-  From ProMED-mail
- Indonesia - 2 Cases Of Measels Confirmed In
- 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.
-  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
- A potentially threatening situation exists, which we
hope will be
- contained successfully by the alertness of the UNICEF
staff in the area. -
- WOUND INFECTIONS, TSUNAMI-RELATED - ASIA
- A ProMED-mail post
- ProMED-mail is a program of the
- International Society for Infectious Diseases
- Date: Sun 9 Jan 2005
- From: David Freedman <firstname.lastname@example.org>
- 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
- 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
- - a multiresistant Gram negative rod (GNR), likely _Acinetobacter
- sensitive to meropenem
- - a GNR, closest resemblance to _Alcaligenes piechaudii_,
- ceftazidime, meropenem, pipericillin, timentin
- - _Pseudomonas aeruginosa_, fully sensitive to antipseudomonas
- - MRSA from initial swab in one superfical ulcer, sensitive
- - 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
- David O Freedman, MD
- ProMED-mail thanks Dr Freedman for contributing this
- Geosentinel. Certainly, the microbiology reflects traumatic
- water exposure. - Mod.LL
- Patricia A. Doyle, PhD
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