Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 2, Issue 34, Monday 29 August, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 34 (19 - 25 August, 2011) in DEWS • 82 districts and 3 agencies provided surveillance data to the DEWS this week from 2,736 Acute Flaccid Paralysis (AFP) health facilities. Acute Jaundice Syndrome (AJS) • A total of 872,608 consultations were reported through DEWS of which 18% were acute respiratory infections (ARI), 12% skin disease, 11% acute diarrhoea, and 7% suspected Acute Respiratory Infections (Upper and Lower) (ARI) Malaria. • A total of 168 alerts with 29 outbreaks were reported in week-34, 2011: Altogether 65 Acute Watery Diarrhoea (AWD)/ Suspected Cholera alerts were for AWD; 25 for Measles; 19 for DHF; 11 for Neonatal Tetanus and Tetanus; Ten for Pertussis; Nine for Leishmaniasis; Eight for Suspected Malaria; seven for Acute Acute Bloody Diarrhoea (BD) diarrhoea; Six for Bloody diarrhoea; Three for Chicken pox; Two for Typhoid; while one Other Acute Diarrhoeas (AD) each for Meningitis, Mumps and Scabies. Suspected Viral Hemorrhagic • National Polio Eradication Initiative reported five new type-1 confirmed polio cases this Fever (VHF) week: These include two cases from Federally Administered Tribal Areas (Khyber agency), Suspected Malaria (Mal) one case from Khyber Pakhtunkhwa province (Peshawar district) and two cases from Ba- lochistan province (Quetta and Killa Abdullah districts). Wild poliovirus type-1 was also Suspected Measles (MS) th isolated from a healthy child in Balochistan province (Quetta district). As of 28 August, Suspected Meningitis (MG) Pakistan has reported a total of 77 polio cases (76 type-1 cases & 1 type-3 case) from 28 districts/towns/tribal agencies/areas. 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 101316192225283134374043464952 Epi‐week Disease Wk-27 Wk-28 Wk-29 Wk-30 Wk-31 Wk-32 Wk-33 Wk-34 Acute Diarrhoea 100,320 (10%) 104,413 (10%) 107,861 (10%) 103,098 (10%) 109,255 (10%) 106,918 (10%) 101,174 (10%) 93,312 (11%) Total consultation 994,345 1,025,647 1,037,391 1,019,120 1,078,912 1,040,292 988,119 872,608 Since July 29, 2010, approximately 42,404,056 patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week 34, 2011 (19 to 25 August, 2011) reports were received from 2,736 health centers and the major causes for seek‐ ing health care by the communities in almost all of the provinces were diarrheal diseases 93,312 (11%), acute respiratory infec‐ tions 158,253 (18%), skin diseases 106,261 (12%) and suspected malaria 60,122 (7%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 2009, 2010 and 2011 up until now. 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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 34 (19 to 25 August, 2011) Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Village Sarar, UC Gojra , Cluster of suspected cases of BD were reported from village Sarar Hassanabad. Stool sample collected and sent to NIH. DHO 22‐Aug BD AJK Muzaffarabad 3 4 0 0 Tehsil Muzaffarabad Muzaffarabad informed. Active surveillance found no other cases. Malaria alert was reported. The case were examined clinically and patients were treated. 17 test were positive out of 30 Balochis‐ 23‐Aug Malaria Chagai BHU Sargesha 0 0 0 0 (P.Vivax 10, P.Falciparium 7) SPR = 56.6%, while FR = 41.1%. DHO was informed and requested to provide RDTs, ACT andas tan Bed nets for further prevention. An alert of Malaria was investigated for 64 reported cases. The cases were examined and slides test was taken. 10/17 of the Balochis‐ 25‐Aug Malaria Jaffarabad BHU Cattle form 11 21 9 23 slides verified positive ( P.Falciparium 5, P.Vivax 3, mixed 2) SPR = 58.8%, while FR = 70%. Medicines was provided. DHO was tan requested to provide bednets to the said location as a preventive measures. Malaria alert was reported. Field investigation including RDTs test for suspected cases. 63 cases were reported, 53 samples Balochis‐ 19‐Aug Malaria Jhal Magsi RHC Jhal Magsi 8 33 7 15 were collected and 33 came out positive (P. Falciparum 10, P. Vivax 22, mixed 1) SPR = 66%, while FR = 33.3%. DHO and tan representative of malaria control program was informed and requested to take preventive measures. Malaria alert was reported. Field investigation was done via DEWS focal person. The case were examined clinically and Balochis‐ 24‐Aug Malaria Kharan BHU Sarawan 0 0 0 0 blood test was taken. 