Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Highlights Epidemiological week no. 41 (7-13 Oct 212) : 74 alerts investigated this week, responding to 1 outbreaks involving 22 measles cases. Vitamin A was provided to cases and EDOsH took action to improve vaccination in affected areas (Page 7) Volume 3, Issue 41, Wednesday 17 October 212 Figure1: 84 districts reported to DEWS in week 41, 212 : 22 alerts investigated this week and 8 outbreaks identified, involving 16 cases, 3 deaths. Outbreaks were controlled by house to house measures to disinfect drinking water and by case management and infection control at health facilities (Page 7) 2 new suspected CCHF case reported in week 41, 212; (Page 6) 1 new polio cases were reported in week 41, 212; (Page 6) 84 districts have reported to DEWS in week 41, ,334 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week 961,66 patients consultations were reported in week 41 compared to 918,266 consultations reported in week 4, 212. Altogether 21 alerts were investigated and response was provided to 31 outbreaks. Priority diseases under surveillance in DEWS Pneumonia Acute Watery Diarrhoea Bloody diarrhoea Other Acute Diarrhoea Suspected Enteric/ Fever Suspected Malaria Suspected Meningitis Suspected Dengue fever Suspected Viral Hemorrhagic Fever Suspected Suspected Diphtheria Suspected Pertussis Suspected Acute Viral Hepatitis Neonatal Tetanus Acute Flaccid Paralysis Scabies Cutaneous Cumulative number of selected health events reported in Epiweek 1 to 41, 212 (1 Jan 13 Oct 212) Disease # of Cases Acute diarrhoea 2,6,41 9% Bloody diarrhoea 143,446.% ARI,412,22 18% S. Malaria 1,47,69 % Skin Diseases 1,399,47 % Unexplained fever 1,82,647 4% Total (All consultations) 3,88,379 Figure2: Weekly trend of Acute diarrhoea in Pakistan; Week1, 211 to week41, 212. Major health events reported during the Epiweek 41 (7 13 Oct 212) Disease # of Cases Acute diarrhoea 8,378 9% Bloody diarrhoea 3,836 <1% 1 ARI 197,4 2% S. Malaria 66,7 7% Skin Diseases 44,232 % Epiweek Unexplained fever 32,37 3% Total (All consultations) 961,66 The graph (Figure2) shows the comparison of weekly trend of Acute diarrhoea as proportional morbidity (percentage of cases out of total consultations) reported to DEWS each week in year 211 and 212. Overall weekly trend of acute diarrhoea is stable in all provinces. Districts in Sindh and are investigating alerts for acute watery diarrhoea/suspected cholera. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 1

2 Weekly Bulletin: DEWS, Pakistan, Week no. 41 (7-13 October 212) Current week's (41/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Civil Hospital Usta 342 cases reported from Civil Hospital Usta Mohammad. Investigation was done using telephone as no access is 12Oct AD Balochistan Jaffarabad Mohammad, UC available to the area due to damaged roads and flood water. Cases were not localized but from different location. Usta M I and III Essential medicines were provided to DHMT. MO was motivated for establishing ORT corner. DHO was informed. 12Oct AD Balochistan Jaffarabad 12Oct Balochistan Chagai 12Oct Balochistan lasbela 11Oct Balochistan 9Oct BD FATA 13Oct FATA 8Oct 12Oct Malaria 1Oct 1Oct 8Oct Lasbela Agency Agency Mardan Relife Medical camp Khan Pur, UC Khan Pur, Tehsil Usta Muhammad Ameenabad, Tehsil Chagai Village Mitha Goth, UC kehwari, Tehsil Uthal Winder, UC Winder, Tehsil Sonmiani UC Kam Shalman,Tehsil Landikotal Village Qari Ijaz Lagat khel,uc Khoga khel,tehsil Landikotal Village Mirwas, UC Bijligar Swabi Budga UC Kabgani Battagram Lower Dir Mardan Village Petrol Pump, Masjid e Aqsa Mohallah Village Kotkay Dehrai, Kombar Bazzar UC and Tehsil Lal Qala Village Aarzi Abad, UC Par Hotti Basti Mandorey, 11Oct Punjab Muzaffargarh Moza Kharak, UC Kharak 7Oct DF Punjab Lahore 8Oct DF Punjab Lahore 9Oct DF Punjab Lahore UC 113 Raiwind Allama Iqbal Town UC 116 Johar town Allama Iqbal Town UC 71 Bilal Ganj Data Ganj Bukhsh Town cases were reported from medical relief camp. Investigation was done using telephone as no access is available to the area due to damaged roads and flood water, team s could not reach to area. Cases were IDPs from different location. Essential medicines were provided to DHMT for the medical camp. MO was motivated for establishing ORT corner. DHO was informed. 