REPORT ON THE EPIDEMIOLOGICAL SITUATION
IN CENTRAL AMERICA
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INFORMATION REGARDING THE HEALTH SITUATION FOLLOWING HURRICANE MITCH: 18
November 1998
I. EFFECTS ON MORBIDITY AND MORTALITY
The following is a description of the health situation in Central America after Hurricane Mitch.
A. NICARAGUA:The areas most damaged by Hurricane Mitch in Nicaragua are the pacific coast and the northern part of the country. To date, 2,447 have been confirmeddead, 885 have disappeared and more than 55,000 are displaced from their homes. The major damages are concentrated on the infrastructure of roadways, sanitation, water supply, and agricultural production.
From the health point of view, the following chart presents a summary of the most recent reports of disease, prepared by the SILAIS (local healthsystems) of the affected zones:
Analysis of the daily morbidity rate in the affected areas according to SILAIS (week 45)
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Dates
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8-11-98
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9-11-98
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10-11-98
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11-11-98
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| Cholera | Estelí (6) Matagalpa (6) |
Matagalpa (4) | Matagalpa (4) | |
| Malaria | Nueva Segovia (11) | Nueva Segovia (11) Matagalpa (7) |
Esteli (13) | León (9) Matagalpa (8) |
| Dengue | Estelí (21) | Boaco (19) León (8) |
León (26) Managua (26) Rivas (4) |
León (11) Boaco (() Rivas (10) |
| Dengue | Estelí (21) | Boaco (19) León (8) |
León (26) Managua (26) Rivas (4) |
León (11) Boaco (() Rivas (10) |
| Febrile symptoms | RAAS(46) Matagalpa (117) |
RAAN (284) RAAS (55) |
RAAN (43) | |
| Hemorrhagic Conjunctivitis | Chiandega (25) | Chinandega (17) |
Source: MINSA Epidemiological Surveillance, 11-11-98
This information is based on the monitoring of 90% of the cities in the country that have maintained daily communication through the epidemiological surveillance system.
The report on suspected cases of cholera in Matalgalpa and Estelí reflect high water contamination in all of the affected SILAIS and limitations of chlorine distribution. In accessible areas, the suspected cases of cholera have been managed in a timely fashion by health personnel. Although there is a risk of an epidemic outbreak, this situation has been controlled up to the present. Cases of dengue reported from León, Boaco, and Rivas show an occurrence similar to that seen during the year, however it is probable that the underreporting of cases occurs in the affected zones. On 13 November 1998, Minsa reported that from 16 suspected cases of leptospirosis, 8 have been hospitalized, 5 have died, and 3 have been confirmed by the laboratory. These cases occurred in Chinandega, in the community of El Viejo. The samples were confirmed in the National Diagnostics and Referral Center of Minsa. Besides these occurrences, one suspected case has been reported in Matagalpa, one in Managua and another in Estelí. Of the 8 SILAIS having the greatest problems, communication has been reestablished by road in 5 areas. The 3 remaining areas (Nueva Segovia, Madriz y RAAN) are connected only by air, thus limiting the quantity of supplies of drugs, food and fuel that can be transported there.Even with this, there are still many isolated communities in all of the affected departments.
B. HONDURAS:
Honduras has been very affected by Hurricane Mitch: the loss of human life, infrastructure and agriculture continue to rise. The estimations of those dead and those in the at-risk population has been surpassed as health teams reach previously isolated zones. Currently, 7,000 people have been confirmed dead, 12,000 have disappeared, approximately 500,000 people are in shelters. There are 29,398 damaged homes, 144,121 destroyed homes, 113 damaged bridges, 8 hospitals with facility damage, and around 46 destroyed or isolated health centers.
From the epidemiological point of view, as reported by the Transmittable Diseases Surveillance System, as of week 42 there exists a slight increase in the number of cases of diarrhea, with a total of 2,730 cases. The major proportion of diarrhea victims is those ages 0 to 3 years, corresponding to the Capital of the country and the Atlantic coast, where the damages to the sanitary infrastructure have been greatest.
Comparing the data from week 42 with the occurrences in the same weeks of previous years, there persists the outbreak of rubella that has been present since before the hurricane. They have also been notified of 2 cases of hemorrhagic Dengue. From 223 damaged health facilities, 63 are still not functioning, however, the population is being attended to in shelters and in the rehabilitated facilities.
