H5N1

Haiyan/Yolanda: Advice for Canadian travellers

The government of Canada has issued some advice for travellers: Typhoon Haiyan (“Yolanda”) in the Philippines. The top seven tips:

If you must travel to the affected areas be aware that there is an increased risk of injury and illness: 

1. Consult a health care provider or visit a travel health clinic preferably six weeks before you travel and purchase travel health insurance. 

2. Get vaccinated. 

Make sure you are up-to-date with all of your routine vaccinations. 

• Discuss your travel plans with your health care provider or travel health clinic as there may be other vaccines to consider for your travel to the Philippines. 

3. Practise safe food and water precautions. 

Widespread damage to infrastructure in the affected areas has displaced millions of people, and has impacted sanitation systems and food and water supplies. Some areas remain inaccessible. There is an increased risk of food- and water-related diseases, like travellers’ diarrhea, cholera, hepatitis A, typhoid and schistosomiasis. 

4. Protect yourself against insect bites. 

Flooding and standing water increase the risk of insect related diseases such as chikungunya, dengue fever, Japanese encephalitis and malaria. Travellers should take precautions to avoid insect bites. 

5. Protect yourself against animal-related diseases. 

Due to the displacement of the people in these areas, there is likely an increase of stray animals. Travellers should take precautions to avoid contact with all animals, as they may carry rabies. 

• Discuss the benefits of getting vaccinated with your health care provider. 

• Avoid contact with all animals, wild or domestic. 

• If bitten or scratched, immediately clean the wound and seek medical attention. 

6. Pack a travel health kit, with first aid supplies and medication to handle minor injuries and illnesses, and to manage pre-existing medical conditions. 

7. Protect yourself against injury and illness:

•  Use caution around downed power lines, water-affected electrical outlets, and interrupted gas lines. 

• Be cautious near moving water. Avoid standing or wading in or driving through moving water. 

• Wear appropriate sturdy footwear in all disaster-affected areas.

If only the Filipino typhoon survivors could all follow this advice!

Typhoon Haiyan/Yolanda and beyond

Via The Lancet, a letter: Typhoon Haiyan and beyond.

The recent Super Typhoon Haiyan, the third category 5 typhoon to strike the Philippines since 2010, tore through Tacloban in the province of Leyte and affected about 13 million people; only 4 weeks after Super Typhoon Usagi affected more than 2·7 million people in southern China. With increasing numbers of disasters related to climate change (from 99 in 1980 to 269 in 2011), Asia is likely to be hit by more typhoons with stronger intensity in the coming decades. 

The 2013 World Disaster Report identified access to information and technology as major challenges for community disaster preparedness, survival, and recovery. 

Media coverage of typhoons and their aftermath often focuses on the immediate ravages, injuries, deaths, and economic loss; however, typhoons and hurricanes bring along less visible long-term consequences for health. 

After major hurricanes and floods, water-borne diseases, such as leptospirosis, can arise from contamination of water and food crops; lack of shelter and population displacement to crowded conditions often leads to a high incidence of chronic respiratory diseases; standing water can serve as a hotbed for mosquito breeding and hence vector-borne illnesses; injuries increase the risks of tetanus; and damaged wires can cause electric shock and fire. 

While these immediate effects might be recorded and reported, well-organised longitudinal data and comprehensive surveillance information are often limited in low-income settings, and, as a result, information about the long-term physical and mental health consequences of floods for the population is not available to guide evidence-based disaster emergency preparedness and response planning. 

The Hyogo Framework for Action identified capacity building and development of disaster health-risk-resilience policies by national governments for disaster-prone communities as key priorities for action. To do so, the research agenda at the community level should identify predictors of and barriers to the ability of households and communities to respond to disaster warnings, and also assess the effectiveness with which information about health responses after a disaster is delivered. 

Research also needs to explore the best way to organise surveillance data and systems to reduce post-disaster health risks. 

How to mobilise community volunteers to engage in evidence-based post-disaster health actions remains a major operational challenge for governments, front-line workers, and academics, and gaps in technical knowledge must be tackled.