8 cases of suspected reported from CD Ameenabad. Response was given on same day. Stool samples were taken and sent to NIH. Patients were rehydrated and advised to use aqua tabs in drinking water. Health and hygiene sessions were conducted in the affected community. Alert reported from community. Investigation was done along with RRT and 2 suspected cases of were found and presented with typical sign and symptoms. Required medicine was provided. Patients were treated according to plan A and B. Health and hygiene session was conducted, Aqua tab and extra pack of ORS distributed. 2 stool sample and 3 water sample collected and sent to NIH. 4 cases of reported. Cases presenting with typical lesions. During active surveillance 3 more cases found. All patients had lesions on their limbs. Inj Glucantime was provided to health facility in charge in outbreak response. Information was shared with district health team. An alert of bloody diarrhea were reported from BHU Kam Shalman. The medical technician also gave information of BD cases from different localities of UC Kam Shalman. On active surveillance 9 cases were found. Stool sample was taken and sent to NIH. Water samples were taken and assessed for contamination and found unsafe for drinking. Health and hygiene sessions were conducted for the affected community. Soaps, aqua tabs and hygiene kits were also distributed in the community. Report shared with Agency surgeon and PHHI Coordinator. An alert of was reported from AHQ Hospital Landikotal.On active surveillance 6 cases were found. Treatment was given in AHQ Hospital Landikotal.Health education was imparted to the parents of the patients. Report was shared with Agency surgeon. A suspected alert was reported from ER Unit of DHQ Hospital Mardan, after investigation of suspected cases at hospital, Epidemiological and Environmental assessment was carried out in the area. 2 cases were identified who had developed diarrhea in past week in the community. Field investigation found contaminated water supply as a possible source. Stool Sample was taken and sent to NIH and was found positive for Cholera. Water samples from source and end users were taken and tested for contamination. Health and hygiene sessions were conducted for affected families. Aqua tabs, soaps, hygiene kits and ORS distributed in the community. EDO health informed about the situation. No more cases reported now. An outbreak of suspected Malaria was reported by local community leaders. The outbreak was investigated by the Joint team. On field investigations, patients presented with high grade fever, headaches, vomiting, rigors and chills, convulsion and body aches. Some patients suspected for dengue. Blood sample was taken and sent to NIH for DF. 3 samples were taken for MP. A session on DF spread and prevention was conducted for the affected household. EDO Health and DSM PPHI were informed. Lab and microscopy results awaited. Two suspected cases were reported from Pediatric Ward, DHQ Hospital Battagram. SO visited the Ward and examined the patient. Vit A was already given. There was no immunization history, no BCG Scar was seen. On active Surveillance more cases of suspected were fond in the same house. Families were refusal to routine immunization. All the five children had no BCG Scar. EPI Technician carried out vaccination at the spot. Vit A was given to all the cases. Total of 21 children below years of age were examined. 11 children were vaccinated for. 1 for BCG, 1 for Penta 1 and 3 for Penta 3. Blood sample was taken from admitted patient and sent to NIH. Detail report was shared with EDO Health and senior Manager Health Battagram. 