Health Action in

Health Newsletter Ministry of Health and Population, Department of Health Services, Epidemiology and Disease Control Division World Health Organization-Emergency and Humanitarian Action - Issue II, October 2005

N Headlines O I N G NEPAL E M R ID • Laboratory Confirmed N - R W E HUMLA ES T T S E Poliomyelitis Case Recently E DARCHULA R N W R R BAJHANG E APU R G A KT A IO B H Detected In Nepal F BAITADI BAJURA MUGU N A UR DH W EL JUMLA E AD DOTI KA S LALITPUR K L A D ACHHAM IKO DOLPA T N T E C R H A MUSTANG N N R P DAILEKH U E Highlights R JAJARKO T G KAILALI IO N RUKUM MANANG C SURKHET E • Japanese Encephalitis in NT BARDIYA MYAGDI RA SALYAN BA L ROLPA GL GORKHA R U T KASKI N G E Nepal A LAM J UN G G B IO R RASUW A N BANKE PYUTHAN GULMI A P A G EA GJ STERN N IN REGION • Influenza Pandemic Y A D DANG S TANAHU A H SINDHU D NUW AKOT PALPA A U I K H SOLU Preparedness ST S A A I A L SANKHUWA L B H AR DO P KHUMBU P I DE P A K A N A L H SABHA PA W CHITW AN H TAPLEJUNG U A MAKW ANPUR KAVRE C R N E • Floods and Landslides M A R OKHAL

A

R S SINDHULI DHUNGA NG U A R A T P R R A T O A H H A K J A E I H R T M P U T H H O H A I TH C A A H N Lymphatic Filariasis B • R A A U T L B DHAN P TERAI A D S A U R T Y KUTA U A A A T P ILAM N U S R O R I HILL A H SIRAHA Elimination Program in R H A A D

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MOUNTAIN N SAPTARI JHAPA U Nepal S MO RANG

EDCD News update • Workshop on Outbreak Laboratory Confirmed Poliomyelitis Case Recently Detected In Nepal Preparedness & Response to Dr. Ganga Ram Choudhary Influenza like illness for Surveillance Coordinator, IPD/WHO Rapid Response Teams Nepal remains at high risk of poliomyelitis because of continued virus • Workshop for the reduction transmission in the Indian states of Uttar Pradesh and . The border of outbreaks from food and between Nepal and is porous with people from either country freely water borne communicable moving back and forth. diseases In Nepal, there were two laboratory confirmed cases of poliomyelitis in 1999 • Rabies Awareness program and four cases in 2000. All cases were identified in the districts bordering • Emergency Preparedness in India. Since the last case in 2000, Nepal has remained polio free until recently. initiated by the District The most recent case in Nepal was a 2-year-old male child from Sarlahi Disaster Relief Committee district in the Central Region of Nepal. The case was recorded by Sadar th Forth coming News Hospital, Sitamani, India on 9 August 2005. The child was presented to the hospital with complaints of weakness in all four limbs for three days. The case • National Annual Review was investigated by the Surveillance Medical Officer (SMO), Sitamani India. Meeting for the Fiscal Year 2004/05, from November 13- A single stool sample was collected on 10th August 2005 and was sent to the 15 2005 in Kathmandu referral laboratory for further investigation as a suspected Poliomyelitis case. The patient could not move, sit, stand, and hold his head. No association of fever, common cold, muscle pain, diarrhea or vomiting was noted. There is no record of second sample being collected by SMO Sitamani. The case was notified to Nepal on 20th September 2005. To be continued second page

Health Action in Nepal (Monthly Health News Letter, Issue II, October 2005) Page No. Page # 1 of 5

Laboratory Confirmed Japanese Encephalitis in Nepal (JE kills over 300 in 2005) Poliomyelitis Case Recently

Detected in[[ Nepal cont.

The immunization record from the Map of Nepal Village Health Worker of the Japanese Encephalitis cases and deaths, 25 October 2005 child’s VDC (Phari Parsa VDC of HUMLA ) showed that the DARCHULA BAJHANG MUGU BAITADI 12 child had received three doses of BAJURA KATHMANDU

DADEL- JUMLA 0 BHAK OPV during routine immunization. DHURA DOTI ACHHAM KALIKOT DOLPA

