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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 2, Tuesday 17 January, 2012 Highlights Priority diseases under surveillance Epidemiological week no. 2 (8 to 14 January, 2012) in DEWS • In week 2, 2012, total 74 districts including 2 agencies providing surveillance data to the Acute Flaccid Paralysis (AFP) DEWS on weekly basis from around 1,399 health facilities. Data from mobile teams is reported Acute Jaundice Syndrome (AJS) through sponsoring BHU or RHC. Acute Respiratory Infections (Upper and Lower) (ARI) • A total of 403,874 consultations were reported through DEWS of which 27% were acute respiratory infections (ARI); 5% were Skin disease; 6% were acute diarrhoea; and 4% were sus‐ Acute Watery Diarrhoea (AWD)/ Sus- pected Cholera pected malaria. Acute Bloody Diarrhoea (BD) • A total of 101 alerts with 5 outbreaks were reported: Altogether 38 alerts for Measles; 18 Other Acute Diarrhoeas (AD) for Neonatal tetanus and tetanus; 17 for Leishmaniasis; 8 for Pertussis; 4 for AWD; 3 for Acute Jaundice Syndrome; 2 for Bloody diarrhoea and 1 for suspected Malaria while 10 for others com‐ Suspected Viral Hemorrhagic Fever (VHF) municable diseases. Suspected Malaria (Mal) • In week 2, 2012, five new type‐1 polio cases were confirmed by the laboratory having date Suspected Measles (MS) of onset of paralysis in 2011; one each from Federally Administered Tribal Areas (Khyber agency), Suspected Meningitis (MG) Khyber Pakhtunkhwa (district Charsadda), Sindh (district Badin), Balochistan (district Khuzdar) and Punjab (district Lahore). This brings the total number of polio cases in 2011 so far to 197 (195 Others type‐1 cases and 2 type‐3 cases) from 60 districts/towns/tribal agencies & areas. Figure‐1: Weekly trend of Acute diarrhoea and ARI in Pakistan, 2010 and 2011. 50 AD BD ARI S. Malaria 45 40 35 30 25 Percentage 20 15 10 5 0 1 3 5 7 9 1 51 49 47 45 43 41 39 37 35 33 31 45 47 11 49 13 51 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 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 wk wk wk Table 1: Most common communicable diseases syndromes reported in 2011, by province Disease Wk-47 Wk-48 Wk-49 Wk-50 Wk-51 Wk-52 Wk-1 Wk-2 Acute respiratory infection 224,061 (26%) 242,844 (27%) 192,900 (27%) 241,869 (28%) 240,042 (29%) 215,219 (30%) 90,563 (27%) 107,692 (27%) Skin diseases 72,895 (8%) 77,057 (9%) 58,406 (8%) 69,079 (8%) 68,422 (8%) 55,185 (8%) 19,737 (6%) 19,582 (5%) Acute diarrhoea 62,650 (8%) 65,718 (7%) 52,625 (7%) 61,478 (7%) 57,942 (7%) 49,544 (7%) 21,574 (6%) 23,844 (6%) Bloody diarrhoea 5,478 (0.64%) 4,912 (0.54%) 4,556 (0.64%) 4,856 (0.57%) 4,332 (0.52%) 4,257 (0.59%) 1,492 (0.44%) 2,204 (0.55%) Suspected malaria 56,468 (7%) 63,826 (7%) 47,753 (7%) 52,040 (6%) 50,480 (6%) 39,991 (6%) 13,887 (4%) 15,050 (4%) Total consultation 859,241 904,948 709,4184 856,582 835,260 717,926 340,073 403,874 • The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as percentage of cases out of total consultations reported to DEWS on weekly basis. • In year 2011, approximately 45,510,570 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K with average weekly consultations at 875,204. • The above table provides the total consultations and proportional morbidity of five disease syndrome. Proportional morbidity of ARI is highest in KP while acute diarrhoea is highest in KP and Balochistan. • Proportional morbidity of suspected malaria were very high for the year at 13% in Balochistan and 12% in Sindh (Please see provincial trends graphs). 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. 2 (8 to 14 January, 2012) Previous week's (1/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Abro Mohla & Bhangar Outbreak of 6 cases of Leishmaniasis from one location. Inj Glucantime was provided and health education 5‐Jan Leishmaniasis Balochistan Nasirabad 1 3 2 0 Mohla town area was given. Hazara town, Brewery 6 new cutaneous Leishmaniasis cases were attended in continuation of previous Cases. Treatment started 6‐Jan Leishmaniasis Balochistan Quetta 0 5 0 1 road through MC supported Program. Till date a total of 66 cases reported from this center. 58 cases of suspected Malaria reported from Hospital out of which 24 were positive for P. Falciparum and 7 7‐Jan Malaria Balochistan Lasbela Civil Hospital Bela 0 0 0 0 were P. Vivax (SPR=54%). The treatment was provided to all patients. Information was shared with DHO for necessary action. 