Download Countermeasures Against Infectious Diseases in the Disaster

The Great East Japan Earthquake
Countermeasures Against Infectious
Diseases in the Disaster-hit Area
Kotaro Herai
Supervisor for Infectious Disease Control Section,
Health Safety Division,
Bureau of Social Welfare and Public Health
Tokyo Metropolitan Government
1-(1) Overview of the Earthquake
Intensity 7
Upper
Intensity 6
Lower
Intensity 6
Upper
Intensity 5
Lower
Intensity 5
Intensity 4
Intensity 3
Intensity 2
Intensity 1
Epicenter
1-(2) Overview of the Tsunami
Iwate Prefecture
Miyagi Prefecture
Fukushima Prefecture
Legend
Tsunami Alert
Large Tsunami: Higher than 3m at its peak
Tsunami: Higher than 2m at its peak
Tsunami Warning
Around 0.5m at its peak
Epicenter
1-(3) Earthquake and Tsunami Related Damage
Prefecture
Dead
(people)
Missing
(people)
Injured
(people)
Destroyed
(fire) or
Washed
Away(homes)
Partially
Destroyed
(fire)
(homes)
Flooded
(homes)
Iwate
4,664
1,511
188
20,182
4,539
2,084
Miyagi
9,492
2,058
4,008
76,078
92,234
18,255
Fukushima
1,604
237
241
18,182
53,754
401
Other
66
4
1,505
4,262
32,506
4,084
Total
15,826
3,810
5,942
118,704
183,033
24,824
*Based on National Police Agency information as of October 20, 2011.
1-(4) Earthquake and Tsunami Related Damage
30,000
25,000
20,000
15,000
10,000
5,000
0
Iwate
Miyagi
Dead （people）
Fukushima
Missing （people）
Other
Injured （people）
Total
(People)
1-(5) Earthquake and Tsunami Related Damage
350,000
300,000
250,000
200,000
150,000
100,000
50,000
0
Iwate
Miyagi
Destroyed（fire）or washed away（homes）
Flooded（homes）
Fukushima
Other
(Buildings)
Total
Partially destroyed（fire）or washed away（homes）
2-(1) Overview of the Earthquake and Tsunami in Miyagi
Prefecture
○Occurred: Around 2:46 p.m. March 11, 2011
○Epicenter Location: Off the Sanriku Coast (depth at seismic center: 24km)
○Scale: Magnitude 9.0
○Max. Seismic Intensity: 7 (Kurihara City, Miyagi Prefecture)
○Tsunami:
・As announced by the Sendai District
Meteorological Observatory:
Utatsu
Ayukawa, Ishinomaki City: Over 8.6m
Kurihara City
Port of Sendai: 7.2m
Shizugawa
Onagawa Fishing Port
*Reference (Research Group Estimates)
Shizugawa, Minamisanrikucho: 15.9m
Onagawa Fishing Port: 14.8m
Utatsu, Minamisanrikucho: 14.7m
Port of
Sendai
Ayukawa
*Compiled based on meeting documents from Miyagi Prefecture’s Disaster Response Headquarters
2-(2) Loss of Life Near Epicenter (Miyagi Pref.)
Kesennuma City
(Pop. 73,279)
Cities and Towns with More Than 500 Dead
Dead: 1,014
Kesennuma City
