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Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

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Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 3, Issue 15, Wednesday 18 April 2012 Highlights Priority diseases under surveillance Epidemiological week no. 15 (8 to 14 April 2012) in DEWS Acute (Upper) Respiratory Infection • In week 15, 2012, total 82 districts including 3 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 2,010 health facilities. Data from mobile teams is reported Suspected Diphtheria through sponsoring BHU or RHC. Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea • A total of 684,278 consultations were reported through DEWS of which 19% were acute Other Acute Diarrhoea respiratory infections (ARI); 8% were acute diarrhoea; 4% were suspected malaria; while 4% were Suspected Enteric/Typhoid Fever Skin disease. Suspected Malaria Suspected Meningitis Suspected Dengue fever • A total of 247 alerts reported while 27 outbreaks were identified in week 15, 2012: Alto‐ Suspected Viral Hemorrhagic Fever gether 142 alerts for Measles; 30 for Leishmaniasis; 16 for NNT and Tetanus; 12 for Typhoid; 11 Pyrexia of Unknown Origin for Pertussis; 9 for acute diarrhoea; 7 for Scabies; 5 for ARI; 4 for Acute jaundice syndrome; 3 for Suspected Measles Suspected Acute Viral Hepatitis AWD; 2 each for Bloody diarrhoea and Diphtheria; while 1 each for CCHF, HF, Food poisoning and Chronic Viral Hepatitis Chicken Pox. Neonatal Tetanus Acute Flaccid Paralysis • In this week no new polio cases was reported. As of 16 April 2012, the total number of polio Scabies Cutaneous Leishmaniasis cases confirmed by the laboratory is 15 from 10 districts/towns/tribal agencies and areas. Others Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐15, 2012. 50 AD BD ARI S. Malaria 45 40 35 30 25 Percentage 20 15 10 5 0 1 3 5 7 9 1 3 5 7 9 11 13 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 15 wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk Table 1: Most common communicable diseases syndromes reported weekly Disease Wk-8 Wk-9 Wk-10 Wk-11 Wk-12 Wk-13 Wk-14 Wk-15 Acute respiratory infection 153,111 (24%) 157,828 (23%) 155,186 (23%) 162,325 (23%) 145,261 (21%) 155,373 (20%) 128,278 (20%) 128,197 (19%) Skin diseases 28,820 (4%) 29,430 (4%) 30,909 (4%) 31,713 (4%) 28,719 (4%) 31,589 (4%) 28,054 (4%) 27,065 (4%) Acute diarrhoea 31,623 (5%) 34,918 (5%) 38,427 (6%) 40,950 (6%) 41,535 (6%) 51,104 (7%) 51,780 (8%) 58,121 (8%) Bloody diarrhoea 2,765 (0.43%) 3,094 (0.45%) 2,874 (0.42%) 3,651 (0.51%) 2,890 (0.42%) 3,480 (0.45%) 2,972 (0.46%) 3,115 (0.46%) Suspected malaria 23,483 (4%) 28,265 (4%) 29,599 (4%) 30,594 (4%) 29,521 (4%) 32,870 (4%) 28,187 (4%) 29,871 (4%) Total consultation 650,423 680,221 688,813 717,186 681,475 769,774 645,028 684,278 • The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as proportional morbidity (percentage of cases out of total consultations) reported to DEWS on weekly basis. • The above table provides the total consultations for each of the last 8 weeks proportional morbidity of five disease syn‐ drome. Proportional morbidity of ARI is highest in Sindh and Khyber Pakhtunkhwa while acute diarrhoea is highest in Ba‐ lochistan and Sindh (please see the graphs for every province in page 6 and 7). 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 Special Bulletin: DEWS, Pakistan, Week no. 15 (8 to 14 April 2012) Previous week's (14/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken An alert of suspected Measles case was reported from Private Clinic. It was investigated and responded in the presence of Health department personelle. During investigation 4 more 4‐Apr Measles KPK Swabi Private Clinic, Topi 1 1 2 1 cases found iin the same locality. Vit.A given,health education sessions conducted,EDO H and EPI coordinator Informed, Measles Mopup Vaccination planned in the Relevant Village. WHO EHA and PPHI provided the essential medicines to the relevant Health Facility. An alert of 2 suspected measles cases was generated by BHU. Active surveillance was carried out in the area. 6 more cases were identified who had developed measles in past month and their history suggested measles. 3 children had active measles. Children were given Vit A. Vaccination status was assessed in the surrounding. Out of 12 houses and 38 children were 5‐Apr Measles KPK Haripur Afghan Refugee camp 3 2 1 4 1 assessed, 29% children had no measles 2 vaccine. 