Vanuatu: Tropical Cyclone Pam
Situation Report No. 4 (as of 18 March 2015)
This report is produced by the OCHA Regional Office for the Pacific (ROP) in collaboration with humanitarian partners. It covers the period from 17 to 18 March 2015. The next report will be issued on or around 19 March 2015.  The Government-led joint Initial Rapid Needs Assessments continued today, indicating an urgent need for food, water, medical supplies, hygiene kits, kitchen kits, tents and bedding.  Emerging aerial images confirm total or near-total destruction of homes, buildings and crops.  A total of 34 schools are being used as evacuation centres on Efate Island and the provinces of Torba and Penama, which prevents children from attending school.  Food supplies in affected areas, particularly in Erromango, are running critically low.  Medicines, body bags and power supplies for hospitals are urgently required.  An estimated 60 per cent of the population in Shefa and Tafea provinces has no access to drinking water. Confirmed fatalities People in evacuation Evacuation centres centres in Efate Source: Vanuatu National Disaster Management Office Situation Overview Government-led joint Initial Rapid Needs Assessments have continued, broadening the reach to include islands in Erromango and Tanna islands (Tafea Province), Emae, Tongoa and Epi islands (Shefa Province), West Ambrym island (Malampa Province) and Pentecote island (Penama Province). The information collected will inform further response decisions. On 18 March, a 12-person team travelled to Tanna in Tafea province. The team consisted of specialists from health, WASH, shelter, food and agriculture, education and protection sectors, as well as medical staff from Vanuatu and Australia. The medical staff also helped stabilize a critically ill nine-year-old girl and transfer her to Port Vila for specialist care. The team that went to Erromango in Tafea Province found no people dead or injured. About 352 houses, seven
schools, 11 churches and one health centre were destroyed. About 1,400 people are either displaced, staying with
family or in badly damaged homes. Water tanks were destroyed or contaminated, leaving 251 people to walk long
distances to collect river water. Minimal communication means exist. Urgent needs are food, water filtration and
purification kits, WASH kits, tools to rebuild houses, and medical supplies for the health centre. Other needs
include fuel, lighting equipment, water tank and pipe repairs, kitchen kits, clothing, blankets, building supplied,
restoration of communication and agriculture support.
In Tanna, the assessment team noted that all roads from the airport to the main city centre are open. The roads in
the north are being cleared of fallen trees with heavy machinery. The roads in the south are closed and could
remain so until around 25 March. Food supplies are critically low. There is an extreme shortage of rice because
stocks were damaged by the cyclone. Supplies of yams will last a month; however, stocks of fresh produce,
including bananas, will last for around one week. The supply of water is another major concern. People are carting
water in buckets.
While some chickens and cows survived, the vast majority of livestock was destroyed. No meat products are The mission of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is to mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors. Coordination Saves Lives
Vanuatu Tropical Cyclone Pam Situation Report No. 4 2
available. Fishing boats were also damaged. Those that were not will be used for fishing when the seas become calmer. Most schools have been damaged beyond minor repairs and will need to be reconstructed. Temporary tents have been requested to enable schooling to recommence. Some of the schools that are still partially usable are currently housing an estimated 1,000 people. Approximately two weeks of fuel remains. The Lenakel Public Hospital - the only hospital on Tanna Island – is functioning, although some parts are very badly damaged and will need to be repaired before they can be occupied. Medical supplies are urgently needed. Power supply to the Lenakel hospital is used only in the morning and afternoon for a short period of time. There is a need for hygiene kits, kitchen kits, tents and bedding. Due to the severe impact of Cyclone Pam experienced on Efate, the Shefa Provincial Headquarters initiated an aerial assessment to measure the impact of Cyclone Pam on the Shepherd Islands (lying between the larger islands of Epi and Éfaté, in the Shefa province of Vanuatu) and the Efate outer islands. The assessment results indicate that the islands of Malakula and Santo were not as severely affected as Ambrym, particularly on the south-eastern part of the island. The assessment results of Epi, the Shepherd Islands, and the Efate Islands are provided below. On the islands north of Efate such as Epi Island, many houses are roofless or destroyed. Road blocks are visible
from the air with fallen trees on the road, while gardens and trees are destroyed. River flooding is visible around the
areas where most gardens were swept down to the sea. Coastal flooding is also visible and landslides have
occurred in most areas of Epi. About 90 per cent of the eastern part of the island has been destroyed.
