Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 3, Issue 7, Wednesday 7 March, 2012 Highlights Priority diseases under surveillance Epidemiological week no. 7 and 8 (12 to 25 February, 2012) in DEWS Acute (Upper) Respiratory Infection • In week 7 and 8, 2012, total 81 districts including 2 agencies provided surveillance data to Pneumonia the DEWS on weekly basis from around 1,838 health facilities. Data from mobile teams is re‐ Suspected Diphtheria ported through sponsoring BHU or RHC. Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea • A total of 1,238,577 consultations were reported through DEWS of which 25% were acute Other Acute Diarrhoea respiratory infections (ARI); 5% were acute diarrhoea; 4% were suspected malaria; while 5% were Suspected Enteric/Typhoid Fever Skin disease. Suspected Malaria Suspected Meningitis Suspected Dengue fever • A total of 387 alerts with 43 outbreaks were reported: Altogether 163 alerts for Measles; 41 Suspected Viral Hemorrhagic Fever each for Leishmaniasis and Pertussis; 35 for NNT and tetanus; 27 for Typhoid; 20 for Scabies; 19 Pyrexia of Unknown Origin for ARI; 13 for AWD; 6 for BD; 5 for AD; 4 for DF; 3 each for AJS and Malaria; 2 for Mumps; while Suspected Measles Suspected Acute Viral Hepatitis 1 each for CCHF, Diphtheria, H1N1, Rabies and Unexplained fever. Chronic Viral Hepatitis Neonatal Tetanus • In As of 25 February, 2012, the total number of polio cases confirmed by the laboratory is 12 Acute Flaccid Paralysis from 10 districts/towns/tribal agencies and areas. Scabies Cutaneous Leishmaniasis Others Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐8, 2012. 50 AD BD ARI S. Malaria 45 40 35 30 25 Percentage 20 15 10 5 0 1 3 5 7 9 1 3 5 7 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 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 Table 1: Most common communicable diseases syndromes reported weekly Disease Wk-1 Wk-2 Wk-3 Wk-4 Wk-5 Wk-6 Wk-7 Wk-8 Acute respiratory infection 92,846 (27%) 110,049 (27%) 130,371 (25%) 137,322 (26%) 114,319 (26%) 138,507 (25%) 154,230(26%) 152,251(23%) Skin diseases 19,973 (6%) 19,746 (5%) 24,721 (5%) 25,639 (5%) 22,020 (5%) 26,786 (5%) 28,370(5%) 28,702(4%) Acute diarrhoea 21,971 (6%) 24,322 (6%) 27,574 (5%) 28,461 (5%) 23,902 (5%) 28,969 (5%) 29,890(5%) 31,395(5%) Bloody diarrhoea 1,502 (0.44%) 2,225 (0.54%) 2,130 (0.42%) 2,665 (0.50%) 2,195 (0.50%) 2,676 (0.49%) 2,689(0.46%) 2,751(0.42%) Suspected malaria 13,970 (4%) 15,113 (4%) 20,375 (4%) 19,817 (4%) 15,582 (4%) 21,752 (4%) 22,672(4%) 23,464(4%) Total consultation 345,403 409,930 511,668 534,412 439,260 547,889 590,424 648,153 • The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as proportional morbidity (percentage of cases out of total consultations) reported to DEWS on weekly basis. • The above table provides the total consultations for each of the last 8 weeks proportional morbidity of five disease syn‐ drome. Proportional morbidity of ARI is highest in KP while acute diarrhoea is highest in Balochistan and FATA (please see the graphs for every province in page 7 and 8). 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 Special Bulletin: DEWS, Pakistan, Week no. 7 and 8 (12 to 25 February, 2012) Previous week's (7/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 5 suspected cases of Leishmaniasis were reported, the vicinity was checked and 2 more cases were found with typical lesions of Leishmaniasis from different location. Injection Glucantime was supplied to the nearest 16‐Feb Leishmaniasis Balochistan Jhal Magsi RHC Jhal Magsi 1 2 0 4 HF for completing the treatment. Issue was raised with DHMT and requested for seriously taken preventive measures. 6 suspected cases of Leishmaniasis were reported and investigated. Inj Glucantime was provided to health 18‐Feb Leishmaniasis Balochistan Lasbela Winder, Lakhra 1 5 0 0 facility Incharge for the patients and guided to take proper treatment. 17 cases of suspected malaria were reported and all slides were tested out of which 10 verified positive 17‐Feb Malaria Balochistan Jhal Magsi BHU Sarangani 3 7 2 5 (SPR=59%), 7 FP and 03 Mix. Anti Malaria medicins were distributed. 5 suspected cases of measles were reported from DHQ Hospital. All patients were the students of Jamiya Madina Madarsa and belong to Aranji area of Khuzdar. Vaccination status was NIL. Vit‐A and Symptomatic Jamia Madina Madarsa 16‐Feb Measles Balochistan Lasbela 0 13 0 0 treatment was given, 8 other cases found during active search. 