Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 3, Issue 14, Wednesday 14 April 2012 Highlights Priority diseases under surveillance Epidemiological week no. 14 (1 to 7 April 2012) in DEWS Acute (Upper) Respiratory Infection • In week 14, 2012, total 82 districts including 3 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 1,973 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 621,004 consultations were reported through DEWS of which 20% were acute Other Acute Diarrhoea respiratory infections (ARI); 8% 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 226 alerts reported while 23 outbreaks were identified in week 14, 2012: Alto‐ Suspected Viral Hemorrhagic Fever gether 131 alerts for Measles; 16 for Leishmaniasis; 14 Pertussis; 12 for Typhoid; 11 for NNT and Pyrexia of Unknown Origin Tetanus; 9 for ARI; 8 each for Acute diarrhoea and Scabies; 6 for AWD; 5 for Bloody diarrhoea; 3 Suspected Measles Suspected Acute Viral Hepatitis for AJS; 2 for Dengue fever; while 1 for Unexplained fever. Chronic Viral Hepatitis Neonatal Tetanus • In this week no new polio cases was reported. As of 9 April 2012, the total number of polio Acute Flaccid Paralysis cases confirmed by the laboratory is 15 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‐14, 2012. 50 AD BD ARI S. Malaria 45 40 35 30 25 Percentage 20 15 10 5 0 9 7 5 3 1 9 7 5 3 1 11 13 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 wk Table 1: Most common communicable diseases syndromes reported weekly Disease Wk-7 Wk-8 Wk-9 Wk-10 Wk-11 Wk-12 Wk-13 Wk-14 Acute respiratory infection 159,074 (26%) 153,111 (24%) 157,828 (23%) 155,186 (23%) 162,325 (23%) 144,691 (21%) 154,763 (20%) 124,220 (20%) Skin diseases 29,199 (5%) 28,820 (4%) 29,430 (4%) 30,909 (4%) 31,713 (4%) 28,641 (4%) 31,370 (4%) 27,140 (4%) Acute diarrhoea 30,607 (5%) 31,623 (5%) 34,918 (5%) 38,427 (6%) 40,950 (6%) 41,368 (6%) 50,813 (7%) 50,021 (8%) Bloody diarrhoea 2,730 (0.45%) 2,765 (0.43%) 3,094 (0.45%) 2,874 (0.42%) 3,651 (0.51%) 2,864 (0.42%) 3,455 (0.45%) 2,829 (0.46%) Suspected malaria 22,883 (4%) 23,483 (4%) 28,265 (4%) 29,599 (4%) 30,594 (4%) 29,448 (4%) 32,758 (4%) 27,706 (4%) Total consultation 605,633 650,423 680,221 688,813 717,186 680,126 767,785 621,004 • 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 and Khyber Pakhtunkhwa while acute diarrhoea is highest in Ba‐ lochistan and Sindh (please see the graphs for every province in page 6 and 7). 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. 14 (1 to 7 April 2012) Previous week's (13/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken During Monitoring visit to the HF of AR Taimar Camp, 2 cases of CL were identified in the OPD register and were under treatment from same HF. During Active surveillance 7 more cases were identified in the area and Khyber Village Baroon, UC 4 patients recieved 2 doses of Inj Glucantime. On job training of AR health staff was conducted for Intrale‐ 27‐Mar Leishmaniasis Pakhtunk‐ Lower Dir 0 7 0 2 Munjai, Tehsil Balmbat sional adminstration of Inj Glucantine. Health & Hygiene sessions conducted, Camp Incharge/RBM was hwa informed and requested for residual spray before the favorable season for vector breeding and transmission. EDO Health and focal person was informed . 8 cases of suspected measles were found during the follow up survey of the area. Vitamin (A) drops given. Total 50 children were assessed for their routine immunization, 60% found unvaccinated. Information shared Khyber Village Nagrai bazaar with the district EPI staff. Mopup activity conducted and 50 children were vaccinated on the same day. In 28‐Mar Measles Pakhtunk‐ Buner near CD Amazai tehsil 1 3 3 1 addition, residents were requested to bring rest of their children to CD Amazai and RHC Nagrai for vaccina‐ hwa Mandan tion. Health education session conducted with the elders and advocate them to vaccinate all their children in future. Khyber 6 cases of suspected measles were found on active surveillance. Vitamin A drops provided.12 children were Village pariwal