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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.