Epidemiological Week No. 52 (23 Dec – 29 Dec) 10 Jan 07/ Vol. 59/ DEWS 2006-52 The affected districts are in the grip of Reporting Units...............................................................2 winter Total number of consultations ........................................2 Photo by Torgrim Halvari DEWS Data, Epidemiological Week No. 52, 2006.........3 DEWS Data, Monthly Summary (Epidemiological Weeks No. 49-52).......................................................................4 Acute Watery Diarrhoea .................................................5 Bloody Diarrhoea............................................................6 Acute Jaundice Syndrome..............................................6 Malaria ............................................................................7 Measles ..........................................................................7 Acute Respiratory Infection ............................................8 Other Reportable Diseases and Conditions ...................8 Outbreak Alert and Response ........................................9 Number of reported cases and deaths per District, AJK ......................................................................................10 Number of reported cases and deaths per District, NWFP ...........................................................................11 In the past month (Epidemiological In week 52, there were 8 deaths weeks 49-52 inclusive), 186,769 health reported from acute respiratory events under surveillance were reported infections in three of the districts. including 49 deaths Three cases of measles were reported from Mansehra This week, there were 270 reporting units contributing to the report. The number of suspected hepatitis cases increased 65% over week 51. In week 52, Total 56,855 consultations were reported, with 19 deaths 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 produced with the financial support of AAI Australia, Americares, CIDA, Denmark, DFID, ECHO, Ireland, Italy, Japan, Korea, Monaco, Norway, SIDA, Slovak Republic, Switzerland, Turkey, USAID 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: Dorcas Taylor, 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 10 Jan 2007 / Vol. 59/ DEWS 2006 -52 Reporting Units The number of sites able to report decreased by 52 this week and the reporting timeliness of the DEWS systems has also decreased compared with last week. This is most likely to do with the Eid ul-Azha which took place at the beginning of the following week, and resulted in many closures of facilities. Some facilities in NWFP were also unable to report because security threats against NGOs resulted in the evacuation of staff from NGO run faciltities. See Table 1 for summary statistics. Table1. Reported heath facilities by district, Earthquake Affected Areas, Pakistan, 2 Dec -29 Dec. Reporting Health Facilities Area Population 2-8 Dec 09-15 Dec 16-22 Dec 23-29 Dec Week 49 Week 50 Week 51 Week 52 Muzaffarabad 894,364 80 100 87 82 Bagh 452,532 44 45 42 32 Poonch 633,712 67 70 63 67 Mansehra / Balakot 1,154,804 58 64 56 61 Battagram / Shangla 592,256 43 40 36 28 Total 3,727,668 292(90%) 319(99%) 284 (88 %) 270 (84 %) Total number of consultations In week 52 there was a decrease in the number of reporting sites, and the number of consultations also decreased to 56,855. The highest number of consultations by district was in Muzaffarabad, with 14,884 and the lowest was in Battagram, at 4,136. No. Unit Reporting Units and Consultations No. Consult. 200000 300 Reporting Unit Consultation 250 150000 200 100000 150 100 50000 50 0 0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 Week Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 – 29 December 2006. 