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. 44 (28 October to 3 November, 2011) • 81 districts and 2 agencies provided surveillance data to the DEWS this week from 2,645 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC. • A total of 865,624 consultations were reported through DEWS of which 212,701 (25%) were acute respiratory infections (ARI); 77,027 (9%) were Skin disease; 64,535 (7%) were acute diarrhoea; and 68,921 (8%) were suspected Malaria. • A total of 126 alerts with 15 outbreaks were reported in week‐44, 2011: Altogether 29 alerts were for Dengue Fever, 27 for AWD, 24 for Measles, 13 for Neonatal tetanus and Tetanus, 9 for Leishmaniasis, 8 for Pertussis, 4 for Bloody diarrhoea, 2 for Malaria, while 10 for other non‐communicable diseases. • National Polio Eradication Initiative reported 9 new polio cases, 1 from Sindh, 4 each from Balochistan and FATA. As of 5 th November, 2011, Pakistan has reported a total of 145 polio cases (143 type‐1 and 2 type‐3) from 44 districts/towns/tribal agen‐ cies/areas. Please see map on page 6. Highlights Disease early warning system and response in Pakistan 01 Volume 2, Issue 44, Thursday 11 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 44, 2011) Disease Wk-37 Wk-38 Wk-39 Wk-40 Wk-41 Wk-42 Wk-43 Wk-44 Acute diarrhoea 109,523 (12%) 110,835 (11%) 105,295 (11%) 97,007 (10%) 93,085 (9%) 74,150 (8%) 62,465 (8%) 64,535 (7%) Total consultation 931,318 1,005,251 995,450 1,014,266 1,033,276 897,025 807,137 865,624 Suspected malaria 64,766 (7%) 78,109 (8%) 83,684 (8%) 82,802 (8%) 86,326 (8%) 68,426 (8%) 58,543 (7%) 68,921 (8%) Acute respiratory infection 175,906 (19%) 193,771 (19%) 205,597 (21%) 209,436 (21%) 223,902 (22%) 213,142 (24%) 193,267 (24%) 212,701 (25%) Bloody diarrhoea 7,920 (0.85%) 8,676 (0.86%) 9,393 (0.94%) 8,075 (0.80%) 8,107 (0.78%) 6,082 (0.68%) 5,441 (.67%) 5,202 (0.60%) Skin diseases 107,435 (12%) 107,243 (11%) 105,912 (11%) 95,842 (9%) 94,167 (9%) 81,134 (9%) 69,304 (9%) 77,027 (9%) 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 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 (37 to 44, 2011) acute diarrhoea cases have been decreased (From 12% to 7%), 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. 0 5 10 15 20 25 30 35 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 Percentage AD BD ARI S. Malaria
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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. 44 (28 October to 3 November, 2011)
• 81 districts and 2 agencies provided surveillance data to the DEWS this week from 2,645 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC.
• A total of 865,624 consultations were reported through DEWS of which 212,701 (25%) were acute respiratory infections (ARI); 77,027 (9%) were Skin disease; 64,535 (7%) were acute diarrhoea; and 68,921 (8%) were suspected Malaria.
• A total of 126 alerts with 15 outbreaks were reported in week‐44, 2011: Altogether 29 alerts were for Dengue Fever, 27 for AWD, 24 for Measles, 13 for Neonatal tetanus and Tetanus, 9 for Leishmaniasis, 8 for Pertussis, 4 for Bloody diarrhoea, 2 for Malaria, while 10 for other non‐communicable diseases.
• National Polio Eradication Initiative reported 9 new polio cases, 1 from Sindh, 4 each from Balochistan and FATA. As of 5th November, 2011, Pakistan has reported a total of 145 polio cases (143 type‐1 and 2 type‐3) from 44 districts/towns/tribal agen‐cies/areas. Please see map on page 6.
Highlights
Disease early warning system and response in Pakistan
01
Volume 2, Issue 44, Thursday 11 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 44, 2011)
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 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 (37 to 44, 2011) acute diarrhoea cases have been decreased (From 12% to 7%), 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.