106 MUSTANG By verbal history, he had also KANCHAN- LALIT PUR DAILEKH 366 JAJARKOT 14 KAILALI 3 RUKUM MANANG received four or more doses of 69 SURKHET 57 1 MYAGDI SALYAN BARDIYA OPV during Supplementary B GORKHA ROLPA AG KASKI 6 LU LAMJUNG NG 498 PARBAT RASUWA Immunization Activity (SIA). BANKE 202 PYUT- HAN GULMI 85 DANG ARGHAK SYANGJA TANAHU SINDHU- 34 HACHI NUWAKOT PALCHOK Although the clinical findings were 4 PALPA 0 DOLAKHA 1 DHADING KATHM KAPIL- 14 396 NAWAL BHAK SULUK- BASTU RUPAN- PARASI HUMBU DEHI P SANKHUWA- TAPLEJUNG not suggestive of poliomyelitis, the 3 1 MAKAWAN- LALIT KAVRE A H SABA CHITWAN H 52 PUR C E M A 35 R OKHAL- DHUNGA first stool specimen collected on 11 PARSA SINDHULI 1 KHOTANG TERHA- R 5 A 6 BHOJ- THUM TH BARA E RAUT- H PUR C 0 AHAT UDAYAPUR DHAN- PA Aug 2005 in India showed that the SARLAHI MAHO- KUTA 2 TARI 42 DHA ILAM NUSA SIRAHA 6 15 child was excreting wild poliovirus 6 4 SUNSARI MORANG 7 SAPTARI JHAPA type 1.The second specimen was 0 29 104 37 Total Cases=1916 collected in Nepal after 52 days of Total Deaths=307 onset, and laboratory result also JE Affected Districts Source; DoHS, EDCD revealed wild poliovirus Type 1. During the follow-up examination on 25 September 2005, it was Until the end of October 2005, there were altogether 1916 Japanese found that the child had residual Encephalitis cases reported to EDCD from 19 districts. Out of that 1609 paralysis but was improving. (84%) patients were cured and 309 (16%) died. Compared to September

2005, 37 additional cases were detected from the Eastern Region and Among five contacts specimens Mid- Western Region of Nepal and out of these 9 died in the month of collected from this case during October 2005. investigation, one contact specimen collected from the patient's elder sister showed that News update in October 2005 the child was also infected with wild poliovirus Type 1. However, “Workshop for reduction of food and water-borne the child is symptom less. By communicable disease outbreak in the Western Region

verbal history, this child had received only two doses of OPV For “the reduction of food and water borne communicable disease outbreak”, a and one or more doses during 2-day workshop was held in Palpa, Western Region of Nepal from 2-3 October Supplementary Immunization 2005. The participants came from the Municipality, Office of the Drinking Activity. Water, NGO/INGO, Veterinary and Agricultural Development Office, and the District Public Health Office (DPHO). Staff from the Mission Hospital, Palpa Response Plan: Nepal has and teachers from Government Schools also attended. After the workshop, planned to conduct three rounds of participants will play an active role for creating awareness at the grass roots mopping up in response to this level and then assist in prevention and control of outbreak from food and water wild poliovirus case. The campaign borne communicable diseases. will cover five districts urgently including the affected district and 2 Day Orientation on Vector Control (Malaria) in Central its surrounding districts i.e. Sarlahi, Region, from 29-30 October 2005 Mahottari, Rauthat, Sindhuli, and Makawanpur in the Central The 2-day orientation program on vector control especially on essential Region. According to the plan, the malariology for Vector Control Assistants (VCA) and Malaria Inspectors was first round of mop up was held in VBDRTC (Vector Borne Disease Research and Training Center) in the conducted successfully within 14 Central Region. Altogether 30 Vector Control Assistants (VCA), Malaria days of the laboratory confirmed Inspectors and representatives from the Regional Health Directorate from 21 poliomyelitis case. In addition, districts of five regions participated actively. 14 districts of especially Terai Sub-National Immunization Days and inner Terai are highly affected by Malaria. The objective of this two day (SNID) will be conducted for the program was to discuss the existing malaria information system and identify remaining Terai districts and areas to improve, to improve the reporting system for outbreaks of malaria and Kathmandu valley in December to discuss monitoring and supervision of malaria prevention and control 2005 and January 2006. activities.

Health Action in Nepal (Monthly Health News Letter, Issue II, October 2005) Page No. Page # 2 of 5

News update in October 2005 Influenza Pandemic Preparedness in Nepal

Workshop on Outbreak Preparedness and Response The National Task Force is working to finalize the National training for Influenza-like Influenza Pandemic Preparedness and Response Plan for Nepal. illness for Rapid Response Teams in the Central and Mid- The plan aims to facilitate and coordinate the implementation of the Western Region activities of both the health and agricultural sectors to prevent and contain Avian Influenza in poultry and humans, and to reduce the There are Rapid Response team for risk and mitigate the impact in the event of an Influenza pandemic. outbreak preparedness and immediate response in all 75 districts. The workshop was held in Kavre in the Under the leadership of the Ministry of Health and Population Central Region and Nepalgunj in the (MOHP) and the Ministry of Agriculture and Cooperatives Mid-Western Region of Nepal from (MOAC), with technical support from WHO, this plan was further 6-7 October and 24-25 October 2005 developed in September 2005 with the participation of different respectively with the support of constituencies from the private and public sector. The most recent WHO. st task force meeting was held on 31 Oct 2005. It was chaired by the Altogether 40 Rapid Response Team Director General of Health Services and co-chaired by the Director (RRT) members from 6 Districts General of Livestock Services. The Director of Epidemiology and (Sindhupalchowk, Kavre, Chitwan, Disease Control Division, the Director of Animal Health Dolakha, Kathmandu and Lalitpur) Directorate, the Joint Secretary of the Ministry of Home Affairs, participated in the Central Region and officials from the Department of Health Services and workshop. Participants included Agriculture all participated. Partners like representatives from Hospitals (NRCS), FAO, WHO, and USAID also attended the meeting. (Kathmandu Medical College, Nepal

