[Medical Relief Response by Miyako Public Health Center after the Great East Japan Earthquake and Tsunami, 2011].

OBJECTIVES: To improve disaster preparedness, we investigated the response of medical relief activities managed by Iwate Prefectural Miyako Public Health Center during the post-acute phase of the Great East Japan Earthquake and Tsunami on March 11, 2011. METHODS: The study divided the post-disaster period into three approximate time segments: Period I (time of disaster through late March), Period II (mid-April), and Period III (end of May in Miyako City, early July in Yamada Town). We reviewed records on medical relief activities conducted by medical assistance teams (MATs) in Miyako City and Yamada Town. RESULTS: Miyako Public Health Center had organized a meeting to coordinate medical relief activities from Period I to Period III. According to demand for medical services and recovery from the local medical institutions (LMIs) in the affected area, MATs were deployed and active on evacuation centers in each area assigned. The number of patients examined by MATs in Miyako rose to approximately 250 people per day in Period I and decreased to 100 in Period III. However, in Yamada, the number surged to 700 in Period I, fell to 100 in Period II, and decreased to 50 in Period III. This difference could be partly explained as follows. In Miyako, most evacuees had consulted LMIs which restarted medical services after disaster, and the number of LMIs restarted had already reached 29 (94% of the whole) in Period I. In Yamada, most evacuees who had consulted MATs in Period I had almost moved to LMIs restarted in Period II. During the same time, a division of roles and coordination on medical services provision was conducted, such as MATs mainly in charge of primary emergency triage, in response to the number of LMIs restarted which reached 1 (20%) in Period I and 3 (60%) in Period II. Following Period III, more than 80% of patients in Miyako had been a slight illness, such as need for health guidance, and the number of people who underwent emergency medical transport reached pre-disaster levels in both locations. These results suggest that demand for medical services of evacuees declined to a stable level in an early stage of Period III. Using the above findings, one might justify supporting local medical institutions' recovery earlier. Then, medical relief activities might be finished properly. CONCLUSION: This study shows useful perspectives in the response of medical relief activities during post-acute phase after disaster and the importance of establishing systems for information management that apply these perspectives.

[Risk of tuberculosis infection among care workers during an outbreak of tuberculosis at a care facility for the elderly].

OBJECTIVES: Owing to limited evidence, the risk of and factors related to tuberculosis (TB) infection among care workers is not understood. We experienced an outbreak of TB with 2 cases of active TB (positive cultures) and 34 cases of latent TB infection at a care facility for the elderly. Using an epidemiological investigation of the outbreak, this study aimed to investigate the risk of and factors related to TB infection among care workers and to establish a system for TB control in care facilities for the elderly. SUBJECTS AND METHODS: The index patient (80-year-old woman; fever for 1.5 months) was diagnosed with TB [bI3: GAKKAI classification, sputum smear (3+)]. We investigated the contacts of the patient. On the basis of the epidemiological investigation, we conducted a contact examination of close contacts, including those of residents and care workers at the care facility and staff at the medical facility to which the patient was referred. Reviewing this information, we compared both the results of the QuantiFERON-TB Gold (QFT-GIT) test and the degree of contact in 10 care workers and 7 nurses who had close contact while providing care services to the patient. RESULTS: The QFT-GIT test was conducted twice: 3 weeks and 11-12 weeks after the last contact with the patient. The number of care workers who tested positive while providing care services to the patient were 3, 0, and 5 according to the contact time of < 20 h, 20 to < 40 h, and 40 to < 60 h, respectively. In addition, one equivocal result was found in the < 20 h group. Equivocal results were noted in 1, 1, and 0 nurses, respectively. Only care workers tested positive using the QFT-GIT test, and one developed active TB. Each of the care workers spent approximately 50 min daily in planned care service to the patient, while each of the nurses spent approximately 20 min for the same. Care workers provided daily care services such as feeding, changing the patient's posture, turning in bed, diaper changing, bathing, and providing a bed bath, and nurses provided services such as the measurement of vital signs, hydration, administration of medication, and exchange of cooling material for lowering body temperature. In addition, care workers had been in contact with the patient while providing care services before the patient developed fever, and nurses initiated contact with the patient for care after the fever developed. With regards to daily health monitoring, the staff of the care facility had not monitored the patient for fever, loss of appetite, and/or weight loss before the fever became apparent. On the basis of these results, we suggest that the risk of TB infection is higher in care workers than in nurses because they work in close proximity (with body contact) with the patient for a longer period of time during the infectious period, including the asymptomatic period. To reduce the risk of TB infection in care workers, it is important to establish early detection systems in care facility residents by improving compliance with TB preventive measures, including routinely conducting closer observation of these health conditions. CONCLUSIONS: The high rate of infection among care workers may have been related to the longer period of close contact while caring for the patient. To reduce such risks, it is important to establish an early detection system for TB preventive measures in care facilities for the elderly.

Coordination by registered dieticians for nutritional and dietary support in disaster in Japan.

PROBLEM: Yamada, a town of Iwate Prefecture in north-eastern Japan, was struck by the tsunami from the Great East Japan Earthquake. In Yamada, it was challenging to manage nutritional and diet support for food aid because these services were unavoidably drawn out for several months in evacuation shelters. CONTEXT: In Japan, food aid in disasters is often provided, divided and distributed erratically due to poor efforts made with regards to dietary support from the perspective of nutrition. The need for nationally registered dieticians to coordinate nutritional and dietary support in evacuation shelters was considered in this disaster. ACTION: A dietary support team was formed of nationally registered dieticians to study the dietary conditions of evacuees in shelters in Yamada and to develop a system to ensure the nutritional and balanced dietary needs of the evacuees. OUTCOME: In this disaster response, model menus were prepared and a menu-food matching system was put in place to order and distribute foods required for balanced meals. Every effort was made to avoid excesses and deficiencies in nutrition; the meals consisted of a staple, main dish, side dish and soup. Along with that, food sanitation and stock management were improved. DISCUSSION: The menu-food matching system put together by the nationally registered dieticians was useful for nutritional and dietary support in this particular disaster. It is recommended that similar nutritional and dietary support coordinated by nationally registered dieticians be considered for disaster management plans where appropriate.