Increased human risk from communicable disease events (outbreaks) after disasters.

Increased human risk from communicable disease events (outbreaks) after disasters.

Written By: Website Administrator

31/03/2014

 

Natural disasters such as floods, hurricanes and droughts occur globally every year because of adverse weather conditions or poor land use. Climate change, together with population growth and urbanization as well as travel will increase the number of disasters and change the disease pattern and frequency of disease outbreaks.

 

Most natural disasters result in major communicable disease outbreaks and deaths. These communicable diseases such as dengue fever, typhoid fever leptospirosis are endemic to Fiji while more recent threats occur from emerging communicable diseases such as Zica Virus (Cook Islands, French Polynesia), Chikungunya (New Caledonia, PNG). An understanding of environmental and host factors, transmission pattern and other characteristics of the infectious agent (virus, bacteria) is essential to the control and prevention of these diseases. However Fiji, an understanding of the risk behaviours is also critical to reduce the incidence and devastating mortality associated with these diseases.

 

The term outbreak is used interchangeably with the similar but more technical term ‘epidemic’. However, the latter is preferred as it appears to cause less panic or anxiety. An outbreak or epidemic is defined as the occurrence of cases of an illness with a frequency that is clearly in excess of what is expected in a given area, therefore, demanding emergency control measures. The Republic of Fiji is currently experiencing a national outbreak or epidemic of dengue fever. Dengue fever infections in Fiji occur throughout the year (endemic) but what is unique in this situation, Dengue serotype 3 (DEN3) is an uncommon type of dengue that has not been detected in the region for many years. The outbreak of dengue fever in Fiji outbreak was initialized described as a localized event in Suva and central division but now the incidence of disease has expanded to other parts of the country.

 

There are a few reasons for the increase in incidence and risk of communicable disease outbreaks in Fiji. Firstly, our location as the hub of trade and travel in the South Pacific increases the populations’ vulnerability and risk to new and emerging communicable diseases. Humans that travel are common hosts to spreading these diseases across borders, often unaware of incubating the agent (virus) because they do not display or experiencing any symptoms or signs of disease until reaching their destination.  Secondly, trade brings into the country a lot of air and sea traffic that potentially carries breeding places for mosquitoes from a foreign country. In addition, the other important factor is related to a changing environment commonly referred to as an impact climate change or extreme weather condition that precipitate frequent occurrence of natural disasters. There is sufficient evidence to show that climatic conditions increase the risk of communicable disease events such as outbreaks in the region. During natural disasters, Pacific island countries are commonly affected because of unprotected exposures to the elements, poor housing structures, lack of proper utilities related to poverty or access and an element of inadequate disaster preparedness efforts due possibly either to ignorance or laissez-faire attitude.

 

The impact of communicable diseases may occur immediately after the disaster but most generally occur weeks after the event due to displacement, disruption of utilities and access to health services, and limited choice in food supply and limited access to basic needs. Communicable diseases that commonly increase after floods in Fiji are diarrhoeal diseases, leptospirosis, dengue fever and typhoid fever. The most common diseases with the highest recorded fatalities are leptospirosis, which presents similar and often mistaken for the severe haemorrhagictypre of Dengue fever. In figure 1, there was a significant increase in cases of Leptospirosis at flood prone areas in Fiji, at least 5-8 weeks after a flooding event. There were approximately 300 cases with 25 deaths following floods in 2012. One of the high risk behaviours associated with this disease in Fiji and commonly seen live television, is wading through infected waters. Unknown to the individual is that animal urine in flooded waters in a very small dose entering through the cornea of the eye is sufficient to cause an infection.

 

cyclone

Figure 1 leptospirosis after sequential flooding disasters, Western division 2012

 

Dengue fever on the other hand is not directly associated with flood because all the containers are washed away (but not destroyed). A dengue fever outbreak may occur when mosquitoes begin breeding again in ideal conditions (man-made containers) after a flood which usually is at least 6 weeks after a flooding event. Transmission of the virus by young mosquitoes can be further exacerbated by disruption of basic water supply and poor sanitation. There are certain risk behaviours such as increased exposure to mosquitoes while socializing outside, wearing minimal clothing due to humidity, movement of infected persons to another area and changes to the environment.

