Download IV. Risk assessment of main infectious diseases

Preliminary Report on Communicable Diseases Risk
Assessment and Interventions after Sichuan Earthquake
Contents
I. Background .................................................................................................................................. 2
II. Historical overview on communicable diseases in Sichuan province and the severely
affected areas. .................................................................................................................................. 4
1. Historical overview on communicable diseases in Sichuan province ................................... 4
2. Historical overview on communicable diseases in 21 severely affected counties ................ 5
III. Risk factors for increased communicable disease burden .................................................... 5
IV. Risk assessment of main communicable diseases ................................................................... 6
1.
Waterborne and food-borne diseases................................................................................. 6
2.
Respiratory and close contact transmitted diseases ........................................................... 7
3.
Vector-borne and zoonotic diseases ................................................................................ 10
4.
Risks of other diseases .................................................................................................... 13
V. Post-earthquake disease surveillance and control ................................................................... 6
1.
Strengthen the protection of water source and drinking water safety ............................. 15
2.
Maintain adequate food supply and food safety .............................................................. 15
3.
Shelter planning and assessment ..................................................................................... 15
4.
Strengthen the monitoring and control of vectors ........................................................... 16
5.
Strengthen health education ............................................................................................ 16
6.
Strengthen disease surveillance and outbreak control ..................................................... 16
7.
Resume the basic public health service ........................................................................... 17
8.
Strengthen case management .......................................................................................... 18
At 14:28 on 12 May 2008, a magnitude 8.0 (Richter scale) earthquake struck
Sichuan province of China, causing heavy casualties, serious collapse of buildings,
destruction of roads and tremendous economic losses. This report is to provide
guidance for taking more effective actions to prevent and control communicable
diseases after the earthquake through analyzing the risk factors related to infectious
disease outbreak in earthquake-affected areas in Sichuan province.
I. Background
The epicenter was located in the county of Wenchuan in the Ngawa Prefecture,
and the worst affected areas are central and northern Sichuan (Ngawa, Mianyang,
Deyang, Chengdu, Guangyuan and Ya'an Perfecture), some areas in Gansu and
Shaanxi were also affected. As of 12:00 on 2 Jun 2008, 69,019 people were reported
dead, 373,573 people were reported injured and 18,627.were reported missing.
Additionally, over 84,000 injured people have been hospitalized after the quake.
Among them, around 54,000 have been discharged from hospitals, 16,000 still remain
in hospitals and over 6,000 were transferred to other parts of China for treatment. An
estimated 5 million buildings have collapsed, and more than 21 million buildings were
damaged in the earthquake-affected areas. The earthquake destroyed over 25 million
homes and has resulted in about 15 million people internally displaced, with the total
affected population of 45.61 million (see the figure below for the severely affected
areas in Sichuan province).
The earthquake has caused heavy casualties of people and live stock, leaving the basic
health facilities and the ecological environment seriously damaged in Sichuan, one of
the most populous provinces in China. The roads and railways in the disaster areas
were destroyed; the water and power supply in the severely affected areas were
interrupted; the systems of public health, medical care and health inspection were
severely affected with many hospitals, clinics and pubic health facilities being damaged
seriously. The maintenance of water and food safety, environment hygiene, basic
health service and infectious disease control are all facing serious challenges.
2
China CDC, May-2008
The overview of
Wenchuan earthquake：
Deaths
Deaths in
in Sichuan
Sichuan Province
Province
Main Areas Affected by Wenchuan Earthquake, Sichuan Province
5,000 至 16,000
(4)
1,000 至 5,000
(5)
100 至 1,000
(3)
0至
100 (172)
Songpan
Songpan
Time: May 12 2008
Magnitude: 8
Epicenter:Wenchuan County
Abaqiangzu
Abaqiangzu
Qingchuan
Qingchuan
Pingwu
Pingwu
Heishui
Heishui
Guangyuan
Guangyuan
Mianyang
Mianyang
Maerkang
Maerkang
Beichuan
Beichuan
Jianyou
Jianyou
Jiange
Jiange
Maoxian
Maoxian
Anxian
Anxian
Lixian
Lixian
Total casualties in the whole country (as
of June 2)

Total deaths: 69019
Xiaojinxian
Xiaojinxian

Total injured: 373573

Number of people missing: 18627

People hospitalized:84810

People discharged: 54374

Number
of
builds
damaged:
Ganzizangzuzizhizhou
Ganzizangzuzizhizhou
21,000,000

People displaced: 15,006,314

Accumulated population affected:
45,612,765
Deaths and Injured in Affected
Mianzhu
Mianzhu
Shifang
Shifang
Wenchuan
Wenchuan
Pengzhou
Pengzhou
Provinces
Deyang
Deyang
Dujiangyan
Dujiangyan
Pixian
Pixian
Chongzhou
Chongzhou
Dayixian
Dayixian
Baoxing
Baoxing
Lushan
Lushan
Chengdu
Chengdu
Yaan
Yaan
Ziyang
Ziyang
China CDC, June 3, 2008
China CDC, June 3, 2008
Province
Deaths
Injured
Sichuan
68467
354045
Gansu
365
N/A
Shanxi
122
2984
Chongqing
18
N/A
Suining
Suining
Henan
2
7
Yunnan
1
51
Hubei
1
14
Guizhou
1
15
Hunan
1
N/A
Meishan
Meishan
3
China CDC, May-2008
After the quake, the infectious diseases prevention and control was already given
the top priority by the Ministry of Health, at the same time efforts were centered on
treating the injured victims in the affected areas. The Ministry of Health has
transferred over 5000 public health workers and health inspection professionals from
30 provinces (autonomous regions, municipalities) to the disaster areas in Sichuan.
Currently the public health actions including maintaining the drinking water safety,
environment hygiene, disinfection and disinfestation have been taken. The public
health assessment in the internally displaced people have begun, the infectious disease
and public health emergency reporting and the syndromic surveillance information
cell phone reporting system have been established, the various preventive measures
are being implemented and the health inspection, disease control and medical care
systems are being recovered. The responsibilities has been assigned to individual
persons so as to achieve the full coverage of the infectious disease prevention and
control in all severely affected areas.
II. Historical overview on communicable diseases in Sichuan province and the
severely affected areas
1. Historical overview on communicable diseases in Sichuan province
In the past 10 years the incidence of class A and B infectious diseases in Sichuan
province have been higher than the national average level, but the overall situation has
been stable. From 2004 to 2007, the annually reported cases of class A, B and C
infectious diseases were between 340,000 and 360,000 with incidence slightly higher
than the national average level. The main diarrhea and food-borne infectious diseases
in Sichuan province are cholera, hepatitis A, hepatitis E, bacillary dysentery and other
infectious diarrhoeal diseases, of which other infectious diarrhea diseases and
bacillary dysentery had comparatively higher incidence; the main respiratory
infectious diseases are pulmonary TB, measles, pertussis, scarlet fever, mumps,
rubella and chicken pox, among which the incidence of TB, mumps and measles was
relatively higher. The main vector-borne diseases are Japanese encephalitis, malaria,
typhus, kala-azar, tsutsugamushi disease and forest encephalitis; main zoonotic
diseases are hemorrhagic fever with renal syndrome, rabies, brucellosis, leptospirosis,
schistosomiasis, echinococcosis, hepatic fascioliasis and streptococcus suis. The most
frequently reported blood born diseases and STDs were AIDS, hepatitis B, hepatitis C,
gonorrhea and syphilis with hepatitis B having higher incidence; other diseases are
those transmitted through respiratory tract, faecal-oral route or close contacts such as
acute hemorrhagic conjunctivitis and hand foot and mouth disease. The main reported
EPI targeted diseases are TB, hepatitis A, hepatitis B, measles, mumps, rubella,
Japanese encephalitis and meningococcal meningitis, of which the incidence of
measles is higher than national average level. No case reported diseases are plague,
SARS, poliomyelitis and diphtheria.
The time distribution for class A and B infectious diseases by different
transmission routes from 2004 to 2007 indicated that the diarrhea and food borne
diseases, zoonotic and vector-borne diseases are going to increase in the summer and
autumn season, while the respiratory infectious diseases are going to decrease, and the
blood borne diseases and STDs are not obviously affected by seasonality. From
4
January to April 2008, there were a total of 96,223 cases of class A, B and C
infectious diseases totally reported in Sichuan, among which 34,441 cases were
tuberculosis and 29,642 were hepatitis (hepatitis B: 25,387 cases, hepatitis A: 1,796
cases), accounting for 66.60% of the total reported cases. In addition, other diseases
with big incidence number are: mumps (7,038 cases), chicken pox (6,135 cases),
bacillary dysentery (4,328 cases), measles (2,351 cases) and rubella (1569 cases).
2. Infectious disease situation in the 21 severely affected counties
In recent years, the incidences of infectious diseases in the 21 seriously affected
counties have been kept at a stable level. The most frequently reported infectious
diseases were still hepatitis B and TB. In addition, the food-borne and diarrhoeal
diseases such as bacillary dysentery, hepatitis A and other infectious diarrhoeal
diseases were also common. Outbreaks of bacillary dysentery and hepatitis A were
reported previously in some counties, and typhoid cases were also reported in
individual counties. Amongst the respiratory infectious diseases, measles, mumps and
chicken pox are most common, particularly measles. Sporadic cases of zoonotic
diseases such as hemorrhagic fever with renal syndrome, rabies, brucellosis,
leptospirosis, schistosomiasis and echinococcosis and vector-borne diseases such as
Japanese encephalitis, malaria and kala-azar had also been reported. In recent years
during summer and autumn, food-borne diseases and diarrhea such as bacillary
dysentery and hepatitis A and respiratory infectious diseases such as measles, chicken
pox and mumps were very common in most of the counties; outbreaks of above
diseases were also reported in some counties before. Although there were cases of
zoonotic diseases such as leptospirosis, schistosomiasis and echinococcosis and
vector-borne diseases such as Japanese encephalitis, malaria and kala-azar reported
before, but no outbreak reported.
