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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 2, Issue 49, Monday 12 December, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 49 (2 to 8 December, 2011) in DEWS • 83 districts and 2 agencies provided surveillance data to the DEWS this week from Acute Flaccid Paralysis (AFP) 2,867 health facilities. Data from mobile teams is reported through sponsoring BHU or Acute Jaundice Syndrome (AJS) RHC. Acute Respiratory Infections • A total of 706,484 consultations were reported through DEWS of which 191,866 (Upper and Lower) (ARI) (27%) were acute respiratory infections (ARI); 58,331 (8%) were Skin disease; 52,347 Acute Watery Diarrhoea (AWD)/ (7%) were acute diarrhoea; and 47,750 (7%) were suspected malaria. Suspected Cholera • A total of 94 alerts with 14 outbreaks were reported in week‐49, 2011: Altogether Acute Bloody Diarrhoea (BD) 31 alerts for Measles; 12 each for AWD and Neonatal tetanus; 8 for Leishmaniasis, 6 for Other Acute Diarrhoeas (AD) Pertussis, 3 for Malaria, 2 for Bloody diarrhoea; and 1 for Acute Jaundice Syndrome; while 19 for others non‐communicable diseases. Suspected Viral Hemorrhagic Fever (VHF) • In this week six new type‐1 polio cases were confirmed by the laboratory, including Suspected Malaria (Mal) one each from Federally Administered Tribal Areas (FR Bannu) & Khyber Pakhtunkhwa Suspected Measles (MS) (Kohat district); and four from Balochistan (Killa Abdullah, Killa Saifullah, Pishin and Harnai districts). As of 12th December, Pakistan has reported a total of 173 polio cases Suspected Meningitis (MG) (171 type‐1 & 2 type‐3) from 56 districts/towns/tribal agencies & areas. Others Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 8 December 2011 (Epi week 31, 2010 to week 49, 2011) 50 AD BD ARI S. Malaria 45 40 35 30 Percentage 25 20 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 45 47 49 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 wk wk wk wk Disease Wk-42 Wk-43 Wk-44 Wk-45 Wk-46 Wk-47 Wk-48 Wk-49 Acute respiratory infection 213,432 (24%) 193,863 (24%) 217,676 (25%) 103,082 (25%) 210,514 (25%) 224,061 (26%) 242,844 (27%) 191,866 (27%) Skin diseases 81,161 (9%) 69,393 (9%) 77,842 (9%) 34,276 (8%) 74,134 (9%) 72,895 (8%) 77,057 (9%) 58,331 (8%) Acute diarrhoea 74,189 (8%) 62,628 (8%) 65,701 (8%) 33,057 (8%) 64,260 (8%) 62,650 (8%) 65,718 (7%) 52,347 (7%) Bloody diarrhoea 6,089 (0.68%) 5,461 (0.68%) 5,289 (0.60%) 2,764 (0.67%) 6,024 (0.72%) 5,478 (0.64%) 4,912 (0.54%) 4,537 (0.64%) Suspected malaria 68,441 (8%) 58,613 (7%) 69,408 (8%) 30,218 (7%) 58,136 (7%) 56,468 (7%) 63,826 (7%) 47,750 (7%) Total consultation 897,598 808,954 879,811 412,812 837,736 859,241 904,948 706,484 Since July 29, 2010, approximately 54,953,184 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports over 800,000 consultations per week. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 8 weeks (42 to 49, 2011) acute diarrhoea cases have been decreased (From 8% to 7%), while at the same time cases of ARI have been increased (From 24% to 27%). A slight fluctuation in the suspected malaria cases have been seen recently after consistent 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. 49 (2 to 8 December, 2011) Current week's (49/2011) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 6 cases of suspected Leishmaniasis were reported. All patients were attended and found with typical 30‐Nov Leishmaniasis Balochistan Lasbela Bela and Winder 1 2 1 2 lesions. Health Education was given and treatment session arranged. Alert of Malaria reported. Total slides tested 17 out of which 11 were positive for P. Falciparum (SPR 65%). 29‐Nov Malaria Balochistan Lasbela RHC Lakhra 1 1 1 8 The patients were treated and information shared with DHO for necessary action. Request was also made to distribute bed nets among affected community. Village Muhammad Khan Suspected case AWD was admitted on hospital, active surveillance done, 1 stool sample was collected and 30‐Nov AWD Sindh Badin Laghari, UC Chabhralo, 1 2 0 0 tested on RDTs supplied by MSF‐H and found positive for V. Cholera species. Health education imparted, Taluka Tando Bago tabs Ciprofloxin given, EDO‐H informed and 2 water sample also taken. Village Faqir Murad Ali Suspected 8 cases AWD were admitted in hospital, Shallow dug well was the source of water, active surveil‐ 26‐Nov AWD Sindh Umer Kot Sanjrani, UC Satreyun, 1 9 2 7 lance found 11 more cases, health education imparted, Aqua tabs, Zinc tabs, ORS, Jerry cans and Hygiene Taluka Samaro kits were distributed, EDO‐H and DSM PPHI distributed and 5 water sample taken. 