Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 2, Issue 29, Monday 25 July, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 29 (15 - 21 July, 2011) in DEWS • 89 districts and 3 agencies provided surveillance data to the DEWS this week from 3,248 Acute Flaccid Paralysis (AFP) health facilities. Acute Jaundice Syndrome (AJS) • A total of 1,029,167 consultations were reported through DEWS of which 18% were acute respiratory infections (ARI), 12% skin disease, 10% acute diarrhoea, and 6% suspected Acute Respiratory Infections Malaria. (Upper and Lower) (ARI) Acute Watery Diarrhoea (AWD)/ • Critical situation of diarrhea in Khyber Pakhtunkhwa is surpassing the proportional mor- Suspected Cholera bidity recorded in the 2010 post-Flood period. 12 out of 21 reporting districts in KP have Acute Bloody Diarrhoea (BD) more than 16% diarrhea cases out of total consultations at public health facilities. Other Acute Diarrhoeas (AD) • A total of 127 alerts with 23 outbreaks were reported in week-29, 2011: Altogether 49 Suspected Viral Hemorrhagic alerts were for AWD; 39 for Measles; 6 for Pertussis, 5 each were for Acute diarrhoea, Fever (VHF) Leishmaniasis and Malaria, 4 each were for Neonatal tetanus and Mumps, 3 each were for Suspected Malaria (Mal) Bloody diarrhoea and Chicken pox, 2 for Scabies, while one each for Meningitis and Ty- phoid. Suspected Measles (MS) Suspected Meningitis (MG) • National Polio Eradication Initiative reported one new confirmed polio case this week from district Pishin in Balochistan. Total 60 (59=type1, and 1=type3) confirmed polio Others cases have been reported in 2011 from 25 districts. 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-22 Wk-23 Wk-24 Wk-25 Wk-26 Wk-27 Wk-28 Wk-29 Other Acute Diarrhoea (Not Watery) 102,005 (10%) 100,753 (10%) 102,217 (10%) 103,978 (10%) 107,924 (10%) 99,777 (10%) 104,139 (10%) 106,851 (10%) Total consultation 995,731 1,009,254 1,028,090 1,019,724 1,087,368 991,853 1,023,160 1,029,167 Since July 29, 2010, approximately 37,391,802 patient consultations have been reported to the DEWS from the five provinces and three agencies and state of AJK. In this week 29, 2011 (15 to 21 July, 2011) reports were received from 3,248 health centers and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases, acute respiratory infections (180,515), skin diseases (122,143) and suspected malaria (60,175). The above graph shows the trend of acute diarrhoea in 2009, 2010 and 2011 up until now. 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. 29 (15 - 21 July, 2011) Previous week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Alert for 46 cases of Malaria was reported, 12/18 samples found positive for Malaria (P. Falciparum 5, P.Vivax 4, Mixed 3). SPR Balochis‐ CD Baloo Pur, Tehsil 14‐Jul Malaria Jaffarabad 7 19 4 16 67% while Falciparum rate also 67%. Appropriate treatment initiated, DHO informed who requested for distribution of bednets tan Sohbat Pur in the affected location. A case of AWD reported from a private hospital. On field investigation a V.c. Ogawa positive case was found in the locality of 12‐Jul AWD ICT Islamabad Merabadia, F11/1 1 0 0 0 Merabadia opposite to F11‐1 sector. Patient recovered. No other case was found during active search. Water disinfection at household level, ORS and hygiene messages shared. Jhazo Maidan, UC One AWD case was reported by private clinic, case investigated jointly with DoH. Sample collected and sent to NIH and found 10‐Jul AWD KPK Hangu 0 1 0 0 Ganjiano Kale positive for V.c. Ogawa. No other suspected cases found on active surveillance. Preventive measures reinforced in the area. Suspected outbreak of AWD was reported from BHU Kundi from village Baji Sar. Patients presented to BHU with severe dehydra‐ tion and informed the in charge of BHU about other cases in their locality with same sign and symptoms. Investigations showed Village Baji Sar, the cases started on 10th of July after having a lunch at a wedding . Samples sent to NIH were found positive for V. c. Ogawa. 15‐Jul AWD KPK Haripur Union Council 3 15 4 24 Total of 46 cases were found on active case finding . 