III. Risk factors for increased communicable disease burden
1. Interruption of access to safe water and sanitation facilities. The disaster
has damaged the drinking water supply system and the sanitation facility on a large
scale, which can disable disaster victims from access the safe water and food and will
increase the risk of waterborne and food borne diseases outbreak such as infectious
diarrhoeal diseases, bacillary dysentery, typhoid and hepatitis A.
2. Population displacement with overcrowding. After the original housing were
destroyed, a large number of population will be internally displaced in shelters and
relief centers where can be very crowded so as to increase the close contact among the
population. The populations are at immediate and high risk from the transmission of
respiratory infectious diseases and overcrowding related diseases such as measles,
acute infectious respiratory diseases, TB, meningitis and acute hemorrhagic
conjunctivitis.
3. Increased exposure to disease vectors. The earthquake can cause big changes
to the habitats for animals and vectors. The rescuing and relief activities and
displacement of populations can result in increased exposure to disease carrying
vectors and animals, increasing the risk of mosquito-borne, rodent-borne and
tick-borne diseases such as malaria, Japanese encephalitis, plague, leptospirosis, lyme
disease and some tick borne rickettsia.
5
4. The increased population movements. The movement of disaster victims
and rescuers will also raise the risk of disease transmission; even bring new pathogens
into the affected areas, increasing the risk of disease outbreak and transmission.
5. The increased susceptibility to disease. After the disaster, due to the
difficulty of food supply and changes of living habits, the affected population
particularly the infants and children, pregnant women and the elderly will be more
vulnerable to malnutrition. Malnutrition with the combination of physical and
psychological impacts compromises natural immunity, leading to more frequent,
severe and prolonged episodes of infections, in particular the infection of conditioned
pathogens or acute attacks by chronic infections. Under such circumstances, patients
with serious conditions are more difficult to treat, meanwhile, severe malnutrition
often masks symptoms and signs of communicable diseases, making prompt clinical
diagnosis and early treatment even more difficult.
6. Poor access to health services. The earthquake severely destroyed or
overwhelmed the health infrastructure and medical service system, which hampers the
disaster victims to access the health services timely, although the government has
provided a large quantity of health resources for the affected areas. At the same time,
national immunization program and other infectious diseases control program such as
the free treatment for TB patients will also be affected even disrupted, contributing an
increased burden of infectious diseases.
IV. Risk assessment of main infectious diseases
1. Waterborne and food-borne diseases
The common waterborne and food-borne diseases are cholera, hepatitis A,
typhoid/paratyphoid fever, bacillary dysentery and other infectious diarrhoeal diseases.
According to historical records, there are reports about the infectious diarrhoeal
diseases caused by Salmonella and norovirus occurring after disasters in some
countries. For example, after the 2005 earthquake in Muzaffarabad, Pakistan, acute
watery diarrhoeal disease broke out in a refugee camp accommodating 1800 people,
of which 750 people were infected. In 1976 after the Tangshan earthquake in China,
there was an epidemic of bacillary dysentery.
(1) The cases reported
Cholera is a type A infectious disease as specified by the Law on Prevention and
Control of Communicable Diseases of PRC and the International Health Regulations
on quarantine infectious diseases. The disease is characterized by acute attacks, fast
transmission and severe symptoms. It may lead to death by serious dehydration,
circulatory failure and muscle spasm if not treated promptly. From 2004 to 2007,
Sichuan reported a total of 38 cholera cases; while in severely affected disaster areas,
12 were from Anxian County (6 cases in 2005, 6 in 2006), 10 from Wenjiang County
(2004) and 1 from Chongzhou City (2005).
Hepatitis A is a kind of acute infectious disease which is transmissible through
the fecal-oral route that may severely damage the liver. Contaminated food, water or
close contact are common methods of transmission. From 2004 to 2007, In Sichuan
province, there were 10,146 reported cases in 2004 and 7261 cases in 2007, showing a
downward trend year by year. From 2004 to 2007, Sichuan reported 15 hepatitis A
outbreaks, none of which occurred in the 21 most seriously affected areas. From the
6
1st to the 18th week of 2008, the number of reported cases of hepatitis A was lower
than that during the same period of 2007. However, the Ngawa prefecture had an
increased incidence in the 12th week, and Maoxian County reported a small scale
outbreak.
The typical clinical symptom of typhoid/paratyphoid fever is persistent high
fever, roseola, comparatively slower pulse, enlargement of liver and spleen and
malaise. Young adults and school children are easily infected. From 2004 to 2007, the
province reported a total of 4,029 cases with annual cases ranging between 325 and
1254, showing a downward trend and making Sichuan one of the provinces with the
lowest incidence of typhoid/paratyphoid fever. From 2004 to 2007 the 21 seriously
affected areas reported a total of 5 typhoid fever and 11 paratyphoid fever cases, all of
which occurred sporadically. From January to April 2008, Lushan County reported 1
typhoid fever case.
Bacillary dysentery is a common and frequently occurring disease. From 2004 to
2007, the annual reported cases of bacillary dysentery in Sichuan were between
23,033 and 32,070, ranking in the top 3 provinces for the highest number of cases in
the country. There were 38 outbreaks reported, 6 of which occurred in the 21 severely
affected areas, and of which 3 were waterborne and other 3 were food-borne.
Other infectious diarrhoeal diseases ( i.e. the infectious diarrhoeal diseases other
than cholera, dysentery and typhoid/paratyphoid fever) are enteritis which are mainly
caused by Salmonella, Escherichia coli, Vibrio, Campylobacter jejuni, Yersinia
enterocolitis, Rotavirus, and Norovirus, etc. From 2004 to 2007, Sichuan reported
36,483 to 48,624 cases annually of other infectious diarrhoeal diseases, ranking either
fifth or sixth in the country, with fatal cases reported each year and 16 outbreaks.
From 2004 to 2007, other infectious diarrhoeal diseases were also reported in the 21
severely affected areas and with higher incidence in summer and autumn.
(2) The post-disaster impact and the risk of disease outbreak
The seriously damaged water supply and sanitation facilities will largely increase
the risk of water and food contamination, and the movement and concentrated living
conditions of disaster victims and rescuers will result in overcrowding and close
contacts. The summer and autumn are the two seasons that diarrhoeal diseases will
happen most frequently, and poor hygiene conditions in the disaster areas due to the
difficulty in disposing feces and waste properly will help flies to breed in large
quantities. These factors will significantly increase the risks for the outbreak of
waterborne and food-borne diseases. Once an outbreak occurs, it is very difficult to
control transmission because the crowded shelters with poor healthcare facilities
provide favorable conditions for transmission.
Based on the above analysis, the risks for the outbreak of bacillary dysentery and
other infectious diarrhoeal diseases is very high (++++), and in the meantime the risk
of increased cases and even a small scale outbreak of cholera, hepatitis A and
typhoid/paratyphoid fever will be high (++～+++).
2. Respiratory and close contact transmitted diseases
After the earthquake, the affected population and the rescue personnel live in
overcrowded settlements, leading to increased close contact among people, and thus
raising the risk of infection. For example, a population with lower immunization
coverage and residing in crowded areas are more easily infected by measles.
Crowding may also facilitate the transmission of TB and meningitis; and it can also
7
cause many occurrences of acute respiratory infections, hand foot and mouth disease
and acute hemorrhagic conjunctivitis.
(1) Acute respiratory infections
The acute upper respiratory infection is very common and can be caused by any
of the following: flu virus, parainfluenza virus, respiratory syncytial virus,
Adenoviruses, rhinovirus, Mycoplasma, Chlamydia, pneumococcus, haemophilus
influenzae, streptococcus and Staphylococcus Aureus, etc. The main symptoms are
fever, coughing and sore throat and can easily break out in crowded places,
particularly during the change of seasons. Failing to provide prompt treatment, it may
spread to the lower respiratory tract and cause bronchitis and pneumonia accompanied
with severe symptoms. The acute lower respiratory infections, particularly pneumonia,
are the main cause responsible for the death of children under 5 years old. Currently,
no comprehensive acute respiratory infection surveillance system has been set up in
China and thus the basic incidence level cannot be determined.
After the disaster, many victims and rescuers live in temporary shelters with poor
conditions, high population density and poor ventilation. Some victims and rescuers
are still sleeping outside. Recently the disaster areas have been experiencing violent
climate changes with the alternation of rainy and sunny weather and dramatic changes
in temperature, which can easily contribute to the occurrence of acute respiratory
diseases. Therefore, the risk of the occurrence and spread of the acute respiratory
infections among the disaster victims and rescuers living in the shelters will be very
high（+++）, particularly acute infections in the form of the common cold and those
caused by bacteria
(2) Measles
The annual incidence of measles in Sichuan during the last 10 years is around
10/100,000, but since 2004, it has seen a continuous rise. In 2007, the reported
number of cases and incidence ranked second in the country with 83.8% of the cases
occurring in children under 15. Sichuan has successfully implemented two
supplementary immunization activities (SIAs) in September 2007 and March 2008
successively, covering children aged 8 months to 14 years old in the whole province.
The severely affected disaster areas recently completed SIAs at the end of March
2008. The immediate immunization assessment showed that the coverage rate is
above 95%. The measles epidemic has been on a downward trend since April, 2008.
Measles is a highly transmissible disease and transmission can not be completely
blocked by way of SIAs. The overcrowding of people will increase exposure to the
disease, and even small scale transmission among the immunized people is sometimes
unavoidable. Measles cases have been identified among the disaster affected
population. Generally speaking, the measles cases will continue to be reported given
the current living, accommodation and food supply conditions. While small scale
outbreaks in some areas is not completely avoidable, however it is unlikely for a large
scale outbreak to occur (++).
(3) Rubella
Sichuan reported 3,513 and 5,280 cases of rubella in 2006 and 2007, which
ranked second and third respectively; while the reported incidence ranked tenth in
China. Of the severely affected areas, Nagwa prefecture had a higher incidence, but
the incidence from January to April this year was significantly lower than last year.
