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Weekly Field Epidemiology Report Federal Disease Surveillance and Response Unit Field Epidemiology & Disease Surveillance Division National Institute of Health (NIH) Islamabad WEEKLY FIELD EPIDEMIOLOGY REPORT Volume 2 Issue 48 Nov 25 - Dec 01, 2019 Date: December 12, 2019 Provincial Technical Officers and fellows of FELTP PDSRUs/RDSRUs. In week 48 of 2019, no new case was assigned at the Disease Surveillance, Response Units reported. (DSRU’s) are working with provincial, and district health Diphtheria Surveillance: authorities on event based disease surveillance and During 2018 total 464 suspected cases of Diphtheria were outbreak response. reported. Total 544 cases reported in 2019 including 11 new DSRUs are sharing the disease surveillance data, case reported last week. outbreak reports and activities of FELTP fellows to the Dengue Surveillance: Federal Disease Surveillance and Response Unit In 2018 total 3204 Dengue cases were reported, from Sindh (FDSRU) at the Field Epidemiology and Disease (2088) while in 2019 total 24,336 cases have been reported Surveillance Division (FEDSD) National Institute of so far. In week 48, 2019, Punjab (62), KP (11), Baluchistan Health (NIH) Islamabad on weekly basis. (45), No report received from KP Merged Areas, ICT, KP, Sindh & AJK. Inside Issues Page No. CCHF Surveillance: Diphtheria /Dengue/ CCHF Surveillance 1 XDR/MDR-Typhoid Surveillance Karachi / In 2018 total 63 CCHF (suspected and confirmed) cases 1-5 Hyderabad Sindh were reported from DSRUs and 75 cases have been reported TVC campaign Sind and AEFI Surveillance 5-6 in 2019. During the last week one new CCHF case ported Update on HIV Outbreak Investigation among from KPK Children in Taluka Ratodero, Larkana-April- 7-9 November 2019 Table 2: Dengue cases reported in 2017, 2018 and month- Varicella and Measles surveillance Punjab 9 wise distribution in year 2019(All provinces and regions) Update on Dengue in merged area and Baluchistan/KP 9-11 Month KPK Sindh AJK ICT TDs - Baluch Punjab Total Table 1: Weekly and Cumulative Diseases Updates Dec KP 01, 2019 Jan–Dec 18,857 2,884 6 120 406 86 579 22,938 Disease Nov 25-30 Total 2017 November Cases in ,2019 2019 Jan-Dec 332 2088 1 0 175 69 539 3204 1 CCHF 1 75 2018 Jan-19 0 143 0 0 0 12 1 156 2 Varicella 20 1,190 Feb-19 0 99 0 0 0 30 0 129 3 Dengue 117 24,488 March-19 0 67 0 0 0 251 0 318 April-19 1 93 0 2 2 549 1 646 4 Chikungunya 0 0 May-19 1 176 0 0 37 535 1 570 5 Measles 42 6,637 June-19 5 219 0 0 0 263 4 565 July-19 33 205 0 0 4 57 38 337 6 Diphtheria 11 544 Aug-19 88 0 2 140 10 6 758 1004 Sept-19 2513 1935 504 2705 235 297 2714 10903 7 suspected/confirmed 0 82 Seasonal Influenza Oct-19 2430 0 0 0 1083 346 4630 8489 Influenza Suspected/Confirmed: In 2018, 3221 Nov-19 143 0 0 0 113 340 623 1219 Total Suspected/confirmed Influenza cases were reported from 5214 2937 506 2847 1484 2686 8770 24,336 2019 1 Volume 2 Issue 48 Nov 25 - Dec 01, 2019 Date: December 12, 2019 Extensive Drug Resistant/Multi Drug Resistant - 2019 Typhoid Fever Surveillance, Sindh (up to Decem 6885 1574 949 9,408 From November 1, 2016 to Dec, 01, 2019 total 21,096 ber Typhoid Fever cases reported from different districts of 01)) Total 10772 2962 1160 14,320 Sindh province. Out of these 14,320 cases found as Extensive Drug Resistant Typhoid cases. Update on Extensive Drug Resistant Typhoid Fever Table 3: Reported XDR Typhoid Fever cases in Sindh by Karachi: year (Nov 2016 –Dec,01, 2019) Total 15893 lab confirmed Typhoid cases reported from ten Other Sindh Year Karachi Hyderabad Districts Total hospitals of Karachi. Out of these 10772 recorded as 2016 0 12 0 12 Extensive Drug Resistant (XDR) Typhoid Fever cases from 2017 175 485 4 664 January 1, 2017 to December 01, 2019. In the week 48 of 2019, total 79 new XDR/MDR Typhoid 2018 3,712 891 207 4,810 Fever cases reported from different hospitals in Karachi. Fig 1: Week wise number of XDR Typhoid fever cases in Karachi, 1st January 2018 to 01 December, 2019(Week 48) Following cases definitions were applied to categorize the the first line recommended drugs for treatment such as Typhoid cases reported: chloramphenicol, ampicillin and trimethoprim- sulfamethoxazole. The strain may be sensitive or resistant to Non Resistant typhoid fever: fluoroquinolone group. It is defined as Typhoid fever caused by Salmonella Typhi or Extensive Drug Resistant (XDR) Typhoid fever: Salmonella Paratyphi A, B or