Haiyan/Yolanda: 1 dead, 13 down with leptospirosis in Leyte

Via Inquirer News: Leyte: 1 dead, 13 down with leptospirosis. Excerpt:

A 58-year-old man died while 13 other persons have been afflicted with leptospirosis. 

Doctor Gloria Fabregas, consultant of Tacloban Mayor Alfred Romualdez, disclosed that a man from Palo town was confirmed to have died due to leptospirosis on Nov. 20 at Eastern Visayas Regional Medical Center (EVRMC) in Tacloban City. 

Six of the 13 cases of leptospirosis monitored by health authorities were from Tacloban, while the rest were from Palo, Jaro and Alangalang towns, all in Leyte province, Fabregas said. 

Fabregas said they expected the number of leptospirosis cases to increase as the city and other parts of Leyte experience continuing rain. 

The 13 cases reported from Nov. 9-26 were treated at  EVRMC. 

EVRMC served as the command center of the Department of Health (DOH) after Supertyphoon “Yolanda” struck central Philippines. 

The command center, however, has been moved to the regional DOH office at the government center in Palo. 

In anticipation of a possible surge of leptospirosis cases in the city and other typhoon-hit areas in Leyte, the DOH has distributed doxycycline, an antibiotic, to prevent the spread of the disease, Fabregas said.

Haiyan/Yolanda: DOH monitors leptospirosis cases in Tacloban

Via ABS-CBN News: DOH monitors leptospirosis cases in Tacloban. Excerpt:

The Department of Health (DOH)-Region 8 is monitoring the increasing number of leptospirosis cases in Tacbloban City. 

The DOH has recorded 13 cases of leptospirosis in the city. Two people have already died of the illness. 

Officials of the DOH have started distributing doxycycline to prevent the further spread of the disease. 

The public is warned against wading in flood and mud, especially those who are involved in clearing operations. Leptospirosis is an infectious disease caused by bacteria found in rats' urine, normally present in flood waters. 

Measles, tetanus 

Aside from leptospirosis cases, the DOH is also monitoring cases of measles in children staying in evacuation centers. The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) are providing vaccines for children. 

Officials are also monitoring the increasing cases of fever, coughs and colds among those in the evacuation centers, as these may be symptoms of more serious illnesses. 

The DOH and the Japanese Self Defense Forces have started fumigating and fogging evacuation centers to protect evacuees from dengue. 

Two people have died of tetanus, while two infants are under observation.

Haiyan/Yolanda: DOH-8 reports deaths due to leptospirosis, tetanus

Via the Philippine Information Agency: DOH-8 reports deaths due to leptospirosis, tetanus.

The Department of Health (DOH) in Eastern Visayas reported two deaths due to tetanus and leptospirosis in typhoon-affected areas.   

DOH Assistant Secretary Paulyn Rosell-Ubial said that at present, they have received 13 suspected cases due to leptospirosis with one death. 

As for tetanus cases, Ubial said 10 cases were reported with one death.   

“I would like to inform the public especially those who need medical attention to visit our hospitals, we have already eight functional hospitals in the region,” said Ubial.   

The five hospitals can now perform major surgical operations such as the Eastern Visayas Medical Center, Remedios T. Romualdez Hospital, Divine Word University Hospital (formerly St. Paul), Field Hospitals of Australia and Germany located at Palo, Leyte. 

“While the other three primary hospitals are accepting out-patient services and minor operations, ” Ubial added.

Philippines: DOH verifies reported deaths due to tetanus, leptospirosis in Haiyan/Yolanda-hit areas

Via InterAksyon.com: DOH verifies reported deaths due to tetanus, leptospirosis in Yolanda-hit areas.

The Department of Health (DOH) is verifying reported number of deaths due to tetanus and leptospirosis in typhoon-affected areas, although no precise figure has yet been released. 

Assistant Health Secretary Dr. Eric Tayag said via Twitter on Friday that a DOH team is currently "in a management of body shifts to outbreak detection and response." 

Tayag said that the shift to outbreak detection and response means that the DOH will disengage in management of bodies, which is now with the National Bureau of Investigation and local government units. 

