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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 46, Monday 21 November, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 46 (11 to 17 November, 2011) in DEWS • 80 districts and 2 agencies provided surveillance data to the DEWS this week from Acute Flaccid Paralysis (AFP) 2,636 health facilities. Data from mobile teams is reported through sponsoring BHU or Acute Jaundice Syndrome (AJS) RHC. Acute Respiratory Infections • A total of 816,850 consultations were reported through DEWS of which 203,121 (Upper and Lower) (ARI) (25%) were acute respiratory infections (ARI); 72,768 (9%) were Skin disease; 61,792 Acute Watery Diarrhoea (AWD)/ (8%) were acute diarrhoea; and 57,597 (7%) were suspected malaria. Suspected Cholera • A total of 124 alerts with 10 outbreaks were reported in week‐46, 2011: Altogether Acute Bloody Diarrhoea (BD) 28 alerts for AWD, 23 for Measles; 22 for Neonatal tetanus and tetanus; 18 for Other Acute Diarrhoeas (AD) Leishmaniasis; 7 for Pertussis; 6 each for Malaria and ARI; 4 each for DHF and Acute diarrhoea; 2 for AJS; while 1 each for CCHF, Diphtheria, Typhoid and unexplained fever. Suspected Viral Hemorrhagic Fever (VHF) • In this week nine new polio cases were confirmed by the laboratory, four from Suspected Malaria (Mal) FATA (three from North Waziristan agency and one from Khyber agency); two each Suspected Measles (MS) from Balochistan (Mastung and Barkhan districts) and Punjab (Vehari and Rahim Yar Khan districts); and one from Khyber Pakhtunkhwa (Lakki Marwat district). As of 21st Suspected Meningitis (MG) November 2011, Pakistan has reported a total of 154 polio cases (152 type‐1 & 2 type‐ Others 3) from 48 districts/towns/tribal agencies and areas. Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 27 October 2011 (Epi week 31, 2010 to week 46, 2011) 50 AD BD ARI S. Malaria 45 40 35 30 25 Percentage 20 15 10 5 0 1 3 5 7 9 45 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 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 Disease Wk-39 Wk-40 Wk-41 Wk-42 Wk-43 Wk-44 Wk-45 Wk-46 Acute respiratory infection 205,597 (21%) 209,436 (21%) 223,902 (22%) 213,432 (24%) 193,863 (24%) 217,676 (25%) 101,386 (25%) 203,121 (25%) Skin diseases 105,912 (11%) 95,842 (9%) 94,167 (9%) 81,161 (9%) 69,393 (9%) 77,842 (9%) 33,869 (8%) 72,768 (9%) Acute diarrhoea 105,295 (11%) 97,007 (10%) 93,085 (9%) 74,189 (8%) 62,628 (8%) 65,701 (8%) 32,405 (8%) 61,792 (8%) Bloody diarrhoea 9,393 (0.94%) 8,075 (0.80%) 8,107 (0.78%) 6,089 (0.68%) 5,461 (0.68%) 5,289 (0.60%) 2,751 (0.68%) 5,706 (0.70%) Suspected malaria 83,684 (8%) 82,802 (8%) 86,326 (8%) 68,441 (8%) 58,613 (7%) 69,408 (8%) 33,8869 (8%) 72,768 (9%) Total consultation 995,450 1,014,266 1,033,276 897,598 808,954 879,811 407,339 816,850 Since July 29, 2010, approximately 52,456,152 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on around 1,000,000 consultations per week, there is a drop in timely reporting due to EID holidays, challenges in accessibility caused by secu‐ rity situation in some areas. 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 (39 to 46, 2011) acute diarrhoea cases have been decreased (From 11% to 8%), while at the same time cases of ARI have been increased (From 21% to 25%). 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. 46 (11 to 17 November, 2011) Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken A Case of suspected AWD was reported, on active surveillance 5 more cases were found in same area with Village Gular, UC & Tehsil severe dehydration, all the patients were referred to DHQ Hospital for IV therapy, Stool samples collected for 11‐Nov AWD KPK Lower Dir 0 2 2 2 Samar Bagh lab confirmation but both found negative for Cholera, Water Samples taken for any fecal contamination, ORS, Hygiene kits & Aqua tabs distributed, Health & Hygiene promotion Session conducted with family members. During active surveillance 2 cases of suspected Pertussis were found having typical Cough with vomiting, 11 Village Sharmakhan‐ more cases were found in the same area but most of them were unimmunized for routine vaccination. some 16‐Nov Pertussis KPK Lower Dir Shontala, UC & Tehsil Samar 7 2 3 1 were already recovered, Erythromycin was provided to all close contacts, Nasophyrangeal swab were taken Bagh from 2 cases for