Report of the visit of NICD team to Reang Refugee Camp, Kanchanpur subdivision, North Tripura district, Tripura State
( 17-22 July 2002)
Executive Summary
1. A team from NICD visited the Reang Refugee Camp in Kanchanpur subdivision of North Tripura district, Tripura State during the period 17-22 July 2002.The visit was made to conduct epidemiological investigation following the reports of unusual increase in the number of deaths in Reang Refugee Camp.
2. Reang Refugee Camps are situated in Kanchanpur subdivision of North Tripura district. These camps are in six places with a total population of 31,094. Out of six camps, two camps namely Kashirampur (Naisingpara) with a population of 16,447 and Longtraikami (Asapara) with a population of 5523 were mainly affected.
3. A total of 103 deaths due to acute bloody diarrhea were reported from these two camps during the period 1st May 2002 to 20th July 2002. The maximum numbers of deaths were reported during the first fortnight of June 2002. However, now the number of deaths had reduced in both the camps.
4. A total of 8258 cases of Acute diarrohea and bloody diarrhea were notified by the medical teams visiting the camps during the period 1st May 2002 to 20th July 2002. During this period, 1113 cases were hospitalized in temporary day care hospitals setup in both the camps. The active cases of Acute Bloody diarrhoea were still observed in the camps but their number had reduced.
5. The team carried out rapid survey of both the camps covering 168 families with a population of 941. The survey revealed that a total of 256 cases had bloody diarrhea during the period 1st May to 20th July 2002 giving an attack rate of 27.2% during the said reference period. The clustering of cases was observed in 37.5% of the families.
6. The detailed case investigation of 15 families (where recent deaths has occurred or active case was present) was carried out by the team .The symptomatology in majority of the cases was passing of large amount of blood and mucus with small amount of stool, fever and abdominal cramps. The duration of illness in most of the cases varied from 3-7 days. The disease affected all the age groups and both sex with slight preponderance in under five years age group.
7. The environmental health assessment of both the camps was carried out by reviewing the water supply system and sanitary disposal system in the area. In these camps, people were using water from hand pumps and stream of water flowing in the mountains. Most of the people in the camp had open toilet near their houses.
8. The team collected thirteen stool and rectal swabs specimen from active cases of acute bloody diarrhea and six water samples from different environmental sources for laboratory analysis. Out of 13 samples, three samples were found positive for Shigella dysenteriae Type A1 and one of these was also positive for Vibrio Cholera o1( ogawa). Further antimicrobial sensitivity of isolated pathogens showed sensitivity to Amikacin and resistant to most of the common antimicrobials.Out of six water samples tested by H2s strip test and coliform count, two samples were found to be unsatisfactory.
9. The clinical, epidemiological and laboratory findings indicate the cause of outbreak as Acute Shigellosis resistant to common antimicrobials and transmitted mainly through person to person transmission due to poor sanitary practices in the refugee camps.
10. The team suggested the following measures for control of outbreak in the refugee camps
a) Creation and maintenance of sanitary latrines in the Refugee camps and ensuring their utilization by the community.
b) Provision of adequate and potable supply of drinking water in the refugee camps.
c) Creation of temporary hospitals with round the clock medical help in these camps to reduce mortality and morbidity in the camps.
d) The cases of acute bloody diarrhea may be treated by antimicrobials like Amikacin and ORS powder.
e) IEC in the area to promote careful handwashing with soap and water as an important control measure to decrease transmission rate in the community .
Strengthening of surveillance of acute diarrheal diseases with monitoring on a daily basis. This is to be continued at least for two weeks after the last case of acute bloody diarrhea notified in the area. The daily monitoring for acute diarrheal diseases should also be initiated in other four refugee camps for detecting early warning signals of any outbreak in Refugee camps.