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. 46 (11 to 17 November, 2011) • 80 districts and 2 agencies provided surveillance data to the DEWS this week from 2,636 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC. • A total of 816,850 consultations were reported through DEWS of which 203,121 (25%) were acute respiratory infections (ARI); 72,768 (9%) were Skin disease; 61,792 (8%) were acute diarrhoea; and 57,597 (7%) were suspected malaria. • A total of 124 alerts with 10 outbreaks were reported in week‐46, 2011: Altogether 28 alerts for AWD, 23 for Measles; 22 for Neonatal tetanus and tetanus; 18 for Leishmaniasis; 7 for Pertussis; 6 each for Malaria and ARI; 4 each for DHF and Acute diarrhoea; 2 for AJS; while 1 each for CCHF, Diphtheria, Typhoid and unexplained fever. • In this week nine new polio cases were confirmed by the laboratory, four from FATA (three from North Waziristan agency and one from Khyber agency); two each from Balochistan (Mastung and Barkhan districts) and Punjab (Vehari and Rahim Yar Khan districts); and one from Khyber Pakhtunkhwa (Lakki Marwat district). As of 21st November 2011, Pakistan has reported a total of 154 polio cases (152 type‐1 & 2 type‐ 3) from 48 districts/towns/tribal agencies and areas. Highlights Disease early warning system and response in Pakistan 01 Volume 2, Issue 46, Monday 21 November, 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 27 October 2011 (Epi week 31, 2010 to week 46, 2011) Disease Wk-39 Wk-40 Wk-41 Wk-42 Wk-43 Wk-44 Wk-45 Wk-46 Acute diarrhoea 105,295 (11%) 97,007 (10%) 93,085 (9%) 74,189 (8%) 62,628 (8%) 65,701 (8%) 32,405 (8%) 61,792 (8%) Total consultation 995,450 1,014,266 1,033,276 897,598 808,954 879,811 407,339 816,850 Suspected malaria 83,684 (8%) 82,802 (8%) 86,326 (8%) 68,441 (8%) 58,613 (7%) 69,408 (8%) 33,8869 (8%) 72,768 (9%) Acute respiratory infection 205,597 (21%) 209,436 (21%) 223,902 (22%) 213,432 (24%) 193,863 (24%) 217,676 (25%) 101,386 (25%) 203,121 (25%) Bloody diarrhoea 9,393 (0.94%) 8,075 (0.80%) 8,107 (0.78%) 6,089 (0.68%) 5,461 (0.68%) 5,289 (0.60%) 2,751 (0.68%) 5,706 (0.70%) Skin diseases 105,912 (11%) 95,842 (9%) 94,167 (9%) 81,161 (9%) 69,393 (9%) 77,842 (9%) 33,869 (8%) 72,768 (9%) Since July 29, 2010, approximately 52,456,152 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 secu‐ rity situation in some areas. 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 (39 to 46, 2011) acute diarrhoea cases have been decreased (From 11% to 8%), while at the same time cases of ARI have been increased (From 21% to 25%). A slight fluctuation in the suspected malaria cases have been seen recently after consistent seasonal increase from week 35 especially from districts in Sindh and Balochistan. 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 wk 41 wk 43 wk 45 Percentage AD BD ARI S. Malaria
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Weekly Epidemiological - WHO Epidemiological ... receive reports on around 1,000,000 consultations per week, there is a drop in timely reporting due to EID ... ACT & bed nets provided
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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. 46 (11 to 17 November, 2011)
• 80 districts and 2 agencies provided surveillance data to the DEWS this week from 2,636 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC.
• A total of 816,850 consultations were reported through DEWS of which 203,121 (25%) were acute respiratory infections (ARI); 72,768 (9%) were Skin disease; 61,792 (8%) were acute diarrhoea; and 57,597 (7%) were suspected malaria.
