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. 17 (22 to 28 April 2012) • In week 17, 2012, total 87 districts including 2 agencies provided surveillance data to the DEWS on weekly basis from around 1,958 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC. • A total of 758,579 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI); 9% were acute diarrhoea; 5% were suspected malaria; while 4% were Skin disease. • A total of 246 alerts reported while 25 outbreaks were identified in week 17, 2012: Alto‐ gether 130 alerts for Measles; 25 for Leishmaniasis; 18 each for AWD and Typhoid; 17 for Acute diarrhoea; 11 for NNT and tetanus; 9 for Pertussis; 8 for Bloody diarrhoea; 3 each for acute jaun‐ dice syndrome and Scabies; 2 for DF; while 1 each for Malaria and ARI. • In this week no new polio cases was reported. As of 30 April 2012, the total number of polio cases confirmed by the laboratory is 15 from 10 districts/towns/tribal agencies and areas. Highlights Disease early warning system and response in Pakistan 01 Volume 3, Issue 17, Wednesday 2 May 2012 Priority diseases under surveillance in DEWS Acute (Upper) Respiratory Infection Pneumonia Suspected Diphtheria Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea Other Acute Diarrhoea Suspected Enteric/Typhoid Fever Suspected Malaria Suspected Meningitis Suspected Dengue fever Suspected Viral Hemorrhagic Fever Pyrexia of Unknown Origin Suspected Measles Suspected Acute Viral Hepatitis Chronic Viral Hepatitis Neonatal Tetanus Acute Flaccid Paralysis Scabies Cutaneous Leishmaniasis Others Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐17, 2012. • 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 the last 8 weeks proportional morbidity of the leading five disease syndrome. Proportional morbidity of ARI is highest in Khyber Pakhtunkhwa, Sindh and Balochistan, while acute diarrhoea is highest in Khyber Pakhtunkhwa, FATA, Sindh and Balochistan (please see the graphs for every province in page 7 and 8). Table 1: Most common communicable diseases syndromes reported weekly Disease Wk-10 Wk-11 Wk-12 Wk-13 Wk-14 Wk-15 Wk-16 Wk-17 Acute diarrhoea 38,427 (6%) 40,950 (6%) 41,535 (6%) 51,227 (7%) 52,033 (8%) 60,539 (9%) 63,332 (9%) 68,364 (9%) Total consultation 688,813 717,186 681,475 772,042 647,695 711,300 718,289 758,579 Suspected malaria 29,599 (4%) 30,594 (4%) 29,521 (4%) 32,888 (4%) 28,298 (4%) 30,846 (4%) 31,573 (4%) 34,721 (5%) Acute respiratory infection 155,186 (23%) 162,325 (23%) 145,261 (21%) 155,558 (20%) 128,653 (20%) 132,836 (19%) 131,146 (18%) 126,299 (17%) Bloody diarrhoea 2,874 (0.42%) 3,651 (0.51%) 2,890 (0.42%) 3,480 (0.45%) 2,977 (0.46%) 3,328 (0.47%) 3,563 (0.50%) 3,421 (0.45%) Skin diseases 30,909 (4%) 31,713 (4%) 28,719 (4%) 31,638 (4%) 28,123 (4%) 28,245 (4%) 28,441 (4%) 30,647 (4%) 0 5 10 15 20 25 30 35 40 45 50 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 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 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. 17 (22 to 28 April 2012)
• In week 17, 2012, total 87 districts including 2 agencies provided surveillance data to the DEWS on weekly basis from around 1,958 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC.
• A total of 758,579 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI); 9% were acute diarrhoea; 5% were suspected malaria; while 4% were Skin disease.
• A total of 246 alerts reported while 25 outbreaks were identified in week 17, 2012: Alto‐gether 130 alerts for Measles; 25 for Leishmaniasis; 18 each for AWD and Typhoid; 17 for Acute diarrhoea; 11 for NNT and tetanus; 9 for Pertussis; 8 for Bloody diarrhoea; 3 each for acute jaun‐dice syndrome and Scabies; 2 for DF; while 1 each for Malaria and ARI.
• In this week no new polio cases was reported. As of 30 April 2012, the total number of polio cases confirmed by the laboratory is 15 from 10 districts/towns/tribal agencies and areas.
Highlights
Disease early warning system and response in Pakistan
01
Volume 3, Issue 17, Wednesday 2 May 2012
Priority diseases under surveillance
in DEWS
Acute (Upper) Respiratory Infection Pneumonia
Suspected Diphtheria Suspected Pertussis
Acute Watery Diarrhoea Bloody diarrhoea
Other Acute Diarrhoea Suspected Enteric/Typhoid Fever
Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐17, 2012.