14 cases of Pertussis investigated, Throat Swab collected, Tab Erythromycin and Cough Syrup provided by Village Ahmed Din, UC Mian 1‐Dec Pertussis Sindh Sanghar 2 4 5 3 EDO‐H, Sensitized regarding proper vaccination and Personal Hygiene and informed EDO‐H to intensify Taluka Sanghar outreach immunization. Current week's (49/2011) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 42 patients of suspected malaria were investigated and treated. 70 slides were tested and 42 (SPR=60%) 2‐Dec Malaria Balochistan Lasbela Civil Hospital Bela 12 13 11 6 verified positive of P. Falciparum=33 and P. Vivax=9 (FR=79%). DHO was informed and requested for bed nets provision. Probable Pertussis, 11 cases were reported. All the patients were attended and found with typical diagnosis Allah Abad UC Kohing Tehsil 5‐Dec Pertussis Balochistan Kalat 7 0 3 1 and given treatment. During active surveillance no more cases were found. Sample were collected and sent Kalat to NIH. 8 cases of typhoid were reported from same area investigation confirmed patient presented with typical 8‐Dec Typhoid Balochistan Harnai Pier sher 2 4 0 2 signs and symptoms. Treatment was advised. Health education was given and community was advised to use boiling water or use aqua tabs to disinfect drinking water. 6 cases of AJS was reported from RHC Khanpur. Blood sample was taken and sent to NIH. Health and 6‐Dec AJS KPK Haripur Khanpur 1 3 0 2 hygiene sessions were carried out for the community. LHWs and MT of the health facility were involved. EDO health was informed. 7 cases of suspected bloody diarrhoea were reported from Afghan Refugee camp Basu Mera. Water sample Afghan Refugee Camp Basu 2‐Dec BD KPK Haripur 2 2 3 0 and stool samples were taken and sent to ATH. 42 CHWs were trained on Health and Hygiene, water Mera purification and ORS. Aqua tabs, ORS and hygiene kits were distributed. 4 confirmed cases of enteric fever were reported from Afghan Refugee camp Basu Mera. Water sample and Afghan Refugee Camp Basu 3‐Dec Typhoid KPK Haripur 0 3 0 1 blood samples were taken. Typhi dot test was performed and found positive. Aqua tabs, ORS and hygiene Mera kits were distributed. AWD alert, 5 AWD cases were admitted in hospital, Kacha well was the source of water, Aqua tabs, Zinc Village Mushtaque Lund, UC 7‐Dec AWD Sindh Badin 0 1 2 2 tabs and ORS distributed, EDOH informed and 1 stool sample collected and found positive for V. c. Ogawa, 2 Haji Sawan, Taluka Matli water samples were collected. AWD alert, 1 AWD case admitted in hospital, during active surveillance 4 more cases were found, Tap Village Mangi shoro, UC water and Clay water was the source of water, health education imparted, Aqua tabs, Zinc tabs and ORS 7‐Dec AWD Sindh Jamshoro 1 1 2 1 M.shoro, Taluka Kotri were distributed, EDO‐H informed, 1 stool sample collected and found positive for V. c. Ogawa, 2 water samples were collected. AWD alert, 1 AWD case was admitted in hospital, during active surveillance 2 more cases were found, Khuda ki Basti# 1, UC 8‐Dec AWD Sindh Jamshoro 0 1 1 1 health education imparted, Tank water and Clay water were the sources of water, Aqua tabs, Zinc tabs, ORS Sonowaller, Taluka Kotri and IEC Material distributed, EDO‐H informed with 1 stool and 2 water samples were taken, result awaited. Village Haji Yar Mohammad Suspected malaria, a total of 70 RDTs were tested, out of which 49 were positive (SPR=70%) including 10 7‐Dec Malaria Sindh Khairpur Kandhar, UC Piryalo, taluka 21 15 23 11 Falciparum, 4 Vivax and 35 Mixed (FR=92%). Treatment provided to all positive cases. EDOH informed and Kingri requested for fumigation and IRS. Suspected malaria, a total of 80 RDTs were tested, out of which 57 were positive (SPR=71%) including 12 Village Ali pur, UC Piryaloi, 8‐Dec Malaria Sindh Khairpur 16 23 27 14 Falciparum, 8 Vivax and 37 Mixed (FR=86%).
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