Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 3, Issue 13, Wednesday 4 April 2012 Highlights Priority diseases under surveillance Epidemiological week no. 13 (25 to 31 March 2012) in DEWS Acute (Upper) Respiratory Infection • In week 13, 2012, total 87 districts including 3 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 1,881 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 755,137 consultations were reported through DEWS of which 20% were acute Other Acute Diarrhoea respiratory infections (ARI); 7% were acute diarrhoea; 4% were suspected malaria; while 4% were Suspected Enteric/Typhoid Fever Skin disease. Suspected Malaria Suspected Meningitis Suspected Dengue fever • A total of 164 alerts with 17 outbreaks were reported/identified in week 13, 2012: Alto‐ Suspected Viral Hemorrhagic Fever gether 93 alerts for Measles; 22 for Leishmaniasis; 13 for Typhoid; 9 for ARI; 6 for NNT; 5 for Per‐ Pyrexia of Unknown Origin tussis; 4 for AWD; 2 each for Acute diarrhoea, Bloody diarrhoea, AJS, Scabies and Chicken Pox; Suspected Measles Suspected Acute Viral Hepatitis while 1 each for Diphtheria and Dengue Fever. Chronic Viral Hepatitis Neonatal Tetanus • In this week no new polio cases was reported. As of 2 April 2012, the total number of polio Acute Flaccid Paralysis cases confirmed by the laboratory is 15 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‐13, 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 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 wk wk Table 1: Most common communicable diseases syndromes reported weekly Disease Wk-6 Wk-7 Wk-8 Wk-9 Wk-10 Wk-11 Wk-12 Wk-13 Acute respiratory infection 141,503 (25%) 159,074 (26%) 153,111 (24%) 157,828 (23%) 155,186 (23%) 158,872 (23%) 141,713 (21%) 150,480 (20%) Skin diseases 27,267 (5%) 29,199 (5%) 28,820 (4%) 29,430 (4%) 30,909 (4%) 31,383 (4%) 28,391 (4%) 31,018 (4%) Acute diarrhoea 29,359 (5%) 30,607 (5%) 31,623 (5%) 34,918 (5%) 38,427 (6%) 40,328 (6%) 40,810 (6%) 49,875 (7%) Bloody diarrhoea 2,681 (0.48%) 2,730 (0.45%) 2,765 (0.43%) 3,094 (0.45%) 2,874 (0.42%) 3,627 (0.51%) 2,853 (0.43%) 3,410 (0.45%) Suspected malaria 21,813 (4%) 22,883 (4%) 23,483 (4%) 28,265 (4%) 29,599 (4%) 30,498 (4%) 29,445 (4%) 32,290 (4%) Total consultation 557,926 605,633 650,423 680,221 688,813 705,715 669,876 755,137 • 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 Sindh, KP and FATA while acute diarrhoea is highest in Balochistan and Sindh (please see the graphs for every province in page 6 and 7). 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. 13 (25 to 31 March 2012) Previous week's (12/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 2 suspected cases of Leishmaniasis were reported from RHC Lakhra and 5 more cases found Village Dovina, Tehsil during active surveillance. Patients having no travel history. Inj Glucantime was advised and 19‐Mar Leishmaniasis Balochistan Lasbela 1 2 1 3 Lakhra guided to take regular treatment. Information was shared with DHMT and requested to take intervention as cases were received on regular basis. Goth Yar Muhammad 6 suspected cases for Measles investigated and Vit‐A was administered, while 3 samples were 19‐Mar Measles Balochistan Nasirabad 0 0 0 0 Pindarani, UC Quba taken and sent to NIH. DHMT was informed. 6 AWD cases from one family at Village Jattgram, Tehsil Wari, Dir Upper reported from RHC Wari . One stool sample collected and sent to NIH but found negative for Cholera. Unpro‐ tected spring water was the suspected source. Line list of cases maintained and shared with Village Jattgram, UC EDO‐H, In charge RHC Wari and health authorities. WHO provided 1430 Aqua tabs, 100 ORS, 19‐Mar AWD KPK Upper Dir 2 2 1 1 Nihagdarra, Tehsil Wari 7 Hygiene kits, 10 jerry cans, 144 soaps and 2 straw filters to the affected families, while EHE chlorinated the main source; Shock chlorination of springs, water storage tanks. On job train‐ ing of community on disinfection of water sources, clothes and utensils and emphasis was given on use of boiling water for drinking. IEC material provided to the villagers. An alert for measles 5 cases reported from two different locations (CD KTS3 and CH Khalabut). 