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					          Preliminary Report on Communicable Diseases Risk
     Assessment and Interventions after Sichuan Earthquake

                                                                 Contents

I. Background .................................................................................................................................. 2

II. Historical overview on communicable diseases in Sichuan province and the severely

affected areas. .................................................................................................................................. 4

       1. Historical overview on communicable diseases in Sichuan province ................................... 4

       2. Historical overview on communicable diseases in 21 severely affected counties ................ 5

III. Risk factors for increased communicable disease burden .................................................... 5

IV. Risk assessment of main communicable diseases ................................................................... 6

       1.     Waterborne and food-borne diseases................................................................................. 6

       2.     Respiratory and close contact transmitted diseases ........................................................... 7

       3.     Vector-borne and zoonotic diseases ................................................................................ 10

       4.     Risks of other diseases .................................................................................................... 13

V. Post-earthquake disease surveillance and control ................................................................... 6

       1.     Strengthen the protection of water source and drinking water safety ............................. 15

       2.     Maintain adequate food supply and food safety .............................................................. 15

       3.     Shelter planning and assessment ..................................................................................... 15

       4.     Strengthen the monitoring and control of vectors ........................................................... 16

       5.     Strengthen health education ............................................................................................ 16

       6.     Strengthen disease surveillance and outbreak control ..................................................... 16

       7.     Resume the basic public health service ........................................................................... 17

       8.     Strengthen case management .......................................................................................... 18
     At 14:28 on 12 May 2008, a magnitude 8.0 (Richter scale) earthquake struck
Sichuan province of China, causing heavy casualties, serious collapse of buildings,
destruction of roads and tremendous economic losses. This report is to provide
guidance for taking more effective actions to prevent and control communicable
diseases after the earthquake through analyzing the risk factors related to infectious
disease outbreak in earthquake-affected areas in Sichuan province.



I. Background

      The epicenter was located in the county of Wenchuan in the Ngawa Prefecture,
and the worst affected areas are central and northern Sichuan (Ngawa, Mianyang,
Deyang, Chengdu, Guangyuan and Ya'an Perfecture), some areas in Gansu and
Shaanxi were also affected. As of 12:00 on 2 Jun 2008, 69,019 people were reported
dead, 373,573 people were reported injured and 18,627.were reported missing.
Additionally, over 84,000 injured people have been hospitalized after the quake.
Among them, around 54,000 have been discharged from hospitals, 16,000 still remain
in hospitals and over 6,000 were transferred to other parts of China for treatment. An
estimated 5 million buildings have collapsed, and more than 21 million buildings were
damaged in the earthquake-affected areas. The earthquake destroyed over 25 million
homes and has resulted in about 15 million people internally displaced, with the total
affected population of 45.61 million (see the figure below for the severely affected
areas in Sichuan province).
The earthquake has caused heavy casualties of people and live stock, leaving the basic
health facilities and the ecological environment seriously damaged in Sichuan, one of
the most populous provinces in China. The roads and railways in the disaster areas
were destroyed; the water and power supply in the severely affected areas were
interrupted; the systems of public health, medical care and health inspection were
severely affected with many hospitals, clinics and pubic health facilities being damaged
seriously. The maintenance of water and food safety, environment hygiene, basic
health service and infectious disease control are all facing serious challenges.




                                           2                  China CDC, May-2008
                                                                                                                          Deaths in Sichuan Province
                                                                                                                          Deaths in Sichuan Province
The overview of                             Main Areas Affected by Wenchuan Earthquake, Sichuan Province
                                                                                                                                 5,000 至 16,000   (4)
Wenchuan earthquake:                                                                                                             1,000 至 5,000    (5)
                                                                       Songpan
                                                                       Songpan                                                     100 至 1,000    (3)
Time: May 12 2008                                                                                                                    0至     100 (172)
Magnitude: 8                           Abaqiangzu
                                       Abaqiangzu                                                           Qingchuan
                                                                                                            Qingchuan
Epicenter:Wenchuan County                                                                   Pingwu
                                                                                            Pingwu
                                                                                                                         Guangyuan
                                                                                                                         Guangyuan
                                                           Heishui
                                                           Heishui
                                                                                               Mianyang
                                                                                               Mianyang
                                     Maerkang
                                     Maerkang
                                                                                        Beichuan
                                                                                        Beichuan       Jianyou
                                                                                                       Jianyou     Jiange
                                                                                                                   Jiange
                                                                          Maoxian
                                                                          Maoxian

                                                                                           Anxian
                                                                                           Anxian
                                                            Lixian
                                                            Lixian

Total casualties in the whole country (as                                           Mianzhu
                                                                                     Mianzhu                            Deaths and Injured in Affected
of June 2)                                                                       Shifang
                                                                                 Shifang                                          Provinces
    Total deaths: 69019                                                                                            Province        Deaths       Injured
                                                               Wenchuan
                                                               Wenchuan
    Total injured: 373573                   Xiaojinxian
                                             Xiaojinxian                       Pengzhou
                                                                               Pengzhou     Deyang
                                                                                            Deyang                  Sichuan         68467        354045
    Number of people missing: 18627                                    Dujiangyan                                   Gansu            365          N/A
                                                                        Dujiangyan
    People hospitalized:84810                                                 Pixian
                                                                               Pixian                               Shanxi            122          2984
    People discharged: 54374                                        Chongzhou
                                                                     Chongzhou
                                                                                                                   Chongqing          18           N/A
    Number       of   builds    damaged:                                      Chengdu
                                                                               Chengdu                            Suining
                                                                                                                  Suining
     Ganzizangzuzizhizhou                                       Dayixian
                                                                Dayixian                                            Henan              2                7
     Ganzizangzuzizhizhou                         Baoxing
                                                  Baoxing
     21,000,000                                         Lushan
                                                         Lushan                                                     Yunnan             1            51
    People displaced: 15,006,314                                                                                       Hubei          1            14
                                                    Yaan
                                                    Yaan                                           Ziyang
                                                                                                   Ziyang
    Accumulated population affected:                                                                               Guizhou            1            15
                                                                China CDC, June 3, 2008
     45,612,765                                                  China CDC, June 3, 2008                            Hunan              1           N/A
                                                                                 Meishan
                                                                                 Meishan


                                                                           3                                                     China CDC, May-2008
      After the quake, the infectious diseases prevention and control was already given
the top priority by the Ministry of Health, at the same time efforts were centered on
treating the injured victims in the affected areas. The Ministry of Health has
transferred over 5000 public health workers and health inspection professionals from
30 provinces (autonomous regions, municipalities) to the disaster areas in Sichuan.
Currently the public health actions including maintaining the drinking water safety,
environment hygiene, disinfection and disinfestation have been taken. The public
health assessment in the internally displaced people have begun, the infectious disease
and public health emergency reporting and the syndromic surveillance information
cell phone reporting system have been established, the various preventive measures
are being implemented and the health inspection, disease control and medical care
systems are being recovered. The responsibilities has been assigned to individual
persons so as to achieve the full coverage of the infectious disease prevention and
control in all severely affected areas.

II. Historical overview on communicable diseases in Sichuan province and the
severely affected areas


1. Historical overview on communicable diseases in Sichuan province

      In the past 10 years the incidence of class A and B infectious diseases in Sichuan
province have been higher than the national average level, but the overall situation has
been stable. From 2004 to 2007, the annually reported cases of class A, B and C
infectious diseases were between 340,000 and 360,000 with incidence slightly higher
than the national average level. The main diarrhea and food-borne infectious diseases
in Sichuan province are cholera, hepatitis A, hepatitis E, bacillary dysentery and other
infectious diarrhoeal diseases, of which other infectious diarrhea diseases and
bacillary dysentery had comparatively higher incidence; the main respiratory
infectious diseases are pulmonary TB, measles, pertussis, scarlet fever, mumps,
rubella and chicken pox, among which the incidence of TB, mumps and measles was
relatively higher. The main vector-borne diseases are Japanese encephalitis, malaria,
typhus, kala-azar, tsutsugamushi disease and forest encephalitis; main zoonotic
diseases are hemorrhagic fever with renal syndrome, rabies, brucellosis, leptospirosis,
schistosomiasis, echinococcosis, hepatic fascioliasis and streptococcus suis. The most
frequently reported blood born diseases and STDs were AIDS, hepatitis B, hepatitis C,
gonorrhea and syphilis with hepatitis B having higher incidence; other diseases are
those transmitted through respiratory tract, faecal-oral route or close contacts such as
acute hemorrhagic conjunctivitis and hand foot and mouth disease. The main reported
EPI targeted diseases are TB, hepatitis A, hepatitis B, measles, mumps, rubella,
Japanese encephalitis and meningococcal meningitis, of which the incidence of
measles is higher than national average level. No case reported diseases are plague,
SARS, poliomyelitis and diphtheria.

     The time distribution for class A and B infectious diseases by different
transmission routes from 2004 to 2007 indicated that the diarrhea and food borne
diseases, zoonotic and vector-borne diseases are going to increase in the summer and
autumn season, while the respiratory infectious diseases are going to decrease, and the
blood borne diseases and STDs are not obviously affected by seasonality. From

                                           4
January to April 2008, there were a total of 96,223 cases of class A, B and C
infectious diseases totally reported in Sichuan, among which 34,441 cases were
tuberculosis and 29,642 were hepatitis (hepatitis B: 25,387 cases, hepatitis A: 1,796
cases), accounting for 66.60% of the total reported cases. In addition, other diseases
with big incidence number are: mumps (7,038 cases), chicken pox (6,135 cases),
bacillary dysentery (4,328 cases), measles (2,351 cases) and rubella (1569 cases).

2. Infectious disease situation in the 21 severely affected counties

     In recent years, the incidences of infectious diseases in the 21 seriously affected
counties have been kept at a stable level. The most frequently reported infectious
diseases were still hepatitis B and TB. In addition, the food-borne and diarrhoeal
diseases such as bacillary dysentery, hepatitis A and other infectious diarrhoeal
diseases were also common. Outbreaks of bacillary dysentery and hepatitis A were
reported previously in some counties, and typhoid cases were also reported in
individual counties. Amongst the respiratory infectious diseases, measles, mumps and
chicken pox are most common, particularly measles. Sporadic cases of zoonotic
diseases such as hemorrhagic fever with renal syndrome, rabies, brucellosis,
leptospirosis, schistosomiasis and echinococcosis and vector-borne diseases such as
Japanese encephalitis, malaria and kala-azar had also been reported. In recent years
during summer and autumn, food-borne diseases and diarrhea such as bacillary
dysentery and hepatitis A and respiratory infectious diseases such as measles, chicken
pox and mumps were very common in most of the counties; outbreaks of above
diseases were also reported in some counties before. Although there were cases of
zoonotic diseases such as leptospirosis, schistosomiasis and echinococcosis and
vector-borne diseases such as Japanese encephalitis, malaria and kala-azar reported
before, but no outbreak reported.

III. Risk factors for increased communicable disease burden

     1. Interruption of access to safe water and sanitation facilities. The disaster
has damaged the drinking water supply system and the sanitation facility on a large
scale, which can disable disaster victims from access the safe water and food and will
increase the risk of waterborne and food borne diseases outbreak such as infectious
diarrhoeal diseases, bacillary dysentery, typhoid and hepatitis A.
    2. Population displacement with overcrowding. After the original housing were
destroyed, a large number of population will be internally displaced in shelters and
relief centers where can be very crowded so as to increase the close contact among the
population. The populations are at immediate and high risk from the transmission of
respiratory infectious diseases and overcrowding related diseases such as measles,
acute infectious respiratory diseases, TB, meningitis and acute hemorrhagic
conjunctivitis.
      3. Increased exposure to disease vectors. The earthquake can cause big changes
to the habitats for animals and vectors. The rescuing and relief activities and
displacement of populations can result in increased exposure to disease carrying
vectors and animals, increasing the risk of mosquito-borne, rodent-borne and
tick-borne diseases such as malaria, Japanese encephalitis, plague, leptospirosis, lyme
disease and some tick borne rickettsia.