Medical College and Patan Hospital) and representatives from EDCD and At this meeting, there was a consensus that: Kathmandu Metropolitan City 1. There should be a joint emergency action plan in case of (KMC). The Regional Health outbreak Director and WHO also participated 2. The Central Disaster Relief Committee chaired by the in this workshop. In the Mi-Western Minister of Home Affairs will coordinate the response and Region Workshop, 28 RRT members preparedness efforts. A Subcommittee for influenza (Medical Officers, Health Assistants, preparedness will be created under the Chairmanship of and Lab Personnel from district and MOHP. MOAC, and other partners will be included as Regional Health Directorate) necessary, and the National Act will be amended to include participated from 8 districts (Surkhet, pandemic preparedness and response Dailekh, Jumla, Rukuum, Puethan, Dang, Bankey, and Bardiya). 3. A detailed Action Plan for emergency preparedness activities will be prepared outlining all activities necessary During the two workshops, all for increasing the operational capacity of key institutions. participants were trained on This will form the basis for raising necessary funds. investigation and response using an example of Influenza-like illness. It was decided that the preparedness plan will be presented at a This will help the district RRT for half-day workshop for finalization of the plan during 2nd week of preparedness as well as undertaking November 2005. Once finalized, it will be presented to the Central timely outbreak investigation and Disaster Management Committee for endorsement and subsequent containment. mobilization of resources.

Health Action in Nepal (Monthly Health News Letter, Issue II, October 2005) Page No. Page # 3 of 5 Lymphatic Filariasis Floods and Landslides in 2005 Elimination Program in Nepal Floods and Landslides in Nepal 2005 Public Health monitoring based on Nepal Red Cross Society, The Program for Elimination of 03 July to 26 October 2005 Lymphatic Filariasis (LF) was HUML DARCHUL initiated in 2003 and has now BAJHAN MUG BAITAD BAJUR come to end for the year KATHMAND

DADEL BHA JUML DHUR 2005.There are five districts DOT ACHHA KALIKO DOLP

MUSTAN under the implementation KANCHAN LALI PU DAILEK JAJARKO KAILAL namely Parsa, Makawanpur and RUKU MANAN SURKHE MYAGD SALYA Chitwan in the Central Region BARDIY GORKH ROLP BA KASK GL LAMJUN UN G PARBA RASUW and Nawalparasi and Rupendehi PYUT BANK HA GULM DAN ARGHA SYANGJ TANAH SINDHU in the Western Region. This HACH NUWAKO PALCHO PALP DOLAKH DHADIN KATH KAPIL NAWA BHA SULUK year the program has reached BAST RUPAN PARAS HUMB DEH SANKHUWA AP TAPLEJUN MAKAWAN LALI CHITWA KAVR HH SAB PU EC AM three million people of those R OKHAL DHUNG PARS SINDHUL KHOTAN TERHA AR BHOJ H five districts. The coverage rate BAR THU ET RAUT PU H AC AHA SARLAH UDAYAPU DHAN P MAHO KUT TAR is around 90% among the DHA ILA < 20 Total Affected families =5895 NUS SIRAH SUNSAR MORAN eligible people, and has 20 - 99 SAPTAR JHA maintained its achievement 100 - 499 > 500 since the program started. Source: Emergency & Humanitarian Action, WHO Nepal, 30 Oct 2005

Experienced Hazards & Human Effects Compared to recent years, the overall impact of floods and landslides has