Missing: 392
Kurihara City
Sendai City (Pop. 1,046,902)
Tome
City
Dead: 704
Kami-machi
Missing: 26
Osaki
City
Minamisanrikucho
Minamisanrikucho
(Pop. 17,382)
Dead: 558
Wakuyacho
Misatomachi
Shikamacho
Ohiramura
Missing: 343
Ishinomaki City
Higashimatsuyama
City
Osatocho
Matsushimamachi
Tomiyamachi
Rifucho
Onagawacho
Taiwacho
Natori City (Pop. 73,576)
Dead: 911
Sendai
City
Missing: 72
Kawasaki
machi
Murata
machi
Zaomachi
Shibatamachi
Shichikashuku
machi
Yamamotocho( Pop. 16,633)
Shiroishi
City
Ogawara
machi
Kakuda
City
Marumorimachi
Dead: 670
Missing: 20
Shiogama City
Tagacho
City
Natori
City
Iwanuma
City
Wataricho
Yamamotocho
Shichirigahamamachi
Higashimatsushima City
(Pop. 42,859)
Dead: 1,044
Missing: 94
Onagawacho (Pop. 9,965)
Dead: 565
Missing: 411
Ishinomaki City
(Pop. 160,336)
Dead: 3,170
Missing: 759
*As of September 13, 2011.
*Compiled based on meeting materials from Miyagi Prefecture’s
Disaster Response Headquarters and the Miyagi Prefectural
Government’s website
2-(3) Number of Evacuees (Miyagi Pref.)
人・戸
People
/ Homes
Homes without power
停電戸数
Applicable homes which
都市ガス復旧対象残数
utility gas has yet to be restored
Evacuees
避難者数
700,000
Electricity
600,000
500,000
Peak evacuees
400,000
320,885人
300,000
200,000
100,000
231,248人
210,500人
Utility gas
(Sendai-shi)
Number of evacuees declining
102,058人
38,875人
32,854人
70,020人
45,078人
27,753人 23,532人17,573人
16,000人
11,966人 8,690人
6,711人
3,711人
2,611人
0
3/12
3/14
3/16
3/18
3/25
4/1
4/11
4/16
4/21
4/28
5/4
5/11
5/18
5/25
6/1
6/8
6/15
6/22
6/29
7/6
7/13
7/20
7/27
8/3
8/10
8/17
8/24
8/31
9/7
9/13
*Compiled based on meeting materials from Miyagi Prefecture’s Disaster Response Headquarters, the Miyagi Prefectural Government’s website and Tohoku
Electric Power Company’s website.
2-(4) Temporary Emergency Housing (Miyagi Pref.)
Homes
戸
25,000
20,000
15,000
10,000
5,000
0
3/24 4/1
4/8 4/16 4/23 4/30 5/12 5/19 5/26 6/6 6/15 6/22 6/29 7/6 7/20 8/3 8/11 8/24 9/7
着工戸数 1,110 2,402 4,385 6,530 9,004 11,30 12,73 13,90 14,93 15,85 17,10 17,73 18,66 21,76 22,51 22,05 22060 22050 22042
1,312 3,081 5,164 7,604 11,17 12,11 12,87 13,92 14,83 16,49 17,27 18682 19767 20764
完成戸数
Construction
着工戸数
work
Housing completed
完成戸数
started
*Compiled based on meeting materials from Miyagi Prefecture’s Disaster Response Headquarters
2-(5) TMG Assistance
・Physical support
・Material support
・Cremation assistance
・Enhanced transport
structure for relief supplies,
etc.
3-(1) Risk Assessment of Infectious Diseases in the
Disaster-hit Areas



