Flood Response in Pakistan

Transcription

1 Weekly Epidemiological Bulletin Flood Response in Pakistan Volume 2, Issue onday 7 February 211 Highlights Epidemiological week no (28 January to 3 February 211) Between 28 Jan to 3 Feb 211 (epidemiological week no., 211), 8 districts in 4 provinces provided surveillance data to the DEWS system. 2,196 fixed health and 8 mobile medical outreach centres provided surveillance data for this week. A total of 779,29 consultations were reported through DEWS of which 31% were acute respiratory infections (ARI), 9% skin disease, 6% acute diarrhoea, and 6% were suspected alaria. Total 1 alerts reported in this Bulletin: 13 from week four and 31 from week five, while 7 alerts are from early in week six. 24 were for measles; 6 were for Influenza; 4 were for each Neonatal Tetanus and AFP; 3 were for Pertussis; 2 were for Viral Hemorrhagic Fever and eningitis; 1 each for Acute Jaundice Syndrome, Acute Watery Diarrhea, Bloody Diarrhea, Chicken Pox, Diphtheria, and Tetanus There was no case of confirmed poliomyelitis reported this 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 DEWS. Priority diseases under surveillance in the flood affected areas 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 Diarrhoea (AD) Suspected Hemorrhagic Fever (VHF) Suspected alaria (al) Suspected easles (s) Suspected eningitis (g) Others Figure-1: Weekly trend of leading priority diseases in flood affected districts of Pakistan, 29 July 21 to 27 January 211 (Epi week 31, 21 to week 4, 211) wk 31 wk 33 wk wk 37 wk 39 wk 41 wk 43 wk 4 wk 47 wk 49 wk 1 wk AD BD ARI S. alaria Table-1: Priority diseases reported during the week -21 to week -211 Diseases Wk- Wk-1 Wk-2 Wk-1 Wk-2 Wk-3 Wk-4 Wk- Skin Disease,686 (8%) 42,813 (8%) 41,4 (8%),424 (8%),947 (9%) 2,822 (8%) 67,23 (9%) 68,87 (9%) ARI (URI and LRI) 132,18 (3%) 166,81 (31%) 18,48 (31%) 194,176 (32%) 28,819 (32%) 212,62 (33%) 231,441 (31%) 243,647 (31%) Other Acute Diarrhoea (Not Watery) 27,989 (6%) 37,1 (7%) 32,933 (6%) 36,46 (6%) 39,41 (6%),2 (%) 41,1 (6%) 44,491 (6%) Bloody Diarrhoea 3,98 (1%) 3,92 (1%) 3,76 (1%) 3,97 (1%) 4,31 (1%) 4,21 (1%),1 (1%) 4,89 (1%) Suspected alaria 27,111 (6%),266 (6%) 2,791 (%) 34,34 (6%),6 (%) 31,624 (%) 37,18 (%) 43,83 (6%) Total consultation 444,112 44,147 9,612 67,661 61,86 644, ,63 779,29 Fax : , wr@pak.emro.who.int. 1

2 Fig-2: Weekly number of reporting health units (Week to week -211) 2 obile Fixed Table-2: Leading causes of seeking health care in the flood affected districts, 29 July 21 to 3 February 211 Diseases Total Skin Diseases 1,81, (12%) Acute Respiratory Infection 3,61,426 (24%) Other Acute Diarrhoea (Not Watery) 1,484,642 (1%) Bloody Diarrhoea 147,678 (1%) Suspected alaria 864,613 (6%) Unexplained Fever 68,894 (4%) Total Consultations 1,281,61 Table-2: easles Case-based Surveillance Status - Pakistan (21) Province Total estimated population Number of suspected measles cases reported including from outbreaks Number of specimen collected and sent for lab confirmation Number of Lab confirmed measles cases % of specimen collection for lab confirmation (min: 8%) Punjab 89,39, % Sindh 37,992,36 1,64 1, % KP 22,29,944 1, % FATA 3,411, % Balochistan 8,33, % AJK 3,14, % GB 1,6, % ICT 1,338, Na Total 167,96,987 4,13 2,312 1,32 8% Figure-3: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 29, 21 and 211 Since July 29, 21, approximately 3,61,426 Acute Respiratory Infection (both Upper and Lower) patient consultations have been reported to DEWS from the flood affected districts of 4 provinces in Pakistan. 