Waves of infection expected in wake of tsunamis

January 2005

As if the waves of destruction were not enough, more than 10 countries will face a battle against infectious diseases in the aftermath of the tsunamis caused by a Dec. 26 earthquake off of Asia’s coast.

According to UNICEF, more than 155,000 people were killed by the tsunamis. The destructive waves of water that battered the shores of South and Southeast Asia and East Africa were caused by a quake off the coast of Northern Sumatra, Indonesia, that measured 8.9 on the Richter scale. Thousands are without homes, safe food and safe water.

Thousands more could die, according to WHO, from the diseases that could spread from unsafe food and water, from a proliferation of mosquitoes and from wounds that are not properly treated.

“The risk of disease has increased substantially, with diarrheal diseases, respiratory infections, malaria and dengue fever being particular threats,” said Lee Jong-Wook, MD, MPH, director-general of WHO, in a published statement.

Unsafe water, unsafe food

Shortly after the tsunamis, health officials the world over began to focus on preventing these diseases, especially food- and waterborne diseases. Clean water, WHO said, is a priority.

“When we think about the illnesses that may emerge there, they really are in categories,” Phyllis Kozarsky, MD, senior traveler’s health consultant at the CDC and professor of medicine and infectious diseases at Emory University, Atlanta, told Infectious Disease News in an interview. “The first category would be the food- and waterborne illnesses because of the major problem with provision of clean water and safe food and shelter, and that’s probably one through 10.”

Diarrhea illnesses are the biggest concern facing the countries right now, with dysentery and cholera among the most troubling, as they can kill quickly. Other concerns are hepatitis A, hepatitis E and typhoid.

Disease due to mosquitoes

The next category of disease is animal-borne and vector-borne, Kozarsky said. The victims already dwell in areas with tremendous vector populations, and with the tsunamis and subsequent monsoons, there could be a proliferation of mosquitoes and other vectors. Illness concerns range from malaria and dengue fever to the uncommon but still possible Japanese encephalitis.

Along with vectors, there is worry that animals will transmit diseases such as rabies and leptospirosis, Kozarsky said.

Victims who are unable to safely clean their wounds or injuries or seek appropriate medical attention face further infection. Kozarsky said skin infections without appropriate care can lead to gangrene or sepsis, as well as tetanus in people who have never been immunized against it.

A third category of concern is respiratory disease. Kozarsky said that an influenza outbreak is “something no one is forgetting.”

Dealing with devastation

This is all in addition to the overriding psychological and emotional issues the survivors face from making it through such a tragedy, she said.

“Unfortunately … the tsunami-affected areas are so resource poor to begin with, and marginalized, that it’s ever-so more devastating,” she said. “Because it’s even been hard to get to many of these areas that are quite remote and see what the devastation is and evaluate it, there’s a tremendous amount of work to be done.”

In a press release, WHO said that disease surveillance and response, coordinated action between all health systems and agencies, provision of public health guidance, ensuring access to essential health care and coordinating medical supplies are other focal points of overseas aid efforts.

In the United States, Kozarsky said, the CDC has posted guidance on its Web site for travelers venturing overseas to aid in relief efforts or for business. Information on appropriate immunizations and prophylaxis is also posted.

For more information:

• The IDSA has listed resources for disease risks on its Web site: www.idsociety.org.
• The CDC has posted information on the aftermath of the tsunamis and up-to-date information for travelers to those parts of the world affected on its Web site at www.cdc.gov.