia/.