4 3 In the graph at right, DEWS reports receiving in 211 are compared to the reports of 21 and 29 from disaster affected districts. This week, DEWS received 243,647 reports of Acute Respiratory Infection, 31% of total consultations, 1% lower than the proportional morbidity reported by DEWS in week /21 but the same as week / Epi week Figure-4: Acute Diarrhea trends, Disaster affected districts, Pakistan 29, 21 and 211 Since July 29, 21, a total of 1,484,642 acute diarrhea patient consultations have been reported to DEWS from the flood affected districts of 4 provinces in Pakistan. In the graph at right, DEWS reports receiving in 211 are compared to the reports of 21 and 29 from disaster affected districts. This week, DEWS received 44,491 reports of acute diarrhea, 6% of total consultations. This is the same proportional morbidity (6%) reported by DEWS in week /21 and in week / Epi-week 2 Fax : , wr@pak.emro.who.int.

3 Table-3: Alerts reported in week 4 and week of 211. Date of alert Alert Province District Location (detailed) Age (yr) Sex Action taken / Notes Upon field investigation 2 suspected cases were found. Samples were collected and 17-Jan-11 easles Sindh Kashmore BHU Jahan Khan, F,F found positive. Cases were treated with two doses of vitamin A and unimmunized children in community were vaccinated. 22-Jan-11 easles Upper Dir SHC Darora 6 F Upon field investigation 1 suspected case was found. Sample was collected and found positive for easles. Case was treated with two doses of vitamin A and unimmunized children in the community were vaccinated. 22-Jan-11 AWD Sindh Kamber Shahda Kot village Abdul Wahid Chandio uc Dost Ali taluka Kamber 7,3,3,,F Alert was reported by NGO. Team responded and found diarrhea cases but none meeting definition of AWD/suspected cholera. HE session conducted. Aqua tab and Hygene kit were distributed. 22-Jan-11 easles Sindh Kashmore BHU Azim Golo 3,6,F Upon field investigation 1 suspected case and 1 death of 3 year old child has been reported from suspected easles. Case was treated with two doses of vitamin A and unimmunized children in the community were vaccinated. 22-Jan-11 easles Sindh Kashmore BHU Din uhammad 24-Jan-11 Diphtheria Peshawar LRH (uhalla Gulab Ahmed Khel) 3, 3, 2, 4, 2, 2 F, F,,,, Upon field investigation 6 Suspected cases were found. No sample was collected due to refusal. Vitamin A was also offered but refused. ass vaccination is planned for the area. Alert was reported by LRH. ADS was administered and patient is improving. Throat swab was cultured at NIH and found positive for Corynebacterium Diphtheriae. 26-Jan-11 easles Sindh Jacobabad Thul City, UC Thul I - Private Clinic 18m, 6 F, F Upon field investigation 2 Suspected cases were found. These patients were missed during the campaign. Vitamin A was given to the patients. 2 Samples were collected and sent to NIH. Unimmunized children in the community were vaccinated. 26-Jan-11 AFP Sindh Ghotki THQ Ghotki (Village irbahar, UC Hussain Beli; Village Chodri Nazir, UC Sardar K Ghoto; Drig allok Wali), 1., 2,, AFP cases reported by Pediatrician THQ. Stool samples collected. Investigation underway. 26-Jan-11 VHF Sindh Jacobabad Hindu uhalla Thull City Jacobabad 24 Alert from Jacobabad, patient traveled to Sukkur for treatment, Dengue test was negative. Upon field investigation 9 Suspected cases were found. 4/ samples collected were positive for easles. Vit.A doses were administered to all patients. Health education was imparted. Unimmunized children in the community were vaccinated, but due to size of outbreak vaccination campaign is planned. Upon field investigation 12 Suspected cases were found. 1/4 samples collected were positive for easles. Vit.A doses were administered to all patients. Health education was imparted. Unimmunized children in the community were vaccinated, but due to size of outbreak vaccination campaign is planned. 