March 25, 2005 Page 1 of 8

Tsunami Disaster: Health Information for Humanitarian 

Workers 

According to the World Health Organization (WHO), countries affected by the December 26, 2004, 

earthquake that occurred off the west coast of Indonesia and the subsequent tsunamis (Indonesia, Sri

Lanka, Maldives, India, Thailand, Malaysia, Bangladesh, Burma (Myanmar), Tanzania, Seychelles, Kenya,

and Somalia) are reviewing their situations and focusing on long-term plans for infrastructure rebuilding 

and rehabilitating their health systems. 

While no large-scale disease outbreaks related to the disaster have been reported, infectious diseases 

such as malaria are endemic in many of the affected countries and may especially pose a risk for persons 

working in areas directly impacted by the disaster and in temporary camps for displaced persons. For a 

situational update by country, see http://w3.whosea.org/index.htm. 

For most of these countries, the U.S. Department of State has rescinded its travel advisories related to the 

earthquake and tsunami; the exception being Indonesia, see http://travel.state.gov/. However, security 

warnings may still be in effect that you should be aware of before you travel. Consult the DOS website for 

the latest information about public announcements and travel warnings. Some of the governments of the 

affected countries may also restrict access to certain areas because of health or security concerns. 

Risks and Health Recommendations 

Because of their potential exposures to impacted areas and people, humanitarian workers are at greater 

risk than tourists or business travelers for developing illness and injuries. It is also essential that workers 

receive all possible support to ensure that they remain healthy during their deployment. These workers 

should also pay special attention to their mental health needs before, during, and after their time in the 

field. This notice provides additional advice specific to the needs of humanitarian workers. 

Significantly decreased levels of health services may be available in impacted areas; therefore, pre-travel 

health preparations are important. Ideally, you should consult a health-care provider 4 to 6 weeks before 

travel. Even if it is less than 4 weeks before you are scheduled to leave, and even if you anticipate

imminent travel (e.g., within 24 hours), you should still see your own doctor or schedule an urgent

appointment through your organization's occupational health services. If you are pregnant, you should 

avoid travel to affected areas, especially areas where malaria exists 

(http://www.cdc.gov/travel/pregnant.htm) because of increased health risks to both you and your unborn 

child.

• Immunizations Some of the vaccines listed below (polio, influenza, typhoid, measles) require a 

single dose and can be given at the same visit. Some vaccine schedules can be accelerated. All 

travelers to affected areas should be sure their routine immunizations are up to date 

(tetanus/diphtheria, polio, measles). Because infections and disease outbreaks are more likely 

following disasters, the following vaccines are recommended: 

• Tetanus/diphtheria vaccine or booster, if the most recent vaccine or booster was 5 years ago or 

more. 

• Hepatitis A even if travel is imminent
Tsunami Disaster: Health Information for Humanitarian Workers 

 (continued from previous page) 

March 25, 2005 Page 2 of 8

• Hepatitis B for optimal protection, ideally vaccination should begin at least 6 months before travel 

so that the full vaccine series can be completed. Because some protection is provided by one or 

two doses, the vaccine series should be initiated, even if it cannot be completed 

• Influenza injectable vaccine if you will be working directly with populations affected by the 

tsunami. If you are not working directly with populations affected by the tsunami, you can receive 

live attenuated influenza vaccine. This vaccine is available for most healthy persons 5-49 years of 

age who are not pregnant; see http://www.cdc.gov/nip/publications/acip-list.htm. 

• Typhoid (oral or injectable) 

• Polio if you have not had a booster since childhood. 

• Measles if you are not immune. Immunity can be assumed if you have documentation of measles 

diagnosed by a physician, laboratory evidence of measles immunity, proof of receipt of two doses 

of live measles vaccine on or after your first birthday, or you were born before 1957. However, 

measles or MMR vaccine can be given to travelers who might be susceptible. 