The other disaster areas all have a lower incidence during recent years. April to July is
the period when the disease frequently occurs and mainly affects children under 15
(89%), while the highest incidence is found amongst 5-9 year old school children.
Among adults, it mainly occurs in people aged 20 to 40.
8
Currently it is the period for high incidence of rubella. Taking into consideration
the crowding at shelters, poor sanitation conditions, and reports by onsite
professionals of rubella cases among the disaster affected population, there is a higher
risk of outbreak or transmission among children in the disaster areas (+++). At the
moment, concerns should be directed towards female adults aged 20 to 40, with
efforts taken to avoid congenital rubella syndrome suffered in pregnancy (+).
(4) Epidemic cerebrospinal meningitis
During 2005 to 2007, Sichuan reported 42 to 126 cases of epidemic meningitis
annually with the reported incidence ranking eighth in the country. The disaster
stricken cities and prefectures reported lower incidence. The peak time for incidence
is between February and April, and then declines gradually after May.
After the earthquake, the affected population moved to settlements where the
higher density of population and poor sanitation conditions will increase the risk of
meningitis. Additionally, historical records show a lower rate of meningitis
immunization in the severely affected disaster areas.
So based on the above analysis, there may be an occurrence of sporadic
meningitis cases and the number of cases may be greater than during the pre-disaster
period (++).
(5) Mumps
Between 2006 to 2007, Sichuan reported about 20,000 mumps cases annually,
ranking third and first nationwide, with the reported incidence ranking thirteenth and
tenth in the country, respectively. The cases are mainly found among children under
15, and the incidence amongst 4-9 year olds reached above 100/100,000. The peak
occurrence time for mumps is between May and August. Currently in the severely
affected disaster areas such as Ngawa, Mianyang, Chengdu, and Deyang, the
incidence has seen an upward trend.
At the moment, it is peak time for mumps (May - August) and the risk is high
due to the living and food conditions at the settlements. The immunization
professionals deployed in the disaster areas have identified mumps cases among the
disaster victims. The recent risk of epidemic mumps will be high (+++).
(6) Pulmonary Tuberculosis (TB)
TB is one of the diseases with higher reported incidence in China, while
frequently occurring in Sichuan. In 2007, the severely affected disaster area reported
incidence of 82.7—152.1/100,000, showing a serious TB situation.
The earthquake has caused damages to the TB prevention and treatment facilities
at different levels with equipment destroyed, normal services disabled, coupled with
other important tasks of disease prevention, altogether leaving the prevention of TB in
a stagnant status and the TB patients unattended. The emergency response system for
supplying the anti-TB drugs has not been established, so the risk of TB transmission
will rise. Non-infectious TB patients may become infectious TB. Meanwhile, the high
density of the shelters, the poor hygiene conditions, malnutrition and some mental
health factors will also lead to the low level resistance of the affected population.
Some latent TB patients will become vulnerable to TB, and the infectious TB patients
are likely to infect nearby contacts and crowds; therefore there exists a high risk of TB
transmission in the disaster areas (+++).
(7) Acute hemorrhagic conjunctivitis
The acute hemorrhagic conjunctivitis is mainly caused by enterovirus type 70,
coxsackie virus type 24 of group A or some types of Adenoviruses and bacteria.
Patients are the main source of infection, and people are infected mainly through
contacting hands, objects or water which are contaminated by virus. The disease may
9
occur throughout the year and will easily become epidemic in the populous area with
poor hygiene conditions. Although it is not very serious or harmful to human health,
the disease often causes wide public concern due to its high communicability. From
2004 to 2007, Sichuan reported a total of 11,251 cases. Among them, 8,119 cases
were reported in 2007, which is significantly higher than previous years. There were
reported cases from the severely affected disaster areas, but in smaller numbers.
The disease is highly infectious by fast transmission which can affect all people.
During this period, the constant, humid weather, and high temperatures will make it
easy for enteric virus to survive. Given the crowded and poor sanitation conditions at
the shelters, the disease will be easily transmitted once cases appear. The previous
reports from the severely affected disaster areas are in small number, but there is still
the possibility of outbreak and transmission of this disease in the crowded shelters.
The comprehensive analysis shows a high risk of outbreak (+++).
(8) Hand foot and mouth disease
HFMD is mainly caused by type 71 enterovirus, group A coxsackie virus and
echovirus, which is highly infectious to all people but particularly more so for infants..
Some severe infections may lead to death. This disease is mainly transmitted through
the faecal-oral route and/or respiratory droplets. It is also communicable through
contact with patient’s skin, blister fluid or contaminated toys or objects. The months
from May to September are highest incidence period. This year, HFMD has broken
out in some parts in the country. The Ministry of Health has designated it as a national
notifiable disease from May 2, 2008, and since then, the number of reported cases has
increased significantly in most parts of China. From 2005 to 2007, the total number of
reported cases in Sichuan was 1805, with 19 cases, 335 cases and 1451 cases each
year respectively, showing an upward trend. The severely affected areas during this
earthquake also reported HFMD cases.
HFMD is highly infectious, rapidly transmitted, and easily infects children with a
high proportion of asymptomatic infections, making it difficult to control. Currently, it
is the peak season for HFMD and it may be easily transmitted given the high
population density, close contacts and poor hygiene conditions at the settlements.
However, the incidence mainly occurs among infants and children. The occurrence
and severity of HFMD is closely related to the type of viruses. Overall, the risk of
HFMD outbreak during the post-earthquake stage is medium (++).
(9) Chicken pox
Chicken pox is highly infectious during the 2 days before and 5 days after the
rash appears. It has high incidence in spring and winter and easily breaks out among
children. Since 2005, there has been a rising trend each year in the number of chicken
pox cases reported by Sichuan especially in Ngawa prefectures. The reported
incidence in Ngawa prefecture was 70/100,000.
The disaster affected population live together in a centralized space with high
density and poor ventilation conditions. The immunization professionals have
identified chicken pox cases among the disaster affected population. The analysis
shows a high risk of a small scale outbreak of chicken pox (+++).
3. Vector-borne and zoonotic diseases
The earthquake and its accompanied consequences have severely damaged the
human and animal habitat environment. The bodies of water that have formed after
the rain are suitable for the breeding of different vectors. The displacement of the
10
affected population will increase the exposure to vector-borne infectious diseases,
leading to the raised possibility of vector-borne diseases. The disaster also caused
deaths, migration and abnormal behavior of animals. The large number of rescuers
entering the affected area are not only susceptible to diseases but may be also
pathogen carriers themselves. The post-disaster changes to certain main factors such
as environment, hosts, vectors and susceptible population will affect the occurrence of
animal-source diseases in a comprehensive way, and the main risks of epidemic
outbreak will largely depend on if the area is the epidemic foci and its active level.
(1) Plague
All of the severely affected counties and districts are not within the scope of our
identified plague epidemic foci.
The earthquake has destroyed the living environment of the rodents, which may
lead to the massive migration or abnormal assembly of rodent animals. After the
disaster, a large number of rescuers and disaster affected population have to camp
outside, and then will be gradually accommodated in camps for rather a long time,
increasing the possibility of contacts with rodent animals and flea bites. In some
severely affected disaster areas, there exist some plague host animals such as marmots,
which should be given sufficient vigilance even though no plague cases have been
discovered during the long-term surveillance.
The analysis shows there is a low risk of plague occurrence in the severely
affected disaster areas (+).
(2) Anthrax
In 2007, Sichuan reported 135 anthrax cases, the Ngawa prefecture, which was
heavily stricken by the earthquake, had been one of the prefectures with more cases
reported in recent years. From January to April this year, the prefecture reported 15
cases and became the area with most reported cases. Some sporadic cases were also
found in Songpan County, another severely affected disaster area.
The anthrax spores can survive in the soil for many years, and contaminated soil
may have been re-exposed by the earthquake and rescue activities, resulting in the
increased risk of occurrence of the disease. The consumption of diseased animals or
infected animal milk that is not thoroughly cooked or boiled may also lead to the
occurrence of disease.
The comprehensive analysis shows a medium risk of an anthrax epidemic (++).
(3) Encephalitis B
From 2005 to 2007, the annually reported cases in Sichuan were between 600
and 1199 with the reported incidence ranking between second to fourth in China. The
severely affected disaster areas have reported low incidence during the recent years.
The cases are mostly found among children under 15, of which children aged 0 to 6
years accounted for 75 – 81% of the total. The peak incidence season is from the end
of June to the end of August.
The climate of high temperatures and rain following the earthquake will create
an ideal environment for mosquitoes to breed in large quantities. The affected
population staying in the camps or other temporary settlements are easily exposed to
insect bites. The disaster area has low immunization coverage, and the rescuers from
the non-Encephalitis B epidemic areas are more vulnerable to infection.
The severely affected disaster area is not a pig production base and the number
of pigs which could be disease hosts were further reduced due to the earthquake.
These circumstances combined with epidemic historical records, we expect a slight
possibility of an Encephalitis B epidemic apart from some sporadic cases. Currently,
overall vaccination has been carried out among children aged 8 months to 6 years.
11
The low risk of disease occurrence will be maintained if the vaccination rate is high
enough (+).
(4) Dengue fever
In 2007, there were 539 cases reported in China, mainly in Guangdong and
Fujian provinces. The major vector for dengue fever, Aedes Eegypti, is not found in
Sichuan, but there exists a second vector, Aedes albopictus. There has not been any
dengue fever epidemic locally apart from some individual cases imported from
foreign countries, so the post disaster epidemic risk is low (+).
(5) Rabies
In recent years, Sichuan saw a rapid growth in the number of rabies cases. The
province reported 372 cases in 2007, but most of which were located in eastern parts
of Sichuan. Cases were also reported in the severely-affected disaster areas, including
Dujiangyan, Pengzhou, Shifang, Pixian, Dayi, Chongzhou and Wenjiang. In 2007,
Dujiangyan reported 6 cases, Pengzhou 4 cases, Shifang 1 case; while no other cases
were reported from other heavy disaster areas.
