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. 38 (16 - 22 September, 2011) • 81 districts and 3 agencies provided surveillance data to the DEWS this week from 2,459 health facilities. • A total of 979,793 consultations were reported through DEWS of which 19% were acute respiratory infections (ARI), 11% Skin disease, 11% acute diarrhoea, and 8% suspected Malaria. • A total of 197 alerts with 47 outbreaks were reported in week-38, 2011: Altogether 94 for DHF; 44 were for AWD, 19 for Measles; 15 for Neonatal Tetanus; 10 for Leishmaniasis; 3 each for Acute diarrhoea, Bloody diarrhoea and Typhoid; 2 for Malaria; while one each for Acute Jaundice Syndrome, CCHF, Meningitis and Pertussis. • National Polio Eradication Initiative reported 2 new type-1 confirmed polio cases this week: One each from district Buner (Khyber Pakhtunkhwa) and Killa Abdullah (Balochistan). As of 22 September, 2011, Pakistan has reported a total of 91 polio cases (90 type-1 cases & 1 type-3 case) from 35 districts/towns/tribal agencies/areas. Highlights Disease early warning system and response in Pakistan 01 Volume 2, Issue 38, Monday 26 September, 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: Three years trend of Acute diarrhoea in Pakistan (2009, 2010, and 2011) Disease Wk-31 Wk-32 Wk-33 Wk-34 Wk-35 Wk-36 Wk-37 Wk-38 Acute Diarrhoea 109,255 (10%) 106,918 (10%) 101,174 (10%) 94,494 (11%) 40,403 (10%) 96,128 (11%) 109,476 (12%) 108,014 (11%) Total consultation 1,078,912 1,040,292 988,119 880,166 389,729 864,693 930,999 979,793 Since July 29, 2010, approximately 45,576,828 patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week 38, 2011 (16 to 22 September, 2011) reports were received from 2,459 health centers and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases 108,014 (11%), acute respiratory infections 187,395 (19%), Skin diseases 105,735 (11%) and suspected malaria 77,356 (8%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 2009, 2010 and 2011 up until now. 0 4 8 12 16 20 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Percentage Epi ‐week 2009 2010 2011
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Weekly Epidemiological - WHO · spray in the area were done. 19‐Sep DHF Khyber Pakhtunk‐ hwa Mansehra Village Dogah Balakot 0 0 0 2 Outbreak of DHF reported from Village Dogah
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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].
• 81 districts and 3 agencies provided surveillance data to the DEWS this week from 2,459 health facilities.
• A total of 979,793 consultations were reported through DEWS of which 19% were acute respiratory infections (ARI), 11% Skin disease, 11% acute diarrhoea, and 8% suspected Malaria.
• A total of 197 alerts with 47 outbreaks were reported in week-38, 2011: Altogether 94 for DHF; 44 were for AWD, 19 for Measles; 15 for Neonatal Tetanus; 10 for Leishmaniasis; 3 each for Acute diarrhoea, Bloody diarrhoea and Typhoid; 2 for Malaria; while one each for Acute Jaundice Syndrome, CCHF, Meningitis and Pertussis.
• National Polio Eradication Initiative reported 2 new type-1 confirmed polio cases this week: One each from district Buner (Khyber Pakhtunkhwa) and Killa Abdullah (Balochistan). As of 22 September, 2011, Pakistan has reported a total of 91 polio cases (90 type-1 cases & 1 type-3 case) from 35 districts/towns/tribal agencies/areas.
Highlights
Disease early warning system and response in Pakistan
01
Volume 2, Issue 38, Monday 26 September, 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: Three years trend of Acute diarrhoea in Pakistan (2009, 2010, and 2011)
Total consultation 1,078,912 1,040,292 988,119 880,166 389,729 864,693 930,999 979,793
Since July 29, 2010, approximately 45,576,828 patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week 38, 2011 (16 to 22 September, 2011) reports were received from 2,459 health centers and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases 108,014 (11%), acute respiratory infections 187,395 (19%), Skin diseases 105,735 (11%) and suspected malaria 77,356 (8%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 2009, 2010 and 2011 up until now.
