Flood Response in Pakistan

Transcription

1 Weekly Epidemiological Bulletin Flood Response in Pakistan Volume 1, Issue 6 Monday 27 September 2010 Highlights Epidemiological week no 38 (18-24 September 2010) Between September 2010 (epidemiological week no. 38), 40 of the 78 floodaffected districts provided surveillance data to the system. Of these 40 districts, 87% reported 6-7 days of the week. 745 fixed health and 215 mobile medical outreach centers provided surveillance data for this week. 486,376 consultations were reported through of which 18% were acute respiratory infections (ARI), 13% were acute diarrhoea, 12% were skin disease, and 9% were suspected malaria. 17 alerts were received and responded to this week; 9 alerts were for acute watery diarrhoea (), 3 were for acute flaccid paralysis, 2 for suspected malaria, 1 wwas for measles and 2 were for meningitis. No deaths were reporting to for this reporting week Note: All presented data are based on the number of patient consultations and include information on priority diseases under surveillance as well as major health events reported through. Priority diseases under surveillance in the flood affected areas Acute Flaccid Paralysis Acute Jaundice Syndrome Acute Respiratory Infections Acute Watery Diarrhoea/ Suspected Cholera Bloody Diarrhoea Other Diarrhoea Suspected Hemorrhagic Fever Suspected Malaria Suspected Measles Suspected Meningitis Unexplained Fever Others Figure-1: Trend of leading diseases in flood affected districts of Pakistan, 29-July to 24 September 2010 (Epi week 31-38, 2010) Table-1: Major health events reported during the week 31-38, 2010 (29 July - 24 September 2010) Week 31 Week 32 Week 33 Week 34 Week 35 Week 36 Week 37 Week 38 Acute Diarrhea 25,689 (13%) 94,288 (11%) 182,548 (14%) 199,607 (14%) 138,644 (13%) 68,909 (12%) 57,072 (14%) 64,925 (13%) Bloody Diarrhea 1,449 (1%) 4,566 (1%) 7,907 (1%) 11,024 (1%) 10,839 (1%) 9,228 (2%) 6,705 (2%) 6,411 (1%) ARI 25,335 (13%) 92,134 (11%) 185,546 (15%) 217,071 (15%) 187,226 (18%) 96,607 (17%) 69,969 (1%) 89,949 (18%) Suspected Malaria 3,954 (2%) 17,348 (2%) 27,453 (2%) 45,542 (3%) 45,652 (4%) 40,441 (7%) 32,692 (8%) 42,759 (9%) Skin 36,383 (19%) 115,080 (14%) 246,959 (20%) 296,441 (21%) 202,630 (19%) 92,039 (16%) 56,844 (14%) 60,704 (12%) Others 101,725 (52%) 521,872 (62%) 615,448 (49%) 654,520 (46%) 468,791 (44%) 251,769 (45%) 191,129 (46%) 221,553 (46%) Total (All Events) 194, ,353 1,265,912 1,424,260 1,053, , , ,376 01

2 Figure-2: Average number of reporting units (fixed and mobile health facilities) by province Table 2: Average number of reporting districts per week Province Week 33 Week 34 Week 35 Week 36 Week 37 Balochistan KPK Punjab Sindh Total Week Figure-3: Frequency of reported districts (Week 38, 2010) 64 districts have in place and 40 districts reported to this week; 6 in Balochistan, 6 in KPK, 10 in Punjab and 18 in Sindh. Not all districts are reporting regularly. The average number of districts and health facilities reporting per week are shown in the table 2 and figure 2 above. 87% of reporting districts reported 6 7 times during the last reporting period, 8% reported between 3 5 times, 5% reported 1 2 times. Figure-4: of fixed and mobile reporting units by province (Week 38, 2010) 02