The earthquake will increase the number of stray dogs and the coexistence of
humans with dogs. The closer contact between humans and dogs may result in a
greater likelihood of humans being bitten. Given the conditions, cases of rabies are
inevitable, but post disaster epidemic risk is low (+).
(6) Human infected streptococcus suis
In 2005, cases of the disease were reported in Ziyang and in regions of Sichuan
province, after which the incidence fell remarkably. In 2007, the whole province
reported only 8 cases located in Chengdu and Ziyang while no cases were found in the
severely-affected disaster areas.
The disease is mainly transmitted through broken skin coming into contact with
infected or dead pigs and is commonly related to occupational behavior. Most of the
earthquake stricken areas are not a production base of pigs. Furthermore, the
earthquake will have decreased pig population, reducing contact between humans and
pigs and lowering the risk of infection while minimizing the possibility of disease
outbreak. Post disaster epidemic risk will be low (+).
(7) Leptospirosis
Sichuan had been the province with the most cases of leptospirosis in China, but
recently incidence of this disease has been brought under control. In 2007, 195 cases
were reported and mainly found in low-lying rainy areas of Southwest Sichuan. The
disease is not common in higher altitude areas, which is characteristic of the
severely-affected earthquake disaster areas.
The major risks are dependent on contact with contaminated water, thus
occurrence of leptospirosis is largely related to floods and paddy field labor. Most
disaster areas are located in the mountains which already had low incidence prior to
the earthquake, so post disaster risk of disease outbreak is low (+).
(8) Renal syndrome hemorrhagic fever (RSHF)
In 2007, Sichuan reported 114 RSHF cases. The severely-affected disaster areas,
including Beicuan, Jiangyou and Anxian had reported cases prior to the earthquake.
However, the post-disaster influx and behavior of rodents may increase the exposure
of human beings to rodents and their feces. The estimated risk of outbreak will not be
high after the quake (++).
(9) Malaria
Sichuan was previously one of the major malaria epidemic zones in China, but it
has experienced a decrease in incidence in the past 20 years. From 2004 to 2007, the
province reported altogether 1747 cases, ranking Sichuan as one of the provinces with
12
the lowest incidence of malaria.
The severely-affected disaster areas reported a low number of cases in recently
years, some of which were imported, therefore the number of local infectious focus is
less. But malaria is capable of relapse and fast transmission, and due to the
overcrowding of people and lack of protective measures against mosquitoes, there still
exists some risk for the occurrence of malaria. The transmission risk of malaria
post-earthquake ranges will be from low to medium (+) - (++).
(10) Kala-azar
From 2004 to 2007, the whole province reported 222 cases of kala-azar. The
most severely-affected disaster counties and districts had reported cases in recent
years, of which Heishui, Maoxian, Jiuzhaigou, Beichuan, Wenchuan and Lixian are
epidemic areas with the largest number of cases occurring in Heishui and Maoxin.
In Gansu province, which is located near the earthquake epicenter of Sichuan,
there is also an upward trend of kala-azar incidence. From 2004 to 2007 the number
of reported cases was 95, 86 and 100 respectively, with the majority of cases found in
Wudu, Wenxian, Zhouqu and Diebu County.
Kala-azar is an opportunistic infectious disease and the ratio between being
infected and the diseased is approximately 9:1. The changes in the environment after
the earthquake will increase the number of sand flies and stray dogs, while the disaster
affected population living in the camps is poorly protected against sand flies.
Furthermore, other factors such as fatigue, malnutrition, which lowers resistance to
the disease, and the entry of large numbers of people without immunization and the
migration of latent infected people, may cause the incidence of kala-azar to increase
and the extension of the epidemic zone (++).
(11) Schistosomiasis
Sichuan has a low incidence of schistosomiasis with annual reported cases
averaging at approximately 400 cases per year since 2004. In the 21 severely-affected
disaster areas, 11 were previously epidemic zones of Schistosomiasis, but they have
all reached the transmission control standard and no snails positive for schistosomiasis
were found.
Because of the existing snail population, the difficulty in treating human and
animal feces after the disaster and the latent infectious source may cause the snails to
reemerge and thereby increase the risk of disease outbreak (+).
4. Risk of other diseases
(1) Hepatitis B
The 1992 national viral hepatitis serum epidemiological study showed that the
surface antigen carrier rate in Sichuan was 10.48% and the hepatitis B infection rate
was 65.48% (slightly higher than the national average). The reported cases of
hepatitis B from 2005 to 2007 in Sichuan ranked between third to seventh highest in
the country, and the incidence ranked ninth to fourteenth highest with an average
annual incidence of 103.52/100,000.
The hepatitis B virus carriers may have reduced their resistance after having
experienced serious psychological trauma, material and property losses and high
mental state of emergency, which could lead to acute attack by hepatitis B virus.
People injured in the earthquake may require blood transfusions or treatment with
blood products, increasing the chance for infection. However, considering the current
control of blood products in China, it is believed the risk of disease being transmitted
13
through blood and blood products will be low. Additionally, while the disaster affected
population resides in crowded shelters with close contacts between people, hepatitis B
is mainly transmitted through blood while there are limited reports of outbreaks
occurring due to close contact. The analysis shows a low risk for rising incidence and
epidemic of hepatitis B (+).
(2) Tetanus
Tetanus is an infectious disease, and tetanus spores are found extensively in soil.
The tetanus bacterium can infect humans through open wounds or broken skin. The
earthquake zone encompasses a vast area of destruction, damaged buildings and
injured people. Therefore, the risk of infection among the affected population and
rescuers will be medium (++)
(3) Avian flu
An avian flu epidemic in animals occurred in Sichuan during December 2005.
From January to April 2006, Sichuan confirmed 3 avian flu human cases. No cases
were reported afterwards.
Because the avian influenza virus can survive continually in the environment, the
risk for post-earthquake infections can not be overlooked. However, the risk is likely
to be low considering the recent disease situation. (+)
(4) SARS
China and other countries have not reported any SARS cases since 2004.
Therefore, the risk of SARS is extremely low (+) – (-).
(5) STDs
The main risk factors for STDs are sexual contact and unsafe sexual activities
such as multiple sexual partners and unprotected sexual intercourse. The most
common STDs include syphilis, gonorrhea, AIDS/HIV, condyloma acuminatum,
genital herpes and genital tract chlamydia trachomatis. Both syphilis and AIDS/HIV
can also be transmitted through blood. In recent years, the incidence of STDs in
Sichuan, particularly in the severely-affected disaster areas, is generally at medium
level relative to the rest of the country.
The earthquake has interfered with the normal ways of living to a large degree.
People tend to lower their demand for sex after having experienced serious mental
trauma, property loss and while they are in a mental state of emergency. Meanwhile,
the diagnosis and treatment of STDs after the earthquake may also be affected. In
general, during the emergency response period, there exists a lower risk of STDs (+)
However, when the situation has stabilized, the sexual activities and health services to
the disaster affected population needs to be further assessed.
V. Post-earthquake disease surveillance and control
The assessment on health service system of disease control, health inspection and
medical care should be taken immediately, and the rebuilding of the medical system
shall be included in the general planning of reconstruction, so as to ensure that the
regular health service re-operate properly as soon as possible.
The post-disaster control should be carried out under the principle of prevention
first and evidence-based with emphasizing water, food safety and environment
hygiene, personal sanitation and immunization so as to reduce the risk of disease
transmission and outbreak. Risk assessment on infectious diseases should be launched
immediately for guiding to take more effective actions to prevent the diseases.
Recover and strengthen routine surveillance, set up post-disaster emergency
monitoring, investigate and identify the cluster cases and cause-unknown cases timely,
14
to early detect and respond to the emergent public health events such as infectious
disease outbreaks or food poisoning.
1. Strengthen the protection of water source and drinking-water safety
Ensuring uninterrupted provision of safe dring water is the most important
preventive measure to minimize the risk of outbreaks of water-borne diseases. In the
meantime, the water source for drinking should be well protected from contamination.
1. Make sure the sufficient drinking water can be supplied to the affected
populations. It is recommended that each person be supplied with at least 15 to 20
litres of clean water per day. Water collected from sources that might have been
contaminated must be boiled or disinfected before drinking. Chlorine is one of the
most effective drinking-water disinfectants to prevent nearly all waterborne diseases.
After 30 minutes, the residual concentration of active chlorine in the water should be
0.5mg/L, which can be determined by the simple field test kit.
2. The provision of appropriate and sufficient water containers, cooking pots and
fuel can reduce the risk of cholera and other diarrhoeal diseases by ensuring that water
storage is protected.
2. Adequate sanitation facilities such as latrines and refuse container should be
provided and ensured they are far away from water source. The shelters for disaster
victims, medical sites and the temporary camps for rescuers shall be key areas for
environmental sanitation. The temporary latrines should be well planned and built to
ensure the feces properly disposed, if possible the disinfection for feces and vomits of
the diarrhoeal patients are recommended. Set up wastes collection points and special
persons shall be appointed for timely cleaning and disposing of the wastes.
2. Maintain adequate food supply and food safety
Malnourished children are more vulnerable to disease pathogens. Infants from
birth to 6 months of age are recommended to be breastfed, and those who are not
breastfed are more vulnerable to infection and to developing diarrhoea. Clean and
digestible food should be provided to infants aged 6 months or above as
supplementary. Attention should be given to maintaining nutrition of nursing mothers.
The personal sanitation of both mothers and infants should be highlighted to avoid
transmission of diarrhoeal diseases due to bad health habits.
Food safety is also to be paid attention. Eat only cooked food and don’t eat raw
or not thoroughly cooked food; particularly the aquatic products should be cooked
thoroughly before eating. Rotten or spoiled food should not be eaten while fruits must
be washed with clean water before consumption. and do not touch food when you are
eating the instant food. Utensils should be disinfected by boiling or disinfectant and
the utensils for preparing raw and cooked foods must be separated. The food to be
served and supplied should be well packed to avoid contamination.