• A total of 124 alerts with 10 outbreaks were reported in week‐46, 2011: Altogether 28 alerts for AWD, 23 for Measles; 22 for Neonatal tetanus and tetanus; 18 for Leishmaniasis; 7 for Pertussis; 6 each for Malaria and ARI; 4 each for DHF and Acute diarrhoea; 2 for AJS; while 1 each for CCHF, Diphtheria, Typhoid and unexplained fever.
• In this week nine new polio cases were confirmed by the laboratory, four from FATA (three from North Waziristan agency and one from Khyber agency); two each from Balochistan (Mastung and Barkhan districts) and Punjab (Vehari and Rahim Yar Khan districts); and one from Khyber Pakhtunkhwa (Lakki Marwat district). As of 21st November 2011, Pakistan has reported a total of 154 polio cases (152 type‐1 & 2 type‐3) from 48 districts/towns/tribal agencies and areas.
Highlights
Disease early warning system and response in Pakistan
01
Volume 2, Issue 46, Monday 21 November, 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 27 October 2011 (Epi week 31, 2010 to week 46, 2011)
Since July 29, 2010, approximately 52,456,152 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 secu‐rity situation in some areas. 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 (39 to 46, 2011) acute diarrhoea cases have been decreased (From 11% to 8%), while at the same time cases of ARI have been increased (From 21% to 25%). A slight fluctuation in the suspected malaria cases have been seen recently after consistent 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, 02
Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken
11‐Nov AWD KPK Lower Dir Village Gular, UC & Tehsil Samar Bagh 0 2 2 2
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 therapy, Stool samples collected for lab confirmation but both found negative for Cholera, Water Samples taken for any fecal contamination, ORS, Hygiene kits & Aqua tabs distributed, Health & Hygiene promotion Session conducted with family members.
16‐Nov Pertussis KPK Lower Dir Village Sharmakhan‐Shontala, UC & Tehsil Samar Bagh
7 2 3 1
During active surveillance 2 cases of suspected Pertussis were found having typical Cough with vomiting, 11 more cases were found in the same area but most of them were unimmunized for routine vaccination. some were already recovered, Erythromycin was provided to all close contacts, Nasophyrangeal swab were taken from 2 cases for confirmation. Outreach Immunization activity was carried out by EPI team in the area. EDO was Informed.
15‐Nov AJS Sindh Badin Village Mian Pota, UC Talhar, Taluka Talhar 0 5 0 2 7 cases of suspected acute viral hepatitis investigated, health education imparted, one pregnant women
suspected case was give TT vaccine, informed MS RHC and DHMT and 3 blood sample taken and sent to NIH
16‐Nov AWD Sindh Mirpur Khas Baloch Mohalla, Old Wolcut Factory, UC # 6, Taluka Mirpurkhas
2 2 1 1 1 suspected case was found in hospital, on active surveillance 5 more cases with diarrhoea were found in the community. Contaminated water of hand pump was the possible source, health education imparted, Aqua tabs, Zinc tabs and ORS distributed, EDO‐H, DSM PPHI informed.
17‐Nov AWD Sindh Thatta Village Allo Tara, UC Sonda, Taluka Thatta. 3 2 6 5
3 Patient were admitted in Hospital, during active surveillance 13 more cases found, Canal was the source of drinking water, health education imparted, Aqua tabs, Zinc tabs, ORS, Jerry cans and water filter distributed, EDO‐H informed and 2 water sample taken.
16‐Nov Malaria Sindh Ghotki Village Muhammad Khan Shar UC Bairoota Taluka Daharki
10 23 8 25
Suspected Malaria Death reported by health technician at EDOH office Mirpur Mathelo. Field investigation done and WHO response, DEWS team performed MP tests on RDTs and found 30 positive cases (P. Falcipa‐rum 17, P. Vivax 3, Mixed 10) in the village. ACT & bed nets provided, Health education session conducted in the community, moreover informed EDOH for fumigation and resudal spray.
