Wound Infections in Repatriated Survivors of the Tsunami Disaster

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Author(s): 
Geertruid M.H. Marres, MD;1 Dylan W. de Lange, MD;2 Luke P.H. Leenen, MD, PhD, FACS;1 Andy I.M. Hoepelman, MD, PhD2

On December 26, 2004, a strong earthquake off the west coast of northern Sumatra triggered a devastating tsunami that hit 8 countries in south Asia, southeast Asia, and east Africa. The tsunami disaster caused more than 280,000 victims, and many of the survivors subsequently died from infection. Measles, diarrhea, viral hepatitis, acute respiratory infections, malaria, and malnutrition are the main causes of death in complex emergencies.1,2 Usually, epidemics of other infectious diseases are expected,1,2 but in this case, only a few cases (clusters) of various communicable diseases were reported, and no major outbreaks were reported.3 Patients who survived the disaster were often severely injured, and the incidence of wound infections was high.4,5 Several reports appeared in the medical literature, on the Internet, and in the lay press of patients being at risk of deadly fungal infections and infections caused by waterborne and highly resistant pathogens.6–8 These reports were based on 1 or 2 repatriated patients and raw data from the Thai Ministry of Public Health regarding the results of cultures taken from 33 patients in Phuket during a surveillance program.9 A report on a group of 17 victims repatriated to Germany and a recent article about a large retrospective survey in Thailand provided more detailed information on culture results and resistance patterns in larger groups of tsunami victims.8,10
In the Netherlands, a Major Incident Hospital was established in the early 1990s during the first Gulf War. The facility is also used as a quarantine unit for repatriated groups of injured Dutch patients as well as a first response unit for (pan)epidemic outbreaks of infectious diseases. On January 1, 2005, 5 days after the tsunami disaster, 23 Dutch tsunami victims were admitted to this hospital. In this report, the authors describe the wound infections, causative organisms, and resistance patterns found in these patients with 6- to 8-month clinical follow-up.

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