20 test came positive out of 38 (9 P.Vivax, 7 P.Falciparium, 4 mixed) patients were treated, SPR = tan 52.6%, while FR = 65%. DHO was requested to provide RDTs, ACT and Bednets for prevention. BHU Allah Dad An alert of Malaria was investigated for 52 reported cases. Health facility was visited 15/22 (68%) found positive, Balochis‐ 25‐Aug Malaria Nasirabad Umrani, Tehsil 8 14 11 19 (P.Falciparium 10, P.Vivax 4, Mixed 1) SPR = 68.18%, while FR = 73.3%. DHO and Merlin representative was informed and tan Manjhi Shoorti requested for distribution of bed nets to the affected community. Village Bubar Two cases of AWD were reported from Aga Khan Health Center Singal. Stool samples taken, Culture sensitivity done and Khutum UC Bubar found positive for V.c. Ogawa ,DHO Ghizer and area Medical Officer informed, Immediate case management procedures Gilgit‐ Tehsil Punial; Village were adopted and patient recovered from acute stage on rehydration, active surveillance done in the area and no other 26‐Aug AWD Ghizer 0 1 0 1 Baltistan Golodas near govt cases were found. Health education session conducted with the patient, family and community notables for better hygienic schoolTehsil Ishko‐ practices. Aqua tab were distributed to the community, drinking water samples from different sources were collected and man sent to Environmental Protection lab. Visceral DHQ hospital Chilas received four patients of suspected visceral Leishmaniasis which were later confirmed on bone marrow Gilgit‐ 23‐Aug Leishma‐ Diamir Hudur Valley 0 0 4 0 biopsy. On field investigation no other case found. Health education session conducted.EDO health and DSM PPHI informed Baltistan niasis about the patients. Glucantime treatment to start. A suspected outbreak of AWD was reported from RHC Khanpur from village Pakh Shahi, Muslimabad as 8 cases were admit‐ Khyber ted with AWD from same village. On active case finding 38 more patients were identified. 2 Stool samples were taken and Village Pakh Shahi, 19‐Aug AWD Pakhtunk‐ Haripur 6 11 17 12 sent to NIH which came back positive for V.c. Ogawa. Water samples were taken which also came back positive for contami‐ UC Muslimabad hwa nation. Aqua tabs, ORS and soaps were distributed. All the cases with AWD were treated and managed on the same day. Health and Hygiene session was conducted for the affected community. EDO Health was informed of the AWD cases. A suspected outbreak of AWD was reported from RHC Ghazi from village Bandi, UC Kothera as 9 cases were admitted with Khyber AWD from same village. On active case finding 16 more patients were identified. Stool samples was taken and sent to NIH. Vilage Bandi, UC 23‐Aug AWD Pakhtunk‐ Haripur 2 8 3 12 Water samples were also taken which came back positive for contamination. Aqua tabs, ORS and soaps were distributed Kothera, Tehsil Ghazi hwa house to house. All the cases with AWD were treated and managed on the same day. Health and Hygiene session was conducted for the affected community. EDO Health was informed of the suspected cases Khyber Village Audigram, AWD alert reported, Four cases identified, active surveillance done, stool sample collected and found positive for V.c. 19‐Aug AWD Pakhtunk‐ Lower Dir Maniyal, UC Lal 1 2 1 0 Ogawa. Water Samples taken for any fecal contamination, ORS, Hygiene kits & Aqua tabs distributed, Health & Hygiene hwa Qilla, Tehsil Balmbat promotion Session conducted with family members, EDO‐H was informed. Khyber Village Kass Kandao, AWD alert reported, 16 cases identified. Active surveillance done, stool sample collected and sent to NIH. Water Samples 23‐Aug AWD Pakhtunk‐ Lower Dir UC Lajbook, Tehsil 1 7 4 4 taken for fecal contamination, ORS, Hygiene kits, Aqua tabs distributed, health and hygiene promotion session conducted hwa Balmbat. with family members, EDO‐H was informed, WASH partners were requested for water Source protection. AWD case was notified from DHQ Timergrah. Active surveillance done in area, 46 cases identified and investigated, stool Khyber Village Shahikoto, sample collected for lab confirmation, Water Samples taken for fecal contamination, ORS, hygiene kits and Aqua tabs 24‐Aug AWD Pakhtunk‐ Lower Dir UC Koto, Tehsil 4 17 4 21 distributed, health and hygiene promotion session conducted with family members, EDO‐H was informed, HRDS was also hwa Balmbat involved during response, other wash partners were requested for interventions. Village Parpety, Khyber AWD alert reported, active surveillance done, 19 cases identified on active surveillance and investigated, stool sample Gombaty, UC 25‐Aug AWD Pakhtunk‐ Lower Dir 3 0 4 12 collected for lab confirmation, Water samples taken for any fecal contamination, ORS, Hygiene kits and Aqua tabs were Kotkay, Tehsil Lal hwa distributed, Health and hygiene promotion session conducted with family members, EDO‐H was informed.