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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 3, Issue 48, Wednesday 5 December 2012 Highlights Figure‐1: 88 districts reported to DEWS in week 48, 2012 Epidemiological week no. 48 (25 Nov to 1 Dec 2012) • Measles: 122 alerts investigated this week, responding to 31 outbreaks involving 397 measles cases. Vitamin A was provided to cases and EDOs‐H took action to improve vaccination in af‐ fected areas (Page 7) • AWD: 4 alerts investigated this week, involving 9 cases. Alerts/Outbreaks were responded timely and appropri‐ ate measures were taken on case man‐ agement and infection control (Page 7) • 88 districts have reported to DEWS in week 48, 2012. 2,517 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this Priority diseases Cumulative number of selected health events reported in week under surveillance Epi‐week 1 to 48, 2012 (1 Jan ‐ 1 Dec 2012) in DEWS Pneumonia Disease # of Cases Percentage • 868,251 patients’ consultations were Acute Watery Diarrhoea Bloody diarrhoea Acute diarrhoea 2,988,251 8% reported in week 48 compared to Other Acute Diarrhoea 762,234 consultations reported in Suspected Enteric/Typhoid Fever Bloody diarrhoea 163,653 0.5% week 47, 2012. Suspected Malaria Suspected Meningitis Suspected Dengue fever ARI 6,683,257 19% Suspected Viral Hemorrhagic Fever Suspected Measles S. Malaria 1,878,776 5% • Altogether 204 alerts were investigated Suspected Diphtheria Suspected Pertussis and response were provided to 35 Suspected Acute Viral Hepatitis Skin Diseases 1,628,384 5% outbreaks. Neonatal Tetanus Acute Flaccid Paralysis Unexplained fever 1,277,383 4% Scabies Cutaneous Leishmaniasis Total (All consultations) 35,702,258 Major health events reported during the Figure‐2: Weekly trend of Acute diarrhoea in Pakistan; Week‐1, 2011 to week‐48, 2012. Epi‐week ‐ 48 (25 Nov ‐ 1 Dec 2012) 20 Disease # of Cases Percentage 2011 2012 Acute diarrhoea 58,501 7% 15 Bloody diarrhoea 3,004 <1% 10 ARI 213,731 25% Percentage S. Malaria 47,789 6% 5 Skin Diseases 33696 4% Unexplained fever 28,807 3% 0 1 3 5 7 9 111315171921232527293133353739414345474951 Epi‐week Total (All consultations) 868,251 • The graph (Figure‐2) shows the comparison of weekly trend of Acute diarrhoea as proportional morbidity (percentage of cases out of total consultations) reported to DEWS each week in year 2011 and 2012. • Overall weekly trend of acute diarrhoea is stable in all provinces. Districts in Sindh and Khyber Pakhtunkhwa are investigat‐ ing alerts for acute watery diarrhoea/suspected cholera. 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 Weekly Bulletin: DEWS, Pakistan, Week no. 48 (25 Nov to 1 Dec 2012) Current week's (48/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for 2 suspected Measles cases were reported from DHQ Hospital Dir Lower, all the cases were from village Village Matakoo Mattako Marongay, UC Gardai, Bajour agency. WHO team investigated the cases and 3 more cases found. The first Bajaur Marongay, UC 30‐Nov Measles FATA 1 2 2 0 suspected case 3 years old female developed fever followed by rash. BCG Scar was not present on 5 out of 5 children Agency Gardai Qazafay and measles vaccination was missed by all children. Blood samples were collected and sent to NIH. Information was Tehsil Utman Khel shared with DHO. Village Andher Measles alert was reported from CD Pindi Lalma. During active surveillance 5 more cases were found in the affected Khyber sher,UC Pindi 26‐Nov Measles FATA 5 0 1 0 area. Blood sample was taken and sent to NIH. Vitamin A was given to suspected measles cases. Health education Agency Lalma,Tehsil Mu‐ imparted and outreach measles vaccination done in the area. Report shared with Agency surgeon and FSMO. lagori village Tangi Shah, Alert for 4 suspected Measles cases were reported from DHQ Hospital Dir Lower belong to village Tangi Shah, UC Khyber UC Mayar and Tehsil Mayar. WHO team investigated the alert. BCG Scar was present on 1 out of 6 children and measles vaccination was 29‐Nov Measles Lower Dir 1 0 2 3 Pakhtunkhwa Samarbagh, Dir missed in all children. Blood sample was collected and sent to NIH. Information shared with EDO‐H, Coordinator LHWs, Lower coordinator EPI and requested outreach campaign in the affected area. Village Taimer, UC Alert for 3 suspected Measles cases reported from DHQ Hospital Dir Lower from village Taimer, UC Taimergara. WHO Khyber Taimergara and team investigated the alert. Blood Sample was collected and sent to NIH. BCG Scar was present on 6 out of 6 children 30‐Nov Measles Lower Dir 2 3 1 0 Pakhtunkhwa Tehsil Taimergara, but