3. Shelter planning and assessment
The shelters and sites for the affected populations should be planed to against
adverse weather (rainstorm, cyclone); the site should be positioned near to the water
source, and where possible on a higher land so it can be easily supplied with water by
15
using the gravity; the land for sheltering sites should have a inclination of 2-4% for
easier water discharge, and discharge ditches should also be planed around or on both
sides of the site. Avoid too many people staying in one shelter site to prevent
overcrowding. Natural ventilation should be considered for tabernacle sites. Easy
access to basic health service in each site should be ensured. Strengthen the
management of livestock and poultry at the shelter to reduce direct contacts between
human and animals. Report and dispose the infected and dead animals and poultries in
accordance with relevant guidelines.
Assess the risk factors of infectious diseases in the shelter sites including
vaccination coverage, nutrition status, food and water safety, environment and
personal sanitation, category and prevalence of infectious diseases in the places where
sheltering sites located, health service accessibility, disease vectors and personal
behavior, for more effective control of diseases.
4. Strengthen the monitoring and control of vectors
Monitoring on disease vectors such as rodents, mosquitoes and flies at the
sheltering sites should be carried out according to the “Guideline for Vector
Surveillance after Wenchuan Earthquake (draft version)” by China CDC. Proper
guidance for controlling vectors should be provided to the affected population based
on the results from surveillance so as to minimize the risks of vector borne diseases.
Residual spray should be instituted in the highly populous environment to reduce
breeding of mosquitoes; use bednets and repellents especially recommended when
sleeping outside. Be aware of fire when using mosquito coils inside the tents.
5. Strengthen health education
Deliver health knowledge to the affected people and rescuers by various
channels. Basic messages are: Hand hygiene of thoroughly hand cleaning before
eating and after defecation. Do not eat raw food or sick animals; do not eat uncooked
meat and dairy products. Defecate only in designated areas and don’t share with
others your own towels or basins. Keep shelter and camp ventilated; change clothing
when climate changes. Visit a doctor when symptoms of fever, vomiting, bellyache
and diarrhea develop. Keep yourself well rested and minimize contacts with others.
Cluster cases should be immediately reported to health authorities for rapid response
and control of disease.
6. Strengthen disease surveillance and outbreak control
Notifiable infectious disease reporting system and event-based public health
emergency reporting system should be rebuilt to early identify and rapidly manage the
infectious disease outbreaks and public health emergencies.
In places where buildings, equipments, people, power supply and
communication are severely damaged, the emergency reporting system should be
established immediately to enable the information of common syndromes and
diseases can be collected quickly for timely detection, identification and management
of potential outbreaks. Stockpile medicine and vaccines for outbreak controlling.
Set up and launch infectious disease emergency laboratory network at the county
16
and provincial level CDCs as soon as possible. Based on the risk assessment, the
laboratory diagnosis of 11 diseases including TB, cholera, typhoid, dysentery,
leptospirosis, measles, influenza, encephalitis B, hepatitis A, , hepatitis E, and
malaria should be established in the severely affected counties. Sichuan provincial
CDC should be responsible for laboratory diagnosis of plague, avian flu (H5N1),
enterorrhagia colibacillosis (O157: H7), tick borne rickettsiosis, dengue, poliomyelitis,
HFRS, meningococcal meningitis, viral diarrhea (norovirus，rotavirus)，streptococcus
suis，diphtheria and HFMD.
The emergency laboratory at severely affected areas should try to take samples
for laboratory confirmation on each suspected TB, malaria and typhoid case. Previous
suspected/probable cases of cholera, leptospirosis, hepatitis A, hepatitis E, measles,
influenza, Japanese encephalitis and malaria reported in temporary medical sites and
shelters should be taken samples for laboratory diagnosis, while not necessary to lab
confirm every case.
Medical service providers in the affected areas should report suspected and
probable cases of plague, avian flu (H5N1) enterorrhagia colibacillosis (O157: H7),
acute flaccid paralysis, tick borne rickettsiosis, HFRS, dengue, diphtheria and
streptococcus suis upon diagnosis, and send the collected samples to Sichuan
provincial CDC for lab confirmation. If any abnormal increasing of viral diarrhea and
HFMD cases are detected, samples should be collected and sent to the provincial
laboratory for outbreak diagnosis.
The distribution of anthrax and Sohistosomiasis natural foci should be idetified
and the animal burial places and snail areas should be marked out to avoid direct
contact.
If vaccine-preventable diseases are found, the emergency mass vaccination
campaign should be launched in accordance with the “vaccination guideline for
earthquake affected areas” and the vaccination coverage should be achieved as
requested.
7. Resume the basic public health service
Routine vaccination, maternal and neonatal health services should be recovered
as soon as possible when the situation of the affected area become stable. Recover
routine vaccination as soon as possible, the temporary vaccination service sites should
be established make sure the children of the appropriate age can be properly
immunized. The priority should be given to the EPI newly included vaccines. Give
vaccination service to the key populations in the sheltering sites, schools and
kindergartens in the affected areas setp by step on the basis of diseases risk
assessment results. Measures must be taken to ensure that the provision, preservation
and transportation of vaccines comply with the relevant requirements.
Resume TB and AIDS intervention programs to ensure the continued
implementation of case identification, free and standardized treatment. Pulmonary TB
patients should be continuously treated and effectively managed in accordance with
the relevant requirement under the national Stop TB program. In addition, the
destruction of leprosy villages or hospital caused by the earthquake may adversely
affect the mental health of the patients, measures should be taken for treatment the
mental interference.
17
8. Strengthen case management
Regulated treatment must be given to the infectious disease casess or suspected
cases according to local available resources to reduce the further transmission of
diseases. The controlling of infectious diseases should comply with relevant national
guidelines and regulations. Improve the awareness of the community on the infectious
diseases to make them understand the importance of early treatment and appropriate
case management.in controlling diseases effectively. Enhance the isolation of
infectious disease patients in the crowded sheltering sites so as to reduce the
transmission of disease due to overcrowding. Additionally, the preventive measures of
tetanus must be taken to avoid cross infections or nosocomial infections during
rescuing or surgical treatment. Treatment and management of gas gangrene and other
diseases should not be neglected.
In summary, disease control remains an arduous task in the quake affected areas
for a long term. During the displacement of the affected populations, recovery of the
public health services and medical facilities still in process, the environment hygiene,
water and food safety will face great challenges, with the combination of the factors
of increased movement of population, overcrowding, immunity compromised, the
occurrence or even outbreak of the diseases such as bacillary dysentery, other
diarrhoeal disease, hepatitis A, mumps, chicken pox, influenza, acute hemorrhagic
conjunctivitis and HFMD are still possible. Some areas must be vigilant on the
occurrence and potential outbreak of Japanese encephalitis, malaria, kala-azar,
leptospirosis, Schistosomiasis, and echinococcosis.
The health administrative departments and disease control facilities at the
different levels of the disaster areas should take measures not only for the rapid
emergency responding but also for the long term containment needs, carry out the risk
assessment of the diseases and public health events in a well planed way, set up and
improve the coordination, surveillance and monitoring, laboratory testing, emergency
response and information communication, adjust and strengthen the strategy to
maintain water and food safety, environmental hygiene and vector surveillance, and
resume routine immunization program to prevent and manage the communicable
diseases outbreak and other public health events scientifically, effectively, orderly and
in the regulated way. Strengthen the guidance on disinfection and insecticide spraying
to avoid any overmuch, superfluous and inappropriate spraying. Enhance the
nosocomial infection control in medical sites, clinics and hospitals. Continue to
improve the public awareness of the disease control and improve their prevention
knowledges and capacities.
Under the leadership of the CPC central committee and the State Council and the
governments at all levels, and the supports by the disease control facilities at all levels,
we will work together closely to achieve our goal of “no major epidemic after the
disaster”.