At present, Tayag said that two leptospirosis deaths have been verified: A 22-year-old male from Tacloban City and a 58-year-old male from Palo, Leyte. 

As for tetanus cases, those verified were all males whose ages ranged from 19 to 60 years, Tayag said. "One came from Tolosa, Leyte and the rest from Tacloban. All of them are alive," he added. 

The risk of dying from tetanus, according to Tayag, increases if symptoms appear within the week after the injury. 

“Tetanus symptoms appear as early as three days after the injury,” he said. “Symptoms include lock jaw, difficulty in swallowing and seizures.” 

He advised survivors to make sure that all wounds sustained in typhoon "Yolanda" should be considered tetanus-prone. 

“All patients should get both anti-tetanus serum and tetanus toxoid,” Tayag said.

The Lancet on Haiyan/Yolanda

Via The Lancet: Typhoon Haiyan: Philippines faces long road to recovery. Excerpt:

The death of 3-day-old infant Althea Mustacia on Nov 16 might have been avoided had ventilators been working at a public medical centre in the Eastern Visayas region of the Philippines's Leyte province. Establishing sustained respiration for the infant who had asphyxia after birth was tragically hampered, however, after power lines went down across the entire region in the wake of Super Typhoon Haiyan, which hit central Philippines on Nov 8. 

Filipino health officials say that most hospitals and health facilities in the typhoon-hit areas are seriously damaged. In Tacloban, in the worst-hit province of Leyte, only one public hospital remains functional following Haiyan (one of the strongest storms ever recorded), according to Gloria Balboa, a regional director at the Philippines Department of Health (DOH). “Now we have to rely on private facilities and some additional hospitals set up by international groups”, she tells The Lancet.  

Balboa is in charge of monitoring the health situation in several disaster areas. She says that, in Eastern Samar, the Australian Government has been deploying teams, while international aid continues to arrive. “However, all the hospitals and facilities are not working. And there are fewer medical staff in Eastern Samar, compared with Tacloban.” 

Although some of the affected people were able to move out, those who have no choice but to stay will face tougher challenges in the near future. Balboa says that the sanitation conditions are worrisome due to the shortage of water. “We are expecting diarrhoea and other infections”, she says. 

According to DOH, risk of diarrhoea, respiratory illnesses, leptospirosis, and influenza outbreaks remains high. To prevent water-borne outbreaks, DOH has been coordinating efforts with humanitarian groups and local governments to provide adequate, clean water through water filtration machines. 

Humanitarian groups face similar sanitation challenges. According to Allison Gocotano, Assistant Projects Officer at Health Futures Foundation, who helped provide basic medical services in a temporary shelter set up in a school in Guiuan, Samar province, about 100 evacuated families have just two toilets to share between them. 

“Water and sanitation are going to be potential problems unless camp management is well established”, he says, adding that the lack of power and regular communication lines makes it much harder to organise people and get things done.

The Lancet also has a thoughtful editorial: The Philippines: learning lessons from past disasters.

Ravaged by Haiyan/Yolanda, Philippines faces threat of serious diseases

Via The New York Times: Ravaged by Typhoon, Philippines Faces Threat of Serious Diseases. Excerpt:

The aftermath of the Philippines typhoon is now threatening the country with outbreaks of debilitating and potentially fatal diseases, including some thought to have been nearly eradicated, because of a collapse in sanitation, shortages of fresh water and the inability of emergency health teams to respond quickly in the week since the storm struck, doctors and medical officials said Thursday.    

Illnesses including cholera, hepatitis, malaria, dengue fever, typhoid fever, bacterial dysentery and others that thrive in tropical, fetid environments, where sewage and water supplies intermingle, could form what doctors fear is the disaster’s second wave. They predicted that leptospirosis, a parasitic disease endemic to the Philippines, could surge. 

And some said they would not be surprised to see a return of polio. The Philippines is part of an area of the western Pacific declared polio-free by the World Health Organization nearly 14 years ago. 

Medical aid groups on the ground in Tacloban, the city of 220,000 that was flattened when the storm made landfall a week ago and that only began to bury its dead on Thursday, have already expressed alarm over the risk of widespread tetanus infections among survivors wounded by shards of corrugated metal and splintered wood. 

