U.N., WHO assess Haiti's health risks, needs after earthquake

United Nations officials have stressed the need for a strongly coordinated effort to bring vital assistance to the roughly 3 million people affected by last week’s earthquake in Haiti, amid the devastated infrastructure and logistical challenges in the wake of the disaster.

Secretary-General Ban Ki-moon, who has traveled to the quake-struck capital of Port-au-Prince, stressed the need to unplug any bottlenecks in the aid operation to ensure that the relief reaches people in need as quickly as possible.

“Help has been arriving. More is coming in. But for those who have lost everything, I know that aid cannot come soon enough,” he told reporters at the U.N. headquarters in New York, adding that the most important challenge is coordination of the relief effort.

The 7.0-magnitude quake Jan. 12 has left one third of the country’s 9 million people in need of food, water, shelter, medical assistance and other urgent aid.

“This disaster ranks among the most devastating and logistically challenging in recent history,” said Margaret Chan, director-general of the World Health Organization. “We are seeing the difficulties that arise when disaster strikes an already disastrous public health situation.”

She noted that many of the problems that agencies try to prevent after a disaster were already present in Haiti, including diseases associated with poor water and sanitation systems, low immunization coverage and widespread malnutrition.

On Jan. 18, the WHO released a public health risk assessment to provide health professionals in U.N. agencies, nongovernmental organizations, donor agencies and local authorities working with populations affected by the emergency in Haiti, with up-to-date technical guidance on the major public health threats faced by the earthquake-affected population.

The assessment addressed a wide range of issues, including the need for vaccinations.

“Public health threats represent a significant challenge to those providing health-care services in this evolving situation. It is hoped that this risk assessment will facilitate the coordination of activities between all agencies working among the populations currently affected by the crisis.”

Wounds and injuries are numerous not only because of the earthquake and its aftershocks, but also because of the subsequent rescue and cleanup activities.

Risk of wound infection and tetanus are high, the WHO says, because of the difficulties with immediate access to health facilities and delayed presentation of acute injuries.

Low vaccination coverage among 1-year-old children and waning tetanus immunity in adults increases the likelihood of morbidity and mortality from tetanus.

“Patients should systematically receive prophylactic antibiotics and tetanus toxoid vaccine if non-immune, together with tetanus immune globulin if the wound is tetanus-prone.”

The WHO also noted that population displacement can result in overcrowding in resettlement areas, raising the risk of transmission of certain communicable diseases that are spread from person to person through respiratory droplets such as measles, diphtheria and pertussis.

However, measles infection has not been confirmed in Haiti since 2001.

The WHO recommended that a mass vaccination campaign be waged for measles/rubella, and tetanus immunization as part of wound care.

Measles and rubella vaccinations are recommended for all people 6 months to 35 years old who are displaced and living in crowded conditions. Also, all emergency public health personnel should be routinely vaccinated against measles and rubella, regardless of age.

The WHO says that when the situation stabilizes, routine vaccinations offered by the national immunization program should be made available to all infants, pregnant women and other people as part of the provision of basic emergency health care services.

Recommendations for hepatitis A vaccination in outbreak situations vary according to the epidemiology of hepatitis A in the community, and the feasibility of rapidly implementing a widespread vaccination program. The use of hepatitis A vaccine to control communitywide outbreaks has been most successful in small, self-contained communities, when vaccination is started early in the course of the outbreak, and when high coverage of multiple-age cohorts is achieved.

Vaccination efforts should be supplemented by health education and improved sanitation.