Weekly Epidemiological Bulletin 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]. Epidemiological week no. 40 (30 September to 6 October, 2011) • 83 districts and 2 agencies provided surveillance data to the DEWS this week from 2,640 health facilities. • A total of 1,006,302 consultations were reported through DEWS of which 22% were acute respiratory infections (ARI), 11% Skin disease, 10% acute diarrhoea, and 6% suspected Malaria. • A total of 225 alerts with 20 outbreaks were reported in week-40, 2011: Altogether 114 for DHF; 41 were for AWD; 21 for Measles;19 for Leishmaniasis; 14 for Neonatal Tetanus and Tetanus; 4 for Malaria; 3 each for Diphtheria and Pertussis; 2 for Bloody diarrhoea; while 1 each for Acute jaundice syndrome, Acute diarrhoea, Typhoid and Mumps. • National Polio Eradication Initiative reported 11 new type-1 confirmed polio cases this week: 2 each from Killa Abdullah and Quetta, while 1 from Pishin (districts in Balochis- tan) 2 from North Waziristan (FATA); 1 each from Peshawar, Buner and Nowshera (districts in Khyber Pakhtunkhwa); and 1 from Gaddap (Sindh). As of 10 October, 2011, Pakistan has reported a total of 111 polio cases (110 type-1 cases and 1 type-3 case) from 38 districts/towns/tribal agencies/areas. Highlights Disease early warning system and response in Pakistan 01 Volume 2, Issue 40, Monday 10 October, 2011 Priority diseases under surveillance in DEWS Acute Flaccid Paralysis (AFP) Acute Jaundice Syndrome (AJS) Acute Respiratory Infections (Upper and Lower) (ARI) Acute Watery Diarrhoea (AWD)/ Suspected Cholera Acute Bloody Diarrhoea (BD) Other Acute Diarrhoeas (AD) Suspected Viral Hemorrhagic Fever (VHF) Suspected Malaria (Mal) Suspected Measles (MS) Suspected Meningitis (MG) Others Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 6 October 2011 (Epi week 31, 2010 to week 40, 2011) Disease Wk-33 Wk-34 Wk-35 Wk-36 Wk-37 Wk-38 Wk-39 Wk-40 Acute Diarrhoea 101,174 (10%) 94,494 (11%) 40,403 (10%) 96,128 (11%) 109,523 (12%) 110,835 (11%) 105,295 (11%) 96,067 (10%) Total consultation 988,119 880,166 389,729 864,693 931,318 1,005,251 995,450 1,006,302 Since July 29, 2010, approximately 47,604,357 patient consultations have been reported to the DEWS from all provinces and three agencies and state of AJK. In this week 40, 2011 (30 September to 6 October, 2011) reports were received from 2,640 health facilities and the major causes for seeking health care by the communities in almost all of the provinces were Acute respiratory infections 207,617 (21%), Skin diseases 95,559 (10%), diarrheal diseases 96,067 (10%), and suspected malaria 82,437 (8%). The above graph shows the trend of four major diseases number of cases out of total consultations reported to DEWS. 0 5 10 15 20 25 30 35 40 45 50 wk‐31 wk‐33 wk‐35 wk‐37 wk‐39 wk‐41 wk‐43 wk‐45 wk‐47 wk‐49 wk‐51 wk 1 wk 3 wk 5 wk 7 wk 9 wk 11 wk 13 wk 15 wk 17 wk 19 wk 21 wk 23 wk 25 wk 27 wk 29 wk 31 wk 33 wk 35 wk 37 wk 39 Percentage AD BD ARI S. Malaria
Transcript
Weekly Epidemiological Bulletin
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].
Epidemiological week no. 40 (30 September to 6 October, 2011)
• 83 districts and 2 agencies provided surveillance data to the DEWS this week from 2,640 health facilities.
• A total of 1,006,302 consultations were reported through DEWS of which 22% were acute respiratory infections (ARI), 11% Skin disease, 10% acute diarrhoea, and 6% suspected Malaria.
• A total of 225 alerts with 20 outbreaks were reported in week-40, 2011: Altogether 114 for DHF; 41 were for AWD; 21 for Measles;19 for Leishmaniasis; 14 for Neonatal Tetanus and Tetanus; 4 for Malaria; 3 each for Diphtheria and Pertussis; 2 for Bloody diarrhoea; while 1 each for Acute jaundice syndrome, Acute diarrhoea, Typhoid and Mumps.
