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 3, Issue 17, Wednesday 2 May 2012 Highlights Priority diseases under surveillance Epidemiological week no. 17 (22 to 28 April 2012) in DEWS Acute (Upper) Respiratory Infection • In week 17, 2012, total 87 districts including 2 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 1,958 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 758,579 consultations were reported through DEWS of which 17% were acute Other Acute Diarrhoea respiratory infections (ARI); 9% were acute diarrhoea; 5% were suspected malaria; while 4% were Suspected Enteric/Typhoid Fever Skin disease. Suspected Malaria Suspected Meningitis Suspected Dengue fever • A total of 246 alerts reported while 25 outbreaks were identified in week 17, 2012: Alto‐ Suspected Viral Hemorrhagic Fever gether 130 alerts for Measles; 25 for Leishmaniasis; 18 each for AWD and Typhoid; 17 for Acute Pyrexia of Unknown Origin diarrhoea; 11 for NNT and tetanus; 9 for Pertussis; 8 for Bloody diarrhoea; 3 each for acute jaun‐ Suspected Measles Suspected Acute Viral Hepatitis dice syndrome and Scabies; 2 for DF; while 1 each for Malaria and ARI. Chronic Viral Hepatitis Neonatal Tetanus • In this week no new polio cases was reported. As of 30 April 2012, the total number of polio Acute Flaccid Paralysis cases confirmed by the laboratory is 15 from 10 districts/towns/tribal agencies and areas. Scabies Cutaneous Leishmaniasis Others Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐17, 2012. 50 AD BD ARI S. Malaria 45 40 35 30 25 Percentage 20 15 10 5 0 9 7 5 3 1 9 7 5 3 1 11 13 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 15 17 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 wk Table 1: Most common communicable diseases syndromes reported weekly Disease Wk-10 Wk-11 Wk-12 Wk-13 Wk-14 Wk-15 Wk-16 Wk-17 Acute respiratory infection 155,186 (23%) 162,325 (23%) 145,261 (21%) 155,558 (20%) 128,653 (20%) 132,836 (19%) 131,146 (18%) 126,299 (17%) Skin diseases 30,909 (4%) 31,713 (4%) 28,719 (4%) 31,638 (4%) 28,123 (4%) 28,245 (4%) 28,441 (4%) 30,647 (4%) Acute diarrhoea 38,427 (6%) 40,950 (6%) 41,535 (6%) 51,227 (7%) 52,033 (8%) 60,539 (9%) 63,332 (9%) 68,364 (9%) Bloody diarrhoea 2,874 (0.42%) 3,651 (0.51%) 2,890 (0.42%) 3,480 (0.45%) 2,977 (0.46%) 3,328 (0.47%) 3,563 (0.50%) 3,421 (0.45%) Suspected malaria 29,599 (4%) 30,594 (4%) 29,521 (4%) 32,888 (4%) 28,298 (4%) 30,846 (4%) 31,573 (4%) 34,721 (5%) Total consultation 688,813 717,186 681,475 772,042 647,695 711,300 718,289 758,579 • 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 the last 8 weeks proportional morbidity of the leading five disease syndrome. Proportional morbidity of ARI is highest in Khyber Pakhtunkhwa, Sindh and Balochistan, while acute diarrhoea is highest in Khyber Pakhtunkhwa, FATA, Sindh and Balochistan (please see the graphs for every province in page 7 and 8). 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. 17 (22 to 28 April 2012) Previous week's (16/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 26 cases of Leishmaniasis were reported. Patients were investigated and found lesion on face, 18‐Apr Leishmaniasis Balochistan Killa Saifullah Village & UC Urgas 3 16 2 5 nose, arm and leg. All the patients have no travel history. Treatment as per WHO protocol was given. All information shared with DHO. 24 cases of suspected malaria were reported from BHU. 21 were tested on RDTs out of which 14 verified positive (slide positivity 67%). Distribution shows 05 FP, 05 Vivax and 04 Mixed 20‐Apr Malaria Balochistan Jhal Magsi Village & UC Barija 3 8 2 11 (Falciparum ratio 64%). All the cases are from one location village barija. Anti Malarial medi‐ cine were supplied to BHU to facilitate patient management. Information shared with DHO and requested for further prevention. 10 cases of Measles were reported from DHQ Hospital. All the patients were timely re‐ sponded and presented with typical signs and symptoms. Vit A drops provided and health Village Nayabad, UC 16‐Apr Measles Balochistan Gwadar 2 6 1 1 education imparted. 10 children were assessed for vaccination, 6 Children found totally Gwadar‐N unvaccinated whereas 4 had received only one dose of Measles. DHMT was informed and requested to send outreach team for vaccination. 