In Tongoa, Tongariki and Buninga (Shepherd Islands) most houses were shattered and roofless. Gardens and
trees are destroyed. Road blocks were visible with fallen trees and school buildings were damaged. In addition to
that, coastal flooding was visible in Emae, Makira, Mataso and Nguna (Shepherd Islands)
All the villages in Paama (in the Malampa Province) have been destroyed almost completely, while Ambryn
appears to be less damaged and Malakula to be unaffected by the cyclone.
In the south, Erromango about 70-80 per cent of the villages have been destroyed. Broken trees and debris are
blocking roads, which can be cleared. The runways as well as the airport terminals are clear.
As assessments are beginning to provide a clearer picture of damage, the confirmed death toll remains at 11. The number of evacuation centres has decreased to 36 on the main island of Efate, with an increasing number of people going back to their homes. About 3,062 people remain in evacuation shelters in Efate, while an unconfirmed number of evacuation shelters exist outside Efate. Communication within and between the islands, as well as access to the affected areas, remains to be the greatest challenge at this point in time. In Tanna, the Initial Rapid Needs Assessment teams had to walk across the island to conduct parts of the assessment as the roads were not accessible. The rapid assessment teams were the first ones from outside the provinces to reach the islands. Basic priority needs are food, water and shelter. Humanitarian Response The Government is leading response efforts across all clusters supported by humanitarian partners. Camp Coordination and Camp Management
 IOM is coordinating operations in evacuation centres together with national partners, including assessments, displacement tracking and gap analysis. non-food items and  IOM is supporting the assessment of evacuation centres, shelter and hygiene non- shelter kits delivered food items, as well as health and water, sanitation and hygiene (WASH) needs. It is also supporting the Government to draft an exit strategy for evacuation centres by linking emergency assistance with durable solutions.  A total of 650 non-food item (NFI) kits and hygiene kits, as well as 500 shelter kits will be delivered over the next three days (19-21 March). United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Coordination Saves Lives Vanuatu Tropical Cyclone Pam Situation Report No. 4 3
 A total of 34 schools are being used as evacuation centers in Efate, Torba and Penama, which prevents children from going to school.  Facilities and resources are damaged in a majority of schools in Efate, Tafea, Torba Schools being used as evacuation centres  Initial Rapid Needs Assessments confirmed that the majority of the schools in Shefa and Tafea Provinces are destroyed and the few classrooms that remain standing are being used as an evacuation centres by people that have lost their homes. Response:
 UNICEF has organized two batches of emergency education supplies to be shipped this week. This will include "school in a box" kits, recreational kits, early childhood development kits, tents and tarpaulins.  The Education Cluster is targeting about 57,000 affected school-aged children from early childhood through to secondary school.  The Education Cluster leadership and operation has yet to reach full capacity. However, they have already conducted assessments of schools in Port Vila, especially those used as evacuation centres.  The UNICEF Pacific Chief of Education has been deployed to Vanuatu to support the joint initiative led by Save the Children and the Ministry of Education.  The Technical Assessment Group is going to carry out a rapid needs assessment on education in Malakula, Ambrym and Penama  A Save the Children Education Advisor from Australia will arrive on 21 March to support the Education Cluster.  UNICEF has airlifted 1,508 school backpacks with stationery supplies and 69 recreation kits to reach a total of 6,210 children (90 children per kit). Food Security
 Food supplies in affected areas, particularly in Erromango, are running critically low. Response:
 The Government has formally submitted a request to the World Food Programme (WFP) for food aid. As a result, the food response is being mobilized.  Key food security messages are being delivered via air drop flyers, FM and HF radio, pamphlets, mobile phone messages and local newspapers to inform farmers of the need for immediate replanting.  Preparations have been completed for the development of a national estimate of the type and quantity of food required for each island based on initial damage and population estimates.  Community food distribution guidelines have been drafted and island maps of food distribution plans are currently being finalized.  The Food Security and Agriculture Cluster (FSAC) joined the multi-cluster Initial Rapid Needs Assessment teams to measure agricultural damage and loss of crops on affected islands.  One WFP Emergency Food Specialist has joined the Vanuatu FSAC in Port Vila to provide technical support for food assistance. Following an official request from the Government, WFP is now mobilizing a food aid response.  FAO's Agricultural Adviser has also arrived in Port Vila. Health and Nutrition