3 Table-3: Followup Alerts reported in week 37, Dates Event Place/District Province Action taken 11 Sep 10 Abdul Rehman Jatoi Village/ Sukkur Sindh 11 Sep 10 Razi Goth/Khairpur Sindh negative for (V. Cholera) Positive for (Ogawa) 14 Sep 10 THQ Matta/Swat KPK 14 Sep 10 CMC Hospital / Larkana Sindh 15 Sep Sep Sep 10 CH Pachakalay (Sultan Wass Village)/Buner RHC Munda (Mian Kalay)/ Lower Dir RHC Munda (Gardai)/Lower Dir 15 Sep 10 Meningitis Kokari/Swat KPK 15 Sep 10 Shikarpur City/Shikarpur Sindh KPK KPK KPK Positive for (Ogawa) negative for (V. Cholera) Aqua tabs were distributed. Active surveillance done in the surrounding areas. Laboratory test negative for (V. Cholera) Active surveillance carried out in the locality. Laboratory test Positive for (Ogawa) Active surveillance carried out in the locality. Laboratory test Positive for (Ogawa) Laboratory test negative for Meningitis. Active surveillance carried out. negative for (V. Cholera) 15 Sep 10 TH Golarchi Thatta Sindh Table-4: Alerts and Outbreaks (Week 38, 2010) One Cholera Kit and one MEHK kit was donated. Dates Event Place/District Province Action taken 18 Sep 10 DHQ Mianwali/Mianwali Punjab 18 Sep 10 BHU Paikhel/Mianwali Punjab Upon investigation no active cases were seen, no sample was taken Upon investigation no active cases were seen, no sample was taken 19 Sep 10 Kotmagsi/Naseerabad Balochistan Sporadic cases were found, no sample was taken 20 Sep 10 DHQ Sibi/Sibi Balochistan Mild diarrhea cases were found, declared as false alert 20 Sep 10 Meningitis Dakorak Village/Swat KPK Laboratory test negative fo meningitis 21 Sep 10 Meningitis DHQ Loralai/Lorali Balochistan Patient s father did not agree, no sample taken 21 Sep 10 Measles RHC Alladand Malakand KPK Sample in transportation 22 Sep 10 Kot Addu/Muzaffarabgarh Punjab Sample collected and test under process 23 Sep 10 Alipur, Bheda Kot/Muzaffargarh Punjab Sample collected and test under process 23 Sep 10 Alipur, Tibbi Arain/Muzaffargarh Punjab Sample collected and test under process 23 Sep 10 BHU Naakband/Kohat KPK 23 Sep 10 DHQ Timergara/Lower Dir KPK 23 Sep 10 Malaria UC Khazana/Lower Dir KPK 23 Sep 10 Malaria UC Norakhiel/Lower Dir KPK 23 Sep 10 AFP Nishter Hospital/Multan Punjab 24 Sep 10 AFP Nishter Hospital/Muzaffargarh Punjab 24 Sep 10 AFP CHC Hospital/Muzaffarargarh Punjab Hygiene education sessions were conducted at mosque. 8,000 aqua tabs and 1,000 ORS were distributed Previously 3 positive cases were identified, no new sample was taken Malaria control program has been informed and will take care of on site sample collection Malaria control program has been informed and will take care of on site sample collection Polio program has been informed and active surveillance is in progress Polio program has been informed and active surveillance is in progress Polio program has been informed and active surveillance is in progress 03

4 Province KPK 6 out of 17 flood affected districts reported to from KPK province 55 fixed health centers and 24 mobile 101,679 patient consultations were reported during the reporting period of September, week 38, alerts were received this week; 3 were for, 2 were for suspected malaria and 1 each for measles and meningitis were reported and responded to this week Figure-5: Trend of priority communicable diseases, province KPK (31-July 24 September 2010) % of total consultations Figure-6: Proportional morbidity of reported health events, KPK province Acute Diarrhoea 11,715 12% ARI 18,780 18% Skin 8,543 8% Suspected malaria 1,515 1% Others 57,477 57% Total Health events 101,679 Province Punjab 10 out of 12 flood affected districts reported data to from Punjab province 164 fixed health centers and 46 mobile 141,915 patient consultations were reported during this reporting period 8 alerts were received and responded this week, 4 were for and 3 were for AFP Figure-7: Trend of priority communicable diseases, province Punjab (3 August 24 September 2010) % of total consultations Figure-8: Proportional morbidity of reported health events, Punjab province Acute Diarrhoea 18,016 13% ARI 25,633 18% Skin 14,852 10% Suspected malaria 12,041 8% Others 51,357 37% Total Health events 141,915 04

5 Province Sindh 18 out of 22 flood affected districts reported to from Province Sindh 504 fixed health centers and 139 mobile 223,401 patient consultations were reported during the reporting period of September, week 38, 2010 No alert was reported for this week from any flood affected districts of province Sindh Figure-9: Trend of priority communicable diseases, province Sindh (6 August - 24 September 2010) % of total consultations Figure-10: Proportional morbidity of reported health events, Sindh Acute Diarrhoea 32,021 14% ARI 42,959 19% Skin 37,309 17% Suspected malaria 24,817 11% Others 58,725 26% Total Health events 223,401 Province Balochistan 6 out of 19 flood-affected districts reported to from province Balochistan 22 fixed health centers and 6 mobile 19,381 patient consultations were reported during the reporting period of September, week 38, alerts were received and responded, 2 for and 1 for meningitis from province Balochistan Figure-11: Trend of priority communicable diseases, province Balochistan (6 August - 24 September 2010) % of total consultations Figure-12: Proportional morbidity of reported health events, Balochistan Acute Diarrhoea 3,137 16% ARI 2,577 13% Suspected Malaria 4,286 23% Unexplained Fever 346 2% Others 8,120 42% Total Health events 19,381 05