2 WMMR Weekly Morbidity and Mortality Report Pakistan 10 Jan 2007 / Vol. 59/ DEWS 2006 -52 DEWS Data, Epidemiological Week No. 52, 2006 Between 23 and 29 December 2006, 56,855 consultations were reported through DEWS. Overall, 29% (16,567) were due to acute respiratory infections (ARI), 6% (2,986) due to acute watery diarrhoea (AWD), 6% (2,995) due to fever of unknown origin (FUO), and 4% (2,416) due to injuries (INJ). ARI accounted for 39% and 26% of consultations in the less than 5 years old and 5 or more years old respectively. All other reportable conditions each represented less than 2 % of the total consultations in week 52. AWD AWD AWD 4% 5% 10% ARI 26% ARI ARI 29% 39% FUO OTH* 5% 42% OTH* OTH* FUO 60% INJ FUO 55% INJ 5% 5% INJ 6% 4% 3% < 5yrs (n=14,944) ≥ 5yrs (n=41,888) All Ages (n=56,855) Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 23 – 29 December 2006. *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, Epidemiological Week No. 52, 2006: Consultations by age ARI in patients under five years old continues to remain steady in most districts. Bagh has seen a decrease in the percent of all ARI cases that are in young children, from a high of 43% to 38% in week 52. Other districts have not fluctuated more than approximately three percentage points either up or down in the past four weeks. See figure 3. 50.0 40.0 30.0 old 20.0 10.0 Percent of all ARI ARI all of Percent 0.0 in patients < 5 years consultations that are 2006-49 2006-50 2006-51 2006-52 Week BAGH BATTAGRAM MA NSERA MUZAFFARABAD POONCH Figure 3: Proportion of all ARI consultations by that are in children under five, by district, Earthquake Affected Areas, Pakistan 2 – 29 December, 2006 3 WMMR Weekly Morbidity and Mortality Report Pakistan 10 Jan 2007 / Vol. 59/ DEWS 2006 -52 DEWS Data, Monthly Summary (Epidemiological Weeks No. 49-52) In the past four weeks, between 2 Dec to 29 Dec 2006 (Epidemiological weeks 49-52 inclusive), 301,057 consultations for health conditions under surveillance were reported, out of a total 335,432 consultations. 28% (85,735) of consultations were due to acute respiratory infection (ARI), 6% (16,616) acute watery diarrhoea (AWD), 6% (18,403) unexplained fever (FUO) and 5% (13,566) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 2 – 29 Dec 2006. Week WEEK 49 WEEK 50 WEEK 51 WEEK 52 TOTAL CFR% Event C D C D C D C D C D AWD 4099 2 5011 1 4020 1 2986 0 16116 4 0.024 BD 319 0 371 0 240 0 232 0 1162 0 0.000 AFP 1 0 3 0 1 0 0 0 5 0 0.000 MAL 444 0 478 0 376 0 312 0 1610 0 0.000 ARI 20772 0 25013 7 23391 7 16567 8 85743 22 0.025 MES 2 0 8 0 0 0 3 0 13 0 0.000 MEN 7 0 7 0 7 0 2 0 23 0 0.000 JAU 26 0 42 1 23 0 38 1 129 2 1.53 TET 1 0 0 1 1 1 0 0 2 2 100.0 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 4667 0 5494 0 5247 0 2995 0 18403 0 0.000 INJ 3446 0 4014 0 3690 1 2416 0 13566 1 0.007 OTH 38249 13 51871 10 42371 18 31303 13 163794 54 0.032 TOTAL 72033 15 92312 20 79367 28 56855 23 300567 86 RU 292 319 284 270 C – Cases, D – Deaths, AWD - Acute Diarrhoea, BD - Bloody Diarrhoea, AFP - Acute Flaccid Paralysis, MAL – Malaria, ARI - Acute Respiratory Infection, MES – Measles, Men - Meningitis, JAU - Acute Jaundice Syndrome, TET - Neonatal Tetanus, AHF Acute Hemorrhagic Fever, FUO –Unexplained fever, INJ – Injuries, OTH – Others, RU – Reporting Units. Please note data from late reporting in previous weeks has been updated. During the same reporting period 79,715 consultations were reported in the less than 5 years old group, (29% of the total consultations), of which 37% (28,887) were due to ARI, 9% (8,685) due to AWD, 7% (5,932) due to FUO and 3% (3,190) were reported as injuries (INJ). Table 3. Total number of reported cases, deaths and monthly Case Fatality Rate (CFR), less than 5 years old, Earthquake Affected Areas, Pakistan 2 – 29 Dec 2006 Week WEEK 49 WEEK 50 WEEK 51 WEEK 52 TOTAL CFR% Event C D C D C D C D C D AWD 1932 2 2356 1 1765 1 1442 0 7495 4 0.053 BD 115 0 115 0 72 0 71 0 373 1 0.268 AFP 1 0 1 0 1 0 0 0 3 0 0.000 MAL 63 0 60 1 37 0 44 0 204 1 0.490 ARI 7263 0 8864 6 8218 6 5862 7 30207 13 0.043 MES 1 0 5 0 0 0 3 0 9 0 0.000 MEN 2 0 1 0 2 0 1 0 6 0 0.000 JAU 5 0 8 1 7 0 6 1 21 2 9.523 TET 0 0 0 0 1 1 0 0 1 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 1342 0 1533 0 1485 0 919 0 5279 0 0.000 INJ 695 0 735 0 762 0 452 0 2644 0 0.000 OTH 8434 6 10329 7 8546 5 6164 5 33473 18 0.053 TOTAL 19853 8 24007 16 20896 13 14944 14 79715 39 RU 292 319 284 270 4 WMMR Weekly Morbidity and Mortality Report Pakistan 10 Jan 2007 / Vol.