31 houses were assessed in 2 both locations 37 children between 9 months to 5 years were Khalabut Township UC assessed. 16 children had measles 1 and 25 children with measles 2 vaccine. 9 children were 19‐Mar Measles KPK Haripur 2 1 1 1 Khalabut below 9 months. EPI coordinator and EDO Health were informed. Measles campaign is planned in 5 UC of District Haripur adjoining Afghan Refugee camp. Health session was con‐ ducted on prevention and spread for the affected families An alert of suspected measles case was reported from BHU Sikandarpur. Active surveillance was carried out and 78 more cases were identified. Vit A given to the cases. Vaccination status was assessed in the surrounding out of seven houses that were assessed, found 15 children Makhan Colony UC 19‐Mar Measles KPK Haripur 1 2 2 3 with no vaccination history of any sort. No BCG scar was seen in any of the children. EPI Sikandarpur coordinator and EDO Health were informed. Immediate mop up campaign was launched in the area for measles, Pentavalent and OPV. Blood samples were taken and set to NIH. Follow‐ up is planned. During routine visit to SGTH WHO Swat team found three cases of Suspected Measles belong‐ ing to the same village. Detailed histories were taken from the patients and Blood Samples Village Sar Sardarey Bar were collected, while Vitamin A doses provided. WHO along with a team from DoH went to 18‐Mar Measles KPK Swat Jabar, UC Aka Maruf 8 1 0 1 Bamikhel, Tehsil Babuzai area for active surveillance and eight more cases were found in the village. Outreach vaccina‐ tion was conducted in the area in which 347 children were vaccinated. Health education session was conducted in the community regarding the importance of routine immunization. Sethaar verho Village Suspected case of measles was reported from GD Boriri, during active surveillance Vit(A) dose 24‐Mar Measles Sindh Shikarpur borriri UC taib taluka 2 0 1 2 was given, immunization status was not good, health education was imparted, EDOH in‐ lakhi formed and 4 Blood samples were collected and sent to NIH. Probable Pertussis cases was found by SO DEWS Sukkur, during active surveillance found 14 village Ulra Jageer taluka cases in 5 houses where only 4 children were found vaccinated, index case has been taken to 24‐Mar Pertussis Sindh Khairpur 3 5 4 2 Kingri Agha khan hospital karachi, health education was imparted, health promotion activity planned with EPI vaccinator and LHWs. Probable Pertussis case was investigated at village haji Achar Chandio; During active surveil‐ Shaheed village haji Achar Chandio lance 7 more cases found. Only one child was fully vaccinated found among 10 children under 24‐Mar Pertussis Sindh 0 0 2 6 Benazirabad taluka Qazi Ahmed 2 years of age, while 3 cases were admitted in hospital. Syrup Erythromycin provided to all the suspects. EDO‐H informed. Current week's (13/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 6 cases of suspected measles were reported from wapda colony. Vit A and supportive treat‐ wapda colony, UC Sadar‐ ment was given to all patients. DHO was informed and started responding to community 28‐Mar Measles Balochistan Kharan 0 3 0 3 ran town about immunization. No sample was collected as parents refused. On the house hold survey 67 children were checked for routine vaccines. 49% were found vaccinated. Alert of 3 suspected measles cases were reported from AHQ Landikotal.On active surveillance Village Musalyan,UC Khyber 4 more cases were found in the area. 1 blood sample collected and Vit (A)drops provided. 28‐Mar Measles FATA Sheikh Mal Khel Mirdad 3 0 4 0 Agency Khel, Tehsil Landikotal mopup activity conducted and vaccinated 75 children. Health education imparted and the details were shared with Agency Surgeon and FSMO. Alert of 3 suspected measles cases were reported from CD Pindi Lalma.