Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 2, Issue 37, Monday 19 September, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 37 (9 - 15 September, 2011) in DEWS • 77 districts and 3 agencies provided surveillance data to the DEWS this week from 2,480 Acute Flaccid Paralysis (AFP) health facilities. Acute Jaundice Syndrome (AJS) • A total of 910,590 consultations were reported through DEWS of which 19% were acute Acute Respiratory Infections (Upper and Lower) (ARI) respiratory infections (ARI), 12% Skin disease, 12% acute diarrhoea, and 7% suspected Malaria. Acute Watery Diarrhoea (AWD)/ Suspected Cholera • Over all diarrhoea has increased by 2% as compared to the previous few weeks. Acute Bloody Diarrhoea (BD) • A total of 181 alerts with 42 outbreaks were reported in week-37, 2011: Altogether 71 Other Acute Diarrhoeas (AD) alerts were for DHF; 65 were for AWD, 14 for NNT and Tetanus, 12 for Measles, 4 for Pertussis, 3 each were for bloody diarrhoea and Leishmaniasis; 2 each for acute diarrhoea Suspected Viral Hemorrhagic and suspected malaria, while 1 each for CCHF, Meningitis, Scabies, Mumps and Chicken Fever (VHF) pox. Suspected Malaria (Mal) Suspected Measles (MS) • National Polio Eradication Initiative reported 5 new type-1 confirmed polio cases this week: These include 3 from Balochistan (one each from districts Quetta Loralai and Suspected Meningitis (MG) Pishin); 2 from Sindh (Hyderabad and Umerkot). As of 15th September, 2011, Pakistan has Others reported a total of 89 polio cases (88 type-1 cases & 1 type-3 case) from 34 districts/towns/ tribal agencies/areas. 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-30 Wk-31 Wk-32 Wk-33 Wk-34 Wk-35 Wk-36 Wk-37 Acute Diarrhoea 103,098 (10%) 109,255 (10%) 106,918 (10%) 101,174 (10%) 93,559 (11%) 39,990 (10%) 95,494 (11%) 106,771 (12%) Total consultation 1,019,120 1,078,912 1,040,292 988,119 874,845 388,100 860,380 910,590 Since July 29, 2010, approximately 44,565,363 patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week 37, 2011 (9 to 15 September, 2011) reports were received from 2,480 health centers and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases 106,771 (12%), acute respiratory infections 170,530 (19%), Skin diseases 106,109 (12%) and suspected malaria 64,093 (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. 37 (9 to 15 September, 2011) Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Village Khel Mehdan, AWD alert was reported from RHC Khel, Distinct Muzaffarabad. Stool sample collected and sent to NIH Islamabad for lab 15‐Sep AWD AJK Neelum UC Khel , Tehsil 13 31 9 20 testing. Water sample taken for quality testing. Case management reinforced community awareness session conducted, IEC Sharda. material distributed and DHO was informed. System generated alert of 534 cases of AD were reported from Killi SATAKZAI, Bolan in a week time. DDK was provided to Balochis‐ Kili sataktzai, UC 9‐Sep AD Bolan 0 0 0 0 DoH. Aqua tabs were distributed in community and health education was given. 2 stool samples and 5 water samples were tan Mach, Tehsil Mach taken. Village Khan Abad, Khyber AWD alert, Case Investigated, Stool sample collected for lab confirmation, Water Samples taken for any fecal contamination, Dokrai, UC Kotkay, 13‐Sep AWD Pakhtunk‐ Lower Dir 1 5 0 4 during active surveillance 10 diarrhoea cases found. ORS, Hygiene kits and Aqua tabs were distributed, health and hygiene Maidan, Tehsil Lal hwa promotion session conducted with family members. EDO‐H was informed. Qilla Chamba Masjid stop UC Kholian Bala; During the week 6 cases of DF with 2 deaths were reported from 5 different locations. The patient presented with fever, Village Kalawan; headaches and body aches. Lab investigations revealed thrombocytopenia and leucopenia. 