27-Jan-11 easles Sindh Badin 27-Jan-11 easles Sindh Badin 27-Jan-11 H1N1 (29) ardan Sher uhammad Nuhrio Village - UC Gharo Umer Wadho Village - UC Dubi DHQ ardan (oh. Rasoolabad, village ayar/ oh. Badragai, village ohabat Khan Shergarh 3,,, 7, 6, 4, 1., 4, 2, 11, 1, 3,, 4, 3, 2, 1,, 3, 4 2m, 4 days F, F, F, F, F,, F,, F F, F, F,,,, F, F,,,, F, Alert was reported from DHQ ardan. Suspected cases were found with flu like symptoms. Samples were found negative for Influenza. 27-Jan-11 H1N1 (29) Punjab DG Khan Commerce College 28 F Hopitalized case of influenza like illness, sampl collected and sent to NIH. 28-Jan-11 H1N1 (29) Swabi BKC (Balar Khel - Zaida; Village Kala- Hostel; Quaid-e-Azam Hostel-Private; ankai ohalla-kirki; Totali- Bunir) 11, 19, 18, 2, 18 F,,, F, Alert was reported from BKC, Swabi. Suspected cases were found with flu like symptoms. All samples were found negative for Influenza. 29-Jan-11 NNT Sindh Ghotki Khawand Bux ahar Vilage-Taluka Khangarh 12days Suspected case of NNT went LAA from CH center, Ghotki. Field visit revealed that patient expired due to complications. 29-Jan-11 eningitis Sindh irpur Khas Civil Hospital (DHQ) 6 F 29-Jan-11 3-Jan-11 3-Jan to 31 Jan Jan and 3 Feb-211 AJS BD easles Haripur Haripur easles Sindh Jamshoro easles Sindh irpur Khas 31-Jan-11 VHF Sindh Ghotki Baji Dara Village-UC Kundi BHU Kothera 6, 4,,, 3 18, 9, 1, 13, 8m, 7m, 11m, 6m,, F,, F,, F, F,,, F, Swabi Kunda ore 4, 2, 3. F, F, Jan uhammad Behrmani, Burfat uhala, Taluka Kotri Karam Ali Laghari Village; Village Azeem Leghari Kalu Sangi Village-UC Bandh 14m, 8m F, F 7, 4, 3,, F 6 F Reinforced case management, isolation, health education, CFR DR revealed bacterial meningitis, culture negative due to pre tx with antibiotics. Alert for AJS was reported from BHU Kundi, Haripur. Upon visiting the adjacent village Baji Dara, UC Kundi 2 suspected cases were found with typical jaundice symptoms. samples were collected and all found positive for Hepatitis A. Health education was given. 36 Antiseptic soaps, 41 family straw filters, 3 Nerox filters and 32, aqua tabs were provided. IEC material was also provided to the community. Alert for bloody diarrhea was reported from BHU Kothera, Haripur. Upon field visit 8 suspected cases were found. No samples were collected as all patients were on antibiotics and were recovering. 4/ water samples were collected and bacteriological contamination was found. Health education was given. Antiseptic soaps, straw filters and aqua tabs were provided. IEC material was also distributed. Upon field investigation 3 Samples were collected from suspected measles cases and all found positive. Vit. A was given. Unvaccinated children of the community were vaccinated. Health education session was conducted. During active surveillance no other active cases were found. Alert was investigated and, after active case search, found false. Suspected measles case identified next day at different UC. Blood sample sent to NIH, Vitamin A doses, Isolation, Health education, Active Surveillance ongoing. Upon field investigation 3 Suspected cases were identified from 2 UCs and tested positive for measles. Vitamin A doses, vaccination in community, and health education was complete, while active case finding is ongoing. Suspected case was reported but field investigation revealed misdiagnosed case. Patient is improved. 31-Jan-11 NNT Sindh Ghotki K. Bux ahar Vill-T Khangarh; CH(UC Ruk); CH (Suleman Pahore Vill-UC Bhand) 12 days, 8days, 8days, F, Suspected case of NNT went LAA from CH centre. Field visit revealed that patient expired due to complications. 2nd case 2 days later also expired. Field investigation underway. 3rd case on 4 Feb treated with TIG and improving. other was not vaccinated against TT. 31-Jan-11 H1N1 (29) Peshawar KTH (Karkhano arket) F Alert was reported from KTH, Peshawar. Suspected case was found with flu like symptoms. Sample was found negative for Influenza. 31-Jan-11 easles Swat THQ atta (Nehar-UC atta); CH Kabal (Damgar Shahi Bagh-UC Dherai) 11m, 7 F, F 2 Suspected cases were reported from health facilities. Samples were collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. Fax : , wr@pak.emro.who.int. 3

