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Overview
In the aftermath of the tsunami that struck Southeast
Asia on 26 December
2004, WHO warned that unless immediate public health
interventions were taken, there was a possibility that the region might face severe disease outbreaks. But due in
part to the unprecedented response from local and international
communities--including the implementation of essential health interventions
recommended by WHO--tsunami-affected areas have so far been spared from any
major health catastrophes.
Five weeks post-tsunami, the health situation remains
under control, with no outbreaks identified. Many clusters of cases have been
investigated and rumours are being identified and
even verified. Immediately following the tsunami, the rapid institution of
emergency surveillance (i.e. an early warning system), in addition to the
provision of clean water and sanitation, made a tremendous difference to
safeguarding public health across the Southeast Asia region. The remarkable
job done by public health workers in averting any significant communicable
disease outbreaks is a testament to the strength of the global community's
emergency public health response systems.
Current Assessment
However reassured the global community may be by the
absence of any major disease outbreaks thus far, because the threat of
communicable diseases remain, it is essential to remain vigilant. People in
tsunami-affected areas are still at great risk of water-borne and
vector-borne diseases such as cholera, malaria, dengue, etc. Indeed, the
dengue season is just now beginning--combined with the monsoon rains, it is
vital to ensure that disease surveillance remains high so that potential
outbreaks can be quickly identified and controlled. Rapid responses to
outbreaks and effective case management will also mean that many potential
deaths may be prevented.
To reduce the risk of malaria and dengue, WHO is
strengthening its support to national authorities to improve vector-borne
disease prevention and control activities. WHO is helping to provide affected
regions with insecticide-treated bednets,
vector-control supplies, and equipment, including larvicides
and space-spraying as a stop-gap measure. The establishment of a proper
drainage system and engineering methods will be key components of WHO's
long-term strategy to rehabilitate and strengthen health infrastructures in
relation to vector control and prevention.
Outbreaks
No major outbreaks of communicable diseases have been
identified, although many clusters of cases and rumours
have been investigated.
 Tetanus
In Indonesia,
91 cases of tetanus were hospitalized in Banda Aceh,
Meulaboh and Sigli. No
new tetanus cases have been reported since 22 January 2005. Injury-related infections will
decrease now that the high-risk period of sustaining injuries in relation to
the tsunami has passed. Educating populations in tsunami-affected areas about
the importance of prevention measures has also helped to reduce the number of
cases.
Measles
Sporadic measles cases have been reported across the
tsunami-affected areas. In Indonesia,
a measles vaccination campaign is currently ongoing, and has thus far reached
77 000 children, 58% of the targeted population. Two cases of measles have
also been identified in Sri Lanka,
where an investigation team has been sent to the field.
Diarrheoal
Disease
To date, there have been no reports of cholera from any
tsunami-affected areas. Cases of bloody diarrhea in Aceh, Indonesia
have been identified as shigella flexneri. No new cases have been detected since 19 January 2005. One case of typhoid
has been diagnosed
Vector-borne Diseases
Sporadic cases of malaria have been reported in
tsunami-affected areas. As of 23
January, 90 cases of malaria were identified in Indonesia.
Anti-malarial drugs have been provided to affected areas by WHO and partners.
Cases of dengue fever have also been reported in Thailand
and Indonesia.
The dengue season peaks in Indonesia
in January and February during the rainy season.
Bednets and insecticides have
been provided by national governments, WHO and partners.
Mental Health
Issues
Psychosocial support programmes
began in the acute emergency phase, and are now expanding their outreach to
all affected communities. In Indonesia,
a strategic plan for mental health services was developed by WHO's Department
of Mental Health in Geneva, and
has been submitted to the Ministry of Health, Indonesia.
Two WHO experts finishing their assignment in Sri
Lanka have developed a plan of action in
collaboration with other UN agencies, the Ministry of Health, and local experts.
They are presently in the Maldives
to study the situation there and to design a plan for providing psychosocial
support to those affected by the tsunami disaster.
Nutrition Concerns
Malnutrition is an emerging concern. People who are
malnourished are not only more susceptible to infections and at a higher risk
of death, but infections can result in moderate malnutrition progressing to
severe, particularly in young children.
The nutrition situation (including the micronutrient status) of
populations affected by the tsunami must be monitored. Malnutrition rates were already high before
the tsunami, but combined with displacement, loss of caregivers, and poor
environmental conditions, it is a disconcerting situation that needs to be
monitored.
Responding to concerns about the large quantities of milk
powder being sent into the region, WHO and UNICEF issued a joint statement on
appropriate infant and young child feeding, cautioning caretakers and health
staff about the unnecessary use of milk powder.
To prevent and control malnutrition among tsunami-affected
populations, WHO will be providing technical support to national authorities
in collaboration with UN partners, and reinforcing national capacities to
manage nutritional needs through information dissemination and training.
WHO's Public Health Goals
and Actions
The public health challenges in the aftermath of the
tsunami will change over time. WHO's priority remains providing support to
national authorities, primarily in communicable disease alert and response,
particularly in the area of water-borne and vector-borne disease control and
prevention. Now that many partners are involved and reporting to the local
ministries of health offices on suspected cases of communicable
diseases--they must be supported in the analysis of data and enhancing their
coordination. A six-month plan has been developed by WHO offices in
tsunami-affected countries, to support relief and rehabilitation efforts.
WHO also recognizes the psychological impact of the tsunami
and has provided support to authorities in implementing psycho-social
responses for the affected populations. With estimates that up to half of all
residents in areas struck by the tsunami will require some psycho-social
interventions (i.e. non-medical), WHO would like to see a shift in mental
health from hospital-based systems to community-based health systems. To this
end, WHO has helped to organize psycho-social training of community leaders
across the region, including teachers and other non-medical staff.
WHO will also assist countries in rehabilitating health
systems destroyed by the tsunami. The strategy will focus on building public
health capacity, establishing surveillance and laboratory back-up,
strengthening logistic management and communication, and refining monitoring
and evaluation systems.
In Aceh,
Indonesia, for
instance, 42 of the 481 public health professionals were killed in the
tsunami; while many others have yet to report to work. The provincial office,
public laboratory, and 53 of 244 health posts were also either partially or
totally destroyed in the disaster. Clearly, the tsunami had a profoundly
destabilizing impact on the surveillance and response capacity of the
Provincial Department of Health. In response, WHO has developed a proposal to
help the Aceh provincial Ministry of Health to
rapidly re-establish, among other priorities, a dedicated surveillance and
response unit, laboratory reference facilities, and the stockpiling of drugs
and vaccines in advance of potential epidemics.
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