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Final Issue: Volume 16 Number 51
Published on: 21 December 2006
Final Issue in PDF
Last updated: Volume 15, No.2 (PDF file, 374 KB)
Following the tsunamis that struck several Asian and east African countries on 26 December 2004, (1) the World Health Organization (WHO) together with the international community, aid agencies, and local Ministries of Health are continuing to co-ordinate the relief effort. Over 150,000 people were killed and there are still approximately three to five million people who lack access to the basic life essentials. At the same time, efforts are beginning to plan the rehabilitation and reconstruction of communities and their basic infrastructures, which have been destroyed or seriously damaged. Surveillance of infectious diseases as well as maintaining access to health care and public health facilities are some of the main health priorities for those involved in the relief effort. No major disease outbreaks have yet been reported, although sporadic cases of diarrhoea, acute respiratory illness, viral fevers, measles, and wound infections have been reported from India, Indonesia, Maldives, Sri Lanka, and Thailand. The latest situation updates are available from the WHO website at <http://www.who.int/hac/crises/international/asia_tsunami/sitrep/en/>.
The Foreign and Commonwealth Office are continuing to advise people not to travel to tsunami-affected areas unless absolutely necessary <http://www.fco.gov.uk/servlet/Front?pagename=OpenMarket/Xcelerate/
ShowPage&c=Page&cid=1007029390590>.For those intending to travel to affected areas, country-specific pre-travel advice for countries most affected by the disaster (ie, India, Indonesia, Malaysia, Maldives, Sri Lanka, and Thailand) is available from the National Travel Health Network and Centre (NaTHNaC) website at <http://www.nathnac.org/healthprofessionals/tsunami.html>.
Antibiotic resistance has been documented in various microorganisms circulating in India and southeast Asia, such as Salmonella spp (Typhi and non Typhi), Vibrio cholerae, Shigella spp, other Enterobacteriaceae, Pseudomonas auruginosa, and Acinetobacter spp). Travellers who have been either directly affected by the tsunamis or involved in the relief effort may in some circumstances be exposed to such microorganisms. Health professionals and microbiologists should be alert to the travel history of the returning patient and, if they suspect failure to respond to empiric therapy, should obtain a relevant specimen for microbiological examination. Screening procedures and guidance on recommended treatments for antibiotic resistant organisms are available on the Health Protection Agency’s website at <http://www.hpa.org.uk/infections/topics_az/travel/current_items/tsunami_amr_probs_gastro.htm>.
All the above information and advice for travellers and health professionals can be accessed through the main tsunami page on the Health Protection Agency’s website at <http://www.hpa.org.uk/infections/topics_az/travel/current_items/tsunami_adv.htm>.
Based on epidemiological and community derived virological surveillance, influenza A is now circulating in the community. As a result, the Department of Health have issued the a statement, which includes guidance from the National Institute of Clinical Excellence (NICE) on the use of antiviral drugs for the prevention or treatment of influenza. This recommends that doctors should consider the prescription of the antiviral agents zanamivir and oseltamivir for suitable patients in all regions of England (1).
In the week ending 09 January 2005, the overall general practitioner (GP) consultation rate for influenza-like illness in England, reported by the weekly returns service of the Royal College of General Practitioners (RCGP) increased to 41/100,000 (based on a survey population of 572,164) with rates of 62, 39 and 30/100,000 in the RCGP northern, central, and southern regions of England respectively. This national rate crosses the new ‘baseline’ threshold of 30/100,000 that was introduced in October 2004 (2). An increase in the number of influenza A isolates of both (H3) and (H1) subtypes have been reported from all regions of England over recent weeks.
Recommendations on the prescription of the antiviral neuraminidase inhibitors, oseltamivir and zanamivir, apply when influenza is known to be circulating in the community. They are triggered when the Health Protection Agency (HPA) advises that influenza viruses are circulating, when the RCGP indicates that new GP consultation rates for influenza–like illness in England have risen above the baseline of 30/100,000, and when community based influenza surveillance schemes indicate that levels of influenza activity have risen above baseline levels.
1.Department of Health. Guidance on the use of antiviral drugs for the prevention of influenza - NICE guidance notes on prescribing antiviral drugs. London : Department of Health, 2005. Available at:
2.Goddard NL, Kyncl J, Watson JM. Appropriateness of thresholds currently used to describe influenza activity in England . Commun Dis Public Health 2003; 6 :238-45.
Since December 2004 both the CDR Weekly and Health Protection Agency (HPA) website search engines have been substantially improved. Both search engines are now powered by the Google search engine, with the major advantage that you can now search content for both the CDR Weekly and the HPA websites separately. This new improved search functionality also helps users find public health information in a more timely fashion, due to the higher specificity and accuracy of search results than was previously available .
For those users searching/browsing the HPA website we have also created an advanced search page that allows searches on both sites: <http://www.hpa.org.uk/search/default.htm>. Users can further increase the accuracy of their searches by adding operators that fine-tune their own keywords. Google supports several advanced operators, which are query words that have special meaning to Google. Further details on refining your search are available from the Google website at: <http://www.google.com/help/refinesearch.html>.
For any further enquires or comments regarding either the CDR Weekly or HPA websites: please contact, <firstname.lastname@example.org>.