Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 2, Issue 7 Monday 21 February 211 Highlights Epidemiological week no. 7 (11 to 17 February 211) 6 districts in 4 provinces provided surveillance data to the DEWS. This system is gradually expanding to provide information about communicable disease threats in all parts of Pakistan as the country goes through the recovery process. 2,381 fixed health and 8 mobile medical outreach centres provided surveillance data for this week. A total of 641,212 consultations were reported through DEWS of which 31% were acute respiratory infections (ARI), 9% skin disease, 6% acute diarrhoea, and % were suspected Malaria. A total of 1 alerts were reported in this bulletin: 44 from week seven, and 7 from week eight. Altogether 26 alerts were for ; 4 each for Chickenpox, Tetanus, and Meningitis; 3 each for Neonatal Tetanus, and Pertussis; 2 for Bloody Diarrhoea; and 1 each for Acute Flaccid Paralysis, Acute Jaundice Syndrome, CCHF, Suspected Malaria, and Mumps. There were four cases of confirmed poliomyelitis reported this week 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 (Ms) Suspected Meningitis (Mg) Others Figure-1: Weekly trend of leading priority diseases in Pakistan, 29 July 21 to 17 February 211 (Epi week 31, 21 to week 7, 211) Table-1: Priority diseases reported during the week 2-21 to week Diseases Wk-2 Wk-1 Wk-2 Wk-3 Wk-4 Wk- Wk-6 Wk-7 Skin Disease 41,43 (8%),424 (8%),947 (9%) 2,822 (8%) 67,23 (9%) 69,212 (9%) 74,62 (9%),799 (9%) ARI (URI and LRI) 18,48 (31%) 194,176 (32%) 28,819 (32%) 212,62 (33%) 231,441 (31%) 24,96 (31%) 26,798 (31%) 197,16 (31%) Other Acute Diarrhoea (Not Watery) 32,933 (6%) 36,46 (6%) 39,41 (6%) 3,2 (%) 41,1 (6%) 4,62 (6%) 49,94 (6%) 38,23 (6%) Bloody Diarrhoea 3,76 (1%) 3,97 (1%) 4,31 (1%) 4,21 (1%),31 (1%) 4,98 (1%) 4,979 (1%) 4,284 (1%) Suspected Malaria 2,791 (%) 34,34 (6%) 3,36 (%) 31,624 (%) 37,18 (%) 43,668 (6%),377 (6%) 34,936 (%) Total consultation 9,612 67,661 61,86 644, ,63 788,126 8,3 641,212 Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int. 1

2 Fig-2: Weekly number of reporting health units (Week to week 7-211) Table-2: Leading causes of seeking health care in the flood affected districts, 29 July 21 to 17 February Wk 33 Wk 3 Wk 37 Wk 39 Wk Wk Wk Wk 47 Mobile Fixed Wk Wk 1 Wk 1 11 Wk 3 Wk 8 Wk 7 Diseases Total Skin Diseases 1,981,761 (12%) Acute Respiratory Infection 4,81,693 (24%) Other Acute Diarrhoea (Not Watery) 1,73,33 (9%) Bloody Diarrhoea 17,4 (1%) Suspected Malaria 9,11 (%) Unexplained Fever 73,6 (3%) Total Consultations 16,786,134 Table-2: Case-Based Surveillance Results, Pakistan, Week 6, 211 Province Population (estimated) Number of Specimen Positive Female Male Punjab 89,39, Sindh 37,992, KP 22,29, FATA 3,411, Balochistan 8,33, AJK 3,14,728 GB 1,6, ICT 1,338, Total 167,96, < > Figure-3: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 29, 21 and 211 Since July 29, 21, a total of 4,81,693 Acute Respiratory Infection (both Upper and Lower) patient consultations have been reported to DEWS from the disaster affected districts of 4 provinces in Pakistan In the graph at right, DEWS weekly reports received for ARI in 211 are compared to the reports of 21 and 29 from disaster affected districts. This week, DEWS received 197,16 reports of Acute Respiratory Infection, 31% of total consultations, 3% lower than the proportional morbidity reported by DEWS in week 7/21 but the same as week 7/ Epi week Figure-4: Acute Diarrhea trends, Disaster affected districts, Pakistan 29, 21 and 211 Since July 29, 21, a total of 1,73,33 acute diarrhea patient consultations have been reported to DEWS from the disaster affected districts of 4 provinces in Pakistan In the graph at right, DEWS weekly reports received in 211 are compared to the reports of 21 and 29 from disaster affected districts. This week, DEWS received 38,23 reports of acute diarrhea, 6% of total consultations. This is the same proportional morbidity (6%) reported by DEWS in week 7/21 but 1% lower from week 7/ Epi-week Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 2 Fax : , wr@pak.emro.who.int.

