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| Sunday, 16 January 2005 |
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Compiled by Carol Aloysius Post tsunami concerns: Water borne infections by Dr. D.P. Atukorale Water - borne infections especially those involving the gastro - intestinal tract is a leading cause of death in developing countries such as Sri Lanka and India and are common after major floods.
A wide array of viral, bacterial and protozoal pathogens are responsible for water - borne infections. The common water - borne infections are: (a) Acute gastro - enteritis due to adenovirus and rotavirus infection which commonly affect children. (b) Hepatitis A and E. (c) Shigella infection (Shigellosis). (d) Salmonella infection (typhoid and paratyphoid). (e) Amoebiasis. Viral gastroenteritis Viral gastroenteritis is a major cause of illness and death particularly in developing countries and young children are mostly affected. Rotaviruses (mainly group A) is the major cause of diarrhoeal illness in young children. Other causes of viral gastroenteritis are enteric adenoviruses. The most important aspect of treatment is adequate fluid and electrolyte replacement, if possible by oral replacement using glucose electrolyte solutions such as Jeevani. Young coconut water (king coconut water) can also be used when there is a shortage of ORS. If the child is dehydrated and is unable to take oral replacement therapy (ORS) IV fluids should be used. Hepatitis A and E Children are usually affected and conditions of overcrowding and poor sanitation facilitate the spread of infection. Drinking water contaminated by faeces and urine of patients is important in the spread of infection. Hepatitis E is a very rare type of water-borne infection. The virus is excreted in the faeces and urine and the spread of infection is by faeco-oral route which occurs in places with poor sanitation. Patients with Hepatitis A and E develop chills, headache, malaise, loss of appetite and distate for smoking. After a few days,the patient develops nausea, vomiting and diarrhoea and right sided upper abdominal pain is common due to the enlargement of the liver. The patient develops jaundice and urine is dark in colour due to bile. Stools are pale. With bed rest, good nutritious diet, supplements of fruit juices and glucose, majority recover fully. Good protein intake should be encouraged. If vomiting is severe, intravenous fluids should be given. Drugs such as antibiotics should be avoided. Infection in the community should be prevented by improving social conditions especially overcrowding and poor sanitation. Shigella Infection This is an acute inflammation of the large intestine characterised by diarrhoea with blood and mucus in the stools. Two main types are bacillary dysentery (Shigellosis) and amoebic infection (amoebiasis). Bacillary Dysentery There are four main pathogenic groups and the majority of cases of bacillary dysentery are caused by Shigella sonnei. Bacillary dysentery occurs in epidemic form where there is a crowded population with poor sanitation and is a constant accompaniment of natural catastrophes such as tsunamis. Spreading occurs due to a contaminated food or by flies and by contact through unwashed hands after defaecation. Outbreaks occur in mental hospitals, school hostels and refugee camps. Bacillary dysentery due to Shigella flexneri causes severe diarrhoea with blood in stools. Shigella dysenteriae cuases severe diarrhoea with profuse blood. Patient complains of colicky abdominal pain and tenesmus. Patients develop fever, dehydration and weakness. Arthritis or iritis may occur. Treatment consists of oral rehydration therapy (ORS) with Jeevani and intravenous fluids may be necessary. Use of anti-diarrhoeal drugs such as Immodium should be avoided. Ciprofloxacin is given for dysteriae and flexneri strains. Salmonella Infections (Enteric fever) (Typhoid and Paratyphoid fever) This is a common infection that occurs where sanitation is primitive and is transmitted by faecal - oral route. These enteric fevers are caused by infection with Salmonella typhi and S. Paratyphi. Contamination of food, milk or water is usually responsible. After an incubation period of about 12 days, the patient develops fever, headache, muscle pains, slow pulse, constipation or diarrhoea and vomiting in the first week of illness. If not treated with antibiotics the patient gets complications such as delirium, intestinal bleeding with or without perforation, pneumonia, meningitis, encephalitis and osteomyelitis. Management Several antibiotics such as chloramphenicol, Ciprofloxacin, Amoxycilin and Cortrimoxazole are used. Cholera Cholera is a severe acute gastro-intestinal infection caused by vibrio cholera. The organism is passed in stools or vomit of patients with cholera. Transmission of infection is through infected drinking water. Severe diarrhoea occurs without pain or colic. The enormous loss of fluid and electrolytes leads to intense dehydration with severe muscular cramps. The skin becomes cold and clammy and eyes are sunken. The blood pressure falls and pulse becomes imperceptible and urine output drops and death from acute circulatory failure may occur in a few hours, unless, fluid and electrolytes are replaced. Improvement is rapid with proper treatment. The above clinical picture is the classical picture. There are milder cases during an epidemic. If not treated the mortality is very high and complications are hypoglycaemia (low blood sugar), fabrile convulsions, and risk of pulmonary oedema due to over-treatment. Tetracycline and Cortrimoxozole are the usual antibiotics. For prevention of infection, strict personal hygiene is necessary. Clean drinking water should be used and flies should not be allowed access to food and public education is very important during an epidemic. Mass vaccination with a single dose of vaccine and mass treatment with tetracycline are of value. Amoebiasis (Amoebic Dysentery): Amoebiasis is usually caused by Entamoeba histolytica, a pathologic intestinal amoeba that is spread between humans by its cysts. It is common in the tropics. Out of amoebae, only E. histolytica gives rise to amoebic dysentery or extra - intestinal amoebiasis e.g. amoebic liver abscess. Cysts of E. histolytica are ingested in water or uncooked food which has been contaminated by human faeces. The parasite may invade the mucous membrance of the large bowel and the lesion is maximum in the caecum. Intestinal amoebiasis (amobic dysentery) usually runs a chronic course with grumbling abdominal pains and two or more unformed stools per day. Periods of diarrhoea alternating with constipation are common. Mucus is usually passed sometimes