• 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 the last 8 weeks proportional morbidity of the leading five disease syndrome. Proportional morbidity of ARI is highest in Khyber Pakhtunkhwa, Sindh and Balochistan, while acute diarrhoea is highest in Khyber Pakhtunkhwa, FATA, Sindh and Balochistan (please see the graphs for every province in page 7 and 8).
Table 1: Most common communicable diseases syndromes reported weekly
Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012)
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
Previous week's (16/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken
18‐Apr Leishmaniasis Balochistan Killa Saifullah Village & UC Urgas 3 16 2 5 26 cases of Leishmaniasis were reported. Patients were investigated and found lesion on face, nose, arm and leg. All the patients have no travel history. Treatment as per WHO protocol was given. All information shared with DHO.
24 cases of suspected malaria were reported from BHU. 21 were tested on RDTs out of which 14 verified positive (slide positivity 67%). Distribution shows 05 FP, 05 Vivax and 04 Mixed (Falciparum ratio 64%). All the cases are from one location village barija. Anti Malarial medi‐cine were supplied to BHU to facilitate patient management. Information shared with DHO and requested for further prevention.
10 cases of Measles were reported from DHQ Hospital. All the patients were timely re‐sponded and presented with typical signs and symptoms. Vit A drops provided and health education imparted. 10 children were assessed for vaccination, 6 Children found totally unvaccinated whereas 4 had received only one dose of Measles. DHMT was informed and requested to send outreach team for vaccination.
2 Pertussis cases were reported. On investigation; 13 more cases were identified with same signs and symptoms. Patient was given health education. Erythrocin and Cough syrup was given. Community awarenesss session was conducted. All patients found totally unvaccinated. Information shared with DHO and EPI representative and requested to send outreach team for vaccination.
19‐Apr Measles FATA Khyber Agency
Mashoom baba Tatara, UC Kambila, Tehsil Mulagori
7 0 6 0
One case and a death due to measles were reported from BHU Kambila. On active surveil‐lance 13 cases including 2 deaths of suspected measles were identified in whom 6 seriously ill children were referred to the KTH Peshawar. The Agency Surgeon, FSMO and PPHI were informed.An investigation team including PPHI monitoring officer was formed for the affected area.Another death was occurred on the day the investigation team arrived there.Vitamin A given to the measles cases.Mass measles vaccination of 130 children were done.Health edu‐cation imparted.Blood samples of two suspected cases taken and sent to NIH Islama‐bad.Report shared with DOH and PPHI.
20‐Apr Measles Khyber Pakhtunk‐hwa
Buner charnee near kalpani tehsil gagra 2 0 4 0
2 cases of suspected measles were reported from BHU. On active surveillance, 4 more sus‐pected measles cases were found. All 6 cases found totally unvaccinated. 12 children were assesed in house cluster, 100% found vaccinated against pentavalent and measles 1 vaccine. 2 blood samples were taken. Information shared with EPI coordinator and outreach vaccination campaign will be planned in the locality.
17‐Apr Measles Khyber Pakhtunk‐hwa
Haripur Afghan Refugee camp 6 7 5 3 2
Alert of suspected measles case was generated by BHU. Suspected case was given Vit A drops. Blood sample was taken and sent to NIH. Active surveillance was conducted in the area. 16 more cases were identified who had measles in past 1 month. During active surveillance and record analysis, 1132 children were assessed for vaccination status. 338 children were missing measles 1 vaccine and 173 children were missing measles 2 vaccine. Children were referred to nearest health facility for completion of vaccination. Health education session on prevention and spread was conducted for the affected families. CHWs were involved in active case find‐ing. EDO Health and Save the children were informed about the outbreak.
18‐Apr Measles Khyber Pakhtunk‐hwa
Haripur Afghan Refugee camp 2 7 10 5 7
Alert of suspected measles case was generated from Afghan Refugee camp 2. Suspected case was given Vit A. Blood sample was taken and sent to NIH. Active surveillance was conducted in the area. 28 more cases were identified who had developed measles in past 1 month. On active surveillance and record analysis, 698 children were assessed for vaccination status.83 children were missing measles 1 vaccine and 35 children missing measles 2 vaccine. CHWs were involved in active case finding. EPI coordinator and save the children were informed about the outbreak. Missing children were referred to nearest health facility for completion of vaccination. Health education on prevention and spread was conducted for the affected families.
