Epidemicprone disease surveillance and results after the tsunami in Aceh Indonesia

The following report is based on that from the European Center for Disease Prevention and Control, Stockholm, Sweden (Ekdahl, 2005), and was prepared by the Ministry of Health, Indonesia, the World Health Organization assisted by the Global Outbreak Alert and Response Network Partners (GOARN), the Centers for Disease Control and Prevention, USA, and multiple other organizations.

Aceh Province, Indonesia, has a population of 4.8 million persons, and represents the area most severely affected by the tsunami on 26 December 2004. This report is based on the system described above, which is designed to provide surveillance, including an early warning and response system (EWARN) to detect epidemic-prone diseases. This includes the capability to investigate outbreaks, confirm pathogens, identify modes of transmission, identify risk factors, and design outbreak management and control methods. The diseases of epidemic potential that were targeted included acute watery diarrhea, bloody diarrhea, dengue, fever of unknown origin (FUO), acute jaundice (as a marker of hepatitis A and E), measles, pyogenic meningitis (meningococcal meningitis), malaria, acute respiratory infections, and tetanus. Data were collected for morbidity and mortality, and were updated weekly.

The data were separately reported for age-groups of less than five years, and for those of five years and older. The EWARN system was established to connect with health facilities (mobile clinics, field hospitals, permanent hospitals, etc.) and laboratories in affected districts. Reporting was augmented by daily telephone calls, text messages or e-mail reporting. Alerts were followed by verification, investigation, and response, as defined above, under the supervision of the Aceh Provincial Health Office and the WHO. The total was up to 123 reporting units from 10 districts.

The height of the emergency phase was between weeks 4 and 10. The following report is from week 12, which included a cumulative total of 184,864 medical consultations. Of these, there were 40,706 consultations for epidemic-prone diseases, and a total of 11 deaths. The specific results for morbidity and mortality from the targeted epidemic-prone diseases are summarized in Table 13.5.

Outbreak investigations following reported alerts were performed for bloody diarrhea (11), acute watery diarrhea (1), dengue (5), typhoid fever (3), acute jaundice (11), malaria (4), meningitis (4), encephalitis (1), measles (24), and scrub typhus (1). These investigations indicated some clusters of cases (tetanus, dengue, bloody diarrhea, typhoid fever, scrub typhus, hepatitis A, hepatitis E), "false alarms" (cholera, malaria, and encephalitis), and a single outbreak of measles.

There was a cluster of tetanus cases with a total of 106 patients who were hospitalized during the month following the tsunami. The case-fatality ratio was 19 percent,

Table 13.5 Morbidity and mortality due to infectious diseases for weeks 4-10, Aceh Province

Diseases

0-4 years

>5 years

Total

Morbidity

Mortality

Morbidity

Mortality

Morbidity

Mortality

Acute

3589

1

5894

0

9483

1

diarrhea

Bloody

128

0

448

0

576

0

diarrhea

Malaria

77

0

562

1

639

1

Fever > 38°

1533

2

3056

0

4589

2

(other)

Measles

70

0

75

0

145

0

URI

6599

3

18,613

3

25,212

6

Acute

4

0

45

0

49

0

jaundice

Meningitis

1

0

12

1

13

1

Total

12,001

6

28,705

5

40,706

11

Reproduced from Ekdahl (2005), with permission.

Reproduced from Ekdahl (2005), with permission.

with the peak onset of symptoms at 2-3 weeks after the tsunami. There was also an outbreak of 35 cases of measles in children aged 5 months-15 years, with the onset of rash in these cases occurring 2-4 weeks after the tsunami. The median age was 4 years. The response included a vaccination campaign targeting children aged 6 months-15 years, which was initiated in mid-January for all displaced persons in camps, and then subsequently extended to surrounding communities.

The analysis of this experience represents data for over 500,000 displaced persons who were housed in temporary shelters or moved to host families across the province. Despite substantial risk factors for epidemic-prone diseases, there were no large outbreaks. These results suggest several conclusions to explain the favorable outcome.

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