A tsunami after-action report: active disease surveillance in tsunami affected areas, southern Thailand, December 2004-February 2005

Background: On December 26, 2004, the Indian Ocean Tsunami affected 6 provinces of Southern Thailand and caused 5,078 deaths, 8,457 injured and 3,716 missing. The National disease surveillance was interrupted. Post-disaster had many epidemic prone diseases and there was no preparedness plan for this event. The objectives of the surveillance was to 1) identify epidemic prone disease and act as an effective early warning system and 2) initiate immediate investigations and timely interventions. Objective: The purpose is to describe the surveillance system that was implemented and findings from the implementation of the surveillance system. System establishment and implementation: The system covered all affected areas in 20 districts of 6 provinces. For 6 provinces, there were 5 teams of Surveillance and Rapid Response Team (SRRT) that were well trained. Each team composed of medical epidemiologists and health professionals from local, regional and central level. The data collecting sites included public and private medical facilities, shelters for displaced people, forensic identification centers and medical laboratories. The definitions of diseases were based on clinical criteria applied by local physicians. The definition of the outbreaks depended on the diseases and clusters of cases, time and place distribution. Logistics were supported by central and regional level. Laboratory testing was supported by regional laboratory centers and National Institute of Health. The data collecting forms were designed as aggregated data. Data were reported daily via E-mail, facsimile and telephone to local and central level. There was no routine surveillance data at that time because the system was directly and indirectly affected from tsunami. Results: There were 24 diseases of six syndromes under surveillance. During 6 weeks of system establishment, the system reported 4,816 cases. The most common of which was diarrhea (68%), followed by wound infections (8%) and pneumonia (5%), respectively. 11 deaths and 7 outbreaks were reported. Conclusion: The surveillance system achieved all objectives. Individual records should be implemented instead, data quality should be improved and long-term outcomes should be followed up. The public health significance of the study is the surveillance provide the suggestion for the active disease surveillance and the public health preparedness plan