2 Pertussis cases were reported. On investigation; 13 more cases were identified with same signs and symptoms. Patient was given health education. Erythrocin and Cough syrup was Killi Samazai, UC Gawal 19‐Apr Pertussis Balochistan Killa Saifullah 7 3 4 1 given. Community awarenesss session was conducted. All patients found totally unvaccinated. Ismailzai Information shared with DHO and EPI representative and requested to send outreach team for vaccination. One case and a death due to measles were reported from BHU Kambila. On active surveil‐ lance 13 cases including 2 deaths of suspected measles were identified in whom 6 seriously ill children were referred to the KTH Peshawar. The Agency Surgeon, FSMO and PPHI were Mashoom baba Tatara, Khyber informed.An investigation team including PPHI monitoring officer was formed for the affected 19‐Apr Measles FATA UC Kambila, Tehsil 7 0 6 0 Agency Mulagori area.Another death was occurred on the day the investigation team arrived there.Vitamin A given to the measles cases.Mass measles vaccination of 130 children were done.Health edu‐ cation imparted.Blood samples of two suspected cases taken and sent to NIH Islama‐ bad.Report shared with DOH and PPHI. 2 cases of suspected measles were reported from BHU. On active surveillance, 4 more sus‐ Khyber pected measles cases were found. All 6 cases found totally unvaccinated. 12 children were charnee near kalpani 20‐Apr Measles Pakhtunk‐ Buner 2 0 4 0 assesed in house cluster, 100% found vaccinated against pentavalent and measles 1 vaccine. 2 tehsil gagra hwa blood samples were taken. Information shared with EPI coordinator and outreach vaccination campaign will be planned in the locality. Alert of suspected measles case was generated by BHU. Suspected case was given Vit A drops. Blood sample was taken and sent to NIH. Active surveillance was conducted in the area. 16 more cases were identified who had measles in past 1 month. During active surveillance and Khyber record analysis, 1132 children were assessed for vaccination status. 338 children were missing 17‐Apr Measles Pakhtunk‐ Haripur Afghan Refugee camp 6 7 5 3 2 hwa measles 1 vaccine and 173 children were missing measles 2 vaccine. Children were referred to nearest health facility for completion of vaccination. Health education session on prevention and spread was conducted for the affected families. CHWs were involved in active case find‐ ing. EDO Health and Save the children were informed about the outbreak. Alert of suspected measles case was generated from Afghan Refugee camp 2. Suspected case was given Vit A. Blood sample was taken and sent to NIH. Active surveillance was conducted in the area. 28 more cases were identified who had developed measles in past 1 month. On Khyber active surveillance and record analysis, 698 children were assessed for vaccination status.83 18‐Apr Measles Pakhtunk‐ Haripur Afghan Refugee camp 2 7 10 5 7 children were missing measles 1 vaccine and 35 children missing measles 2 vaccine. CHWs hwa were involved in active case finding. EPI coordinator and save the children were informed about the outbreak. Missing children were referred to nearest health facility for completion of vaccination. Health education on prevention and spread was conducted for the affected families. Seven suspected cases of measles were detected and responded, vitamin A drops given, one blood specimen collected and sent to NIH, on field investigation found 43% children fully 17‐Apr Measles Punjab D. G. Khan Mitha khoo uc Gadai 5 1 0 1 vaccinated. Health education session conducted. Provided IEC material. Outreach vaccination activity planned with the help of DOH. An alert of AWD was reported from hospital with severe dehydration, during active surveil‐ Village Guhram Khan lance 7 more cases were found, Water supply suspected as the source of disease, Aqua tabs, 18‐Apr AWD Sindh Dadu Gopang, near Pir Najeeb 0 5 2 1 Zinc tabs and ORS distributed, health and Hygiene session was conducted, EDOH, THO, DSC ullah and FP‐National program was informed, 1 Stool and 2 water samples were collected for lab testing. 6 cases of AWD were admitted in THQ, active search for more cases was done, Hand Pump Village Essani Khoso, near was the source of water, Aqua tabs, Zinc tabs supplied, IEC material and ORS distributed, 18‐Apr AWD Sindh Matiari Oil field, Palijani station, 0 1 0 5 taluka Matiari health sessions conducted, EDOH informed, 3 Stool and 4 water samples collected for lab testing.