3 Suspected cases were reported from DHQ Hospital Dir Lower on 1th Oct, 212. Blood Sample collected and sent to NIH Islamabad. On field investigations, 2 more cases in the family were found. All children missed vaccination and BCG scar was not present. Health education session was conducted with the community and Vit.A drops given to children. Information was shared with EDOH, Coordinator LHWs, coordinator EPI to intensify Mop up campaign in village Kotkay Dehrai, Kombar, UC and Tehsil Lal Qala. A suspected alert was reported from Isolation unit of DHQ Hospital Mardan. Patient was found unimmunized for measles vaccination. Epidemiological assessment was carried out in the area and surroundings. Within same family 2 more clinical cases and 2 cases from surrounding were identified. Vitamin A capsules were given. All children of less then years were sent to near by HF for vaccination. EPI team was informed and requested for outreach immunization in the area soon after ongoing SIAD. Health education session was conducted with the family members and community, LHW's working in the area was involved. EDOH Focal person & EPI Coordinator were informed. RRT was activated & team visited basti Mandorey where 3 households were interviewed & ten more similar cases were found & were referred to RHC Khangarh. Health education to family members in households visited. Distribution of ORS, hygiene kits, water filters, soaps, Aqua Tabs, ORS, jerry cans, buckets & IEC among them. Drinking water sources sampling was also done along with their disinfection. SMO RHC Khangarh sensitized. Along with continuous strict surveillance continuous HE sessions were suggested. EM assessment was done & required medicines were shifted from prepositioned DDK in EDOH office stores. 1 Confirmed, 1 Probable and 16 suspected cases of Dengue fever notified on dash board from Jinnah Hospital Lahore. The cases were investigated and blood sample was taken and sent to laboratory for detection of dengue specific antibodies, result for IgM and IgG is positive for 1 cases. Dengue monitoring cell declared outbreak in this union council after reviewing the data. There is no travel history by confirmed patient. SO along with CDCO, DDHO and entomologist visited the area and case investigation & Vector Surveillance was carried out. Mechanical Larviciding at two places and chemical Larviciding was done at one place. IRS done in the house of positive case as well as neighboring houses. Health Education session was given to the community focusing on Proper solid waste disposal, improved water storage practices, use of screening, protective clothing and repellents. IEC material was distributed by Female sanitary petrol in the houses. ADG(VBD) and EDO Health Lahore were informed and updated about the response. 1 Confirmed, 1 Probable and 26 suspected cases of Dengue fever notified on dashboard from Teaching Hospitals of Lahore. The cases were investigated and blood sample were taken and sent to laboratory for detection of dengue specific antibodies, results for IgM and IgG are positive for one case. Dengue monitoring cell declared outbreak in this union council. There is no Travel History for confirmed patient. SO along with CDCO,DDHO and entomologist visited the area. Vector Surveillance was carried out. Larva was found positive in one container so mechanical Larviciding was done. IRS done in the houses of Patients. Health Education session was given to the community on Proper solid waste disposal, improved water storage practices, use of screening, protective clothing and repellents. IEC material distributed by Female sanitary petrol in the community. ADG(VBD) and EDO Health Lahore were informed. 1 Confirmed, 1 Probable and 4 suspected cases of Dengue fever notified on dashboard from Mayo hospital and DHQ hospital Lahore. The cases were investigated and blood samples were taken and sent to lab for detection of dengue specific antibodies, results for IgM and IgG are positive for one case. Dengue monitoring cell declared outbreak in this union council. There is no Travel History of any confirmed case patient. SO along with CDCO,DDHO and entomologist visited the area. Vector Surveillance was carried out. IRS done in the houses of Patients. Health Education session was given to the community on Proper solid waste disposal, improved water storage practices use of screening, protective clothing and repellents. IEC material distributed by Female sanitary petrol in the community. ADG (VBD) and EDOH Lahore were informed. The response teams were guided for correct uploading of vector data. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 2

