Fearing a Second Wave of Devastation Post-Tsunami

Jan. 27, 2004 — -- In the tense days following the Asian tsunami, as the death toll climbed into the tens of thousands, health experts feared the disaster could spawn a second wave of deaths from disease.

"Unless the necessary funds are urgently mobilized and coordinated in the field we could see as many fatalities from diseases as we have seen from the actual disaster itself," Dr. David Nabarro, head of crisis operations at the World Health Organization, told The Associated Press.

But one month later, with just a handful of disease cases coming from the region, it appears that statements like Nabarro's may have helped to mobilize the health efforts that successfully prevented massive outbreaks of diseases such as cholera and typhoid.

"People had a high level of awareness," said Dr. Stephen S. Morse, epidemiologist and director of the Center for Public Health Preparedness at the Mailman School of Public Health at Columbia University in New York.

"That awareness and that mobilization is very important," said Morse. "It paid off, then, with people acting rapidly and doing immunization to prevent that spread [of disease]. Some of it is good prevention, some of it is good luck."

Generosity Saved Lives

A number of factors contributed to the relatively low incidence of disease seen following the tsunami, including the generosity of donor nations and individuals worldwide.

"It's the result of an enormous international effort," said Dr. Robert Edelman, professor of medicine and associate director for clinical research at the University of Maryland's Center for Vaccine Development. "We've been lucky, we've been proactive, and the outpouring of international aid has been tremendous."

Edelman also credits the fact that many residents of the areas affected by the tsunami did not collect in densely populated refugee camps, where the spread of disease likely would have been rapid.

"People were kept in isolated villages -- that reduced the overall impact," he said.

Dr. Martin J. Blaser, chairman of the Department of Medicine at New York University School of Medicine and president-elect of the Infectious Diseases Society of America, believes the spread of disease was thwarted by the stable health systems in many areas affected by the tsunami.

"The most important factor is that these communities were previously healthy," said Blaser, adding that if cholera had been a problem before the tsunami, many more cases would be seen now.

Risk of Epidemics Remains High

But as Columbia's Morse warned, "We're not out of the woods yet."

The rainy season is just beginning in many of the countries affected by the tsunami, bringing with it pools of standing water that are ideal breeding grounds for the mosquitoes that spread malaria and dengue fever.

"It's still not prime breeding season for these diseases," said Edelman. "At that time, there's going to have to be a massive effort to spray for mosquitoes."

Indonesia has already started a comprehensive program to recognize and treat malaria in the event of an outbreak, Dr. Tony Stewart, medical epidemiologist with the Center for International Health, said in a written statement to the International Society for Infectious Diseases.

Cases of measles, a communicable disease, and tetanus caused by infected injuries have been reported from communities throughout the area. Stewart said a measles immunization program was under way, and that the number of new tetanus cases was on decline. Just about all the tetanus cases, he said, "seem to be the result of injuries sustained on the day of the tsunami."

'In This for the Long Haul'

As the world's attention shifts elsewhere, many experts worry that support for the region will fade. "Some of the consequences of falling out of the media spotlight are some resources will no longer be available," said Morse.

Immunizations against diseases like measles and tetanus must continue, he said, adding that many of the region's needs remain unmet.

Mental health needs following the disaster, which took more than 280,000 lives, will continue to present challenges, experts said. In order to provide safe drinking and proper sanitation, much of the region's infrastructure will have to be rebuilt, a task that will not end any time soon.

"We have to remain vigilant and continue to upgrade the public health infrastructure," said Edelman. "The important thing to remember is that it's going to be years before these people are put into solid houses. We're in this for the long haul."