measles vaccination was missed. Alert was shared with EDO‐H, Coordinator LHWs, coordinator EPI and requested Dir Lower to conduct mop up campaign in affected area. Alerts for suspected Measles case, given 1st dose of Vitamin‐A while 2nd dose was handed over. During active surveil‐ lance neighboring 10 house holds were visited and found 8 more cases. During survey, among 12 children of age 9 Basti Koreeja, UC months – 5 years, 8 were having BCG scar and 8 had received single shot of Measles vaccine. While among 15 children Muzaffar‐ 29‐Nov Measles Punjab Utra Sandhila, 3 2 0 3 among age group 5‐15 years, 10 had BCG scar. DOH, DDOH MZG, DSC, MO BHU Utra Sandhila and staff were also given garh Muzaffargarh briefing on the situation. DOH instructed vaccinator to ensure 100% completion of routine EPI to due defaulters and to administer Measles booster to all children under 10 years of age (not covered during last Measles Campaign), within this week. Blood sample of a patient was drawn and sent to NIH. Health education given in households visited. Diphtheria case was notified from PMCH Nawabshah. Case was investigated and found unvaccinated. Only OPV drops Shaheed UC Ismail Khan 28‐Nov Diphtheria Sindh 0 0 0 1 were verified by parents. ADS (Anti Diphtheria Serum) was provided from WHO office and Tab erythrosine was given to Benazir Abad Brohi, taluka Daur contacts. One throat swab taken for culture and sensitivity. DHMT Informed. BHU Kot Arbab Mir Alert for suspected Malaria cases, 3 times more then previous 3 weeks average at BHU Level. Total 307 cases were 24‐Nov Malaria Sindh Tharparkar Muhammad, taluka 21 144 14 128 found positive from 866 cases (SPR=35%). Out of them Positive FP=97(36%), Vivax210(68%). Health education was Diplo imparted regarding prevention of Mosquito bite. Informed DHO office and requested to take measures to control Suspected measles case was reported from THQ Mehar. During field investigation total 8 cases were found from the Dahar Muhalla, same area. Vaccination status revealed that for 16 children who were checked, BCG=11(68%), Penta1=7(43%), Pen‐ 26‐Nov Measles Sindh Dadu Gulshan colony, city 3 3 1 1 ta2=5(31%), Penta3=4(25%), Measles‐1=8(50%), Measles‐2=6(37%). One Blood sample collected from reported case. and taluka Mehar Vitamin (A) dose given to all cases. Health education was given on importance of immunization. EDOH informed about the cases. Suspected measles case was reported from THQ Mehar and it has complete sign and symptoms of Measles. During field investigation 7 more cases were found from same area. Out of them 5 were BCG +ve, 3 were Measles‐1 and 2 were Village Mahesar, Measles‐2 vaccinated. Vitamin (A) dose given to all cases, blood sample was collected and send to NIH. Health educa‐ 26‐Nov Measles Sindh Dadu near city Mehar, 2 0 4 2 tion was given on importance of immunization. Vaccination status was taken from area where total 21 children were taluka Mehar checked. BCG=14(66%), Penta1=10(47%), Penta2=7(33%), Penta3=5(23%), Measles‐1=11(52%), Measles‐2=8(38%). EDOH informed about the cases. Suspected measles case was reported from THQ Mehar. During field investigation total 11 cases were found from the Village Qazi Arif, UC same area, whereas out of them 7 were BCG +ve, 4 were Measles‐1 and 2 were Measles‐2 vaccinated. Vitamin (A) dose 26‐Nov Measles Sindh Dadu Qazi Arif, taluka 3 2 4 2 given to all cases and one blood sample collected from reported case. Health education was given on the importance of Mehar immunization. Vaccination status was taken from area where total 29 children were checked. BCG=22(75%), Penta1=15 (51%), Penta2=10(34%), Penta3=7(24%), Measles‐1=17(58%), Measles‐2=12(41%) and EDOH informed about the cases. Suspected measles case was reported from THQ K.N Shah. Case has cough, coryza, conjuctivitis, rashes and high grade fever from past 4 days. During active surveilliance, 8 more cases were found and out of them 5 were BCG +ve, 3 were Village Mado, UC Measles‐1 and 2 were Measles‐2 vaccinated. Vitamin (A) dose given to all cases. Health education given on importance 27‐Nov Measles Sindh Dadu Chorr Qambar, 4 0 3 2 of immunization. Vaccination status was taken from the area where total 24 children were assessed, BCG=16(66%), taluka K.N Shah Penta1=11(45%), Penta2=8(33%), Penta3=7(29%), Measles‐1=10(41%), Measles‐2=8(33%). EDOH informed about the cases and 2 Blood samples collected. One Death due to Measles was reported from city Dadu. Case had symptoms of cough, coryza, rashes, high grade fever and difficulty in breathing.
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