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
20‐Sep AJS AJK Hattian Village Bandi‐Bala‐Peran, UC Chak‐hama, Hattiyan Bala
0 4 0 1 5 suspected case of AJS reported. 5/5 Blood samples collected and found positive for Hepatitis E Virus. No other case was found during field investigation.
21‐Sep AWD Balochis‐tan
Bolan Village Haji shehr, tehsil Dhadar
17 21 19 11 68 suspected AWD cases reported. stool sample was taken and sent to NIH. Medicines, aqua tabs were distributed. Health and hygiene session was conducted for awareness raising in the community.
21‐Sep Malaria Balochis‐tan
Kech Ginnah, UC Ginnah, Turbat
13 26 32 22 93 cases of suspected malaria were reported. 71 samples tested and 52 were found positive for Falciparum. DHO was informed and requested to distribute Bed nets to the affected locality and do other preventive measures and case manage‐ment.
17‐Sep Mea‐sles
Balochis‐tan
Kalat Marjan UC Dashte Goaram tehsil Kalat
2 0 6 1 Alert of 9 Measles cases including one death was received from DHQ hospital. 2 blood samples were collected and sent to NIH. Vit.A and health education was given. During field investigation other cases were also examined. This issue is discussed with DHO to use outreach team for immunization of surrounding house children.
21‐Sep Mea‐sles
Balochis‐tan
Ziarat Shereen 5 0 1 0 6 cases of suspected measles were reported. Blood sample taken and sent to NIH. Active surveillance done no more cases were found. Vit.A was given to the cases, Health and hygiene sessions were conducted with community on disease pattern and safety measures.
0 2 0 0 1 outbreak of DHF was reported from Bajour Agency. Agency Surgeon informed with request for fogging. Active surveillance carried out & no other case identified. Health education given to community regarding prevention of Dengue fever.
20‐Sep AWD Gilgit‐Baltistan
Astore FAP Fakir kot 10 5 5 10 30 cases of AWD reported. Stool sample sent to NIH. DSM PPHI informed and asked him to arrange a medical camp in the locality. Patients with dehydration sent to DHQ hospital Gilgit .I/V fluids transferred to the concerned FAP. Aqua tabs distrib‐uted. Health education conducted in community school and to the people of the locality as well.
22‐Sep DHF Gilgit‐Baltistan
Ghizer Village Kanchi Silpi UC Gahkuch Tehsil Punial
0 1 0 0 First case of DHF was reported. Blood sample positive for IgM Dengue. Patient has a positive travel history of Lahore. DHO Ghizer, MS DHQ Gilgit took all preventive measures including establishment of Isolation ward for Dengue, anti mosquito sprays, printing and distribution of IEC material among public for awareness, on air messages through cable and radio etc.
16‐Sep AWD Khyber Pakhtunk‐hwa
Upper Dir Lower Dir (Village Aamriat, UC Falam, Osherey Darra)
2 2 1 3
8 cases of AWD reported. Case Investigated, 4 Water Samples collected and sent to NIH.100 ORS, 1500 aqua tabs, 10 hygiene kits, one straw filter, 5 Jerry Cans and IEC material were provided to affected family and surrounding families. Springs were chlorinated and HTH chorine powder provided for further chlorination. Health & Hygiene promotion Session conducted with family members and Imam of mosque.
19‐Sep DHF Khyber Pakhtunk‐hwa
Abbottabad Sheikh ul Bandi 0 2 0 0 2 outbreaks of DHF were reported from different parts of District Abbottabad. Health Education provided to the attendants of the patient. EDO H informed for necessary action. 1 patient has a positive travel history to Lahore
16‐Sep DHF Khyber Pakhtunk‐hwa
Haripur Village Doyain Khushkian
1 2 0 3
6 outbreaks of DHF reported from different parts of District Haripur. No travel history to dengue endemic areas. A joint team of WHO and Dept of health visited the area. A session on DF spread and prevention was conducted for the affected house‐hold. LHWS of the area informed of the case. Health sessions through LHWs conducted in the area. Fogging and residual spray in the area were done.
