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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 11, Wednesday 21 March 2012 Highlights Priority diseases under surveillance Epidemiological week no. 11 (11 to 17 March 2012) in DEWS Acute (Upper) Respiratory Infection • In week 11, 2012, total 85 districts including 3 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 1,947 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 689,606 consultations were reported through DEWS of which 23% were acute Other Acute Diarrhoea respiratory infections (ARI); 6% 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 204 alerts with 30 outbreaks were reported/identified in week 11, 2012: Alto‐ Suspected Viral Hemorrhagic Fever gether 89 alerts for Measles; 22 for Typhoid; 21 for Leishmaniasis; 17 for ARI; 10 for NNT and Pyrexia of Unknown Origin tetanus; 9 Pertussis; 7 for Scabies; 6 for AWD; 5 for AD; 4 for DF; 3 each for AJS, BD and Malaria; Suspected Measles Suspected Acute Viral Hepatitis 2 each for Diphtheria and Unexplained fever; while 1 for Rabies. Chronic Viral Hepatitis Neonatal Tetanus • As of 15 March 2012, the total number of polio cases confirmed by the laboratory is 14 Acute Flaccid Paralysis 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‐11, 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 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 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-4 Wk-5 Wk-6 Wk-7 Wk-8 Wk-9 Wk-10 Wk-11 Acute respiratory infection 137,322 (26%) 114,319 (26%) 138,507 (25%) 159,074 (26%) 153,068 (24%) 157,723 (23%) 154,851 (23%) 155,629 (23%) Skin diseases 25,639 (5%) 22,020 (5%) 26,786 (5%) 29,199 (5%) 28,807 (4%) 29,411 (4%) 30,904 (4%) 30,460 (4%) Acute diarrhoea 28,461 (5%) 23,902 (5%) 28,969 (5%) 30,607 (5%) 31,598 (5%) 34,878 (5%) 38,383 (6%) 39,511 (6%) Bloody diarrhoea 2,665 (0.50%) 2,195 (0.50%) 2,676 (0.49%) 2,730 (0.45%) 2,765 (0.43%) 3,094 (0.46%) 2,874 (0.42%) 3,593 (0.52%) Suspected malaria 19,817 (4%) 15,582 (4%) 21,752 (4%) 22,883 (4%) 23,483 (4%) 28,265 (4%) 29,610 (4%) 29,779 (4%) Total consultation 534,412 439,260 547,889 605,633 650,286 679,975 687,708 689,606 • 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, KP and FATA while acute diarrhoea is highest in Balochistan and Sindh (please see the graphs for every province in page 5 and 6). 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. 11 (11 to 17 March 2012) previous week's (10/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Outbreak for Leishmaniasis identified at Khaliqabad and adjacent area. Registration found total 75 patients with lesions from one week to one year. DHO and ADHO CDC were in‐ 7‐Mar Leishmaniasis AJK Mirpur Village Khaliqabad 3 7 20 45 formed. Health education sessions held at schools. Healthcare providers trained on treatment guidelines. Alert for AWD, 16 cases were reported and investigated at DHQ hospital Dhadar. During field 5‐Mar AWD Balochistan Bolan Village Brahim bani 4 4 2 6 investigation along with district health team found no more suspected cases. 1 stool swab and 4 water samples were collected and sent to NIH. Aqua‐tabs distributed in the community. Alert for suspected Leishmaniasis, 6 cases were reported from two different locations. Pa‐ tients have no traveling history. Lesions were mostly on legs. No any other case was found Village Winder & Uthal, 6‐Mar Leishmaniasis Balochistan Lasbela 1 4 0 1 during active search. Patients were advised to take proper and regular treatment. Health and Tehsil Uthal hygiene session was conducted with patient family member and community. DHO informed and requested to conduct household spraying. Village Ahmed khan 6 cases of AWD were reported from hospital, active surveillance conducted and 2 stool and 4 Tando Allah 9‐Mar AWD Sindh lashari, UC Pak Singhar 0 2 0 4 water samples taken, hand pump was the source of suspect, Aqua tabs, Zinc tabs and ORS Yar taluka Tando Allahyar distributed in the community, EDOH informed. Alert for 14 cases of Measles, during active surveillance Vitamin (A) given to children, none Village Adam Mallah UC had been vaccinated for measles. Health education imparted regarding routine immuniza‐ 7‐Mar Measles Sindh Thatta Mugal Bin taluka jati 6 2 6 0 district thatta tion, EDOH informed and requested for mop‐up; 8 Blood samples were collected and sent to NIH. 42 probable Pertussis cases were investigated in 2 different locations. During active surveil‐ Village Khuda Buksh lance 57 contact children found in community out of them only 4 were having BCG Scar. 7‐Mar Pertussis Sindh Ghotki Mangrio; Village Abdul 13 6 15 8 Ghani Bozdar Health education given; Erythromycin given to cases and contacts. 3 throat swabs were taken and sent to NIH. DHO and DSV were informed. Probable Pertussis case was reported and investigated in Shah Bhitai hospital. During active GOR Colony, Latifabad # surveillance cluster of 10 houses was taken and found 11 children, out off them 2 were unvac‐ 7‐Mar Pertussis Sindh Hyderabad 1 3 1 1 01 cinated, health education regarding proper hygiene and importance of immunization was imparted, Erythromycin was given and 2 throat swabs were taken and sent to NIH. Probable Pertussis case investigated, during active surveillance in the village, cluster of houses Village Chak # 23, UC was checked and found 22 children none of them were vaccinated, Erythromycin given to the 7‐Mar Pertussis Sindh Sanghar 0 9 3 6 Gujri taluka Sanghar cases, health education was imparted regarding importance of vaccination, EDOH informed and requested for mop‐up the area and 1 throat swab collected and sent to NIH. Two Probable Pertussis cases were reported from DHQ Sujawal. Active surveillance conducted Village Khameeso Khan and found 13 more cases, majority of the children received Anti biotic medicine, four throat 8‐Mar Pertussis Sindh Thatta Pathan UC Ali Bahar 2 3 8 2 Sujawal samples were taken, health education imparted, routine immunization of the area was checked and found <70%, Erythromycin syrup given to cases; EDOH informed. Alert for Typhoid, 1 suspected case admitted in THQ hospital, during active search 5 more Village Sajaee, UC Sob‐ suspected Typhoid cases were found, out of them 1 was Widal positive; Health education 7‐Mar Typhoid Sindh Tharparkar 0 4 1 1 hiar, Taluka Diplo imparted, rain water was the source of suspect; Aqua tabs distributed in the community; while 3 water samples collected and sent to NIH. Current week's (11/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 14 cases of Cutaneous Leishmaniasis were reported. No other case was found during active search. Injection Glucantime provided to health facility incharge and advised to give proper treatment and if new case will vill Mora,Bagla UC Chirala 13‐Mar Leishmaniasis AJK Bagh 1 4 0 9 report then inform. The outbreak was discussed with DHO and requested to distribute bed nets and conduct Tehsil Dhirkot household spraying. Health education session was conducted with the community for their personal protec‐ tion from sand fly as well as screening of doors and windows. 8 cases of Cutaneous Leishmaniasis was reported. HCPs were requested to report any new case of cutaneous Sheikh Zaid hosp Rawala‐ Leishmaniasis report to HF.DOH as well as CDC department were informed. Health education session was 16‐Mar Leishmaniasis AJK Poonch 1 0 1 4 kot conducted with the patients for their personal protection from sand fly as well as screening of doors and windows. 7 cases of Cutaneous Leishmaniasis were reported. Patients were investigated and mostly lesions found on 14‐Mar Leishmaniasis Balochistan Killa Saifullah Village Urgas 0 0 0 7 nose, arms and legs. No travel history. Treatment as per WHO protocol was given. Information shared with DHMT. Village Notani, UC 5 cases of C Leishmaniasis were investigated and reponded. Cases were presented with typical lesions. Lab 13‐Mar Leishmaniasis Balochistan Khuzdar 0 2 1 2 Baghbana ,Tehsil Khuzdar results came out positive. Injection Glucantime was provided with health and hygiene education.
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