People in disaster-hit areas were forced to live
communally in shelters (resulting in a new risk for the
spread of infectious diseases).
Taking this into account, the National Institute of
Infectious Diseases presented its approach to an
“infectious disease risk assessment.”
Based on this, the National Institute of Infectious
Diseases recommended the need for close monitoring of
infectious diseases with a relatively higher risk of
spreading in disaster-hit areas and shelters.
3-(2) Infectious Disease Risk Assessment
①地域・避難所で
1.Potential to
流行する可能性の
spread locally
and in shelters
評価
2. Consequence
②公衆衛生上の
to public health
重要性の評価
3. Risk
③リスク評価
assessment
Opportunities for
Transmission
Transmission Risk
Status
Immunization Rate
Few
Settled
High
Some
Worsened in certain
areas
High, but some susceptible
individuals present
Many
Worsened overall
No immunizations or vaccines
Category
Prevalence Rate / Fatality Rate
1 (Low)
Low
2 (Medium)
Higher than acceptable levels
3 (High)
High
Low risk
Medium risk
High risk
Consequence
to public health
Potential to spread
locally and in
evacuation centers
3-(3) Risk Assessment Chart
Potential to
Spread in
Disaster-hit
Areas and
Shelters
Public Health
Consequence
Risk Assessment
Comment
Acute Diarrheal
Illness
３
２
３
Reports of occurrences in
shelters
Acute Respiratory
Tract Infection
３
２
３
Reports of occurrences in
shelters
Influenza / Influenzalike Illness
３
３
３
Reports of occurrences in
shelters
Measles
２
３
３
*Recognized case where a
journalist spending time in the
disaster-hit zone contracted the
disease
Tetanus
２
３
３
Reports of cases related to the
earthquake disaster
3-(4) Cases of Infectious Gastroenteritis Post-Quake (Miyagi
Pref.)
*The Great East Japan Earthquake struck in the 10th week
11th week (3/14) to 20th week (5/22) of 2011
Infectious Gastroenteritis
Kurihara
21st week (5/23) to 30th week (7/31) of 2011
Infectious Gastroenteritis
Kurihara
Kesennuma
Tome
Kesennuma
Tome
Osaki
Osaki
Ishinomaki
Sendai
Sennan
(c)Miyagi Prefectural Institute of
Public Health and Environment
Ishinomaki
Shiogama
Shiogama
Sendai
All of Miyagi
Prefecture
Number of cases per fixed-point
surveillance medical institution (people)
Sennan
(c)Miyagi Prefectural Institute of
Public Health and Environment
All of Miyagi
Prefecture
Number of cases per fixed-point
surveillance medical institution
(people)
3-(5) Cases of Influenza Post-Quake (Miyagi Pref.)
*The Great East Japan Earthquake struck in the 10th week
11th week (3/14) to 20th week (5/22) of 2011
Influenza
Kurihara
21st week (5/23) to 30th week (7/31) of 2011
Influenza
Kurihara
Kesennuma
Tome
Kesennuma
Tome
Osaki
Osaki
Ishinomaki
Sendai
Sennan
(c)Miyagi Prefectural Institute of
Public Health and Environment
Ishinomaki
Shiogama
Shiogama
Sendai
All of Miyagi
Prefecture
Number of cases per fixed-point
surveillance medical institution (people)
Sennan
(c)Miyagi Prefectural Institute of
Public Health and Environment
All of Miyagi
Prefecture
Number of cases per fixed-point
surveillance medical institution
(people)
3-(6) Epidemic Situation of Infectious Diseases in
Japan (Infectious Gastroenteritis)
Infectious Gastroenteritis
*Including cases reported as “children’s vomiting and diarrheal illnesses” up to March 1999
Number of reports per fixed-point surveillance medical institution
:
Week
*The Great East Japan Earthquake struck in the
10th
week
2011
3-(7) Epidemic Situation of Infectious
Diseases in Japan (Influenza)
Influenza
Number of reports per fixed-point surveillance medical institution
:
Week
*The Great East Japan Earthquake struck in the
10th
week
2011
3-(8) Occurrence of Tetanus Cases (Miyagi Pref.)
Week
Occurrences
11th
1
12th
1
13th
2
14th
1
15th
0
16th
0
17th
0
18th
0
19th
1
20th and after
0
破傷風
Tetanus
5
4
3
2
1
0
第11週
11th Week
th Week
14第14週
第17週
17th Week
第20週以降
20th Week and After
Cases
発生数
In Japan:
・DPT vaccines are given a total of 4 times to build basic immunity. 3
times between the age of 3 months and 7 years 6 months, and once
one year after the 3rd vaccination.
・Additional immunity is provided with a single DT vaccination provided
between the age of 11 and 12.
4-(1) Increased Surveillance at Shelters
Health consultations
and visits performed
by physicians and
public health nurses
Raised awareness
about preventative
measures, such as
hand washing, gargling
and coughing etiquette.
Surveillance
implemented in
shelters
4-(2) Shelter Surveillance
Weekly Report
Public Health
Center
FAX
FAX
FAX
Health Volunteers
Shelters
Cough XX persons
Diarrheal XX persons
Fever
XX persons
：
Detection
of
outbreak
Purpose: To ascertain
occurrences of infectious
diseases prone to shelters and
quickly detect mass outbreaks.
 Performed surveillance by
signs and symptoms, not by
disease name.
 Reported by health volunteers,
not by healthcare practitioners.
 Sent via fax not over the
Internet.
Critical to secure health
volunteers that can make
prompt and accurate reports.
4-(3) Flow of Shelter Surveillance Information
Flow of Shelter Surveillance Information
Shelter
Purpose of this surveillance program: For use in
public health response to preventing illnesses and
their spread
Signs and
symptoms
Information
collection
Data registration
Public health measures
implemented by local
governments, etc
Data
shared
Shared with
local
governments,
etc.
Data
analysis
Infectious Disease
Surveillance Center
Data collection
4-(4) Shelter Surveillance Map
Digestive
symptoms
Respiratory symptoms (excluding
Influenza)
Increase in cases
Influenza
Rash accompanying a fever
People
4-(5) Actual Conditions of Shelter Surveillance