3 Weekly Bulletin: DEWS, Pakistan, Week no. 41 (7-13 October 212) Cont d current week's (41/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 1 Confirmed and 6 suspected cases of Dengue fever notified on dashboard from Jinnah Hospital and General Hospitals of Lahore. The cases were investigated and blood sample were taken and sent to laboratory testing, result for IgM and IgG positive for one case. Dengue monitoring cell declared 11Oct DF Punjab Lahore outbreak in this union council. There is no Travel History of any confirmed case patient. SO along UC 13 Kot lukh put 2 with CDCO,DDHO and entomologist visited the area. Vector Surveillance was carried out. Larva was Nishter town found positive in one container, mechanical Larviciding was done. IRS done in the houses of Patients. Health Education session was given to the community on Proper solid waste disposal, improved water storage practices, use of screening, protective clothing and repellents. IEC material distributed by Female sanitary petrol in the community. ADG(VBD) and EDOH Lahore were informed. 12Oct DF Punjab Lahore 11Oct Sindh Matiari 11Oct Sindh Matiari 6Oct 1Oct Sindh Sindh Qambar Shahdadkot Qambar Shahdadkot 11Oct BD Sindh Sukkur 8Oct Sindh Dadu 12Oct Sindh hyderabad 12Oct Sindh Kashmore 12Oct Sindh Khairpur 9Oct Sindh Larkana 1Oct Sindh Larkana 1Oct Sindh Sukkur 12Oct Pertussis Sindh Ghotki UC 126, Garden town Allama Iqbal Town Village Allah Dino Sand, UC AD Sand, taluka Matiari Village Zulfiqar Shah ji Wasi, UC and taluka Matiari Loung Brohi, UC Mastoi, taluka Sajawal Koore Datoo, UC Seelera, Taulka Shahdadkot Village Thariri, UC Arrore. Taluka Rohri Village Mureed Dero, UC Pat Gul, taluka Johi UC Hatree, taluka Hyderabad Village Haji Aalam Balkani, UC Akhero Village Ali Murad Shaikh UC Belharo Taluka Gambat Near Dargah Mashori, UC Pathan, taluka Bakrani Noonari Muhalla, Waris Dino Machi, UC Waris Dino Machi, taluka Ratodero Village Dhughar Laghari, UC Junas, Taluka Panoakil Village M Bachal Faqeer Lund UC Yaro Lund Taluka Mirpur Mathelo Confirmed and 6 suspected cases of Dengue fever notified on dashboard from Teaching Hospitals of Lahore. The cases were investigated and blood sample was taken and sent to laboratory for detection of dengue specific antibodies, results for IgM and IgG are positive for one case. Dengue monitoring cell declared outbreak in this union council. There is no Travel History of confirmed patient. SO along with CDCO,DDHO and entomologist visited the area. Vector Surveillance was carried out. Larva was found positive in one container so mechanical Larviciding was done. IRS done in the houses of Patients. Health Education session was given to the community on Proper solid waste disposal, improved water storage practices, use of screening, protective clothing and repellents. IEC material distributed by Female sanitary petrol in the community. ADG(VBD) and EDO Health Lahore were informed. case was admitted at THQ Matiari with severe dehydration. During field investigation more cases were found and investigated. Aqua tabs, Zinc tabs and ORS distributed. Health education imparted. EDOH informed and 1 Stool with 2 water samples collected. Lab results awaited. case was admitted at THQ Matiari with severe dehydration. During field investigation 7 other cases were found and investigated. Water from the Hand pump was the source of contamination. Aqua tabs, Zinc tabs and ORS distributed. Health education imparted. EDOH informed. One death due to reported from private Practioner of Shahdadkot. During field Investigation found 6 more recovered cases from same location. Hand pump was the source of water. Health education imparted regarding hand washing and health and Hygiene. Aqua tabs, ORS and life straw filters were distributed. DHMT informed and 3 water samples collected. Suspected case was reported from THQ Shahdadkot. During field Investigation 6 more suspected recovered cases from same location. Source of water is Hand pump. Health education imparted regarding hand washing and health and Hygiene. Aqua tabs, ORS and life straw filter distributed. DHMT informed. One stool sample collected and sent to NIH and 3 water samples collected. cases of BD reported from BHU Thariri. Alert was verified as all cases were from same location. Field investigation conducted along with MO and found 2 more cases. Source of water was Hand pump. One Rectal swab collected. water samples collected. Health education imparted to the affected families & community on personal