Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan
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Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 4, Issue 38, Wednesday 25 September 2013 Highlights Figure-1: 73 districts reported to DEWS in week 38, 2013 Epidemiological week no. 38 (15 to 21 Sept 2013) • Dengue fever: During this week, 2,139 Dengue fever cases have been reported. The highest num- ber of DF cases 1,759 reported from district Swat, Khyber Pakhtunkhwa. The outbreak in Swat is being responded jointly. • CCHF: In week 38, 2013, 2 new suspected CCHF cases reported, both the cases belongs to Af- ghanistan and admitted at hospital in Quetta, both the cases having history of contact with animals (taking care at home). While on 24th September, 3 more suspected CCHF cases were reported 1 each from districts Quetta, Killa Abdul- lah and Zhob. Epidemiological investigation con- ducted and treatment initiated (Page 5). • In this week, 73 districts and 2192 health facilities Priority diseases under surveillance in Cumulative number of selected health events reported in DEWS Epi-week 1 to 38, 2013 (29 Dec 2012 to 21 September 2013) have reported to Disease Early Warning system Pneumonia (DEWS), compared to 73 districts with 2047 Acute Watery Diarrhoea Disease # of Cases Percentage health facilities shared weekly data in week 37, Bloody diarrhoea Acute Diarrhoea ARI 6,105,558 20% 2013 to the DEWS. Suspected Enteric/Typhoid Fever Suspected Malaria Bloody diarrhoea 81,159 <0.5% Total 923,417 patients consultations reported this Suspected Meningitis • Suspected Dengue fever Acute diarrhoea 2,419,404 8% week compared to 934,448 consultations in week Suspected Viral Hemorrhagic Fever Suspected Measles S. Malaria 1,345,257 4% 37, 2013. Suspected Diphtheria Suspected Pertussis Skin Diseases 1,206,055 4% • Altogether 101 alerts were investigated and 11 Suspected Acute Viral Hepatitis outbreaks were identified and timely responded. Neonatal Tetanus Unexplained fever 951,567 3% Acute Flaccid Paralysis Scabies Total (All consultations) 30,963,411 Cutaneous Leishmaniasis Major health events reported during the Epi-week - 38 (15 - 21 September 2013) Figure-2: Number of Dengue fever positive cases in Pakistan, 1 Jan to 21 Sept 2013 Disease # of Cases Percentage 2500 ARI 164,970 18% 2000 Bloody diarrhoea 2,102 <0.5% 1500 Acute diarrhoea 66,390 7% 1000 # of case s S. Malaria 43,587 5% 500 Skin Diseases 36,082 4% 0 Unexplained fever 28,650 3% Wk-1 Wk-2 Wk-3 Wk-4 Wk-5 Wk-6 Wk-7 Wk-8 Wk-9 Wk-10 Wk-11 Wk-12 Wk-13 Wk-14 Wk-15 Wk-16 Wk-17 Wk-18 Wk-19 Wk-20 Wk-21 Wk-22 Wk-23 Wk-24 Wk-25 Wk-26 Wk-27 Wk-28 Wk-29 Wk-30 Wk-31 Wk-32 Wk-33 Wk-34 Wk-35 Wk-36 Wk-37 Wk-38 Total (All consultations) 923,417 In 2013 Dengue fever outbreaks reported from the less endemic areas in Pakistan. A huge Dengue fever outbreak is being confronted in district Swat of Khyber Pakhtunkhwa province. In district Swat from 7th August to 25th September total 6,376 Dengue fever cases and 23 deaths have been reported. Rapid diagnostic Test Kits are used for diagnosis locally, and se- lected numbers of samples are also sent to NIH Islamabad reference Laboratory for confirmation and Sero typing. 15 samples tested at NIH revealed that three types of virus (DNV-1; DNV-2; DNV-3) were detected in different patients from Swat. This year few cases of Dengue fever have been diagnosed in Gawadar with no travel history out of the district (most probably the infection was acquired locally). District administration Swat has notified Dengue Task Force and Dengue Response Cell has been established at the EDO Health Office Swat. Joint outbreak control activities are carried in the district by all partners and the concerned line de- partments. From 1st January to 25th September 2013, Sindh reported 1,472, Punjab 196, and Balochistan 8 Dengue fever cases. This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected]. 01 Weekly Bulletin: DEWS, Pakistan, Week no. 38 (15 to 21 September 2013) Outbreaks (Wk-38/2013): Date Disease Province District Area <5M >5M <5F >5F Action Taken Cantonment, UC 152; DATA-Ganj Bakhsh Town UC 77 6 new outbreaks of Dengue fever, 207 suspected Dengue fever cases were reported Qila Gujar Singh; from 6 UCs of Lahore. 