4 Table-4: Alerts reported in week 4 and week 4 of 211. (Cont d) Date of alert Alert Province District Location (detailed) Age (yr) Sex Action taken / Notes 31-Jan-11 easles ICT Islamabad Children's Hosp, PIS (uhalla ullan-saray Kharboza) 4., 3., 3. F, F, Alert was reported from CH PIS, Islamabad and 3 cases were reported. Vit.A was given. Sample was collected from 1 patient and found positive for easles. CDA was notified for mass vaccination and 11 children were vaccinated. 1-2-Feb-11 Pertussis Sindh Ghotki Azeem Oghai Village - UC; Hussain Beli; Sindhi Primary School, athelo Chowk 2,, Upon field investigation a suspected case was found in UC Hussain Beli. Active surveillance found no other cases. Later alert from school was foun to be rumor. 1-Feb-11 easles Balochistan Jaffarabad Kaliri Village - BHU Gandakha 3, 3, 16m, 17m,, 14m, 4, 7, 4, 1,,, F, F, F, F,,, F Alert was reported from BHU Gandakha, Jaffarabad and upon field visit 1 cases were reported. Samples were collected from 3 patients and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. 1-Feb-11 H1N1 (29) ardan KTH (UC aday Baba) Alert was reported from KTH, Peshawar. Suspected case was found with flu like symptoms. Sample was found negative for Influenza. 1-Feb-11 easles ardan DHQ ardan (Afridi ohalla- Sugar ill Road) 2., 4m, F 2 Suspected cases were reported from health facility. Samples were collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. 1-Feb-11 easles Haripur BHU Tofkian 3. 1 Suspected case was reported from health facility. Sample was collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. No other new cases were found. 1-Feb-11 easles Sindh Khairpur 1-Feb-11 AFP Shangla 1-Feb-11 Tetanus Sindh Jacobabad 1-Feb-11 H1N1 (29) Punjab ultan 2-Feb-11 Pertussis Sindh Naushahro Feroze 2-Feb-11 NNT Balochistan Bolan 3-Feb-11 Chicken Pox Haripur 3-Feb-11 easles Balochistan Quetta 3-Feb-11 AFP Balochistan Sibi 3-Feb-11 AFP Sindh irpur Khas BHU Bachal Bhambroo Shadad ohalla- Dandai Village CC Hospital Larkana (Garhi Khairo Taluka) Shadab Colony, DA Chowk Chakar Chandio Village -UC Abad DHQ Sibi (Kachhi- Bolan) RHC Sirikot (Bottigram) BHU Pashtoonabad DHQ Sibi (Kutmundai) Civil Hospital (DHQ) 18m, F, F 2 Suspected cases were reported from health facility. Samples were collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. 4m AFP case was notified. Stool samples collected. Investigation underway , 4, 1, 1 1days 9,, 11, 11,,,,, F, F 14m,, 4,, 8m Upon field investigation a suspected case was found. TIG was provided by WHO. Patient is improving. Hospitalized case of influenza like illness, sample collected and sent to NIH. Upon field investigation 24 suspected cases were found. 4 samples were collected and sent to NIH. Hygiene education sessions were conducted. Upon field investigation 1 Suspected case was found at DHQ Sibi. Patient expired the same day. other had no TT vaccination. Infant delivered at home without clean delivery kit. Alert was reported for suspected measles cases. Upon field investigation, physical examination revealed chicken pox cases. During active surveillance no other cases were found. Upon field investigation 3 samples were collected from suspected measles cases and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. No other cases were found. During active surveillance an AFP case was notified. Stool sample collected and sent to NIH. Investigation is underway. 