5 blood samples were taken and Khyber Village Dingi, UC all found positive for IgM Dengue. The patient was referred to BBS Hospital Rawalpindi but died on 15 Sep. Epidemiological 10‐Sep DHF Pakhtunk‐ Haripur Dingi; Village Ghayri‐ 0 3 0 3 and environmental assessments were carried out in the area. A session on DF spread and prevention was conducted for the hwa han, UC Koklian; affected household. Health session was carried out during Jumma Prayers in the area. Fogging was done and bed nets were Village Shah provided by EDO in the area. Maqsood UC Shah Maqsood Khyber Abbottabad DHQ Alert for DF, sample was collected and found positive for Dengue IgM, patient isolated at DHQ hospital, fog spray was done 12‐Sep DHF Pakhtunk‐ Lower Dir (Township, plot #6, 0 1 0 0 and bed nets were provided by EDO. hwa Lahore) Khyber Alert for DF reported from DHQ Hospital3 cases were admitted in Isolation ward by OPD, blood sample found positive for Village Timber Near 10‐Sep DHF Pakhtunk‐ Mansehra 0 1 0 0 Dengue IgM, health education conducted, and bed nets provided to the patients. EDO health informed and requested for Phulra hwa further necessary action. Khyber Village Landai Alert for DF, one case was reported from SGTH, blood sample found positive for dengue IGM. WHO Team along with DoH 14‐Sep DHF Pakhtunk‐ Swat Karinuna, UC Sakhra, 0 1 0 0 conducted a response at UC Sakhra and distributed LL INs. hwa Tehsil Matta AWD alert, ERT visited the area where 20 households were interviewed, six more cases were found and referred to RHC Basti Kalar Babran, Baseera. Health education provided to family members. Distribution of hygiene kits, water filters, soaps, Aqua Tabs, ORS & 14‐Sep AWD Punjab Muzaffargarh Moza Ali Daha, UC 0 3 0 3 IEC among them. Control measures and importance of awareness among general masses about safe drinking water, food & Noohanwali personal hygiene. alert for suspected DF 2 cases reported from a private hospital. The cases were investigated, blood samples were taken and found positive for IgG. Patients were shifted to Dengue ward, LLINS applied around the bed to prevent spread of infection. Chah Chandnewala; 13‐Sep DHF Punjab D. G. Khan 0 2 0 0 WHO team along with CDCO and entomologist visit the area, IRS plus insecticide spray of the household and in the vicinity Muradwala carried out. Dengue Prevention session was given to the community. EDO Health was informed and requested to update the provincial CDC. NHM; Mulas Pur Alert for suspected case of DF was reported from Nishtar hospital, the case was investigated blood sample was taken and 15‐Sep DHF Punjab Khanewal Kabir Wala District 0 1 0 0 found positive. The details and the line list are shared with the EDOH Khanewal and requested for taking further prevention Khanewal measures. chak no 131/TDA u/ cSemipurbhagal; Alert for DF 3 cases were reported from DHQ Hospital. 3 blood samples were taken and found positive for IgG. Patients were chak no 125tda U/c shifted to Dengue ward, LLINS applied around the bed to prevent spread of infection. During field investigation Dengue 12‐Sep DHF Punjab Layyah 0 3 0 0 tailindus; basti Prevention session were conducted in the community. EDO Health was informed and requested to take further necessary islampur u/c 2 measures. choubara rural Mohalla Alam Kheel,Balu Khel; Alert for DF, 5 cases were reported from five different locations. The cases were investigated. 5 blood samples were taken Betian,PAF Road; and all found positive for IgG. Patients was shifted to Dengue ward, LLINS applied around the bed to prevent spread of 10‐Sep DHF Punjab Mianwali Chidru Village and 0 4 0 1 infection. During field investigation IRS and insecticide spray of the household and in the vicinity carried out. Dengue Preven‐ UC Chodru; Paikhel; tion sessions were conducted in the community. EDO Health was informed and requested to update the provincial CDC. Line Piplan city, Tehsil listing updated. Piplan Alert for DF, 10 cases were reported from Nishter hospital. The cases were shifted to isolation ward. The details and the line list were shared with the EDOH Multan. WHO SO along with Health department team visited the areas and conducted house 12‐Sep DHF Punjab Multan Nishter Hospital 0 10 0 0 to house survey and found no more cases. two dengue awareness sessions were conducted in the feild and distributed IEC material regarding dengue prevention. Fogging of the whole union council is done by a CDC team from the health depart‐ ment. Naushahro Village Bohio UC Kor AWD alert, 36 cases were reported from two different locations. During field investigation two samples taken and sent to NIH 14‐Sep AWD Sindh 5 9 3 4 Feroze Hassan for lab confirmation, results awaited. Alert for AD, 15 cases were reported from GMCH Sukkur, upon investigation cases were found with acute diarrhea, Health 15‐Sep AD Sindh Sukkur Sukkur City 12 0 3 0 staff was sensitized on case definition of AD, health and hygiene session was also conducted for the affected.