near BHU 28‐Mar Measles Pakhtunk‐ Buner 2 3 1 0 assessed for their routine immunization coverage, out of which 4 children found unvaccinated. Health and Langow tehsil Mandan hwa hygiene education imparted. Line list shared with EPI staff for mopup activity. Alert of one suspected measles case was generated by BHU Tofkian. Vitamin (A) provided, Health education imparted, on active surveilliance found 4 more cases of post Measles & prodermal phase, Two blood samples Khyber Village Gakhra, UC collected & sent to NIH, routine immunization of the area was checked and found 4 children had no measles 26‐Mar Measles Pakhtunk‐ Haripur 2 1 1 1 Tofkian vaccine, 6 children were missing measles‐2 vaccine, 2 children had no BCG scar, 1 child was missing penta 3 hwa and 1 child was totally unvaccinated. Missed children were referred to BHU Tofkian for completion of vacci‐ nation. Follow‐up was done and found no more cases. EDO H and EPI coordinator were informed. Alert of 2 suspected cases of Measles were reported from BMC Swabi. During investigation 6 more cases Khyber found iin the same locality. Vit.A given,health education sessions conducted,EDO H and EPI coordinator 29‐Mar Measles Pakhtunk‐ Swabi BMC Swabi, Punjpir 1 4 2 1 Informed, Measles Mopup Vaccination done in the Relevant Village. WHO EHA and PPHI provided the essen‐ hwa tial medicines to the relevant Health Facilities. Nomades near Railway 9 Suspected cases of measles reported by DSC . All cases were Nomades. On active Surveillance 3 more cases 26‐Mar Measles Punjab Bhakkar Crossing, Behal Road,UC 7 0 5 0 were found. Alltogether 51 Children were checked for vaccination( BCG+ Measles) and 100% of children were Bhakkar Urban II found unvaccinated. mopup activity conducted on the same day. Vit A drops given, health and hygiene Five suspected cases found on active surveillance, vitamin (A) drops was given, 1 blood sample collected and Street 4 near Xblock 28‐Mar Measles Punjab D. G. Khan 1 0 0 4 sent to NIH. On field investigation only 43% children found vaccinated. Health education session conducted. Model TOWN uc urban 6 Mop up activity planned for community after informing DDOH and DSV of the District . Alert was received through automated SMS from eDEWS alert generation system, 07 cases of TF reported from RHC. Line list was obtained. 4 cases were reported from Khanbela Town. On further investigation, 1 more suspected case was identified and refered to RHC. 2 of the cases had a history of travelling to District Rahim Yar Khanbela, Tehsil Liaqat‐ Kashmore and on the way ate street food. Widal Test was positive for both cases. All the patients were 28‐Mar Typhoid Punjab 0 4 1 2 Khan pur prescribed with oral antibiotics. Aqua Tabs and Jerry cans were distributed among community, Health facility and LHWs for further distribution. 02 Health Education sessions were conducted with the community. 03 LHWs were mobilized to conduct further health education sessions on Safe drinking water, safe food handling and hygiene. 5 suspected cases of measles were found on active surveilliance visit, vitamin(A) drops provided, house to Fazal abad colony, UC 29‐Mar Measles Sindh Badin 1 2 1 1 house immunization status was checked and found 12 childrens, all were vaccinated, health education Mati, taluka matli, regarding importance of vaccination was imparted, EDOH informed and 1 Blood sample collected. Alert of one suspected measles case was reported from private clinic, on active surveilliance found 4 more Shahee bazar, Thakur das cases,On house to house survey, 9 children were assessed but only 3 childrens were found vaccinated, 30‐Mar Measles Sindh Hyderabad 2 0 2 1 gali, taluka Hyderabad Vitamin(A) drops given, health education imparted, DHO, DSC, DSV and FP‐Measles was informed and 2 Blood sample collected for lab confirmation. Alert of one Suspected case was admitted in NIH, active surveilliance of the area was done, Vitamin(A) dose was given, Immunization status was checked and found(BCG/OPV=71%, OPV1/PENTA1=36&, OPV2/ Street # 25.