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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 2, Issue 25, Monday 27 June, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 25 (17 - 23 June, 2011) in DEWS • 90 districts and 3 agencies provided surveillance data to the DEWS this week from 3,341 fixed health Acute Flaccid Paralysis (AFP) facilities and 5 mobile medical outreach centres. Acute Jaundice Syndrome (AJS) • A total of 1,012,742 consultations were reported through DEWS of which 18% were acute respiratory Acute Respiratory Infections infections (ARI), 11% skin disease, 10% acute diarrhoea, and 6% were suspected Malaria. (Upper and Lower) (ARI) Acute Watery Diarrhoea (AWD)/ • Currently 76 DEWS surveillance officers are responding to alerts in 104 districts and agencies all over Suspected Cholera the country. Acute Bloody Diarrhoea (BD) • A total of 147 alerts with 11 outbreaks were reported in week-25, 2011: Altogether 73 alerts were for Other Acute Diarrhoeas (AD) Measles; 29 for AWD, 9 for Leishmaniasis, 8 for Acute diarrhoea, 7 for Pertussis, 4 for Acute Jaundice Syndrome, 3 each were for Meningitis and Neonatal Tetanus, 2 each for Chicken Pox, Mumps, Sca- Suspected Viral Hemorrhagic bies and Tetanus, while 1 each for DHF, Hemorrhagic Fever and Malaria. Fever (VHF) Suspected Malaria (Mal) • National Polio Eradication Initiative reported three confirmed polio cases this week. One each from Suspected Measles (MS) Killa Abdullah, and Khuzdar districts in Balochistan; and one from Jamshoro district in Sindh. Total 54 confirmed polio cases have been reported in 2011 from 24 districts. Suspected Meningitis (MG) Others Figure‐1: Three years trend of Acute diarrhoea in Pakistan, (2009, 2010 and 2011) 20 2009 2010 2011 16 12 Percentage 8 4 0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Epi‐week Disease Wk-18 Wk-19 Wk-20 Wk-21 Wk-22 Wk-23 Wk-24 Wk-25 Other Acute Diarrhoea (Not Watery) 85,473 (10%) 94,472 (10%) 102,955 (11%) 106,720 (10%) 102,005 (10%) 100,753 (10%) 101,336 (10%) 103,438 (10%) Total consultation 864,932 904,711 976,358 1,020,071 995,731 1,009,254 1,013,505 1,012,742 Figure‐1 above represents trend of "proportional morbidity." This is the number of new consultations for acute diarrhea divided by the total number of consultations. The very dramatic peak starting about week 31, 2010, demonstrates the increase in acute diarrhoea cases from the flood‐affected areas starting in KP the first week of August 2010. The “proportional morbidity” of diarrhoea in 2011 so far follows the seasonal trend of 2009 and early 2010. However the cholera cases and outbreaks are above the usual number and started earlier than usual this year. Last week 10 districts had outbreaks of AWD, 8 more were confirmed this week. This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 25 (17 - 23 June, 2011) Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 23 June 2011, Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 25/2011) compiled from weekly reports Diseases Total 4000 Mobile Fixed 6 5 3500 7 7 Skin Diseases 3,494,190 (11%) 3 8 6 7 7 7 6 8 13 6 3000 6 6 8 8 Acute Respiratory Infection 7,955,651 (24%) 8 8 8 11 2500 11 8 11 8 11 2000 8 12 411 Acute Diarrhoea 3,078,316 (9%) 400 375 331 11 215 361 3354 3341 1500 192 26 3259 3250 3215 3196 153 3120 26 3058 3022 3021 2982 128 2935 2909 2785 105 2745 46 81 2547 2466 58 2450 2404 2349 1000 2322 2262 2255 2251 Bloody Diarrhoea 285,916 (1%) 2199 2022 2021 1797 1680 500 1463 1289 1215 1167 1158 1143 999 1130 1113 1111 967 949 1073 1067 879 Suspected Malaria 1,942,552 (6%) 854 0 2 3 4 5 6 7 8 9 Unexplained Fever 1,291,756 (4%) 11 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 14 15 16 17 18 19 20 21 22 23 24 25 10 11 12 13 ‐ Wk Wk Wk Wk Wk Wk Wk Wk 1 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 Wk Wk Wk Total Consultations 33,238,687 Wk Focus on: Basic Messages about Cholera Treatment and Prevention Through collaboration of the Ministry of Health district and provincial levels, National Institute of Health and the Disease Early Warning System (DEWS) teams and Environmental Health Engineers supported by WHO and WASH teams supported by UNICEF cholera has been detected and controlled in all four major provinces during