Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 3, Issue 1, Tuesday 1 January, 212 Highlights Special Issue Summary 211 Priority diseases under surveillance in DEWS In the year 211, total 9 districts including 2 agencies providing surveillance data to the DEWS on weekly basis from around 3,3 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC. A total of 4,1, consultations were reported through DEWS of which 1,2,91 (23%) were acute respiratory infections (ARI); 4,44,2 (1%) were Skin disease; 4,29,21 (9%) were acute diarrhoea; and 2,2, (%) were suspected malaria. In year 211, A total of,2 alerts with 1,3 outbreaks were reported: Altogether 11 alerts for Measles; 1 for AWD; for Dengue fever; 333 for Neonatal tetanus and tetanus; 29 for ; 2 for Pertussis; 131 for Malaria; 9 for Bloody diarrhoea; 1 for acute jaundice syndrome; while 9 for others communicable diseases. In week 1, 212, three new type 1 polio cases were confirmed by the laboratory: two from FATA (Khyber agency) and one from Khyber Pakhtunkhwa (Tank district). As of 9 th January 212, Pakistan has reported a total of 192 polio cases (19 type 1 & 2 type 3) for the year 211 from districts/towns/tribal agencies/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 Diarrhoeas (AD) Suspected Viral Hemorrhagic Fever (VHF) Suspected Malaria (Mal) Suspected Measles (MS) Suspected Meningitis (MG) Others Figure 1: Weekly trend of Acute diarrhoea and ARI in Pakistan, 21 and AD 21 AD 211 ARI 21 ARI Epi week Table 1: Most common communicable diseases syndromes reported in 211, by province Disease Sindh KPK Punjab Balochistan Gilgit Baltistan AJ&K FATA ICT Acute respiratory infection 4,, (23%) 2,43,11 (3%) 2,32,341 (21%) 4,3 (21%) 133,94 (1%) 1,1 (1%) 2,21 (21%) 33,344 (31%) Acute diarrhoea 1,2,93 (9%) 933, (11%) 94,12 (%),94 (11%) 99,94 (13%),21 (%) 3,1 (11%) 12,9 (12%) Bloody diarrhoea 134,32 (1%) 11,3 (1%) 1,3 (.2%) 9,2 (3%), (1%) 1, (.1%),122 (1%) 44 (.4%) Suspected malaria 1,924,19 (1%) 1,9 (2%) 31,44 (3%) 42,14 (13%) 91 (.13%),92 (1%) 23,1 (%) 93 (1%) Skin diseases 2,4,929 (14%) 3,93 (4%) 1,, (9%) 21,1 (%) 4,1 (%) 4,2 (4%) 1,29 (%) 3,134 (3%) Total consultation 2,1,3,,31 11,14,99 3,,114 41,9 1,, ,9 1,3 The above graph shows the weekly trend of acute diarrhoea and ARI as percentage of cases out of total consultations reported to DEWS in 21 and 211. In 21, DEWS expanded after the August Flood, and total consultations were 11,,31. In year 211, approximately 4,1, patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K with average weekly consultations at,24. The above table provides the total consultations in 211 in each province and the overall frequency and proportional morbidity of five disease syndrome by province. Proportional morbidity of ARI is highest in KP while acute diarrhoea is highest in KP and Balochistan. Proportional morbidity of suspected malaria were very high for the year at 13% in Balochistan and 12% in Sindh. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 1

2 Special Bulletin: DEWS, Pakistan, Week no. 1 (1 to January, 212) Current week's (1/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Abro Mohla & Bhangar Outbreak of cases of from one location. Inj Glucantime was provided and Jan Balochistan Nasirabad Mohla town area health education was given. Jan Balochistan Quetta Hazara town, Brewery road 1 Jan Malaria Balochistan Lasbela Civil Hospital Bela Jan Malaria Balochistan Lasbela RHC Lakhra 1 Jan AJS KPK Haripur 3 Jan Measles KPK Lower Dir 4 Jan Measles KPK Lower Dir Jan Measles KPK Lower Dir Jan Measles KPK Upper Dir Bagh Banda, Village Kundi, UC Kundi, Tehsil Ghazi Village Navagai, UC Rabat, Tehsil Balmbat Village Shagai, UC Rabat, Tehsil Balmbat Village Ttoru, UC Drangal, Tehsil Samar Bagh Lower Dir (Village Warri Payeen, UC & Tehsil Warri) new cutaneous cases were attended in continuation of previous Cases. Treatment started through MC supported Program. Till date a total of cases reported from this center. cases of suspected Malaria reported from Hospital out of which 24 were positive for P. Falciparum and were P. Vivax (SPR=4%). The treatment was provided to all patients. Information was shared with DHO for necessary action. 