Outbreak management in disaster has to be planned and implemented prior to, during and after the disaster is over. The risk of outbreaks following disaster is related to the size, health status and living conditions of the displaced population. The risk is increased due standing water in floods for vector borne diseases, overcrowding, inadequate water and sanitation and poor access to health care. The 2006-2007 flood in Johore resulted in 2 episodes of food poisoning and an outbreak of coxsackie A24 acute haemorrhagic conjunctivitis. Only 19,667 (12.5%) of the 157,018 displaced persons suffered from communicable diseases which comprised of acute respiratory disease 7361(28%), skin infection 4241(19%), acute gastroenteritis 1872(8%) and conjunctivitis 589 (2%). The routine disease surveillance and environmental control were enhanced to cover the relief centers and flood areas. Risk assessment of communicable disease carried out resulted in prompt control measures and good coverage of preventive activities. In conclusion the Johore State Health Department has successfully manage the outbreaks during the major flood.
Introduction : The 2006 -2007 flood in Johore which displaced more than 312,386 residents of the state was an extraordinary event and tested everyone preparedness. The disaster caused massive material, economic and environmental losses exceeded the state and local community capacity, forcing them seeks help from other states. Needs assessment, effectiveness of health services as well as leadership and nongovernment organization involvement were evaluated and constitute lessons learnt from the experiences.
Methodology : This is a descriptive review of the Johore flood. The review was based on literature search using established data and published reports of previous disasters. Discussion will focus on the 4 S’s of the surge capacity that is Structure, Staffing, Supplies and System (policies & procedures). Result : Structure- although 49 or 14% of health facilities in the state were affected by the flood, health services continued to be given. Majority of the relief centers were schools with better facilities. Funding for repairs obtained early approval as estimation of damages was timely applied. Temporary isolation centers for the conjunctivitis outbreak was appropriate implemented. Staffing- Leadership was assumed by the Johore State Health Department, the strongest and most prepared health sector. Needs assessment resulted in additional staff being deployed from other states allowing local staff to have their break from work as well as personal stress. Local staff became multi-skilled players. Training in disaster preparedness has to be of utmost priority to support such needs. Supplies- Personnel protective and pest control equipment, and medical supplies were adequately supplied. The laboratory services were well prepared. Pamphlets, posters, buntings and banners were distributed including five new health promotion materials. System- Flood disaster plan of action was well in place resulting in efficient management of the operating rooms, data management, coordination of services and disease surveillance through early warning system.
Conclusion : Public health preparedness is a matter of good governance and management based on evidence and experience. There is a need for a permanent and stable program for the Ministry of Health to prepare and coordinate the response to all disasters.
The state of Johore, Malaysia had been hit by the worst flood in the Malaysian modern history on the 19th December 2006 (first wave) and the 12th January 2007 (second wave) affecting all the eight districts. A total number of 157,018 and 155,368 Johore population had been displaced by the first and the second wave event respectively. The Johore State Health Department activated the Flood Action Plan which include mobilising medical teams to conduct daily clinical examinations on the flood victims and health teams to inspect flood relief centres, food premises and homes at flood-hit areas with regard to prevent and control communicable diseases. The spreadsheet format was used to collect data on diseases, injury and death throughout the Johore flood disaster period starting from the 19th December 2006 until 19th February 2007. Analyses showed that 19,670 flood victims (36.3%) had communicable diseases and 34,530 (67.0%) had non-communicable diseases. As for the communicable diseases and symptoms/syndromes related to communicable disease, 41.3% were acute respiratory infections (ARI) followed by 25.9% skin infections, 19.1% fever, 10.1% acute gastroenteritis (AGE) and 3.0% acute conjunctivitis. Other infectious diseases include 61 notifiable diseases (46 food poisoning, 14 dengue fever and one tuberculosis), 20 leptospirosis (with two deaths), 20 chicken pox and two melioidosis cases. The Batu Pahat district had the highest incidence for the majority of the communicable diseases because of the prolonged flooding period. No cholera, typhoid, malaria, measles or hand-foot-mouth disease (HFMD) cases were detected among the Johore flood victims. Trends of disease incidence follow the number of evacuees placed in the relief centres corresponding to respective wave. A total of 507 flood victims had physical injuries related to flood mostly due to fall onto wet floor at the relief centres. Fifteen deaths due to drowning were mainly caused by accidental fall into the flood water. The incidence of communicable diseases encountered had been appropriately anticipated and managed attributed to enhanced public health control programmes augmented by syndromic and laboratory surveillance on potentialy fatal infectious diseases. Equal emphasis should be given to the surveillance and control of chronic diseases.