8m, 12, 6 F,, F AFP cases were notified. Stool samples collected. Investigation underway. 4-Feb-11 easles Upper Dir Barawal (DHQ Timargara-Lower Dir) 11m Alert was reported from DHQ Timergara, Lower Dir. Suspected case was found with typical measles symptoms. Sample was collected and sent to NIH. Vit. A was given, Hygiene education session was conducted. 4-Feb-11 easles Sindh Ghotki andar ohalla - irpur athelo 3., 3 F, 2 easles cases were found and treated with two doses of vitamin A. Investigation is underway. 4-Feb-11 eningitis Sindh Ghotki CH Center-UC Khanpur ahar 6 F Alert was reported from health facility. Investigation is under way and followup is planned. -Feb-11 easles Sindh Ghotki Habibullah Gabol Village-UC Garhi Chakar 2., 1, 1, 4 F,,, F Upon field investigation 17 suspected cases were found and 1 death was reported. 4 samples were collected and sent to NIH. Vit.A was given to active cases. opping activity in the Km area is planned with the help of district authorities. -Feb-11 easles Sindh Ghotki Gul uhammad Gabol Village-UC Garhi Chakar Upon field investigation 7 suspected cases were found. 1 sample was collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. -Feb-11 easles Sindh Hyderabad Shah Latif, Lalo Lashari Colony 11, 9m F, F During active surveillance 2 easles cases were found. 2 samples were collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. Fax : , wr@pak.emro.who.int. 4

5 Province This week 14 districts reported to DEWS from KP province, 6 health centers reported 141,91 patients consultations to DEWS. ARI is the leading disease in KP province. ARI cases reported 7,733 (41%), 1% less proportional morbidity as compared with last week. 1 alerts are reported in this Bulletin for weeks 4 and ; of which 6 were for easles, 4 were for Influenza, while 1 each for Diphtheria, Acute Jaundice syndrome, Bloody diarrhoea, Acute Flaccid Paralysis, and Chicken Pox. Figure-: Trend of priority communicable diseases, province KP (31-July 21 to 3 February 211) wk 7 9 wk 41 wk 43 wk 4 wk 47 wk 49 wk AD BD ARI S. alaria Diseases Wk-2 Wk-3 Wk-4 Wk- Skin Diseases,618 (4%),47 (4%),98 (4%),862 (4%) ARI (URI and LRI) 6,714(44%) 6,12(42%) 64,368 (42%) 7,733 (41%) Other Acute Diarrhoea (Not Watery) 8,332 (6%) 8,4 (6%) 9,148 (6%) 8,9 (6%) Bloody Diarrhea 1,64 (1%) 96 (1%) 91 (1%) 1,72 (1%) Suspected alaria 1,99 (1%) 1,84 (1%) 1,719 (1%) 2,4 (1%) Total consultations 147,71 143,81 1,34 141,91 Province Punjab 11 districts reported data to DEWS from Punjab province 73 fixed health centers reported a total of 18,273 patient consultations during this reporting period ARI cases reported were 49,92 (27%), 1% lower as compared with last week. Two hospitalized cases were found with influenza like illness. Throat swabs were collected and sent by reverse cold chain to NIH for processing alaria cases are still reported from flood affected districts. This week a total of 6,72 malaria samples were tested of which 24 were positive (slide positivity rate 3.%), while falciparum rate was 2.4%. Figure-6: Trend of priority communicable diseases, province Punjab (3 August 21 to 3 February 211) wk 7 9 wk 41 wk 43 wk 4 wk 47 wk 49 wk AD BD ARI S. alaria Diseases Wk-2 Wk-3 Wk-4 Wk- Skin Diseases 1,719 (1%) 14,16 (9%) 1,613 (8%) 1,862(9%) ARI (URI and LRI) 4,123 (2%) 49,926 (29%) 3,761 (28%) 49,92 (27%) Other Acute Diarrhoea (Not Watery) 1,636 (7%) 7,981 (%) 1,41 (%) 9,9 (%) Suspected alaria 6, (4%) 4,7 (3%) 4,81 (2%),288 (3%) Total consultations 162,834 17, ,134 18,273 Fax : , wr@pak.emro.who.int.