17‐Apr Measles Punjab D. G. Khan Mitha khoo uc Gadai 5 1 0 1
Seven suspected cases of measles were detected and responded, vitamin A drops given, one blood specimen collected and sent to NIH, on field investigation found 43% children fully vaccinated. Health education session conducted. Provided IEC material. Outreach vaccination activity planned with the help of DOH.
18‐Apr AWD Sindh Dadu Village Guhram Khan Gopang, near Pir Najeeb ullah
0 5 2 1
An alert of AWD was reported from hospital with severe dehydration, during active surveil‐lance 7 more cases were found, Water supply suspected as the source of disease, Aqua tabs, Zinc tabs and ORS distributed, health and Hygiene session was conducted, EDOH, THO, DSC and FP‐National program was informed, 1 Stool and 2 water samples were collected for lab testing.
18‐Apr AWD Sindh Matiari Village Essani Khoso, near Oil field, Palijani station, taluka Matiari
0 1 0 5
6 cases of AWD were admitted in THQ, active search for more cases was done, Hand Pump was the source of water, Aqua tabs, Zinc tabs supplied, IEC material and ORS distributed, health sessions conducted, EDOH informed, 3 Stool and 4 water samples collected for lab testing.
Suspected cases of AWD was reported from community, active surveillance done along with PPHI & Merlin NGO and found five more cases of AWD in the village, open Dug well was the suspected source of water, Aqua tabs, Zinc tabs, ORS and IEC Material distributed, health education imparted, EDOH informed and 2 Water samples collected for quality testing.
18‐Apr CCHF Sindh Karachi NIBD (National Institute of Blood Disease), Gul‐shan‐e‐Iqbal Town
0 1 0 0
1 confirmed case of CCHF was reported from NIBD, EDO representative accompanied during investigation, case belongs to quetta, initially case was suspected for Malaria and anti Malar‐ial treatment given.Later on CCHF diagnosed by lab test. Platelets count reduced to 10,000, patient attendent were sensitized regarding proper Hygiene, brief about the mode of trans‐mission, advised to use insect repellents and information shared with SO DEWS Quetta.
Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012)
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 (17/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken
24‐Apr Measles AJK Poonch vill Naka Kharick UC Town Tehsil Rawalakot 1 4 0 4
An alert of suspected measles case was reported from Sheikh Zaid Hosp Rawalakot . Upon field investigation 8 more suspected cases were found, blood samples collected from 5 sus‐pected cases and sent to NIH.Vaccination status of 21 children from 11 household were assessed and all of them found vaccinated against Measles 1 vaccine. All the cases were studying at same school. School was visited and no more case was found. Vit. A was given to active cases. DOH was informed and mop up vaccination has been planned in the UC. Health education session conducted in the community.
An alert of suspected AWD was reported from CD. Investigation team reached the area and on active search 12 more suspected cases were found. Health and hygeine session conducted in the locality. Aqua tabs and ORS were distributed. 2 stool samples and 3 water samples were collected for lab testing.
26‐Apr Leishmaniasis Balochistan Killa Saifullah Village and UC Shna Khuwara 4 1 2 9 16 suspected cases of Cutaneous Leishmaniasis were reported. Patients were investigated and lesions were found on face, nose, arm and leg. No travel history. Outbreak was declared and treatment as per WHO protocol was started. Information shared with DHMT.
The alert of suspected measles is in continuation of Measles outbreak from Noshki Jadeed. During followup visit 13 more suspected cases of measles were found. Vit‐A drops were given to cases. Two blood samples were collected. 43 children were assessed for routine immuniza‐tion, only (48%) 21 children were partially vaccinated against BCG whereas none of the child found vaccinated against measles. Health education imparted and EDO‐H was informed.
25‐Apr Leishmaniasis Khyber Pakhtunk‐hwa
Mardan Village Pir Ali, Kandao Baba & Jan Abad, UC Qasim
0 15 8 23
An Outbreak of Cutaneous Leishmaniasis with 11 cases were reported from 3 adjacent villages of UC Qasim. In response Active surveillance was conducted and 35 more cases were identi‐fied in the areas, line list maintained. onjob training of health staff was conducted for Intrale‐sional adminstration of Inj Glucantine. Health & Hygiene sessions conducted, RBM focal person was informed and requested for residual spray in the areas. EDO Health and focal person was informed.
26‐Apr Pertussis Khyber Pakhtunk‐hwa
Swabi Private Clinic, TandKohi 1 0 1 3
Suspected case of Pertussis was reported from BMC Swabi. Case was investigated and re‐sponded in the presence of Health department personelle. On active search, 4 more cases were found in the same locality. Erythromycin given to all cases and contacts, outreach vacci‐nation campaign initiated in the locality, Health education imparted. EDO H and EPI coordina‐tor Informed.