confirmation. Outreach Immunization activity was carried out by EPI team in the area. EDO was Informed. Village Mian Pota, UC 7 cases of suspected acute viral hepatitis investigated, health education imparted, one pregnant women 15‐Nov AJS Sindh Badin 0 5 0 2 Talhar, Taluka Talhar suspected case was give TT vaccine, informed MS RHC and DHMT and 3 blood sample taken and sent to NIH Baloch Mohalla, Old Wolcut 1 suspected case was found in hospital, on active surveillance 5 more cases with diarrhoea were found in the 16‐Nov AWD Sindh Mirpur Khas Factory, UC # 6, Taluka 2 2 1 1 community. Contaminated water of hand pump was the possible source, health education imparted, Aqua Mirpurkhas tabs, Zinc tabs and ORS distributed, EDO‐H, DSM PPHI informed. 3 Patient were admitted in Hospital, during active surveillance 13 more cases found, Canal was the source of Village Allo Tara, UC Sonda, 17‐Nov AWD Sindh Thatta 3 2 6 5 drinking water, health education imparted, Aqua tabs, Zinc tabs, ORS, Jerry cans and water filter distributed, Taluka Thatta. EDO‐H informed and 2 water sample taken. Suspected Malaria Death reported by health technician at EDOH office Mirpur Mathelo. Field investigation Village Muhammad Khan done and WHO response, DEWS team performed MP tests on RDTs and found 30 positive cases (P. Falcipa‐ 16‐Nov Malaria Sindh Ghotki Shar UC Bairoota Taluka 10 23 8 25 rum 17, P. Vivax 3, Mixed 10) in the village. ACT & bed nets provided, Health education session conducted in Daharki the community, moreover informed EDOH for fumigation and resudal spray. Village Pir Dino Khaskheli, 19‐cases of malaria (7 P. Falciparum and 2 Mix) found confirmed by RDT, health education imparted to family 11‐Nov Malaria Sindh Thatta 6 8 1 4 UC Jhirk, Taluka Thatta members and other neighbor, Anti Malaria medicines and Bed Nets provided and EDO‐H informed. Village Sheikh Muhammad 25‐cases of malaria (8 P. Falciparum and 3 Mix) found confirmed by RDT, health education imparted to family 16‐Nov Malaria Sindh Thatta Ismail, UC Jhirk, Taluka 2 8 4 11 members and other neighbor, Anti Malaria medicines and Bed Nets provided and EDO‐H informed. Thatta Village Bhoongrai Khosa, UC 15 Suspected case investigated, Throat Swab collected, sensitized regarding proper vaccination and Personal 14‐Nov Pertussis Sindh Tharparkar 1 4 2 8 Mitho Dabhro, Taluka Diplo Hygiene, informed EDO‐H, DSM PPHI, MS DHQ regarding the cases and Throat swab taken. Village Baando Kapri, UC 9 case of Pertussis were investigated, History of Patient was taken, Health education imparted regarding 16‐Nov Pertussis Sindh Tharparkar Warawah, Taluka Nagar‐ 4 2 2 Vaccination and Proper health and Hygiene, Anti Biotic and Antipyratic tabs given, inform EDO‐H, DSM‐PPHI, parkar MS THO. Current week's Alerts: Province Sindh Cont’d: Province Sindh Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Naushahro 17‐Nov AD Baladi Mohalla, UC and taluka Kandiyaro 1 1 1 1 14‐Nov Diphtheria Dadu Najab shah Mohalla, UC and Taluka Johi 0 1 0 0 Feroze Village Muhammad Khan Shar UC Bairoota 15‐Nov AJS Badin Village Mian Pota, UC Talhar, Taluka Talhar 0 5 0 2 16‐Nov Malaria Ghotki 10 23 8 25 Taluka Daharki 15‐Nov AJS Benazirabad Police Line Dispensory, UC 1 2 0 1 0 Jhirck City, Mallah Mohalla, UC Jhirk Taluka Village Haji Channesar Jat, Dadar ko Farm, 11‐Nov Malaria Thatta 1 4 0 3 12‐Nov AWD Badin 1 1 0 1 Thatta UC Rahuki Village Pir Dino Khaskheli, UC Jhirk, Taluka Gayoosala, Usmanabad near Bilala Masjid, 11‐Nov Malaria Thatta 6 8 1 4 17‐Nov AWD Hyderabad 0 0 0 3 Thatta UC‐16, Taluka Hyderabad Village Sheikh Muhammad Ismail, UC Jhirk, 12‐Nov AWD Mirpur Khas Rajar Colony, UC #5, Taluka Mirpurkhas 1 2 0 0 16‐Nov Malaria Thatta 2 8 4 11 Taluka Thatta Village Junejo Colony, near Bus Trrminal 16‐Nov AWD Mirpur Khas 0 1 0 0 Mirpurkhas, UC Turk Ali Mari 17‐Nov Measles Jacobabad Channa Mohalla, UC Jaffarabad 0 0 1 0 Opposite Bhittai hospital, Baloch Colony, UC 16‐Nov AWD Mirpur Khas 1 0 0 1 15‐Nov Measles Jamshoro Ameer complex UC Nagoline Taluka Kotri 0 0 1 0 #5 Taluka Mirpurkhas Village Faiz Muhammad Laghari, near Near SDA office, Khuda Ki Basti # 3 UC 16‐Nov AWD Mirpur Khas 0 1 0 0 15‐Nov Measles Jamshoro 0 0 1 0 Jamrau Mori, UC Doulat Pur Sonowaller Village Haji Mubarak Khaskheli, Kapri Mo‐ Village Shah Paro, near G.
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