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 44 (27 October to 3 November, 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, 02
Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken
2‐Nov BD AJK Muzaffara‐bad
Village Buttle, U.C Kahori, Tehsil Patika. 1 2 1 3 Alert for 7 cases of Bloody Diarrhea reported from BHU Patika. Stool sample collected for lab confirmation.
DHO Muzaffarabad informed. Active surveillance done and no other cases found, health education given.
Probable diphtheria case, 6 years old, not vaccinated except polio, hospitalized on 6 Nov, tracheotomy, ADS 80,000 IU, expired on 7 Nov 11 pm, respiratory distress, 2 siblings and 7 cousins in household also un‐vaccinated, started on prophylactic erythromycin, vaccination scheduled.
6‐Nov Diphtheria ICT Islamabad G‐Sokh, Bharakaho 1 0 0 0 Probable diphtheria case, 20 months old female, not vaccinated except polio drops, hospitalized on 6 Nov, ADS 80,000 IU, tracheostomy on 7 Nov, acute renal failure, myocarditis, expired 8 Nov, 6 siblings un‐vaccinated, family moved from Bajaour 6 years ago, erythromycin provided for all household members, field
28‐Oct AWD Sindh Badin Village Jeo Lund, Taluka Tando Bago 1 5 0 3 Alert for case of AWD hospitalized for dehydration, reinforced case management, active surveillance done
and located 8 other cases of AD in the field, health education provided to the affected families, Aqua tabs
Alert for hospitalized case of AWD who was also having Malaria positive, 5 other AD cases on active surveil‐lance, health education imparted to families, Aqua tabs, Zinc tabs, Bed NETS and ORS distributed, MO, BHU and DHMT informed, 1 Stool and 2 water sample collected.
1 0 1 5 Alert for 7 AWD cases hospitalized with dehydration, community water supply is the source of water, health education imparted regarding Boiling of water and hand washing with soap, Aqua tabs, Hygiene kits and ORS distributed, EDO‐H informed, 1 stool and 2 water sample taken.
31‐Oct AWD Sindh Thatta Village Adam Bhambharo, UC Sonda 2 1 3 2
Alert for AWD hospitalized with severe dehydration, (Keenjhar) canal was the source of water, health education imparted to neighbors, Community and Household members, Aqua tabs, Zinc tabs, ORS, Jerry cans and Filters distributed, EDO‐H informed and 2 water sample taken.
29‐Oct BD Sindh Tando Allah Yar
Village Aijaz Ali shah, Fazil stop, UC Began Jarwar 1 3 1 1 Alert for BD case admitted in hospital with dehydration. Active surveillance in field located 5 other cases,
health education imparted to affected families regarding proper hand washing and Health and Hygiene;
2‐Nov BD Sindh Umer Kot Village Nimro Khoso, UC Padhrio Farm, Taluka Samaro 2 3 0 1 Alert for 2 cases BD admitted in hospital, active surveillance done, health education imparted, Aqua tabs,
water filters, Hygiene kits, Jerry cans and ORS distributed, MS‐THQ, EDO‐H informed and 2 water sample
1‐Nov H1N1 KPK Haripur Haripur city 0 0 0 1
Alert for confirmed case H1N1 reported from Haripur city. Case initially suspected to be Dengue fever with platelets dropping from 280,000 to 156,000. She was referred to private hospital in Islamabad on 27‐10‐11 where her throat swab was positive for H1N1. EDO Health was informed. Joint team of WHO and DoH conducted active surveillance, no more cases were found. The affected family was educated on respiratory etiquette and preventive measure. LHW was educated on case definition and was instructed by DoH to monitor community and in specific the close contacts for suspected sign and symptoms. IEC material was also distributed.