11‐Nov Malaria Sindh Thatta Village Pir Dino Khaskheli, UC Jhirk, Taluka Thatta 6 8 1 4 19‐cases of malaria (7 P. Falciparum and 2 Mix) found confirmed by RDT, health education imparted to family
members and other neighbor, Anti Malaria medicines and Bed Nets provided and EDO‐H informed.
16‐Nov Malaria Sindh Thatta Village Sheikh Muhammad Ismail, UC Jhirk, Taluka Thatta
2 8 4 11 25‐cases of malaria (8 P. Falciparum and 3 Mix) found confirmed by RDT, health education imparted to family members and other neighbor, Anti Malaria medicines and Bed Nets provided and EDO‐H informed.
14‐Nov Pertussis Sindh Tharparkar Village Bhoongrai Khosa, UC Mitho Dabhro, Taluka Diplo 1 4 2 8 15 Suspected case investigated, Throat Swab collected, sensitized regarding proper vaccination and Personal
Hygiene, informed EDO‐H, DSM PPHI, MS DHQ regarding the cases and Throat swab taken.
4 2 2 9 case of Pertussis were investigated, History of Patient was taken, Health education imparted regarding Vaccination and Proper health and Hygiene, Anti Biotic and Antipyratic tabs given, inform EDO‐H, DSM‐PPHI, MS THO.
Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F
17‐Nov AD Naushahro Feroze Baladi Mohalla, UC and taluka Kandiyaro 1 1 1 1
15‐Nov AWD Tharparkar Village Jarelo, Rind Mohalla, UC Tar Ahmed, Taluka Chachro. 0 1 0 0
14‐Nov AWD Thatta Sonda Citu UC Sonda 0 1 0 0 16‐Nov AWD Thatta Village Allah Buksh Tara, UC Sonda 0 1 0 0 16‐Nov AWD Thatta Village Moosa Merbahar, UC Sonda 1 0 1 1
16‐Nov AWD Thatta Village Saleh Muhammad Sheikh, Taluka Shah Bundar. 1 1 1 1
17‐Nov AWD Thatta Village Allo Tara, UC Sonda, Taluka Thatta. 3 2 6 5
15‐Nov AWD Umer Kot Khoso Paro, near Ali Nawaz Khaskheli house, UC 2, Taluka Umerkot 1 1 1 0
15‐Nov AWD Umer Kot Village Waryam Rajar, Bheel Paro, UC Atta Muhammad Pali 0 1 0 2
Cont’d: Province Sindh Date Disease District Area <5M >5M <5F >5F
14‐Nov Diphtheria Dadu Najab shah Mohalla, UC and Taluka Johi 0 1 0 0
16‐Nov Malaria Ghotki Village Muhammad Khan Shar UC Bairoota Taluka Daharki 10 23 8 25
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, 03
Current week's Alerts: Province Balochistan Date Disease District Area <5M >5M <5F >5F
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
Province Khyber Pakhtunkhwa:
• This week 607 health facilities from 16 districts reported to DEWS with a total of 138,635 patients consultations.
• The proportional morbidity of AD dropped by 1% as com-pared with last week.
• 17 alerts were reported in this week, 15 were for Measles; while 1 each for AWD and Pertussis.
• 2 outbreaks, 1 each for AWD and Pertussis both were from Lower Dir were received and responded this week.
Figure-3: Trend of priority communicable diseases, province KPK
Province Sindh:
• This week 882 health facilities from 23 districts reported a total of 360,852 patient consultations.
• In Sindh, AD cases reported were 28,686 (8%), 1% lower pro-portional morbidity as compared with last week.
• 57 alerts were reported from Sindh in this week: 27 were for AWD; 14 for Neonatal tetanus; 6 for Measles, 4 for Malaria, 2 each for Pertussis and AJS, while 1 each for AD and Diphthe-ria.
• 9 outbreaks, 3 for Malaria, while 2 each for AWD and Pertus-sis, while 1 for AJS were received and responded this week.