C strains, which are sensitive It is defined as typhoid fever caused by Salmonella to first and second line drugs (ampicillin, chloramphenicol, typhi strain which are resistant to first line drugs, trimethoprim-sulfamethoxazole, cefixime and ceftriaxone). fluoroquinolones and third-generation cephalosporin Any isolate sensitive to first line drugs but resistant to (Ceftriaxone) fluoroquinolone group will also be considered as Non- The Technical Support Officer and the FELTP fellows of the Resistant typhoid. Regional DSRU Karachi reached out to the major hospitals Multi-Drug Resistant (MDR) Typhoid fever: in the city and collected the Typhoid data from hospitals in It is defined as Typhoid fever caused by Salmonella Typhi or Salmonella Paratyphi A, B or C strains which are resistant to 2 Volume 2 Issue 48 Nov 25 - Dec 01, 2019 Date: December 12, 2019 whatever form it is available. They segregated and analyzed 15-19 Y 11.3 2282550 678 30 the data for the Drug resistance pattern. 20-24 Y 9.7 1959357 460 23 The XDR Typhoid cases were reported mostly among the children and maximum number 4421 (41%) of the XDR 25-29 Y 8 1615964 274 17 cases were reported in the 0-4 years age group. 30-34 Y 6.2 1252372 119 10 The overall attack rate was 53/100,000 population. Highest 35-39 Y 5.4 1090776 60 6 attack rate was found in 0-4 years age group i.e.162/100,000 40-44 Y 4.3 868581 46 5 followed by 5-9 years age group i.e. 119/100,000. Females 45-49 Y 4 807982 43 5 had higher attack rate (65/100,000) as compared to males 50-54 Y 2.7 545388 35 6 Table 4: Age and gender specific attack rates of XDR Typhoid reported from Karachi during January 1, 2017 to December 01, 2019 55-59 Y 2.7 545388 22 4 Percentage Attack Age Number of XDR of rate 60-64 Y 2.4 484789 22 5 Group Population Typhoid Population /100,000 >65 4.3 868581 19 2 0-4 Y 13.5 2726940 4421 162 Total 100 20199554 10772 53 5-9 Y 13.4 2706740 3212 119 Male 51 10301767 4357 42 10-14 Y 12.1 2444146 1361 56 Female 49 9897777 6415 65 Fig 2: Number of XDR and drug sensitive Typhoid fever cases reported from January 1, 2017 to December 01, 2019 in Karachi Total 15893 of Typhoid cases were reported * Typhoid cases from Aga Khan University Typhoid cases from other hospitals 7372 Hospital 8521 Non-Resistant Extensive Drug Extensive Drug Non-Resistant Typhoid Fever Resistant Typhoid Resistant Typhoid Typhoid Fever 3161 Fever 5360 Fever 5412 1960 Total Extensive Drug Resistant 10198 * AKU does not share the complete susceptibility report of typhoid fever cases 3 Volume 2 Issue 48 Nov 25 - Dec 01, 2019 Date: December 12, 2019 Fig 3: Time distribution of XDR and Non-Resistant Typhoid Fever cases reported from January 1, 2018 –December 01, 2019 in Karachi The highest Incidence Rate of the cases was reported from The PDSRU Hyderabad at DGHS Sindh, Hyderabad is 5 towns: Gulshan-e-Iqbal (AR=27.1/100,000), Saddar following up for the XDR/MDR Typhoid cases in District (16.6/100,000), North Nazimabad (AR 10.7/100,000), Hyderabad. Malir (AR 10.1/100,000), Gulberg (AR 10.1/100,000) and Total 5,203 Salmonella Typhoid cases reported from the Gulberg (AR 9.7/100,000). While lowest Incidence was November 2016 to 01 December 2019 from different recorded in SITE town (AR=0.1/100,000). districts of Sindh province excluding Karachi. Among these Reported by: Dr Asif Syed TSO Karachi, Dr Anum Vigio and Dr. 4122 were of extensive drug resistant cases. Among the total Ishfaque (fellows 10th Cohort) Extensive Drug resistance cases 2962 (72%) XDR-cases are 2. Update on Extensive Drug Resistant Typhoid from District Hyderabad. Fever in district Hyderabad: Fig 4: XDR Typhoid cases reported by month in district Hyderabad Nov 2016 - December 01, 2019 250 200 150 100 No of cases of No 50 0 N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N Year - Year-17 Year -18 Year-19 16 Month wise cases 4 Volume 2 Issue 48 Nov 25- December 01, 2019 Date: December 12, 2019 Table 5: District wise (excluding Karachi) total Typhoid 2962 2186266 13.5 and XDR Typhoid cases in Sindh (Nov 2016 -Dec 01, 2019) Male 1749 1106469 15.8 Total No of Female 1213 1079797 11.2 Typhoid XDR % XDR Total 2962 2186266 13.5 Name of District cases cases cases Hyderabad 3775 2962 71.9 Water Analysis Report (PCR): Tando Alha Yar 22 16 0.4 In 69 % (9/13) of the cases, coliforms and/ or thermo-tolerant Badin 141 100 2.4 Dadu 41 34 0.8 E.coli were isolated from household drinking water.
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