18
Table 1
Severely
affected
counties
Pixian
County
Top 10 infectious diseases and other key infectious diseases in the 21 severely affected counties in Sichuan, 2004～2007
Cases of Class
A, B, C in the
past 4 years
(2446)
2004～2007 top ten diseases of reported cases (total cases)
1
2
Hepatitis
Diarrhea
B
(2530)
(1804)
3
4
5
Pengzhou
City
(3184)
TB
TB
mumps
(1685)
(1103)
(1042)
mumps
Diarrhea
(294)
(183)
Hepatitis bacillary
B
dysentery
(1886)
(724)
Hepatitis
B
TB
(5959)
(2264)
(1571)
(653)
(496)
Diarrhea
TB
Hepatitis
B
mumps
bacillary
dysentery
(3325)
(1980)
Du Jiangyan
(2515)
Chongzhou
City
(1498)
TB
(2051)
Wenjiang
District
(1392)
(332)
Diarrhea gonorrhea
(1722)
(763)
Condylom
Hepatitis
a
bacillary
B
Acuminat dysentery
um
(1223)
(822)
(576)
7
8
9
10
Other diseases under
attention
Condylom
Streptococcus suis、Rabies、
a
gonorrhea
Hepatitis A syphilis malaria
Acuminat
um
(865)
(453)
(440)
(329)
(297)
Schistosomiasis 、Rabies 、
Condyloma
malaria、JE、
chicken pox Acuminatu gonorrhea Hepatitis A syphilis
echinococcosis 、
m
Streptococcus suis
(175)
(128)
(113)
(83)
(69)
Condyloma
chicken malaria、Schistosomiasis、JE、
Acuminatu syphilis
mumps Hepatitis A
pox Rabies、echinococcosis
m
(443)
(406)
(384)
(245)
(171) Streptococcus suis、kala-azar
malaria、Rabies、kala-azar、
Condyloma
Hepatiti
gonorrhea Acuminatu syphilis
Rubella
s A Streptococcus suis、JE、
m
echinococcosis
(484)
(283)
(247)
(170)
(169)
Schistosomiasis、Rabies 、
Schistoso Hepatitis urethriti Streptococcus suis、malaria、
Diarrhea gonorrhea
miasis
untyped
s
JE
bacillary
chicken pox
dysentery
Dayi County
(1006)
6
bacillary
dysentery
(584)
mumps
(440)
Hepatitis
B
TB
Diarrhea
mumps
gonorrhea
(1169)
(1019)
(944)
(594)
(369)
(346)
(267)
(243)
Condyloma
bacillary
Acuminatu syphilis
dysentery
m
(346)
(246)
(182)
19
(154)
Hepatitis
untyped
(148)
(136)
cholera、Streptococcus suis、
urethriti
Rabies、Schistosomiasis 、
s
malaria
(88)
Mianzhu
City
(2333)
Shifang City
(1824)
Anxian
Country
Beichuan
County
Pingwu
County
Jiangyou
City
(2115)
(648)
(765)
(6036)
Qingchuan
County
(1069)
Lushan
(505)
Hepatitis
B
TB
(3749)
(1954)
(778)
Hepatitis
B
TB
Diarrhea
(1841)
(1551)
(795)
Hepatitis
B
TB
Diarrhea
(2366)
(1843)
TB
mumps
(769)
(595)
(1140)
Hepatitis
B
(421)
Diarrhea
Hepatitis
B
mumps
(644)
(584)
(571)
Hepatitis
Diarrhea
B
(8032)
(6544)
Hepatitis
B
TB
(1565)
bacillary
(968)
mumps
Condylom
Hepatiti
a
mumps
gonorrhea
s
Acuminat
untyped
um
(765)
(539)
(499)
(489)
(408)
(300)
(293)
Hepatiti
bacillary
Hepatitis A gonorrhea chicken pox mumps
syphilis
s
dysentery
untyped
(520)
(410)
(303)
(244)
(192)
(192)
(173)
Condylom
bacillary
a
urethriti
chicken pox mumps Hepatitis A
gonorrhea
dysentery
Acuminat
s
um
(1063)
(639)
(626)
(331)
(288)
(206)
(113)
bacillary
Hepatiti
chicken pox
Diarrhea
measles
Rubella gonorrhea
dysentery
sA
(369)
(275)
(143)
(99)
(66)
(64)
(64)
Condyloma
bacillary
conjunct
TB
chicken pox
Acuminatu gonorrhea Hepatitis A
dysentery
ivitis
m
(538)
(281)
(181)
(92)
(84)
(83)
(74)
Condylom
bacillary
a
chicken pox mumps
gonorrhea
urethritis syphilis
dysentery
Acuminat
um
bacillary
Diarrhea chicken pox
Hepatitis A
dysentery
TB
(4231)
(1231)
influenza chicken pox
(818)
TB
(1135)
measles
(284)
(257)
chicken pox Hepatitis B
JE、Schistosomiasis 、
malaria、kala-azar
JE、Schistosomiasis、
kala-azar、Rabies
Schistosomiasis 、cholera 、
JE、kala-azar、leptospirosis 、
HFRS、malaria
malaria、hemorrhagic fever 、
JE、kala-azar、
JE、kala-azar、
echinococcosis 、malaria
cholera、JE、kala-azar、
HFRS、echinococcosis 、
leptospirosis 、
Schistosomiasis 、
malaria、Streptococcus suis
bacillary JE、malaria、kala-azar
Hepatitis
Diarrhea
mumps
gonorrhea dysenter
A
y
(206)
(110)
(76)
(56)
(47)
Diarrhea Schistosomi measles leptospirosis Hepatiti leptospirosis 、malaria、JE
(1041)
20
(1012)
(1003)
(554)
(538)
County
Baoxing
County
Wenchuan
Lixian
County
Maoxian
County
dysentery
(474)
(229)
(677)
(440)
(621)
Hepatitis
B
(292)
TB
TB
(376)
Xiajin
County
(455)
TB
(424)
Heishui
County
(465)
(371)
mumps
TB
(261)
(219)
bacillary
TB
dysentery
(620
(567
bacillary
mumps
dysentery
(538)
(489)
(653)
Songpan
County
(445)
TB
(932)
(164)
Hepatitis
B
(518)
TB
asis
(289)
(286)
(74)
(71)
(70)
Condyloma
bacillary
Hepatitis
Diarrhea chicken pox
Acuminatu
dysentery
A
m
(141)
(79)
(55)
(27)
(17)
mumps
chicken pox Diarrhea
(460)
(247)
(155)
HB
Diarrhea
Hepatitis A
(222)
(182)
(82)
(80)
bacillary
Diarrhea
mumps Hepatitis B measles
dysentery
(530)
(482)
(275)
(198)
(159)
bacillary
mumps Diarrhea Hepatitis B Hepatitis A
dysentery
(227)
(194)
(150)
(115)
(32)
bacillary
mumps
Hepatitis B measles Hepatitis A
dysentery
(380)
(367)
(241)
(122)
(117)
bacillary chicken
Hepatitis B Diarrhea
mumps
dysentery
pox
(434)
(131)
(115)
(61)
(60)
21
(61)
sA
(60)
JE、leptospirosis 、
gonorrhea syphilis
(17)
(7)
genital
measles gonorrhea Hepatitis A
herpes
(99)
(87)
(51)
(45)
conjunct
Rubella
measles gonorrhea
ivitis
(51)
(37)
(24)
(20
Hepatitis Condyloma gonorrh
chicken pox
A
Acuminatum ea
(101)
(60)
(30)
(29)
urethriti
measles gonorrhea Rubella
s
(27)
(15)
(10)
(7)
chicken
Diarrhea influenza gonorrhea
pox
(105)
(23)
(11)
(8)
Hepatiti
measles influenza gonorrhea
sA
(58)
(51)
(50)
(42)
kala-azar、echinococcosis 、
echinococcosis
kala-azar、echinococcosis
kala-azar、echinococcosis 、
anthrax
anthrax、echinococcosis 、
malaria、
kala-azar、echinococcosis 、
Table 2
Risk assessment of the key infectious diseases
in affected areas, Sichuan
Diseas
Level of risk☆
Bacillary dysentery
++++
Other infectious diarrhea
++++
Cholera
+++
Hepatitis A
+++
Typhoid and paratyphoid
+++
TB
+++
Acute upper respiratory tract infection
+++
Rubella
+++
Mumps
+++
Acute hemorrhagic conjunctivitis
+++
Chicken pox
+++
Measles
++
Meningococcal meningitis
++
HFMD
++
Anthrax
++
Kala-azar
++
Hemorrhagic fever with renal syndrome
++
Tetanus
++
Malaria
+～++
Plague
+
HB
+
Japanese Encephalitis
+
Leptospirosis
+
Dengue
+
Rabies
+
Schistosomiasis
+
Streptococcus suis
+
Avian influenza/H5N1
+
Syphilis /gonorrhea
+
SARS
-～+
Diseases and infections not covered in the report
Viral diarrhea
++
Pneumonia
++
HE
++
Food poinsoning
++
Tick borne rickettsiosis
++
Gas gangrene
++
HC
+
Echinococcosis
+
Brucellosis
+
Typhus
+
Poliomyelitis
+
HIV/AIDS
+
MRSA
+
☆Note the risk level from none to high is presented as “-” none, “+” low, “++”
medium, “+++”high risk, “++++” very high risk
22
Attachment
Geographical Distribution of Cases of Key Communicable Diseases,
in the 21 Severely Affected Counties in Sichuan, 2004～2007
songpan
songpan
115
115
pingw
pingwuu
qingchuan
qingchuan
1,565
1,565
584
584
heishui
heishui
115
115
beichuan
beichuan
anxian
anxian
2,366
2,366
mianzhu
mianzhu
shifang
shifang
3,749
3,749
1,841
1,841
lixian
lixian
182
182
xiaojin
xiaojin
jiangyou
jiangyou
8,032
8,032
421
421
maoxian
maoxian
198
198
w
wenchuan
enchuan
pengzhou
pengzhou
518
518
5,959
dujiangyan
dujiangyan5,959
1,722
1,722
pixian
pixian
2,530
2,530
chongzhou
chongzhou
w
w
enjiang
enjiang
dayi
dayi
1,223
1,223
1,169
1,169
724
724
241
241
baoxing
baoxing
2004~2007 cumulative number
of Hepatitis B cases
5,000 to 8,040
3,000 to 4999
1,000 to 2999
200 to 999
110 to 199
261
261
lushan
lushan
(2)
(1)
(7)
(7)
(4)
286
286
songpan
songpan
376
376
pingw
pingwuu
qingchuan
qingchuan
968
968
538
538
heishui
heishui
932
932
maoxian
maoxian
653
653
jiangyou
jiangyou
4,231
4,231
anxian
anxian
1,843
1,843
mianzhu
mianzhu
shifang
shifang
1,954
1,954
1,551
1,551