1 cases of suspected Malaria reported from RHC out of which 11 were positive 9 for P. Falciparum and 2 for mix (SPR=%). Treatment was provided to all patient as per WHO protocol. All the information was shared with DHO for necessary action. cases of acute vomiting were reported from RHC and BHU from village Kundi. On investigation there were 14 more cases in that area presented with severe vomiting and dizziness without diarrhoea or any other complaint. These cases belonged to one family and were in 4 adjacent houses sharing a single source of water which is a well. There is no history of communal or shared food. cases were severely dehydrated and were given IV fluids. Water samples were taken from source and water tanks and sent to NIH. Water from tanks was contaminated while source had no bacterial growth. Blood samples were taken and showed raised ALT, serum urea and eosinophils. 2 out of three samples also showed thrombocytopenia. Serology for Hep A was negative. Patients were treated symptomatically and are stable. Families informed to avoid source of water and use another source. Hygiene session held. EDO health was informed of the outbreak. Alert for measles, during active surveillance more cases were found, routine outreach vaccination conducted in the area by EPI Team, Vit A was given, Blood Sample Collected for confirmation of antibodies, Health education session conducted with the family members and community, patient isolated, EDO H & EPI Coordinator were informed. Alert for Measles, during active surveillance more cases were found, routine outreach vaccination conducted in the area by EPI Team, Vit A was given, Blood Sample Collected for confirmation of antibodies, Health education session conducted with the family members and community, patient isolated, EDO H & EPI Coordinator were informed. Alert for Measles, during active surveillance no more cases found, routine outreach vaccination conducted in the area by EPI Team, Vit A was given, Blood Sample Collected for confirmation of antibodies, Health education session conducted with the family members and community, patient isolated, EDO H & EPI Coordinator were informed. Suspected Measles case reported from OPD DHQ Hospital belongs to Upper Dir. The concern S.O informed for active surveillance. Blood Sample collected and sent to NIH, Health education session conducted with the family members. Jan AJS Punjab Rajanpur Basti Jaskaani, Moza Kotla Naseer, UC kotla Naseer 1 13 Alert for Hepatitis C generated through media, report about unusually high number of Chronic Hepatitis cases and deaths in Rajanpur. Report was shared with the EDOH Rajanpur. Joint investigation and response team including SO DEWS Rajanpur, DDHO Rajanpur, DMS DHQ hospital and National Hepatitis Control Program focal person along with outreach team members including MO, LHS and vaccinator of BHU Kotla Naseer visited more than 1 household in bastis. 21 cases of Hepatitis C had lab reports indicating. 2 deaths were reported in last 2 months. One at THQ Rojhan diagnosed with Hepatoma. The second death at DHQ hospital Rajanpur was 1 years old boy with confirmed Hepatitis C at the time of death. DMS DHQ hospital and National Hepatitis control program focal person provided awareness sessions and shared with the community about availability of free of charge services for diagnosis and treatment of everyone irrespective of any bias os cast, color, creed and socio economic status. Further investigation planned. 