• Rabies is endemic throughout the tsunami-affected areas. Exposure to animal bites, most notably 

from dogs in resource-poor countries, poses a risk for rabies 

(http://www.cdc.gov/travel/diseases/rabies.htm). Proper administration of the rabies pre-exposure 

series (days 0, 7 and 21 or 28) requires at least 3 weeks to complete. Although risk of exposure to 

stray animals may be increased in countries affected by the tsunamis and thus increased risk of 

exposure to rabies, there would be little to no value in instituting incomplete pre-exposure 

prophylaxis for rabies. In the event of an animal bite, the patially immunized individual would be 

considered unimmunized and should receive full postexposure prophylaxis (i.e., rabies immune

globulin (RIG) + 5 doses of vaccine). If either rabies immune globulin or rabies vaccine is not 

available in the country of destination, the exposed person should either return home or travel to 

the closest major city where these biologics are available to initiate rabies postexposure 

prophylaxis as soon as possible. 

• Japanese encephalitis (JE), which is endemic in SE Asia, is spread by infected mosquitoes.

Although risk of Japanese encephalitis may be increased in all countries in Asia affected by the 

tsunami, full 3-dose vaccination requires 2-4 weeks to complete (days 0, 7, 14 or 30). However, an 

abbreviated schedule of 2 doses (days 0, 7) has been shown to protect 80% of vaccinees. 

Because serious adverse reactions to the vaccine (generalized itching, respiratory distress, 

angioedema, anaphylaxis) can occur in some individuals up to 1 week after vaccination, the full 

course of immunization should be completed at least 10 days before departure, and vaccinees 

should be advised to remain in areas with access to medical care during this 10-day period.

JE vaccination is not recommended for imminent travel; such travelers should take measures to 

prevent mosquito bites, such as using insect repellent and sleeping under insecticide-treated bed 

nets (http://www.cdc.gov/travel/bugs.htm). For travelers scheduled to depart in 2 weeks or more, 

JE vaccine should be administered (http://www.cdc.gov/travel/diseases/jenceph.htm). 

• Cholera vaccine, if outbreaks of cholera are being reported. Since this immunization is not

available in the U.S., it would have to be obtained at an intermediate destination.

• Yellow fever vaccine is recommended only if you are traveling to the affected areas in East Africa 

or to Asia from endemic areas in Africa and South America. There is no yellow fever risk in

Asia. 
Tsunami Disaster: Health Information for Humanitarian Workers 

 (continued from previous page) 

March 25, 2005 Page 3 of 8

Malaria Prophylaxis 

There is no immunization against malaria. Although no antimalarial drug is 100% protective, taking

antimalarial drugs correctly and consistently is the most important factor in preventing this debilitating

and potentially fatal condition. Malaria symptoms can include fever and flu-like illness, including chills,

headache, muscle aches, and fatigue. Malaria may also cause low red blood cell counts (anemia) and 

yellowing of the skin and whites of the eye (jaundice). If not promptly treated, infection with Plasmodium

falciparum, the most harmful malaria parasite, may cause coma, kidney failure, and death. Travelers who 

become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after returning 

home (for up to 1 year) should seek immediate medical attention and should be sure to tell the physician

their travel history. 

CDC malaria prophylaxis recommendations for countries affected by the earthquake/tsunami, including 

most of Indonesia, have been returned to the pre disaster standard recommendations with the exception 

of those for Aceh Province, Indonesia. An antimalarial drug regimen should be taken for travel to all areas 

of Aceh Province. 

For information about antimalarial drugs for countries in Southeast Asia, see 

http://www.cdc.gov/travel/regionalmalaria/seasia.htm. 

For East Africa, see http://www.cdc.gov/travel/eafrica.htm. 

For the Indian subcontinent, see http://www.cdc.gov/travel/indianrg.htm. 

Risks from Injury 

The risk for physical injury during and after a natural disaster is particularly high. Persons who anticipate 

the need to travel in tsunami-affected areas should wear sturdy footwear to protect their feet from 

widespread debris present in these areas. Tetanus (http://www.cdc.gov/travel/diseases/dtp.htm) is a 

potential health threat for persons who sustain wounds. Any wound or rash has the potential for becoming 

infected; therefore, wounds and skin rashes should be assessed by a health-care provider as soon as 

possible. Immediately cleanse any wounds, cuts, or animal bites with soap and clean water, and apply 

antibiotic ointment and a clean bandage. Travelers should be familiar with basic first aid for self-treatment 

of any injury until medical attention can be obtained. 