lixian
lixian
222
222
xiaojin
xiaojin
424
424
beichuan
beichuan
769
769
w
wenchuan
enchuan
pengzhou
pengzhou
567
567
2,264
2,264
dujiangyan
dujiangyan
1,980
1,980
pixian
pixian
1,685
chongzhou
chongzhou 1,685
w
w
enjiang
2,051
2,051 enjiang
dayi
dayi
1,019
1,019
1,886
1,886
baoxing
baoxing
164
164
lushan
lushan
371
371
23
2004~2007 cumulative number
of TB cases
3,000 to 4,240
2,000 to 2999
1,000 to 1999
500 to 999
160 to 499
(1)
(2)
(7)
(6)
(5)
songpan
songpan
27
27
qingchuan
qingchuan
257
257
pingw
pingwuu
52
52
heishui
heishui
58
58
beichuan
beichuan
maoxian
maoxian
159
159
anxian
anxian
14
14
mianzhu
mianzhu
shifang
shifang
44
96
96
lixian
lixian
37
37
xiaojin
xiaojin
w
wenchuan
enchuan
baoxing
baoxing
11
2004～2007 cumulative number
of Measels cases
pengzhou
pengzhou
99
99
43
dujiangyan
dujiangyan 43
58
58
pixian
pixian
111
111
chongzhou
chongzhou
w
wenjiang
enjiang
24
24
dayi
dayi
10
10
28
28
122
122
jiangyou
jiangyou
58
58
99
99
1 dot = 1 case
cumulative number of cases
200 to 257
100 to 199
50 to 99
10 to 49
0 to 9
lushan
lushan
70
70
(1)
(3)
(8)
(7)
(2)
songpan
songpan
10
10
qingchuan
qingchuan
22
22
pingw
pingwuu
42
42
heishui
heishui
77
beichuan
beichuan
maoxian
maoxian
21
21
jiangyou
jiangyou
75
75
anxian
anxian
77
77
lixian
lixian
51
51
xiaojin
xiaojin
66
66
mianzhu
mianzhu
shifang
shifang
18
18
116
116
w
wenchuan
enchuan
pengzhou
pengzhou
32
32
107
dujiangyan107
dujiangyan
170
170
pixian
pixian
31
31
chongzhou
chongzhou
w
w
enjiang
enjiang
17
17
dayi
dayi
77
36
36
55
baoxing
baoxing
55
2004~2007 cumulative number
of Rubella cases
1 dot = 1case
cumulative number fo cases
100 to 170
50 to 99
10 to 49
5 to 9
lushan
lushan
99
24
(3)
(4)
(9)
(5)
songpan
songpan
194
194
qingchuan
qingchuan
110
110
pingw
pingwuu
571
571
heishui
heishui
60
60
beichuan
beichuan
anxian
anxian
626
626
lixian
lixian
489
489
xiaojin
xiaojin
jiangyou
jiangyou
1,041
1,041
595
595
maoxian
maoxian
275
275
mianzhu
mianzhu
shifang
shifang
489
489
244
244
w
wenchuan
enchuan
pengzhou
pengzhou
460
460
384
dujiangyan384
dujiangyan
763
763
pixian
pixian
1,103
1,103
chongzhou
chongzhouw
w
enjiang
enjiang
440
440
dayi
dayi
594
594
294
294
380
380
baoxing
baoxing
2004~2007cumulative number
of Mumps cases
1 dot = 1case
cumulative number of cases
1,000 to 1,110 (2)
500 to 1,000 (5)
200 to 500 (11)
100 to 200 (2)
60 to 100 (1)
219
219
lushan
lushan
445
445
songpan
songpan
33
pingw
pingwuu
qingchuan
qingchuan
284
284
281
281
heishui
heishui
131
131
beichuan
beichuan
maoxian
maoxian
101
101
mianzhu
mianzhu
shifang
shifang
765
765
303
303
w
wenchuan
enchuan
88
pengzhou
pengzhou
247
247
171
dujiangyan171
dujiangyan
58
58
pixian
pixian
1,042
1,042
chongzhou
chongzhou
w
w
enjiang
enjiang
62
62
dayi
dayi
58
58
175
175
baoxing
baoxing
79
79
jiangyou
jiangyou
1,135
1,135
anxian
anxian
639
639
lixian
lixian
99
xiaojin
xiaojin
369
369
2004~2007 cumulative number
of Chicken pox cases
1 dot= 1case
cumulative number of cases
500 to 1,140
200 to 499
100 to 199
10 to
99
0 to
9
lushan
lushan
289
289
25
(4)
(6)
(4)
(4)
(3)
songpan
songpan
11
qingchuan
qingchuan
33
pingw
pingwuu
11
heishui
heishui
11
beichuan
beichuan
maoxian
maoxian
77
anxian
anxian
88
lixian
lixian
00
xiaojin
xiaojin
mianzhu
mianzhu
shifang
shifang
11
44
w
wenchuan
enchuan
00
pengzhou
pengzhou
00
dujiangyan
dujiangyan 55
00
pixian
pixian
00
chongzhou
chongzhou
w
wenjiang
enjiang
00 00
dayi
dayi00
baoxing
baoxing
00
jiangyou
jiangyou
00
00
2004~2007 cumulative number
of Meningococcal meninggitis cases
1dot = 1case
cumulative number of cases
5 to 8 (3)
2 to 4 (2)
1
(4)
0
(12)
lushan
lushan
00
songpan
songpan
00
qingchuan
qingchuan
99
pingw
pingwuu
43
43
heishui
heishui
00
maoxian
maoxian
22
jiangyou
jiangyou
85
85
anxian
anxian
24
24
lixian
lixian
11
xiaojin
xiaojin
beichuan
beichuan
00
mianzhu
mianzhu
shifang
shifang
17
17
17
17
w
wenchuan
enchuan
11
pengzhou
pengzhou
11
11
18
dujiangyan 18
dujiangyan
40
40
pixian
pixian
86
86
chongzhou
chongzhou
w
wenjiang
enjiang
10
10
dayi
dayi
37
37
41
41
baoxing
baoxing
00
2004~2007cumulative number
of Scarlet fever cases
1 dot = 1case
cumulative number of cases
50 to 86
30 to 49
10 to 29
1 to 9
0
lushan
lushan
22
26
(2)
(4)
(6)
(5)
(4)
songpan
songpan
00
qingchuan
qingchuan
23
23
pingw
pingwuu
74
74
heishui
heishui
00
beichuan
beichuan
anxian
anxian
78
78
mianzhu
mianzhu
shifang
shifang
77
40
40
lixian
lixian
20
20
xiaojin
xiaojin
jiangyou
jiangyou
165
165
16
16
maoxian
maoxian
44
w
wenchuan
enchuan
11
pengzhou
pengzhou
33
25
dujiangyan 25
dujiangyan
14
14
pixian
pixian
39
39
chongzhou
chongzhou
w
w
enjiang
enjiang
99
dayi
dayi26
88
26
baoxing
baoxing
00
2004~2007cumulative number
of Acute hemorrhagic conjunctivitis cases
1 dot = 1case
cumulative number of cases
100 to 165
50 to 99
10 to 49
1 to 9
0
lushan
lushan
22
(1)
(2)
(8)
(7)
(3)
songpan
songpan
00
pingw
pingwuu
qingchuan
qingchuan
00
11
heishui
heishui
00
beichuan
beichuan
66
maoxian
maoxian
00
anxian
anxian
00
mianzhu
mianzhu
shifang
shifang
44
00
lixian
lixian
00
xiaojin
xiaojin
jiangyou
jiangyou
16
16
w
wenchuan
enchuan
pengzhou
pengzhou
00 dujiangyan
dujiangyan 44
11
pixian
pixian
66
66
chongzhou
chongzhou
w
w
enjiang
enjiang
22
66
dayi
dayi 88
00
baoxing
baoxing
00
2004~2007cumulative number
of Hand foot and mouth disease cases
1 dot = 1case
cumulative number of cases
50 to 66 (1)
10 to 49 (1)
1 to 9 (9)
0
(10)
lushan
lushan
44
27
songpan
songpan
00
qingchuan
qingchuan
00
pingw
pingwuu
00
heishui
heishui
00
maoxian
maoxian
00
jiangyou
jiangyou
99
anxian
anxian
12
12
mianzhu
mianzhu
shifang
shifang
00
00
lixian
lixian
00
xiaojin
xiaojin
beichuan
beichuan
00
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 00
00 dujiangyan
00
pixian
pixian
00
chongzhou
chongzhou
w
w
enjiang
enjiang
00
10
10
dayi
dayi 00
00
baoxing
baoxing
00
2004~2007 cumulative number
of cholera cases
1 dot= 1case
cumulative number of cases
12 (1)
10 (1)
9 (1)
0 (18)
lushan
lushan
00
songpan
songpan
32
32
pingw
pingwuu
qingchuan
qingchuan
76
76
83
83
heishui
heishui
42
42
beichuan
beichuan
maoxian
maoxian
60
60
w
wenchuan
enchuan
pengzhou
pengzhou
51
51dujiangyan
dujiangyan 245
245
169
169pixian
pixian
329
329
chongzhou
chongzhou
w
w
enjiang
enjiang
116
116 75
dayi
dayi
75
83
83
117
117
baoxing
baoxing
17
17
jiangyou
jiangyou
202
202
anxian
anxian
331
331
mianzhu
mianzhu
shifang
shifang
499
499
520
520
lixian
lixian
80
80
xiaojin
xiaojin
62
62
lushan
lushan
60
60
28
2004~2007cumulative number
of Hepaittis A cases
1 dot= 1case
cumulative number of cases
400 to 520
200 to 399
100 to 199
50 to 99
17 to 49
(2)
(4)
(3)
(9)
(3)
songpan
songpan
11
pingw
pingwuu
qingchuan
qingchuan
22
22
heishui
heishui
00
beichuan
beichuan
maoxian
maoxian
33
anxian
anxian
55
mianzhu
mianzhu
shifang
shifang
14
14
88
lixian
lixian
11
xiaojin
xiaojin
jiangyou
jiangyou
88
00
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan
dujiangyan 77
12
12
pixian
pixian
12
12
chongzhou
chongzhou
w
wenjiang
enjiang
10
10
dayi
dayi
66
33
11
11
baoxing
baoxing
44
2004~2007 cumulative number
of Hepatitis E cases
1 dot = 1case
cumulative number of cases
10 to 14 (4)
5 to 9 (5)
1 to 4 (10)
0
(2)
lushan
lushan
44
songpan
songpan
227
227
pingw
pingwuu
qingchuan
qingchuan
47
47
181
181
heishui
heishui
434
434
beichuan
beichuan
maoxian
maoxian
482
482
jiangyou
jiangyou
1,231
1,231
anxian
anxian
1,063
1,063
mianzhu
mianzhu
shifang
shifang
539
539
192
