Disease Risks at Sichuan (WHO) part 1

Risk factors for increased communicable disease burden

1. Interruption of access to safe water and sanitation facilities. The populations displaced by the
earthquake are at immediate and high risk of outbreaks of water/sanitation/hygiene-related and foodborne diseases such as cholera, shigellosis due to Sd1, typhoid fever, and hepatitis A and E.

2. Population displacement with overcrowding. Populations in the affected areas and relief centres are at immediate risk of diseases spread by respiratory transmission such as measles and pneumonia. Increased risk of meningitis is also associated with overcrowding.

3. Increased exposure to disease vectors. Displacement of populations due to earthquake-related destruction of housing can result in increased exposure to disease-carrying vectors, including those for Japanese encephalitis.

4. Poor access to health services is of immediate concern. The degradation of the health infrastructure and of the means of communication prevent access to usual services, as well as to emergency medical and surgical services put in place in response to this crisis.

5. When deaths result from a natural disaster, exposure to dead bodies is not associated with
disease transmission. There is no evidence that corpses pose a risk of epidemics after natural
disasters. Standard infection control precautions should be observed when handling human corpses.


PRIORITY COMMUNICABLE DISEASES

Water/sanitation/hygiene-related and foodborne diseases

The displaced populations in China are at high risk from outbreaks of water, sanitation, and hygienerelated diseases, as well as foodborne diseases, due to reduced access to safe water and sanitation systems.

Disruption of usual water sources and contamination of water by destroyed sewage infrastructure may result in unsafe drinking-water being consumed, increasing the risk of exposure. Cholera has been reported in Sichuan Province recently, and the strengthening of prevention and treatment of cholera has been a focus of the MoH. Salmonella typhi (causing typhoid fever), hepatitis A and hepatitis E, and Shigella dysenteriae type 1 (Sd1) are also present and have epidemic potential. Diarrhoea is a major cause of under five mortality; WHO estimates that diarrhoea accounts for 12% of under-five deaths in China.

Leptospirosis is a bacterial zoonosis present worldwide. Infection in humans may occur indirectly when the bacteria comes into contact with the skin (especially if damaged) or the mucous membranes. It can also result from contact with moist soil or vegetation contaminated with the urine of infected animals, or with contaminated water as a result of swimming or wading in floodwaters, accidental immersion or occupational abrasion.

Vector-borne diseases

Population displacement can result in an increased exposure to vectors, and therefore to vector-borne diseases. Additionally, movement of susceptible populations into higher-risk areas can increase the risk of transmission. With the vast destruction associated with this earthquake, pools of water suitable for vector breeding may develop with subsequent rains.

Japanese encephalitis (JE) occurs in the Asian region, transmitted by the Culex mosquitoes which breed particularly in flooded areas and rice fields. Inadequate shelter, rains in the earthquake-affected area, and the disruption of vector control programmes due to the earthquake could lead to an increased exposure to vectors.

The virus circulates in Ardeidae birds (herons, egrets), and pigs act as amplifying hosts for the
virus. (Sichuan Province is a major pig-producing source for China and neighbouring countries).

Humans are incidental hosts, and infection occurs primarily in children. A national programme to vaccinate schoolage children against JE free of charge has recently commenced, but coverage is estimated to be low.

Culicine mosquitoes are normally zoophilic (feeding mainly on animals) but may also bite humans. China CDC maintains an annual surveillance and monitoring of JE in this region. Vector control methods and personal protection information can be found in section 3.7.

Human plague cases have been reported in the past in the mountain regions of Sichuan, where known natural foci for Yersinia pestis circulate among the wild rodents and their fleas. The disturbance of the natural enzootic cycle can result in increased contact between the wild and domestic rodent populations increasing the chance of exposure of people to potentially infective rodents. Populations displaced by the earthquake may be at higher risk of exposure to rats and fleas carrying Y. pestis, not only in Sichuan but possibly in surrounding provinces where plague is endemic (including Gangsu, Xinghai, Yunnan, and Guizhou). Detection and management of cases, as well as methods for control of pests and environmental contamination, should follow MoH guidance.

