Post Tsunami Precautions

		Four months after the tsunamis that devastated large areas of South East Asia, relief efforts in most of the affected areas have progressed from emergency management to the development of long-term plans for infrastructure rebuilding and rehabilitation of health systems.

The major epidemics of communicable diseases envisaged in the aftermath of the disaster have been avoided, with disease surveillance and early warning systems now in place. Water supplies and sanitation systems are operating effectively. Governments have rescinded their travel advisories for most areas including Sri Lanka, the Maldives, India, Thailand, Malaysia, Bangladesh, Myanmar, Tanzania, the Seychelles, Kenya and Somalia. However, Indonesia is still causing concerns for travellers, in particular Aceh and Northern Sumatra.

Humanitarian and health workers working in the worst affected areas remain at highest risk of developing illness or injury, not least from the ongoing psychological impact that follows such enormous loss of life. However, business travellers still need to take additional precautions, ideally consulting a health care provider four-six weeks before departure to ensure adequate preparation and immunisation.

Significantly decreased health services may still be operating in many areas so make sure all routine vaccinations are up to date, specifically tetanus, diptheria, polio and measles.

Risk of infection from insect borne diseases may still be increased, despite a significant number of mosquito control measures in many areas. In Banda Aceh, 200,000 homes have been sprayed with insecticide. Bed nets and plastic sheeting treated with insecticide have been widely distributed. However, malaria is endemic in much of South East Asia and travellers should take medical advice to ensure they are taking appropriate antimalarial medication. An antimalarial drug regimen should be taken for travel to all parts of Aceh Province. For employees with prolonged exposure, travelling with a malaria testing kit can be a useful precaution allowing a quick and clear diagnosis where symptoms are relatively mild or inconclusive.

Japanese Encephalitis is also spread by infected mosquitoes and is endemic across the region. Vaccinations are effective but serious adverse reactions do occassionally occur in some individuals. Any vaccination schedule for this potentially fatal disease should be completed at least 10 days before departure. Alternatively visitors should travel with equipment to minimise the risk of mosquito bites, including impregnated bed nets, long sleeved clothing and insect repellants.

Displaced animals, from snakes and other reptiles to small mammals and dogs, also pose an increased hazard after a natural disaster. In a remote medical environment, prevention is better than cure, so it is important to take simple measures to avoid possible incidents. Few reptiles are aggressive unless disturbed. Snakes tend to be active at night and in warm weather. Finding out about the local species and their habits will go a long way to minimising the risks of attack. Extra precautions for field staff working alone in high-risk areas could include a procedure for regular contact. Copies of route plans and operational movements should be logged centrally to enable an emergency team to be despatched.

Rabies is endemic throughout most of the tsunami-affected areas. A rabies vaccination requires three weeks to complete. In the case of an animal bite, anyone without full immunisation should obtain a post exposure prophylaxis as quickly as possible.