 There are eleven confirmed fatalities and an unknown number of injuries.  Medicines, body bags and power supplies for hospitals are urgently required.  Provision of health care services and emergency care including medical personnel for key affected areas is  Disease control, surveillance and outbreak response including vaccination program is required.  There is a need to address mental health issues on affected people, including social and emotional health  Health facility structures need to be repaired and communications reestablished. United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Coordination Saves Lives Vanuatu Tropical Cyclone Pam Situation Report No. 4 4

 Six teams comprising nurses from the Ministry of Health were deployed to communities around Port Vila to provide vaccination against measles, polio and tetanus. These teams also conducted rapid assessments, distributed bed nets and provided health education to the affected communities.  Japan is deploying 23 health care specialists and Australia 20 health care specialists to assist the Ministry of Health, especially at hospitals.  A UNICEF Cold Chain Specialist accompanied the above teams to assess the cold chain situation and provide on-site repairs and training. He also provided on-the-job training for six medical staff in Epi Island on ice pack conditioning and proper packing of vaccines in passive containers as well as designed and shared a simple vaccine utilization forms to summarize vaccine utilization data from the field. The Epi Island national cold room now has electricity.  UNICEF is part of the nine-member assessment team to be deployed to Tanna tomorrow. Medical and emergency supplies, comprising of ORS, Vitamin A, Albendazole, and more arrived in Port Vila. UNICEF delivered a second tent, large size, to the national referral hospital to manage the overflow of patients.  Infrastructure repairs, medicine storage facilities and mobile hospital are still to be established as a priority activity (medical, surgical, maternity wards are already repaired in some hospitals).  Assessments and measles vaccinations are underway in Shefa and Penama Provinces.  Assistance for repairs of health facilities remains a gap.  Coordination with the Ministry of Health regarding flights to provinces is critical to ensure key health personnel can attend to the care of the sick and injured and medical supplies can be shipped. Protection
 Port Vila: During several visits to Port Vila Central Hospital, Gender and Protection Cluster members noted that the emergency waiting room was almost entirely populated by men, raising the question of whether women are experiencing difficulty in accessing health facilities. Given that the health cluster reports significant numbers of heavily pregnant women, an investigation is needed to see whether access to healthcare is problematic for women, to inform appropriate response.  Data has not been collated yet from the assessment teams, which went to Emae and Tanna. However, observations by Gender and Protection Cluster members on the assessment teams are as follows: Emae: Evacuation centres were overcrowded, lacked privacy and lighting, particularly around toilet facilities (all outside). Appropriate attention to the needs of people with a disability or high-level care needs seemed lacking. Tanna: An extensive number of schools have been destroyed and those that remain are being used as evacuation centres. Similar problems were observed in evacuation centres in Emae (although women are well represented on committees). It is likely that extended occupancy of evacuation centres could disrupt children's return to learning without intervention. Response:
 Emae: Immediate advocacy on the need to ensure people with high-level needs were not left unattended was conducted and for inclusion of women on community committees.  In Port Vila, services for existing clients of organizations supporting people with a disability are resuming, in collaboration with the Ministry of Justice. Vanuatu Society for Disabled Persons is planning to make visits to evacuation centres and affected communities, to identify numbers and needs of persons with disability. Vanuatu Education Policy Advocacy Coalition is prepared to bring in ambulatory devices if required.  World Vision delivered shelter kits and hygiene kits in areas of Port Vila where WV supports kindergartens.  UN Women has been consulting with women vendors affected by the cyclone to document their experience.  UNICEF is preparing information and education materials on psycho-social support.  