The population in shelters has not been stable. In the first 24 hours after Mitch it was estimated that around 800,000 people were occupying various shelters in the country. The figures from November 13 indicate that approximately more than 500,000 people have remained in the 938 shelters. With the base of the actions that have been developed in Honduras and the strengthening of the epidemiological surveillance system, the principle diseases that have been detected up until November 12 are displayed in the following chart in order of frequency:
HONDURAS NATIONAL CONSOLIDATION OF DISEASES FROM OBLIGATORY
NOTIFICATION IN THE EMERGENCY UPDATED THROUGH 13 NOVEMBER 1998
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DISEASES
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FREQUENCY
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Total
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Percentage
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| Acute respiratory infections | 32, 184 | 33.9 |
| Dermatological infections | 19.424 | 20.4 |
| Acute diarrheal sickness | 12,871 | 13.5 |
| Conjunctivitis | 4,704 | 4.9 |
| Pneumonia/Bronchitis | 2,402 | 2.5 |
| Malaria | 895 | 0.9 |
| Dengue fever | 589 | 0.6 |
| Dog bites | 36 | 0.04 |
| Snake bites | 18 | 0.02 |
| OTHERS | 21,956 | 23.1 |
| TOTAL | 87,775 | 100% |
* Including 3 suspected cases of cholera. A laboratory has not confirmed these
nor have epidemiological confirmation, since no samples were taken.
No other cases were reported, however, all measures to control outbreaks are
being implemented.
On 16 November 1998, an alert was received regarding pesticide contamination in the River Choluteca. PAHO experts, who found 16 barrels of, amongst others, pesticides Tolueno and Endosulfano, confirmed the alert; the latter is prohibited for importation. The affected community has approximately 3,100 habitants dispersed in 440 dwellings. One of the barrels was found in a well that supplies the community with its water. This well has since been closed and information was offered to the community regarding the risks and how to people should avoid travel in zones where the pesticide spilling occurred.
C. GUATEMALA
Among the effects caused by this natural phenomenon, the losses are indicated at 263 people dead, 121 missing, 6 wounded, and more than 75,000 evacuated; 21,000 homes destroyed or damaged and 8 bridges have been destroyed.
According to reports from the 27 health districts, until 9 November the main diseases of obligatorily reports were the following: acute respiratory infection, diarrhea and pneumonia. In 67% of these health districts there have been suspected cases of cholera, with 59% of these cases confirmed. In 78% of these districts, animal bites that are potential transmitters of rabies have been reported; in 56% of the districts, they have clinically diagnosed cases of hepatitis and malaria; in 44% of the districts, classic Dengue fever has been reported.Cholera has been reported prior to the disasters in all of the health districts, with the exception of San Marcos. Below, some considerations in relation to this disease are described:
- Cholera has been epidemiologically active in Guatemala in the weeks prior to the passage of Hurricane Mitch.
- The sanitary conditions and the environment created by Mitch can increase the risk of cholera in the population.
- The reported number of cholera cases at the national level during the period
of 4 to 13 November ("post-Mitch") is less than the reported number
the week prior to the disaster. The number corresponds with the weekly reported
average during the year in progress.
The available information suggests that the actual situation does not correspond to a cholera outbreak on the national level that could be attributed to the hurricane; however, in the upcoming days this situation will be analyzed with greater detail, in search of:
- the spatial (geographical) distribution of cases of cholera post-Mitch and
the presence of cholera cases in shelters
Revision of case-fatality rate in the post-Mitch period:
- In the majority of cases and reported deaths, at least two commonly known
sources in cholera outbreaks may be effectively identified: the viewing ceremonies
of the dead and social gatherings.
These situations suggest similarity with that which was observed during the 1991 spread of cholera in the Amazon jungle in Perú: the sum of innumerable and very small outbreaks (well located) that went unattended in the first months then finally reached a regional rate that mobilized needed emergency action.
For the early detection of outbreaks, it is suggested to:
- strengthen local active epidemiological surveillance with the active search of cholera cases in the affected populations, and analyze the epidemiological information on the most desegregate levels (local places, municipalities, etc.);
- implement well-placed campaigns of social communication (e.g. displaced populations, native communities, shelters, etc.) that have demonstrated being most useful in both the prevention and early detection of cholera cases in the community
- guarantee the immediate availability of local resources for rehydration
(within the home, community and hospital) for a reduction in the epidemic's
impact.