Analysis of weekly data from BHU Miranpur for week 43 showed very unusual rise in Acute Diarrhea cases to 119, crossing the alert threshold of 45, most of these cases (81) were of children under 5 years of age. On review of the OPD data at the BHU, more than 65% (79) of the cases were from Moza Miranpur. Field investigation found 9 more cases of AD in 20 randomly selected households. Hand pumps are the sole source of drinking water for the community. HE Session was conducted for the community by SO DEWS and
26 Cases of suspected Malaria investigated, total 14+v (54% SPR) confirmed by RDT in which 9PV+ve, 4PF+v, 1Mix+v, (36% FR); cases treated, health education imparted to the community, coordinated action planned by DOH, PPHI, MERLIN and CARE intl,
Responding to alert for malaria, tested 25 fever cases with RDT. Results showed 18 positive (72%); 6 were P. falciparum or mixed infections (24%) and 12 were P. Vivax (48%). Cases treated with appropriate meds and vector control response coordinated.
3‐Nov Pertussis Sindh Matiari Village Sahar Mangwano, UC Shah Alam, Taluka Matiari 7 5 5 4 Alert for Pertussis; Active surveillance identified 21 probable cases, Health education imparted, EDO‐H
informed and 2 Throat sample collected.
3‐Nov Pertussis Sindh Matiari Village Suleman Mangwano, Taluka Matiari 8 9 7 13 During active surveillance found 34 cases of probable Pertussis, Health education imparted, EDO‐H in‐
formed and 1 Throat sample taken.
Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F
28‐Oct AWD Battagram Village Shingalo Bala, UC Gijjbori 0 1 0 0
Epidemiological Bulletin: DEWS, Pakistan, Week no. 44 (27 October to 3 November, 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, 03
Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F
28‐Oct AWD Badin Village Jeo Lund, Taluka Tando Bago 1 5 0 3
Epidemiological Bulletin: DEWS, Pakistan, Week no. 44 (27 October to 3 November, 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
Province Khyber Pakhtunkhwa: • This week 649 health facilities from 18 districts reported to
DEWS with a total of 140,356 patients consultations.
• The proportional morbidity of AD is showing gradual decline during the last 6 weeks after a consistent higher proportion (16%) from week 35, 2011.
• 24 alerts were reported in this week, 13 were for Measles; 6 for DHF; 2 for AWD; while 1 each for Acute diarrhoea, CCHF and H1N1.
• 1 outbreak for H1N1 was received and responded.
Figure-3: Trend of priority communicable diseases, province KPK
Province Sindh:
• This week 890 health centers from 22 districts reported to DEWS with a total of 379,741 patient consultations.
• In Sindh, AD cases reported were 31,405 (8%), same propor-tional morbidity as compared with last week.
• 48 alerts were reported from Sindh in this week: 23 were for AWD; 8 for Neonatal tetanus; 6 for Measles; 3 each for Bloody diarrhoea and Pertussis; 2 each for DHF and Malaria; while 1 for Leishmaniasis.
• 10 outbreaks 4 for AWD and 2 each for Bloody diarrhoea, Malaria and Pertussis were received 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 43) Current Week (44) Total A O A O A O A O
Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 44/2011)
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
2595
2536
2645
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
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 44 (27 October to 3 November, 2011) Province Punjab: • This week 483 health facilities from 8 districts reported data to
DEWS from Punjab province with a total of 218,951 patient consultations.
• AD cases reported were 11,577 and showing proportional morbidity lower by 1% as compared with last week .
• 33 alerts were reported in this week from Punjab; 20 were for DHF; 2 for Neonatal tetanus and tetanus; 2 each for AWD, Leishmaniasis and Pertussis; while 1 each for AD, ARI, Mumps, Scabies and Unexplained fever.
• 10 outbreaks 4 for AWD; 2 each for BD, Malaria and Pertussis were received and responded 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 122 health facilities from 10 districts with a total of 29,843 patient consultations.
• ARI cases reported were 5,531 (19%), while Acute diarrhoea reported 1,181 (4%) cases.