An alert of suspected measles was reported by MO THQ. On active surveillance, 5 more cases of suspected measles were found. Blood samples were drawn from 2 cases and sent to NIH for lab confirmation. Vit A doses were given to the cases. 46 children were assessed for rou‐tine immunization out of which 67% (31) of the children were partially vaccinated and rest of the children were totally unvaccinated. HE session conducted for the community about im‐portance of Immunization against VPDs. Findings were discussed with DHO Rajanpur and it was decided that mop‐up measles vaccination campaign will be carried out in the area after finishing of Polio NIDs.
Suspected cases of AWD was admitted in hospital with severe Dehydration, community mem‐bers refrain for further investigation at home, Hand pump was the source of water, Aqua tabs, Zinc tabs supplied and ORS distributed in hospital, health education imparted, EDOH, THO, DSC, FP‐EPI informed and 2 water samples collected for lab testing.
26‐Apr AWD Sindh Dadu Village Dar Mangneja, taluka K.N Shah 1 0 4 1
An alert of suspected AWD was investigated in hospital, during active surveillance 5 more suspected cases were found, water supply was the source of water, Aqua tabs, Zinc tabs and ORS distributed, health education imparted, EDOH, THO, DSC and FP National program was informed and 2 water samples collected for quality testing.
24‐Apr AWD Sindh Tando Muhammad Khan
Village Ali Muhammad, UC & taluka Bulri Shah Karim
0 3 0 3
Suspecetd case of AWD was admitted in DTC center,on active search 5 more suspected cases of AWD found in the village, Water supply was the source of water, Aqua tabs, Zinc tabs and ORS distributed, health education imparted, EDOH informed, 1 Stool sample and 2 water samples were collected for testing.
25‐Apr Measles Sindh Dadu Village Allah Wasayo Janweri, UC Mangwani, taluka Mehar
6 1 0 2
An alert of suspected case of Measles was investigated in hospital, on active surveillance, 8 more cases of suspected measles were found. vaccination status were assessed for 9 children, 30% of the children were vaccinated against measles 1 vaccine and 16% for measles 2 vaccine. Vitamin(A) dose was given to all cases, health education imparted, children were referred to THQ for completion of vaccination, EDOH, THO, EPI‐FP informed and 1 Blood sample collected for lab testing.
2 suspected cases of measles were admitted in MCH centre.During active search 5 more cases of measles were found from the locality, 5 blood samples collected and sent to NIH, Vitamin (A) was given to all cases, health education imparted regarding isolation and prevention of Measles, information share with EDOH & DSV and request for vaccination in the village.
An alert of suspected measles were reported by Polio team. Investigation was carried out by DEWS and Polio team. On active search 7 cases of suspected measles were found. Vitamin (A) was given to all cases, health education imparted, information shared with EDOH & DSV for vaccination in the village and 5 Blood samples collected and send to NIH for lab confirmation.
23‐Apr Measles Sindh Hyderabad Latifabad Unit #12, near Kamal Autos, taluka Latifabad
0 1 1 3
An alert of measles was reported from DGH, during active search 4 more cases were found, vaccination status were assessed for 10 children and only 3 (30%) children were found vacci‐nated for measles 1 vaccine, Vitamin (A) drops given to all cases, health education imparted, DHO, DSC and DO informed and 5 Blood sample were collected for lab confirmation.
24‐Apr Measles Sindh Karachi Musani 2 Muhalla, Village Rehri Goth, UC2, Bin Qasim town
5 0 1 1
Suspected case of Measles was informed by DTHO Bin Qasim town and NPO‐WHO, during active surveillance 7 more suspected cases were found, vitamin(A) dose was given to all cases, vaccination status were assessed for 9 children and none of the children found vaccinated against measles vaccine. Health education imparetd, THMT and THO informed and request for immunization in the area and 1 Blood sample collected for lab confirmation.
An alert of measles was reported by PEO during POLIO monitoring. On active surveillance, 6 suspected cases of measles were found. 52 children were assessed for routine immunization and none of the child found vaccinated against measles 1 & 2 vaccine where as 21% children were partially immunized with BCG vaccine. Vitamin (A) was given to all cases, health educa‐tion imparted, community members sensitized regarding importance of vaccination. Informa‐tion shared with DHMT & DSC and 5 blood samples collected for lab confirmation.
Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012)
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
Cont’d Current week's (17/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken
24‐Apr Measles Sindh Naushahro feroze
Ward # 13, Old Station, near Jiskani Masjid, Moro 0 0 8 3
An alert of suspected measles case was reported from a private clinic, on active search 11 more suspected cases of measles were found, Vitamin(A) were given to all cases, health education imparted, 15 children were assessed for routine immunization status, 33% (5) of the children were found vaccinated against measles 1 vaccine where as none of the child vaccinated for measles 2. DHMT and EDOH informed and 6 Blood samples collecetd for lab testing.
An alert of suspected measles case was reported from BHU, during active surveillance 5 more cases of suspected measles were found, Vitamin (A) provided and Health Education imparted, 5 blood samples were taken for lab confirmation. Immunization status was assessed for 6 children and only 2 (less than half) found vaccinated against measles 1 vaccine whereas none of the children received measles 2 vaccine. DHMT and EDOH was informed for implementa‐tion of routine immunization in the locality
26‐Apr Measles Sindh Tando Muhammad Khan
Village Suleman Soomro, UC Mula Katiar, taluka Tando Muhammad Khan
4 1 2 2
An alert of suspected Measles case was reported from the community, during active surveil‐lance 8 more suspected cases were found, 9 children were assessed for routine immunization and only 1 child were found vaccinated gainst measles 1 vaccine and none for measles 2 vaccine. Vitamin(A) given to all cases, health education imparted, EDOH informed and 1 Blood sample collected for lab confirmation.
23‐Apr Measles Sindh Thatta Village Allah Dad Solangi, UC Googani, taluka Shah Bunder
2 1 3 4
Suspected case of Measles was notified from THQ Sujawal, active surveilliance was done in the village and found 9 more cases of post Measles, Cluster of 15 houses were taken where 23 children were assessed, routine coverage found below 70%, health education imparted, Vitamain (A) was given, blood sample collected and infromation share with DHO, THO & TSV.
23‐Apr Measles Sindh Thatta Village Chatto Jamali, UC Chouhar Jamali, taluka Shah Bunder
4 0 3 0
Suspected case of Measles & one death was notified from community. On active surveillance 5 more cases of Measles were found, Cluster of 15 houses were taken where 18 children were assessed, routine coverage was below 50%, health education imparted, Vitamain (A) was given to the cases. Infromed DHO, THO & TSV.
An alert of suspected pertussis case was notified from a private clinic, during active surveil‐lance, 9 more cases were foundin the locality. House to House cluster taken to assess the routine immunization status and none of the child found vaccinated, 14 days complete dose of erythromycin was provided to all patients and close contacts. informed EDOH & DSV for vaccination and conducted health promotion in the area.
An alert of suspected Pertussis cases were reported from community, on active search 13 suspected cases were found,13 children were assessed for routine immunization and none of the child found vaccinated. Health promotion activity conducted in the locality, information provided to Incharge BHU, DHMT and request for mop‐up the area.
Suspected case of Pertussis was informed by AWARE NGO team. On active search 65 more cases of Pertussis were found, No health facility located in the village, immunization status of children under 5 years of age were assessed and all children found totally unvaccinated, health education imparted regarding importance of immunization. Erythromycin tabs and syrups , Cough syrups supplied. Health education material distributed, EDOH was informed and 5 Nasal Swabs were collected for lab confirmation.
24‐Apr Pertussis Sindh Thatta Village Haji Usman Lodo, UC Gul Muhammad Baran, taluka Jati
4 0 4 1
Suspected 5 cases of pertussis were reported by Dr. Soomar Khoso, On active surveillance, 4 more cases were found, vaccination status were checked for 9 children and only 9% children found partially vaccinated with penta 1. Health education imparted, Erythromycin was given to cases and informed DHO,THO, TSV and 5 Throat samples were collected for testing.
Distribution of Wild Polio Virus cases Pakistan 2011 and 2012
As of 30 April 2012, the total number of polio cases confirmed by the labora‐tory is 15 from 10 districts/towns/tribal agencies and areas.