Motor vehicle crashes are a leading cause of serious injury (http://www.cdc.gov/travel/other/injuries.htm) 

among travelers. Avoid drinking and driving; wear a safety belt; follow the local customs and laws

regarding pedestrian safety and vehicle speed; obey the rules of the road; use helmets on bikes, 

motorcycles, and motor bikes; avoid riding on an overloaded bus or mini-bus, and where possible, hire a 

local driver.

Preventing Electrocutions 

Avoid downed power lines. During power outages, many people use portable electrical generators ( 

http://www.bt.cdc.gov/poweroutage/workersafety.asp). If the portable generator is improperly sized, 

installed, or operated, it can send power back to the electrical lines. This problem is called “backfeed” or 

“feedback” in the electrical energy in power lines. Backfeed can seriously injure or kill repair workers or 

people in neighboring buildings. In addition, electrical power and natural gas or propane tanks should be 

shut off and any open flames nearby extinguished to avoid secondary fires, electrocution, or explosions. 

Battery-powered flashlights and lanterns, rather than candles, gas lanterns, or torches, should be used

when available. 
Tsunami Disaster: Health Information for Humanitarian Workers 

 (continued from previous page) 

March 25, 2005 Page 4 of 8

Risks from Food and Water 

Natural disasters contribute to the spread of many serious food and water-borne diseases, through 

disruption of water supplies and sewage systems. Diarrheal diseases, typhoid 

(http://www.cdc.gov/travel/diseases/typhoid.htm), and hepatitis A 

(http://www.cdc.gov/travel/diseases/hav.htm) and E (http://www.cdc.gov/travel/diseases/hev.htm) can

possibly occur. Measures to ensure safe food and water are of great importance in preventing the spread 

of such diseases. Food should be thoroughly cooked; salads and ice cubes should be avoided. If a trusted 

source of bottled water is not available, water should be boiled or disinfected with iodine or chlorine. For 

more details, see http://www.cdc.gov/travel/foodwater.htm. 

If travelers' diarrhea (TD) develops, loperamide (Imodium) can be taken as directed. If you are carrying 

an antibiotic such as a fluoroquinolone (e.g. ciprofloxacin) for self-treatment of acute diarrhea, you can 

begin treatment. As an alternative, azithromycin can also be used. This medication can be taken until

symptoms subside, which typically takes 1- 3 days, although in tsunami-affected areas it may take longer.

If diarrhea is accompanied by high fever or blood, you should seek medical care. Hydration is key to the 

effective management of any diarrheal disease. Though oral rehydration solutions are ideal for treatment

of severe diarrhea, replacement of lost fluids by drinking clean water is the most important means of

maintaining wellness.

As with other infectious illnesses, one of the most important preventive practices is careful and frequent 

hand washing. Cleaning your hands often using either soap and water or waterless, alcohol-based hand 

wash removes potentially infectious materials from your skin and helps prevent disease transmission. 

Risks from Insect Bites 

Because of standing water in these areas, mosquito breeding can become a problem, and outbreaks of 

malaria (http://www.cdc.gov/travel/diseases/malaria/index.htm), Japanese encephalitis 

(http://www.cdc.gov/travel/diseases/jenceph.htm) and dengue

(http://www.cdc.gov/travel/diseases/dengue.htm) are possibilities. In addition to malaria prophylaxis and 

Japanese encephalitis vaccine, other measures should be used for protection from mosquito and other 

insect bites. Use an insect repellent containing DEET

(http://www.cdc.gov/ncidod/dvbid/westnile/mosquitorepellent.htm), wear long-sleeved shirts and long

pants when outdoors, and sleep under an insecticide-treated bed net (preferably treated with permethrin) 

http://www.cdc.gov/malaria/control_prevention/vector_control.htm#itn. 

Risks from Snake Bites 

Displaced reptiles, such as snakes, may be encountered following flooding and other natural disasters. 

Snakes tend to be active at night and in warm weather. As a precaution, travelers should wear boots and 

long pants when walking outdoors at night in areas possibly inhabited by venomous snakes. Proper 

protection, such as the aforementioned clothing, careful attention to one's surroundings, and overall

avoidance of contact, are the best measures to avoid injury. 