3 Table-3: Alerts reported in week 7 and 8 of 211. Date of alert Disease Province District Location Male Female Action taken / Notes < > < > 11-Feb-11 Chicken Pox Balochistan Nasirabad Mangoli IDP Camp cases with typical Chicken Pox symptoms were found in Mangoli IDP Camp. Discussed with EDO for mobile medical camp for symptomatic case management and health education. 11-Feb-11 Punjab Muzaffargarh DHQ Muzaffargarh (Taj Nursery, Rawley Wala) 1 1 Upon field investigation 2 suspected cases were found from the village. 2 Samples were collected and sent to NIH, both were negative for. Vit. A doses were given to all children found in the vicinity. No other active case was found. 11-Feb-11 Sindh Sukkur Waspur Bhakkar Chowk 1 Upon field investigation found misdiagnosis for. 11-Feb-11 Sindh Kashmore Jogi Khan Bajkani Village-UC Haibat 1 Suspected alert of was reported from the village. Vitamin A was given to patient, blood sample collected and sent to NIH. No Other case found. 11-Feb-11 Haripur BHU STC Suspected cases were reported from health facility. Sample was collected and sent to NIH. Cases were treated with two doses of vitamin A. No other new cases were found. 11-Feb-11 BD Haripur BHU STC-4 3 Upon field investigation 8 bloody diarrhoea cases were found. 3 samples were collected and sent to NIH. Initial investigation suggested contaminated water source is the cause. Environmental health investigations are underway and Health education initiated. 11-Feb-11 BD Haripur BHU STC Upon field investigation 14 bloody diarrhoea cases were found. Initial investigation suggested contaminated water source is the cause. Environmental health investigations are underway. 11-Feb-11 Haripur BHU STC- Bassu Mera Suspected cases were reported from Makhan Colony. Investigations are under process. 2 doses of Vit A were given to the cases. 11-Feb-11 Sindh Jamshoro Khursheed Colony- Taluka Kotri 1 2 Upon field investigation 3 suspected cases were found. Vitamin A was given, and blood sample was collected and sent to NIH. Health education was imparted. 11-Feb-11 AFP Sindh Khairpur Khairpur 1 Cross notified to EPI, PEI and EDOH. Stool samples were collected and sent to NIH. 12-Feb-11 NNT Sindh Badin CH Badin (Mirza Farm- UC Gharo Taluka Golarchi) 1 Upon field investigation no such case was found. Immunization status of the community revealed no TT vaccination in the locality. 12-Feb-11 Pertussis Balochistan Nasirabad 12-Feb-11 Mumps Sindh Jacobabad Ward #3, Syed Rasheed Shah Village BHU Noor Muhammad Pathan 2 3 Upon investigation 2 suspected cases with typical signs and symptoms of whooping cough were found. Patients were on Tx with antibiotics. Information shared with EDO, EPI coordinator. Alert was reported from health facility and upon field investigation 3 suspected cases were found. Advised supportive treatment to avoid mixing with other children. 12-Feb-11 Pertussis Sindh Jacobabad BHU Noor Muhammad Pathan 1 Upon field investigation a suspected case was found. No other case found on field investigation. This UC is under immunized so outreach sessions are being planned to provide two doses of pentavalent and to children at risk. 12-Feb-11 Sindh Jacobabad BHU Noor Muhammad Pathan 4 3 cases were reported from an INGO. 2 blood samples were collected and sent to NIH. 12-Feb-11 Sindh Larkana Village Allah Rakhio- Warah 2 Upon investigation 2 suspected cases were found. Sample were collected and sent to NIH. 12-Feb-11 Meningitis Sindh Khairpur Khairpur 1 During active surveillance a suspected case was found at Mukhtiar Medical center. Later patient expired due to complications. No other cases reported. 