Province Cases 2011 Cases 2012
P1 P3 P1 P1+P3
Punjab 9 ‐ 1 ‐
Sindh 33 ‐ 2 ‐
Khyber Pakhtunkhwa 23 ‐ 4 ‐
FATA 57 2 4 1
Balochistan 73 ‐ 2 ‐
AJ&K ‐ ‐ ‐ ‐
Gilgit‐Baltistan 1 ‐ ‐ ‐
Islamabad ‐ ‐ ‐ ‐
Total 196 2 13 1
P3
‐
‐
‐
1
‐
‐
‐
‐
1
Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012)
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
Number of alerts by province, week 17, 2012
Province Sindh Date Disease District Area <5M >5M <5F >5F
26‐Apr Measles Bagh vill nakar Saliyan Maldiyalan UC saliyan Tehsil Bagh 1 0 0 0
24‐Apr Measles Poonch vill Naka Kharick UC Town Tehsil Raw3ala‐kot 1 4 0 4
Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012)
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
Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F
25‐Apr AD Kohat Village Suleman Talab 0 0 0 0 23‐Apr Leishmaniasis Lakki Marwat Mohallah Boghanan 0 1 0 0 25‐Apr Leishmaniasis Mardan Village Pir Ali, Kandao Baba & Janabad 0 15 8 23 23‐Apr Leishmaniasis Nowshera Ghazi Abad, Dak Ismail Khel 0 3 0 1 23‐Apr Leishmaniasis Nowshera Halki Banda, Dak Ismail Khel 0 0 0 1 23‐Apr Leishmaniasis Nowshera Shah Kot, Dak Ismail Khel 1 0 0 1 27‐Apr Leishmaniasis Nowshera Farangi Talab, Dak Ismail Khel 0 1 0 0 27‐Apr Leishmaniasis Nowshera Hospital Korona, Dak Ismail Khel 0 0 1 0 27‐Apr Leishmaniasis Nowshera Kotki Kalay, Dak Ismail khel 0 1 0 1 27‐Apr Leishmaniasis Nowshera Phase 6, Sector A, Block 3, Tent 52 0 1 0 0 27‐Apr Leishmaniasis Nowshera Phase 6, Sector D, Block 2, Tent 32 1 0 0 0 27‐Apr Leishmaniasis Nowshera Shah Kot Bala, Saleh Khana 0 1 0 1 28‐Apr Leishmaniasis Nowshera Lashkar Khel, Spin Khak 0 0 0 1 28‐Apr Leishmaniasis Nowshera Usman Khel, Inzari 0 0 0 1 23‐Apr Leishmaniasis Shangla Village Kabalgram 0 1 0 0 27‐Apr Leishmaniasis Shangla village Martung, Puran 0 1 0 0 23‐Apr Measles Abbottabad Ochar, Upper Salhad 1 0 0 0 24‐Apr Measles Bannu Koti Sadad 0 0 1 0 27‐Apr Measles Battagram Village Jabree Phagora, UC Rajdhari, 1 0 0 0 24‐Apr Measles D. I. Khan City 2 1 0 0 0 24‐Apr Measles D. I. Khan Daraban, Tehsil Daraban 0 0 2 0 24‐Apr Measles D. I. Khan Mandhra 1 0 0 0 24‐Apr Measles D. I. Khan Pahar Pur Urban, Tehsil Pahar Pur 2 0 0 0 24‐Apr Measles D. I. Khan Shaikh Yousaf 0 1 0 0 24‐Apr Measles D. I. Khan Shor Kot 0 0 1 0 24‐Apr Measles D. I. Khan UC City 1 0 0 1 0 24‐Apr Measles D. I. Khan Wanda Rorri, Tehsil Kulachi 1 0 0 0 27‐Apr Measles D. I. Khan Kachi Kot Garh, Tehsil Pahar Pur 0 1 0 0 27‐Apr Measles D. I. Khan Opposite Nawab Adda 0 0 1 0 27‐Apr Measles D. I. Khan Shah Hassan Khel, Abdul Khail 0 0 1 0 27‐Apr Measles D. I. Khan Village Garah Bakhta 2 0 0 0 24‐Apr Measles D.I. Khan Mianwali (Pharpoor) 0 0 1 0 27‐Apr Measles Hangu J‐ 07, IDP Camp Togh Sarai 1 0 0 0 22‐Apr Measles Haripur Village Kotla, UC Muslimabad 1 0 3 1 22‐Apr Measles Haripur Village Muslimabad, UC Muslimabad 0 2 1 1 23‐Apr Measles Haripur Village Bagra, UC Bagra 1 1 0 0 24‐Apr Measles Haripur Afghan Refugee Camp 15 1 1 0 0 25‐Apr Measles Haripur Village Jab, UC Pind Kamal Khan 0 3 1 0 26‐Apr Measles Haripur Police Chooki Muhallah, Haripur city 1 0 0 0 26‐Apr Measles Haripur Railway Station Muhallah,Haripur city 2 0 0 0 27‐Apr Measles Haripur Talokar Road, Naee Abadi, Haripur city 0 1 0 0 27‐Apr Measles Haripur Village Gandhian 0 0 1 0 26‐Apr Measles Karak Banda Menzai, UC Banda Dawood Shah 1 0 0 0 26‐Apr Measles Kohat Deri banda, UC Shahpur 0 1 0 0 26‐Apr Measles Kohat Near railway station, UC Khushal garh 1 0 0 0 26‐Apr Measles Kohat UC Surgul 0 0 1 0 25‐Apr Measles Mansehra Charach Behali 1 0 0 1 26‐Apr Measles Mansehra Kohistan Colony Near Dedra Chowk 1 0 1 1 24‐Apr Measles Mardan Village Jhanga Banda, UC Lund Khwar 0 1 2 1 26‐Apr Measles Mardan Afghan Refugee Camo, Dargai 0 0 1 0 26‐Apr Measles Mardan Village Hajiyan Kheila, UC Rashakai 0 0 1 0
Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012)
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
Province Khyber Pakhtunkhwa:
• 509 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS on weekly basis with a total of 139,017 patients consultations in week 17, 2012.