6 Province Sindh This week 21 districts reported to DEWS from Sindh province, and 631 health centers reported a total of 38,172 patient consultations during the reporting period of week, 211. In Sindh, ARI cases reported were 114,97 (3%), 2% higher as compared with last week 3 alerts are reported in this Bulletin for weeks 4 and : 16 were for suspected easles; 3 were for each Neonatal Tetanus and Pertussis; 2 were for each Viral Hemorrhagic Fever, Acute Flaccid Paralysis, and eningitis; while 1 was for each Acute Watery Diarrhea and Tetanus Figure-7: Trend of priority communicable diseases, province Sindh (6 August 21 to 3 February 211) wk 7 9 wk 41 wk 43 wk 4 wk 47 wk 49 wk AD BD ARI S. alaria Diseases Wk-2 Wk-3 Wk-4 Wk- Skin Diseases 29,818 (11%) 28,24 (11%) 4,191 (13%) 43,499 (11%) ARI (URI and LRI) 82,34 (3%) 76,167 (3%) 89,42 (28%) 114,97 (3%) Other Acute Diarrhoea (Not Watery) 1,169 (%) 13,89 (%) 16,679 (%) 21,49 (6%) Bloody Diarrhea 1,418 (1%) 1,281 (1%) 2,123 (1%) 1,964 (1%) Suspected alaria 21,21 (8%) 18,617 (7%) 23,48 (7%) 29,318 (8%) Total consultations 276,26 23, ,6 38,172 Province Balochistan Figure-8: Trend of priority communicable diseases, province Balochistan (6 August 21 to 27 January 211) In this week, 11 districts reported to DEWS from Balochistan province. 32 fixed and 8 mobile medical outreach centers reported to DEWS A total of 63,22 patient consultations were reported during the reporting period of week, 211. In Balochistan, ARI cases reported were 19,133 (3%), same proportional morbidity as compared with last week. 3 alerts were reported for weeks 4 and in this Bulletin: one alert each of NNT from Bolan and AFP from Sibi and a suspected easles outbreak in Jafferabad wk 7 9 wk 41 wk 43 wk 4 wk 47 wk 49 wk AD BD ARI S. alaria Diseases Wk-2 Wk-3 Wk-4 Wk- Skin Diseases 4,714 (8%) 4,4 (6%) 4,936 (8%) 3,91 (6%) ARI (URI and LRI) 19,67 (3%) 24,144 (33%) 19,9 (3%) 19,133 (3%) Other Acute Diarrhoea (Not Watery) 4,668 (7%),79 (7%) 4, (7%) 4,14 (7%) Bloody Diarrhea 1,87 (3%) 2,44 (3%) 2,213 (3%) 1,769 (3%) Suspected alaria,817 (9%) 6,86 (9%) 6,88 (11%) 6,928 (11%) Total consultations 62, 73,6 63,648 63,22 6 Fax : , wr@pak.emro.who.int.