Attempts to kill snakes are dangerous; therefore, all snakes should be left alone. The venom of a small or 

immature snake can be even more concentrated than that of larger ones. Fewer than half of all snakebite 

wounds actually contain venom, but travelers should be advised to seek medical attention any time a bite 

wound breaks the skin because of bacterial contamination from the snake's mouth.

If medical care is rapidly available, then initial treatment should include immobilization of the affected limb 

and minimizing physical activity as much as possible (ideally entirely immobilizing the patient) while 
Tsunami Disaster: Health Information for Humanitarian Workers 

 (continued from previous page) 

March 25, 2005 Page 5 of 8

transport to a medical facility occurs. If care is delayed, a loose-fitting pressure bandage that does not 

restrict arterial and venous flow (but does limit lymphatic flow) is recommended as a first-aid measure 

while the victim is moved as quickly as possible to a medical facility. Tourniquets that impair blood flow to 

the affected limb are generally contraindicated.

Specific therapy for snakebites is controversial and should be left to the judgment of local emergency

medical personnel. 

Other Risks 

Leptospirosis (http://www.cdc.gov/travel/diseases/lepto.htm) infection may occur in those who wade, 

swim, or bathe in waters contaminated by animal urine. Infection with Yersinia pestis (plague)

(http://www.cdc.gov/travel/diseases/plague.htm) is usually contracted through the bite of rodent fleas,

but also may be acquired by direct contact with infectious materials or inhalation of infective droplets.

Potential explosion hazards exist from displaced land mines in areas of prior conflict. Stay on highways 

and asphalt roads to minimize chances of contact with landmines. Earthquake aftershocks may continue to

occur, so for safety, avoid coastal areas affected by tsunami, including avoidance of travel by boat and 

swimming in bodies of water in those regions. Arrange to sleep in the highest location possible. 

During natural disasters, technological malfunctions may release hazardous materials (e.g., toxic 

chemicals from a point source displaced by winds, seismic motion, or rapidly moving water). Natural 

disasters may also lead to air pollution. Lung infections may occur after inhalation of sea water 

contaminated with ocean-bottom debris and industrial materials churned up by the tsunamis. Disasters 

resulting in massive structural collapse can cause the release of chemical or biologic contaminants (e.g.,

asbestos, petrochemical fuels, and arthrospores, which may lead to fungal infections). Travelers with 

chronic pulmonary disease may be more susceptible to adverse effects from these exposures. 

Health risks are also related to the extremely hot temperatures found in these areas (heatstroke) and the 

effects of the sun on the eyes (cataracts) and skin (skin cancer, sunburn). See 

http://www.cdc.gov/chooseyourcover/SunDay-brochure.htm. For eye protection, wear wraparound 

sunglasses that provide 100 % UV ray protection. Always wear a broad-spectrum (protection against both 

UVA and UVB rays) sunscreen and lip screen with at least SPF 15. Familiarize yourself with the signs of

illness related to extreme heat. See http://www.bt.cdc.gov/disasters/extremeheat/heat_guide.asp#def. 

Psychological/Emotional Effects 

Because of the tremendous loss of life, serious injuries, missing and separated families, and destruction of 

whole areas, humanitarian aid workers may find the situation extremely stressful. Keeping items of 

comfort, such as family photos, favorite music CDs, or religious material nearby can often offer comfort in 

such situations. Checking in with family members and close friends from time to time can also be a source 

of support. For detailed information about mental health resources following a disaster, see 

http://www.bt.cdc.gov/disasters/tsunamis/mentalhealth.asp. 

Illness Abroad 

If you develop fever, cough, unusual rash, or difficulty breathing while traveling, you should get medical 

attention as soon as you possibly can. Because illness and injury are a real possibility for people going to 

areas following a natural disaster, realize that most functioning hospitals and clinics may be busy caring

for hundreds of people who have been injured and therefore would be unable to treat travelers. If you

become seriously ill, you may require evacuation to other parts of a country or outside the country to 
Tsunami Disaster: Health Information for Humanitarian Workers 

 (continued from previous page) 

March 25, 2005 Page 6 of 8

receive adequate medical care. Consider purchasing a supplemental health insurance policy that includes 

evacuation insurance. See the U.S. Department of State website for additional information, 

http://travel.state.gov/. 

