Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 3, Issue 10, Wednesday 14 March 2012 Highlights Priority diseases under surveillance Epidemiological week no. 10 (4 to 10 March 2012) in DEWS Acute (Upper) Respiratory Infection • In week 10, 2012, total 84 districts including 2 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 1,878 health facilities. Data from mobile teams is reported Suspected Diphtheria through sponsoring BHU or RHC. Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea • A total of 672,038 consultations were reported through DEWS of which 23% were acute Other Acute Diarrhoea respiratory infections (ARI); 6% 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 203 alerts with 12 outbreaks were reported in week 10, 2012: Altogether 94 alerts Suspected Viral Hemorrhagic Fever for Measles; 22 for Leishmaniasis; 17 for Typhoid; 14 for Pertussis; 12 for ARI; 11 for NNT and Pyrexia of Unknown Origin Tetanus; 9 for AWD; 8 for Scabies; 5 for AD; 3 for Bloody diarrhoea; while 2 each for AJS, DF, Suspected Measles Suspected Acute Viral Hepatitis Diptheria and Malaria. Chronic Viral Hepatitis Neonatal Tetanus • As of 10 March 2012, the total number of polio cases confirmed by the laboratory is 13 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‐10, 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 9 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 wk Table 1: Most common communicable diseases syndromes reported weekly Disease Wk-3 Wk-4 Wk-5 Wk-6 Wk-7 Wk-8 Wk-9 Wk-10 Acute respiratory infection 130,371 (25%) 137,322 (26%) 114,319 (26%) 138,507 (25%) 159,074 (26%) 152,681 (24%) 157,106 (23%) 152,988 (23%) Skin diseases 24,721 (5%) 25,639 (5%) 22,020 (5%) 26,786 (5%) 29,199 (5%) 28,796 (4%) 29,346 (4%) 30,514 (5%) Acute diarrhoea 27,574 (5%) 28,461 (5%) 23,902 (5%) 28,969 (5%) 30,607 (5%) 31,551 (5%) 34,668 (5%) 37,812 (6%) Bloody diarrhoea 2,130 (0.42%) 2,665 (0.50%) 2,195 (0.50%) 2,676 (0.49%) 2,730 (0.45%) 2,765 (0.43%) 3,056 (0.46%) 2,756 (0.41%) Suspected malaria 20,375 (4%) 19,817 (4%) 15,582 (4%) 21,752 (4%) 22,883 (4%) 23,482 (4%) 28,261 (4%) 29,388 (4%) Total consultation 511,668 534,412 439,260 547,889 605,633 649,508 671,023 672,038 • 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 and FATA while acute diarrhoea is highest in Balochistan and Sindh (please see the graphs for every province in page 5 and 6). 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. 10 ( 4 to 10 March 2012) Current week's (9/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 6 case of suspected Leishmaniasis were reported. Patients have no traveling history. Lesions were mostly on Mosiani,UC Welput legs. No other case was found during active search, Inj Glucantime provided to health facility incharge and 27‐Feb Leishmaniasis Balochistan Lasbela 2 3 0 1 North, Tehsil Bela advised to give proper treament and if new case will report then inform. The outbreak was discussed with DHO and requested to distribute bed nets and conduct household spraying. Alert of 7 cases TF was received through weekly DEWS report. On investigation found that the cases are from the same locality, and the water source is the surface water from the dam which they keep in resorvior at RHC Ahmadon, UC Kach, 27‐Feb Typhoid Balochistan Ziarat 1 4 0 2 home. Laboratory testing showed 4 were positive for typhoid 3 cases results were pending. Shortage of Tehsil Ziarat medicine and laboratory facility is felt in the whole UC. Matter was discussed with DHO and RHC incharge. Follow up visit was planned next week. Alert for Measles, active surveillance conducted, remote area with total population of 150 houses, 7 more Village Kolalano Cham, cases were found in the surrounding and 4 recovered cases were also identified, routine outreach vaccination 27‐Feb Measles KPK Lower Dir UC Asbanrd, Tehsil 1 5 1 1 conducted in the area by EPI Team and vaccinated 40 children for routine immunization, Vit‐A was given, Adenzai Blood Sample Collected for confirmation of antibodies, Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed. Alert for Measles, active surveillance conducted, remote area