                                           5
      4. The increased population movements. The movement of disaster victims
and rescuers will also raise the risk of disease transmission; even bring new pathogens
into the affected areas, increasing the risk of disease outbreak and transmission.
      5. The increased susceptibility to disease. After the disaster, due to the
difficulty of food supply and changes of living habits, the affected population
particularly the infants and children, pregnant women and the elderly will be more
vulnerable to malnutrition. Malnutrition with the combination of physical and
psychological impacts compromises natural immunity, leading to more frequent,
severe and prolonged episodes of infections, in particular the infection of conditioned
pathogens or acute attacks by chronic infections. Under such circumstances, patients
with serious conditions are more difficult to treat, meanwhile, severe malnutrition
often masks symptoms and signs of communicable diseases, making prompt clinical
diagnosis and early treatment even more difficult.
      6. Poor access to health services. The earthquake severely destroyed or
overwhelmed the health infrastructure and medical service system, which hampers the
disaster victims to access the health services timely, although the government has
provided a large quantity of health resources for the affected areas. At the same time,
national immunization program and other infectious diseases control program such as
the free treatment for TB patients will also be affected even disrupted, contributing an
increased burden of infectious diseases.


IV. Risk assessment of main infectious diseases

1. Waterborne and food-borne diseases

     The common waterborne and food-borne diseases are cholera, hepatitis A,
typhoid/paratyphoid fever, bacillary dysentery and other infectious diarrhoeal diseases.
According to historical records, there are reports about the infectious diarrhoeal
diseases caused by Salmonella and norovirus occurring after disasters in some
countries. For example, after the 2005 earthquake in Muzaffarabad, Pakistan, acute
watery diarrhoeal disease broke out in a refugee camp accommodating 1800 people,
of which 750 people were infected. In 1976 after the Tangshan earthquake in China,
there was an epidemic of bacillary dysentery.
     (1) The cases reported
     Cholera is a type A infectious disease as specified by the Law on Prevention and
Control of Communicable Diseases of PRC and the International Health Regulations
on quarantine infectious diseases. The disease is characterized by acute attacks, fast
transmission and severe symptoms. It may lead to death by serious dehydration,
circulatory failure and muscle spasm if not treated promptly. From 2004 to 2007,
Sichuan reported a total of 38 cholera cases; while in severely affected disaster areas,
12 were from Anxian County (6 cases in 2005, 6 in 2006), 10 from Wenjiang County
(2004) and 1 from Chongzhou City (2005).
     Hepatitis A is a kind of acute infectious disease which is transmissible through
the fecal-oral route that may severely damage the liver. Contaminated food, water or
close contact are common methods of transmission. From 2004 to 2007, In Sichuan
province, there were 10,146 reported cases in 2004 and 7261 cases in 2007, showing a
downward trend year by year. From 2004 to 2007, Sichuan reported 15 hepatitis A
outbreaks, none of which occurred in the 21 most seriously affected areas. From the

                                           6
1st to the 18th week of 2008, the number of reported cases of hepatitis A was lower
than that during the same period of 2007. However, the Ngawa prefecture had an
increased incidence in the 12th week, and Maoxian County reported a small scale
outbreak.
      The typical clinical symptom of typhoid/paratyphoid fever is persistent high
fever, roseola, comparatively slower pulse, enlargement of liver and spleen and
malaise. Young adults and school children are easily infected. From 2004 to 2007, the
province reported a total of 4,029 cases with annual cases ranging between 325 and
1254, showing a downward trend and making Sichuan one of the provinces with the
lowest incidence of typhoid/paratyphoid fever. From 2004 to 2007 the 21 seriously
affected areas reported a total of 5 typhoid fever and 11 paratyphoid fever cases, all of
which occurred sporadically. From January to April 2008, Lushan County reported 1
typhoid fever case.
      Bacillary dysentery is a common and frequently occurring disease. From 2004 to
2007, the annual reported cases of bacillary dysentery in Sichuan were between
23,033 and 32,070, ranking in the top 3 provinces for the highest number of cases in
the country. There were 38 outbreaks reported, 6 of which occurred in the 21 severely
affected areas, and of which 3 were waterborne and other 3 were food-borne.
      Other infectious diarrhoeal diseases ( i.e. the infectious diarrhoeal diseases other
than cholera, dysentery and typhoid/paratyphoid fever) are enteritis which are mainly
caused by Salmonella, Escherichia coli, Vibrio, Campylobacter jejuni, Yersinia
enterocolitis, Rotavirus, and Norovirus, etc. From 2004 to 2007, Sichuan reported
36,483 to 48,624 cases annually of other infectious diarrhoeal diseases, ranking either
fifth or sixth in the country, with fatal cases reported each year and 16 outbreaks.
From 2004 to 2007, other infectious diarrhoeal diseases were also reported in the 21
severely affected areas and with higher incidence in summer and autumn.
      (2) The post-disaster impact and the risk of disease outbreak
      The seriously damaged water supply and sanitation facilities will largely increase
the risk of water and food contamination, and the movement and concentrated living
conditions of disaster victims and rescuers will result in overcrowding and close
contacts. The summer and autumn are the two seasons that diarrhoeal diseases will
happen most frequently, and poor hygiene conditions in the disaster areas due to the
difficulty in disposing feces and waste properly will help flies to breed in large
quantities. These factors will significantly increase the risks for the outbreak of
waterborne and food-borne diseases. Once an outbreak occurs, it is very difficult to
control transmission because the crowded shelters with poor healthcare facilities
provide favorable conditions for transmission.
      Based on the above analysis, the risks for the outbreak of bacillary dysentery and
other infectious diarrhoeal diseases is very high (++++), and in the meantime the risk
of increased cases and even a small scale outbreak of cholera, hepatitis A and
typhoid/paratyphoid fever will be high (++~+++).

2. Respiratory and close contact transmitted diseases

     After the earthquake, the affected population and the rescue personnel live in
overcrowded settlements, leading to increased close contact among people, and thus
raising the risk of infection. For example, a population with lower immunization
coverage and residing in crowded areas are more easily infected by measles.
Crowding may also facilitate the transmission of TB and meningitis; and it can also

                                            7
cause many occurrences of acute respiratory infections, hand foot and mouth disease
and acute hemorrhagic conjunctivitis.
     (1) Acute respiratory infections
     The acute upper respiratory infection is very common and can be caused by any
of the following: flu virus, parainfluenza virus, respiratory syncytial virus,
Adenoviruses, rhinovirus, Mycoplasma, Chlamydia, pneumococcus, haemophilus
influenzae, streptococcus and Staphylococcus Aureus, etc. The main symptoms are
fever, coughing and sore throat and can easily break out in crowded places,
particularly during the change of seasons. Failing to provide prompt treatment, it may
spread to the lower respiratory tract and cause bronchitis and pneumonia accompanied
with severe symptoms. The acute lower respiratory infections, particularly pneumonia,
are the main cause responsible for the death of children under 5 years old. Currently,
no comprehensive acute respiratory infection surveillance system has been set up in
China and thus the basic incidence level cannot be determined.
     After the disaster, many victims and rescuers live in temporary shelters with poor
conditions, high population density and poor ventilation. Some victims and rescuers
are still sleeping outside. Recently the disaster areas have been experiencing violent
climate changes with the alternation of rainy and sunny weather and dramatic changes
in temperature, which can easily contribute to the occurrence of acute respiratory
diseases. Therefore, the risk of the occurrence and spread of the acute respiratory
infections among the disaster victims and rescuers living in the shelters will be very
high(+++), particularly acute infections in the form of the common cold and those
caused by bacteria
     (2) Measles
     The annual incidence of measles in Sichuan during the last 10 years is around
10/100,000, but since 2004, it has seen a continuous rise. In 2007, the reported
number of cases and incidence ranked second in the country with 83.8% of the cases
occurring in children under 15. Sichuan has successfully implemented two
supplementary immunization activities (SIAs) in September 2007 and March 2008
successively, covering children aged 8 months to 14 years old in the whole province.
The severely affected disaster areas recently completed SIAs at the end of March
2008. The immediate immunization assessment showed that the coverage rate is
above 95%. The measles epidemic has been on a downward trend since April, 2008.
     Measles is a highly transmissible disease and transmission can not be completely
blocked by way of SIAs. The overcrowding of people will increase exposure to the
disease, and even small scale transmission among the immunized people is sometimes
unavoidable. Measles cases have been identified among the disaster affected
population. Generally speaking, the measles cases will continue to be reported given
the current living, accommodation and food supply conditions. While small scale
outbreaks in some areas is not completely avoidable, however it is unlikely for a large
scale outbreak to occur (++).
     (3) Rubella
     Sichuan reported 3,513 and 5,280 cases of rubella in 2006 and 2007, which
ranked second and third respectively; while the reported incidence ranked tenth in
China. Of the severely affected areas, Nagwa prefecture had a higher incidence, but
the incidence from January to April this year was significantly lower than last year.
The other disaster areas all have a lower incidence during recent years. April to July is
the period when the disease frequently occurs and mainly affects children under 15
(89%), while the highest incidence is found amongst 5-9 year old school children.
Among adults, it mainly occurs in people aged 20 to 40.

                                           8
      Currently it is the period for high incidence of rubella. Taking into consideration
the crowding at shelters, poor sanitation conditions, and reports by onsite
professionals of rubella cases among the disaster affected population, there is a higher
risk of outbreak or transmission among children in the disaster areas (+++). At the
moment, concerns should be directed towards female adults aged 20 to 40, with
efforts taken to avoid congenital rubella syndrome suffered in pregnancy (+).
      (4) Epidemic cerebrospinal meningitis
      During 2005 to 2007, Sichuan reported 42 to 126 cases of epidemic meningitis
annually with the reported incidence ranking eighth in the country. The disaster
stricken cities and prefectures reported lower incidence. The peak time for incidence
is between February and April, and then declines gradually after May.
      After the earthquake, the affected population moved to settlements where the
higher density of population and poor sanitation conditions will increase the risk of
meningitis. Additionally, historical records show a lower rate of meningitis
immunization in the severely affected disaster areas.
      So based on the above analysis, there may be an occurrence of sporadic
meningitis cases and the number of cases may be greater than during the pre-disaster
period (++).
      (5) Mumps
      Between 2006 to 2007, Sichuan reported about 20,000 mumps cases annually,
ranking third and first nationwide, with the reported incidence ranking thirteenth and
tenth in the country, respectively. The cases are mainly found among children under
15, and the incidence amongst 4-9 year olds reached above 100/100,000. The peak
occurrence time for mumps is between May and August. Currently in the severely
affected disaster areas such as Ngawa, Mianyang, Chengdu, and Deyang, the
incidence has seen an upward trend.
      At the moment, it is peak time for mumps (May - August) and the risk is high
due to the living and food conditions at the settlements. The immunization
professionals deployed in the disaster areas have identified mumps cases among the
disaster victims. The recent risk of epidemic mumps will be high (+++).
      (6) Pulmonary Tuberculosis (TB)
      TB is one of the diseases with higher reported incidence in China, while
frequently occurring in Sichuan. In 2007, the severely affected disaster area reported
incidence of 82.7—152.1/100,000, showing a serious TB situation.
      The earthquake has caused damages to the TB prevention and treatment facilities
at different levels with equipment destroyed, normal services disabled, coupled with
other important tasks of disease prevention, altogether leaving the prevention of TB in
a stagnant status and the TB patients unattended. The emergency response system for
supplying the anti-TB drugs has not been established, so the risk of TB transmission
will rise. Non-infectious TB patients may become infectious TB. Meanwhile, the high
density of the shelters, the poor hygiene conditions, malnutrition and some mental
health factors will also lead to the low level resistance of the affected population.
Some latent TB patients will become vulnerable to TB, and the infectious TB patients
are likely to infect nearby contacts and crowds; therefore there exists a high risk of TB
transmission in the disaster areas (+++).
      (7) Acute hemorrhagic conjunctivitis
      The acute hemorrhagic conjunctivitis is mainly caused by enterovirus type 70,
coxsackie virus type 24 of group A or some types of Adenoviruses and bacteria.
Patients are the main source of infection, and people are infected mainly through
contacting hands, objects or water which are contaminated by virus. The disease may