6 Since July 29, 2010, approximately 6,243,723 patient consultations have been reported to from the flood affected provinces in Pakistan. is currently in place in 64 of the 78 flood affected districts (82%) and reporting is received from 50 of these 64 districts (78%) The major causes for seeking healthcare by the affected communities continue to be diarrhoel diseases, acute respiratory infections, skin diseases and suspected malaria. In KPK, ARI increased from 13% to 18% while AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from In Punjab, a higher proportion of suspected malaria was reported this week (1% to 8%), however, it is important to note the corresponding decrease in unexplained fever (17% to 7%). Thus, caution should be used when interpreting these data. In Sindh, proportional morbidity of major health events remained the same when compared to last week. In Balochistan, reporting remains irregular due to security issues. Suspected malaria continues to make up the largest proportion of consultations. Percentage Figure-13: AD trends, KPK, 2009 and 2010 Weekly pattern of acute diarrhea, IDP crisis and hosting districts, Khayber Pakhtunkhwa ( ) Figure-14: alerts and confirmed cholera cases since July 29, Epi week Seventeen alerts were raised during this reporting period. Nine alerts were for bringing the total number of alerts for to 126. There are currently 67 confirmed cholera cases through. The laboratory samples were collected from all sites, as necessary, and sent to National Institute of Health (NIH) for laboratory confirmation. Relevant public health actions were initiated in the field to arrest a potential outbreak. Focus On. Malaria Floods may indirectly lead to an increase in vector borne diseases through the expansion in the number and range of vector habitats. Standing water caused by heavy rainfall or overflow of rivers can act as breeding sites for mosquitoes, and therefore enhance the potential for exposure of the disaster affected population and emergency workers to infections such as dengue, malaria and West Nile fever. Flooding may initially flush out mosquito breeding, but it comes back when the waters recede. The lag time is usually around 6 8 weeks before the onset of a malaria epidemic. The risk of outbreaks is greatly increased by complicating factors, such as changes in human behavior (increased exposure to mosquitoes while sleeping outside, a temporary pause in disease control activities, overcrowding), or changes in the habitat which promote mosquito breeding (landslide, deforestation, river damming, and rerouting). i Malnutrition and other concurrent infections can leave displaced populations particularly vulnerable to malaria infection as well. In 2008, about 15% of Pakistan s population lived in areas of high malarial transmission (only 4% lived in malaria free zones ) and 4.5 million suspected malaria cases were reported in Pakistan, accounting for 6% of all outpatient visits and 18% of all medical admissions. ii Movement of people from areas of low endemicity to hyperendemic regions can result in high levels of transmission and infection in a population with relatively little previous exposure. Movement in the other direction risks high levels of transmission as well: despite having left hyperendemic areas, persons moving to areas with low endemicity but suitable vector conditions may raise the epidemic risk there. In particular, the Anopheles mosquito vector may be prevalent in areas of stagnant water or flooding, as is seen in Pakistan. Although the risk of transmission of malaria can increase in the context of an emergency, effective control and the reduction of transmission is possible. Flooding does not necessarily lead to an immediate major increase in mosquito numbers, and there may still be time to implement preventive measures such as indoor residual spraying. Distribution of insecticide treated nets, especially long lasting nets (LLNs), including how to use these nets are frequently effective options in areas where their use is well known. This will also have an effect on other mosquito borne diseases. iii Malarial treatments are more complex, however, and generally take the form of antimalarial drugs, though these must have demonstrated efficacy against local strains and rigid compliance to maintain the effectiveness of the treatment and deter evolution of drug resistance. i Flooding and communicable diseases fact sheet. Risk assessment and preventive measures. World Health Organization. Accessed 26 Sept ii World Health Organization. World Malaria Report Geneva iii Flooding and communicable diseases fact sheet. Short-term measures. World Health Organization. Accessed 26 Sept The objective of this weekly epidemiological bulletin is to provide a snap shot on selected health events reported from the communities affected by the current flood in Pakistan. While every attempt is made to present the weekly trend of the epidemic prone diseases, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin doesn t provide any health information on areas not covered by the emergency health response operations of MoH, Pakistan and WHO. The primary focus of is the early detection of epidemic prone diseases, to facilitate a rapid public health response. We would like to thank all the numerous national and international partners who have contributed to the Disease Early Warning System. For further information and feed-back Epidemic Investigation Cell, National Institute of Health, Chak Shahzad, Islamabd, Paksitan. : eic.nih@gmail.com World Health Organization, Pakistan : wr@pak.emro.who.int 06

7 Alerts of Acute watery diarrhoea (31 July to 26 September 2010) 07