hygiene, frequent hand washing with soap, use of aqua tabs and boiling of water. Aqua tabs & jerry cans distributed to affected families & contacts and all information shared with DHO & DHMT. Suspected case of was reported by THO Johi. During field investigation 11 more cases were found, out of them 6 children had BCG+ve, 4 were 1 vaccinated and 3 were 2 vaccinated. Vitamin (A) dose given to all cases. Health education imparted. Vaccination status of 22 children were assessed. BCG=1(4%), Penta1=8(36%), Penta2=(22%), Penta3=7(18%), 1=9 (4%), 2=6(27%). EDOH informed about the cases and 1 Blood sample collected. Suspected case was reported by research officer from AKU. During field investigation, 4 more cases were found. Vitamin (A) dose was given. Health education imparted. Vaccination status of 21 children were assessed. BCG=17(81%), Penta1=16(76%), Penta2=16(76%), Penta3=16(76%), 1=9 (%), 2=(%). THMT informed about the case and 3 Blood samples collected. alert was cross notified by SO DEWS Sukkur. During field investigation 8 more cases were found. Cases were not vaccinated. Blood sample was collected. Vitamin (A) drops given to cases. Health session was imparted on importance of routine immunization. EPI status: 28 children were assessed & only 6(21%) Children had BCG scars. THMT informed and 2 Blood sample collected. Suspected case was reported from THO Gambat. On field investigations, 43 cases were found in the village. All cases were line listed. Vitamin A was provided and sample sent to NIH Islamabad. EPI cluster was taken and out of children 26 children were found without BCG scar. All information was shared with DHMT. Mop up activity regarding routine immunization was advised. Planning has been done after NID Oct this exercise will be done. Suspected case of reported from private Clinic. Case was BCG +ve and not vaccinated for other antigens. During active search 4 more cases were found. Vitamin (A) dose was given to all cases. Health education imparted. Vaccination status of 11 children were assessed. BCG=(4%), Penta1=4(36%), Penta2=3(27%), Penta3=(%), 1=4(36%), 2=(%). DHO informed about the case and Blood samples collected. Suspected case of reported from private clinic Ratodero. During field investigation 4 more cases were found. Vitamin (A) dose was given to all cases. Health education imparted. Vaccination status of 9 children were assessed. BCG=(%), Penta1=(%), Penta2=2(22%), Penta3=(%), 1=3(33%), 2=(%). DHO informed about the case and 3 Blood samples collected. One Death due to suspected reported from GMC teaching hospital. Field investigation conducted along with TSV Panoakil & vaccinator of the area, where found 9 more suspected cases. Vitamin A given to all cases. Health education imparted to cases & contacts on personal hygiene & importance of routine immunization. Eight cases had BCG scar & 7 were vaccinated for 1. Cluster of routine immunization checked where out of 1 children. BCG=(1%), 1=(4%) & 2=(%). Information shared with DHO & DHMT and 1 Blood sample collected. Pertussis alert received from community. On filed investigation, 21 suspected cases were found. 14 doses complete course of erythrosine provided to all patients and close contacts. No sample was taken as all cases had received Antibiotics. Routine immunization status was observed zero. No child had BCG scar. Information was shared with DHMT and requested for vaccination in the area. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 3

4 Weekly Bulletin: DEWS, Pakistan, Week no. 41 (7-13 October 212) Figure3: Number of alerts received and responded, week 38 41, 212 Figure4: Number of consultations by age and gender, week 41, Pertussis Malaria # of consultations 1 1 Wk38 Wk39 Wk4 Wk41 CCHF < 1 yr 14 yr 14 yr yr + yr Male Female Province : 484 health facilities from 18 districts of sent reports to DEWS with a total of 132,418 patients consultations reported in week 41, 212. Total 39 alerts were received and appropriate measures were taken. Altogether 26 alerts for ; 4 for ; 3 for DF; 2 for ARI; while 1 each for BD,, Malaria and. Acute diarrhoea trend shows a decrease as compared with last week. Figure-: Trend of acute diarrhoea diseases, province Figure-6: Number of alerts received and responded week 38-41, 212, province KPK CCHF Malaria