Clinical Updates
30 May 2006 Printable (PDF) format
Indonesia earthquake - Advice for relief workers and other travellers to affected areas
On Saturday 27 May 2006 at 5.54 am local time an earthquake measuring 6.2 on the Richter scale struck the island of Java, 20-25 km southwest of Yogyakarta [1].
The worst hit area was the Bantul district, south of Yogyakarta. The district has a population of 790,000 and the majority of houses have reportedly been destroyed. At least one hospital in the district has been destroyed and as a result other hospitals in the area are overcrowded. Evacuation of the area had already commenced as a precautionary measure against possible eruption of Mt. Merapi. An estimated 200,000 people are currently displaced.
A situation map of the affected area can be found on the ReliefWeb website.
Those planning to visit the affected areas, such as relief workers, should be aware of potential hazards and the possibility of increased risk of injury and illnesses.
The situation is evolving and subject to change. Further information will be posted as it becomes available.
Vaccination advice
All travellers should be up to date with their routine immunisations including MMR as measles is endemic in the region, and BCG, particularly for work in refugee settings and for long-term stay.
Boosters are recommended for the following if not received with the past 10 years:
In the UK, the trivalent tetanus, diphtheria and polio vaccine, is the vaccine of choice.
- Hepatitis A and typhoid immunisations are recommended.
- Hepatitis B: Persons involved with patient care or contact with bodily fluids should be vaccinated.
- Cholera: Given the potential for cholera to occur in refugee settings in the affected areas, at this time vaccination of aid workers is recommended.
- Rabies: Rabies vaccination before travel should be considered as adequate post-exposure treatment with rabies immune globulin and vaccine is not likely to be available. Rabies in resource-poor regions of the world is usually transmitted by the bite of an infected dog and avoidance of all dogs is necessary.
- Japanese encephalitis: Japanese encephalitis is endemic to Indonesia, however, the risk to travellers who restrict their itinerary to urban areas is low and vaccination would not normally be recommended. Travellers who will be in rural areas shoud consider vaccination. All travellers should take insect bite avoidance measures.
Travellers leaving at short notice are still recommended to seek appropriate vaccinations. Those who are unable to obtain a full vaccination course prior to travel should attempt to complete the course overseas. If this is not possible, they should take care in exercising precautions against the vaccine-preventable diseases.
Malaria prevention advice
Malaria is usually a low risk in the urban areas of Java, and for travel restricted to urban areas, malaria chemoprophylaxis is not usually necessary.
However, there is an increased risk of malaria in rural areas of Java. The recommended chemoprophylaxis is chloroquine plus proguanil. Mefloquine, doxycycline or atovaquone/proguanil are suitable alternatives for those unable to take chloroquine plus proguanil. Chemoprophylaxis should be initiated before travel, taken during travel and continued for a period of time after leaving the malarious areas. Specific details about malaria and each of the preventive regimens can be found on NaTHNaC malaria information page.
All travellers are advised to take insect bite avoidance measures to prevent malaria and other mosquito transmitted diseases such as dengue fever. Malaria is transmitted by Anopheles mosquitoes during the hours from dusk to dawn.
Food and water advice
As a result of damage to water and sewage systems the risk of diarrhoeal illnesses may be increased. Reliable sources of bottled water may not be available and water purification will be necessary. Bringing water to a boil is the most reliable method, but this may not always be practical. Using iodine or chlorine preparations to purify water is usually effective, but protozoan parasites such as Cryptosporidium and Giardia are not always killed by these agents. In these cases iodine or chlorine treatment should be combined with filtration of water using a portable water filter that has a filter size of 0.2 µm to 1.0 µm should be performed.
Self treatment for diarrhoeal illness can be carried by relief workers and used where necessary and in the absence of contraindications. Self treatment may include oral rehydration treatment taken with purified water, an anti-motility agent such as loperamide and a treatment course of ciprofloxacin (500mg twice daily for up to three days) or azithromycin (500 mg initially and then 250 mg daily for up to three days). Individuals with diarrhoea that is associated with fever or passing blood should seek prompt medical evaluation. Personal hygiene, including frequent hand washing, is essential.
Other health risks
The risk of injury after a natural disaster is high. Structural damage to buildings and roads, and interruptions to basic services all pose a risk. Dust inhalation and, trauma are potential hazards.
There is severe damage to health facilities together with shortages of surgical supplies and medicines. Travellers should carry with them a personal first aid kit.
The infectious disease risk from handling dead bodies is low [2].
Support for British Citizens
Persons planning to visit the affected areas should regularly consult the Foreign and Commonwealth Office for up-to-date security and safety advice.
References
1. World Health Organization. Indonesia earthquake: May 2006. Information note 29 May 2006 [cited 30 May 2006] Available online at http://www.who.int/hac/crises/ind/
sitreps/Indonesia%20earthquake%20info
2. Pan American Health Organization. Management of Dead Bodies in Disaster Situations. 2004. www.paho.org/English/dd/ped/ManejoCadaveres.htm
Links to further information
World Health Organization situation reports
http://www.who.int/hac/crises/idn/sitreps/en/index.html
WHO Regional Office for South-East Asia situation reports
http://www.searo.who.int/en/Section23/Section1108/
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