19‐Sep DHF Khyber Pakhtunk‐hwa
Mansehra Village Dogah Balakot
0 0 0 2 Outbreak of DHF reported from Village Dogah Mansehra. EDO H informed. No other case found in the area on active surveil‐lance. Necessary action taken
18‐Sep DHF Khyber Pakhtunk‐hwa
Shangla Kuza Hujra/Tehsil Chakesar
0 2 0 1
3 outbreaks from different parts of District Shangla was cross notified by SO Swat.2/3 confirmed cases had positive travel history to Lahore. A response team led by DEWS‐SO visited the village The community joint session was conducted highlight‐ing the preventive measures, and at the same time fogging of the whole village along with household spray was started, 250 bed nets have been distributed. Active surveillance with TMA and PHED was conducted. Probable breeding sites were identi‐fied and later drained. The community health committee was informed about the situation and strictly advised by the District Government to abide by the standard preventive measures according to WHO guidelines.
18‐Sep DHF Khyber Pakhtunk‐hwa
Swat Village Shaftalu, UC Kishawra, Tehsil Charbagh
0 1 0 0 An outbreak of DF was reported from village Shaftalu Swat. There was no positive travel history to Dengue endemic areas. WHO Team along with DoH conducted a response at this village and distributed ITNs.
21‐Sep AWD Punjab Mianwali Near Railway line ,UC Rokhri
1 4 0 1 6 AWD cases reported from DHQ hospital. Stool sample sent o NIH. Education about hygiene and health given in the commu‐nity, Medicine supplied to near health facility, aqua tabs, soaps and ORS distributed to patients families. Reporting staff trained about definitions. Filters and water purification methods were also conveyed.
8 outbreaks of DF reports provided from different locations of Tehsil Bhakkar. Positive travel history to Lahore. Necessary measures at hospital ensured. All the locations were visited 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 mem‐bers done.
20‐Sep DHF Punjab D. G. Khan Nishter Hospital Multan (D.G Khan)
0 6 0 2 8 Patients with DF reported at Nishtar Hospital Multan from different locations of DG Khan district. Positive travel history to Lahore. 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 DEWS district DG Khan doing the follow up in the area.
0 12 0 5 17 confirmed cases of DF reported from different locations of Khanewal district . Necessary measures at hospital ensured. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and com‐munity members done. Health department at district Khanewal. Follow up in the area is on going.
9 outbreaks of DHF reported from different locations of district Layyah both from the city and rural areas. Present travel history to epidemic area. Necessary measures at hospital ensured. All the locations were visited one by WHO team and DoH staff. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Follow up is on going.
22‐Sep DHF Punjab Multan Nishter Hospital Multan
0 23 0 3
25 confirmed cases of DHF reported from different locations of Tehsil Multan and mostly from the city areas. Positive travel history to Lahore. Only 3 cases are indigenous to Multan and no travel history. Necessary measures at hospital ensured. All the locations were visited 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. Follow up is on going.
1 7 0 1 9 confirmed cases (outbreak) of DF reported from different locations of Muzaffargarh district and mostly from the rural areas. Positive travel history to Lahore. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Follow up is on going.
19‐Sep DHF Punjab Rahim Yar Khan
Sh. Zayed Hospital RY Khan (Rahim Yar Khan)
0 17 1 3
21 confirmed cases of DF reported at Sh Zaid Hospital RY Khan from different locations of District RY Khan. Patients having travel history of epidemic area. Necessary measures at hospital ensured. All the locations were visited one by WHO team and DoH staff for active case finding. IRS and fumigation was conducted in all the areas. HE to the family and community mem‐bers done on patient care and prevention. Follow up is ongoing.