• 3 alerts one each for DHF, Bloody diarrhoea and Pertussis was re-ceived and responded this week.
• This week 42 health facilities in 2 agencies reported from FATA, with a total of 7,507 patient consultations.
• ARI cases reported were 2,007 (27%), while Acute diarrhoea was reported 580 cases (8%)
• Two alerts for Neonatal tetanus were received and responded this week.
Province Gilgit Baltistan:
• In this week, 78 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 21,048 pa-tient consultations.
• ARI cases reported were 5,249(25%), while Acute Diar-rhoea were 1,709 (8%).
• 3 alerts 2 for Pertussis and 1 for Measles was received and responded this week.
Figure-7: Trend of priority communicable diseases, Gilgit Baltistan
FATA:
Province Balochistan:
• In this week, 16 districts reported to DEWS from Ba-lochistan province. 381 health centers reported a total of 68,178 patient consultations.
• AD reported in 6,479 (10%) of the total consultations, same proportional morbidity as compared with the last week.
• 13 alerts were reported in this week from Balochistan, 6 for Leishmaniasis; 4 for Measles; while 1 each for Neo-natal tetanus, Rabies and Typhoid.
• No outbreak for any disease was reported this week.
Figure-6: Trend of priority communicable diseases, province Balochistan
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 44 (27 October to 3 November, 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]. 06
Focus on: Situation in Sindh (week 44, 2011)
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 infected districts/towns/agencies.
Year 2011: As of 5 November, 2011, the total number of polio cases con‐firmed by the laboratory is 145 (143=type‐1, and 2=type3) from 44 districts.
• There were no heavy rains were forecasted by Met Department this week and no heavy rains were observed except small showers at scattered places.
• Some BHUs and GDs are still under water in districts Badin, Mirpurkhas, Umarkot, Sanghar and Tando Allahyar. But all the DHQs are functioning including DHQ Sanghar which was heavily submerged in rain water. While 9 DTCs are working properly and reporting on daily basis, the number of diarrhea cases in each plan (A, B and C) is decreasing day by day.
• This week a total of 48 alerts and outbreaks were reported from 19 districts of Sindh, while 4 districts did not report any alert. Thatta is the district which reported a large number of alerts (8), while Jacobabad, Mirpurkhas and Naushehro Feroz reported 1 alert for each. AWD alerts were on the top and contributing 50% (24) of alerts, followed by NNT 9 cases, Measles 6, Pertussis and BD 3 for each, Ma‐laria 2 alerts. One case of Leishmaniasis was reported from Jacobabad. The number of VPD alerts (Measles and Pertussis) is increasing in every week, as season changes and in view of low routine immunization in Sindh. While 61 confirmed dengue cases with 2 deaths were also reported.
• Sindh malaria control program has collected a total of 29,563 slides plus RDTs out of which 2808 were found positive for malaria. Plas‐modium Vivax was on the top with 1491 positive number of cases, followed by falciparum 787 cases and mixed 530 cases (FR = 47%). No death due to malaria was reported from any corner of Sindh. Highest FR was found in district Thatta 63%, followed by Badin 43% and Jacobabad 41%.
Pakistan Dengue Situation, 5th November 2011 Since the beginning of the year and as of 5th November 2011 ; 519,466 cases of suspected dengue fever cases and 22,343 Lab confirmed cases were reported from Provincial Dengue Focal Points from across the country with 337 deaths (CFR = 1.51%).
Over 90% of cases were reported in Punjab province. Following data of lab confirmed cases is received from the provincial health depart‐ment.
Provinces 2011
Suspected Confirmed Deaths
Punjab 516583 20565 314
Sindh 1295 916 15
Islamabad 968 620 2
Khyber Pakhtunkhwa 502 210 6
AJK 99 21 0
FATA 7 6 0
Balochistan 6 3 0
Gilgit Baltistan 6 2 0
Total 519466 22343 337
Epidemiological Bulletin: DEWS, Pakistan, Week no. 44 (27 October to 3 November, 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