CBS' Cowardice And
Diseases, Infections Among
Tsunami Survivors

From Patricia Doyle, PhD
[1] From ProMED-mail
Indonesia - 2 Cases Of Measels Confirmed In Aceh
ABC News online
Associated Press report
The World Health Organization on Mon 10 Jan 2005 confirmed 2 unconnected cases of measles in tsunami survivors on the Indonesian island of Sumatra, and health workers quickly vaccinated more than 1000 people to head off the spread of the virus.
The cases occurred in separate villages outside the regional capital of Banda Aceh, the area hit hardest by the 26 Dec 2004 earthquake and tsunami, according to WHO, which considers just one case of measles an outbreak because it is so contagious. "2 cases have been reported in 2 separate villages," said Moira Connolly, who tracks outbreaks for WHO. The United Nations children's agency, UNICEF, already was in the midst of a campaign to vaccinate 600 000 people in devastated Sumatra against the disease when the cases occurred, and it immediately inoculated a ring of 1200 people living around the villages where each case was confirmed. Malnutrition in refugee camps has been known to push the death rate as high as 30 per cent, Connolly said. But malnutrition is not considered an issue yet among tsunami survivors.
Measles circulates in Indonesia, and there have been several outbreaks during the last few years, because most children have not been vaccinated. WHO recommends immunizing more than 90 per cent of children to protect the population from outbreaks. In Aceh province, only about 25 per cent of the children were vaccinated before the earthquake, said Dr Georg Petersen, WHO's representative in Indonesia. As aid agencies flooded into the province in the wake of the tsunami, mass measles vaccination was a high priority from the beginning. Overcrowded refugee camps provide opportunities for the virus to spread out of control.
Vaccinating people living in neighborhoods surrounding a case usually shuts down transmission very effectively and drastically reduces the severity of any cases that slip through. Patients are not contagious during the 12 days they are incubating the disease, which spreads through coughing and sneezing.
So far, there have been no major outbreaks of disease since a magnitude-9.0 earthquake in the Indian Ocean triggered a tsunami that killed more than 150 000 people across southern Asia and Africa.
[2] From ProMED-mail
Measles Spreads In Relief Camps
Times Of India
NEW DELHI -- Despite mass immunisation campaigns, measles seems to be spreading in relief camps in tsunami-affected areas. At least 13 cases of measles have been reported among children in relief camps in Andamans and 15 in Tamil Nadu.
Addressing journalists on Friday evening, Union health secretary P K Hota said the government was on "high alert". He said the cases of measles and chicken pox reported so far were sporadic and spread over several relief camps. Hota said there was no major breakdown in health conditions.
As there is no known treatment for chicken pox in the modern system of medicine, Hota said practitioners of homeopathic medicine had been sent to the areas. Health teams had been sent to most areas, he added. More than 100 doctors had been mobilised by the centre to supplement the resources of state governments.
Hota said the government would be alert on all medical needs of the affected areas for at least another 2 months. The centre was looking out for 50 doctors and 50 paramedics who would be willing [to work] in the areas for 2 months.
Experts say cases of typhoid and jaundice may not start appearing for another month or so as they have a long incubation period. Hota said the coming few months would also be crucial for monitoring the health of expectant mothers and babies and that antenatal care would be stepped up.
A potentially threatening situation exists, which we hope will be
contained successfully by the alertness of the UNICEF staff in the area. -
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sun 9 Jan 2005
From: David Freedman <>
GeoSentinel sites and network members are increasingly reporting serious wound infections in those injured in the tsunami. Aeromonas and pseudomonas are not unexpected in this situation, but these findings have not yet been well publicized in all the guidelines put out on tsunami-related disease risks. All such wounds that appear infected should be treated with intravenous therapy with more than routine antistreptococcal and antistaphylococcal therapy while appropriate cultures are pending.
From Pat Charles in Australia
Have had 2 patients who have returned from Phuket. The 1st had multiple skin lacerations, 3 of which were very deep. Swabs from 2 of these grew _Aeromonas hydrophila_. It was resistant to amoxicillin, amoxicillin-clavulanate, and cephalexin. It was susceptible to ceftriaxone, the carbapenems, aminoglycosides, and ciprofloxacin. The 3rd deep laceration cultured _Pseudomonas aeruginosa_, which was susceptible to all standard anti-pseudomonals.
The 2nd patient had extensive superficial areas of skin disruption. Some of these were cellulitic, and _Aeromonas hydrophila_ was cultured. Susceptibilities were identical to the above patient. Patient also had some degree of aspiration pneumonia and was treated with meropenem, then changed to ciprofloxacin, and is doing well.
From Pam Konecny in Australia
A 56 year old patient from Sri Lanka was injured in the tsunami while in a beach hut in Tangalle and was washed 1 km inland to a rice paddy. [The patient suffered] multiple superficial lacerations and 2 deeper soft tissue injuries, to the right leg and left iliac crest, [which were] debrided "locally" and at Colombo hospital. The microbiology and histopathology to date is as follows:
- probable disseminated mucormycosis arising from the deep leg wound
- multiresistant _E. coli_ sensitive to chloro and meropenem only
- a multiresistant Gram negative rod (GNR), likely _Acinetobacter sp_,
sensitive to meropenem
- a GNR, closest resemblance to _Alcaligenes piechaudii_, sensitive to
ceftazidime, meropenem, pipericillin, timentin
- _Pseudomonas aeruginosa_, fully sensitive to antipseudomonas drugs
- MRSA from initial swab in one superfical ulcer, sensitive to vancomycin
- probable _Aeromonas sp._
- _Proteus sp._
- some things on the vibrio plates to be identified
- no _Burkholderia_ yet!
From Elizabeth Teeland, Mondial Assistance, Australia
I was in Phuket last week tracking patients for Mondial Assistance. Most had infected lacerations to lower limbs and aspiration pneumonia. The leg wounds had been debrided 2 and 3 times in some cases, and the commonest organisms isolated were _E. coli_, _Aeromonas hydrophila_ and unidentified Gram negative organisms.
From Prativa Pandey in Kathmandu
Some of our expatriates from Nepal who were hurt during the tsunami are undergoing treatment in Bangkok for wound infections. I will keep track of what infections they have had.
From Francesco Castelli in Brescia Italy
A few days ago, we admitted a young woman who returned from the tsunami area with infected leg wounds. The wounds were due to traumatic injuries acquired during the tsunami. No specific microorganisms were isolated from the wounds. She was discharged after broad spectrum antimicrobial therapy.
David O Freedman, MD
ProMED-mail thanks Dr Freedman for contributing this information from
Geosentinel. Certainly, the microbiology reflects traumatic injuries with
water exposure. - Mod.LL
Patricia A. Doyle, PhD
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