Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 2, Issue 13, Monday 04 April, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 13 (25 - 31 March 2011) in DEWS Acute Flaccid Paralysis (AFP) • 74 districts in 5 provinces and State of Azad Jammu and Kashmir (AJK) provided surveil- lance data to the DEWS. This system is gradually expanding to provide information about Acute Jaundice Syndrome (AJS) communicable disease threats in all parts of Pakistan as the country goes through the re- Acute Respiratory Infections covery process. (Upper and Lower) (ARI) • 2,835 fixed health facilities and 12 mobile medical outreach centres provided surveillance Acute Watery Diarrhoea (AWD)/ data for this week. Suspected Cholera • A total of 845,183 consultations were reported through DEWS of which 25% were acute Acute Bloody Diarrhoea (BD) respiratory infections (ARI), 11% skin disease, 9% acute diarrhoea, and 6% were suspected Other Acute Diarrhoeas (AD) Malaria. Suspected Viral Hemorrhagic • A total of 61 alerts were reported in week-13, 2011: Altogether 31 alerts were for Measles; Fever (VHF) 7 were for Pertussis, 6 were for chickenpox, 4 each were for Meningitis, and Malaria, 3 Suspected Malaria (Mal) were for Tetanus; 2 for Leishmaniasis, while 1 each for Acute Jaundice Syndrome, Diph- theria, Influenza, and Mumps. Suspected Measles (MS) • There were 2 polio cases confirmed this week: 1 from FATA (FR Lakki) , and 1 from Suspected Meningitis (MG) Sindh (Badin) Others Figure-1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 31 March 2011 (Epi week 31, 2010 to week 13, 2011) 50 45 40 35 30 25 Percentage 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 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 wk wk wk wk AD BD ARI S. Malaria Table-1: Priority diseases reported during the week 5 to week 12, 2011 Diseases Wk-6 Wk-7 Wk-8 Wk-9 Wk-10 Wk-11 Wk-12 Wk-13 Skin Disease 75,030 (9%) 56,464 (9%) 68,055 (9%) 61,675 (8%) 79,747 (9%) 82,310 (9%) 75,043 (9%) 77,157 (9%) ARI (URI and LRI) 267,612 (31%) 201,493 (31%) 250,489 (30%) 217,495 (30%) 249,133 (29%) 261,405 (28%) 223,829 (27%) 218,272 (26) Other Acute Diarrhoea (Not Watery) 50,346 (6%) 39,728 (6%) 53,257 (6%) 46,412 (6%) 57,134 (7%) 65,107 (7%) 67,046 (8%) 71,945 (9%) Bloody Diarrhoea 5,069 (1%) 4,437 (1%) 4,851 (1%) 4,862 (1%) 5,494 (1%) 5,990 (1%) 5,589 (1%) 6,439 (1%) Suspected Malaria 50,431 (6%) 35,061 (5%) 46,665 (6%) 40,357 (6%) 52,266 (6%) 56,251 (6%) 52,712 (6%) 55,132 (7%) Total consultation 860,286 653,895 821,436 721,987 850,554 923,109 825,367 845,183 This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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. 13 (25 - 31 March 2011) Table-2: Leading causes of seeking health care in the flood affected districts, 29 Fig-2: Weekly number of reporting health units (Week 33-2010 to week 13-2011) July 2010 to 31 March 2011 3000 6 13 Diseases Total Mobile Fixed 6 6 8 8 2500 8 Skin Diseases 2,426,823 (11%) 11 11 8 8 11 8 8 2000 11 Acute Respiratory Infection 5,508,467 (25%) 8 1500 12 (Not 411 26 11 Other Acute Diarrhoea 400 1,936,188 (9%) 2834 331 26 2786 375 2740 Watery) 361 215 2546 2399 2401 192 46 2377 2295 1000 2247 2196 2192 153 2186 2159 128 1960 105 1856 Bloody Diarrhoea 190,508 (1%) 81 58 1627 1391 1342 500 1259 1139 881 826 788 758 745 715 702 655 Suspected Malaria 1,253,573 (6%) 597 575 509 502 0 439 9 8 7 6 5 4 3 2 Unexplained Fever 876,087 (4%) 11 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 13 12 11 10 ‐ 1 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 Wk Wk Total Consultations 21,791,709 Focus on: Polio Here we are sharing a serious concern from the polio eradication program, Epi-week # Province / Agency District / Area Cases during the last three weeks a total of 11 new cases of type‐1 polio cases FATA Khyber 1 (See table on the right) were confirmed by the laboratory. They include 4 Sindh Badin 1 cases from FATA (Khyber, Kurram, Lakki Marwat and FR Lakki) 3 cases Wk‐11 Sindh TM