7 Islamabad Capital Territory This week Islamabad is reporting from four health centers, and a total of 3,427 patient consultations. ARI cases reported were 1,922 (6%), 6% higher as compared with last week, but overall higher than other areas. Figure-9: Trend of priority communicable diseases, Islamabad (1-27 January 211) wk 2 wk 4 wk AD BD ARI S. alaria Diseases Wk-2 Wk-3 Wk-4 Wk- Skin Diseases 78 (3%) 78 (2%) 44 (1%) 61 (2%) ARI (URI and LRI) 1,7 (8%) 2,263 (8%) 1,9 (1%) 1,922 (6%) Other Acute Diarrhoea (Not Watery) 236 (9%) 2 (7%) 14 (3%) 32 (9%) Bloody Diarrhea 21 (1%) Suspected alaria 18 (1%) Total consultations 2,69 3,873 3,81 3,427 Focus on: Tetanus and Neonatal Tetanus DEWS has had alerts from November 21 to this month from Balochistan and Sindh for cases of both Tetanus and Neonatal Tetanus. It is likely that there are other un-reported cases of both of these diseases in other areas of Pakistan as well due to low levels of immunity. Tetanus is not spread by human to human contact so it is not occurring in epidemics but it may occur in geographic clusters where the population is unimmunized and it has overall a 4% mortality rate. Tetanus is caused by a toxin produced by the bacteria Clostridium tetani which live predominantly in the soil. It is easy to get this infection whenever a break in the skin is not cleaned properly. For instance, anyone who has not been immunized against tetanus in the last ten years and sustains a deep wound or any dirty puncture, cut or abrasion during flood clean-up is susceptible to tetanus. 1 Similarly, Neonatal Tetanus affects a newborn when the mother is not adequately vaccinated against tetanus and if the infant s umbilical cord is not kept clean or if non-sterilized instruments or dressings are used on the cord. Confirmation of neonatal tetanus is entirely clinical and does not depend upon bacteriological confirmation. The Confirmed Case Definition is any neonate with a normal ability to suck and cry during the first two days of life and who, between the ages of 3 and 28 days cannot suck normally and becomes stiff or has convulsions or both. 2 Tetanus signs and symptoms in older children and adults include: sardonic smile (mocking smile), lock jaw (cannot open the mouth), opisthotonos (stiff arched back), and rigid abdomen. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. In tetanus, noise, bright light, touching the body or moving part of the body will trigger muscle spasms. Spasms last for several minutes and may occur frequently, interfering with breathing when they affect the larynx and muscles of respiration. Therapeutic objectives of treatment of tetanus include prevention of further spasms by killing Clostridium tetani to stop further toxin production (antibiotic); neutralising circulating toxin (tetanus immunoglobulin TIG); administering muscle relaxants; and provision of supportive care till spasms cease completely. A suspected case of tetanus or neonatal tetanus should always be admitted to the hospital. WHO recommendations are to use Human Tetanus Immunoglobulin (TIG) for tetanus treatment: Adults and Children: 1 units/kg (or 3-6 units) I, single dose; Neonates: units I, single dose. TIG provides protection longer than antitoxin of animal origin (ATS) and causes few adverse reactions. Tetanus disease does not induce immunity; patients without a history of primary TT vaccination should receive a second dose 1 2 months after the first dose and a third dose 6-12 months later. 1 Trenwith, C. Flood clean-up strains medical supplies. Brisbane times. 2 NIH, Pakistan. Case Definitions and Standard Procedures August Dire, D. Tetanus: Treatment & edication. edscape article. Sep 16, Fax : , wr@pak.emro.who.int.

8 aps: 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 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: In week-4 two new type-1 polio cases were confirmed by the laboratory from - KP (Peshawar district) and Federally Administered Tribal Areas - FATA ( Agency). The total number of infected districts/towns/agencies is 3 to date. GILGIT- BALTISTAN ISLAABAD PAKISTAN To support the national commitment to polio eradication, we are dedicating one page to polio eradication activities every week in the Weekly Epidemiologic Bulletin. On 31 January 211 a sub-national polio immunization campaign began in 6 districts/ towns/ agencies of the country, targeting million children aged below five years. Please see following map (Pakistan). Campaign in Sindh will start on 2 nd February. DEWS Surveillance Officers are also participating in the campaigns and the polio eradication effort. Fax : , wr@pak.emro.who.int. 8

9 Confirmed Alerts Fax : , wr@pak.emro.who.int. 9