3 Jan Pertussis Sindh Dadu 4 Jan Pertussis Sindh Dadu Distribution of Wild Polio Virus cases Pakistan 21 and 211 Year 211: As of 9th January, 212, the total number of polio cases confirmed by the laboratory is 192 (19=type 1, and 2=type 3) from districts/towns/tribal agencies and areas. Province Village Kaloo Khan Karmani, near Wapda colony Village Mazar Burguri, UC Torr Taluka Johi Cases 21 Cases 211 P1 P3 P1 P3 Punjab 1 Sindh Khyber Pakhtunkhwa FATA Balochistan 2 AJ&K Gilgit Baltistan 1 Islamabad Total Suspected case of Pertussis found in hospital, during active surveillance more cases found, Child was not vaccinated, 9 out of 1 children were vaccinated in the community, health education imparted, Erythromycin provided, EDOH, THO, DSM, EPI FP inform and 1 throat sample taken. Suspected cases of Pertussis reported in Village, Active surveillance done, Throat sample taken, vaccination status was not good, out of 2 children were vaccinated in the area, health education session was conducted, Erythromicine provided, EDOH, THO, DSM, EPI FP inform and request for immunization. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 2

3 Special Bulletin: DEWS, Pakistan, Week no. 1 (1 to January, 212) Current week's Alerts: Province Khyber Pakhtunkhwa Current week's Alerts: Province Sindh Date Disease District Area <M >M <F >F Date Disease District Area <M >M <F >F 1 Jan Measles Shangla Village dherai 1 Village Dada Mazzari, UC Phalkara, 4 Jan AWD Badin Taluka Matli 1 Jan Measles Shangla Village Kadona 1 Village KB Chakar Khan, UC Chinni, 1 Jan Measles Shangla Village Kandao 1 3 Jan Measles Dadu 1 Taluka Johi 1 Jan Measles Shangla Village Mach Kandai 1 Village Ghulam Fareed Narejo UC Ripri 3 Jan Measles Khairpur 1 2 Gambat Village Navey Kalay, UC & Tehsil Measles Lower Dir 1 Samar Bagh. 3 Jan Measles Qambar Village Bagodero Behind Court UC 1 4 Jan Measles Charsadda Village Dab Banda 1 Shahdadkot Qambar 1 Jan AJS Haripur Bagh Banda, Village Kundi, UC Kundi, Tehsil Ghazi Jan Measles Nowshera Village Jallozai Pabbi 1 Jaffarabad 4 Jan Tank Sheikh Uttar 1 3 Jan Measles Lower Dir Village Navagai, UC Rabat, Tehsil Balmbat Jan Measles Lower Dir Village Shagai, UC Rabat, Tehsil Balmbat Jan Measles Lower Dir Village Ttoru, UC Drangal, Tehsil Samar Bagh 1 Jan Measles Swat Village and UC Kanju, Tehsil Kabal 1 Jan Measles Swat Jan Measles Upper Dir Jan Measles Swat Jan Measles Swat Village Malak Abad Damghar Dherai, UC Kanju, Tehsil Kabal Lower Dir (Village Warri Payeen, UC & Tehsil Warri) Abul Samad Khan street No., UC Kanju, Tehsil Kabal Village Sangotha Shamali Mohallah, UC Aka Maruf Bami Khel, Tehsil Babuzai Jan Diphtheria Kohat Street 13 College colony 1 Current week's Alerts: Province Punjab Date Disease District Area <M >M <F >F Chicken pox Lahore 31 Dec Malaria Muzaffargarh 1 Jan Measles Mianwali Main Bazar Multan Chungi Multan road 1 3 THQ Jatoi 13 3 Bakhera,Kacha Mughlian walla,uc Khola,Tehsil Piplan Jan ARI Mianwali BHU Paki Shah Mardan Jan Measles Mianwali Grid Station,Kalkhund Kheel,Near Iqbal Hotel,UC Yaroo Kheel 1 1 Jan UXF Mianwali THQ Issa Kheel; Isa Khel City Jan Measles Mianwali Touheedabad,Mohallah Khanokhell,UC Gandha,Tahsil IssaKheel 1 ARI Layyah Chak 14 TDA, UC Jaman Shah Jan Scabies AD UXF UXF Muzaffargarh Muzaffargarh Rahim Yar Khan Rahim Yar Khan Rahim Yar Khan Adda Rung Pur, UC Rung Pur Basti Dingi, UC Chak Farazi BHU Abadpur RHC Zahirpir, Tehsil Khanpur Muslim Town, UC Moinabad Tehsil Khanpur 1 Jan Pertussis D. G. Khan Basti Berot UC Tuman Qaisrani 3 Jan AJS Rajanpur Basti Jaskaani, Moza Kotla Naseer, UC kotla Naseer 1 13 Current week's Alerts: ICT; AJK; FATA; GB Date Disease District Area <M >M <F >F Jan Mirpur Village Khaliqabad 1 Jan