                                            9
occur throughout the year and will easily become epidemic in the populous area with
poor hygiene conditions. Although it is not very serious or harmful to human health,
the disease often causes wide public concern due to its high communicability. From
2004 to 2007, Sichuan reported a total of 11,251 cases. Among them, 8,119 cases
were reported in 2007, which is significantly higher than previous years. There were
reported cases from the severely affected disaster areas, but in smaller numbers.
     The disease is highly infectious by fast transmission which can affect all people.
During this period, the constant, humid weather, and high temperatures will make it
easy for enteric virus to survive. Given the crowded and poor sanitation conditions at
the shelters, the disease will be easily transmitted once cases appear. The previous
reports from the severely affected disaster areas are in small number, but there is still
the possibility of outbreak and transmission of this disease in the crowded shelters.
The comprehensive analysis shows a high risk of outbreak (+++).
     (8) Hand foot and mouth disease
     HFMD is mainly caused by type 71 enterovirus, group A coxsackie virus and
echovirus, which is highly infectious to all people but particularly more so for infants..
Some severe infections may lead to death. This disease is mainly transmitted through
the faecal-oral route and/or respiratory droplets. It is also communicable through
contact with patient’s skin, blister fluid or contaminated toys or objects. The months
from May to September are highest incidence period. This year, HFMD has broken
out in some parts in the country. The Ministry of Health has designated it as a national
notifiable disease from May 2, 2008, and since then, the number of reported cases has
increased significantly in most parts of China. From 2005 to 2007, the total number of
reported cases in Sichuan was 1805, with 19 cases, 335 cases and 1451 cases each
year respectively, showing an upward trend. The severely affected areas during this
earthquake also reported HFMD cases.
     HFMD is highly infectious, rapidly transmitted, and easily infects children with a
high proportion of asymptomatic infections, making it difficult to control. Currently, it
is the peak season for HFMD and it may be easily transmitted given the high
population density, close contacts and poor hygiene conditions at the settlements.
However, the incidence mainly occurs among infants and children. The occurrence
and severity of HFMD is closely related to the type of viruses. Overall, the risk of
HFMD outbreak during the post-earthquake stage is medium (++).
     (9) Chicken pox
     Chicken pox is highly infectious during the 2 days before and 5 days after the
rash appears. It has high incidence in spring and winter and easily breaks out among
children. Since 2005, there has been a rising trend each year in the number of chicken
pox cases reported by Sichuan especially in Ngawa prefectures. The reported
incidence in Ngawa prefecture was 70/100,000.
     The disaster affected population live together in a centralized space with high
density and poor ventilation conditions. The immunization professionals have
identified chicken pox cases among the disaster affected population. The analysis
shows a high risk of a small scale outbreak of chicken pox (+++).

3. Vector-borne and zoonotic diseases

     The earthquake and its accompanied consequences have severely damaged the
human and animal habitat environment. The bodies of water that have formed after
the rain are suitable for the breeding of different vectors. The displacement of the

                                           10
affected population will increase the exposure to vector-borne infectious diseases,
leading to the raised possibility of vector-borne diseases. The disaster also caused
deaths, migration and abnormal behavior of animals. The large number of rescuers
entering the affected area are not only susceptible to diseases but may be also
pathogen carriers themselves. The post-disaster changes to certain main factors such
as environment, hosts, vectors and susceptible population will affect the occurrence of
animal-source diseases in a comprehensive way, and the main risks of epidemic
outbreak will largely depend on if the area is the epidemic foci and its active level.
     (1) Plague
     All of the severely affected counties and districts are not within the scope of our
identified plague epidemic foci.
     The earthquake has destroyed the living environment of the rodents, which may
lead to the massive migration or abnormal assembly of rodent animals. After the
disaster, a large number of rescuers and disaster affected population have to camp
outside, and then will be gradually accommodated in camps for rather a long time,
increasing the possibility of contacts with rodent animals and flea bites. In some
severely affected disaster areas, there exist some plague host animals such as marmots,
which should be given sufficient vigilance even though no plague cases have been
discovered during the long-term surveillance.
     The analysis shows there is a low risk of plague occurrence in the severely
affected disaster areas (+).
     (2) Anthrax
     In 2007, Sichuan reported 135 anthrax cases, the Ngawa prefecture, which was
heavily stricken by the earthquake, had been one of the prefectures with more cases
reported in recent years. From January to April this year, the prefecture reported 15
cases and became the area with most reported cases. Some sporadic cases were also
found in Songpan County, another severely affected disaster area.
     The anthrax spores can survive in the soil for many years, and contaminated soil
may have been re-exposed by the earthquake and rescue activities, resulting in the
increased risk of occurrence of the disease. The consumption of diseased animals or
infected animal milk that is not thoroughly cooked or boiled may also lead to the
occurrence of disease.
     The comprehensive analysis shows a medium risk of an anthrax epidemic (++).
     (3) Encephalitis B
     From 2005 to 2007, the annually reported cases in Sichuan were between 600
and 1199 with the reported incidence ranking between second to fourth in China. The
severely affected disaster areas have reported low incidence during the recent years.
The cases are mostly found among children under 15, of which children aged 0 to 6
years accounted for 75 – 81% of the total. The peak incidence season is from the end
of June to the end of August.
     The climate of high temperatures and rain following the earthquake will create
an ideal environment for mosquitoes to breed in large quantities. The affected
population staying in the camps or other temporary settlements are easily exposed to
insect bites. The disaster area has low immunization coverage, and the rescuers from
the non-Encephalitis B epidemic areas are more vulnerable to infection.
     The severely affected disaster area is not a pig production base and the number
of pigs which could be disease hosts were further reduced due to the earthquake.
These circumstances combined with epidemic historical records, we expect a slight
possibility of an Encephalitis B epidemic apart from some sporadic cases. Currently,
overall vaccination has been carried out among children aged 8 months to 6 years.

                                          11
The low risk of disease occurrence will be maintained if the vaccination rate is high
enough (+).
     (4) Dengue fever
     In 2007, there were 539 cases reported in China, mainly in Guangdong and
Fujian provinces. The major vector for dengue fever, Aedes Eegypti, is not found in
Sichuan, but there exists a second vector, Aedes albopictus. There has not been any
dengue fever epidemic locally apart from some individual cases imported from
foreign countries, so the post disaster epidemic risk is low (+).
     (5) Rabies
     In recent years, Sichuan saw a rapid growth in the number of rabies cases. The
province reported 372 cases in 2007, but most of which were located in eastern parts
of Sichuan. Cases were also reported in the severely-affected disaster areas, including
Dujiangyan, Pengzhou, Shifang, Pixian, Dayi, Chongzhou and Wenjiang. In 2007,
Dujiangyan reported 6 cases, Pengzhou 4 cases, Shifang 1 case; while no other cases
were reported from other heavy disaster areas.
     The earthquake will increase the number of stray dogs and the coexistence of
humans with dogs. The closer contact between humans and dogs may result in a
greater likelihood of humans being bitten. Given the conditions, cases of rabies are
inevitable, but post disaster epidemic risk is low (+).
     (6) Human infected streptococcus suis
     In 2005, cases of the disease were reported in Ziyang and in regions of Sichuan
province, after which the incidence fell remarkably. In 2007, the whole province
reported only 8 cases located in Chengdu and Ziyang while no cases were found in the
severely-affected disaster areas.
     The disease is mainly transmitted through broken skin coming into contact with
infected or dead pigs and is commonly related to occupational behavior. Most of the
earthquake stricken areas are not a production base of pigs. Furthermore, the
earthquake will have decreased pig population, reducing contact between humans and
pigs and lowering the risk of infection while minimizing the possibility of disease
outbreak. Post disaster epidemic risk will be low (+).
     (7) Leptospirosis
     Sichuan had been the province with the most cases of leptospirosis in China, but
recently incidence of this disease has been brought under control. In 2007, 195 cases
were reported and mainly found in low-lying rainy areas of Southwest Sichuan. The
disease is not common in higher altitude areas, which is characteristic of the
severely-affected earthquake disaster areas.
     The major risks are dependent on contact with contaminated water, thus
occurrence of leptospirosis is largely related to floods and paddy field labor. Most
disaster areas are located in the mountains which already had low incidence prior to
the earthquake, so post disaster risk of disease outbreak is low (+).
     (8) Renal syndrome hemorrhagic fever (RSHF)
     In 2007, Sichuan reported 114 RSHF cases. The severely-affected disaster areas,
including Beicuan, Jiangyou and Anxian had reported cases prior to the earthquake.
However, the post-disaster influx and behavior of rodents may increase the exposure
of human beings to rodents and their feces. The estimated risk of outbreak will not be
high after the quake (++).
     (9) Malaria
     Sichuan was previously one of the major malaria epidemic zones in China, but it
has experienced a decrease in incidence in the past 20 years. From 2004 to 2007, the
province reported altogether 1747 cases, ranking Sichuan as one of the provinces with

                                          12
the lowest incidence of malaria.
      The severely-affected disaster areas reported a low number of cases in recently
years, some of which were imported, therefore the number of local infectious focus is
less. But malaria is capable of relapse and fast transmission, and due to the
overcrowding of people and lack of protective measures against mosquitoes, there still
exists some risk for the occurrence of malaria. The transmission risk of malaria
post-earthquake ranges will be from low to medium (+) - (++).
      (10) Kala-azar
      From 2004 to 2007, the whole province reported 222 cases of kala-azar. The
most severely-affected disaster counties and districts had reported cases in recent
years, of which Heishui, Maoxian, Jiuzhaigou, Beichuan, Wenchuan and Lixian are
epidemic areas with the largest number of cases occurring in Heishui and Maoxin.
      In Gansu province, which is located near the earthquake epicenter of Sichuan,
there is also an upward trend of kala-azar incidence. From 2004 to 2007 the number
of reported cases was 95, 86 and 100 respectively, with the majority of cases found in
Wudu, Wenxian, Zhouqu and Diebu County.
      Kala-azar is an opportunistic infectious disease and the ratio between being
infected and the diseased is approximately 9:1. The changes in the environment after
the earthquake will increase the number of sand flies and stray dogs, while the disaster
affected population living in the camps is poorly protected against sand flies.
Furthermore, other factors such as fatigue, malnutrition, which lowers resistance to
the disease, and the entry of large numbers of people without immunization and the
migration of latent infected people, may cause the incidence of kala-azar to increase
and the extension of the epidemic zone (++).
      (11) Schistosomiasis
       Sichuan has a low incidence of schistosomiasis with annual reported cases
averaging at approximately 400 cases per year since 2004. In the 21 severely-affected
disaster areas, 11 were previously epidemic zones of Schistosomiasis, but they have
all reached the transmission control standard and no snails positive for schistosomiasis
were found.
      Because of the existing snail population, the difficulty in treating human and
animal feces after the disaster and the latent infectious source may cause the snails to
reemerge and thereby increase the risk of disease outbreak (+).

4. Risk of other diseases

     (1) Hepatitis B
     The 1992 national viral hepatitis serum epidemiological study showed that the
surface antigen carrier rate in Sichuan was 10.48% and the hepatitis B infection rate
was 65.48% (slightly higher than the national average). The reported cases of
hepatitis B from 2005 to 2007 in Sichuan ranked between third to seventh highest in
the country, and the incidence ranked ninth to fourteenth highest with an average
annual incidence of 103.52/100,000.
     The hepatitis B virus carriers may have reduced their resistance after having
experienced serious psychological trauma, material and property losses and high
mental state of emergency, which could lead to acute attack by hepatitis B virus.
People injured in the earthquake may require blood transfusions or treatment with
blood products, increasing the chance for infection. However, considering the current
control of blood products in China, it is believed the risk of disease being transmitted

                                           13
through blood and blood products will be low. Additionally, while the disaster affected
population resides in crowded shelters with close contacts between people, hepatitis B
is mainly transmitted through blood while there are limited reports of outbreaks
occurring due to close contact. The analysis shows a low risk for rising incidence and
epidemic of hepatitis B (+).
      (2) Tetanus
      Tetanus is an infectious disease, and tetanus spores are found extensively in soil.
The tetanus bacterium can infect humans through open wounds or broken skin. The
earthquake zone encompasses a vast area of destruction, damaged buildings and
injured people. Therefore, the risk of infection among the affected population and
rescuers will be medium (++)
      (3) Avian flu
      An avian flu epidemic in animals occurred in Sichuan during December 2005.
From January to April 2006, Sichuan confirmed 3 avian flu human cases. No cases
were reported afterwards.
      Because the avian influenza virus can survive continually in the environment, the
risk for post-earthquake infections can not be overlooked. However, the risk is likely
to be low considering the recent disease situation. (+)
      (4) SARS
      China and other countries have not reported any SARS cases since 2004.
Therefore, the risk of SARS is extremely low (+) – (-).
      (5) STDs
       The main risk factors for STDs are sexual contact and unsafe sexual activities
such as multiple sexual partners and unprotected sexual intercourse. The most
common STDs include syphilis, gonorrhea, AIDS/HIV, condyloma acuminatum,
genital herpes and genital tract chlamydia trachomatis. Both syphilis and AIDS/HIV
can also be transmitted through blood. In recent years, the incidence of STDs in
Sichuan, particularly in the severely-affected disaster areas, is generally at medium
level relative to the rest of the country.
      The earthquake has interfered with the normal ways of living to a large degree.
People tend to lower their demand for sex after having experienced serious mental
trauma, property loss and while they are in a mental state of emergency. Meanwhile,
the diagnosis and treatment of STDs after the earthquake may also be affected. In
general, during the emergency response period, there exists a lower risk of STDs (+)
However, when the situation has stabilized, the sexual activities and health services to
the disaster affected population needs to be further assessed.