• National Polio Eradication Initiative reported 11 new type-1 confirmed polio cases this week: 2 each from Killa Abdullah and Quetta, while 1 from Pishin (districts in Balochis-tan) 2 from North Waziristan (FATA); 1 each from Peshawar, Buner and Nowshera (districts in Khyber Pakhtunkhwa); and 1 from Gaddap (Sindh). As of 10 October, 2011, Pakistan has reported a total of 111 polio cases (110 type-1 cases and 1 type-3 case) from 38 districts/towns/tribal agencies/areas.
Highlights
Disease early warning system and response in Pakistan
01
Volume 2, Issue 40, Monday 10 October, 2011
Priority diseases under surveillance
in DEWS
Acute Flaccid Paralysis (AFP)
Acute Jaundice Syndrome (AJS)
Acute Respiratory Infections (Upper and Lower) (ARI)
Acute Watery Diarrhoea (AWD)/ Suspected Cholera
Acute Bloody Diarrhoea (BD)
Other Acute Diarrhoeas (AD)
Suspected Viral Hemorrhagic Fever (VHF)
Suspected Malaria (Mal)
Suspected Measles (MS)
Suspected Meningitis (MG)
Others
Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 6 October 2011 (Epi week 31, 2010 to week 40, 2011)
Total consultation 988,119 880,166 389,729 864,693 931,318 1,005,251 995,450 1,006,302
Since July 29, 2010, approximately 47,604,357 patient consultations have been reported to the DEWS from all provinces and three agencies and state of AJK.
In this week 40, 2011 (30 September to 6 October, 2011) reports were received from 2,640 health facilities and the major causes for seeking health care by the communities in almost all of the provinces were Acute respiratory infections 207,617 (21%), Skin diseases 95,559 (10%), diarrheal diseases 96,067 (10%), and suspected malaria 82,437 (8%). The above graph shows the trend of four major diseases number of cases out of total consultations reported to DEWS.
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 40 (30 September to 6 October, 2011)
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]. 02
Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken
11 22 7 13 Alert for malaria was reported. Investigation, testing of 53 samples; 25 were positive (11 Pf,10 Pv and 4 mixed)‐ SPR 47%; FR 60%. Cases were treated and RDTs and treatment provided for future cases. DHO informed for further preventive measures
5‐Oct Malaria Balochistan Kharan Jouzan U/C southern Kharan town
3 13 2 10 Malaria alert was reported. 28 Slides were tested and 19 were positive (Vivax= 11 Falciparum=8)‐ SPR 68%; FR 42%. Anti Malaria medicines were provided to cases and affected families were advised to take preventive measures.
6‐Oct Pertussis Balochistan Chagai Girdi jungle Refugee camp
1 1 2 1 5 cases were investigated and found with typical symptoms. Erythromycin was given to case and contacts. Health education promoting infant immunization session, hand washing and cough etiquette was conducted among affected families.
30‐Sep AWD KPK Shangla Village Dawut/UC sarkoo/Tehsil Chakesar
50 140 42 90
AWD alert age 25 years, presenting to BHU Maira; Diarrhea onset to severe dehydration 48 h. ; Stool sample sent for analysis, Active surveillance was conducted with DOH/ NPH/PRCS‐GRC/PPHI. Several more cases of AWD were identified all drinking water from one source the spring and a community tank. Outbreak was declared, HUB and National office informed. Mobile DTC established which treated a total of 322 patients till end of patient intake on 5th October, Community tank was examined and shock chlorination performed, Health and hygiene session conducted in the community with 263 participants over 6 days including 106 female attendants. Hygiene kits, aquatabs, and jerry cans distribution have been started. Followup planned.
30‐Sep Measles KPK Haripur Village Dharyian, UC Nara Amazai
9 11 2 6
5 cases and 1 death of measles were reported from village Dharyian UC Nara Amazai. Joint WHO‐DOH team carried out Epidemiological assessment. Blood samples sent to NIH. Active case finding further revealed 23 more cases that had measles within past month. All the active cases were given VitA. Immunization status was poor. EDO health and EPI coordinator were informed of the outbreak. Health education sessions were carried out on immunization and preventive measures. 3 day mop up campaign for all children under 15 years was planned and executed in the area.