21 blood samples collected and sent to NIH for laboratory test- ing. The result for 9 cases were found positive for Dengue IgM. All the positive cases of 15-20- Allama Iqbal Town DF Punjab Lahore UC 112; Samanabad 0 143 0 64 Dengue fever were admitted in the hospital and kept in isolation ward. DPC along with Sep Town UC 106; Sama- CDCO, DDHO and entomologist were visit the area. Health education sessions were nabad Town UC 89 conducted in the community. Follow up planned. Information shared with ADG (VBD) Gulshan Ravi; Shali- and EDOH Lahore. mar Town UC 23 Shadbagh. An alert of probable Diphtheria was reported from Children Hospital Lahore. The Pa- tient belongs to district Hafizabad and admitted in Emergency ward of the Children Village Ahmedur hospital, Lahore. ADS was given to patient on the time of admission. There is no travel- Diph- 15-Sep Punjab Hafizabad Gujranwala Road 0 0 0 1 ling history of Patient. 1 sample of Throat swab collected and sent to NIH for labora- theria Hafizabad tory testing. EDO(H) Hafizabad was also informed. All close contacts at Paternal ad- dress were advised Syp. Erythrosine at Lahore. DG health, Director CDC and Director EPI were informed. Alert for probable Diphtheria case has been reported by Children Hospital Lahore. Case management was ensured. Patient was admitted in Emergency ward under su- pervision of Medical unit 2. The Patient Belongs to Kasur district. ADS was Supplied to Chak no 3 Naikot Patient on the same day of admission. There is no travelling history of Patient. Case Diph- 15-Sep Punjab Kasur mazed Pind 0 0 0 1 Response was Done by District Kasur. Throat Swab was Collected by SO DEWS Lahore theria Tehsil Pattoki and Dispatched to NIH for Diphtheria Detection. EDO(H) Kasur was also informed. All close contacts at Paternal address were advised Syp. Erythrosine at Lahore. The Pa- tients expires on second day of Admission. DG health, Director CDC and Director EPI were informed. A probable Diphtheria case has been reported by Children Hospital Lahore. The Pa- tient Belongs to UC 125 Lahore district. ADS was Supplied to Patient on the same day of admission. There is no travelling history of Patient. Throat Swab was Collected by Village Palaray Diph- SO DEWS Lahore and Dispatched to NIH for Diphtheria Detection. All close contacts 18-Sep Punjab Lahore Manga Road UC 0 1 0 0 theria at Paternal address were Examined and advised Syp. Erythrosine during field investi- 125 Iqbal Town gation. DSC, DDOH, SO, DSV, IV and LHS perform field investigation. EDOH, DG health, Director CDC and Director EPI were informed . Case Response was Done by SO Dews Lahore. Alert for probable Diphtheria case has been reported by Children Hospital Lahore. Case management was ensured. The Patient Belongs to Nankana Sahib district. ADS Village Tar khan was Supplied to Patient on the same day of admission. There is no travelling history of Diph- Nankana Wala Jaranwala 16-Sep Punjab 1 0 0 0 Patient. Case Response was Done by District Nankana Sahib. Throat Swab was Col- theria Sahib road Mandi Faiza- lected by SO DEWS Lahore and Dispatched to NIH for Diphtheria Detection. EDO(H) bad Nankana sahib was also informed. All close contacts at Paternal address were advised Syp. Erythrosine at Lahore. DG health, Director CDC and Director EPI were informed . Alert for probable Diphtheria case has been reported by Children Hospital Lahore. Case management was ensured. Patient was admitted in Emergency ward under su- pervision of Medical unit 1. The Patient Belongs to Sheikhupura district. ADS was Diph- Sheikhu- Street Mohalla Supplied to Patient on the same day of admission. There is no travelling history of 21-Sep Punjab 0 0 0 1 theria pura Nadeem road Patient. All close contacts at Paternal address were advised Syp. Erythrosine. Trache- otomy was done immediately, patient was shifted to ICU. Throat Swab was not Col- lected as Patient expired after one hour of admission. DG health, Director CDC and Director EPI were informed. This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected]. 02 Weekly Bulletin: DEWS, Pakistan, Week no. 38 (15 to 21 September 2013) Figure-3: Number of alerts received and responded, week 35 - 38, 2013 Figure-4: Number of consultations by age and gender, week 38, 2013 50 300000 250000 40 Measles Dengue fever 200000 30 Leishmaniasis 150000 NNT consultations of # # ofale rts 20 100000 AWD Diphtheria 50000 10 CCHF 0 < 1 yr 1-4 yr 5-14 yr 15-50 yr 50 + yr Male 28373 73608 101004 159407 54922 0 Wk-35 Wk-36 Wk-37 Wk-38 Female 27805 68779 100447 245065 64007 Province Khyber Pakhtunkhwa: Figure-5: Weekly trend of Acute diarrhoea, province Khyber Pakhtunkhwa 253 health facilities from 11 districts of Khyber 20 Pakhtunkhwa sent reports to DEWS with a total of 2011 2012 99,282 patients consultations reported in week 38, 2013 2013.