Security 

Always carry passports and travel documents (in a water-tight packet) and make sure a family

member/friend has copies of the passport and other travel documents, as well as details of your travel

plans and how to contact you. Also, make arrangements to check in with family/friends at specific 

intervals. 

For security warnings consult the DOS website for the latest information http://travel.state.gov/. 

Suggested Items to Bring with You 

Humanitarian workers should plan for travel as if there will be no services, including no electricity, safe

water, or food distribution systems, in the country they are visiting. They should try to pack to be as selfsufficient as possible and bring only those items necessary for their trip. Because of space limitations on

conveyances to relief sites, only one bag or item may be allowed per person. 

In addition to a basic travel health kit (http://www.cdc.gov/travel/other/travelers-health-kit.htm), 

humanitarian workers should bring the following items:

Food and water (http://www.cdc.gov/travel/food-drink-risks.htm) 

• Bottled water or water filters/purification system/water purification tablets 

• Nonperishable food items 

Toiletries 

• Toilet paper in a zip-lock bag 

• Alcohol-based hand sanitizer 

• Sunblock (spf 15 or higher) 

• Insect repellent containing DEET 

• Menstrual supplies 

• Extra pair of prescription glasses, copy of prescription and protective case for eye glasses 

• Eyeglasses repair kit 

• Contact lenses, lens cleaner 

• Toothbrush/toothpaste 

• Skin moisturizer 

• Soap, shampoo 

• Lip balm 

• Razor, extra blades* 

• Scissors* 

• Nail clippers/tweezers* 

• Q-tips, cotton swabs 

• Sewing kit 

• Laundry detergent 

• Small clothesline/pins 

Clothing 
Tsunami Disaster: Health Information for Humanitarian Workers 

 (continued from previous page) 

March 25, 2005 Page 7 of 8

• Comfortable, lightweight clothing

• Long pants

• Long-sleeved shirts 

• Hat 

• Boots 

• Shower shoes 

• Rain gear 

• Bandana/handkerchief 

• Towel (highly absorbent, travel towels if possible) 

• Gloves (Leather gloves if physical labor will be performed; rubber gloves if handling blood or body

fluids) 

Activities of daily living 

• Sunglasses 

• Safety goggles 

• Electricity converters 

• Waterproof watch 

• Flashlight 

• Spare batteries 

• Knife, such as a Swiss Army Knife or Leatherman* 

Security 

• Money belt

• Cash 

• Cell phone (with charger) 

• Candles, matches, lighter in a ziplock bag 

• Ziplock bags 

• Extra passport-style photos 

• Photocopy of all important documents (bring copies and leave copies with employer and next of 

kin) 

Next-of-kin contact information, first page of passport, driver's license, travelers checks, immunization 

schedule, birth certificate, credit cards, diplomas/medical licenses, emergency telephone numbers, blood 

type, Social Security number, travel tickets. 

• An item of comfort (i.e., family photo, spiritual or religious material) 

Shelter/site 

• Mosquito bed net treated with permethrin 

Information on country 

• Maps 

• General information (http://www.cia.gov/cia/publications/factbook/) 
Tsunami Disaster: Health Information for Humanitarian Workers 

 (continued from previous page) 

March 25, 2005 Page 8 of 8

*packed in checked baggage, may be confiscated if in carry-on baggage on commercial airliner 

On return from one of the affected areas, humanitarian workers who are unwell or who have become 

injured for any reason should receive a medical evaluation. This should include psychological support and 

counseling as necessary. Returning humanitarian workers should seek health care in the event of fever, 

rash, respiratory illness or any other unusual symptoms. 

Additional information about the humanitarian relief work in response to the tsunami can be found at

http://www.reliefweb.int/w/rwb.nsf. 

For more information, visit www.bt.cdc.gov/disasters/tsunamis, or call CDC at 

800-CDC-INFO (English and Spanish) or 888-232-6348 (TTY).