last two weeks. With prompt, effective treatment, Cholera mortality is less than 1%. Cholera is spread via the fecal‐oral route, most commonly by drinking water or eating food which is contaminated by sewage. Treatment • Any person with diarrhea should drink more fluids, such as water, juice, and soup. The best drink is a balanced solution of sugar and salts called ORS (oral rehydration salts) which is provided at public health facilities or can be purchased in the market and mixed with safe water to provide quick fluid replacement. Zinc supplement is also recommended. • If diarrhea is continuous or vomiting prevents drinking fluids, the patient should go urgently to a hospital or clinic to re‐ ceive intravenous fluids. Patients who are promptly treated respond rapidly and recover. Prevention • Always be sure you are drinking water is safe ‐ filtered, chlorinated, or bottled. Avoid ice in restaurants and drinks and ice cream sold in the market because they may not be made with safe water. • “Boil it, cook it, peel it or leave it” is good advice about raw fruits and vegetables in countries endemic for cholera. Cook food well, eat it hot, keep it covered, and peel fruits and vegetables. • Wash hands after using the toilet and before eating, or use an antiseptic hand gel. Distribution of Wild Polio Virus cases Pakistan 2010 and 2011 Year 2010: The total number of polio cases reported in 2010 is 144 including 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/agencies. Year 2011: The total number of new type‐1 polio cases confirmed by the laboratory is 54 till date from 24 districts. Cases 2010 Cases 2011 Province P1 P3 P1 P3 Punjab 6 1 - - Sindh 26 1 13 - Khyber Pakhtunkhwa 19 5 6 - FATA 63 11 18 - Balochistan 6 6 16 - AJK - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 54 - This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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]. 02 Epidemiological Bulletin: DEWS, Pakistan, Week no. 25 (17 - 23 June, 2011) Previous week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 14 AWD cases were reported. Field investigation was conducted and all the cases were visited. Severely dehy‐ Ali Mohammad Goth, 14‐June AWD Balochistan Lasbela 2 3 0 9 drated patients were referred to JGQ Hospital Hub. 2 samples were collected and found positive for V.c. Ogawa. Veerahub, UC Dureji Health Education was given as well as safe drinking water methodology was also stressed. Number of AD cases Three AWD cases who belong to village Nara reported from Ayub Teaching Hospital. Laboratory test of 3 Samples Village Nagri Payan, declared positive for V.c. Ogawa. District response team activated. Active surveillance conducted in the area. 13‐June AWD KPK Abbottabad 0 2 0 1 Havelian Necessary logistics provided, Aqua tabs, IEC material, soaps provided, Health and hygiene sessions provided through LHWs in the area. WHO and UNICEF collaborated in WASH response. AWD alert, one stool sample was collected and found positive for V.c. Ogawa. In the locality/area 10 households were interviewed but no more similar case or suspect was found. Health education to family members in house‐ St No. 6 Mohallah holds visited. Distribution of soaps, Aqua Tabs, jerry cans, water filters & IEC among them. Nearest HF was visited Islampura School wala 13‐June AWD Punjab Sargodha 0 0 1 0 & SMO was given briefing on the situation, control measures & importance of awareness among general masses Chowk Sargodha UC about safe drinking water, food & personal hygiene & it was also suggested to advise LHWs, CDC supervisor & 148 School Health & Nutrition Supervisor to impart above said information among community while conducting their HE sessions in the catchment area. EM & EH assessment was also done at HF. A death due to AWD was reported, upon field investigation 54 more AWD cases found with severe dehydration, rapid response team mobilized to affected village, field clinic established, Joint health & hygiene session conducted Village Jumoo Khan 10‐June AWD Sindh Naushahro Feroze 1 26 4 23 in collaboration with EDO‐H and NGO teams. Distributed Aqua tabs, ORS and IEC material. 1/2 stool samples found Mari , UC‐Dageja positive for V.c.
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