There is no significant risk of malaria transmission within the earthquake-affected areas of Sichuan Province. Although malaria remains a serious public health problem in China, it occurs primarily in Yunnan and Hainan Provinces where risk of transmission of P. falciparum is high. The Province of Sichuan reported 289 cases in 2003 (accounting for <1% of total malaria cases reported by the country.

Aedes aegypti,, the primary vector for dengue is currently not reported in Sichuan Province. Aedes albopictus, a secondary vector for dengue, is present in Sichuan Province. China reported less than 600 cases of dengue in 2007, primarily in provinces further south.

What Should you Do If Earthquake?

Earthquakes

You will never have warning that an earthquake is coming. To make sure you and your house are prepared, you should:

o Secure cupboards and bookcases to the wall using bolts. Also try to keep heavy objects on lower shelves so they won’t fall on you during an earthquake

o Make sure your water heater is secured to a wall. That way, it won’t fall during an earthquake and hurt someone or start a fire

o If you live in an area that has a lot of earthquakes, make sure that your home is bolted to your foundation. Although this might be expensive, it could save you from a lot of damage to your house during an earthquake


Here are some tips of what to do during an earthquake:

o Do NOT go outside. You could get hurt from falling glass or parts of buildings. If you are outside, stay away from buildings and power lines

o Take cover under a desk, table, or other large and stable piece of furniture. Hold on to it. Or, stand in a doorway and brace yourself

o Stay away from windows, heavy furniture, appliances, mirrors, pictures, and anything else that could fall and hurt you. Also stay away from fireplaces. You could lose your balance and hurt yourself on the fire

o If you are driving when an earthquake happens, stop the car if it’s safe. Stay inside your car until the earthquake stops, and don’t drive near bridges or tunnels. Try not to stop by power lines, light posts, signs, or trees. These could fall and hurt you

o Stay alert for falling objects. Most people get injured by falling objects during an earthquake, not by the shaking itself

o Do NOT use matches, lighters, or candles. If there is a broken gas line, you could spark a fire or explosion

o Do NOT use elevators. There might be a power outage due to the earthquake, and you could get stuck in the elevator


After the earthquake stops, here’s what you should do:

o Check yourself and others for injuries. Call 999 if you or someone else needs immediate medical assistance. If the phone lines are not working, try using a cell phone

o Check to see if electric, water, and gas lines are damaged. If they are, shut off the valves
Stay away from damaged buildings and areas. You could get hurt by broken glass and falling objects

o Listen to the radio for more information

How to Prepare for a Flood

If you live in a high flood risk area, personal preparation is the key to avoiding disaster.

Take solid steps ahead of time to ensure the safety of your family and minimize property loss, even when the flood waters come lapping at your doorstep.

By following this list of flood safety tips, your family and home will be ready when waters begin to rise.

Before a Flood Strikes

Step1
Call your local emergency organization office to assess your home's flood risk.

Step2
Put together a supply kit including battery-powered flashlights and radio, first aid and medications, rain gear and warm clothing, sleeping bags or bedding, several days worth of canned foods and bottled water, and any other personal items you must have for health and safety.

Step3
Form a family emergency/evacuation plan. Make sure everyone knows where to go in the event of a flood warning. Make a list of those places you could go--houses of family or friends, shelters or other safe public buildings on higher ground. Provide each family member with a written list of the locations and phone numbers, preferably in order, from first to last resort.

Step4
Check with your insurance agent on whether or not flood insurance is available for your home. Consult a professional when making flood insurance decisions.

Step5
Elevate your water heater, furnace and electrical panel to minimize damage if they are in flood-prone areas of your home.

During a Flood Watch or Warning

Step1

Fill your car's gas tank at the earliest suspicion of flood-producing weather or conditions. It will be your quick getaway if the time comes.

Step2

Move what furniture and valuables you can to the highest floor of the house, or in single story homes, raise them off of the ground as much as possible. Do this at the onset of a flood watch.

Step3

Stay tuned to local TV and radio for constant updates on the weather forecast, flood level, and watches and warnings. Take all advice and warnings seriously.

Step4

Evacuate to higher ground as soon as a flood warning is issued. Follow your family evacuation plan while avoiding waterways at all costs. Do not drive into standing water and abandon your car immediately if it does stall in water. Search for high, dry ground, and get there as quickly as possible.