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 Outbreaks: Cont’d Date Disease Province District Area <5M >5M <5F >5F Action Taken
Outbreak of DHF from Basti Davar cross notified by SO DEWS DG Khan. Training of THQ Hospital Jampur and RHC Dajal staff on management of patients conducted. Active surveillance conducted. Provision of IEC materials to community and outreach staff by health department. Health education session conducted at the household level in area conducted IEC material distributed.
17‐Sep AWD Sindh Karachi Lassi Goth Gadap tawn
4 2 6 2 14 cases, 1 death reported and 2 Stool samples taken and sent to NIH. Reinforced case management, Active Surveillance done, Health education conducted, Aqua Tabs distributed, Health staff briefed regarding Rapid alert reporting
16‐Sep AWD Sindh Mirpur Khas Village Muhammad Hassan Mari
3 1 1 1 Six AWD cases and 1 death reported. 1 Stool sample collected and sent to NIH for lab confirmation (result awaited). Rein‐forced case management, Health education sessions conducted. Aqua tabs, Jerry cans and IEC Material distributed
17‐Sep AWD Sindh Naushahro Feroze
Village Mashori UC Mithiani
8 4 8 0 Responding to the alerts, on active surveillance 51 AWD cases including 3 deaths reported. 2 Stool samples collected and sent o NIH. Results awaited,. Health education conducted.
16‐Sep AWD Sindh Sanghar Village Rukun Burrira, Taluka Sinjhoro
8 7 5 5 25 AWD cases, 4 deaths reported. Reinforced case management. Health education sessions conducted. ORS sachet, Zinc tablets provided for patients, Aqua tabs, Jerry cans, IEC Material, Hygiene kits distributed in the affected community. 2 Stool and 5 water sample collected and sent to NIH.
20‐Sep AWD Sindh Tharparkar Village Kheemabh, UC Mirwah, Taluka Nagarparkar
0 0 0 0 6 death due to AWD reported. Surveillance done, Community sensitized regarding hand wash and health Hygiene session conducted. Aqua tabs, ORS and water filter distributed. Medical teams mobilized in the area. Supplies for case management provided.
18‐Sep AWD Sindh Thatta
Village Ahmed Dokey ,UC Ma‐har,taluka Shah Bunder
2 2 1 2 7 AWD cases reported. 4 Stool and 2 water samples taken and sent to NIH. Reinforced case management. Health education sessions conducted, Aqua tabs distributed in community, Zinc tabs and ORS distributed to patients.
19‐Sep DHF Sindh Ghotki Mian Abdul Sami Muhallah UC Dahraki
1 1 0 0
2 outbreaks of DHF reported from different parts of District Ghotki. No travel history observed. MS was provided hospital case management guidelines. Active case finding was carried out. Nearest health facility was informed of the suspected case and staffs were briefed on case definition and early referral of the cases. EDO Health and Malaria control program officer was informed of the case. Bed nets were distributed fumigation was done in area
20‐Sep Mea‐sles
Sindh Thatta Village Abdullah Ghandro UC Sonda taluka thatta
3 1 4 5 13 cases of suspected measles reported. 5 Blood sample taken and sent to NIH. Active Surveillance done, Vitamin (A) given, Health education sessions conducted, EDO‐H informed.
Current week's Alerts: AJK; FATA; GB and ICT Date Disease District Area <5M >5M <5F >5F
19‐Sep Meningitis skardu Village hussain abad U/C H.abad district Skardu
0 1 0 0
Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F 19‐Sep AD Kohat Village Suleman Talab, Shahpur II 0 1 0 0
16‐Sep AWD Lower Dir Village Markharaon, Petto Darra, UC Bandagai, Timargara.