The Women's Crisis Centre and the Police Family Protection Unit are being approached to participate in the Gender and Protection Unit. This should help to establish a better picture regarding incidents of sexual and gender-based violence, already identified as a significant problem in Vanuatu, as well as identifying referral pathways.  UNICEF supported the NDMO to conduct evacuation centre surveys in 16 of the Evacuation Centers in Port Vila. Child protection standards varied greatly between the different evacuation centres, but common themes are over-crowding, lack of privacy, lack of lighting and emergency power supply.  In addition to a national Child Protection officer, and a Child Protection specialist from Fiji, UNICEF Pacific is deploying a Child Protection in emergencies expert from Indonesia. There is an information gap on the full United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Coordination Saves Lives Vanuatu Tropical Cyclone Pam Situation Report No. 4 5
extent of displacement and conditions in evacuation centres but this should improve within the next few days as assessments are taking place, which will allow for a more refined planning of support.  Information about the situation of vulnerable groups continues to be a gap, as only rapid assessments with limited protection and gender content have been possible to date. Access to locations beyond Efate continues to be extremely limited.  Approximately 30,000 houses are in the worst affected areas of Vanuatu. Up to 50 per cent damage levels are being used for initial response planning purposes People in evacuation (approximately 15,000 houses). However subsequent initial damage assessment centres in Efate reports indicate this could be higher in some areas.  36 evacuation centres are in operation in Efate, housing approximately 3,026 people. There is also an unconfirmed number of evacuation centres in Torba and Penama, with UNICEF stating that at least six schools being used as evacuation centres. The number of evacuation shelters has decreased from previous days, with an increasing number of people going back to their homes. Response:
 The Vanuatu Red Cross Society has commenced assessments / distributions in evacuation centres.  IFRC is mobilizing additional human resources for the response operation.  In-country shelter stocks (tool kits, tarpaulins, NFIs) have been identified.
 The NDMO is currently developing a request for further stock assistance.
Water, Sanitation and Hygiene
According to estimates, about 60 per cent of the population in Shefa and Tafea has no access to clean drinking water. Based on individual reports, access to water has of the population in emerged as the greatest need. Shefa and Tafea is  Based on individual reports, Mataso (400 people), Etas (3,000 people), Eratap
believed to have no (1,300 people), Salini (200 people) and Prima (200 people) in Shefa Province have access to drinking no access to water due to lack of power to operate the piped water supplies. Ground water sources have been contaminated and rainwater harvesting structures have been damaged. Response:
 The Department of Geology, Mines and Water Resources (DGMWR) has declared the water supplied by the main utility, UNELCO, as safe to drink.  DGMWR and UNICEF reconnected private water supply systems in Teoumaville (on the outskirts of Port Vila).  Save the Children, Red Cross and the Adventist Development Relief Agency (ADRA) provided WASH NFIs, hygiene promotion and general support to the management of sanitary facilities at evacuation centres.  Vanuatu Mobile Force is trucking UNELCO water to the surrounding areas of Port Vila .  The Mele area in Shefa Province will be supported by the Red Cross from 19 March onwards with the deployment of a mobile water treatment plan and distribution of water containers.  The Ministry of Lands is to liaison with UNELCO to reconnect public water systems without power on a priority  Eratap will be provided a generator and fuel to operate the public water system with support of ADRA and UNICEF. Mataso, Etas, Eratap, Salini and Prima will be supported by water trucking in collaboration with ADRA, OXFAM and UNICEF.  UNICEF handed over WASH NFIs for 2,000 families to the Provincial Government of Tanna.  The WASH cluster is using Vanuatu ferries to ship WASH items to Tanna.  UNICEF has airlifted health kits to cover 50,000 patients; 31,300 ORS sachets; 330 zinc tablets; 32 de-worming tablets; 3,000 WASH kits; 200 hygiene kits; 3,000 soaps for hand washing; 5 x 5,000 litre collapsible water tanks and 5 x 1,500 litre collapsible water tanks. United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Coordination Saves Lives

Vanuatu Tropical Cyclone Pam Situation Report No. 4 6