08 Patients with DF reported at Nishter Hospital Multan from different locations of Khanewal district and mostly from the rural areas. All of them have history of either travel or stay at Lahore in recent past or an established epidemilogical link with Dengue patient. Necessary measures at hospital ensured. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department informed at district Khanewal and provincial level. Follow up is on going.
6‐Oct DHF Punjab Multan Nishter Hospital Multan, Multan City
0 22 0 1
23 Patients with DF reported at Nishter Hospital Multan from different locations of Tehsil Multan and mostly from the city areas. 18 patients have history of either travel or stay at Lahore in recent past or an established epidemilogical link with Dengue patient. Only 5 cases are indigenous to Multan and no travel history. Necessary measures at hospital ensured. All the locations were visited one by one by WHO team and DoH staff. Active case finding of the area done in the respective localities. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department informed at district and provincial level. vector density survey was conducted at all the 5 places by the Assist. entomologist. Follow up is on going.
11 Patients with DF reported at Nishter Hospital Multan from different locations of Muzaffargarh district and mostly from the rural areas. All of them have history of either travel or stay at Lahore in recent past or an estab‐lished epidemilogical link with Dengue patient. Necessary measures at hospital ensured. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department & SO informed at district Muzaffargarh and provincial level. Follow up is on going.
3 DHF patients from R.Y.Khan district ‐ one working in Karachi, one from Lahore and one from RYK. Blood samples sent to IPH. 3 Contact samples from each were collected and screened using ICT. IRS and outdoor fumigation/fogging of the house and neighbouring 30‐36 HH was also conducted through CDC program. HH were visited for finding additional cases. Health Education session was also conducted and LHWs mobilized to conduct additional sessions.
09 Patients with DF reported at Nishter Hospital Multan from different locations of Vehari district and mostly from the rural areas. All of them have history of either travel or stay at Lahore in recent past or an established epidemilogical link with Dengue patient. Necessary measures at hospital ensured. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department informed at district Vehari and provincial level. Follow up is on going.
5‐Oct Leishmaniasis Punjab Khushab Village Pael,UC Pael Padhrar,Khushab
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11 Leishmaniasis Cases were reported from UC Pael Padhrar District Khushab. EDOH was informed. IRC who is running a Leishmaniasis control project in the region was engaged to visit location, linelist cases and train health care providers for leishmaniasis treatment and prevention, Patients were screened by DDOH for IM and IL injections, Duty of dispenser in RD Pael to collect injections from EDO(H) office, Malaria Program requested for fogging and IRs of the area.
6‐Oct AWD Sindh Hyderabad Village Ghelo Noon‐ari
5 0 5 0 1 AWD case and 9 patients with moderate dehydration and 1 Death reported from hospital, People drinking contaminated water from Hand Pump, convey health education, Provided Aqua tabs, Jerrycans, Family Filters and Hygiene kits for health and Hygiene, EDO‐H informed and 2 water sample taken.
6‐Oct AD Sindh Matiari
Village Panj Moro Uc shahmir Rahoo Taluka New Saeeda‐bad
2 2 1 2 Alert for diarrhea with 10 cases hospitalized with Moderate dehydration, People drinking contaminated water from Hand Pump, conveyed health education, Provided Aqua tabs, Jerrycans, Family Filters, Zinc tabs, IEC Mate‐rial and Hygiene kits for health and Hygiene, EDO‐H informed, 1 Stool and 2 water sample taken.
5‐Oct AWD Sindh Naushahro Feroze
Channa Muhallah UC Darbelo, taluka Kandiyaro
4 2 1 0 1 death due to AWD confirmed, upon investigation 6 other cases found, WHO team responded alert and pro‐vided EH material and health & hygiene education to affected community.
6‐Oct AWD Sindh Naushahro Feroze
UC‐Darbello ,Channa Paaro Taluka Kan‐diaro
1 2 2 2 One alert for AWD and 6 cases diarrhea with moderate dehydration, Health hygiene session conducte , Aqua tabs, toilet soaps, laundry soaps hygeine kits, IEC material distributed
2 6 1 4 Alert for 4 deaths from AWD, on Active Surveillance 9 AWD cases were found, health education provided, Aqua tabs, Zinc tabs, Jerrycans and ORS distributed, EDO‐H informed .