Mohmand Agency Gandav mian mandi 1 4 Jan Measles Sukkur Kumbhar Mohalla, Near GMC hospital 1 NNT Khairpur Near RHC Chondiko 1 NNT Khairpur Pir Mohalla Gambat 2 NNT Khairpur 3 Jan Pertussis Dadu 4 Jan Pertussis Dadu Current week's Alerts: Province Balochistan Date Disease District Area <M >M <F >F Jan AJS Chagai Gharib Abad UC Nokundi 2 1 Jan Leishmaniasibad Allah Yar Jaffara Shaheed Murad Colony, Tehsil Dera 2 Jan Magsi Hospital Gandawah Jhal Bhanry Pat Kar ra, UC Mir Pur, DHQ Jan Magsi Jhal Noshehra, UC Khari, BHU Noshehra 1 2 Kech UC Sarikehan 1 Wahair, Tehsil Wadh Saleh Abad, Chamrok UC Khand & Khuzdar 2 1 Jan Saifullah Urgas 1 2 Killa Jan Leishmaniasibad area Nasira Abro Mohla & Bhangar Mohla town Jan Leishmaniasibad Khan Bughti Nasira Ghot Jamal Khan Bughti & Sawali 2 1 Jan Panjgur UC Chitkan, Mohallah Chitkan Bazar 1 Jan Quetta Hazara town, Brewery road 1 Sibi Near batha, UC#4 1 Jan Malaria Lasbela Civil Hospital Bela Jan Malaria Lasbela RHC Lakhra Jan Measles Chagai Killi Toheed Abad Chagai Village 1 1 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 3 Jan Measles Village Ghulam Raza Katoher deh Gondlo, taluka Kot Diji Village Kaloo Khan Karmani, near Wapda colony Village Mazar Burguri, UC Torr Taluka Johi Goth Haji Chutta Khan, Umrani Paryani, Mirwah, District Nasirabad Jan Pertussis Larkana Village mitho dero, UC Bero chandio 1 3 Jan Pertussis Qambar Village Beer Sharif Qambar 1 Shahdadkot 1 4 Jan Measles Kech Kolwai Bazar UC Absar 1 3 Jan Measles Khuzdar Taj Abad UC Baleena Kattan Tehsil Khuzdar 2 Jan Measles Lasbela Daroo hotel Hub 3 Jan Measles Lasbela New labor colony, UC Pathra 2 1 Jan NNT Bolan Village Qadir khan 1 Jan Pertussis Chagai Killi Sor Gill, UC Sadder Dalbandin Jan Typhoid Chagai Killi Qasim Khan, Dalbandin, UC town 2 2

4 Table 1: Leading causes of seeking health care in districts, year 211, compiled from weekly reports Diseases Number of Consultations Acute respiratory infection 1,2,91 (23%) Skin diseases 4,44,2 (1%) Acute diarrhoea 4,29,21 (9%) Bloody diarrhoea 343, (1%) Suspected malaria 2,2, (%) Special Bulletin: DEWS, Pakistan, Week no. 1 (1 to January, 212) Figure 2: Weekly number of reporting health facilities (Week 1 to 2, 211) Number of HFs 4 Mobile Fixed Unexplained fever 1,34,1 (4%) Total consultations 4,1, Wk 1 11 Wk 3 Wk Wk Wk 9 Wk 11 Wk 13 Wk 1 Wk 1 Wk 19 Wk 21 Wk 23 Epi week Wk 2 Wk 2 Wk 29 Wk 31 Wk 33 Wk Wk 3 Wk 39 Wk 41 Wk 43 Wk 4 Wk 4 Wk 49 Wk 1 Table 2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease Current Week (1, 212) Total A O A O A O A O Acute watery diarrhoea Acute jaundice syndrome Bloody diarrhoea Dengue fever Measles Pertussis NNT + tetanus Malaria Others Total Province Khyber Pakhtunkhwa (211): 1, health facilities from 2 districts from Khyber Pakhtunkhwa were reported to DEWS on weekly basis with a total of,,31 patients consultations in year 211. A total of 1,3 alerts were reported in the same time period; Altogether for Measles; 2 for AWD; 233 for Dengue fever; 41 for Pertussis; for ; 22 for Bloody diarrhoea; 19 for Neonatal tetanus and tetanus; 11 for AJS; while 129 for other communicable diseases. 299 outbreaks were reported during the year; out of which 19 for AWD; for Dengue fever; 12 for Measles; 11 for Bloody diarrhoea; for AJS; for ; for Pertussis; while 31 for other communicable diseases. Province Sindh (211): 1, health facilities from 19 districts in Sindh were reported on weekly basis to DEWS with a total of 2,1,3 patient consultations in ,9 alerts were reported from Sindh in 211; out of which 1 for AWD; for Measles; 21 for Neonatal tetanus and tetanus; 14 for Dengue fever; 129 for Pertussis;3 for Malaria; 21 for Bloody diarrhoea; 11 for ; for AJS; while 1 for other communicable diseases. 391 outbreaks were also received and appropriate response were taken; out of which 212 for AWD; 1 each for Measles and Pertussis; 2 for Malaria; 13 for Dengue fever; 2 each for AJS and Bloody diarrhoea; 1 for ; while 11 for other communicable diseases. Figure-3: Trend of priority communicable diseases, province KPK wk wk 2 wk Figure-4: Trend of priority communicable diseases, province Sindh wk wk 2 wk For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 4