0 0 0 3
21‐Sep AWD Lower Dir Village Kashodal, UC & Tehsil Samar Bagh 0 1 0 3
22‐Sep AWD Lower Dir Village Matta, Shatai Darra, Tehsil Balmbat 1 0 0 3
19‐Sep AWD Shangla Village Machar/Alpurai 0 1 0 0
16‐Sep AWD Upper Dir Lower Dir (Village Aamriat, UC Falam, Osherey Darra)
2 2 1 3
16‐Sep AWD Upper Dir Lower Dir (Village Olagai‐Jabai, UC Falam, Osherey Darra)
1 0 0 1
20‐Sep BD Kohat Village Naakband, Union Council Bilitang 2 4 3 8
22‐Sep DHF D. I. Khan Street 06 Gilani Town D I Khan 0 1 0 0
22‐Sep DHF Lower Dir DHQ Hospital Gilgit 0 1 0 0
22‐Sep DHF Lower Dir Village Gombat Banda, UC & Tehsil Lal Qilla, Maidan, Lower Dir
21‐Sep DHF D. I. Khan Village Zandar Wanda Khaliq Shah Band Kurai Tehsil PaharPur
0 1 0 0
Current week's Alerts: Province Khyber Pakhtunkhwa (Cont’d) Date Disease District Area <5M >5M <5F >5F 18‐Sep DHF Shangla Village Munz Kele Shokar/Martung 0 1 0 0
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 Sindh Date Disease District Area <5M >5M <5F >5F
20‐Sep AD Badin Village Umer Malwani, UC Seerani 2 0 1 1
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 19 districts reported to DEWS from 715
health facilities with a total of 172,302 patients con-sultations.
• The proportional morbidity of AD showing decline during the last three weeks after a consistent higher proportion (16%) for almost 10 weeks.
• 55 alerts were reported in this week, 44 were for DHF, 6 for AWD, 3 for Measles, while one each for Acute diarrhoea and Bloody diarrhoea.
• 7 outbreaks identified and responded.
Figure-3: Three years trend of Acute diarrhoea, province KPK
Province Sindh:
• This week 20 districts reported to DEWS from 642 health centers with a total of 438,020 patient consul-tations.
• In Sindh, AD cases reported were 52,226 (12%), same proportional morbidity as compared with last week.
• 70 alerts were reported from Sindh in this week: 29 were for AWD; 21 for DHF; 9 for Neonatal Tetanus; 6 for Measles; 2 for Leishmaniasis; while one each for Acute diarrhoea, Bloody diarrhoea and Malaria.
• 8 outbreaks identified and responded.
Figure-4: Three years trend of Acute diarrhoea, province Sindh
Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease
Post Flood 2010 2011 (up till wk 37) Current Week (38) Total
Epidemiological Bulletin: DEWS, Pakistan, Week no. 38 (16 to 22 September, 2011) Province Punjab: • 7 districts reported data to DEWS from Punjab prov-
ince, 398 health facilities reported a total of 207,410 patient consultations during this week.
• AD cases reported were 16,958 and stabilize between 6% - 8% from last four weeks.
• 31 alerts were reported in this week from Punjab; 22 were for DHF; 4 for AWD; 2 each were for Measles and Neonatal Tetanus; while one was for Leishmani-asis.
• 12 outbreaks identified and controlled
Figure-5: Trend of acute diarrhoea, province Punjab (3 August 2010 to 22 September 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
State of Azad Jammu and Kashmir:
• In this week, weekly report received from 114 health centers from 10 districts, with a total of 40,669 patient consultations.
• ARI cases reported were 6,431 (16%), while Acute diarrhoea re-ported 2,567 (6%) cases.
• 7 alerts were received and responded this week; 3 each for DHF and Measles; while one for acute Jaundice Syndrome.
• This week 55 health centers in 3 agencies reported from FATA, with a total of 12,847 patient consultations.
• ARI cases reported were 2,315 (18%), while Acute diarrhoea re-ported 1,114 cases (9%)
• Three alerts received and responded this week; 2 for DHF and one for AWD.
Gilgit Baltistan:
• In this week, 82 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 28,725 patient consultations.
• ARI cases reported were 5,106 (18%), while Acute Diarrhoea 4,835 (17%).
• 5 alerts received and responded this week, one each for AWD, DHF, Pertussis, Meningitis and Typhoid.
Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 22 September 2011)
FATA:
Province Balochistan:
• In this week, 18 districts reported to DEWS from Balochistan province. 453 health centers reported a total of 79,820 patient consultations.