Some aid groups have already reported exhausting their initial supplies of vaccine to thwart tetanus, a potentially fatal bacterial infection that can cause painful muscle contractions, the inability to swallow and the locking of the jaw. 

“The population is at increased risk of tetanus as well as outbreaks of acute respiratory infections, measles, leptospirosis and typhoid fever,” the United Nations Office for the Coordination of Humanitarian Affairs, the main international conduit for distributing relief to the Philippines, said on its website. The basic health infrastructures “are severely damaged in the worst affected areas and medical supplies are low.” 

Nearly 4,000 people are known to have been injured in the storm, the Philippines government said Thursday on its typhoon disaster website, which puts them at immediate risk of infections and contagion. Relief groups consider the injured figure low because many areas destroyed in the storm have yet to be surveyed on the ground. 

Doctors Without Borders, the Paris-based medical aid group that has sent emergency teams into outlying regions of the Philippine archipelago not reached by others, said Thursday that survivors on many islands were in need of everything, especially fresh drinking water. 

Esther Sterk, a physician with the group that was helping to assess the immediate needs, said a damaged hospital in Roxas City, in northern Panay Island, was bracing for patients afflicted by contagious diseases. “They are already seeing cases of respiratory infections and diarrhea, and we expect the number of cases to increase,” Dr. Sterk said in an emailed update.

Super typhoon Haiyan hits Category 5, an extremely serious threat to Philippines

Via The Washington Post: Super typhoon Haiyan hits Category 5, an extremely serious threat to Philippines. Excerpt:

The western Pacific storm Haiyan has intensified without interruption since Sunday and is now a dangerous Category 5 super typhoon, with maximum sustained winds exceeding 160 mph.  It is on a path due west, and landfall Friday in the central Philippines is inevitable. 

Haiyan – known as Yolanda in the Philippines – is likely the strongest storm to form on the planet this year. 

“Based on satellite imagery, [Haiyan's] the strongest storm I’ve seen since Bopha (2012),” says Ryan Maue, a meteorologist with WeatherBell Analytics. 

Super typhoon Bopha, whose peak winds reached 175 mph, caused hundreds of fatalities on the southern Philippine island of Mindanao in December 2012. 

Maue says it’s possible Haiyan’s maximum sustained winds have reached 180 mph. 

“[The] system has developed to almost max intensity for a cyclone,” notes a NOAA bulletin. 

Officially, the Joint Typhoon Warning Center forecasts additional strengthening over the next day, but with the storm near its theoretical maximum strength – it’s more likely it has leveled off. As it continues westward over the Philippine Sea, its inner core may re-organize through what’s known as an eyewall replacement cycle, which would briefly weaken the storm. But water temperatures are very warm along Haiyan’s path, so significant weakening is unlikely.

This is going to be bad—not only the storm itself, but the aftermath of malnutrition, malaria, dengue, and leptospirosis.

India: Mumbai reports 198 leptospirosis cases

Via the Mumbai Mirror: With 198 cases, leptospirosis at 4-yr high in city. Excerpt:

As many as 198 cases of leptospirosis have been reported in Mumbai this year, the highest in the last four years, with 12 cases reported in October itself. 

Three people have lost their lives to the infection, and the doctors have urged citizens to keep their surroundings clean. 

Leptospirosis is a bacterial infection caused by a strain of leptospira. It is most commonly transmitted from animals to humans when people with wounds or breaks in the skin come into contact with water or soil that has been contaminated with animal urine. The animals that transmit the infection to humans include rats, skunks, and foxes. 

Health practitioners said the number of cases reported this year is only collected from the public hospitals, and it will rise significantly if private clinics and hospitals are covered as well. 

This year's first death due to leptospirosis was reported on July 25, when a 25-year-old Dharavi resident succumbed to the disease, followed by a 22-year-old man from Kumbharwada on August 9, and an 18-year-old fruit seller from Saki Naka, who died on August 12. 

In 2010, 18 people had succumbed to the disease (135 cases reported), while six people died of leptospirosis the following year (141 cases reported). Last year saw two deaths due to the disease, while 151 cases had been reported.