 More UNICEF supplies are scheduled to leave on upcoming commercial flights, which will include 91 school in a box kits, 11 recreational kits, 22 early childhood development kids, tents and tarpaulins.  There are logistical challenges to distribute relief supplies outside Port Vila.  In-country water, sanitation and health supplies, particularly of water pumps, are limited.  There is a lack of access to large transport mechanisms for water trucking. Communications with Communities
 Radio and telephone communication with outer islands is yet to be established and therefore access to life- saving information remains a concern. Response:
 Digicel communications is active in central Port Vila. The company is working with Telecom Vanuatu Limited (TVL) to restore communications. Digicel currently has eight engineers located in Epi, working to restore connectivity around the Shepherd Islands. Another 12 engineers have arrived in Tanna who will also be working on the restoration of communications.  TSF Emergency Response Teams went to Tafea Province, where a satellite connection was established on the island of Tanna, facilitating relief efforts and coordination capacities. TSF will also be cooperating with the United Nations as well as the NDMO in the provinces of Torba, Sanma, Penama, Malampa and Shefa to carry out assessments and identify communication requirements of the estimated 150,000 affected people spread across Vanuatu. Emergency Telecommunications
 Telecoms Sans Frontieres (TSF) responders are working to re-establish telecommunication networks in the five Provincial Disaster Management Centres.  Two ICT specialists from WFP arrived with some 150 kilos of communication equipment to supply and support the Government as well as coordinate the overall ICT response.  WFP handed over two satellite telephones to the Government, which was immediately deployed to Malakula Logistics
 UNICEF has been working with NDMO, WFP and other partners on a logistics plan for the smooth distribution of humanitarian supplies from designated hubs and the airport.  WFP with assistance from UNICEF is to establish two storage hubs, one in Port Vila and another in Tanna. The WFP staff will also help run these hubs.  A total of eight Australian Defence Force planes have delivered emergency relief supplies and personnel to Vanuatu. Both the Australian Defence Force and New Zealand Defence Force plan to have flights into Port Vila on 18 March.  Port Vila Airport has reopened for commercial airlines.  The Port in Port Vila is operational. The cargo ship, Pacific Islander, is arriving on 18 March with general  There has been a number of offers of logistical assistance and once needs are established these may be utilised to assist the distribution of relief items.  The Logistics Cluster has established a way to record and track current and expected stocks which will help to establish what is needed once the assessments are complete. Agencies are asked to send pipeline and distribution information to  Five aircrafts are supporting operations as part of the France, Australia and New Zealand (FRANZ) alliance. A British military plane is also en route to Vanuatu with supplies. United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Coordination Saves Lives Vanuatu Tropical Cyclone Pam Situation Report No. 4 7
 There is a need to augment storage in Port Vila and in Tanna, particularly as the amount of relief items to arrive is likely to increase.  The main artery to Te Ouma, the main vegetable growing area in Efate has been cut off.  There are long waiting lines for fuel.  As a number of social media sites are requesting donation of goods to send to Vanuatu, a policy is needed to either prevent or manage the arrival of unsolicited goods from abroad.  Supply ships will need to have the capacity to self-unload. Britain will contribute £500,000 (US$ 733,000) to the International Federation of the Red Cross Emergency Appeal to help the people affected by Tropical Cyclone Pam and deploy three additional humanitarian experts to the region. The funding for the Red Cross appeal is the first allocation from the £2 million (US$ 2.9 million) in emergency support pledged by the UK immediately after the disaster in Vanuatu, while the deployment of experts to the region is an important part of British efforts to ensure a strong and coordinated response from Commonwealth partners. The UK's Department for International Development also contributed £1.1M (US$ 1.6 million) for a RAF heavylift C-17 to join the Australian-led relief supplies airlift (Amberley/Vanuatu). The Government of Italy has made a 300,000 euro (US$ 440,000) multilateral contribution to IFRC to fund temporary shelters and water, hygiene and medical supplies, as well as efforts to locate and reunite missing persons. The funds will also be used to support local IFRC risk-training activities. The Australian Defence Force (ADF) has provided two C130 planes that travelled from Port Villa to Tanna – they have flown the Australian Department of Foreign Affairs and Trade (DFAT), consulate personnel and the Vanuatu Prime Minister. In addition they have also flown an ADF infrastructure assessment