Khan 1 from Sindh (Badin, TM Khan), 2 from Khyber Pakhtunkhwa (Peshawar, Khyber Pakhtunkhwa Peshawar 1 Nowshera), and 2 from Balochistan (Pishin, and Killa Abdulla). Khyber Pakhtunkhwa Nowshera 1 st As of 31 March, Pakistan has reported a total of 26 polio cases (all type‐1) FATA Kurram 1 from 13 districts/tribal areas/agencies. FATA Lakki Marwat 1 Wk‐12 Balochistan Pishin 1 Clustering of type‐1 polio cases in south Sind is of serious concern and war‐ Balochistan Killa Abdulla 1 rant aggressive response with appropriate oral polio vaccine. Four type‐1 FATA FR Lakki 1 polio cases have been reported in the past eight weeks from neighboring Wk‐13 areas of three districts. Sindh Badin 1 Technical Advisory Group for Polio Eradication in Pakistan and Afghanistan met this week on 24 and 25 March to review the current situation in both countries, evaluate impact of eradication activities and advise further guidance on strategies and activities employed for polio eradi‐ cation as appropriate. This was followed by the inter‐country coordination meeting for polio eradication in Pakistan and Afghanistan on 26th March to further consolidate cross border collaboration for polio eradication. Figure-3: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 2009, 2010 and 2011 40 Since July 29, 2010, a total of 5,508,467 Acute Respiratory Infection (both Upper and Lower) patient consultations have been reported to DEWS from 35 the districts participating in DEWS in 5 provinces and state of AJK. 30 25 In the graph at right, DEWS weekly reports received for ARI in 2011 are com‐ 20 pared to the reports of 2010 and 2009 from disaster‐affected districts. Percentage 15 2009 10 This week, DEWS received 218,272 reports of Acute Respiratory Infection, 26% 2010 2011 of total consultations, 1% lower proportional morbidity reported by DEWS in 5 week‐13/2010, but as same in week‐13/2009. 0 1 4 7 101316192225283134374043464952 Epi week Figure-4: Acute Diarrhea trends, Disaster affected districts, Pakistan 2009, 2010 and 2011 20 2009 18 Since July 29, 2010, a total of 1,936,188 acute diarrhea patient consultations 2010 16 have been reported to DEWS from the districts participating in DEWS in 5 2011 provinces and state of AJK. 14 12 In the graph at right, DEWS weekly reports received in 2011 are compared to 10 the reports of 2010 and 2009 from disaster‐affected districts. 8 Percentage 6 This week, DEWS received 71,945 reports of acute diarrhea, 9% of total con‐ 4 sultations. This is same proportional morbidity than reported by DEWS in 2 week‐13/2010, but 1% higher then week‐13/2009. 0 1 4 7 101316192225283134374043464952 Epi‐week This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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]. 02 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Table-3: Alerts reported in week 13 of 2011 Male Female Date of alert Province District Location Disease Action taken / Notes > <5 <5 >5 5 5 suspected cases reported, 2 samples taken and sent to NIH for lab 26-Mar-11 Balochistan Chagai Girdi Jungle Measles 1 4 0 0 confirmation. Health awareness sessions conducted in the community. Informed EDO‐H and EPI Field investigation conducted, six patients of Chickenpox found. Health Chicken 29-Mar-11 Jaffarabad Tent City 4 0 0 2 Balochistan Pox education was given on prevention of the disease and advised the pa‐ tients to visit nearest HF for further treatment. Alerts from 2 different locations reported 90 cases (65 and 25 respec‐ BHU Gandakha and tively). 43 samples (29 and 14) tested and 25 found positive (16 and 9). 31-Mar-11 Balochistan Jaffarabad BHU Mohd Ibrahim Malaria 0 0 0 0 Gajani EDO‐H informed and requested to provide ant malarial drugs and RDTs at the reporting health facilities. Two alerts from 2 different locations reported 43 cases (9 and 14 respec‐ BHU Barija and BHU tively). 23 samples (9 and 14) tested and 16 found positive (7 and 9). RDT 25-Mar-11 Balochistan Jhal Magsi Malaria 0 0 0 0 Dhor-Ri Kits provided.