17 cases of suspected Malaria reported from RHC out of which 11 were positive 9 for P. Falciparum and 2 for 7‐Jan Malaria Balochistan Lasbela RHC Lakhra 0 0 0 0 mix (SPR=65%). Treatment was provided to all patient as per WHO protocol. All the information was shared with DHO for necessary action. Alert for measles, during active surveillance 7 more cases were found, routine outreach vaccination con‐ Village Navagai, UC ducted in the area by EPI Team, Vit‐A was given, Blood Sample Collected for confirmation of antibodies, 3‐Jan Measles KPK Lower Dir 5 1 2 0 Rabat, Tehsil Balmbat Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed. Alert for Measles, during active surveillance 5 more cases were found, routine outreach vaccination con‐ Village Shagai, UC Rabat, ducted in the area by EPI Team, Vit‐A was given, Blood Sample Collected for confirmation of antibodies, 4‐Jan Measles KPK Lower Dir 3 2 1 0 Tehsil Balmbat Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed. Alert for Measles, during active surveillance no more cases found, routine outreach vaccination conducted in Village Ttoru, UC Drangal, the area by EPI Team, Vit‐A was given, Blood Sample Collected for confirmation of antibodies, Health educa‐ 5‐Jan Measles KPK Lower Dir 1 0 0 0 Tehsil Samar Bagh tion session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed. Lower Dir (Village Warri Suspected Measles case reported from OPD‐DHQ Hospital belongs to Upper Dir. The concern S.O informed for 5‐Jan Measles KPK Upper Dir Payeen, UC & Tehsil 1 0 0 0 active surveillance. Blood Sample collected and sent to NIH, Health education session conducted with the Warri) family members. Village Kaloo Khan Suspected case of Pertussis found in hospital, during active surveillance 5 more cases found, Child was not 3‐Jan Pertussis Sindh Dadu Karmani, near Wapda 2 1 2 1 vaccinated, 9 out of 15 children were vaccinated in the community, health education imparted, Erythromycin colony provided, EDOH, THO, DSM, EPI FP inform and 1 throat sample taken. Suspected cases of Pertussis reported in Village, Active surveillance done, Throat sample taken, vaccination Village Mazar Burguri, UC 4‐Jan Pertussis Sindh Dadu 6 1 5 2 status was not good, 8 out of 20 children were vaccinated in the area, health education session was con‐ Torr Taluka Johi ducted, Erythromycin provided, EDOH, THO, DSM, EPI FP inform and request for immunization. Current week's (2/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for Bloody diarrhoea, 3 cases were reported from BHU Manakarai. Stool sample was taken and sent to Khyber NIH. Water samples were tested and found to be contaminated. LHWs were involved in active case finding 2 9‐Jan BD Pakhtunk‐ Haripur Village Manakarai 0 3 1 1 more cases were found. Aqua tabs were distributed in the community for disinfection of household water. hwa Health and hygiene sessions were conducted. EDO health was informed of the cases Village Cheejpur, UC Alert for probable Pertussis, 14 suspected cases were found in village, vaccination is not regular, health 12‐Jan Pertussis Sindh Dadu Chorr Qambar, Taluka 4 1 8 1 education imparted, 1 Throat sample taken, EDOH, THO and EPI focal person informed. K.N.Shah Village Long Khoso, UC Alert for probable Pertussis, 7 suspected cases were found in village, Vaccination status is very poor, health 12‐Jan Pertussis Sindh Dadu 2 0 3 2 Gozo, Taluka K.N Shah education imparted, 1 Throat sample taken, EDOH, THO and EPI focal person informed. Village Sangrano, UC Alert for probable Pertussis, 7 suspected cases were found in village, health education imparted, area was 12‐Jan Pertussis Sindh Sanghar Chotiyaryoon, Taluka 0 4 0 3 partially vaccinated, Erythromycin and Cough syrup provided to cases and contacts and EDOH informed. Sanghar Alert for Typhoid from Islamabad for Haripur district. A case of AJS and with Widal positive from village Kot Najibullah. During active surveillance 13 more suspected cases were identified. Medicines were provided to Khyber the CD. 14 LHWs were involved in active case finding and response. 6 water samples were taken and 4 of 12‐Jan Typhoid Pakhtunk‐ Haripur Village Kot Najibullah 0 8 1 6 them were contaminated.
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