V. Post-earthquake disease surveillance and control

      The assessment on health service system of disease control, health inspection and
medical care should be taken immediately, and the rebuilding of the medical system
shall be included in the general planning of reconstruction, so as to ensure that the
regular health service re-operate properly as soon as possible.
      The post-disaster control should be carried out under the principle of prevention
first and evidence-based with emphasizing water, food safety and environment
hygiene, personal sanitation and immunization so as to reduce the risk of disease
transmission and outbreak. Risk assessment on infectious diseases should be launched
immediately for guiding to take more effective actions to prevent the diseases.
Recover and strengthen routine surveillance, set up post-disaster emergency
monitoring, investigate and identify the cluster cases and cause-unknown cases timely,

                                           14
to early detect and respond to the emergent public health events such as infectious
disease outbreaks or food poisoning.

1. Strengthen the protection of water source and drinking-water safety

      Ensuring uninterrupted provision of safe dring water is the most important
preventive measure to minimize the risk of outbreaks of water-borne diseases. In the
meantime, the water source for drinking should be well protected from contamination.
      1. Make sure the sufficient drinking water can be supplied to the affected
populations. It is recommended that each person be supplied with at least 15 to 20
litres of clean water per day. Water collected from sources that might have been
contaminated must be boiled or disinfected before drinking. Chlorine is one of the
most effective drinking-water disinfectants to prevent nearly all waterborne diseases.
After 30 minutes, the residual concentration of active chlorine in the water should be
0.5mg/L, which can be determined by the simple field test kit.
      2. The provision of appropriate and sufficient water containers, cooking pots and
fuel can reduce the risk of cholera and other diarrhoeal diseases by ensuring that water
storage is protected.
      2. Adequate sanitation facilities such as latrines and refuse container should be
provided and ensured they are far away from water source. The shelters for disaster
victims, medical sites and the temporary camps for rescuers shall be key areas for
environmental sanitation. The temporary latrines should be well planned and built to
ensure the feces properly disposed, if possible the disinfection for feces and vomits of
the diarrhoeal patients are recommended. Set up wastes collection points and special
persons shall be appointed for timely cleaning and disposing of the wastes.

2. Maintain adequate food supply and food safety

     Malnourished children are more vulnerable to disease pathogens. Infants from
birth to 6 months of age are recommended to be breastfed, and those who are not
breastfed are more vulnerable to infection and to developing diarrhoea. Clean and
digestible food should be provided to infants aged 6 months or above as
supplementary. Attention should be given to maintaining nutrition of nursing mothers.
The personal sanitation of both mothers and infants should be highlighted to avoid
transmission of diarrhoeal diseases due to bad health habits.
     Food safety is also to be paid attention. Eat only cooked food and don’t eat raw
or not thoroughly cooked food; particularly the aquatic products should be cooked
thoroughly before eating. Rotten or spoiled food should not be eaten while fruits must
be washed with clean water before consumption. and do not touch food when you are
eating the instant food. Utensils should be disinfected by boiling or disinfectant and
the utensils for preparing raw and cooked foods must be separated. The food to be
served and supplied should be well packed to avoid contamination.

3. Shelter planning and assessment

     The shelters and sites for the affected populations should be planed to against
adverse weather (rainstorm, cyclone); the site should be positioned near to the water
source, and where possible on a higher land so it can be easily supplied with water by
                                           15
using the gravity; the land for sheltering sites should have a inclination of 2-4% for
easier water discharge, and discharge ditches should also be planed around or on both
sides of the site. Avoid too many people staying in one shelter site to prevent
overcrowding. Natural ventilation should be considered for tabernacle sites. Easy
access to basic health service in each site should be ensured. Strengthen the
management of livestock and poultry at the shelter to reduce direct contacts between
human and animals. Report and dispose the infected and dead animals and poultries in
accordance with relevant guidelines.
      Assess the risk factors of infectious diseases in the shelter sites including
vaccination coverage, nutrition status, food and water safety, environment and
personal sanitation, category and prevalence of infectious diseases in the places where
sheltering sites located, health service accessibility, disease vectors and personal
behavior, for more effective control of diseases.

4. Strengthen the monitoring and control of vectors

     Monitoring on disease vectors such as rodents, mosquitoes and flies at the
sheltering sites should be carried out according to the ―Guideline for Vector
Surveillance after Wenchuan Earthquake (draft version)‖ by China CDC. Proper
guidance for controlling vectors should be provided to the affected population based
on the results from surveillance so as to minimize the risks of vector borne diseases.
Residual spray should be instituted in the highly populous environment to reduce
breeding of mosquitoes; use bednets and repellents especially recommended when
sleeping outside. Be aware of fire when using mosquito coils inside the tents.

5. Strengthen health education

      Deliver health knowledge to the affected people and rescuers by various
channels. Basic messages are: Hand hygiene of thoroughly hand cleaning before
eating and after defecation. Do not eat raw food or sick animals; do not eat uncooked
meat and dairy products. Defecate only in designated areas and don’t share with
others your own towels or basins. Keep shelter and camp ventilated; change clothing
when climate changes. Visit a doctor when symptoms of fever, vomiting, bellyache
and diarrhea develop. Keep yourself well rested and minimize contacts with others.
Cluster cases should be immediately reported to health authorities for rapid response
and control of disease.

6. Strengthen disease surveillance and outbreak control

      Notifiable infectious disease reporting system and event-based public health
emergency reporting system should be rebuilt to early identify and rapidly manage the
infectious disease outbreaks and public health emergencies.
      In places where buildings, equipments, people, power supply and
communication are severely damaged, the emergency reporting system should be
established immediately to enable the information of common syndromes and
diseases can be collected quickly for timely detection, identification and management
of potential outbreaks. Stockpile medicine and vaccines for outbreak controlling.
      Set up and launch infectious disease emergency laboratory network at the county
                                          16
and provincial level CDCs as soon as possible. Based on the risk assessment, the
laboratory diagnosis of 11 diseases including TB, cholera, typhoid, dysentery,
leptospirosis, measles, influenza, encephalitis B, hepatitis A, , hepatitis E, and
malaria should be established in the severely affected counties. Sichuan provincial
CDC should be responsible for laboratory diagnosis of plague, avian flu (H5N1),
enterorrhagia colibacillosis (O157: H7), tick borne rickettsiosis, dengue, poliomyelitis,
HFRS, meningococcal meningitis, viral diarrhea (norovirus,    rotavirus), streptococcus
suis,diphtheria and HFMD.
       The emergency laboratory at severely affected areas should try to take samples
for laboratory confirmation on each suspected TB, malaria and typhoid case. Previous
suspected/probable cases of cholera, leptospirosis, hepatitis A, hepatitis E, measles,
influenza, Japanese encephalitis and malaria reported in temporary medical sites and
shelters should be taken samples for laboratory diagnosis, while not necessary to lab
confirm every case.
        Medical service providers in the affected areas should report suspected and
probable cases of plague, avian flu (H5N1) enterorrhagia colibacillosis (O157: H7),
acute flaccid paralysis, tick borne rickettsiosis, HFRS, dengue, diphtheria and
streptococcus suis upon diagnosis, and send the collected samples to Sichuan
provincial CDC for lab confirmation. If any abnormal increasing of viral diarrhea and
HFMD cases are detected, samples should be collected and sent to the provincial
laboratory for outbreak diagnosis.
      The distribution of anthrax and Sohistosomiasis natural foci should be idetified
and the animal burial places and snail areas should be marked out to avoid direct
contact.
      If vaccine-preventable diseases are found, the emergency mass vaccination
campaign should be launched in accordance with the ―vaccination guideline for
earthquake affected areas‖ and the vaccination coverage should be achieved as
requested.

7. Resume the basic public health service

     Routine vaccination, maternal and neonatal health services should be recovered
as soon as possible when the situation of the affected area become stable. Recover
routine vaccination as soon as possible, the temporary vaccination service sites should
be established make sure the children of the appropriate age can be properly
immunized. The priority should be given to the EPI newly included vaccines. Give
vaccination service to the key populations in the sheltering sites, schools and
kindergartens in the affected areas setp by step on the basis of diseases risk
assessment results. Measures must be taken to ensure that the provision, preservation
and transportation of vaccines comply with the relevant requirements.
     Resume TB and AIDS intervention programs to ensure the continued
implementation of case identification, free and standardized treatment. Pulmonary TB
patients should be continuously treated and effectively managed in accordance with
the relevant requirement under the national Stop TB program. In addition, the
destruction of leprosy villages or hospital caused by the earthquake may adversely
affect the mental health of the patients, measures should be taken for treatment the
mental interference.



                                           17
8. Strengthen case management

     Regulated treatment must be given to the infectious disease casess or suspected
cases according to local available resources to reduce the further transmission of
diseases. The controlling of infectious diseases should comply with relevant national
guidelines and regulations. Improve the awareness of the community on the infectious
diseases to make them understand the importance of early treatment and appropriate
case management.in controlling diseases effectively. Enhance the isolation of
infectious disease patients in the crowded sheltering sites so as to reduce the
transmission of disease due to overcrowding. Additionally, the preventive measures of
tetanus must be taken to avoid cross infections or nosocomial infections during
rescuing or surgical treatment. Treatment and management of gas gangrene and other
diseases should not be neglected.
     In summary, disease control remains an arduous task in the quake affected areas
for a long term. During the displacement of the affected populations, recovery of the
public health services and medical facilities still in process, the environment hygiene,
water and food safety will face great challenges, with the combination of the factors
of increased movement of population, overcrowding, immunity compromised, the
occurrence or even outbreak of the diseases such as bacillary dysentery, other
diarrhoeal disease, hepatitis A, mumps, chicken pox, influenza, acute hemorrhagic
conjunctivitis and HFMD are still possible. Some areas must be vigilant on the
occurrence and potential outbreak of Japanese encephalitis, malaria, kala-azar,
leptospirosis, Schistosomiasis, and echinococcosis.
     The health administrative departments and disease control facilities at the
different levels of the disaster areas should take measures not only for the rapid
emergency responding but also for the long term containment needs, carry out the risk
assessment of the diseases and public health events in a well planed way, set up and
improve the coordination, surveillance and monitoring, laboratory testing, emergency
response and information communication, adjust and strengthen the strategy to
maintain water and food safety, environmental hygiene and vector surveillance, and
resume routine immunization program to prevent and manage the communicable
diseases outbreak and other public health events scientifically, effectively, orderly and
in the regulated way. Strengthen the guidance on disinfection and insecticide spraying
to avoid any overmuch, superfluous and inappropriate spraying. Enhance the
nosocomial infection control in medical sites, clinics and hospitals. Continue to
improve the public awareness of the disease control and improve their prevention
knowledges and capacities.
     Under the leadership of the CPC central committee and the State Council and the
governments at all levels, and the supports by the disease control facilities at all levels,
we will work together closely to achieve our goal of ―no major epidemic after the
disaster‖.