12-Feb-11 Sindh Kashmore WAPDA coloney-uc Kashmore coloney Vitamin A was given to patient, 3 blood samples collected, field community investigation completed. No other case found. 12-Feb-11 Sindh Kashmore Mast Ali Mazari Village- UC Kashmore coloney 4 Vitamin A was given to patient, 4 blood sample collected and sent to NIH for lab confirmation, field community investigation completed. 13-Feb-11 Balochistan Nasirabad Goth Ali Nawaz Darbali 1 1 Alert was received from village and upon field investigation, it was misdiagnosed with measles as no patients with symptoms was found. 13-Feb-11 Balochistan Nasirabad Muhallah Raees Jan Mohammad Solangi 1 Alert was received from locality and upon field investigation, it was misdiagnosed with measles as no patients with symptoms were found. 13-Feb-11 Sindh Mirpurkhas Village Ghulam Muhammad Leghari-Mirwah 1 Upon field investigation 1 suspected case was found. Vitamin A was given, Isolation was done. Sample was collected and sent to NIH. Health education was given. 13-Feb-11 Sindh Badin Sher Muhammad Nuhrio Chak-2, Golarchi 2 Upon field investigation 2 suspected cases were found. 2 samples were collected and sent to NIH. Vit. A doses were administered to all patients. Unimmunized children in the village were vaccinated. 13-Feb-11 Sindh Badin Kaseero Khaskheli Village - Seerani Road 3 Upon field investigation 3 suspected cases were found. 2 samples were collected and sent to NIH. Patients were isolated. Vit. A doses were administered to all patients. Unimmunized children in the village were vaccinated. Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int. 3

4 Table-4: Alerts reported in week 7 and 8 of 211. (Cont d) Date of alert Disease Province District Location Male Female Action taken / Notes < > < > 14-Feb-11 Sindh Thatta Village Bejar Khoso 2 Upon field investigation 2 suspected cases were found. 2 samples were collected and sent to NIH. Patients were isolated. Vit. A doses were administered to all patients. District health authorities have planned vaccination campaing for the village, health education was given. 14-Feb-11 Pertussis Sindh Badin Chibhar Khaskheli Village-UC Kadi kazia Upon field investigation 6 suspected cases were found. Unimmunized children in the village were vaccinated. Health education was imparted. 14-Feb-11 Sindh Jamshoro 14-Feb-11 Sindh Jamshoro Sher ali Village -Taluka Sehwan Care colony Taluka Sehwan Feb-11 Sindh Thatta Selman Baran Village 1 1-Feb-11 NNT Balochistan Bolan Nosher 1 Upon field investigation 1 suspected case was found. Samples was collected and sent to NIH. Patient was isolated. Vit. A doses were administered. Vaccination was done. Upon field investigation 1 suspected case was found. Sample was collected and sent to NIH. Patient was isolated. Vit. A doses were administered. Health education was given. Upon field investigation 1 suspected case was found. 