with streaks of blood and stools often have a very offensive odour. There is tenderness over the colon. Sometimes there may be diarrhoea with blood and mucus simulating bacillary dysentery. Infection responds quickly to oral metronidazole which is usually given for five days. Other more expensive drugs such as tinidazole or Diloxanide furoate may be given. For prevention, personal precautions against contracting amoebiasis consist of not eating fresh uncooked vegetables drinking and unboiled drinking water. **** Food safety after floods Food safety is very important especially for people living in the flood stricken areas. Following are some guidelines on ensuring that the food you eat is safe. Do not eat any food that may have come into contact with flood water. Discard any food without a waterproof container if there is any chance that it has come into contact with flood water. Undamaged, commercially canned foods can be saved if you remove the can labels, thoroughly wash the cans, and then disinfect them with a solution consisting of one cup of bleach in 5 gallons of water. Re-label your cans, including expiration date, with a marker. Food containers with screw-caps, snap-lids, crimped caps (soda pop bottles), twist caps, flip tops, and home canned foods should be discarded if they have come into contact with flood water because they cannot be disinfected. For infants, use only pre-prepared canned baby formula that requires no added water, rather than powdered formulas prepared with treated water. Frozen and refrigerated foods If your refrigerator or freezer is without power for a long period: Divide your frozen foods among friends, freezers if they have electricity. Seek freezer space in a store, church, school, or commercial freezer that has electrical service, or Use dry ice - 25 pounds of dry ice will keep a 10-cubic-foot freezer below freezing for 3-4 days. (Exercise care when handling dry ice, because it freezes everything it touches. Wear dry, heavy gloves to avoid injury). Thawed food can usually be eaten or refrozen if it is still refrigerator cold, or if it still contains ice crystals. To be safe, remember, "When in doubt, throw it out," Discard any food that has been at room temperature for two hours or more, and any food that has an unusual odour, colour, or textures. Your refrigerator will keep foods cool for about four hours without power if it is unopened. Add block or dry ice to your refrigerator if the electricity will be off longer than four hours. Center for Disaster Control (CDC) ################# Dealing with animals and mosquitoes Recent newspapers have highlighted a new problem following the tsunami: the presence of hundreds of dogs which in search of food have begun attacking human beings in the tsunami ravaged areas. The following article discusses how to deal with both roaming dogs and mosquitoes that have multiplied in such areas. Many wild animals have been forced from their natural habitats by the ravages of the tsunami and many domestic animals are also without homes. Take care of yourself to avoid these animals, because they may carry rabies. Remember most animals are disoriented and displaced, too. Do not corner an animal. If an animal must be removed, contact your local animal control authorities. Your local and state health department can provide information about the types of wild animals that carry rabies in your area. Rats may be a problem during and after a disaster such as this. Take care to secure all food supplies, and remove any animal carcasses in the vicinity by contacting 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. Frequently asked questions Q: Are there any special health risks I need to be aware of when disposing of dead animals after a natural disaster? The risk to humans from animal carcasses is low if proper precautions are taken. * Practise proper hand washing to prevent infection with certain pathogens that may be transmitted from farm animals, including Salmonella and E. coli. * Secure all food sources and remove any animal carcasses to avoid attracting rats. * Wear insect repellant when outdoors. Flooding may lead to more mosquitoes, which can carry disease. * Be on the alert for snakes that may be hiding in unusual places after flooding. If you are bitten, try to identify the snake so that if it is poisonous, you can be given the correct antivenom. Do not cut the wound or attempt to suck the venom out. Contact your local emergency department for further care. People working to clean up areas containing swine or poultry carcasses should take the following precautions: * Wear protective clothing, including waterproof gloves, waterproof boots, and protective eye-wear (cover any open wounds). * Use duct tape to seal tops of gloves and boots to prevent water seepage. * Wear respiratory protection . * If you smell hydrogen sulphide (a rotten egg smell), get out of the building and call the health authorities. * Clean and disinfect all clothing and boots after handling carcass-contaminated materials. * Wash work clothes separately from street clothes. * Wash hands thoroughly before placing fingers in mouth (nail biting, etc.) * Shower and wash hair thoroughly after handling carcass-contaminated materials. Q: How do I dispose of the remains of a dead animal in my property? A: 1. Wear gloves. 2. Cover your gloved hand with a plastic trash bag, pick up the remains, then invert the trash bag over the remains and seal the bag. 3. For larger animals, use a shovel to place remains inside a plastic trash bag, then rinse off the shovel with water. 4. Call your local animal care and control agency for further instructions and to request pickup. 5. Wash your hands, with soap and disinfectant. Mosquitoes The large amount of pooled water remaining after the flood will lead to an increase in mosquito population. Mosquitoes are most active at sunrise and sunset. To protect yourself from mosquitoes, use screens on dwellings, and wear long-sleeved and long-legged clothing. Insect repellents containing DEET are very effective. Be sure to read all instructions before using DEET. Care must be taken when using DEET on small children. Products containing DEET are available from retail outlets and through local and state health departments. To control mosquito populations, drain all standing water left in containers around your home. From the Department of Health and Human Services (CDC) |
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The greatest impact is seen in infants and children. Young children and
the elderly are at greatest risk especially in temporary relief camps
because of poor sanitation and inadequate water supplies and lack of
sufficient drinking water.
