Health effects of earthquake

General Health Precautions Following Earthquake
At this time, travelling to the affected areas listed above should expect that the risks of exposure to water-borne diseases such as traveller's diarrhea, typhoid, and cholera, and to food-borne diseases is increased at this time.
Intestinal infections caused by bacteria, parasites, or viruses transmitted from contaminated food or water can cause travellers diarrhea. Bacteria are the most common cause of gastrointestinal illness. The most common causes include Escherichia coli, Campylobacter jejuni, Salmonella species and Shigella species. Less common bacteria include the Aeromonas, Plesiomonas and Yersinia species and non-cholera vibrio species and rarely the Vibrio cholerae species.
Parasites that cause acute diarrhea in travellers include Giardia lamblia, Entamoeba histolytica and cryptosporidium among others. Norwalk virus (NV) and Norwalk-like viruses (NLV) are common causes of viral gastroenteritis with outbreaks generally occurring where people congregate in close quarters for extended periods.
There may also be an increased risk of insect-borne diseases such as malaria, dengue fever and japanese encephalitis in the post-flooding period. Dengue occurs in all countries affected by the earthquake and is found predominately in urban and surrounding areas. Except for the Maldives, Malaria is known to occur in the following either all regions or some regions within the affected countries of India, Sri Lanka, Indonesia, Thailand, Malaysia, Bangladesh, Burma (Myanmar), Mauritius, and Somalia.
Outbreaks of leptospirosis, a communicable disease acquired through contact with the urine of infected animals, may also occur. Contact may occur through swimming, accidental or occupational immersion, or through direct contact with urine or tissues of infected animals.
Recommendations
It is recommended travellers seek the advice of their personal physician or travel clinic prior to travel for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication and personal protective measures.
Travellers should ensure that their routine (childhood) immunizations - including diphtheria, whooping cough (pertussis), tetanus, polio, measles, mumps and rubella - are up to date. Vaccination against influenza should be considered for travellers at high risk for influenza complications and for those traveling to Thailand where human cases of avian influenza have occurred.
Immunizations to prevent typhoid and hepatitis A are recommended for travellers to areas affected by the earthquake as a result of the current poor sanitary conditions. The risk of acquiring cholera is very low if food and water precautions are observed. Cholera vaccines are available but they are not recommended for the prevention of cholera in the majority of travellers to endemic areas.
Preventing malaria in travellers includes personal protective measures to reduce the risk of mosquito bites, as well as the appropriate use of antimalarial medications.
Given the magnitude of this natural disaster and the anticipated potential adverse health affects, travellers should be especially diligent with food and water precautions. For regions with increased mosquito activity, insect precautions should be taken as well.
General Food and Water Precautions:
Eat only food that has been well-cooked and is still hot when served.
Drink only purified water that has been boiled or disinfected with chlorine or iodine, or commercially bottled water in sealed containers.
Avoid ice, unless it has been made with purified water.
Avoid uncooked foods. Fruit and vegetables that can be peeled are usually safe.
Wash hands before eating or drinking!!
IF U GET DIARRHOEA
Should you develop nausea, stomach cramps, diarrhea or vomiting during travel or after returning, you should seek medical attention if the symptoms persist longer than 48 hours, or if there is bloody diarrhea. Be sure to tell the physician where you were travelling and the foods/beverages that you consumed.
Most cases of traveller's diarrhea are self-limiting and clear up in a few days. Be sure to drink more fluids (bottled water or boiled water, or weak tea if still travelling) as soon as diarrhea starts. The antidiarrheal drug, Imodium (loperamide HCL), may be used BY ADULTS for short term relief of symptoms. It is not recommended for use in children under 12 years of age.
Use of antibiotics (such as ciprofloxacin, cotrimoxazole, doxycycline, or tetracycline) as a preventative measure is not recommended; however, they may be prescribed by a travel medicine clinic for use should diarrhea develop in a location where medical help is not available .
Personal Measures to Avoid Mosquitoes
Female Anopheles mosquitoes bite mainly during the evening and night. Using personal insect protective measures will reduce your risk of being bitten by these mosquitoes.
stay in well-screened or completely enclosed, air-conditioned accommodation;
sleep under insecticide-treated bed nets;
wear clothing that reduces the amount of exposed skin; wear long-sleeved shirts (tightly weaved material, sleeves down, buttoned/zipped up, tucked into pants) and long pants (tucked into socks or footwear); light-coloured clothing may be less attractive to some mosquitoes and make mosquitoes more noticeable;
use DEET-based products as repellents on exposed skin. The higher the concentration of DEET in the repellent formulation, the longer the duration of protection. However, this relation reaches a plateau at about 30% to 35%. DEET formulations that are "extended duration" (ED), such as polymers, are generally considered to provide longer protection times, and may be associated with less DEET absorption. Formulations over 30% are not currently available in Pakistan, although they are available internationally, including in the United States. Most repellents containing "natural" products are effective for shorter durations than DEET and for this reason are not considered the preferred products for protecting against mosquito bites.
For children, alternative personal protective measures, such as mosquito nets treated with insecticide, should be the first line of defense, especially for infants less than 6 months of age. Portable mosquito nets, including self-standing nets, placed over a car seat, a crib, playpen, or stroller help protect against mosquitoes. However, as a complement to the other methods of protection, the judicious use of DEET should be considered for children of any age. Recent medical literature suggests that DEET does not pose a significant or substantial extra risk to infants and children. DEET/sunscreen combination products are not generally recommended, because DEET can decrease the efficacy of sunscreens. As well, sunscreens should be used liberally and often while DEET should be used sparingly and only as often as required. If application of both is necessary, the Canadian Dermatology Association recommends that the sunscreen be applied first and allowed to penetrate the skin for 20 minutes, prior to applying DEET.
Prevention of leptospirosis is best achieved by avoiding contact with potentially contaminated water. Travellers who may be at high risk because of their activities at the site of the earthquake should discuss with a physician the appropriate preventative medication should this be a risk.
Travellers are reminded to practice heightened personal hygiene including good hand-washing practices. Using soap and hot water and lathering for at least 20 seconds is the single most important procedure for preventing infections. This is because disease-causing micro-organisms can frequently be found on the hands. Alternatively, travellers can use waterless, alcohol-based antiseptic hand rinses.
Travellers should also be aware of the increased potential for injury at sites affected by natural disasters. Debris, downed power lines, structural and electrical damage to buildings, gas leaks, and damage to infrastructure contain many hazards. The most common injury following disasters is cut feet. Travellers should wear protective clothing and sturdy shoes. Travellers who do become injured should seek prompt medical attention as injuries are prone to infection in such conditions.
Travellers are advised that health care services may be limited in affected areas due to disaster relief efforts. Hospitals and outpatient clinics may have been destroyed or severely damaged; facilities that are operational may be overwhelmed and medical supplies depleted. Evacuation for travellers requiring medical attention may be required. Travellers with pre-existing medical conditions should consult with their physicians as they may not be able to access medical care at this time.

Dr Abdul Aziz Awan