title: Investigation of an Influenza A (H3N2) outbreak in evacuation centres following the Great East Japan earthquake, 2011.
abstract: BACKGROUND
  The Great East Japan Earthquake of magnitude 9.0 that struck on 11 March 2011 resulted in more than 18000 deaths or cases of missing persons. The large-scale tsunami that followed the earthquake devastated many coastal areas of the Tohoku region, including Miyagi Prefecture, and many residents of the tsunami-affected areas were compelled to reside in evacuation centres (ECs). In Japan, seasonal influenza epidemics usually occur between December and March. At the time of the Great East Japan Earthquake on 11 March 2011, influenza A (H3N2) was still circulating and there was a heightened concern regarding severe outbreaks due to influenza A (H3N2).
  
  
  METHODS
  After local hospital staff and public health nurses detected influenza cases among the evacuees, an outbreak investigation was conducted in five ECs that had reported at least one influenza case from 23 March to 11 April 2011. Cases were confirmed by point-of-care tests and those residues were obtained and subjected to reverse transcription PCR and/or real time RT-PCR for sub-typing of influenza.
  
  
  RESULTS
  There were 105 confirmed cases detected during the study period with a mean attack rate of 5.3% (range, 0.8%-11.1%). An epidemiological tree for two ECs demonstrated same-room and familial links that accounted for 88.5% of cases. The majority of cases occurred in those aged 15-64 years, who were likely to have engaged in search and rescue activities. No deaths were reported in this outbreak. Familial link accounted for on average 40.5% of influenza cases in two ECs and rooms where two or more cases were reported accounted for on average 85% in those ECs. A combination of preventative measures, including case cohorting, personal hygiene, wearing masks, and early detection and treatment, were implemented during the outbreak period.
  
  
  CONCLUSIONS
  Influenza can cause outbreaks in a disaster setting when the disaster occurs during an epidemic influenza season. The transmission route is more likely to be associated with sharing room and space and with familial links. The importance of influenza surveillance and early treatments should be emphasized in EC settings for implementing preventive control measures.
authors.affiliation: Department of Virology, Tohoku University Graduate School of Medicine, 2-1 Seiryo machi, Aoba-ku, Sendai 9808575, Japan. kamigakit@med.tohoku.ac.jp.
authors.forename: Taro
authors.initials: T
authors.lastname: Kamigaki
authors.forename: Jin
authors.initials: J
authors.lastname: Seino
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tohma
authors.forename: Nao
authors.initials: N
authors.lastname: Nukiwa-Soma
authors.forename: Kanako
authors.initials: K
authors.lastname: Otani
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Oshitani
mesh_terms: D000293:Adolescent; D000328:Adult; D004190:Disasters; D004196:Disease Outbreaks; D055866:Earthquakes; D005260:Female; D006801:Humans; D015994:Incidence; D053122:Influenza A Virus, H3N2 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018635:Rescue Work; D057192:Tsunamis