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WMMR Pakistan Epidemiological Week N00 21 (20 – 26 May 2006) 31 May 06/ Vol. 26/ DEWS 2006-21 Reporting Units...............................................................2 Total number of consultations ........................................2 0 DEWS Data, Epidemiological Week N 21 2006............3 DEWS Data, Monthly Summary .....................................5 Acute Diarrhoea..............................................................7 Bloody Diarrhoea............................................................7 Acute Jaundice Syndrome..............................................8 Malaria ............................................................................8 Measles ..........................................................................9 Acute Respiratory Infection ..........................................10 Scabies remains a problem in the Maternal and Neonatal Health (UNFPA) ......................11 earthquake-affected areas. The distribution Outbreak Alert and Response ......................................12 of soaps and benzyl benzoate lotion to treat Measles ...........................................................12 the skin condition caused by bad hygiene Acute Jaundice Syndrome...............................12 due to lack of water is ongoing. Malaria.............................................................12 For more information on scabies: http://www.who.int/water_sanitation_health/di Number of reported cases and deaths AJK .................13 seases/scabies/en/ Number of reported cases and deaths NWFP .............14 In the past month (Epidemiological Two (2) cases of suspected weeks 18-21 inclusive), 341,521 meningitis with no related death health events under surveillance were reported; 1 case from were reported including 47 deaths. Muzaffarabad and 1 case from This week, 213 of the 215 reporting Rawalakot/Poonch district. units (99%) reported a total of Five hundred and seventy-two (572) 89,374 consultations, including 9 cases of Bloody diarrhoea were deaths. reported; of them, 38% were from A total of 16,471 ARI cases with 5 Mansehra district. related death (CFR, 0.030). Thirty-one (31) cases of suspected No case of Acute Flaccid Paralysis measles were reported; 58% (18/31) reported from any district. were from Mansehra district. The Weekly Morbidity and Mortality Report (WMMR) is published by the Ministry of Health of Pakistan (MOH) and the World Health Organization (WHO). The WMMR is built on surveillance data that health service providers and NGOs transmit on a weekly basis from health facilities and hospitals in those areas affected by the earthquake that struck Pakistan on 8 October 2005. The WMMR objectives are to monitor the trend of health conditions over a period of time and provide vital information to all health partners. The WMMR is only a snapshot of the health conditions in those facilities where events are registered and data collected and does not necessarily reflect the situation from other health facilities. The WMMR is a publication that has been developed for emergencies and previously used in other areas such as the Darfur Crisis. The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, House #6, Street #20, F-7/2, Islamabad, Pakistan For More Information, please contact: Dr. Hammam El Sakka, Senior Medical Epidemiologist, WHO/EHA/Pakistan; [email protected] or Dr. Birjees Mazher Kazi, Chief, Public Health Laboratories Division, NIH MOH; [email protected] or WHO Webpage: http://www.whopak.org/disaster WMMR Weekly Morbidity and Mortality Report Pakistan 30 May 2006 / Vol. 27/ DEWS 2006 -21 Reporting Units The total number of reporting sites trained for the Disease Early Warning System (DEWS) in the earthquake affected areas remains 215; 213 (99%) sent their surveillance data on time during the epidemiological week 21 (20-26 May 2006). The reporting timeliness of the DEWS system has increased by 4% compared with the previous week (Epidemiological week 20); mainly due to increase of units reporting from Mansehra, Muzaffarabad and Poonch districts but decreasing in Battagram/Shangla. As the WHO offices in Balakot and Mansehra were merged, the surveillance data from Balakot was included together with Mansehra district data (Table 1). Table 1. Number of reporting heath facilities by district, Earthquake Affected Areas, Pakistan, 21 April-26 May 2006. Reporting Health Facilities Area Population 29Apr-5May 6-12 May 13-19 May 20-26 May Week 18 Week 19 Week 20 Week 21 Muzaffarabad 894,364 31 28 27 33 Bagh 452,532 25 31 34 34 Poonch 633,712 50 51 48 52 Mansehra / Balakot 1,154,804 66 62 62 64 Battagram / Shangla 592,256 24 19 32 29 Islamabad 10,500 1 1 1 1 Total 3,738,168 197 (92%) 192 (89%) 204 (95%) 213 (99%) Total number of consultations The total number of units reporting on time increased by 9 this week, over the previous week (from 204 units last week to 213 units this week), reporting units are increased in Mansehra, Muzaffarabad and Poonch districts but decrease in Battagram district. The total number of consultations reported throughout DEWS increased by 9% compared with the previous week (81,821 to 89374). The weekly trend of reporting units participating in the DEWS and the number of consultations is shown in Figure 1. No. Unit Reporting Units and Consultations No. Consult. 