Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 2, Issue 45, Monday 14 November, 2011 Highlights Priority diseases under surveillance Epidemiological week no. 45 (4 to 10 November, 2011) in DEWS Acute Flaccid Paralysis (AFP) • 80 districts and 2 agencies provided surveillance data to the DEWS this week from 2,314 health facilities. Data from mobile teams is reported through sponsoring BHU or Acute Jaundice Syndrome (AJS) RHC. Acute Respiratory Infections (Upper and Lower) (ARI) • A total of 397,222 consultations were reported through DEWS of which 97,966 Acute Watery Diarrhoea (AWD)/ (25%) were acute respiratory infections (ARI); 33,447 (8%) were Skin disease; 31,381 Suspected Cholera (8%) were acute diarrhoea; and 29,893 (8%) were suspected malaria. The timeliness Acute Bloody Diarrhoea (BD) decreased compared with last week due to EID holidays. Other Acute Diarrhoeas (AD) • A total of 59 alerts with 6 outbreaks were reported in week‐45, 2011: Altogether Suspected Viral Hemorrhagic 15 alerts for AWD, 7 for Neonatal tetanus, 6 each for Leishmaniasis and Measles, 2 for Fever (VHF) Malaria, 1 each for Bloody diarrhoea and Pertussis, while 21 for other non‐ Suspected Malaria (Mal) communicable diseases. Suspected Measles (MS) • National Polio Eradication Initiative reported in this week no new polio case was Suspected Meningitis (MG) reported from any district. Others Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 27 October 2011 (Epi week 31, 2010 to week 45, 2011) 50 AD BD ARI S. Malaria 45 40 35 30 Percentage 25 20 15 10 5 0 1 3 5 7 9 45 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 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 wk Disease Wk-38 Wk-39 Wk-40 Wk-41 Wk-42 Wk-43 Wk-44 Wk-45 Acute respiratory infection 193,771 (19%) 205,597 (21%) 209,436 (21%) 223,902 (22%) 213,432 (24%) 193,364 (24%) 217,168 (25%) 97,966 (25%) Skin diseases 107,243 (11%) 105,912 (11%) 95,842 (9%) 94,167 (9%) 81,161 (9%) 69,317 (9%) 77,697 (9%) 33,447 (8%) Acute diarrhoea 110,835 (11%) 105,295 (11%) 97,007 (10%) 93,085 (9%) 74,189 (8%) 62,498 (8%) 65,503 (7%) 31,381 (8%) Bloody diarrhoea 8,676 (0.86%) 9,393 (0.94%) 8,075 (0.80%) 8,107 (0.78%) 6,089 (0.68%) 5,445 (.67%) 5,276 (0.60%) 2,647 (.67%) Suspected malaria 78,109 (8%) 83,684 (8%) 82,802 (8%) 86,326 (8%) 68,441 (8%) 58,552 (7%) 69,281 (8%) 29,893 (8%) Total consultation 1,005,251 995,450 1,014,266 1,033,276 897,598 807,463 877,957 397,222 Since July 29, 2010, approximately 51,215,386 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on around 1,000,000 consultations per week, there is a drop in timely reporting due to EID holidays, challenges in accessibility caused by floods, security and infrastructure. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 8 weeks (38 to 45, 2011) acute diarrhoea cases have been decreased (From 11% to 8%), while at the same time cases of ARI have been increased (From 19% to 25%). Sus‐ pected malaria cases have also shown seasonal increase from week 35 especially from districts in Sindh and Balochistan. 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. 45 (3 to 10 November, 2011) Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for malaria, reported from BHU Sarangani and investigated. All cases were reported Balochis‐ from village Sarangani. A total of 36 cases were attended and 32 samples were taken. 19 5‐Nov Malaria Jhal Magsi BHU Sarangani 9 11 7 9 tan samples were found positive (P.f. 8, P.v. 8 and mixed 3) (SPR =59.38%; FR = 57.90%) and treated. Malaria representative was informed for further preventive measures. Alert for malaria investigated, all cases were reported from town area of Jhalmagsi. A total of 301 suspected cases were reported and 184 samples were tested from which 143 (SPR = 78%) Balochis‐ 10‐Nov Malaria Jhal Magsi RHC Jhal Magsi 78 93 57 73 verified positive and treated (P.f. 47, P.v. 56 and mixed 40) (FR = 60.84%). DHO and Malaria tan representative was informed and briefed about the severity of the disease and requested for preventive measures. Probable diphtheria case, 6 years old, not vaccinated except polio, hospitalized on 6 Nov, Chunggi, Pind Paracha tracheotomy, ADS 80,000 IU, expired on 7 Nov 11 pm, respiratory distress, 2 siblings and 7 6‐Nov Diphtheria ICT Islamabad 0 1 0 0 (PIMS Hosp) cousins in household also un‐vaccinated, started on prophylactic erythromycin, EPI coverage survey ongoing and vaccination response planned. Probable diphtheria case, 20 months