team and two light vehicles. A medical evacuation team has also been flown in by the ADF, which also evacuated four critical casualties. ADF is conducting a key leadership engagement (ADF contingent commander and provincial government) to discuss a priority list that would cover reconstruction and aid requirements. Information about financial contributions should be sent to General Coordination Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Valerie Amos, decided to designate Ms. Osnat Lubrani - Resident Coordinator for Fiji with multi-country coverage of the Federated States of Micronesia, Kiribati, the Marshall Islands, Nauru, Palau, Solomon Islands, Tonga, Tuvalu, and Vanuatu - as Humanitarian Coordinator for Vanuatu effective immediately for a period of three months. In her role as Humanitarian Coordinator, Ms. Lubrani will lead the response to the impact of Cyclone Pam. United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Coordination Saves Lives Vanuatu Tropical Cyclone Pam Situation Report No. 4 8
Impact of TC Pam on other Pacific Island countries Following severe inundation from storm surges and sea swells of three to five metres generated by TC Pam on 11 and 12 March, the Government of Tuvalu (population 10,800) declared a State of Emergency on 13 March. Seven islands have been affected. The worst affected were the northern islands of Nanumaga and Nanumea, and the central islands of Nui and Vaitupu. The capital atoll, Funafuti, was mostly unaffected. The main impacts are to shelter, infrastructure, food crops and livestock, and water and sanitation. Disaster management in Tuvalu is managed by one person and there has been a request for coordination support. OCHA ROP will deploy a staff members on 19 March, and two Australian Civilian Corps specialists in WASH and logistics/coordination will arrive the same day. New Zealand has provided aerial surveillance and equipment to assist with the clean-up. Australia and USAID have both donated $50,000 to support response activities. UNICEF has sent a specialist and WASH supplies, a health kit for 10,000 people and water purification tablets. IFRC in collaboration with Tuvalu Red Cross will be mobilizing WASH supplies and is deploying a coordination specialist from the Cook Islands. A patrol boat has departed from Samoa with Red Cross relief items, such as blankets and kitchen sets, and is due to arrive in Funafuti, the capital of Tuvalu, on 19 March. The boat will then be used to support inter-island distributions and assessments. Medical supplies are needed to prevent the spread of water-borne diseases, with diarrhoea already reported in some young children. There are concerns there will be further damage to already impacted areas as the next high tide is due on 20 March (this Friday). Kiribati
The Kiribati Government reported severe damage in its three southern islands following high winds and sea surges from TC Pam. High waves caused extensive damage to sea walls and the Dai Nippon Causeway which joins the towns of Betio and Bairiki. The Betio national hospital and maternity ward was also damaged. Kiribati Red Cross is supporting residents displaced from their homes along the shoreline in Tamana and Arorae. The Disaster Management Committee is monitoring progress and assisting communities to build or strengthen sea walls. UNICEF has emergency prepositioned stocks in Tarrawa, with additional supplies due to arrive on 24 March. Solomon Islands
In the Solomon Islands, there have been reports of inundation and damage to islands in Malaita and Temotu Province. IFRC estimate that more than 30,000 people are affected. The National Disaster Management Office has activated the cluster system in Honiara, the capital of Solomon Islands, and sent an initial assessment and response team to the worst-affected island of Anuta to the south-east. UNICEF is ready to provide WASH supplies to Anuta. World Vision has in-country presence and is supporting assessments and aid to islands in Temotu. A UNICEF staff member will be deployed to Temotu on 21 March to monitor distribution of WASH items, community awareness, and assessments on child protection issues. IFRC announced an Emergency Plan of Action on 17 March to support the distribution of non-food relief items, including water, sanitation and emergency health supplies and to enable the mobilisation of volunteers for assessments and distributions. The response in Solomon Islands is being delayed by logistical constraints, as it can take two to three days to reach some remote islands. Background on the crisis
Severe Tropical Cyclone (TC) Pam struck Vanuatu (population 234,000), affecting the capital of Port Vila, as an extremely destructive
category 5 cyclone on the evening of 13 March at around 11 p.m. local time. The cyclone's eye passed close to Efate Island, where the
capital is located, and winds are estimated to have reached 250kmph with gusts peaking at around 320kmph.