 

The risk of disease outbreaks and deaths during natural disasters and public health emergencies may be further minimized through early introduction of disease surveillance for early detection of outbreaks, epidemic preparedness, effective prevention and control including case management. Early detection, reporting and response are vital to limit the spread of outbreaks and epidemics. Failure to implement timely, effective and coordinated measures could also result in the occurrence of other chronic diseases:

  • Re-emergence of old disease threats e.g. TB;
  • Outbreaks of changed disease patterns e.g. Typhoid fever;
  • Outbreaks due to changed vulnerability such as heavy urbanization with more informal housing sectors;
  • Further spread of neglected diseases e.g. Leprosy, etc.
  • High morbidity and mortality from delayed epidemic detection and response e.g. dysentery, meningitis.
  • Emergence of a few ‘super bugs’ which are resistant to all antibiotics. They were limited to hospitals previously, but are now circulating in communities.

 

It never ends with the list of communicable diseases that increase after natural disasters and extreme weather conditions which benefit the proliferation of the vectors (mosquitoes) due largely to the risk bhaviours of humans.

 

The greatest challenge with these diseases after a natural disaster is the common clinical presentation that is indistinct from others. Although caused by different agents, they often require a different treatment regime for infected individuals. For example; Dengue fever is similar in presentation to Leptospirosis but is a virus infection with no specific treatment while the latter is only effectively treated with antibiotics early in the disease course. It is often uncommon to have patients presenting to the clinic with one disease and sent home to return with another, especially when there are no diagnostic laboratory tests with 100% accuracy to detect either disease. Commonly, a subjective decision is made based on severity of presentation. This emphasizes the importance of prevention at the individual level on avoidance of floodwaters and reduction of man-made containers that breed mosquitoes. The individual level motivation must occur before any successful engagement of the community. Mass communication done proactively has an important in educating the public to adopt protective behavior and in reducing the risks to the individual, family and community.

Cyclone Dengue

Cyclone Dengue

Written By: Website Administrator

31/03/2014

Authors: Dr Devina Nand and Dr Eric Rafai

 

Global

Approximately 40% of the world is at risk of Dengue (≈2.5 billion people). There are 50 – 100 million cases of Dengue every year. Almost 500 000 require hospitalization and 25 000 cases die annually.

Dengue fever has been reported in over 100 countries in Africa, the America’s, the Caribbean, Eastern Mediterranean, South East Asia and the Western Pacific regions.

Dengue fever outbreaks commonly occur in populated urban and residential areas of tropical nations. The disease is distributed along the distribution of the vector (agent that carries the disease). In this case, the vector is the mosquito (in particular the Aedesaegypti). The distribution remains 40˚North to 40˚South latitude.

 

map

Figure 1: Map of distribution of Dengue Cases Globally (source WHO Dengue training ppt)

 

The yellow areas are where there is known risk of transmission of Dengue Fever. The red dots denote areas such as Hawaii, Galapagos Islands, Sudan, Nepal, Bhutan and Madagascar where Dengue re-emerged in 2000-2006 after many years of being in remission.

 

Regional

The region has been experiencing Dengue outbreaks before the 1950’s in countries like American Samoa, Cook Islands, Fiji, French Polynesia, Guam, Kiribati, New Caledonia, PNG, Solomon Islands, Tonga, Tuvalu and Vanuatu. Resurgence in outbreaks was documented from the 1970’s.

Fiji is vulnerable to dengue fever outbreaks that occur at neighbouring Pacific Island countries. Our vulnerability is related to travel through our country and hub for trade in the Pacific. The same dengue 3 & Dengue virus serotype 3) outbreak in Fiji occurred in the Solomons, Vanuatu in 2012 and Kiribati early this year

French Polynesia, Queensland (Australia) and possibly Tonga are currently reporting DEN 3 outbreaks..

mapii

Figure 2: Map of distribution of endemic and non-endemic countries for Dengue in the Western Pacific Region. (source: WHO)

 

map3

Figure 3: Map of distribution of outbreaks as at 10/03/14 in the Western Pacific Region. (source: http://www.spc.int/phs/PPHSN/)

 

 

The Republic of Fiji

Fiji declared an outbreak in December 2013 and commenced immediately on its outbreak response that is not limited to enhancing clinical management of cases, monitoring the disease in affected and unaffected areas, increasing public awareness, prevention strategies, targeting clinical interventions, mobilizing community groups, government and stakeholders. Currently there is over 15, 446 suspected cases of Dengue notified to the Ministry of Health. There have been 12 confirmed deaths.  About   10% of these cases in Fiji are hospitalized. The initial outbreak was centered in the Central division in December; it has peaked in the Western division with the Northern division showing an increase in numbers.