• AD reported in 9,464 (12%) of the total consulta-tions, same proportional morbidity as compared with last week.
• 26 alerts were reported in this week from Balochis-tan, 7 were for Leishmaniasis; 5 for Measles; 4 for Neonatal Tetanus; 3 for AWD; 2 for Typhoid; while one each for Acute diarrhoea, Bloody diarrhoea, CCHF, DHF and Malaria.
• 4 outbreaks identified and controlled.
Figure-6: Three years trend of Acute diarrhoea, 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]. 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: The total number of polio cases confirmed by the laboratory is 91 (90=type‐1, and 1=type3) till date from 35 districts.
Focus on: Dengue Fever
What is Dengue? Dengue is the most widespread mosquito‐borne infection in human beings, which in recent years has become a major international public health con‐cern. Over the last 15 years, we have witnessed a dramatic increase in the global incidence of dengue and its severe manifestations such as dengue hemorrhagic fever. Dengue fever is a severe, flu‐like illness with fever, headache and muscle and joint pains that affects children and adults, but seldom causes death. Dengue hemorrhagic fever (DHF) is a potentially deadly complication in about 1‐3% of cases that begins with a sudden rise in temperature which usually continues for two to seven days and can be as high as 40‐41°C. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever when the temperature drops, followed by signs of circulatory failure. With modern intensive supportive therapy, the fatality rates can be reduced to less than 1%. How Dengue spreads? Dengue spreads through the bite of infected Aedes Aegypti mosquito. The mosquito gets the virus by biting infected person. The symptoms of the dis‐ease appear about 5‐7 days after the infected bite. There is no way to tell if a mosquito is carrying the Dengue virus. Therefore, people must protect them‐selves from all mosquito bites. How can we prevent Dengue? Prevent mosquito bites
• Dengue mosquitoes bite during the daytime, protect yourself from the bite.
• Wear full‐sleeve clothes and long dresses to cover the limbs. Avoid wearing black color.
• Use repellents. Care should be taken in using repellents on very young children or the elderly
• Use mosquito coils and electric vapor mats during the daytime
• Use insecticide treated nets (ITNs) to protect young children, pregnant women, old people, in addition to others who may rest during the day.
• Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes.
Province Cases 2010 Cases 2011 P1 P3 P1 P3
Punjab 6 1 1 -
Sindh 26 1 17 -
Khyber Pakhtunkhwa 19 5 8 -
FATA 63 11 25 1
Balochistan 6 6 38 -
AJK - - - -
Gilgit‐Baltistan - - 1 -
Islamabad - - - -
Total 120 24 90 1
Where do mosquitoes live and breed? Dengue mosquitoes breed in stored, exposed, water collection systems. The favoured breeding places are: barrels, drums, jars, pots, buckets, flower vases, plant saucers, tanks, discarded bottles/tins, tyres, or water coolers, and other places where rainwater collects or is stored.
• Drain out the water from window air coolers when not in use, as well as draining all unused tanks, barrels, drums, and buckets.
• Remove all objects containing water such as plant saucers from the house.
• All stored water containers should be kept covered at all times.
• Collect and destroy discarded containers in which water collects, such as bottles, plastic bags, tins, tyres, etc.
• Efficient disposal of all solid waste/garbage. How should we take care of a Dengue patient?
• Keep body temperature below 39oC. Give the patient paracetamol (not more than four times in 24 hours). Fever can also be reduced by sponging patient with tepid water.
• Do not give the patient Aspirin or Ibuprofen (Brufen) or similar medi‐cine for fever or pain. Give only paracetamol.
• Give large amounts of fluids (water, soups, milk and juices) along with the patient’s normal diet
• The patient should rest
• Immediately consult your physician if any of the following manifesta‐tions appear: Red spots or points on the skin; bleeding from the nose or gums; frequent vomiting; vomiting with blood; black stools; sleepi‐ness; constant crying (children); abdominal pain; excessive thirst (dry mouth); pale, cold or clammy skin; or difficulty in breathing.
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