1 sample was collected and sent to NIH. Patient was isolated. Vit. A doses were administered. District health authorities have planned vaccination campaing for the village, health education was given. Upon field investigation a suspected case was found. TIGs provided by WHO, no history of TT vaccination of the mother. Baby delivered at home by a local dai, cord was tied with threads and cut by a blade. District health authorities have been informed. 1-Feb-11 Chicken Pox Punjab Muzaffargarh Bagraon Village-UC Noohan Wali Upon investigation 8 suspected case with typical Chicken Pox symptoms were found. Health education sessions were conducted. 1-Feb-11 Mardan Kaat Kali Par Hoti 1 An alert of suspected measles case was reported. Upon field investigation 1 suspected case was found. 1 sample was collected and sent to NIH. No other cases found on active surveillance. 16-Feb-11 Sindh Naushahro Feroze Sobo Chang Village-UC Jandho Rajpur 6 RHC Halani reported the alert. 2 doses of Vitamin A was given to patient, blood sample collected, field community investigation completed. 17-Feb-11 Haripur Afghan Refugee camp # An alert of suspected measles case reported from the camp. 3 samples were collected and sent to NIH. Cases were treated with two doses of vitamin A. Vaccination status checked in the area. District Health authorities were informed. No other cases found on active surveillance. 17-Feb-11 CCHF Mansehra Ayub Teaching Hospital (Batal Mandi) 1 Suspected case of CCHF was reported from Ayub Teaching Hospital. Patient died in the hospital and WHO team visited the house of deceased next day. Active surveillance in the area conducted. Sample was collected and sent to NIH. Realatives were educated on preventive measures during burial process. Fever clinic established. Contacts were traced. No suspected case was found in the contacts so far. 17-Feb-11 Meningitis Sindh Thatta Ali Muhammad Khaskhali Village 1 Reinforced case management, patient was isolated, health education was given. CSF DR but could not be taken due to no lab facilities. 17-Feb-11 Tetanus Sindh Larkana Masti Khan Chandio Village-UC Fatehpur 1 During a routine visit, a suspected case of Tetanus was found. Health education was given. 17-Feb-11 NNT Sindh Ghotki MCH Centre (Village Subo Shaikh-UC Umar Daho) 1 Upon field investigation suspected case was found. TIG was provided by WHO. Health education was imparted. District health authorities have planned control measures. 17-Feb-11 Chicken pox Sindh Ghotki Bhatai Nagar-UC II Ghotki city 3 Upon field investigation 3 suspected cases were found. Health education was imparted. District health authorities have planned for control measures. 17-Feb-11 Meningitis Sindh Sukkur Village Sobho Shaikh, UC Umar Draho 1 Patient expired before reaching Hospital, case management done, and found meningitis with pneumonia. 17-Feb-11 Chicken Pox Sindh Larkana Rice Canal Larkana City Upon field investigation 6 suspected cases were found. Health education was imparted. District health authorities have planned for control measures. 17-Feb-11 Sindh Jacobabad Domki Village-near district Jail 1 Vitamin A was given to patient, blood sample collected, field community investigation completed. 