192
lixian
lixian
538
538
xiaojin
xiaojin
275
275
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 496
620
620dujiangyan
496
367
367
584
584
pixian
pixian
865
865
chongzhou
chongzhou
w
w
enjiang
enjiang
576
576 346
dayi
dayi
346
332
332
baoxing
baoxing
55
55
lushan
lushan
474
474
29
2004~2007 cumulative number
of Bacillary dysentery cases
1,000 to 1,240
500 to 999
200 to 499
100 to 199
40 to
99
(2)
(6)
(9)
(2)
(2)
songpan
songpan
00
qingchuan
qingchuan
11
pingw
pingwuu
00
heishui
heishui
22
beichuan
beichuan
anxian
anxian
00
mianzhu
mianzhu
shifang
shifang
00
00
lixian
lixian
11
xiaojin
xiaojin
jiangyou
jiangyou
00
00
maoxian
maoxian
00
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 11
11 dujiangyan
11
pixian
pixian
44
chongzhou
chongzhou
w
w
enjiang
enjiang
55 22
dayi
dayi
33
00
baoxing
baoxing
00
2004~2007 cumulative number
of Typhoid fever and Paratyphoid fever cases
1 dot = 1case
cumulative number of cases
lushan
lushan
1 to 5 (10)
0
(11)
00
songpan
songpan
150
150
qingchuan
qingchuan
206
206
pingw
pingwuu
644
644
heishui
heishui
61
61
beichuan
beichuan
maoxian
maoxian
530
530
jiangyou
jiangyou
6,544
6,544
anxian
anxian
1,140
1,140
mianzhu
mianzhu
shifang
shifang
778
778
795
795
lixian
lixian
82
82
xiaojin
xiaojin
143
143
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan1,571
155
155dujiangyan
1,571
105
105
3,325
3,325
pixian
pixian
1,804
1,804
chongzhou
chongzhou
w
w
enjiang
346
346 enjiang
dayi
dayi
944
944
183
183
baoxing
baoxing
141
141
lushan
lushan
74
74
30
2004~2007 cumulative number
of other infectious diarrhea cases
2,000 to 6,550
1,000 to 1999
500 to 999
200 to 499
60 to 199
(2)
(3)
(5)
(2)
(9)
songpan
songpan
22
qingchuan
qingchuan
22
pingw
pingwuu
22
heishui
heishui
24
24
beichuan
beichuan
anxian
anxian
11
lixian
lixian
00
xiaojin
xiaojin
jiangyou
jiangyou
77
22
maoxian
maoxian
20
20
mianzhu
mianzhu
shifang
shifang
11
22
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 1
11 dujiangyan
1
44
pixian
pixian
00
chongzhou
chongzhou
w
wenjiang
enjiang
00 00
dayi
dayi00
00
baoxing
baoxing
00
2004~2007 cumulative number
of Kala-azar cases
1 dot = 1case
cumulative number of cases
20 to 30
5 to 19
3 to 4
1 to 2
0
lushan
lushan
00
(2)
(1)
(1)
(9)
(8)
songpan
songpan
00
pingw
pingwuu
qingchuan
qingchuan
00
00
heishui
heishui
00
beichuan
beichuan
maoxian
maoxian
00
jiangyou
jiangyou
11
anxian
anxian
104
104
lixian
lixian
00
xiaojin
xiaojin
00
mianzhu
mianzhu
shifang
shifang
22
22
w
wenchuan
enchuan
pengzhou
pengzhou
00 dujiangyan
dujiangyan 13
13
00
pixian
pixian
00
chongzhou
chongzhou
w
wenjiang
enjiang
243
243 11
dayi
dayi 66
00
baoxing
baoxing
00
lushan
lushan
71
71
31
2004~2007 cumulative number
of Schistosomiasis cases
1 dot= 1case
cumulative number of cases
100 to 243 (2)
20 to 99 (1)
5 to 19 (2)
1 to 4 (4)
0
(12)
songpan
songpan
00
qingchuan
qingchuan
00
pingw
pingwuu
00
heishui
heishui
00
beichuan
beichuan
00
maoxian
maoxian
00
anxian
anxian
33
lixian
lixian
00
xiaojin
xiaojin
jiangyou
jiangyou
11
mianzhu
mianzhu
shifang
shifang
00
00
w
wenchuan
enchuan
pengzhou
pengzhou
00
dujiangyan 00
dujiangyan
00
pixian
pixian
00
chongzhou
chongzhou
wenjiang
enjiang
00w
dayi
dayi
00
00
00
baoxing
baoxing
22
2004~2007 cumulative number
of Leptospirosis cases
1 dot = 1case
cumulative number of cases
61 (1)
3 (1)
2 (1)
1 (1)
0 (17)
lushan
lushan
61
61
songpan
songpan
22
qingchuan
qingchuan
00
pingw
pingwuu
11
heishui
heishui
22
beichuan
beichuan
maoxian
maoxian
11
jiangyou
jiangyou
22
anxian
anxian
00
lixian
lixian
55
xiaojin
xiaojin
00
mianzhu
mianzhu
shifang
shifang
00
00
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 22
11 dujiangyan
11
pixian
pixian
00
chongzhou
chongzhou
w
w
enjiang
enjiang
dayi
dayi
00 00
11
44
baoxing
baoxing
00
2004~2007 cumulative number
of Echinococcosis cases
1 dot= 1case
cumulative number of cases
1 to 5 (11)
0
(10)
lushan
lushan
00
32
songpan
songpan
00
qingchuan
qingchuan
22
pingw
pingwuu
77
heishui
heishui
00
beichuan
beichuan
anxian
anxian
11
lixian
lixian
00
xiaojin
xiaojin
jiangyou
jiangyou
11
12
12
maoxian
maoxian
00
mianzhu
mianzhu
shifang
shifang
22
00
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 18
00 dujiangyan
18
77
pixian
pixian
11
chongzhou
chongzhou w
wenjiang
enjiang
dayi
dayi
22 11
22
11
baoxing
baoxing
00
2004~2007 cumulative number
of Malaria cases
1 dot = 1case
cumulative number fo cases
10 to 18
5 to 9
2 to 4
1
0
lushan
lushan
22
(2)
(2)
(5)
(5)
(7)
songpan
songpan
00
qingchuan
qingchuan
12
12
pingw
pingwuu
22
heishui
heishui
00
beichuan
beichuan
maoxian
maoxian
00
jiangyou
jiangyou
77
anxian
anxian
12
12
lixian
lixian
00
xiaojin
xiaojin
22
mianzhu
mianzhu
shifang
shifang
33
22
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 6
00 dujiangyan
6
11
pixian
pixian
00
chongzhou
chongzhou
w
w
enjiang
enjiang
dayi
dayi
11 00
11
00
baoxing
baoxing
33
2004~2007 cumulative number
of Japanese Encephalitis cases
1dot = 1case
cumulative number of cases
10 to 12
5 to 9
2 to 4
1
0
lushan
lushan
66
33
(2)
(3)
(5)
(3)
(8)
songpan
songpan
00
qingchuan
qingchuan
00
pingwuu
pingw
00
heishui
heishui
00
jiangyou
jiangyou
beichuan
beichuan
22
maoxian
maoxian
00
anxian
anxian
11
lixian
lixian
00
xiaojin
xiaojin
22
mianzhu
mianzhu
shifang
shifang
00
00
enchuan
wenchuan
w
pengzhou
pengzhou
dujiangyan 0
00 dujiangyan
0
00
pixian
pixian
00
chongzhou
chongzhou
enjiang
wenjiang
w
00 00
dayi 00
dayi
00
baoxing
baoxing
00
2004~2007 cumulative number
of Hemorrhagic fever w ith renal syndrome cases
1 dot = 1case
cumulative number of cases
lushan
lushan
1 to 3 (3)
(18)
0
00
songpan
songpan
00
qingchuan
qingchuan
00
pingw
pingwuu
00
heishui
heishui
00
beichuan
beichuan
maoxian
maoxian
00
jiangyou
jiangyou
00
anxian
anxian
00
mianzhu
mianzhu
shifang
shifang
00
11
lixian
lixian
00
xiaojin
xiaojin
00
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 4
00 dujiangyan
4
66
pixian
pixian
22
chongzhou
chongzhouw
w
enjiang
enjiang
44
dayi
dayi
33
33
00
baoxing
baoxing
00
2004~2007 cumulative number
of Rabies cases
1 dot = 1case
cumulative number of cases
lushan
lushan
6
(1)
1 to 5 (6)
0
(14)
00
34
songpan
songpan
00
qingchuan
qingchuan
00
pingw
pingwuu
00
heishui
heishui
00
beichuan
beichuan
maoxian
maoxian
00
jiangyou
jiangyou
00
00
anxian
anxian
00
lixian
lixian
00
mianzhu
mianzhu
shifang
shifang
00
00
xiaojin
xiaojin
w
wenchuan
enchuan
pengzhou
pengzhou
dujiangyan 00
00 dujiangyan
00
pixian
pixian
00
chongzhou
chongzhou
w
wenjiang
enjiang
00
dayi
dayi 00
00
44
baoxing
baoxing
00
2004~2007 cumulative number
of Anthrax cases
1 dot = 1case
cumulative number of cases
4 (1)
0 (20)
lushan
lushan
00
songpan
songpan
31
31
qingchuan
qingchuan
151
151
pingw
pingwuu
247
247
heishui
heishui
72
72
beichuan
beichuan
maoxian
maoxian
70
70
jiangyou
jiangyou
3,288
3,288
anxian
anxian
766
766
mianzhu
mianzhu
shifang
shifang
1,092
1,092
880
880
lixian
lixian
46
46
xiaojin
xiaojin
140
140
w
wenchuan
enchuan
pengzhou
pengzhou
1,610
dujiangyan
dujiangyan1,610
1,155
1,155
pixian
pixian
1,334
1,334
chongzhou
chongzhou
w
wenjiang
enjiang
dayi
dayi
1,386
1,386899
899
379
379
20
20
229
229
baoxing
baoxing
59
59
lushan
lushan
2004~2007 cumulative number
of STD cases
2,000 to 3,290
1,000 to 1999
500 to 999
200 to 499
20 to 199
(1)
(5)
(3)
(5)
(7)
68
68
Remark: STD include syphilis, gonorrhea ,Condyloma Acuminatum, genital herpes and genital tract chlamydia
trachomatis
35