6‐Oct AWD Sindh Umer Kot Village Chaudhri Abdul Rafiq Arain, UC Araro Burghuri
3 5 0 3 AWD cases reported in hospital. Reinforced proper case management, health education regarding hand washing, EDO‐H informed and 11 cases investigated. Water source investigation planned.
2‐Oct Malaria Sindh Naushahro Feroze
UC‐Bhiria, Relief camp, primary school Bhiria
2 5 4 5 16 cases (falciparum‐6 & vivax 10) malaria confirmed by RDT , OPD cases treated, hospital treatment arranged for severe cases, 20 bednets distributed by SO‐WHO, request was made to EDO for fumigation.
Epidemiological Bulletin: DEWS, Pakistan, Week no. 40 (30 September to 6 October, 2011)
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]. 03
Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F
3‐Oct AD N Feroze Village Bhimani, deh Kandiaro 6 4 5 4
5‐Oct AWD Dadu Village Ahmed Khan Brihmani 3 1 0 0
6‐Oct AWD Dadu Shafan Abad Colony, Phulji Station 1 1 0 0
5‐Oct Typhoid Chagai Killi khan jan Town Dalbandin 0 1 1 2
Epidemiological Bulletin: DEWS, Pakistan, Week no. 40 (30 September to 6 October, 2011)
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]. 04
Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F
6‐Oct BD Skardu Abbas abad oro UC kumra Tehsil Skardu
0 0 0 1
5‐Oct DHF Gilgit DHQ Hospital Gilgit 0 2 0 1
4‐Oct Leishmani‐
asis Diamer DHQ Hospital Chilas 1 1 0 0
3‐Oct Measles Diamer DHQ Hospital Chilas 1 0 0 0
Epidemiological Bulletin: DEWS, Pakistan, Week no. 40 (30 September to 6 October, 2011)
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]. 05
Province Khyber Pakhtunkhwa: • This week 739 health facilities from 20 districts reported to
DEWS with a total of 173,371 patients consultations.
• The proportional morbidity of AD showing gradual decline during the last 4 weeks after a consistent higher proportion (16%) for almost 10 weeks.
• 51 alerts were reported in this week, 29 were for DHF, 13 for Measles, 6 for AWD, 2 for Diphtheria, while 1 for Neo-natal Tetanus.
• 2 outbreaks 1 each for AWD and Measles were identified and responded.
Figure-3: Trend of priority communicable diseases, province KPK
Province Sindh:
• This week 727 health centers from 20 districts reported to DEWS with a total of 425,927 patient consultations.
• In Sindh, AD cases reported were 45,301 (11%), propor-tional morbidity lower by 1% as compared with last week.
• 65 alerts were reported from Sindh in this week: 32 were for AWD; 18 for DHF; 8 for Neonatal tetanus; 2 each for Ma-laria and Tetanus, while 1 each for Acute diarrhoea, Measles and Pertussis.
• 7 outbreaks 6 for AWD and 1 for Malaria were identified and responded.
Figure-4: Trend of priority communicable diseases, province Sindh
Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease
Post Flood 2010 2011 (up till wk 39) Current Week (40) Total
Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 6 October 2011, compiled from weekly reports
Diseases Total
Acute Respiratory Infection 10,584,864 (22%)
Skin Diseases 5,169,031 (11%)
Acute Diarrhoea 4,573,445 (10%)
Bloody Diarrhoea 406,345 (1%)
Suspected Malaria 2,883,295 (6%)
Unexplained Fever 1,822,502 (4%) Total Consultations 47,604,357
Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 40/2011)
949 107
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854
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2021
226
2234
922
5521
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232
2245
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425
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2745
2909
2935
2982
3120
302
130
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305
831
96
325
032
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433
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332
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 40 (30 September to 6 October, 2011) Province Punjab: • This week 469 health facilities from 8 districts re-
ported data to DEWS from Punjab province with a total of 248,785 patient consultations.
• AD cases reported were 18,516 and showing propor-tional morbidity lower by 2% as compared with last week .
• 66 alerts were reported in this week from Punjab; 59 were for DHF; 4 for Leishmaniasis; 2 for AWD while 1 for Neonatal Tetanus.
• 8 outbreaks 7 for DHF and 1 for Leishmaniasis were identified and responded.
Figure-5: Trend of priority communicable diseases, province Punjab
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]. 06
State of Azad Jammu and Kashmir:
• In this week, reports received from 111 health facilities from 10 districts with a total of 36,422 patient consultations.