 

Other Diseases in Fiji may mimic to Dengue Fever

The symptoms of Dengue fever include fever with:

  • Nausea or vomiting
  • Muscle or joint pains
  • Severe headache or pain behind the eyes (retro-orbital pain)
  • Rash

 

The Warning signs include:

  • Any bleeding (gums, nose, blood in stool, vomiting blood, vaginal bleeds, bruising or bleeding under the skin)
  • Persistent vomiting
  • Abdominal pain
  • Restlessness or lethargy

 

However, it is important to understand that the symptoms and signs are similar to other infectious diseases in the region. These include:

 

  • Leptospirosis ( endemic in Fiji)
  • Typhoid fever (endemic in Fiji)
  • Influenza ( seasonal in Fiji)
  • Zika virus (New Caledonia, Cook Is., French Polynesia)
  • Chikungunya virus (New Caledonia, PNG)
  • Other viral illnesses such as West Nile virus.

 

Leptospirosis and Dengue fever can be fatal if the person remains untreated at home and comes to the hospital very late in the course of the disease

It is very important to consult a doctor if you are having any of the symptoms mentioned above so treatment can be received early and precautions taken to prevent others from falling sick.

It is also important to protect oneself and family from the bite of mosquitoes.

 

Conclusion

The Republic of Fiji is not alone in experiencing dengue outbreaks. Other countries in the Western Pacific Region are experiencing the same challenges including the more developed nations such as Queensland, Australia. Globally, the Americas, South East Asia and Africa continue to experience dengue outbreaks.

The only effective responses are to work together, every individual, community and institution to reduce the breeding of mosquitoes by destroying man-made containers that breed mosquitoes, protecting ourselves from getting bitten by mosquitoes, protecting people suffering from Dengue from being bitten by mosquitoes and transferring the disease, and educating everyone around us in the importance of consulting a doctor when someone falls sick.

 

References

  1. Bhatt et al. (2013). The Global Distribution of Dengue. WHO database
  2. http://www.spc.int/phs/PPHSN/
  3. Singh N., Kiedrzynski T., Lepers C., Benyon E. S. (2005). Dengue in the Pacific –  an update of the current situation Retrieved from https://www.spc.int/phs/pphsn/Publications/PHDSurveillance/Surveillance-pages111-119.pdf.
  4. World Health organization Dengue Training Slides

 

POLHN Boosts Continuing Professional Development for Medical Professional

POLHN Boosts Continuing Professional Development for Medical Professional

Written By: Website Administrator

11/03/2013

 

Health professional across Fiji have begun taking Pacific Open Learning Health Net (POLHN) seriously to establish Continuing Professional development.

 

POLHN was created in 2003 in partnership with Pacific Health Ministries and the World Health Organisation to ensure the availability of high quality training and education resources for health professionals, in order to improve health and health services in the region through online learning.

 

POLHN now has 16 learning centres around Fiji Islands and operates in 12 countries, providing access to online Continuing Professional Development (CPD) courses through an expanding network of learning centres, managed by a team of POLHN Country Coordinators supported by focal points. The majority of the centres are equipped with computers connected to the Internet, printers, scanners and projectors.

Early this year 10 Ministry of Health staff in Nabouwalu, on the coastline of Vanua Levu, graduated from POLHN’s basic computer course. Staff Nurse TavaitaLomani and husband IfeiremiDau of Wainunu Nursing Station each attained more than 15 short course certificates: “The good thing about POLHN is that I can access courses anytime and from anywhere. The courses are free, so I do not have to worry about cost” said Ifeiremi.

 

Inspired by the couples’ story, Staff Nurse Krishneel Kumar of Lautoka Hospital followed their footsteps and completed several self paced courses from Lippincott Nursing Centre and Global Health eLearning Center. After finishing numerous courses during his night shifts; “I feel more confident in dealing with patients,” Krishneel says.

 

POLHN’s aim is to ensure health professionals have access to a variety of courses and digital health resources available through the Internet. POLHN believes that continuous health education is essential in order to improve the quality of health care provided to the people of Fiji and the Pacific. Many of POLHN’s courses can be completed entirely online, and for health workers who have yet to build their confidence using computers, POLHN offers basic and intermediate computer literacy training

 

There are more than 1000 short courses, available through the POLHN website. There are also postgraduate courses in health services management and public health, through the Fiji National University as well as a variety of specialized public health courses designed for health professionals. All POLHN courses are offered at no cost to Ministry of Health workers.

 

Currently, POLHN is running a Poster Competition open to everyone, to design a poster promoting POLHN and lifelong learning. The poster competition ends on 31 March, 2013 and there are 100s of free giveaways. The winner will get chance to be in the 10th year POLHN retreat, so get your creative ideas flowing and send your poster designs to yasinm@wpro.who.int / sarkisn@wpro.who.int

 

Stay tuned for more news from POLHN and keep learning!