Looking Back While Moving Forward with Enteric Fever Surveillance in Pakistan

LOOKING BACK WHILE MOVING FORWARD WITH ENTERIC FEVER SURVEILLANCE IN PAKISTAN. Dr. Farah Naz Qamar Assistant Professor, Pediatric Infectious disease, Aga Khan University, Pakistan 2 Outline • Overview • SEAP sites • Health care utilization survey • Defining catchment area • SEAP II results • Trends of AMR for typhoid • Summary 4/11/2017 4/11/2017 3 Overview of SEAP in Pakistan Phase 1 • Retrospective review of data • AKUH –2012-2014 • KGH –2014 Phase II • Prospective study • October 2016- September 2018 • AKUH, KGH, NICH, AKUH Lab Network 4/11/2017 5 SEAP II Pakistan Sites Aga Khan University National Institute of Hospital Child Health: • Inpatient • Surgical cases only – Medical – Surgical • AKUH Lab Network • Outpatient Blood Culture confirmed cases Kharadar General Hospital • Inpatient • Outpatient 4/11/2017 6 Phase II -Sites AKUH KGH NICH Aga Khan University Laboratory Network 4/11/2017 7 Enrollments SAPORT 4/11/2017 8 Health care utilization survey: Catchment Areas Aga Khan University Hospital (AKUH) • Culture proven cases (approx. 60% ) • Three towns • Gulshan-e-Iqbal, • Jamshed, and • Gulberg Kharadar General Hospital (KGH) • Febrile cases (approx. 60% ) • Three towns • Lyari town • Kharadar union council from Sadar town • Machar Colony and Baba Bhitt union council from Kemari Town 4/11/2017 9 AKUH Catchment Area 4/11/2017 10 KGH Catchment Area 4/11/2017 11 AKUH Catchment Area 4/11/2017 12 Health care utilization survey 4/11/2017 13 HCUS S# Town Total Clusters Total Households Number of Households from where Households Approached data collection refused for for Interview completed interview 1 Gulberg 14 Residential = 08 174 130 44 Non Residential = 04 2 Gulshan E Iqbal 80 Residential = 37 574 491 83 Non Residential = 43 3 Jamshed 28 Residential = 24 565 496 69 Non Residential = 04 4 Lyari 80 Residential = 53 1072 1005 67 Non Residential = 27 5 Kemari 40 Residential = 32 264 260 4 Non Residential = 08 Total 240 Residential = 154 2649 2382 267 Non Residential = 86 4/11/2017 14 RESULTS 4/11/2017 15 Enrollment Progress (October 17, 2016 – March 18, 2017) 4/11/2017 16 Cases of Ileal Perforation Site of Case # Enrollment Age Gender Outcome 1 NICH 12 years Female Recovered 2 NICH 5 years Female Recovered 3 NICH 7 years Female Died 4 NICH 7 years Male Recovered 5 NICH 5 years Male Recovered 6 NICH 12 years Male Recovered 7 NICH 7 years Male Recovered 8 NICH 12 months Male Recovered 9 NICH 8 years Male Recovered 10 NICH 4 years Female Recovered 11 AKU 15 years Male Recovered 4/11/2017 17 Comparison of Demographic Data 4/11/2017 18 Cases amongst children 0-5 Years 4/11/2017 19 Seasonality of Typhoid in Pakistan 90 84 r e Typhi Paratyphi 80 v 76 76 77 e 80 74 f 72 72 c i r 67 66 e 70 t 62 60 61 n 59 e 56 60 53 55 55 n 52 52 50 52 51 e 48 v 47 s 45 45 o 50 44 44 43 44 r e 41 41 s p 38 38 a 37 36 e c 35 r 40 32 32 31 33 33 u 30 30 t 28 29 29 28 l 25 25 27 26 u 30 24 23 24 23 24 24 c 22 20 f 19 18 19 17 18 o 16 20 14 r 13 e 9 9 10 b 10 m u N 0 l l l t t t r r r r c r c r c v v v y y y g g g n b p n b p n b p n n n u u u c c c a a a e e e a a a p p p o o o u u u a a a e e e e e e u u u J J J J J J J J J O O O F S F S F S A A A D D D A A A N N N M M M M M M 2012 2013 2014 4/11/2017 20 Trends of MDR Cases 2012-2017 4/11/2017 21 Trends of Ciprofloxacin Resistance Cases 2012-2017 4/11/2017 22 Summary • Typhoid fever is endemic in the region • High rates of MDR and fluoroquinolone resistance • Narrow therapeutic options • High rates of intestinal perforations • 80% of the cases are S. Typhi , even a monovalent vaccine will have an impact on disease control in Pakistan 4/11/2017 23 4/11/2017 24 Acknowledgements • Sabin Vaccine Institute • Pakistan SEAP Team • Tahir Yousufzai • Bill and Melinda Gates • Dr Sadia Shakoor Foundation • Dr Bushra Jamil • Dr Saqib Qazi • Dr Nasir Saddal • Scientific Advisory Process for Optimal Research on • Attaullah Baig Typhoid (SAPORT) • Dr Kahlid Pervaiz.

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