Pertussis Wk38 Wk39 Wk4 Wk41 Province Sindh: 96 health facilities from 23 districts in Sindh province reported to DEWS with a total of 34,67 patients consultations in week 41, 212. Total 6 alerts received while 13 outbreaks were identified and appropriate measures were taken. Altogether 27 alerts for ; 14 for NNT; 13 for ; 4 for ; 3 for Pertussis; while 2 each for BD and. Acute Diarrhoea shows an stable trend in last few weeks. Figure-7: Trend of trend of acute diarrhoea, province Sindh Figure-8: Number of alerts received and responded week 38-41, 212, province Sindh Pertussis Wk38 Wk39 Wk4 Wk41 Province Punjab: 463 health facilities from 9 districts in province Punjab reported to DEWS with a total of 22,723 patients consultations in week 41, 212. Total 3 alerts were received and appropriate measures were taken. Altogether 1 alerts for Dengue fever; 9 for ARI; 8 for ; 7 for ; 4 each for AD, Scabies and NNT; 2 each for and BD; while 1 each for AJS, and Meningitis. AD shows a Stable trend in last few weeks. Figure-9: Trend of acute diarrhoea, province Punjab Figure-1: Number of alerts received and responded week 38-41, 212, province Punjab Malaria Wk38 Wk39 Wk4 Wk41 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 4

5 Province Balochistan: Weekly Bulletin: DEWS, Pakistan, Week no. 41 (7-13 October 212) 293 health facilities from 2 districts in province Balochistan reported to DEWS with a total of 44,88 patients consultations in week 41, 212. Total 27 alerts reported and 4 outbreaks were identified and appropriate measures were taken in week 41, 212. Altogether 6 each for Acute diarrhoea and ; for ; 4 for ARI; 3 for ; while 1 each for NNT, Pertussis and. A decrease noted in AD trend from last few weeks. Figure-11: Trend of acute diarrhoea, province Balochistan Figure-12: Number of alerts received and responded week 38-41, 212, Balochistan Malaria CCHF Wk38 Wk39 Wk4 Wk41 Pertussis Province Gilgit Baltistan: 6 health facilities from 1 district in Gilgit Baltistan reported to DEWS with a total of 6,412 patients consultations in week 41, 212. One alert for measles was reported in week 41, 212. AD showing decrease from last few weeks. Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week 38-41, 212, Gilgit Baltistan Wk38 Wk39 Wk4 Wk41 FATA: 4 health facilities from 3 agencies in FATA reported to DEWS with a total of 11, patients consultations in week 41, alerts; 4 each for and ; 2 for BD; while 1 for NNT were reported in week 41, 212 and appropriate measures were taken. An increase in AD is noted this week. Figure-: Trend of acute diarrhoea, FATA Figure-16: Number of alerts received and responded week 38-41, 212, FATA Wk38 Wk39 Wk4 Wk41 State of Azad Jammu and Kashmir: 121 health facilities from 9 districts in AJ&K reported to DEWS with a total of 23,8 patients consultations in week 41, 212. alerts, 3 for ; while 1 each for AJS and DF were reported in week 41, 212. A decrease noted for AD as compare with last few weeks. Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 38-41, 212, AJ&K Wk38 Wk39 Wk4 Wk41 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

6 Weekly Bulletin: DEWS, Pakistan, Week no. 41 (7-13 October 212) Table1: Number of alerts and outbreaks reported and investigated with appropriate response Disease (up till week 4) Current week 41, 212 Total for 212 (week 141, 212) A O A O A O A O Acute watery diarrhoea Acute jaundice syndrome Bloody diarrhoea Dengue fever Pertussis NNT + tetanus Malaria Others Total Distribution of Wild Polio Virus cases Pakistan 211 and 212 In week 41, 212 one new type1 polio cases was reported Federally Administered Tribal Areas (Bajour Agency). As of 13 October 212, Pakistan has reported a total of 44 polio cases including 41 type1, 2 type3 and 1 mixture type1 and 3 polio cases from 26 districts/tribal agencies. Province Cases 211 Cases 212 P1 P3 P1 P3 P1+P3 Punjab 9 3 Sindh FATA Balochistan 73 3 AJ&K GilgitBaltistan 1 1 Islamabad Total Follow up of CCHF, and Dengue CCHF: CCHF is a serious viral hemorrhagic fever with up to % case fatality rate, caused by an RNA virus of family Bunyaviridae, genus Nairovirus, carried by Hyalomma species of ticks. Human beings become infected by tick bites or crushing the ticks, which are usually found on sheep, cattle, goats or camels, and their slaughtered skins. They may also be exposed to the virus in blood or tissues of a viremic animal during its slaughter and butchering; or by contact with infected blood or secretions of acute human cases in home or hospital setting. 