200000 200 Reporting Unit Consultation 150000 150 100000 100 50 50000 0 0 W42W43W44W45W46W47W48W49W50W51W52W1W2W3W4W5W6W7W8W9W10W11W12W13W14W15W16W17W18W19W20W21 Week Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 -26 May 2006. 2 WMMR Weekly Morbidity and Mortality Report Pakistan 30 May 2006 / Vol. 27/ DEWS 2006 -21 DEWS Data, Epidemiological Week N0 21 2006 Between 20 and 26 May 2006, 89,374 consultations for health events under surveillance were reported through DEWS. Overall, 19% (16,471) were due to Acute Respiratory Infections (ARI), 11% (9,690) due to Acute Diarrhoea (AWD), 6% (5,813) due to Fever of Unknown Origin (FUO), and 5% (4,418) due to Injuries (INJ). ARI represented 26% and 17% in the less than 5 years old and 5 or more years old respectively. AWD was found to be higher in those less than 5 years old and represented 18% of the total consultations compared to 9% in those 5 years old or more (Figure 2). AWD ARI AWD ARI 11% 19% 18% 26% AWD ARI 9% 17% FUO 6% FUO FUO 6% INJ 8% 5% INJ INJ OTH 5% OTH 44% 4% 59% OTH 63% < 5yrs (n=20,655) ≥ 5yrs (n=68,719) All Ages (n=89,374) Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 20-26 May 2006. During this reporting week, 33% (29,933/89,374) of all reportable conditions were reported from Mansehra district, 22% (19,870) reported from Muzaffarabad, followed by 19% (17,366) from Bagh district. Less than 1% of the consultations were reported from H-11 camp in Islamabad, due to the decrease in number of IDPs to less than 1,000 populations. The distribution of the total number of consultations by age and district is shown in Figure 3. No. Cases Consultations by Age and District (n=89,374) 25000 < 5yrs >= 5yrs 20000 15000 10000 5000 0 MUZ-AJK BAG-AJK POO-AJK MAN-NWFP BAT-NWFP ISLA District / Province Figure 3. The total number of consultations by age and district, Earthquake Affected Areas, Pakistan, 20-26 May 2006. 3 WMMR Weekly Morbidity and Mortality Report Pakistan 30 May 2006 / Vol. 27/ DEWS 2006 -21 DEWS Data, Epidemiological Week N0 21, 2006, 5 years of age and older In the current week, ARI was the most common health event reported among 5 years of age and older, with 7 related deaths (CFR 0.010). Seventeen (17) clinically diagnosed measles (MES) were reported; of them, 76% (13/17) from Mansehra, 12% (2/17) from Bagh, 1 case from Muzaffarabad and 1 from Poonch district. No measles (MES) cases were reported from Battagram district and H-11 camp Islamabad. One meningitis (MEN) case was reported from Poonch district. No cases of Acute Flaccid Paralysis (AFP) were reported (Figure 4). 12,000 8,000 4,000 0 ARI AWD FUO INJ BD MAL JAU MES MEN AFP TET AHF Cases 11,360 5,875 4,098 3,559 413 289 56 17 1 0 0 0 CFR % 0.044 0 0 0 0 0 0 0 0 0 0 0 Figure 4. Primary causes for the reported cases and weekly CFRs, 5 years of age and older, Earthquake Affected Areas, Pakistan, 20-26 May 2006. DEWS Data, Epidemiological Week N0 21, 2006, less than 5 years In the less than 5 year age group, 20,655 consultations were reported; 25% (5,111) of these reported were attributed to ARI with no related death, while 18% (3,815) were due to acute watery diarrhoea (AWD) with no related death. Fourteen (14) clinically diagnosed Measles (MES) cases were reported; of them 36% (5/14) from Mansehra, 3 cases (21%) from Muzaffarabad, 3 cases from Bagh district, 2 cases from Battagram and 1 case from Poonch district . No measles cases were reported from H-11 camp Islamabad. No AFP case reported from any district. One (1) suspected meningitis (MEN) cases were reported from Muzaffarabad district (Figure 5). Please see attached tables (6-11) for district wise reporting. 8,000 4,000 0 ARI AWD FUO INJ BD MAL MES JAU AHF MEN AFP TET Cases 5,111 3815 1,715 859 159 118 14 9 1 1 0 0 CFR % 000000000000 Figure 5. Primary causes for the reported cases and their weekly CFRs, LESS than 5 years old, Earthquake Affected Areas, Pakistan, 20 -26 May 2006. 4 WMMR Weekly Morbidity and Mortality Report Pakistan 30 May 2006 / Vol. 27/ DEWS 2006 -21 DEWS Data, Monthly Summary (Epidemiological Weeks N0 18-21) In summary for the past month between 21 April and 26 May (Epidemiological weeks 18-21 inclusive), a total of 341,521 health events under surveillance were reported, of which 19% (64,952) were due to acute respiratory infection (ARI), 9% (31,871) acute diarrhoea (AWD), 6% (19,578) Unexplained fever (FUO) and 5% (17,238) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 21 April-19 May 2006.
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