                                            18
     Table 1      Top 10 infectious diseases and other key infectious diseases in the 21 severely affected counties in Sichuan, 2004~2007
  Severely    Cases of Class                                2004~2007 top ten diseases of reported cases (total cases)                               Other diseases under
  affected    A, B, C in the
                                  1           2         3            4           5             6          7              8      9          10              attention
  counties     past 4 years
Pixian                                                                                                         Condylom                       Streptococcus suis、Rabies、
County                         Hepatitis                                                bacillary                  a
                 (2446)                  Diarrhea      TB         mumps     chicken pox              gonorrhea           Hepatitis A syphilis malaria
                                  B                                                     dysentery              Acuminat
                                                                                                                  um
                                (2530)      (1804)    (1685)      (1103)      (1042)        (865)      (453)     (440)     (329)      (297)
Dayi County                                                                                                                                   Schistosomiasis 、Rabies 、
                                                                                                     Condyloma
                                           Hepatitis bacillary                                                                                malaria、JE、
                 (1006)          TB                               mumps      Diarrhea    chicken pox Acuminatu gonorrhea Hepatitis A syphilis
                                              B      dysentery
                                                                                                         m                                    echinococcosis 、
                                                                                                                                              Streptococcus suis
                                (1886)      (724)     (332)        (294)       (183)        (175)      (128)     (113)      (83)       (69)
Pengzhou                                                                                 Condyloma
                               Hepatitis                                     bacillary                                               chicken malaria、 Schistosomiasis、JE、
City             (3184)                      TB      Diarrhea gonorrhea                  Acuminatu syphilis     mumps Hepatitis A
                                  B                                          dysentery                                                 pox Rabies、echinococcosis
                                                                                              m
                                (5959)      (2264)    (1571)       (653)       (496)        (443)      (406)     (384)     (245)      (171) Streptococcus suis、kala-azar
Du Jiangyan                                                                                          Condyloma                                malaria、Rabies、kala-azar、
                                                     Hepatitis               bacillary                                               Hepatiti
                 (2515)        Diarrhea      TB                   mumps                   gonorrhea Acuminatu syphilis    Rubella
                                                        B                    dysentery                                                 s A Streptococcus suis、JE、
                                                                                                         m                                    echinococcosis
                                (3325)      (1980)    (1722)    (763)          (584)        (484)      (283)     (247)     (170)      (169)
Chongzhou                                            Condylom                                                                                 Schistosomiasis、Rabies 、
City                                       Hepatitis     a    bacillary                                        Schistoso Hepatitis urethriti Streptococcus suis、malaria、
                 (1498)          TB                                           mumps        Diarrhea gonorrhea
                                              B      Acuminat dysentery                                          miasis   untyped        s    JE
                                                        um
                                (2051)      (1223)     (822)    (576)          (440)          (346)   (267)    (243)          (154)       (136)
Wenjiang                                                                                            Condyloma                                      cholera、Streptococcus suis、
District                       Hepatitis                                                  bacillary                          Hepatitis   urethriti
                 (1392)
                                  B
                                             TB      Diarrhea     mumps      gonorrhea
                                                                                          dysentery
                                                                                                    Acuminatu syphilis
                                                                                                                             untyped         s     Rabies、Schistosomiasis 、
                                                                                                        m                                          malaria
                                (1169)      (1019)    (944)        (594)       (369)        (346)     (246)    (182)          (148)        (88)




                                                                                         19
Mianzhu                                                                                                 Condylom
                                                                                                                              Hepatiti      JE、Schistosomiasis 、
City                    Hepatitis                                    bacillary                               a                              malaria、kala-azar
               (2333)                 TB        Diarrhea chicken pox           Hepatitis A     mumps               gonorrhea       s
                           B                                         dysentery                          Acuminat
                                                                                                                              untyped
                                                                                                            um
                         (3749)      (1954)      (778)          (765)      (539)      (499)     (489)     (408)      (300)     (293)
Shifang City                                                                                                                  Hepatiti      JE、Schistosomiasis、
                        Hepatitis                                                                        bacillary
               (1824)                 TB        Diarrhea    Hepatitis A gonorrhea chicken pox mumps                 syphilis       s        kala-azar、Rabies
                           B                                                                            dysentery
                                                                                                                              untyped
                         (1841)      (1551)      (795)          (520)      (410)      (303)     (244)     (192)      (192)     (173)
Anxian                                                                                                  Condylom                            Schistosomiasis 、cholera 、
Country                 Hepatitis                            bacillary                                       a                urethriti     JE、kala-azar、 leptospirosis 、
               (2115)                 TB        Diarrhea                chicken pox mumps Hepatitis A              gonorrhea
                           B                                 dysentery                                  Acuminat                   s        HFRS、malaria
                                                                                                            um
                         (2366)      (1843)      (1140)        (1063)      (639)      (626)     (331)     (288)      (206)     (113)
Beichuan                                        Hepatitis                bacillary                                            Hepatiti      malaria、hemorrhagic fever 、
County         (648)      TB        mumps                   chicken pox             Diarrhea   measles   Rubella gonorrhea
                                                    B                    dysentery                                               sA         JE、kala-azar、
                         (769)       (595)        (421)         (369)      (275)      (143)      (99)      (66)       (64)       (64)
Pingwu                                                                                        Condyloma                                     JE、kala-azar、
                                    Hepatitis                                       bacillary                                 conjunct
County         (765)    Diarrhea                mumps            TB     chicken pox           Acuminatu gonorrhea Hepatitis A               echinococcosis 、malaria
                                       B                                            dysentery                                   ivitis
                                                                                                  m
                         (644)       (584)       (571)          (538)      (281)      (181)      (92)      (84)       (83)       (74)
Jiangyou                                                                                                Condylom                            cholera、JE、kala-azar、
City                    Hepatitis                            bacillary                                       a                              HFRS、echinococcosis 、
               (6036)             Diarrhea        TB                    chicken pox mumps     gonorrhea            urethritis syphilis
                           B                                 dysentery                                  Acuminat                            leptospirosis 、
                                                                                                            um
                                                                                                                                                Schistosomiasis 、
                         (8032)      (6544)      (4231)       (1231)      (1135)           (1041)   (1012)    (1003)     (554)      (538)
                                                                                                                                            malaria、Streptococcus suis
Qingchuan                                                                                                                         bacillary JE、malaria、kala-azar
                        Hepatitis                                                                           Hepatitis
County         (1069)                 TB        influenza chicken pox    measles       Diarrhea   mumps               gonorrhea dysenter
                           B                                                                                   A
                                                                                                                                     y
                         (1565)      (968)       (818)         (284)      (257)         (206)      (110)      (76)      (56)        (47)
Lushan         (505)    bacillary   mumps         TB        chicken pox Hepatitis B    Diarrhea Schistosomi measles leptospirosis Hepatiti leptospirosis 、malaria、JE



                                                                                      20
County             dysentery                                                          asis                                sA
                     (474)      (445)     (371)      (289)      (286)      (74)       (71)     (70)             (61)      (60)
Baoxing
                   Hepatitis                                             bacillary
                                                                                   Condyloma
                                                                                             Hepatitis                             JE、leptospirosis 、
County     (229)                mumps      TB       Diarrhea chicken pox           Acuminatu                 gonorrhea syphilis
                      B                                                  dysentery              A
                                                                                       m
                     (261)    (219)      (164)       (141)       (79)      (55)       (27)     (17)             (17)       (7)
Wenchuan
           (677)
                   bacillary
                                TB
                                        Hepatitis
                                                    mumps    chicken pox Diarrhea        measles gonorrhea Hepatitis A
                                                                                                                        genital    kala-azar、echinococcosis 、
                   dysentery               B                                                                            herpes
                      (620     (567      (518)       (460)      (247)         (155)        (99)      (87)       (51)      (45)
Lixian             bacillary                                                                                           conjunct    echinococcosis
           (440)             mumps         TB         HB      Diarrhea   Hepatitis A     Rubella   measles gonorrhea
County             dysentery                                                                                             ivitis
                     (538)    (489)        (222)     (182)       (82)     (80)             (51)      (37)       (24)      (20
Maoxian                                  bacillary                                                 Hepatitis Condyloma gonorrh     kala-azar、echinococcosis
           (621)      TB       Diarrhea             mumps Hepatitis B measles          chicken pox
County                                   dysentery                                                    A      Acuminatum ea
                    (653)        (530)     (482)     (275)      (198)    (159)            (101)      (60)       (30)      (29)
Songpan                        bacillary                                                                               urethriti   kala-azar、echinococcosis 、
County     (292)      TB                  mumps Diarrhea Hepatitis B Hepatitis A         measles gonorrhea Rubella
                               dysentery                                                                                    s      anthrax
                    (376)        (227)     (194)     (150)      (115)     (32)             (27)      (15)       (10)       (7)
Xiajin                                   bacillary                                                                     chicken     anthrax、echinococcosis 、
County     (455)      TB        mumps              Hepatitis B measles Hepatitis A      Diarrhea influenza gonorrhea
                                         dysentery                                                                        pox      malaria、
                    (424)        (380)     (367)     (241)      (122)    (117)            (105)      (23)       (11)       (8)
Heishui
           (465)      TB
                               bacillary chicken
                                                   Hepatitis B Diarrhea mumps            measles influenza gonorrhea
                                                                                                                       Hepatiti    kala-azar、echinococcosis 、
County                         dysentery    pox                                                                           sA
                    (932)        (434)     (131)     (115)       (61)     (60)             (58)      (51)       (50)      (42)




                                                                         21
               Table 2     Risk assessment of the key infectious diseases
                                 in affected areas, Sichuan
Diseas                                                     Level of risk☆
Bacillary dysentery                                        ++++
Other infectious diarrhea                                  ++++
Cholera                                                    +++
Hepatitis A                                                +++
Typhoid and paratyphoid                                    +++
TB                                                         +++
Acute upper respiratory tract infection                    +++
Rubella                                                    +++
Mumps                                                      +++
Acute hemorrhagic conjunctivitis                           +++
Chicken pox                                                +++
Measles                                                    ++
Meningococcal meningitis                                   ++
HFMD                                                       ++
Anthrax                                                    ++
Kala-azar                                                  ++
Hemorrhagic fever with renal syndrome                      ++
Tetanus                                                    ++
Malaria                                                    +~++
Plague                                                     +
HB                                                         +
Japanese Encephalitis                                      +
Leptospirosis                                              +
Dengue                                                     +
Rabies                                                     +
Schistosomiasis                                            +
Streptococcus suis                                         +
Avian influenza/H5N1                                       +
Syphilis /gonorrhea                                        +
SARS                                                       -~+
Diseases and infections not covered in the report
  Viral diarrhea                                            ++
  Pneumonia                                                 ++
  HE                                                        ++
  Food poinsoning                                           ++
  Tick borne rickettsiosis                                  ++
  Gas gangrene                                              ++
  HC                                                        +
  Echinococcosis                                            +
  Brucellosis                                               +
  Typhus                                                    +
  Poliomyelitis                                             +
  HIV/AIDS                                                  +
  MRSA                                                      +
☆ Note the risk level from none to high is presented as “-” none, “+” low, “++”
medium, “+++”high risk, “++++” very high risk

                                      22
Attachment
       Geographical Distribution of Cases of Key Communicable Diseases,
           in the 21 Severely Affected Counties in Sichuan, 2004~2007




                                                  songpan
                                                  songpan
                                                     115
                                                     115                                        qingchuan
                                                                                                qingchuan
                                                                           pingw u
                                                                           pingw u                1,565
                                                                                                 1,565
                                                                               584
                                                                               584
                                heishui
                                heishui
                                  115
                                  115
                                                                       beichuan
                                                                       beichuan
                                                                                          jiangyou
                                                                                         jiangyou
                                                    maoxian
                                                    maoxian              421
                                                                         421            8,032
                                                                                        8,032
                                                         198
                                                        198
                                                                       anxian
                                                                       anxian
                                 lixian
                                  lixian                                 2,366
                                                                         2,366
                                                                 mianzhu
                                                                 mianzhu
                                    182
                                   182
                                                             shifang
                                                             shifang
                                                                     3,749
                                                                    3,749
                   xiaojin                                    1,841
                                                              1,841
                   xiaojin
                                       w enchuan
                                       w enchuan           pengzhou
                                                          pengzhou
                   241
                   241
                                             518
                                             518
                                                 dujiangyan 5,959
                                                 dujiangyan 5,959
                                                     1,722
                                                      1,722                 2004~2007 cumulative number
                                                             pixian
                                                            pixian
                                                                            of Hepatitis B cases
                                           chongzhou
                                           chongzhou          2,530
                                                             2,530
                                                             w enjiang
                                                             w enjiang               5,000 to 8,040   (2)
                                            dayi
                                           dayi        1,223
                                                      1,223 1,169
                                                           1,169
                                               724
                                               724                                   3,000 to 4999    (1)
                      baoxing
                      baoxing                                                        1,000 to 2999    (7)
                            261                                                        200 to 999     (7)
                            261 lushan
                                lushan                                                 110 to 199     (4)
                                 286
                                 286