Also you can considered other below tips.

Before a flood happens, make sure you’re ready: ·

o Learn about your community’s emergency plans, warning signals, evacuation routes and locations of emergency shelters·

o For drains, toilets and other sewer connections, install backflow valves or plugs to prevent floodwaters from entering·

o Gather your emergency supply kit and stay tuned to local radio or TV stations for updates·

o Do NOT keep valuable items and appliances in your basement. They could get ruined during a flood·

o Make sure your fuse box (or main breaker) and utility meters are raised above the flood level in your home. Water and electricity don’t mix·

o Turn off all utilities at the main power switch ·

o Fill bathtubs, sink and plastic soda bottles with clean water ·
o Bring outdoor possessions, such as lawn furniture and trash cans inside or tie them down securely·
o Fill your vehicle’s gas tank and make sure the emergency kit for your car is ready·

o If no vehicle is available, make arrangements with friends or family for transportation·

o Put livestock and family pets in a safe area. Due to food and sanitation requirements, emergency shelters cannot accept animals·

o Adjust the thermostat on refrigerators and freezers to the coolest possible temperature· Have flood insurance

When flooding happens, here’s what you should do:

If a flood warning is issued for your area or you are directed by authorities to evacuate the area, never ignore such orders .Take only essential items with you .

Disconnect appliances to prevent electrical shock when power is restored

Follow the designated evacuation routes and expect heavy traffic Go to higher ground immediately .

Do NOT try to drive through water, even if it’s not moving. You car can easily get swept away

After a flood, here are some of the things you need to be aware of:

Avoid illness.

o Always wash your hands with soap and water that has been boiled or disinfected before preparing or eating food, after toilet use, after participating in flood cleanup activities and after handling articles contaminated with flood water or sewage Make sure your food is safe:

o Do not eat any food that may have come into contact with flood water

o For infants, use only pre-prepared canned baby formula that requires no added water, rather than powdered formulas prepared with treated water

o Discard any refrigerated or frozen food that has been at room temperature for two hours or more and any food that has an unusual odor, color or texture

Make sure your water is safe:

o Do not use contaminated water to wash dishes, brush your teeth, wash and prepare food, wash your hands, make ice or make baby formula. You can use an alcohol-based hand sanitizer to wash your hands

o If you use bottled water, be sure it came from a safe source. If you do not know that the water came from a safe source, you should boil or treat it before you use it. Use only bottled, boiled or treated water until your supply is tested and found safe

o Bringing water to a rolling boil for one minute will kill most organisms.

How to Handle Animals:
Many wild animals may be forced from their natural habitats by flooding, and many domestic animals may also be without homes after a flood. Take care to avoid these animals Do not corner an animal .

If an animal must be removed, contact your local animal control authorities. If you are bitten by any animal, seek immediate medical attention .

If you are bitten by a snake, first try to accurately identify the type of snake so that, if poisonous, the correct anti-venom may be administered

How to Deal with Electric and Gas Utilities:

Electrical power and natural gas or propane tanks should be shut off to avoid fire, electrocution or explosions until it is safe to use them .

Use battery-powered flashlights and lanterns, rather than candles, gas lanterns or torches.

If you smell gas or suspect a leak, turn off the main gas valve, open all windows and leave the house immediately .

Notify the fire department and do not turn on the lights or do anything that could cause a spark.

Avoid any downed power lines, particularly those in water.

All electrical equipment and appliances must be completely dry before using them. You should have a certified electrician check these items if there is any question

How to Clean Up:

Walls, hard-surfaced floors and many other household surfaces should be cleaned with soap and water and disinfected with a solution of 1 cup of bleach to 20 liters of water .

Wash all linens and clothing in hot water, or dry clean them .

For items that cannot be washed or dry cleaned, such as mattresses and upholstered furniture, air dry them in the sun and then spray them thoroughly with a disinfectant.

Steam clean all carpeting .

If there has been a backflow of sewage into the house, wear rubber boots and waterproof gloves during cleanup .

Remove and discard contaminated household materials that cannot be disinfected, such as wall coverings, cloth, rugs and drywall