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
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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