For further information, please contact:
Sune Gudnitz
, Head of Office, OCHA ROP Mobile: +67 9999 1664 (Suva)
Sebastian Rhodes Stampa, UNDAC Team Leader,Mobile +66 89204 2721 (Port Vila)
Jennifer Bose, Humanitarian Reports Officer, OCHA ROAPMobile: +66 92261 8502 (Port Vila)
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Microsoft powerpoint - the genus vibrio_web [režim kompatibility]

THE GENUS VIBRIO, AND ASSOCIATED BACTERIA General Characteristics of Vibrio, · Gram-negative· Facultative anaerobes· Fermentative bacilli · Polar flagella · Oxidase positive Ø Formerly classified together as Vibrionaceae · Primarily found in water sources· Cause gastrointestinal disease


J Oral Maxillofac Surg66:223-230, 2008 Outcomes of Placing Dental Implants in Patients Taking Oral Bisphosphonates: A Review of 115 Cases Bao-Thy Grant, DDS,* Christopher Amenedo, DDS,† Katherine Freeman, DrPH,‡ and Richard A. Kraut, DDS§ Purpose: In recent years, numerous cases of bisphosphonate-associated osteonecrosis of the jaw havebeen reported involving both intravenous and oral therapy regimens. The majority of these cases haveinvolved intravenous bisphosphonates. Subsequently, drug manufacturers and the US Food and DrugAdministration issued warnings about possible bisphosphonate-associated osteonecrosis of the jaw. TheAmerican Dental Association and the American Association of Oral and Maxillofacial Surgeons assembledexpert panels to formulate treatment guidelines. Both panels differentiated between patients receivingbisphosphonates intravenously and those receiving the drugs orally. However, the recommendationswere based on limited data, especially with regard to patients taking oral bisphosphonates. We wantedto ascertain the extent to which bisphosphonate-associated necrosis of the jaw has occurred in our dentalimplant patients. We also wanted to determine whether there was any indication that the bisphospho-nate therapy affected the overall success of the implants as defined by Albrektsson and Zarb.Patients and Methods: We identified 1,319 female patients over the age of 40 who had received dentalimplants at Montefiore Medical Center between January 1998 and December 2006. A survey about bisphos-phonate therapy was mailed to all 1,319 patients. Responses were received from 458 patients of whom 115reported that they had taken oral bisphosphonates. None had received intravenous bisphosphonates. All 115patients were contacted and informed about the risk of bisphosphonate-associated osteonecrosis of the jaw.Seventy-two patients returned to the clinic for follow-up clinical and radiological evaluation.Results: A total of 468 implants were placed in the 115 patients who reported that they had receivedoral bisphosphonate therapy. There is no evidence of bisphosphonate-associated osteonecrosis of thejaw in any of the patients evaluated in the clinic and those contacted by phone or e-mail reported nosymptoms. Of the 468 implants, all but 2 integrated fully and meet criteria for establishing implantsuccess. Implant success rates were comparable for patients receiving oral bisphosphonate therapy andthose not receiving oral bisphosphonate therapy.Conclusions: Guidelines for treatment of dental patients receiving intravenous bisphosphonate treatmentsshould be different than for patients taking the oral formulations of these medications. In this study, oralbisphosphonate therapy did not appear to significantly affect implant success. Implant surgery on patientsreceiving bisphosphonate therapy did not result in bisphosphonate-associated osteonecrosis of the jaw.Nevertheless, sufficient evidence exists to suggest that all patients undergoing implant placement should bequestioned about bisphosphonate therapy including the drug taken, the dosage, and length of treatment priorto surgery. For patients having a history of oral bisphosphonate treatment exceeding 3 years and those havingconcomitant treatment with prednisone, additional testing and alternate treatment options should be con-sidered.© 2008 American Association of Oral and Maxillofacial SurgeonsJ Oral Maxillofac Surg 66:223-230, 2008