17-Feb-11 TET Sindh Qambar Shahdadkot Village Dhani Bux Mugeri-UC Rawanti 1 Patient is admitted in CMC Larkana, TIG received by patient provided by WHO, Repeated visits will be done for progress and monitoring 17-Feb-11 TET Sindh Larkana Village Masti Khan Chandio-UC Fateh pur 1 Patient is admitted in CMC Larkana, TIG received by patient provided by WHO, Repeated visits will be done for progress and monitoring 18-Feb-11 TET Sindh Shikarpur Village Chohi Shakh 1 Patient is admitted in CMC Larkana, TIG received by patient provided by WHO. 18-Feb-11 Sindh Khairpur Village Tali Mirwah UC Sabar Rind Taluka Thari mirwah 1 Vitamin A was given to patient, blood sample collected, field community investigation completed. 18-Feb-11 Meningitis Sindh Khairpur Khairpur 1 Admitted in private center as a suspected meningitis, expired last night on Feb-11 Malaria Sindh Sukkur Colony #, near civil hospital Sukkur 1 1 Admitted as a case of Malaria and also diagnosed as Suspected Meningites 19-Feb-11 Punjab Rawalpindi Fauji Colony-Pirwadhai 1 19-Feb-11 AJS Punjab Rawalpindi Darkali Shershahi 1 Upon field investigation a suspected measles case was found. 1 sample was collected and sent to NIH. Case was treated with two doses of vitamin A. Child was missed during last vaccination campaign. Active surveillance in the area revealed no other cases. Upon field investigation an Acute Jaundice case was found. 3 water samples were collected and sent to NIH. Active surveillance in the area revealed no other cases. Chlorination of the water sources is planned by the health authorities. 19-Feb-11 Mardan Sector B-Sheikh Maltoon Town 1 1 Upon field investigation 2 suspected measles cases were found. 2 samples were collected and sent to NIH. Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int. 4

5 Province This week 13 districts reported to DEWS from KP province, 19 health centers reported 11,499 patients consultations to DEWS. ARI is the leading disease in KP province. ARI cases reported 48,2 (42%), 2% higher proportional morbidity as compared with last week. 8 alerts were reported in this Bulletin from, of which were for, 2 were for Bloody Diarrhoea, and 1 was for CCHF. Figure-: Trend of priority communicable diseases, province KP (31-July 21 to 17 February 211) Diseases Wk-4 Wk- Wk-6 Wk-7 Skin Diseases,98 (4%) 6,199 (4%),33 (4%) 4,77 (4%) ARI (URI and LRI) 64,368 (42%) 61,46 (41%),91 (4%) 48,2 (42%) Other Acute Diarrhoea (Not Watery) 9,148 (6%) 9,161 (6%) 7,799 (6%) 7,371 (6%) Bloody Diarrhea 91 (1%) 1,171 (1%) 97 (1%) 827 (1%) Suspected Malaria 1,719 (1%) 2,12 (1%) 1,411 (1%) 1,322 (1%) Total consultations 1,34 1, , Province Punjab 11 districts reported data to DEWS from Punjab province, 684 fixed health centers reported a total of 171,288 patient consultations during this reporting period ARI cases reported were 44,394 (26%), 1% low proportional morbidity as compared with last week. 4 alerts were reported in this bulletin, 2 were for, while 1 each was for Chickenpox, and Acute Jaundice Syndrome. Malaria cases are still reported from flood affected districts. This week a total of,72 malaria samples were tested of which 164 were positive (slide positivity rate 2.9%), while falciparum rate was 49.4%. Figure-6: Trend of priority communicable diseases, province Punjab (3 August 21 to 17 February 211) Diseases Wk-4 Wk- Wk-6 Wk-7 Skin Diseases 1,613 (8%) 1,862(9%) 14,989 (8%) 14,211 (8%) ARI (URI and LRI) 3,761 (28%) 49,92 (27%) 47,421 (27%) 44,394 (26%) Other Acute Diarrhoea (Not Watery) 1,41 (%) 9,9 (%) 9,71 (%) 8,37 (%) Suspected Malaria 4,81 (2%),288 (3%),4 (3%) 4,898 (3%) Total consultations 194,134 18, , ,288 Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int.