D. EL SALVADOR
The indirect effects of Hurricane Mitch on this country are located in the pacific coastal zone where the main damage reported being 240 people dead, 235 disappeared, 1,500 isolated, and around 27,000 persons affected.
E. COSTA RICA
This country has been indirectly influenced by Hurricane Mitch. According to national reports as of 1 November, 1687 people were temporarily lodged in 38 shelters, 4 were dead, 10 wounded, and 4 had disappeared. Also, there were 36 damaged bridges, 9 damaged water supply systems, 740 affected homes, and 30 overflowing hydrographic watersheds. The zone most affected was the pacific coast. On 9 November, a state of alert was released and the following instructions were provided for emergency committees, institutions, personnel of the National Commission of Emergency, and the general public: prepare reports relating the main effects, prepare detailed reports on the damages that occurred, evaluate the response actions that were completed, maintain the surveillance of the behavior of rivers and the zones affected by landslides for the remaining rainy period.
F. BELIZE
Of the 60,000 evacuated persons from Belmopan, 50% of those were placed in official shelters. Some cases of diarrhea and conjunctivitis have been reported; the main problem that has been detected is waste disposal. In the affected areas drugs and food were distributed. By 2 November, the situation was under control.
GENERAL COMMENTS
Of the reports being received, the diseases are characteristic of a difficult sanitation environment and difficult hygienic conditions in shelters that are overcrowded for a prolonged period of time. These diseases are subjects of permanent epidemiological surveillance and case control; tactics of sanitation and vector control are overemphasized in order to eliminate the risk of epidemic outbreak that could exceed the actual capacity of the health services.
II. EFFECTS ON THE HEALTH INFRASTRUCTURE
The effects on health infrastructure were of larger magnitude in Honduras, where 8 hospitals were reported as having great structural damage and 48 other health facilities are also damaged.
III. HEALTH PRIORITIES OF THE AFFECTED COUNTRIES
Within the affected countries whose health systems have been evaluated, there have been emergency priorities released. The countries are now focusing their efforts on these priorities, which may be summarized in the following aspects:
a) Environmental sanitation:
- provision of safe water
- provision of latrines
- basic hygiene tactics in shelters
- safe handling of food
b) Provision of essential drugs attained through the national health system.
c) Epidemiological surveillance and control of epidemic outbreaks, especially in cases of leptospirosis in Nicaragua and cholera in Guatemala.
d) Programs on vector and rodent control
e) Rehabilitation of health infrastructure
IV. INTERNATIONAL APPEAL
PAHO/WHO issued two appeals (see annex).
To date, PAHO has made an appeal for the sum of US$1,455,000.
The PAHO/WHO combined appeal was for a sum of US$11,342,000.
To date, PAHO has directly received the following funds:
Canada: Can$ 500,000.00
USA/OFDA US$2,000,000.00
Sweden US$500,000.00
Holland US$ 25,000.00
PAHO Funds US$ 350,000.00, cash to Honduras and Nicaragua
Approximately US$160,000.00 for mobilization costs of 60 experts sent to all of the countries in the fields of environmental health, vector control, epidemiology and disease control, supply management, nutrition, assessment of health services, food management, vaccination and other fields.
V. REHABILITATION AND RECONSTRUCTION PROGRAMS
Nicaragua and Honduras have identified the following initial projects:
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VI. Coordination on the National and International Level
Prior to the impact of Hurricane Mitch, PAHO/WHO coordinated its work with Ministries of Health by sending experts in health administration in cases of disaster to Honduras and Nicaragua. Because of this, the first evaluations of the impact on health were made just a few hours following the disaster. PAHO was able to rapidly make its first appeal and respond to the detected necessities with the health authorities. This evaluation was shared with the agencies of the United Nations and the Inter American System, and was also given to the UNDAC teams, which arrived in the days following the disaster.
Currently, PAHO experts, in cooperation with PNUD and the Inter American Development Bank in Honduras and CEPAL, PNUD and PAHO in Nicaragua, are developing missions to evaluate the needs of the health infrastructure and services. The mission will use these results to prepare specific medium-to-long-term projects addressing rehabilitation and reconstruction. In this sense, it is justifiable to alert the international community about the portfolios of projects that will be prepared, besides those projects previously explained and the annexed copy.
Finally, PAHO, together with the countries, is reprogramming the regular cooperation funds to focus on the emergency's needs. It is also negotiating the reprogrammation of extrabudgetary funds to respond to the emergency projects.