with total population of 150 houses, 7 more cases were found in the surrounding, routine outreach vaccination conducted in the area by EPI Team and Village Anderey, UC 1‐Mar Measles KPK Lower Dir 7 0 1 0 vaccinated 33 children for measles, Vit‐A was given, Blood Sample Collected for confirmation of antibodies, Kotto, Tehsil Balmbat Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed. Case of probable Pertussis was investigated in hospital. During active surveillance in community found 13 Tando Allah Village Ahmed Khan 27‐Feb Pertussis Sindh 4 4 4 2 more cases. In cluster of 30 houses found 16 children, out of them 9 were unvaccinated, Syp Erythrocin given Yar Lund, Taluka Chambar for treatment and health and hygiene education was given, EDOH informed and 3 Throat swab collected. 34 probable Pertussis cases were investigated, during active surveillance, SO visited health facility to check Qambar Village Lakhtia, UC 28‐Feb Pertussis Sindh 7 11 8 8 EPI center and found 2 days vaccination was available for community, immunization status was 20%, health Shahdadkot Boohar, Taluka Kambar education was imparted regarding importance of vaccination, Erythromycin given and EDOH informed. Village Ehsan ali Baladi, K.N Shah; Village Ghulam 43 probable Pertussis cases were investigated in 4 different locations in district Dadu. During active surveil‐ Rasool Khushk; Village lance 45 contact children found in community out of them 21 were vaccinated; health education given; 1‐Mar Pertussis Sindh Dadu 14 9 6 14 Bahawalpur Sekhani; Erythromycin given to cases and contacts. 4 throat swabs were taken and sent to NIH. EDOH, focal person EPI Village Hafiz Babar, taluka were informed. Johi Village Hashim Khaskheli, Alert for Measles, suspected case was admitted in hospital, Vitamin (A) given, health education was imparted, Hyderi Mohalla, UC 1‐Mar Measles Sindh Karachi 11 5 5 1 case was not vaccinated, during active surveillance in community found 22 children none of them was vacci‐ Murad Memon, Gaddap nated, information share with THO and request for Mop‐up the area and 1 Blood sample collected. town AJS alert: BHU jamro Medical officer reported AJS cases from same location, team was comprised as SO Village saen bux jaffri UC DEWS, MO PPHI, EM & vaccinator. During investigation 18 cases were found & line listed. All cases were 2‐Mar AJS Sindh Shikarpur 2 12 0 4 jamra taluka lakhi referred by MO PPHI for laboratory investigation to DHQ lab. IEC material distributed & health promotion session was conducted. community was sensitized on hygiene & safe drinking water. Current week's (10/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Outbreak for Leishmaniasis identified at Khaliqabad and adjacent area. Registration found total 75 patients 7‐Mar Leishmaniasis AJK Mirpur Village Khaliqabad 3 7 20 45 with lesions from one week to one year. DHO and ADHO CDC were informed. Health education sessions held at schools. Healthcare providers trained on treatment guidelines. Alert for AWD, 16 cases were reported and investigated at DHQ hospital Dhadar. During field investigation 5‐Mar AWD Balochistan Bolan Village Brahim bani 4 4 2 6 along with district health team found no more suspected cases. 1 stool swab and 4 water samples were collected and sent to NIH. Aqua‐tabs distributed in the community. Alert for suspected Leishmaniasis, 6 cases were reported from two different locations. Patients have no Village Winder & Uthal, traveling history. Lesions were mostly on legs. No any other case was found during active search. Patients 6‐Mar Leishmaniasis Balochistan Lasbela 1 4 0 1 Tehsil Uthal were advised to take proper and regular treatment. Health and hygiene session was conducted with patient family member and community. DHO informed and requested to conduct household spraying. Village Ahmed khan 6 cases of AWD were reported from hospital, active surveillance conducted and 2 stool and 4 water samples Tando Allah 9‐Mar AWD Sindh lashari, UC Pak Singhar 0 2 0 4 taken, hand pump was the source of suspect, Aqua tabs, Zinc tabs and ORS distributed in the community, Yar taluka Tando Allahyar EDOH informed.