Clinical Updates
12 October 2005 Printable (PDF) version
South Asia Earthquake - Advice for relief workers and other travellers to affected regions
Just before 9am local time on 8 October 2005 an earthquake measuring 7.6 on the Richter scale struck northeast of Islamabad, Pakistan [1].
The areas most seriously affected are the following:
Pakistani-administered Kashmir: particularly Muzaffarabad, Bagh and Rawala Kot
Pakistan’s North West Frontier Province: particularly Manshera and Balakot
Indian-administered Kashmir: particularly Barramulla, Uri
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 possible hazards and increased risk of injury and illnesses.
The situation is evolving and subject to change. Further information will be posted as it becomes available.
Food and water advice
As a result of damage to water and sewage systems and the resulting lack of clean water supply, 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 be killed by these agents. In these cases combining iodine or chlorine treatment 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. This should 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), in the absence of contraindications. Individuals with diarrhoea that is associated with fever or passing blood should seek prompt medical evaluation. Personal hygiene, including frequent hand washing, is essential.
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. As rabies in resource-poor regions of the world is usually transmitted by the bite of an infected dog, avoidance of all dogs is necessary.
Travellers leaving at short notice are still recommended to seek appropriate vaccinations. Although full protection from vaccines may not be achieved prior to departure, a rising level of immunity will develop.
Travellers 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 a risk at altitudes below 2000m in India, Pakistan and Afghanistan. This includes the cities of Islamabad and Rawalpindi. 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.
Travellers are also 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.
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, trauma and exposure to the environment with the risk of hypothermia 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.
The British High Commission in Islamabad has set up a consular desk in Islamabad airport to provide immediate assistance to British nationals who may have travelled to Pakistan in response to the earthquake (0092 51 201 2000, Main Switchboard).
References
1. World Health Organization. Earthquake 08 October 2005 Pakistan, India, Afghanistan. Overview of events as of 8th October. Cited 10 October 2005. www.who.int/hac/crises/pak/sitreps/pakistan_earthquake_
2. Pan American Health Organization. Management of Dead Bodies in Disaster Situations. 2004. www.paho.org/English/dd/ped/ManejoCadaveres.htm
Links
World Health Organization: Health Action in Crises - South Asia Earthquake. www.who.int/hac/crises/international/pakistan_earthquake/en
Health Protection Agency: Earthquake in Kashmir.
http://www.hpa.org.uk/infections/topics_az/travel/current_items
Kashmir_earthquake/Kashmir_adv.htm
updated 14 October 2005
Disclaimer | Copyright | Privacy | Sitemap | Accessibility