Department of Health
PUBLIC HEALTH ALERT
Please immediately bring to the attention of all doctors

31 December 2004

ADVICE FOR MEDICAL PRACTITIONERS TREATING PEOPLE WHO HAVE RETURNED FROM EARTHQUAKE / TSUNAMI AFFECTED COUNTRIES

Disruption of sanitation, food, and water supplies in regions affected by the recent disaster in the Asian region will have led to high risk of exposure to infectious diseases. It is important that medical practitioners think about the possibility of infectious diseases not frequently encountered in Australia and consider the possibility of these diseases in people who become unwell after returning from Tsunami affected countries.

It is essential that a clinical history including travel exposure is provided to diagnostic laboratories when microbiological tests are ordered.

Unusual conditions that might be encountered include:

• Typhoid and Paratyphoid fever: Incubation period 1 day - 1 month.

• Cholera: Incubation period a few hours - 5 days.

• Melioidosis: Incubation period a few hours – 5days

• Amoebiasis: Incubation period days to months (may be years)

• Malaria: incubation period variable, usually between 7 and 30 days.

• Dengue fever: incubation period usually 3 - 14 days.

• Hepatitis A: Incubation period 15 - 50 days.

• Hepatitis E: Incubation period 15 - 64 days.

• Pneumonia caused by typical pathogens or unusual environmental organisms following inhalation of water.

• Wound infections with unusual agents such as Vibrio, atypical mycobacteria.

• Leptospirosis: Incubation period 4 - 19 days.

Be aware that diagnostic laboratories may not routinely perform tests for some of these infections.

Please consider the following when ordering diagnostic tests:

• Take blood cultures in all patients with fever, (including patients with diarrhoea) in addition to any specific tests.

• Send stool for micro, culture and sensitivity and examination for ova, cysts and parasites in any patient presenting with diarrhoea.

• Send sputum for bacterial, fungal, and mycobacterial culture if pneumonia occurs.

• Send swabs for micro, culture and sensitivity from all infected wounds, particularly if there has been contamination by sea or dirty water; include this information in the history provided to the laboratory.

• Consider the need for rabies prophylaxis in travellers who have suffered animal bites or scratches while overseas.

• Consider tetanus boosters in patients who have wounds.

Dr Jane Raupach - Acting Director, Communicable Disease Control Branch
Contact telephone number: 8226-7177 (24 hours/7 days)