8 cases were severely dehydrated and 4 out of them were admitted in Kundi, Tehsil Ghazi different health facilities of Ghazi for treatment. Aqua tabs, ORS and soap were distributed and Health and Hygiene session was conducted for the affected community. EDO Health was informed of the outbreak One case of AWD reported. Sample collected and found positive for V.c. Ogawa, active surveillance conducted and 423 diar‐ Mohallah Pirano rhoea cases found in the area. EDO‐H, DSM PPHI, MS DHQH and Coordinator National programme informed and alerted. Health 11‐Jul AWD KPK Mardan Korona, UC Manga, 102 79 108 118 and Hygiene session conducted. LHWs continue house to house survey for diarrhea patients and to provide health and hygiene Charsadda Road education and distribute aqua tabs in the community. District Rapid Response team mobilized to strengthen RHC Manga and staff alerted and trained on diarrhea case management. 1 AWD case was reported from UC Pir Ashab, Tehsil and District Bhakkar, on active surveillance no more cases were found. Stool 13‐Jul AWD Punjab Bhakkar UC Pir Ashab 0 0 0 1 sample collected and found positive for V.c. Ogawa water samples were tested and found contaminated. Health and hygiene session given, ORS use was explained, life straws, jerry cans, aqua tabs and soaps were distributed in the community. UC Zeir Pir Village, Seven cases of AWD were recorded. Reinforce case management, Health education, Aqua tabs, ORS, IEC Material, family filters, 13‐Jul AWD Sindh Matiari Deper Lakha, Near 0 5 1 1 Jerry cans and Zinc Tabs provided, 1 stool sample collected and found positive for V.c. Ogawa, 5 Water samples also collected mansoorah for quality testing , EDO‐H and DOH Informed. Village Rab Rakhio Qambar 1 AWD case reported, stool samples found positive for V.c. Ogawa, 3 drinking water samples also collected for quality testing. 13‐Jul AWD Sindh Lakho, Tehsil 0 0 0 1 Shahdadkot The alert responded along with rapid response team of EDOH. Qambar Current week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Balochis‐ Village Kud Sayan‐UC AWD outbreak comprising of 35 cases. 2 stool sample collected and found positive for V.c. Ogawa, 4 water sample were also 16‐Jul AWD Lasbela 7 9 4 15 tan Kathore, Tehsil Bela collected. Report submitted to provincial office while AWD line list is being shared with provincial office on daily basis. AWD outbreak reported in media. Cases investigated with collaboration with DHO and health authorities staff, house to Balochis‐ Kehn, Barani Bhaint, UC 17‐Jul AWD Khuzdar 6 24 2 21 house survey revealed cases with typical sign and symptoms. Two stool and two water samples were collected and sent to tan Ornach, Tehsil Nall NIH. Health education session conducted, water filters, aqua tabs, hygiene kits were distribute in the community. Union Council Tasp Balochis‐ During NID, AWD alert was reported, area visited, 12 patients found. Early response team meeting was conducted with DHO 21‐Jul AWD Panjgor Sarekalat, Mohalla 5 4 1 2 tan and health authorities. DTC established in BHU Tasp Bazar. Medicine, Health education sessions provided. Johan Dun 43 cases on summing were observed and 14/19 verified positive of Malaria (P. Falciparum 6, P.Vivax 3, mixed 5). The DHO Balochis‐ CD Meher Ali, Tehsil 21‐Jul Malaria Jaffarabad 8 12 4 19 was informed and requested for distribution of bednets to the said location. (SPR=74%, FR=79%). Appropriate treatment tan Sohbat Pur initiated. 63 Suspected cases of Malaria reported from Jam Ghulam Qadir Hospital hub, 11/21 found positive for P. Falciparum, Balochis‐ Jam Ghulam Qadir 21‐Jul Malaria Lasbela 0 0 0 0 Information was shared with EDO Health and MS Jam Ghulam Qadir Hospital Hub for fogging and distribution of Bed net in tan Hospital, Hub the community. Request for RDT Kits was also made for Health Facilities of Lasbela. SPR=52%. 29 cases were observed. 10/17 samples collected were verified positive of Malaria (P.Falciparium 6, P. Vivax 3). The DHO Balochis‐ 21‐Jul Malaria Nasirabad BHU Kot Mengal 4 11 5 9 was informed and requested for distribution of bednets to the said location. SPR= 59%, FR= 60%). Appropriate treatment tan initiated. Zahoor colony, UC Balochis‐ 19‐Jul Typhoid Chagai Saddar, Killi Dilmurad, 0 2 2 1 Five suspected cases were reported. Health education sessions were conducted. DHO and health authorities were informed. tan UCPadag 4 suspected AD cases with moderate dehydration were reported and 23 more found during active surveillance in village Barkot, Haripur. The patients presented with moderate dehydration. Initial epidemiological investigation suggested contami‐ nated water was the source. Stool sample was taken sent to NIH and found positive for V.c. Ogawa. Environmental assess‐ 15‐Jul AWD KPK Haripur Village Bagra, UC Bagra 6 8 2 13 ment was carried out water samples were taken and found contaminated.