                                                  songpan
                                                  songpan
                                                     376
                                                     376                                       qingchuan
                                                                                               qingchuan
                                                                           pingw u
                                                                           pingw u                968
                                                                                                  968
                                                                            538
                                                                            538
                                heishui
                                heishui
                                  932
                                  932
                                                                   beichuan
                                                                   beichuan               jiangyou
                                                                                         jiangyou
                                                      maoxian
                                                      maoxian           769
                                                                       769              4,231
                                                                                        4,231
                                                        653
                                                        653
                                                                      anxian
                                                                      anxian
                                  lixian
                                 lixian                                 1,843
                                                                        1,843
                                 222                            mianzhu
                                                                mianzhu
                                 222
                                                            shifang
                                                            shifang
                                                                    1,954
                                                                   1,954
                                                             1,551
                                                             1,551
                  xiaojin
                  xiaojin
                                       w enchuan
                                       w enchuan
                    424
                    424                                   pengzhou
                                                          pengzhou
                                            567
                                            567              2,264
                                                             2,264
                                                 dujiangyan
                                                 dujiangyan
                                                     1,980
                                                     1,980                 2004~2007 cumulative number
                                                            pixian
                                                            pixian         of TB cases
                                                            1,685
                                                            1,685
                                             chongzhou
                                            chongzhou
                                                           w enjiang
                                                           w enjiang              3,000 to 4,240     (1)
                                           dayi
                                           dayi       2,051
                                                      2,051
                                                           1,019
                                                          1,019                   2,000 to 2999      (2)
                                              1,886
                                              1,886
                       baoxing
                       baoxing                                                    1,000 to 1999      (7)
                            164                                                     500 to 999       (6)
                            164 lushan
                                lushan                                              160 to 499       (5)
                                 371
                                 371




                                                           23
                                   songpan
                                   songpan
                                       27
                                       27                                       qingchuan
                                                                                qingchuan
                                                             pingw u
                                                             pingw u               257
                                                                                   257
                                                                 52
                                                                 52
                  heishui
                  heishui
                    58
                    58
                                                       beichuan
                                                       beichuan
                                                                          jiangyou
                                                                           jiangyou
                                         maoxian
                                         maoxian           99
                                                           99                58
                                                                            58
                                           159
                                          159
                                                      anxian
                                                       anxian
                   lixian
                  lixian                                  14
                                                          14
                    37                           mianzhu
                                                 mianzhu
                    37
                                              shifang
                                              shifang
                                                      4
                                                      4
                                                 96
                                                 96
xiaojin
xiaojin
                         w enchuan
                         w enchuan
122
122
                                            pengzhou
                                            pengzhou             2004~2007 cumulative number
                              99
                               99 dujiangyan 43                  of Measels cases
                                    dujiangyan 43
                                         58
                                        58                             1 dot = 1 case
                                              pixian
                                             pixian
                                                111
                                               111               cumulative number of cases
                             chongzhou
                             chongzhou
                                           w enjiang
                                           w enjiang
                             dayi
                             dayi         24
                                         24                            200 to 257     (1)
                                               10
                                              10
                                  28
                                  28                                   100 to 199     (3)
   baoxing
   baoxing
                                                                        50 to 99      (8)
          1
          1                                                             10 to 49      (7)
                  lushan
                   lushan
                                                                         0 to 9       (2)
                   70
                   70




                                      songpan
                                      songpan
                                         10
                                         10                                        qingchuan
                                                                                   qingchuan
                                                                pingw u
                                                                pingw u                22
                                                                                      22
                                                                 42
                                                                 42
                    heishui
                    heishui
                         7
                         7
                                                          beichuan
                                                          beichuan
                                                                           jiangyou
                                                                            jiangyou
                                       maoxian
                                       maoxian              66
                                                            66                75
                                                                             75
                                            21
                                            21
                                                           anxian
                                                           anxian
                     lixian
                      lixian                                   77
                                                              77
                                                    mianzhu
                                                    mianzhu
                        51
                        51
                                                shifang
                                                shifang
                                                         18
                                                         18
  xiaojin                                         116
                                                  116
  xiaojin
                             w enchuan
                             w enchuan        pengzhou
                                             pengzhou
    5
    5
                                32
                                 32 dujiangyan107
                                      dujiangyan107
                                                                 2004~2007 cumulative number
                                          170
                                          170
                                               pixian
                                               pixian            of Rubella cases
                                                  31
                                                  31
                                 chongzhou
                                chongzhou                             1 dot = 1case
                               dayi
                               dayi        17
                                           17 w enjiang
                                              w enjiang
                                                77               cumulative number fo cases
                                    36
                                    36
        baoxing
        baoxing
                                                                      100 to 170    (3)
              5
              5                                                        50 to 99     (4)
                    lushan
                     lushan
                                                                       10 to 49     (9)
                      9
                      9                                                 5 to 9      (5)




                                              24
                                songpan
                                songpan
                                   194
                                   194                                       qingchuan
                                                                             qingchuan
                                                          pingw u
                                                          pingw u               110
                                                                                110
                                                             571
                                                             571
            heishui
            heishui
                 60
                 60
                                                   beichuan
                                                   beichuan
                                                                       jiangyou
                                                                      jiangyou
                                  maoxian
                                  maoxian              595
                                                       595           1,041
                                                                     1,041
                                       275
                                      275
                                                    anxian
                                                    anxian
               lixian
                lixian                                 626
                                                       626
                                              mianzhu
                                              mianzhu
                  489
                 489
                                          shifang
                                          shifang
                                                  489
                                                  489
                                            244
                                            244
xiaojin
xiaojin
                      w enchuan
                      w enchuan        pengzhou
                                      pengzhou
380
380
                          460
                          460 dujiangyan384
                               dujiangyan384
                                                          2004~2007cumulative number
                                   763
                                   763
                                        pixian
                                        pixian            of Mumps cases
                                         1,103
                                         1,103
                          chongzhouw enjiang
                           chongzhouw enjiang                   1 dot = 1case
                         dayi
                         dayi       440
                                   440
                                         594
                                        594               cumulative number of cases
                             294
                             294
     baoxing
     baoxing
                                                                1,000 to 1,110 (2)
      219
      219                                                         500 to 1,000 (5)
           lushan
          lushan
                                                                  200 to 500 (11)
               445
               445
                                                                  100 to 200 (2)
                                                                   60 to 100 (1)




                               songpan
                               songpan
                                   3
                                   3                                      qingchuan
                                                                          qingchuan
                                                       pingw u
                                                       pingw u               284
                                                                             284
                                                          281
                                                          281
            heishui
            heishui
                131
                131
                                                  beichuan
                                                  beichuan
                                                                     jiangyou
                                                                    jiangyou
                                 maoxian
                                 maoxian            369
                                                    369            1,135
                                                                   1,135
                                      101
                                     101
                                                   anxian
                                                   anxian
               lixian
                lixian                                639
                                                      639
                                             mianzhu
                                             mianzhu
                   9
                   9
                                         shifang
                                         shifang
                                                 765
                                                 765
                                           303
                                           303
xiaojin
xiaojin
                     w enchuan
                     w enchuan
 8
 8                                    pengzhou
                                     pengzhou
                          247
                          247 dujiangyan171
                               dujiangyan171
                                   58
                                    58                  2004~2007 cumulative number
                                        pixian
                                        pixian          of Chicken pox cases
                                         1,042
                                         1,042
                           chongzhou
                           chongzhou                          1 dot= 1case
                                      w enjiang
                                     w enjiang
                                    62
                                    62
                         dayi
                         dayi            58
                                         58
                             175
                             175                        cumulative number of cases
     baoxing
     baoxing
                                                              500 to 1,140   (4)
       79
       79                                                     200 to 499     (6)
               lushan
                lushan
                                                              100 to 199     (4)
               289
               289                                             10 to    99   (4)
                                                                0 to     9   (3)




                                         25
                                  songpan
                                  songpan
                                       1
                                       1                                            qingchuan
                                                                                    qingchuan
                                                              pingw u
                                                              pingw u                   3
                                                                                        3
                                                                  1
                                                                  1
                heishui
                heishui
                   1
                   1
                                                       beichuan
                                                       beichuan
                                                                           jiangyou
                                                                            jiangyou
                                       maoxian
                                       maoxian              0
                                                            0                 0
                                                                              0
                                          7
                                          7
                                                          anxian
                                                          anxian
                 lixian
                  lixian                                      88
                                                    mianzhu
                                                    mianzhu
                     0
                     0
                                                shifang
                                                shifang
                                                         1
                                                         1
                                                    4
                                                    4
xiaojin
xiaojin
                       w enchuan
                       w enchuan               pengzhou
                                               pengzhou
   0
   0
                              0
                              0 dujiangyan 5
                                   dujiangyan 5
                                        0
                                        0                       2004~2007 cumulative number
                                             pixian
                                            pixian              of Meningococcal meninggitis cases
                            chongzhou
                             chongzhou          0
                                                0
                                         w enjiang
                                        w enjiang                     1dot = 1case
                                         0 0
                                        0 0
       baoxing              dayi 0
                            dayi 0                              cumulative number of cases
       baoxing
          0                                                           5 to 8 (3)
          0       lushan
                 lushan
                                                                      2 to 4 (2)
                  0
                  0                                                   1       (4)
                                                                      0      (12)




                                    songpan
                                    songpan
                                           0
                                           0                                           qingchuan
                                                                                       qingchuan
                                                                 pingw u
                                                                 pingw u                   9
                                                                                           9
                                                                      43
                                                                      43
                 heishui
                 heishui
                      0
                      0

                                                          beichuan
                                                          beichuan            jiangyou
                                                                               jiangyou
                                      maoxian
                                      maoxian                 00                 85
                                                                                85
                                            2
                                            2
                                                           anxian
                                                           anxian
                   lixian
                  lixian                                       24
                                                              24
                      1                               mianzhu
                                                      mianzhu
                      1
                                                  shifang
                                                  shifang
                                                           17
                                                           17
                                                     17
                                                     17
  xiaojin
  xiaojin
                           w enchuan
                           w enchuan
   1
   1                                      pengzhou
                                         pengzhou
                              11
                               11 dujiangyan 18
                                   dujiangyan 18
                                        40
                                       40                        2004~2007cumulative number
                                            pixian
                                            pixian               of Scarlet fever cases
                                               86
                                               86
                              chongzhou
                             chongzhou
                                                                        1 dot = 1case
                             dayi
                             dayi       10 w enjiang
                                        10 w enjiang
                                             37
                                             37
       baoxing                   41
                                 41                              cumulative number of cases
       baoxing
            0                                                           50 to 86    (2)
            0     lushan
                   lushan                                               30 to 49    (4)
                   2
                   2                                                    10 to 29    (6)
                                                                         1 to 9     (5)
                                                                         0          (4)




                                                 26
                                songpan
                                songpan
                                     0
                                     0                                         qingchuan
                                                                               qingchuan
                                                         pingw u
                                                         pingw u                   23
                                                                                  23
                                                             74
                                                             74
               heishui
               heishui
                 0
                 0
                                                     beichuan
                                                     beichuan
                                                                       jiangyou
                                                                        jiangyou
                                  maoxian
                                  maoxian              16
                                                       16               165
                                                                       165
                                        4
                                        4
                                                    anxian
                                                   anxian
               lixian
                lixian                                 78
                                                       78
                                              mianzhu
                                              mianzhu
                  20
                  20
                                          shifang
                                          shifang
                                                  7
                                                  7
xiaojin                                      40
                                             40
xiaojin
                      w enchuan
                      w enchuan
 1
 1                                     pengzhou
                                       pengzhou
                           33 dujiangyan 25
                                dujiangyan 25
                                    14
                                     14                     2004~2007cumulative number
                                          pixian
                                         pixian             of Acute hemorrhagic conjunctivitis cases
                                             39
                                            39
                           chongzhou
                          chongzhou                               1 dot = 1case
                                      9
                                      9  w enjiang
                                        w enjiang
                         dayi 26
                         dayi 26           8
                                           8                cumulative number of cases
     baoxing
     baoxing
                                                                  100 to 165   (1)
          0
          0    lushan
                lushan                                             50 to 99    (2)
                                                                   10 to 49    (8)
                2
                2
                                                                    1 to 9     (7)
                                                                    0          (3)