6 Province Sindh This week 22 districts reported to DEWS from Sindh province, and 878 health centers reported a total of 288,21 patient consultations during the reporting period of week 7, 211. Figure-7: Trend of priority communicable diseases, province Sindh (6 August 21 to 17 February 211) 4 4 In Sindh, ARI cases reported were 84,72 (29%), 1% lower proportional morbidity as compared with last week alerts are reported from Sindh in this Bulletin for weeks 7 and 8: 17 were for suspected ; 4 each were for Meningitis, and Tetanus, 2 each were for Chickenpox, Pertussis and Neonatal Tetanus, while 1 each was for Acute Flaccid Paralysis, Suspected Malaria, and Mumps. 1 1 Diseases Wk-4 Wk- Wk-6 Wk-7 Skin Diseases 4,191 (13%) 43,499 (11%),682 (11%) 32,73 (11%) ARI (URI and LRI) 89,42 (28%) 114,97 (3%) 144,8 (3%) 84,72 (29%) Other Acute Diarrhoea (Not Watery) 16,679 (%) 21,49 (6%) 26,643 (6%) 16,3 (6%) Bloody Diarrhea 2,123 (1%) 1,964 (1%) 2,17 (<1%) 1,64 (1%) Suspected Malaria 23,48 (7%) 29,318 (8%) 36,627 (8%) 2,78 (7%) Total consultations 314,6 38,172 48, ,21 Province Balochistan In this week, 13 districts reported to DEWS from Balochistan province. 296 fixed and 8 mobile medical outreach centers reported a total of 63,622 patient consultations. ARI reported in 18,38 (29%) of the total consultations, which is 3% less as compared to the proportional morbidity last week. alerts were reported for week 7 in this Bulletin: 2 alerts were for, while 1 each for Pertussis, Chickenpox, and Neonatal Tetanus. Malaria cases are still reported from Jaffarabad, Kech and Jhal Magsi districts. This week a total of 7 malaria samples were tested of which 113 were positive and slide positivity rate was 36%, while falciparum rate was 69.3%. Figure-8: Trend of priority communicable diseases, province Balochistan (6 August 21 to 17 February 211) Diseases Wk-4 Wk- Wk-6 Wk-7 Skin Diseases 4,936 (8%) 3,91 (6%) 3,34 (%) 4,99 (6%) ARI (URI and LRI) 19,9 (3%) 19,133 (3%) 21,731 (32%) 18,38 (29%) Other Acute Diarrhoea (Not Watery) 4, (7%) 4,14 (7%),22 (8%) 6, (1%) Bloody Diarrhea 2,213 (3%) 1,769 (3%) 1,848 (3%) 1,794 (3%) Suspected Malaria 6,88 (11%) 6,928 (11%) 7,289 (11%) 7,9 (12%) Total consultations 63,648 63,22 67,87 63,622 Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 6 Fax : , wr@pak.emro.who.int.

7 Islamabad Capital Territory This week Islamabad is reporting from four health centers, and a total of 2,782 patient consultations. Figure-9: Trend of priority communicable diseases, Islamabad (1 January to 17 February 211) 7 6 ARI cases reported were 1,47 (3%), 6% higher as compared with last week, but overall higher than other areas. 2 alerts were received this week; 1 for, and 1 for Acute Jaundice Syndrome wk 1 wk 2 wk 3 wk 4 wk wk 6 wk 7 Diseases Wk-4 Wk- Wk-6 Wk-7 Skin Diseases 44 (1%) 61 (2%) 62 (2%) 29 (1%) ARI (URI and LRI) 1,9 (1%) 1,922 (6%) 1,47 (47%) 1,47 (3%) Other Acute Diarrhoea (Not Watery) 14 (3%) 32 (9%) 36 (11%) 192 (7%) Bloody Diarrhea Suspected Malaria Total consultations 3,81 3,427 3,127 2,782 Distribution of Wild Polio Virus cases Pakistan 21 and 211 Province Cases 21 Cases 211 P1 P3 P1 P3 PUNJAB SINDH KHYBER PAKHTUNKHWA FATA BALOCHISTAN AJK GILGIT BALTISTAN ISLAMABAD PAKISTAN Year 21: The total number of polio cases in 21 so far is 144 including 12 type-1 cases and 24 type-3 cases and the total number of infected districts/towns/agencies is 4 to date. Year 211: The total number of new type-1 polio cases were confirmed by the laboratory is 8 to date. Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 7 Fax : , wr@pak.emro.who.int.

8 Confirmed Alerts (29 July 21 to 17 February 211) Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : , wr@pak.emro.who.int. 8