Not sufficient information was obtainable because many
of the medical institutions that normally report fixed-point
surveillance data were damaged in the disaster.
Given the huge number of shelters, a system was set up
to utilize permanent staff from these shelters as health
volunteers to identify those exhibiting symptoms. In this
regard, a call was made for cooperation.
Even if electronic devices and specialized medical
services are not available, a surveillance program could
be initiated by those with the basic knowledge of
epidemiology of infectious diseases. This could be
possible even when medical infrastructure was damaged
by the disaster.
4-(6) Challenges and Solutions in Shelters from a
Infectious Disease Countermeasure
Perspective

Epidemic season for the
norovirus and influenza, etc.

Large numbers of evacuees
living communally in confined
spaces.
Unsanitary conditions found in
facilities, such as restrooms,
etc.

Countermeasures against source of
infections

Quick detection of occurrences

Quarantine of people exhibiting symptoms

Hygiene control of food
Countermeasures against transmission
routes

Ensure sound interior environment by
ventilating air, etc.

Ensure proper environment for hand
washing

Sanitary control of restrooms
Countermeasures for susceptible

People’s physical and mental
strength decreases in the
aftermath of the disaster.



individuals
Nutrition management
Mental care
Protective inoculations
5-(1) Earthquakes and Infectious Disease (Japan)
Year
1923
1948
1995
2004
Earthquake
Deaths
Occurrence of Infectious Disease
Great Kanto
Earthquake
105,385
Increase in rabies cases the following
year.
Fukui Earthquake
Great HanshinAwaji Earthquake
Niigata Chuetsu
Earthquake
3,769
No particular occurrences noted.
6,434
No particular occurrences noted.
68
No particular occurrences noted.
5-(2) Earthquakes and Infectious Disease (World)
Year
Earthquake
1999
Taiwan
Earthquake
2004
Sumatra
Earthquake
2008
2010
Sichuan
Earthquake
Haiti Earthquake
Deaths
Occurrence of Infectious Disease
2,415
Increase in reported respiratory illnesses.
Otherwise, no particular occurrences
noted.
227,898
Increase in diarrheal illnesses in certain
areas. Otherwise, no particular
occurrences noted.
87,000
Trauma patients experiencing
complicated symptoms of gas gangrene
occurred on a several tens of thousands
of people scale.
Over
220,000
Cholera outbreak with 270,000 infected,
Led to 4,700 deaths.
5-(3) Future Challenges




Establish infectious disease countermeasures
for situations when logistics and lifelines are cutoff.
Provide support to public health activities and
information sharing in disaster-hit areas and
emergency rescue teams.
Improve surveillance system for infectious
diseases.
Secure channels of communication during an
emergency.
6 Wrap-up



Japan experienced an unprecedented natural
disaster in the Great East Japan Earthquake and
ensuing tsunami.
With serious secondary and even tertiary
damage, such as the nuclear power accident
caused by the tsunami, a long-term support is
required.
Although a large-scale infectious disease
epidemic did not occur, we need to keep
relevant records from this disaster to utilize in
future countermeasures.
Tokyo Sky Tree
Thank you very much.