• 69 alerts were reported in week 17; Altogether 49 for Measles; 13 for Leishmaniasis; 2 each for NNT, Per-tussis and Typhoid; while 1 for Acute diarrhoea.
• 2 outbreaks, 1 each for Leishmaniasis and Pertussis were identified and appropriate measure were taken.
Figure-3: Trend of priority communicable diseases, province KPK
Province Sindh:
• 530 health facilities from 23 districts in Sindh reported on weekly basis to DEWS with a total of 279,052 patient consultations in week 17, 2012.
• 76 alerts were reported; Altogether 49 for Measles; 16 for AWD; 6 for Pertussis; 3 for NNT; while 1 each for Typhoid and Scabies.
• 18 outbreaks, 11 for Measles; 4 for Pertussis; while 3 for AWD were identified and appropriate measures were taken.
Figure-4: Trend of priority communicable diseases, province Sindh
Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease
2010 2011 2012 (up till week 17) Total A O A O A O A O
Figure‐2: Number of consultations by age and gender, week 17, 2012
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Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012) Province Punjab: • 405 health facilities from 8 districts reported data to
DEWS in Punjab with a total of 219,618 patient con-sultations.
• A total of 65 alerts were reported in this week; Alto-gether 18 for Measles; 16 for AD; 13 for Typhoid; 8 for BD; 2 each for AJS, DF and Scabies; while 1 each for ARI, Leishmaniasis, Malaria and Tetanus.
• 1 outbreak for Measles was identified and appropriate measures were taken.
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]. 08
State of Azad Jammu and Kashmir:
• 140 health facilities from 10 districts reported to DEWS in this week with a total of 29,069 patient consultations.
• 6 alerts, 3 each for Leishmaniasis and Measles were received and appropriated measures were taken.
• 38 health facilities from 2 agencies reported from FATA in this week, with a total of 11,025 patient consultations.
• 10 alerts, 5 for Measles; 4 for NNT; while 1 for Leishmaniasis were received and appropriate measures were taken.
Province Gilgit Baltistan:
• 28 health facilities from 4 districts in Gilgit Baltistan reported to DEWS in week 17, with a total of 13,955 patient consultations.
• Less number of report were received because of ongo-ing unstable situation in Gilgit Baltistan.
• 1 alert for Measles was received and appropriate meas-ures were taken.
Figure-7: Trend of priority communicable diseases, Gilgit Baltistan
FATA:
Province Balochistan:
• 444 health facilities from 22 districts in Balochistan reported to DEWS, with a total of 66,843 patient con-sultations.
• 18 alerts were reported in week 18 from Balochistan; Altogether 7 for Leishmaniasis; 4 for Measles; 2 each for AWD and Typhoid; while 1 each for AJS, NNT and Pertussis.
• 3 outbreaks, 1 each for AWD, Leishmaniasis and Mea-sles were identified and appropriate measures were taken.
Figure-6: Trend of priority communicable diseases, province Balochistan
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Focus on: Acute Watery Diarrhea/Cholera
Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholera present in faecally contaminated water or food. Primarily linked to insufficient access to safe water and proper sanitation, its impact can be even more dramatic in areas where basic environmental infrastructures are dis‐rupted or have been destroyed. Countries facing complex emergencies are particularly vulnerable to cholera outbreaks. Massive displacement of IDPs or refugees to overcrowded settings, where the provision of potable water and sanitation is challenging, constitutes also a risk factor. Every year, there are an estimated 3–5 million cholera cases and 100,000–120,000 deaths due to cholera worldwide.
