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 2, Issue 43, Monday 31 October, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 43 (21 to 27 October, 2011) in DEWS • 81 districts and 2 agencies provided surveillance data to the DEWS this week from Acute Flaccid Paralysis (AFP) 2,514 health facilities. Data from mobile teams is reported through sponsoring BHU or Acute Jaundice Syndrome (AJS) RHC. Acute Respiratory Infections (Upper and Lower) (ARI) • A total of 802,810 consultations were reported through DEWS of which 192,059 (24%) were acute respiratory infections (ARI); 69,127 (9%) were Skin disease; 62,127 Acute Watery Diarrhoea (AWD)/ Suspected Cholera (8%) were acute diarrhoea; and 58,508 (7%) were suspected Malaria. Acute Bloody Diarrhoea (BD) • A total of 140 alerts with 11 outbreaks were reported in week‐43, 2011: Altogether Other Acute Diarrhoeas (AD) 33 alerts were for Dengue Fever, 33 for AWD, 28 for Measles, 17 for Neonatal tetanus Suspected Viral Hemorrhagic and Tetanus, 10 for Leishmaniasis, 6 each for Malaria and Pertussis, 1 Bloody diarrhoea, Fever (VHF) while 6 for other non‐communicable diseases. Suspected Malaria (Mal) • National Polio Eradication Initiative reported 4 new polio cases, 1 each from Sindh Suspected Measles (MS) (Thatta), FATA (Waziristan North), Balochistan (Pishin) and Khyber Pakhtunkhwa Suspected Meningitis (MG) st (Swabi). As of 31 October, 2011, Pakistan has reported a total of 136 polio cases (134 Others type‐1 and 2 type‐3) from 42 districts/towns/tribal agencies/areas. Please see map on page 6. Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 27 October 2011 (Epi week 31, 2010 to week 43, 2011) 35 AD BD ARI S. Malaria 30 25 20 Percentage 15 10 5 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 51 49 47 45 43 41 39 37 35 33 31 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 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 Disease Wk-36 Wk-37 Wk-38 Wk-39 Wk-40 Wk-41 Wk-42 Wk-43 Acute respiratory infection 158,580 (18%) 175,906 (19%) 193,771 (19%) 205,597 (21%) 209,436 (21%) 221,144 (22%) 210,475 (24%) 192,059 (24%) Skin diseases 104,676 (12%) 107,435 (12%) 107,243 (11%) 105,912 (11%) 95,842 (9%) 93,937 (9%) 80,944 (9%) 69,127 (9%) Acute diarrhoea 96,128 (11%) 109,523 (12%) 110,835 (11%) 105,295 (11%) 97,007 (10%) 92,214 (9%) 73,343 (8%) 62,127 (8%) Bloody diarrhoea 7,387 (0.85%) 7,920 (0.85%) 8,676 (0.86%) 9,393 (0.94%) 8,075 (0.80%) 8,016 (0.78%) 6,007 (0.68%) 5,389 (.67%) Suspected malaria 58,753 (7%) 64,766 (7%) 78,109 (8%) 83,684 (8%) 82,802 (8%) 85,698 (8%) 68,059 (8%) 58,508 (7%) Total consultation 864,693 931,318 1,005,251 995,450 1,014,266 1,023,163 886,224 802,810 Since July 29, 2010, approximately 50,324,518 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on about 1,000,000 consultations per week, there is a drop in timely reporting due to challenges in accessibility caused by floods, security and infrastructure. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 6 weeks (38 to 43, 2011) acute diarrhoea cases have been decreased (From 12% to 8%), while at the same time cases of ARI have been increased (From 18% to 24%). Sus‐ pected Malaria cases have also shown seasonal increase from week 35 especially from districts in Sindh and Balochistan. 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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 43 (21 to 27 October, 2011) Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for suspected Malaria, 23 cases were reported. 21 samples were taken and 17 verified positive 27‐Oct Malaria Balochistan Jhal Magsi BHU Barija 3 8 5 7 (PF=5,PV=8,and Mix=4); SPR=81%, while FR = 53%. RDTs were distributed and DHO was informed. Alert for CCHF, one death of a suspected CCHF case was reported from village Khaido, district Haripur. The patient had initially presented with fever and body aches. Lab investigations revealed thrombocytopenia. Blood sample was taken and sent to NIH which came back positive for CCHF. A joint team of WHO and Dept 27‐Oct CCHF KPK Haripur Village Khidoo 0 1 0 0 of health visited the area. Epidemiological and environmental assessments were carried out. A session on CCHF spread and prevention was conducted in the community. EDO Health was informed. Residual spray in the area was also carried out. AWD alert, suspected case found in Hospital and investigated during active surveillance 