5 Province Punjab (211): Around health facilities from districts reported data to DEWS from 12 districts in Punjab province in 211 with a total of 11,14,99 patient consultations. A total of 1,1 alerts were reported in 211 from Punjab, 39 for Dengue fever; 194 for Measles; 13 for AWD; 4 for ; 3 for Bloody diarrhoea; 2 for Pertussis; 13 for malaria; for AJS; while 2 for Other communicable diseases. 11 outbreaks were also received and appropriate response were taken; Altogether 3 for AWD; 1 for dengue fever; 9 for ; for Measles; 2 for Pertussis; 1 each for Bloody diarrhoea and Malaria; while for other communicable diseases. Special Bulletin: DEWS, Pakistan, Week no. 1 (1 to January, 212) Figure-: Trend of priority communicable diseases, province Punjab wk wk 2 wk Province Balochistan (211): 2 health facilities from 2 districts in Balochistan were reported to DEWS in year 211 on weekly basis, with a total of 3,,114 patient consultations. 1 alerts were reported in year 211 from Balochistan; Altogether 19 for ; 191 for Measles; for Pertussis; 1 for Malaria; 1 for AWD; 42 for Neonatal tetanus and tetanus; 1 for AJS; 13 for Dengue fever; 3 for Bloody diarrhoea; while 12 for others communicable diseases. 123 outbreaks were also received and appropriate response were provided; Altogether for Malaria; 29 for AWD; 9 for Pertussis; each for Measles and ; 1for bloody diarrhoea; while 1 for other communicable diseases. Figure-: Trend of priority communicable diseases, province Balochistan wk wk 2 wk Province Gilgit Baltistan (211): 2 health facilities from districts in Gilgit Baltistan were reported to DEWS in year 211 on weekly basis with a total of 41,9 patient consultations. 14 alerts were reported in year 211 from Gilgit and Baltistan; Altogether 99 for Measles; 1 for AWD; 9 for Pertussis; for bloody diarrhoea; for Dengue fever; for ; 4 for AJS; 3 for Malaria; while 13 for other communicable diseases. 21 outbreaks were also received and appropriate response were provided; Altogether for AWD; 3 for Pertussis; 1 each for AJS; Bloody diarrhoea; Dengue fever; Measles and ; while for other communicable diseases. Figure-: Trend of priority communicable diseases, Gilgit Baltistan wk 2 wk 22 wk 24 wk 2 wk 2 wk wk wk 4 wk 42 wk 44 wk 4 wk 4 wk wk 2 State of Azad Jammu and Kashmir (211): FATA (211): 12 health facilities from 1 districts were reported from AJ&K were reported to DEWS in year 211 on weekly basis with a total of 1,,134 patient consultations. 14 alerts with 33 outbreaks were reported from AJ&K; altogether 41 for Measles; 32 for AWD; 13 for Dengue fever; for AJS; 4 for Bloody diarrhoea; 3 for ; 2 for Pertussis; while 3 for other communicable diseases. 3 health facilities in 3 agencies reported from FATA in year 211, with a total of 342,9 patient consultations. 99 alerts with 1 outbreaks were reported in 211; Altogether 41 for Measles; 2 for Neonatal tetanus and tetanus; 14 for AWD; for ; 4 for Dengue fever; 3 for Pertussis; 2 for bloody diarrhoea; 1 for Malaria; while 9 for other communicable diseases wk 2 wk 22 wk 24 wk 2 wk 2 wk wk wk 4 wk 42 wk 44 wk 4 wk 4 wk wk wk 2 4 wk 2 wk 22 wk 24 wk 2 wk 2 wk wk wk 4 wk 42 wk 44 wk 4 wk 4 wk wk 2 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

6 Alerts and outbreaks, week 1, 212 Special Bulletin: DEWS, Pakistan, Week no. 1 (1 to January, 212) For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.