6 blood samples were collected and sent to Uthal NIH. All treatment made available, special team appointed for further immunization to surrounding area for affected children. Alert for measles case from RHC Sinjavi. On field investigation total of 15 cases of measles were found with Killi gavarai, Killi surbot, mixed, post and fresh cases. There is no immunization history in the village. Vitamin A capsule was given to 16‐Feb Measles Balochistan Ziarat 8 1 4 2 UC Sinjavi, Tehsil Sinjavi the cases with the next dose to parents. Sample was taken and sent to NIH. Matter was discussed with the DHO. DHO assured that a team will be sent to do the vaccination. 6 suspected cases of Leishmaniasis were reported from BHU Torkham. The area was visited by WHO/EHA Village Bacha Mina, UC Khyber team and found 36 more cases on active surveillance and line listed. The elders of the area were informed to 15‐Feb Leishmaniasis FATA Torkham, Tehsil Landiko‐ 3 12 5 21 Agency send the cases to the BHU,if they find more.The agency surgeon and PPHI staff was informed about the tal outbreak.The plan is to provide medicine and to take preventive measures in the coming summer season. Suspected cases of BD reported from BHU Dalola. Deputy EDO H, Coordinator PPHI informed. IV fluids, Khyber Antibiotics, ORS, Aqua tabs provided at BHU. Active surveillance done with coordinator PPHI, EPI coordinator, 17‐Feb BD Pakhtunk‐ Abbottabad Dalola 0 3 0 5 LHS, Medical Technician, EPI worker. 2 stool samples and 3 water samples were taken for testing. Aqua tabs hwa distributed among the villagers and health education given. Follow up visit conducted, 10 CL Cases were found in surrounding, 3 cases were under treatment from nearby Khyber HF. ITN's, Antiseptic Soaps distributed. onjob training was given to health staff for Intralesional adminstration Village Jelly, UC Munjai, 15‐Feb Leishmaniasis Pakhtunk‐ Lower Dir 0 5 0 5 of Inj Glucantime, 1st dose of Glucantine was given on spot and all were asked to come to HF on same day Tehsil Balmbat hwa next week for 2nd dose. Health & Hygiene sessions conducted, RBM was informed and requested for residual spray before the favorable season for vector breeding and transmission. 3 suspected cases of Measles reported from Women & children hospital and CMH Abbottabad. Sample taken Khyber and sent to NIH. Vitamin A given. On active surveillance along with EI coordinator, concerned EPI worker and Shergan, Pandothana, 14‐Feb Measles Pakhtunk‐ Abbottabad 2 0 0 1 local LHW. No active case found but a younger sister of one suspected Measles case died having sign & Pawa hwa symptoms of Measles according to the parents. 35 children less than 5 years were vaccinated for measles, 3 newly born children were given BCG, OPV & Penta. Village Gul hassan 6 probable cases of Pertussis were identified in private clinic, during active surveillance 3 out of 6 has BCG 17‐Feb Pertussis Sindh Dadu Laghari, UC Dirgh bala, 2 3 0 1 scar, health awareness education was given, vaccination was done in the village, 19 BCG, 9 Pentavalent, 10 Taaluka Johi Measles and 3 women for T.T, Erythromycin given, EDOH, FP EPI informed and 1 Throat sample taken. Village Mullan Panhwar, 9 probable Pertussis cases were investigated in village, active surveillance done, 1 Throat sample was col‐ 18‐Feb Pertussis Sindh Dadu UC Makhdoom bilawal, 2 4 0 3 lected, 6 out of 9 have no BCG scars, health education imparted, Erythromycin given to all cases, vaccination taluka Dadu done during investigation, EDOH, THO, FP‐EPI and MO BHU informed. Alert of probable Pertussis cases were reported from MCH centre Ghotki. upon field investigation 20 cases Village More Dayo UC were found. House to house cluster done routine immunization status was found zero. DEWS team re‐ 18‐Feb Pertussis Sindh Ghotki 8 4 7 1 Khawara sponded and given 14 days complete dose of erythromycin to all suspected cases and close contacts. Health education imparted in the village informed EDOH & DSV for vaccination in area/village. During the field investigation of measles alert 45 cases of suspected pertusis were found. DEWS SO along with Village Laiq Bhurgari, Vil EM & EH local NGO and DHMT team responded 730 tab of erythrocin and cough syrups were distributed 14‐Feb Pertussis Sindh Khairpur Jan M, Vil Irshad, UC 17 6 16 6 among all suspected cases and close contacts.