                                  songpan
                                  songpan
                                      0
                                      0                                         qingchuan
                                                                                qingchuan
                                                            pingw u
                                                            pingw u                 0
                                                                                    0
                                                                1
                                                                1
                heishui
                heishui
                    0
                    0
                                                      beichuan
                                                      beichuan
                                                                         jiangyou
                                                                          jiangyou
                                   maoxian
                                   maoxian               6
                                                         6                  16
                                                                           16
                                         0
                                         0
                                                    anxian
                                                     anxian
                 lixian
                  lixian                                 0
                                                         0
                     0
                     0                         mianzhu
                                               mianzhu
                                            shifang
                                            shifang
                                                    4
                                                    4
                                                0
                                                0
 xiaojin
 xiaojin
                         w enchuan
                         w enchuan
  0
  0                                     pengzhou
                                        pengzhou
                             0 dujiangyan 4
                              0 dujiangyan 4
                                     1
                                     1                       2004~2007cumulative number
                                        pixian
                                        pixian               of Hand foot and mouth disease cases
                                            66
                                            66
                            chongzhou
                            chongzhou
                                        w enjiang
                                         w enjiang                  1 dot = 1case
                                     22
                           dayi 8
                           dayi 8         66                 cumulative number of cases
      baoxing
      baoxing
                                                                    50 to 66 (1)
           0
           0    lushan
                 lushan                                             10 to 49 (1)
                  4                                                  1 to 9 (9)
                  4
                                                                     0       (10)




                                               27
                                 songpan
                                 songpan
                                     0
                                     0                                         qingchuan
                                                                               qingchuan
                                                                                   0
                                                                                   0
                                                         pingw u
                                                         pingw u
                                                             0
                                                             0
              heishui
              heishui
                   0
                   0
                                                      beichuan
                                                      beichuan          jiangyou
                                                                       jiangyou
                                   maoxian
                                   maoxian                0
                                                          0            9
                                                                       9
                                         0
                                         0
                                                      anxian
                                                       anxian
                lixian
                 lixian                                 12
                                                        12
                    0
                    0                          mianzhu
                                               mianzhu
                                           shifang
                                           shifang
                                                   0
                                                   0
xiaojin                                        0
                                               0
xiaojin
                       w enchuan
                       w enchuan
  0
  0                                      pengzhou
                                        pengzhou
                            0 dujiangyan 0
                             0 dujiangyan 0
                                     0
                                     0                       2004~2007 cumulative number
                                          pixian
                                         pixian              of cholera cases
                                             00
                           chongzhou
                           chongzhou                              1 dot= 1case
                                       w enjiang
                                       w enjiang
                                     00
                          dayi 0
                          dayi 0           10
                                          10                 cumulative number of cases
      baoxing
      baoxing
                                                                  12 (1)
          0
          0     lushan
                 lushan                                           10 (1)
                 0                                                 9 (1)
                 0
                                                                   0 (18)




                                 songpan
                                 songpan
                                    32
                                    32                                      qingchuan
                                                                            qingchuan
                                                          pingw u
                                                          pingw u               76
                                                                               76
                                                             83
                                                             83
              heishui
              heishui
                 42
                 42
                                                      beichuan
                                                      beichuan
                                                                      jiangyou
                                                                       jiangyou
                                   maoxian
                                   maoxian              62
                                                        62             202
                                                                      202
                                        60
                                        60
                                                       anxian
                                                       anxian
                lixian
                 lixian                                   331
                                                          331
                   80
                   80                            mianzhu
                                                 mianzhu
                                           shifang
                                           shifang
                                                   499
                                                   499
xiaojin                                      520
                                             520
xiaojin
                       w enchuan
                       w enchuan
117
117                                       pengzhou
                                         pengzhou
                            51 dujiangyan 245
                             51 dujiangyan 245               2004~2007cumulative number
                                     169 pixian
                                     169 pixian              of Hepaittis A cases
                                             329
                                            329                   1 dot= 1case
                           chongzhou
                           chongzhou
                                      116
                                      116 w enjiang
                                          w enjiang          cumulative number of cases
                          dayi
                          dayi              75
                                           75
                               83
                               83
   baoxing
   baoxing                                                        400 to 520    (2)
        17                                                        200 to 399    (4)
        17    lushan
               lushan                                             100 to 199    (3)
                60
                60                                                 50 to 99     (9)
                                                                   17 to 49     (3)




                                          28
                                songpan
                                songpan
                                    1
                                    1                                         qingchuan
                                                                              qingchuan
                                                         pingw u
                                                         pingw u                  2
                                                                                  2
                                                              2
                                                              2
               heishui
               heishui
                  0
                  0
                                                     beichuan
                                                     beichuan
                                                                        jiangyou
                                                                         jiangyou
                                  maoxian
                                  maoxian               0
                                                        0                  8
                                                                           8
                                        3
                                        3
                                                    anxian
                                                     anxian
                lixian
                 lixian                                  5
                                                         5
                                               mianzhu
                                               mianzhu
                    1
                    1
                                          shifang
                                          shifang
                                                  14
                                                  14
                                              8
                                              8
 xiaojin
 xiaojin
                      w enchuan
                      w enchuan
  1
  1                                     pengzhou
                                        pengzhou
                            1
                            1
                                dujiangyan 7
                               dujiangyan 7
                                     12
                                     12                 2004~2007 cumulative number
                                         pixian
                                        pixian          of Hepatitis E cases
                                            12
                                            12
                            chongzhou
                            chongzhou
                                                               1 dot = 1case
                          dayi
                          dayi        10 w6enjiang
                                     10 w6enjiang
                               3
                               3                        cumulative number of cases
      baoxing
      baoxing
                                                               10 to 14 (4)
           4
           4    lushan
                 lushan                                         5 to 9 (5)
                 4                                              1 to 4 (10)
                 4
                                                                0       (2)




                                songpan
                                songpan
                                  227
                                  227                                         qingchuan
                                                                              qingchuan
                                                            pingw u
                                                            pingw u              47
                                                                                 47
                                                             181
                                                             181
               heishui
               heishui
                434
                434
                                                     beichuan
                                                     beichuan
                                                                         jiangyou
                                                                        jiangyou
                                 maoxian
                                 maoxian               275
                                                       275             1,231
                                                                       1,231
                                      482
                                     482
                                                    anxian
                                                   anxian
               lixian
                lixian                                1,063
                                                     1,063
                                              mianzhu
                                              mianzhu
                  538
                 538
                                          shifang
                                          shifang
                                                  539
                                                  539
                                            192
                                            192
xiaojin
xiaojin
                      w enchuan
                      w enchuan
367
367                                    pengzhou
                                      pengzhou
                          620 dujiangyan 496
                          620 dujiangyan 496
                                  584
                                  584 pixian
                                       pixian
                                         865
                                         865             2004~2007 cumulative number
                          chongzhou
                         chongzhou                       of Bacillary dysentery cases
                                  576
                                   576 w enjiang
                                       w enjiang
                         dayi
                         dayi          346
                                       346                        1,000 to 1,240    (2)
                              332
                              332
   baoxing
   baoxing
                                                                    500 to 999      (6)
       55
       55                                                           200 to 499      (9)
               lushan
                lushan                                              100 to 199      (2)
               474
               474                                                   40 to    99    (2)




                                          29
                                 songpan
                                 songpan
                                     0
                                     0                                       qingchuan
                                                                             qingchuan
                                                          pingw u
                                                          pingw u                1
                                                                                 1
                                                              0
                                                              0
               heishui
               heishui
                 2
                 2
                                                     beichuan
                                                     beichuan
                                                                       jiangyou
                                                                        jiangyou
                                  maoxian
                                  maoxian               0
                                                        0                 0
                                                                          0
                                        0
                                        0
                                                     anxian
                                                      anxian
                lixian
               lixian                                     0
                                                          0
                 1                              mianzhu
                                                mianzhu
                 1
                                           shifang
                                           shifang
                                                   0
                                                   0
                                               0
                                               0
xiaojin
xiaojin
                     w enchuan
                     w enchuan
 0
 0                                    pengzhou
                                      pengzhou
                          1 dujiangyan 1
                           1 dujiangyan 1
                                   1
                                   1
                                      pixian
                                      pixian
                                          44
                          chongzhou
                           chongzhou                  2004~2007 cumulative number
                                   55 w enjiang
                                      w enjiang       of Typhoid fever and Paratyphoid fever cases
                         dayi
                         dayi           22
                              3
                              3
     baoxing
     baoxing                                                1 dot = 1case
          0
          0                                           cumulative number of cases
               lushan
                lushan
                0                                           1 to 5 (10)
                0
                                                            0      (11)




                                      songpan
                                      songpan
                                          150
                                          150                                        qingchuan
                                                                                     qingchuan
                                                                  pingw u
                                                                  pingw u               206
                                                                                        206
                                                                    644
                                                                    644
                     heishui
                     heishui
                         61
                         61
                                                            beichuan
                                                            beichuan
                                                                              jiangyou
                                                                             jiangyou
                                           maoxian
                                           maoxian            143
                                                              143           6,544
                                                                            6,544
                                             530
                                            530
                                                          anxian
                                                           anxian
                     lixian
                      lixian                                 1,140
                                                            1,140
                                                     mianzhu
                                                     mianzhu
                        82
                        82
                                                 shifang
                                                 shifang
                                                         778
                                                         778
     xiaojin                                       795
                                                   795
     xiaojin
                              w enchuan
                              w enchuan
     105
     105                                     pengzhou
                                            pengzhou
                                155 dujiangyan1,571
                                155 dujiangyan1,571
                                        3,325
                                        3,325pixian
                                              pixian
                                               1,804
                                               1,804           2004~2007 cumulative number
                                 chongzhou
                                chongzhou
                                              w enjiang
                                             w enjiang         of other infectious diarrhea cases
                               dayi
                               dayi       346 944
                                          346 944
                                    183
                                   183
          baoxing
          baoxing                                                   2,000 to 6,550    (2)
                                                                    1,000 to 1999     (3)
              141
              141 lushan
                  lushan                                              500 to 999      (5)
                      74                                              200 to 499      (2)
                      74
                                                                       60 to 199      (9)




                                                30
                                songpan
                                songpan
                                    2
                                    2                                               qingchuan
                                                                                    qingchuan
                                                         pingw u
                                                         pingw u                        2
                                                                                        2
                                                                 2
                                                                 2
               heishui
               heishui
                 24
                 24
                                                   beichuan
                                                   beichuan
                                                                           jiangyou
                                                                            jiangyou
                                   maoxian
                                   maoxian               2
                                                         2                    7
                                                                              7
                                        20
                                        20
                                                     anxian
                                                     anxian
                lixian
                 lixian                                  11
                                               mianzhu
                                               mianzhu
                    0
                    0
                                           shifang
                                           shifang
                                                    1
                                                    1
                                               2
                                               2
xiaojin
xiaojin
                       w enchuan
                       w enchuan
 0
 0                                      pengzhou
                                       pengzhou
                            1 dujiangyan 1
                           1 dujiangyan 1
                                                             2004~2007 cumulative number
                                    4
                                    4                        of Kala-azar cases
                                         pixian
                                        pixian
                                            00
                            chongzhou
                           chongzhou                                 1 dot = 1case
                                      w enjiang
                                      w enjiang
                                     0 0
                                    0 0                      cumulative number of cases
                          dayi 0
                          dayi 0
     baoxing
     baoxing
                                                                     20 to 30   (2)
          0
          0                                                           5 to 19   (1)
                lushan
               lushan
                                                                      3 to 4    (1)
                 0
                 0                                                    1 to 2    (9)
                                                                      0         (8)




                               songpan
                               songpan
                                    0
                                    0                                         qingchuan
                                                                              qingchuan
                                                       pingw u
                                                       pingw u                    0
                                                                                  0
                                                             0
                                                             0
               heishui
               heishui
                   0
                   0
                                                  beichuan
                                                  beichuan
                                                                        jiangyou
                                                                         jiangyou
                                 maoxian
                                 maoxian             0
                                                     0                     1
                                                                           1
                                       0
                                       0
                                                  anxian
                                                  anxian
                lixian
                 lixian                                104
                                                      104
                                             mianzhu
                                             mianzhu
                    0
                    0
                                         shifang
                                         shifang
                                                  2
                                                  2
                                             2
                                             2
 xiaojin
 xiaojin
                       w enchuan
                       w enchuan
  0
  0                                    pengzhou
                                       pengzhou
                            0 dujiangyan 13
                            0 dujiangyan 13                  2004~2007 cumulative number
                                    0
                                    0                        of Schistosomiasis cases
                                        pixian
                                        pixian
                                           00                        1 dot= 1case
                           chongzhou
                           chongzhou
                                      w enjiang
                                      w enjiang              cumulative number of cases
                                   243
                                   243
                          dayi 6
                          dayi 6         11
      baoxing
      baoxing                                                        100 to 243 (2)
                                                                      20 to 99 (1)
           0
           0    lushan
                 lushan                                                5 to 19 (2)
                                                                       1 to 4 (4)
                 71
                 71
                                                                       0        (12)