• ARI cases reported were 5,439 (15%), while Acute diarrhoea re-ported 1,875 (5%) cases.
• 7 alerts 4 for DHF, 2 for Measles and 1 for AWD were received and responded this week.
• This week 36 health facilities in 2 agencies reported from FATA, with a total of 8,137 patient consultations.
• ARI cases reported were 1,754 (22%), while Acute diarrhoea re-ported 687 cases (8%)
• 3 alerts 1 each for Diphtheria, Leishmaniasis and Pertussis were received and responded this week.
Province Gilgit Baltistan:
• In this week, 81 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 26,925 patient consultations.
• ARI cases reported were 5,648 (21%), while Acute Diarrhoea 3,725 (14%).
• 5 alerts received and responded this week, 2 were for Measles, while 1 each for DHF, Bloody diarrhoea, and Leishmaniasis.
Figure-7: Trend of priority communicable diseases, Gilgit Baltistan
FATA:
Province Balochistan:
• In this week, 18 districts reported to DEWS from Balochis-tan province. 477 health centers reported a total of 86,735 patient consultations.
• AD reported in 9,242 (11%) of the total consultations, 1% higher proportional morbidity as compared with the last week.
• 28 alerts were reported in this week from Balochistan, 13 were for Leishmaniasis; 3 each were for DHF and Measles; 2 for Neonatal tetanus and Tetanus; while 1 each for AJS, Bloody diarrhoea, Pertussis, Typhoid and Mumps.
• 3 outbreaks 2 for Malaria and 1 for Pertussis were identi-fied and responded.
Figure-6: Trend of priority communicable diseases, province Balochistan
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 40 (30 September to 6 October, 2011)
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]. 07
Distribution of Wild Polio Virus cases Pakistan 2010 and 2011
Year 2010: The total number of polio cases reported in 2010 is 144 includ‐ing 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/agencies. Year 2011: As of 10 October, 2011, the total number of polio cases con‐firmed by the laboratory is 111 (110=type‐1, and 1=type3) from 38 districts.
Focus on: Malaria
Floods may indirectly lead to an increase in vector‐borne diseases through the expansion in the number and range of vector habitats. Standing water caused by heavy rainfall or overflow of rivers can act as breeding sites for mosquitoes, and therefore enhance the potential for exposure of the disaster‐affected population and emergency workers to infections such as dengue and malaria. Flooding may initially flush out mosquito breeding, but it comes back when the waters recede. The lag time is usually around 6‐8 weeks before the onset of a malaria epidemic.
The risk of outbreaks is greatly increased by factors related to disasters: increased exposure to mosqui‐toes of displaced persons sleeping outside and disruptions to health care and disease control activities. Malnutrition and other concurrent infections can leave displaced populations particularly vulnerable to malaria infection as well.
Pakistan is a malaria endemic country; the estimated numbers of malaria cases which may occur annually are as high as 1.6 million. However the reported confirmed cases from the public sector health facilities (microscopy centers) in 2009 were 167,579 cases, with 71,970 cases due to P. falciparum (39%). After the 2010 Flood, malaria was found in more districts and there were almost double the number of cases re‐ported overall (287,870) and of P. falciparum (116,105).
Although the risk of transmission of malaria can increase in the context of an emergency, effective control and the reduction of transmission is possible. There may still be time to implement preventive measures such as indoor residual spraying and distribution of insecticide‐treated nets, as effective options in areas where their use is well‐known. This will also have an effect on other mosquito‐borne diseases. The most important intervention is to have adequate diagnostic facilities, whether microscopy units or rapid diag‐nostic tests, and to effectively treat all confirmed cases.
DEWS teams have responded to malaria alerts in the following districts since 1st September 2011: (Thatta, Badin, Larkana, Sukkur and Naushahro Feroze in Sindh and Chagai, Ziarat, Kech, Kharan and Jhal Magsi in Balochistan).
Province Cases 2010 Cases 2011 P1 P3 P1 P3
Punjab 6 1 2 -
Sindh 26 1 20 -
Khyber Pakhtunkhwa 19 5 12 -
FATA 63 11 28 1
Balochistan 6 6 47 -
AJK - - - -
Gilgit‐Baltistan - - 1 -
Islamabad - - - -
Total 120 24 110 1
Epidemiological Bulletin: DEWS, Pakistan, Week no. 40 (30 September to 6 October, 2011)
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]. 08
