An Outbreak of Conjunctivitis due to Bacterial Streptococcus pneumoniae, District Sargodha-Pakistan-2010 Dr. Zafar H. Maken - FELTP Pakistan

METHODOLOGY Epidemic Curve Risk Factors Analysis

Health education of teachers Health education of Imam masjid Case Definition: 9 Cases: 105 - Controls: 195 §A case was defined as any resident of Mohallah 8 Risk factors Odds 95% CI P Value Balochan presenting between August 10 to 7 ratio September 30, 2010, with an episode of two or Team arrived Close contact, sharing 7.6 4.5—13.5 < 0.05 6 more of the following; of clothes, towels etc. 5 §Red or itchy eyes Low socioeconomic 5.28 3.4—8.4 < 0.05 §Pain 4 status §Edema of the eyelids No. of Cases 3 § 2 Mohallah Balochan Morning crusting LIMITATIONS §Exudate from eyes 1 INTRODUCTION §Active case finding was done at the local school 0 §Limited Laboratory resources for pneumoccal 10 12 14 16 18 20 22 24 26 28 30 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 and community th th typing §Conjunctivitis is an inflammation of the Date of Onset (Aug 10 – Sep 30 ) § conjunctiva caused by several types of bacteria Descriptive analysis of cases was carried out §Limited information could be gathered on risk and viruses using line list Spot Map factors due to low literacy rate § §Conjunctival swabs taken from randomly Mode of transmission is through direct contact or HOSPITAL selected 20 cases for culture & sensitivity Eye Examination fomites DRAIN § CONCLUSION §Incubation period is 24-72 hours Case-control study: §Age and sex matched controls were selected RESULTS (n=105) ATER AGNANT W § ST Outbreak of conjunctivitis was caused by from the school and community SEWRAGE ROAD Streptococcus pneumoniae Map of Sargodha District BACKGROUND §Odds ratios were calculated for risk factors Variables Results §Males more affected as the outbreak originated §On August 16, 2010, the ophthalmologist of using Epi Info (Version 7 ) Age range 2 – 55 years in the boys’ school TER SCHOOL AGNANTA THQ Hospital, Sahiwal reported TER ST W Median age 8 years A §Low SES, sharing of clothes and towels were §12 cases of conjunctivitis with 9 from a boys’ significantly associated with the disease AGNANT W SARGODHA school ST Male : female 2.3 : 1 AGNANT § ST TER Lack of awareness regarding hand and personal § WA All residents of Mohallah Balochan hygiene in the community § School-going children 65 (62 %) Te a m i n c l u d i n g F E LT P f e l l o w a n d §No case was reported after September 30th ophthalmologist were deputed for investigation Attack rate (%) 7.0 % 2010 on the same day Frequency of Signs and Symptoms §Meeting conducted with local health department for situation analysis Age Distribution of Cases 90 RECOMMENDATION 40 80 35 §Hand hygiene education should be a part of the 70 Historical Gate, Sahiwal, Sargodha District 30 school curriculum 60 25 § 50 Health awareness of the community STUDY SETTING 20 Play ground of local school 40 §Toilets should be built for each household with § 15 Sargodha district is located in the north-east of No. of Cases 10 30 mechanism of proper drainage of sewage Pakistan 5 20 § 0 Sahiwal is a subdivision of Sargodha % of Cases 10 0-5 6-10 11-15 16-20 21-25 26-above IMPACT §Outbreak neighborhood (Mohallah Balochan) Age in years 0 §Densely populated town in the east of Sahiwal Red Eye & Exudate from Pain Orbital Crusting in the Eyelids Edema Age & Gender Wise Itiching one eye or both morning District Government allocated resources for: §Population is 1500 with 263 households Investigation Team Distribution of Cases Clinical Features §Two Health education sessions for school §88% houses are built from mud teachers and Imam masjid (Prayer leader in the Age Group (years) §80% population belongs to low Socioeconomic OBJECTIVES Males Females mosque) conducted 0-5 24 10 Laboratory Diagnosis status (SES) § §To determine the extent of outbreak 6-10 22 2 Information, Education and Communication §Literacy rate is 10% §Out of 20 samples, 15 were positive for (IEC) Material printing and distribution among §To confirm the cause of outbreak 11-15 18 5 (Ref: District Government Survey, Sargodha 2005) 16-20 14 3 Streptococcus pneumoniae school children and community having §To identify the risk factors messages about: §Nearest health facility is the Tehsil Headquarter 21-25 0 5 §Same sensitivity patterns were observed - (THQ) Hospital half a mile away §To recommend preventive measures Government Secondary School for Boys 25 above 0 2 among all pneumococcal isolates ?Frequently hand washing (Students waiting for eye examination) Total 78 27

FELTP-PAKISTAN, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan. Tel: +92-51-9255302, 9255304, Fax: +92-51-9255307, e-mail: [email protected] Annual EIS International Night, 62nd EIS Conference 26th April 2013, Atlanta USA