2 new suspected cases of CCHF in week 41. In 212, a total of 4 suspected cases have been reported throughout the country with 39 confirmed to date and 14 deaths; (CFR is 3.9%). 21 confirmed cases have been reported from Balochistan; 7 from Sindh; 6 from and from Punjab. Chart at right illustrates current situation of CCHF cases in 212. # of cases Number of CCHF cases (week 1 to 41, 212), Pakistan Epiweek Approximately all the cases have contact history with animal trading/handling, tick bite, contact with patient, tannery worker, butcher/animals slaughtering, a traditional practice of wearing fresh animal skin (posti) to treatment ailment. These animals and their skins have continuous movement!intra Pakistan and between neighboring countries (Afghanistan and Iran). Any contact of a CCHF patient should monitor his/her temperature for 14 days and see a doctor if fever develops. The anti viral medicine Ribavirin has been effective in saving lives of patients who report early to the health facility. Suspeceted Positive For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 6

7 Weekly Bulletin: DEWS, Pakistan, Week no. 41 (7-13 October 212) : As of 13 October 212, more measles cases and deaths have been reported in Pakistan than in 12 months last year. Table 1 summarizes the situation of measles in 212 up to 13 October; and table 2 illustrates the alerts and outbreaks in week 41 (7 to 13 October, 212). Table1 212 (Week 1 41) Table2 Epi week 41, 212 Province # of Alerts # of Outbreaks # of Cases # of Deaths Province # of Alerts # of Outbreaks # of Cases # of Deaths AJ&K Balochistan FATA Gilgit Baltistan ICT Punjab Sindh Total AJ&K 3 3 Balochistan 13 1 FATA 4 4 Gilgit Baltistan 1 1 ICT Punjab 8 1 Sindh Total As it is shown in the above table that majority of the measles cases have been reported from Sindh and provinces. Both of these provinces have announced the EPI facilities will be providing measles vaccine twice a week for all children under age. Dengue: The chart at right showing the weekly number of confirmed Dengue cases reported by surveillance focal points from the Departments of Health in Sindh and Punjab in 212. Total number of confirmed dengue cases to date in 212 is 233 in Sindh and 319 in Punjab. Month of peak incidence in 21 was November while peak incidence in 211 was in September and October. # of cases Weekly trend of positive Dengue cases reported from Sindh and Punjab, week 1 to 41, 212 Punjab Sindh Malaria: The chart at right shows the Malaria slide positivity and Falciparum rate reported in week 41, 212. Total number of malaria cases tested in this week is 1988, out of which 373 were found positive; 2348 for P. Vivax; 938 for P. Falciparum; while 287 for Mixed (SPR = 17.97%; F. R = 34.28%) Malaria slide positivity and falciparum rate, week 41, 212 SPR FR : The surveillance definition for a case of Acute Watery Diarrhoea () or suspected cholera in an endemic area, is any case over age 2 years with severe dehydration or death due to diarrhoea of 3 or more stools in 24 hours. An outbreak is defined as a cluster of 6 or more cases of or any number of cases with at least one confirmed case of Vibrio cholera. The table at right summarizes the situation of in last four weeks, 16 September to 13 October 212. During the period, a total of 83 alerts were reported and 27 confirmed out breaks were identified and were responded very efficiently and in systematic manner. The Surveillance Officers in the districts with the close coordination of trained rapid response teams from Department of Health and partners address the outbreaks. Balochistan Sindh FATA Punjab KPK GB AJK ICT Province Week 38 41, 212 Outbreaks # of Alerts # of Outbreaks with confirmed # of Cases # of Deaths V. cholera AJ&K 1 Balochistan FATA Gilgit Baltistan ICT Punjab Sindh Total For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 7

8 Alerts and outbreaks, week 41, 212 Weekly Bulletin: DEWS, Pakistan, Week no. 41 (7-13 October 212) For Correspondence: NIH: WHO: Tel : , Fax : ; wr@pak.emro.who.int. 8