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Situation report 27

Strong cooperation and coordination on disease surveillance along with early action on water and sanitation has helped ensure that to date, no disease outbreaks have been reported. WHO is strengthening its disease surveillance, as sufficient time has now passed for mosquito vectors to multiply to levels which could potentially cause severe public health problems.

Summary

• There continue to be sporadic cases of disease in the region--diarrhoea, respiratory infections, malaria, dengue, etc. but no unusual outbreaks of communicable diseases have been reported.
• The annual rains in some areas, particularly Sri Lanka and Indonesia and new mosquito breeding grounds increases the risks of dengue and malaria. A rise in isolated cases is normally expected at this time. WHO and partners are strengthening vector-control programmes.
• WHO continues to promote the need for mental health work in the affected areas.

Health Priorities

Communicable Diseases

Across the region, WHO has put in place or strengthened surveillance systems and has prepared stockpiles of supplies and teams of experts to respond in the case of an outbreak.

• India: No outbreaks have thus far been reported. India has now moved from focusing on immediate relief to longer term rehabilitation and reconstruction.
• Indonesia: In Aceh, WHO is collaborating with 13 agencies on communicable disease surveillance. A review of tetanus cases by WHO and Medecins Sans Frontieres has now been completed. Between 31 December 2004 and 22 January 2005, 91 hospital admitted cases were identified in Banda Aceh, Meulaboh and Sigli, of which 11 were fatal. There are 7000 doses of tetanus immunoglobulin onsite as a preventive measure. No bloody diarrhoeal cases have been reported since 19 January 2005. The target population of measles vaccination is approximately 1.3 million in all 21 districts of Aceh. This includes children and adolescents from five months to 15 years. To date 54,357 children and adolescents have been vaccinated.

• Sri Lanka: No unusual cluster of cases of communicable disease have been reported. WHO is carrying out a review of communicable disease surveillance in the camps, community and hospitals. A telephone notification system in place should potential epidemics or unusual health events arise.
• Thailand: There continue to be reports of sporadic cases of diarrhoea, acute respiratory infections, malaria and dengue hemorrhagic fever. No significant outbreaks have been detected from provinces affected by the tsunami: Phuket, Phang Nga, Krabi and Ranong.

Other health issues (Mother and child health, mental health)

• India: WHO has developed a framework for psychosocial support to affected populations, together with UNDP and UNICEF. The training of NGO volunteers to provide such support will be expanded in Andhra Pradesh and Pondicherry by offering technical assistance to eight institutes in India.
• Indonesia: The Ministry Of Health, WHO and UNICEF have established four teams for operational monitoring of displaced persons camps.
• Sri Lanka: In Ampara and Batticaloa districts, about 37 different agencies are offering psychosocial support including counseling, critical incident stress management, family support, training-of-trainer programmes, training counselours, screening and diagnostic tools, family tracing, support for women and children, and specific services for orphans. UNICEF has requested WHO assistance with the chlorination guidelines and the cleaning of wells and latrines. WHO recommends that environmental hygiene be promoted in areas such as Sainthamaruthu and Kalmunai (garbage disposal in particular). A dog control program to prevent rabies is also necessary. Environmental hygiene should also include vector control strategies for urban breeding sites. The WHO team in Jaffna has reported difficulties with water distribution due to a lack of tankers. Inadequate sanitation continues to be a problem in some camps. UNICEF and WHO are leading a rapid sanitation needs assessment in affected areas.
• Thailand: The government’s Mental Health Department has reported that more than 9 000 people in affected areas have received counseling both individually and in groups since the tsunami struck. WHO is participating in the planning of a mental health assessment study, to be carried out by the Department of Mental Health and the Thai-US Collaboration Centre on Public Health from 8-15 February.

Health system and infrastructure (functioning health facilities, access)

• India: WHO, in cooperation with UNICEF is finalizing a format and mechanism for assessing health care systems in affected areas.
• Indonesia: A preliminary assessment of health facilities has been carried out by the Ministry of Health (MoH), the Centers for Disease Control (CDC) and WHO to determine the capacity of existing hospitals and public health laboratories. Initial observations are: some buildings are suitable for use but debris needs to be cleared and essential services restored; loss of staff, equipment and command lines pose difficulties; and that clinical laboratories are available in some hospitals but public health services are available only at the Provincial Health Laboratory. A joint WHO/UNICEF assessment in IDP camps of Banda Aceh City found one site where 2 000 people had no access to a fixed or mobile health clinic. An NGO will be identified to operate clinics at the site.

MAP: Health facilities in Aceh province, Indonesia

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• Sri Lanka: A number of aid agencies have expressed an interest in collaborating with WHO and the Ministry of Health on strengthening laboratory capacity. They have requested clear guidance on the needed diagnostic capacities. Laboratory strengthening should include training in lab management, quality assurance, bio-safety procedures and practices, and occupational health and safety, including staff vaccination, health monitoring, and incident management protocols.

Contributions/pledges to WHO for the Indian Ocean Tsunami response 25 January 2005