8% children had no BCG sca 5% children were totally unvaccinated. The rest were completely vaccinated. Missed children were re‐ ferred to BHU STC 4 for completion of vaccination. Blood samples were taken and sent to NIH. Follow‐up was done. Health session was conducted. EDO H, Save the children and EPI coordi‐ nator were informed of possible outbreak. Alert of suspected measles was notified. Active Surveillance conducted, 5 more cases were found in the same family surounding camp. EPI staff was requested for routine outreach AR Taimar Camp, Timar‐ 6‐Apr Measles KPK Lower Dir 4 0 2 0 vaccination in the area. Vit‐A was given, Blood Sample Collected for confirmation of antibod‐ gara Lower Dir. ies, Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed. An alert of 2 suspected cases of Measles reported by MO BHU. SO along with two EPI vaccina‐ tor visited the area on next day and examined the children presented with signs and symp‐ Kukkoo Mera Shergarh toms of Measles, (runny nose, conjunctivitis, flu, fever and rashes) there were four children in 6‐Apr Measles KPK Mansehra 2 1 1 2 Oghi one house. on house to house visit, two more suspected cases were found in that area. vit A given. Total 52 children vaccinated under 15 years of age in the area only 6 children were not vaccinated before, HE conducted, one sample taken and sent to NIH for confirmation Alert of 2 suspected measles cases were reported by Pediatrician THQ Hospital. Field investi‐ gation revealed that there were 16 more measles cases in the same area. All the cases had a history of fever, rash, conjuctivitis and cough within last 30 days.Vaccination status of 42 Basti Farooqabad, UC 4‐Apr Measles Punjab Rajanpur 4 8 5 1 children was checked randomly. Only 2 children had BCG scar while all others were not vacci‐ Basti Khoja, DG Khan nated at all. 5 Blood samples were collected and sent to NIH. Vit A drops provided. HE session was conducted for the community about importance of routine immunization.Findings were shared EDOH Rajanpur for mop up measles vaccination campaign in the affected area. 2 suspected cases of measles notified by a medical officer of RHC from Village Shakal Chandio. During field investigation, five more suspected cases of measles were found, informed to S Benazira‐ Village shakal khan DHO, DSC and DSV for containment measures, routine immunization was checked for 16 2‐Apr Measles Sindh 1 1 4 1 bad chandio UC kazi ahmed 2 children in which 6 childrens were fully immunized and 5 were partially immunized and 5 were unvaccinated. report shared to DHMT, vitamin A capsules given and also health educa‐ tion imparted. Suspected Pertussis was reported from Villagers, active surveilliance done, childrens were not Village Mamoon Muhalla, vaccinated, Cluster for immunization was assessed, where 8 childrens were checked and 2‐Apr Pertussis Sindh Badin 3 1 0 1 UC Seerani, taluka Badin found unvaccinated, health education imparted, Erythrisine was given, DHMT and HCPs were informed and requested for immunization and 1 Throat sample collected. Suspected case of measles was investigated in village, active surveillance done, Vitamin(A) Village Sher Muhammad drops provided, vaccination status was checked for 27 children where 7 children were found 4‐Apr Measles Sindh Dadu Rustumani, UC T.R Khan, 3 2 3 2 vaccinated against BCG and only 1 child found vaccinated against Measles, health education taluka Johi regarding importance of immunization was delivered, EDOH, FP‐EPI, DSM and MO were informed and 3 Blood sample collected. Alert of suspected Measles case was notified by a community person, active surveillance Village Shah baig Jamali, done, Vitamin(A) was given, cluster for routine immunization was checked and found 4‐Apr Measles Sindh Larkana UC Ratokot, taluka 0 0 0 5 Larkana BCG=67%, Penta=35%, Measles=46%, health education was imparted, community sensitized for routine immunization, EDOH informed and request for routine immunization. Alert of suspected measles case was reported from private practitioner, active surveilliance done and found 4 more cases, Mop‐up was conducted by area vaccinator, Vitamin(A) was Yaqoob Buriro, UC 4‐Apr Measles Sindh Shahdadkot 3 0 2 0 given to cases, immunization status was checked and found BCG=10%, Measles= 0% and Gebidero, taluka Kambar Measles1=0%, sensitized community regarding vaccination, THO informed and 3 Blood sam‐ ple collected.
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