5 more cases were 25‐Oct AWD Sindh Badin Ward # 05, UC Talhar 2 2 0 2 found, health education provided. Aqua tabs, Zinc tabs, ORS and Hygiene kits were distributed. EDO‐H informed, 1 stool and 2 water sample taken. AWD alert, suspected case admitted in hospital with Dehydration, during active surveillance found 5 more Malik Shah Town, UC Nago‐ 27‐Oct AWD Sindh Jamshoro 3 2 0 1 cases, water supply was the source, health education imparted, Aqua tabs, Zinc tabs, ORS, Jerry cans and line IEC material distributed, EDO‐H informed, 1 stool and 2 water samples were taken. AWD alert, suspected case found in Hospital during active surveillance 6 more cases were found in the Village Fazil Noohani, Digri village, health education imparted to house hold, Doctors and Paramedic briefed on case definition and 27‐Oct AWD Sindh Mirpur Khas 1 3 1 2 City reporting. Aqua tabs, Zinc Tabs, ORS and hygiene kits were distributed. Water sample was found contami‐ nated. AWD alert, suspected case with deaths reported from IDP camp, during active surveillance found 21 more 26‐Oct AWD Sindh Sanghar IDP camp near Village Berwari 2 11 2 7 cases. Hand pump was the source of water, health education provided, Aqua tabs, Zinc tabs, ORS, Jerry cans and hygiene kits were distributed. EDO‐H and DSM informed, 1 stool and 2 water samples were taken. AWD alert, during active surveillance 7 more cases found with severe dehydration, health education im‐ Village Rajo Lashari, UC 24‐Oct AWD Sindh T. Allah Yar 2 3 1 1 parted. Aqua tabs, Zinc tabs, ORS, Jerry cans and hygiene kits were distributed. EDO‐H informed, 1 stool and Dhingano Bozdar 2 water samples were taken. Village Loolja, UC Kandi Alert for Malaria, 20 cases were investigated, 11 confirmed by RDT, SPR=55%, health education was im‐ 22‐Oct Malaria Sindh Dadu 0 0 0 0 chukki parted. TMA/TMO, EDO‐H and DOH were informed and requested for fumigation. Alert for Malaria, 30 cases were investigated, 49 RDT conducted out of them 30 were confirmed, SPR=61%, 23‐Oct Malaria Sindh Tharparkar Tent Village, Nohato Road 1 18 1 10 health education imparted. Bed nets were provided to the patients; EDO‐H, Malaria Focal Person were informed. Alert for probable Pertussis, 14 suspected cases were found during the monitoring of polio campaign at village Allah Wasayo Chachar, UC Qadirpur. House to house search was carried out, routine immunization 25‐Oct Pertussis Sindh Ghotki Village Allah Wasayo 7 2 4 1 status was found to be zero. Health education imparted in the village and informed EDOH and DSV and requested for vaccination in the village. Alert for Pertussis, 5 suspected cases were found during the monitoring of polio campaign at village Khuda Bux Marnas, UC Bago Daho. House to house case searching done, routine immunization status was found 26‐Oct Pertussis Sindh Ghotki Village Khuda Bux Marnas 2 1 1 1 to be zero. Health education imparted in the village and informed EDOH and DSV and requested for vaccina‐ tion in the village. Current week's Alerts: Province Khyber Pakhtunkhwa Current week's Alerts: Province Balochistan Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 27‐Oct AWD Battagram Village Shingli Bala, UC Gijjbori 0 1 0 0 26‐Oct DHF Quetta Fatima Jinnah Chest Hospital 0 2 0 0 25‐Oct BD Kohat Village Garhi Mawaz Khan 0 2 0 6 27‐Oct CCHF Haripur Village Khidoo, Haripur 0 1 0 0 26‐Oct Leishmaniasis Awaran wadi UC camp Jhaoo 1 0 0 0 21‐Oct DHF D. I. Khan Gur Wali, Kirri Shamozai, Tehsil Paroa, 0 1 0 0 21‐Oct Leishmaniasis Jhal Magsi Balina kotra UC Khari CD Kotra 1 0 0 0 26‐Oct DHF D. I. Khan P.O. Kot Jai, Tehsil Pahar Pur 0 1 0 0 25‐Oct Leishmaniasis Jhal Magsi DHQ Hospital‐Basti Kamal Shah UC Gandawah 1 0 0 0 24‐Oct DHF Haripur Haripur city 0 1 0 0 25‐Oct DHF Haripur Saidan Kharan, Haripur 0 1 0 0 24‐Oct Leishmaniasis Kalat Khail UC Kalat Saddar Tehsil Kalat 0 1 0 0 21‐Oct DHF Lower Dir Village & UC Khungi Sha, Tehsil Timar‐ 0 1 0 0 27‐Oct Leishmaniasis Khuzdar Tehsil Khuzdar and Nall 0 2 0 0 22‐Oct DHF Lower Dir Village & UC Rabat, Tehsil Timargara 0 1 0 0 27‐Oct DHF Shangla Mohallah Ali Khel , Village Choga 0 1 0 0 25‐Oct Leishmaniasis Panjgur UC Washbood, Mohalla Qazi Abad 0 1 0 0 23‐Oct Diphtheria Kohistan Village Dhaan (Thapan), UC Ranolia 2 1 0 0 27‐Oct Leishmaniasis Quetta Hazara town, Brewery road 0 0 0 1 27‐Oct Leishmaniasis Tank Dabarra 1 0 0 0 27‐Oct Malaria Jhal Magsi BHU Barija 3 8 5 7 21‐Oct Measles D.