                                        31
                                      songpan
                                      songpan
                                           0
                                           0                                           qingchuan
                                                                                       qingchuan
                                                                 pingw u
                                                                 pingw u                   0
                                                                                           0
                                                                       0
                                                                       0
                    heishui
                    heishui
                        0
                        0
                                                          beichuan
                                                          beichuan
                                                                               jiangyou
                                                                                jiangyou
                                       maoxian
                                       maoxian                 0
                                                               0                  1
                                                                                  1
                                             0
                                             0
                                                           anxian
                                                           anxian
                     lixian
                      lixian                                   33
                                                     mianzhu
                                                     mianzhu
                         0
                         0
                                                 shifang
                                                 shifang
                                                          0
                                                          0
  xiaojin                                            0
                                                     0
  xiaojin
                            w enchuan
                            w enchuan         pengzhou
                                             pengzhou
     0
     0
                                 00 dujiangyan 0
                                      dujiangyan 0                     2004~2007 cumulative number
                                           0
                                           0                           of Leptospirosis cases
                                               pixian
                                               pixian
                                                   0
                                                   0                       1 dot = 1case
                                chongzhou
                                chongzhou
                                              w enjiang
                                             w enjiang                 cumulative number of cases
                                           00
                               dayi
                               dayi             00
         baoxing                    0
                                    0
         baoxing                                                           61 (1)
              2                                                             3 (1)
              2     lushan
                     lushan                                                 2 (1)
                       61
                       61                                                   1 (1)
                                                                            0 (17)




                                   songpan
                                   songpan
                                       2
                                       2                                             qingchuan
                                                                                     qingchuan
                                                             pingw u
                                                             pingw u                     0
                                                                                         0
                                                                   1
                                                                   1
                  heishui
                  heishui
                    2
                    2
                                                      beichuan
                                                      beichuan
                                                                            jiangyou
                                                                             jiangyou
                                        maoxian            0
                                                           0                   2
                                                                               2
                                        maoxian
                                           1
                                           1
                                                       anxian
                                                       anxian
                   lixian
                  lixian                                   00
                    5                              mianzhu
                                                   mianzhu
                    5
                                               shifang
                                               shifang
                                                        0
                                                        0
xiaojin                                            0
                                                   0
xiaojin
                        w enchuan
                        w enchuan
 4
 4                                       pengzhou
                                         pengzhou
                              1 dujiangyan 2
                               1 dujiangyan 2
                                       1
                                       1
                                          pixian
                                          pixian               2004~2007 cumulative number
                                              0
                                              0                of Echinococcosis cases
                              chongzhou
                             chongzhou
                            dayi
                            dayi          w enjiang
                                         w enjiang
                                        0 0
                                       0 0                             1 dot= 1case
                                 1
                                 1
     baoxing
     baoxing                                                   cumulative number of cases
          0
          0                                                            1 to 5 (11)
                   lushan
                  lushan
                                                                       0      (10)
                   0
                   0




                                                32
                                songpan
                                songpan
                                    0
                                    0                                           qingchuan
                                                                                qingchuan
                                                            pingw u
                                                            pingw u                 2
                                                                                    2
                                                               7
                                                               7
               heishui
               heishui
                 0
                 0
                                                     beichuan
                                                     beichuan
                                                                        jiangyou
                                                                         jiangyou
                                  maoxian
                                  maoxian               12
                                                        12                 1
                                                                           1
                                        0
                                        0
                                                      anxian
                                                      anxian
               lixian
                lixian                                    11
                                              mianzhu
                                              mianzhu
                   0
                   0
                                          shifang
                                          shifang
                                                   2
                                                   2
xiaojin                                       0
                                              0
xiaojin
                        w enchuan
                        w enchuan
 1
 1                                     pengzhou
                                       pengzhou
                            0 dujiangyan 18
                            0 dujiangyan 18                    2004~2007 cumulative number
                                                               of Malaria cases
                                    7
                                    7
                                        pixian
                                       pixian                        1 dot = 1case
                                           11
                           chongzhou w enjiang
                          chongzhou w enjiang                  cumulative number fo cases
                          dayi
                          dayi      22
                                         11                          10 to 18   (2)
                               2
                               2
     baoxing
     baoxing
                                                                      5 to 9    (2)
          0
          0                                                           2 to 4    (5)
               lushan
                lushan                                                1         (5)
                2
                2                                                     0         (7)




                                songpan
                                songpan
                                    0
                                    0                                         qingchuan
                                                                              qingchuan
                                                         pingw u
                                                         pingw u                 12
                                                                                 12
                                                             2
                                                             2
               heishui
               heishui
                    0
                    0
                                                     beichuan
                                                     beichuan
                                                                      jiangyou
                                                                       jiangyou
                                  maoxian
                                  maoxian               2
                                                        2                7
                                                                         7
                                        0
                                        0
                                                      anxian
                                                      anxian
                lixian
                 lixian                                   12
                                                         12
                                              mianzhu
                                              mianzhu
                    0
                    0
                                          shifang
                                          shifang
                                                   3
                                                   3
 xiaojin                                      2
                                              2
 xiaojin
                        w enchuan
                        w enchuan
  0
  0                                     pengzhou
                                        pengzhou
                            0 dujiangyan 6
                             0 dujiangyan 6
                                                             2004~2007 cumulative number
                                     1
                                     1                       of Japanese Encephalitis cases
                                         pixian
                                        pixian
                                            00
                            chongzhou
                           chongzhou                               1dot = 1case
                                     11  w enjiang
                                         w enjiang
                          dayi
                          dayi            00                 cumulative number of cases
                               1
                               1
      baoxing
      baoxing
                                                                   10 to 12   (2)
           3
           3                                                        5 to 9    (3)
                lushan
                 lushan
                                                                    2 to 4    (5)
                 6
                 6                                                  1         (3)
                                                                    0         (8)




                                          33
                                    songpan
                                    songpan
                                         0
                                         0                                        qingchuan
                                                                                  qingchuan
                                                              pingw u
                                                              pingw u                 0
                                                                                      0
                                                                 0
                                                                 0
                heishui
                heishui
                     0
                     0                                                         jiangyou
                                                                                jiangyou
                                                        beichuan
                                                        beichuan
                                        maoxian
                                        maoxian            2
                                                           2               2
                                                                           2
                                              0
                                              0
                                                         anxian
                                                         anxian
                   lixian
                    lixian                                   11
                                                   mianzhu
                                                   mianzhu
                       0
                       0
                                               shifang
                                               shifang
                                                        0
                                                        0
                                                   0
                                                   0
xiaojin
xiaojin
                         w enchuan
                         w enchuan
 0
 0                                         pengzhou
                                          pengzhou
                               0 dujiangyan 0
                               0 dujiangyan 0
                                       0
                                       0
                                            pixian
                                           pixian
                                               00            2004~2007 cumulative number
                              chongzhou
                              chongzhou
                                         w enjiang
                                         w enjiang           of Hemorrhagic fever w ith renal syndrome cases
                             dayi
                             dayi       0 0
                                       0 0
                                  0
                                  0                               1 dot = 1case
     baoxing
     baoxing
                                                             cumulative number of cases
          0
          0
                 lushan
                  lushan
                                                                  1 to 3 (3)
                    0
                    0                                             0      (18)




                                              songpan
                                              songpan
                                                  0
                                                  0                                        qingchuan
                                                                                           qingchuan
                                                                        pingw u
                                                                        pingw u                0
                                                                                               0
                                                                          0
                                                                          0
                             heishui
                             heishui
                                0
                                0
                                                                 beichuan
                                                                 beichuan
                                                                                   jiangyou
                                                                                    jiangyou
                                               maoxian
                                               maoxian               0
                                                                     0                0
                                                                                      0
                                                     0
                                                     0
                                                                 anxian
                                                                anxian
                              lixian
                               lixian                                0
                                                                     0
                                                           mianzhu
                                                           mianzhu
                                  0
                                  0
                                                        shifang
                                                        shifang
                                                                0
                                                                0
              xiaojin                                       1
                                                            1
              xiaojin
                                    w enchuan
                                    w enchuan
               0
               0                                      pengzhou
                                                      pengzhou
                                          0 dujiangyan 4
                                           0 dujiangyan 4
                                                   6
                                                   6
                                                       pixian
                                                      pixian            2004~2007 cumulative number
                                                          22
                                         chongzhouw enjiang
                                          chongzhouw enjiang            of Rabies cases
                                        dayi
                                        dayi       44
                                                        33                  1 dot = 1case
                                             3
                                             3
                   baoxing
                   baoxing
                                                                        cumulative number of cases
                        0
                        0
                               lushan
                              lushan                                        6       (1)
                               0
                               0                                            1 to 5 (6)
                                                                            0      (14)




                                                      34
                                                           songpan
                                                           songpan
                                                              0
                                                              0                                       qingchuan
                                                                                                      qingchuan
                                                                                   pingw u
                                                                                   pingw u                0
                                                                                                          0
                                                                                       0
                                                                                       0
                                        heishui
                                        heishui
                                            0
                                            0
                                                                              beichuan
                                                                              beichuan
                                                                                                 jiangyou
                                                                                                jiangyou
                                                            maoxian
                                                            maoxian              0
                                                                                 0                 0
                                                                                                   0
                                                                  0
                                                                  0
                                                                               anxian
                                                                               anxian
                                         lixian
                                          lixian                                   00
                                                                         mianzhu
                                                                         mianzhu
                                             0
                                             0
                                                                     shifang
                                                                     shifang
                                                                              0
                                                                              0
                       xiaojin
                       xiaojin                                           0
                                                                         0
                                                w enchuan
                                                w enchuan
                           4
                           4                                       pengzhou
                                                                  pengzhou
                                                      0 dujiangyan 0
                                                       0 dujiangyan 0
                                                               0
                                                               0
                                                                    pixian
                                                                   pixian            2004~2007 cumulative number
                                                                       00            of Anthrax cases
                                                      chongzhou
                                                     chongzhou
                                                                 w enjiang
                                                                 w enjiang
                                                               00                          1 dot = 1case
                                                    dayi 0
                                                    dayi 0           0
                                                                     0
                               baoxing
                               baoxing                                               cumulative number of cases
                                    0
                                    0                                                      4 (1)
                                         lushan
                                          lushan
                                                                                           0 (20)
                                          0
                                          0




                                                           songpan
                                                           songpan
                                                              31
                                                              31                                       qingchuan
                                                                                                       qingchuan
                                                                                     pingw u
                                                                                     pingw u              151
                                                                                                          151
                                                                                      247
                                                                                      247
                                         heishui
                                         heishui
                                           72
                                           72
                                                                              beichuan
                                                                              beichuan
                                                                                                  jiangyou
                                                                                                 jiangyou
                                                            maoxian
                                                            maoxian             140
                                                                                140             3,288
                                                                                                3,288
                                                                 70
                                                                 70
                                                                               anxian
                                                                               anxian
                                           lixian
                                          lixian                                  766
                                                                                  766
                                           46                            mianzhu
                                                                         mianzhu
                                           46
                                                                     shifang
                                                                     shifang
                                                                             1,092
                                                                            1,092
                                                                       880
                                                                       880
                          xiaojin
                          xiaojin
                                                w enchuan
                                                w enchuan
                           20
                           20                                     pengzhou
                                                                   pengzhou
                                                     229
                                                     229
                                                          dujiangyan1,610
                                                         dujiangyan1,610
                                                            1,155
                                                             1,155                   2004~2007 cumulative number
                                                                   pixian
                                                                    pixian           of STD cases
                                                                     1,334
                                                                    1,334
                                                      chongzhou
                                                      chongzhou                            2,000 to 3,290    (1)
                                                                 w enjiang
                                                                 w enjiang
                                                    dayi
                                                    dayi      1,386
                                                              1,386                        1,000 to 1999     (5)
                                                                    899
                                                                   899
                                                        379
                                                       379                                   500 to 999      (3)
                               baoxing
                               baoxing
                                                                                             200 to 499      (5)
                                 59
                                 59                                                           20 to 199      (7)
                                         lushan
                                          lushan
                                          68
                                          68




Remark: STD include syphilis, gonorrhea ,Condyloma Acuminatum, genital herpes and genital tract chlamydia
trachomatis




                                                                   35

				
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