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 45) Current Week (46) Total A O A O A O A O
Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 46/2011)
949
1073
1143
1111
1130
1158
1167
1113
1067
999
879
854
967
1289
1215 1463 1797
1680 2022
2021 2262
2349
2255
2199
2251
2322
2450
2466
2404
2547 2785
2745
2909
2935
2982
3120
3021
3022
3058
3196
3250
3215
3259
3354
3375
3363
3234
3259
3251
3142
3329
3156
3109
2752
1488
2522
2564
2532
2648
2671
2716
2597
2550
2706
2455
2636
361
375 411
331
400
215
192
153
128
105
81 58 4626 2611
8 128 1111 11 11 8 8 8 8 8 8 6
6 6 13 8 6 6 7 7 7 8
7 7 36 6 6 2 2
0
500
1000
1500
2000
2500
3000
3500
4000
Wk 33
Wk 35
Wk 37
Wk 39
Wk 41
Wk 43
Wk 45
Wk 47
Wk 49
Wk 51
Wk 1‐11
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
Epi‐week
Number of HFs
Mobile Fixed
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
wk 41
wk 43
wk 45
Percentage
AD BD ARI S. Malaria
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
wk 41
wk 43
wk 45
Percentage
AD BD ARI S. Malaria
Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 (11 to 17 November, 2011) Province Punjab: • This week 484 health facilities from 8 districts reported data to
DEWS from Punjab province with a total of 195,835 patient consultations.
• AD cases reported were 11,974 (6%) and showing 1% higher proportional morbidity as compared with last week .
• 23 alerts were reported in this week from Punjab; 6 were for ARI; 4 each for DHF and Leishmaniasis; 3 each for AD and NNT; 2 for Malaria; while 1 for unexplained fever.
• No outbreak for any disease was received this week.
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]. 05
State of Azad Jammu and Kashmir:
• In this week, reports were received from 118 health facilities from 10 districts with a total of 26,151 patient consultations.
• ARI cases reported were 5,313 (20%), while Acute diarrhoea reported 969 (4%) cases.
• No alerts or outbreak was received this week from any area of AJ&K.
• This week 39 health facilities in 2 agencies reported from FATA, with a total of 6,858 patient consultations.
• ARI cases reported were 1,695 (25%), while Acute diarrhoea was reported 512 cases (7%)
• 3 alerts, 2 for Neonatal tetanus and 1 for Measles were received and responded this week.
Province Gilgit Baltistan:
• In this week, 47 health centers from 5 districts in Gilgit Baltistan sent weekly report with a total of 16,668 pa-tient consultations.
• ARI cases reported were 2,760 (17%), while Acute diar-rhoea were 1,297 (8%).
• No alert or outbreak was received in this week from any area of Gilgit Baltistan.
Figure-7: Trend of priority communicable diseases, Gilgit Baltistan
FATA:
Province Balochistan:
• In this week, 18 districts reported to DEWS from Ba-lochistan province. 459 health centers reported a total of 71,851 patient consultations.
• AD reported in 6,761 (9%) of the total consultations, 2% lower proportional morbidity as compared with the last week.
• 24 alerts were reported in this week from Balochistan, 14 for Leishmaniasis; 4 for Pertussis; 3 for Neonatal tetanus and tetanus; while 1 each for CCHF, Measles and Typhoid.
Figure-6: Trend of priority communicable diseases, province 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]. 06
Distribution of Wild Polio Virus cases Pakistan 2010 and 2011
Year 2010: The total number of polio cases reported in 2010 is 144 including 120 type‐1 cases and 24 type‐3 from 40 in‐fected districts/towns/agencies. Year 2011: As of 18 November, 2011, the total number of polio cases confirmed by the laboratory is 154 (152=type‐1, and 2=type3) from 48 districts.
Pakistan Dengue Situation, 5th November 2011 Since the beginning of the year and as of Week 46th 2011; 554,663 cases of suspected dengue fever cases and 23,019
Lab confirmed cases were reported across the country with 356 deaths (CFR = 1.55%). Over 90% of cases were reported in Punjab province.
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