Cholera is characterized in its most severe form by a sudden onset of acute watery diarrhea that can lead to death by severe dehydration. The extremely short incubation period ‐ two hours to five days ‐ enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 75% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their feces for 7 to 14 days and are shed back into the environ‐ment, possibly infecting other individuals. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrheal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by cholera. Cholera is endemic in Pakistan. In 2010, the Ministry of Health in Pakistan reported laboratory confirmation of 99 cases of Vibrio cholera. These cases have been reported sporadically from a wide geographical area in the flood‐affected provinces of Sindh, Punjab and KPK. In 2011, total of 541 out‐breaks, 11,811 suspected cases out of which 519 were confirmed cases and 218 deaths with suspected Cholera had also been reported. WHO‐DEWS team, department of health and health partners jointly responded to these outbreaks. Table shows the distribution of outbreaks by Province in 2011. Although in 2012 no confirmed outbreaks of cholera have been reported so far but with the start of the diarrhoea season the risk of Acute Watery Diar‐rhoea (AWD) outbreaks has also increased now.
Risk factors for Acute Watery Diarrhoea: Lack of safe water, inadequate quantity and quality of water, poor personal hygiene, poor washing facilities, insufficient soap for washing hands, Poor sanita‐tion, inadequate cooking facilities, Overcrowding, population movement/displacement.
Key steps for prevention and control: Ensuring adequate safe drinking water supply and proper sanitation are the most important means of protection against severe diarrhoeal diseases including cholera epidemics.
Safe drinking water: In areas where the infrastructure for provision of safe drinking water does not exists simple inexpensive measures can be used to make water safe for drinking at household level as follows. Boiling: Bringing water to a vigorous, rolling boil and keep it boiling for one minute will kill Vibrio cholera O1 and most other organisms that cause diarrhoea. Chlorination at household: First prepare stock solution by mixing 33 gm of bleaching powder in one litre of water and store it in a brown glass bottle. Then put 3 drops (0.6 ml) of stock solution in one litre of water or 30 drops (6 ml) in 10 litres of water or 60 ml in 100 litres. Do not cover the container for first 30 minutes after adding stock solution in it and wait 30 minutes before drinking or using the water. Alternatively, water disinfection tablets (eg. Aquatabs) can be added to the water ac‐cording to package instructions. Solar water disinfection: Another small‐scale and cost‐effective immediate technique is solar water disinfection (SODIS) by which transparent plastic bottles filled with water are placed horizontally on a flat surface and exposed to solar light for about 5 hours in order to let the ultraviolet light in solar irradiation kill the pathogens. The effect of solar irradiation can be enhanced by painting the bottom half of the bottle black or placing them on a black background. (Note: In case of Cholera outbreak Chlorination is the only option to make the water safe for consumption)
Hand‐washing Studies of diarrhoea show that washing hands with soap and water (where soap is not available one may use ash) reduces the incidence of diarrhoea by up to 35%. Hands must be washed: After defecation; After any direct or indirect contact with stools; Before preparing and distributing food; Before eating; Before feeding children.
Sanitation Improvements in water supply and environmental sanitation will reduce the incidence of diarrhoeal diseases in the long run. Even where sanitation is poor, simple measures help ensure the safe disposal of stools and must be followed – particularly in the case of out‐breaks of diarrhoeal diseases: No defecation on the open ground – cover stool with soil (or use trench latrines that are regularly covered); No defecation near a water supply/source; Disposal of chil‐dren’s stools in toilets or latrines or buried in the ground; Washing hands with soap (or ash) after any contact with stools; Build and use latrines – a pit latrine 2 metres deep with an opening of 1 metre by 1 metre can be used by a family of 5 persons for a period of 2 to 4 years. Latrines must be sited downhill and away from sources of drinking‐water (at least 30 metres), wash daily and regularly disinfected with cresol or bleaching powder.
Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012)
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]. 09
Province # of outbreaks # of suspected cases # of Lab‐confirmed cases # of deaths
Sindh 213 2463 183 111
Khyber Pakhtunkhwa 189 4594 198 40
Punjab 73 389 75 24
Baluchistan 30 2427 28 21
FATA 8 197 9 2
GB 8 92 10 1
AJK 20 1649 16 19
Total 541 11811 519 218
Key messages:
Cholera is transmitted through contaminated water or food. Prevention and preparedness of cholera require a coordinated multidisciplinary approach Cholera can rapidly lead to severe dehydration and death if left untreated Once Vibrio cholera is confirmed, the WHO clinical case definition is sufficient to diagnosis and management of cases. Laboratory testing is required only for antimicrobial sensitivity testing and for confirming the end of an outbreak. Provision of safe water, proper sanitation, and food safety are critical for preventing occurrence of cholera Health education aims at communities adopting preventive behavior for averting contamination ORS can successfully treat 80% of cholera cases Appropriate antibiotics can reduce the duration of Vibrio Cholera bacterium in the patient stool
Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 2012)
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]. 10
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