old female, not vaccinated except polio drops, hospital‐ ized on 6 Nov, ADS 80,000 IU, tracheotomy on 7 Nov, acute renal failure, myocarditis, expired 6‐Nov Diphtheria ICT Islamabad G‐Sokh, Bharakaho 1 0 0 0 8 Nov, 6 siblings un‐vaccinated, family moved from Bajaour 6 years ago, erythromycin pro‐ vided for all household members, field investigation ongoing, coordination of outreach vacci‐ nation planned. A Case of suspected AWD was reported, on active surveillance 5 more cases were found in same area with severe dehydration, all the patients were referred to DHQ Hospital for IV Village Gular, UC & 11‐Nov AWD KPK Lower Dir 0 2 2 2 therapy, Stool samples collected for lab confirmation, Water Samples taken for any fecal Tehsil Samar Bagh contamination, ORS, Hygiene kits & Aqua tabs distributed, Health & Hygiene promotion Ses‐ sion conducted with family members. EDO‐H was informed. 6 New cases of Leishmaniasis reported. No travel history. Clinical diagnosis was confirmed by IRC trained HCPs. Antileishmaniasis IM & IL injections provided. Community visited for active Leishmani‐ Tolla Mangalli, UC 4‐Nov Punjab Mianwali 0 2 0 4 case finding but no more cases found. Health Education was given to the family. Vector con‐ asis Chapri, Tehsil Issakhel trol of the area was advised. Line listing is ensured. BHU Chapri has an HCP trained on Leishmaniasis management. Current week's Alerts: Province Sindh Current week's Alerts: Province Punjab <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Date Disease District Area 4‐Nov AD Bhakkar Chuni Shumali, UC Gadola 2 9 3 10 4‐Nov AWD Dadu Marakhpur City Dadu 0 0 1 1 4‐Nov ARI RY Khan UC Langiwaar, Tehsil Khanpur 31 12 39 23 10‐Nov AWD Hyderabad Laloo Lashari, Kali Mori Taluka Hyderabad 0 1 0 0 5‐Nov ARI RY Khan UC Arif Balouch, Tehsil Liaqatpur 19 15 26 21 10‐Nov AWD Hyderabad Near Pathan Colony Hyderabad 0 1 0 0 5‐Nov ARI RY Khan UC Arif Balouch. Tehsil Liaqatpur 21 28 17 30 5‐Nov DHF Bhakkar DHQ Hospital Bhakkar, Chimni Mohallah 0 1 0 0 10‐Nov AWD Jamshoro Mahboob colony, Garibabad, UC Sanwaller 0 1 1 1 7‐Nov DHF DG Khan Block 18, Fareed abad Colony 0 1 0 0 10‐Nov AWD Matiari City Nasarpur Taluka Matirai 1 0 0 0 10‐Nov DHF Khanewal Nishter Hospital Multan‐Khanewal 0 38 0 2 10‐Nov AWD Mirpur Khas Bunglani Muhalla, Village Ali Nawaz Shah 1 1 1 0 4‐Nov DHF Multan Nishter Hospital Multan‐Muzaffargarh 0 2 0 0 6‐Nov AWD T Allah Yar Qubo Stop Taluka Tando Allahyar 0 0 0 1 10‐Nov DHF Multan Nishter Hospital Multan‐Multan City 0 7 0 2 4‐Nov DHF Muzaffargarh Moza Thathi Hamza, Chah Sar wala 0 1 0 0 10‐Nov AWD T Allah Yar Capri Cinema, Tando Adam city 1 0 0 0 9‐Nov DHF Pakpattan Nishter Hospital Multan‐Pakpattan 0 3 0 1 10‐Nov AWD T Allah Yar Siddique Akbar Madarsah 0 1 0 0 10‐Nov DHF RY Khan Sheikh Zaid Hospital‐Mohalla Gharibabad 0 2 0 0 Leishmani‐ 10‐Nov AWD Tharparkar IDP Camp Naukot, UC Mohrano 0 1 0 0 10‐Nov DG Khan Chah Chajrewala, near Basti Jam 0 1 0 0 asis 5‐Nov AWD Thatta Village M. Siddique, UC Chuohar Jamali 1 1 0 1 Leishmani‐ 4‐Nov Mianwali Tolla Mangalli, UC Chapri, Tehsil Issakhel 0 2 0 4 10‐Nov AWD Thatta UC 2 Makli cement factory, Taluka Thatta 1 0 0 0 asis Leishmani‐ 4‐Nov Rajanpur Basti Sontra, Moza Qazi Wala 0 0 0 2 10‐Nov AWD Thatta Village Soof Khaskhali UC Chillya 0 0 0 1 asis 10‐Nov AWD Thatta Village Umar Khaskhali UC Kala Kot 1 0 0 0 10‐Nov Scabies Muzaffargarh Basti Ahmad Mohana & Basti Jarh 28 41 33 50 9‐Nov UXF Mianwali THQ Kalalbagh, Mohalla Zameerabad 4 42 6 74 5‐Nov BD T Allah Yar Village Ghulam Hussain Lashari 2 1 1 1 10‐Nov UXF Muzaffargarh BHU Usman Koria 2 4 8 5 10‐Nov DHF Sukkur SZH RY Khan 0 1 0 0 Current week's Alerts: Province Khyber Pakhtunkhwa 10‐Nov Measles Sanghar Village Bochan Keerio, UC Kanahar 4 0 2 0 Date Disease District Area <5M >5M <5F >5F 10‐Nov NNT Karachi 12.No, Baldia Town 1 0 0 0 11‐Nov AWD Lower Dir Village Gular, UC & Tehsil Samar Bagh 0 2 2 2 10‐Nov NNT Karachi Mohalla Firdaus Chali, Quaidabad 0 0 1 0 10‐Nov NNT Kashmore Village Saendad Bhangwar, taluka Tangwani 1 0 0 0 4‐Nov DHF Haripur Afghan Refugee camp 20 0 1 0 0 10‐Nov NNT Khairpur Village Allah dino Bhutto, UC Rasool abad 0 0 1 0 4‐Nov DHF Haripur Village Muradabad 0 1 0 0 10‐Nov NNT Benazirabad Village Nabi Buksh, UC Haber 1 0 0 0 9‐Nov NNT Shikarpur Village Channa Junejo near Madeji 1 0 0 0 7‐Nov DHF Swabi National Program Swabi, Marghuz 0 1 0 0 10‐Nov NNT Sukkur Village Mohbat Abro, UC Lal Jurio 1 0 0 0 10‐Nov Measles Haripur Afghan Refugee camp Bassu