been less severe with fewer districts affected during the monsoon season. According to Nepal Red Cross Society, a total of 5895 families have been affected by floods and landslides this year. Immediately after the end of th the monsoon season, on the 16 October 2005, heavy rains and floods caused a boat accident in the in in the Eastern Region. 5 people were killed and 6 people are missing. On the 20th October 2005, Dang district in the Mid-Western Region experienced heavy rains with large landslides and localized flooding. 3 people were killed and 800 families were affected. Assistance was provided by the Post Mass Drug Administration District Disaster Relief Committee and the local chapters of Nepal Red (MDA) sample survey is under way in Rupendehi in the Cross Society, and no additional outside assistance was required. (Source: Nepal Red Cross Society, July 3 to October 26 2005) Western Region and Parsa in the Eastern Region to determine the actual coverage rate, to monitor the proportion and Forthcoming News in 2005 nature of adverse reactions National Annual Review Meeting for the Fiscal Year 2004/05, following co-administration of From 13-15 November 2005 the given drugs on Filariasis Day, to assess reasons for non- The Health Sector National Annual Review Meeting is going to be held from acceptance of the drug by 13-15 November 2005 for the fiscal year 2004/05. The focus of the meeting means of direct and indirect will be: interview, and to identify reasons for inadequate or drop 1. Progress report of goals and budgeting in expenses for activities in the fiscal in coverage in some places. The year 2004/05. program in 2. The progress report of analytical trends of three years (2002/03, 2003/04 and is fully financed by the World 2004/05) with main health indicators. Bank. Expenses for the remaining four districts were 3. The contribution of External Development Partners (EDP) and NGOs to the met with HMG allocated budget activities to achieve the goals of the Health Sector Implementation Plan. and WHO country budget. Lack 4. The problems / Constraints / Issues raised in the regional review meeting of of resources has limited the the fiscal Year 2004/05 in the Regional Health Directorate. speed of expansion of the program into more districts. 5. The main strategy for better performance especially for the low performance districts in order to improve performance. Health Action in Nepal (Monthly Health News Letter, Issue II, October 2005) Page No. Page # 4 of 5 3. Request to Division of Road Office, Charikot, Dolakha to have a Bull Dozer Emergency Preparedness ready at a safe area of Arniko Highway. in Sindhupalchowk 4. Request to District Health Office Sindhupalchowk for the emergency District preparedness for reduction of humanitarian loss and provision of immediate first aid treatment to potential victims. Sindhupalchowk district lies in 5.Request to Nepal Red Cross Society Branch Office Sindhupalchowk for the the central region of Nepal on the necessary emergency preparedness for the probable incident Northern boarder with . A 6. Request to Tatopani Tax Office, Monitoring Office and Boarder Traffic Post Office, for regular coordination with Chinese Officers. crack was detected in the rock over the on the As part of the preparedness efforts, the District Health Office Sindhupalchowk Tibet side which could result in a requested to Epidemiology and Disease Control Division (EDCD) for landslide blocking the river, additional emergency supplies. EDCD and WHO EHA (Emergency causing severe impact to people Preparedness and Humanitarian Action) provided emergency drugs and upstream and downstream. A medical supplies with a total cost of 1285 US dollars in October 2005. District Disaster Relief committee meeting was held to prepare for the reduction of the hazards as well as to improve N HUMLA emergency preparedness. The DARCHULA CHINA BAJHANG Disaster Relief BAITADI BAJURA

Committee decided to prepare DADEL- JUMLA DHURA DOTI ACHHAM KALIKOT DOLPA

MUSTANG the local resources as follows: KANCHAN- PUR DAILEKH JAJARKOT KAILALI Sindhupalchowk RUKUM MANANG Border with MYAGDI SALYAN 1. Sindhupalchowk Landslide & BARDIYA GORKHA ROLPA BA KASKI GL LAMJUNG UN G PARBAT BANKE RASUWA Floods Information Sharing Sub PYUT- HAN GULMI DANG ARGHAK SYANGJA TANAHU SINDHU- HACHI NUWAKOT PALCHOK Committee should be formed. PALPA DOLAKHA DHADING KATHM KAPIL- NAWAL SULUK- RUPAN- BHAK BASTU PARASI HUMBU DEHI P SANKHUWA- TAPLEJUNG MAKAWAN- HA The Sub-committee will work in CHITWAN LALITKAVRE H SABA C PUR E M A R OKHAL- PARSA DHUNGA coordination with the Tatopani SINDHULI KHOTANG TERHA- AR H BHOJ- THUM T BARARAUT- HE PUR AC AHAT DHAN- P SARLAHI MAHO- UDAYAPUR Revenue Office and Kodari KUTA INDIA TARI ILAM DHANUSASIRAHA Monitoring Office for sharing SUNSARIMORANG SAPTARI JHAPA information regarding floods and landslides. 2. Request to Bhotekhosi Power Company to make an early warning signal of danger.

Contacts for further information

Ministry of Health and Dr. M.B. Bista Population Director Department of Health Epidemiology & Disease Control Division Services Department of Health Services Epidemiology and Disease Teku, Kathmandu, Nepal Control Division (EDCD) Tel: +977-1-4255796/4262268 Fax: +977-1-4262268

Dr. Kan Tun WHO Representative World Health Organization World Health Organization (WHO) UN House, P.O. Box 108 Pulchowk, Kathmandu, Nepal Email: [email protected]

Ms. Trine Ladegaard Technical Officer Emergency & Humanitarian Action Email: [email protected]

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