Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 3, Issue 19, Wednesday 16 May 212 Highlights Epidemiological week no. 19 (6 to 12 May 212) Priority diseases under surveillance in DEWS In week 19, 212, total 86 districts including 3 agencies provided surveillance data to the DEWS on weekly basis from around 2,148 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC. A total of 73,67 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI); 1% were acute diarrhoea; % were suspected malaria; while 4% were Skin disease. A total of 239 alerts reported while 26 outbreaks were identified in week 19, 212: Altogether 143 alerts for Measles; 22 for Typhoid; 19 for Leishmaniasis; 11 for Pertussis; 9 for acute diarrhoea; 7 each for Malaria and AWD; 6 for Bloody diarrhoea; for Scabies; 3 for CCHF; 2 each for AJS and Diphtheria; while 1 each for ARI, DF and Tetanus. In this week no new polio case was reported. As of 14 May 212, Pakistan has reported a total of 16 polio cases (13 type1, 2 type3, 1 mix type1 and 3) from 1 districts/tribal agencies Acute (Upper) Respiratory Infection Pneumonia Suspected Diphtheria Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea Other Acute Diarrhoea Suspected Enteric/Typhoid Fever Suspected Malaria Suspected Meningitis Suspected Dengue fever Suspected Viral Hemorrhagic Fever Pyrexia of Unknown Origin Suspected Measles Suspected Acute Viral Hepatitis Chronic Viral Hepatitis Neonatal Tetanus Acute Flaccid Paralysis Scabies Cutaneous Leishmaniasis Others Figure1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week1, 211 to week19, wk wk 1 wk 1 3 Table 1: Most common communicable diseases syndromes reported weekly Disease Wk-12 Wk-13 Wk-14 Wk-1 Wk-16 Wk-17 Wk-18 Wk-19 Acute respiratory infection 14,261 (21%) 1,8 (2%) 128,63 (2%) 133,329 (19%) 131,477 (18%) 13,7 (17%) 113,7 (18%) 124,79 (17%) Skin diseases 28,719 (4%) 31,638 (4%) 28,123 (4%) 28,32 (4%) 28,487 (4%) 31,6 (4%) 27,27 (4%) 31,92 (4%) Acute diarrhoea 41,3 (6%) 1,227 (7%) 2,33 (8%) 61,71 (9%) 63,11 (9%) 7,982 (9%) 64,841 (1%) 7,88 (1%) Bloody diarrhoea 2,89 (.42%) 3,48 (.4%) 2,977 (.46%) 3,338 (.47%) 3,64 (.%) 3,616 (.46%) 3,426 (.3%) 3,69 (.%) Suspected malaria 29,21 (4%) 32,888 (4%) 28,298 (4%) 3,938 (4%) 31,61 (4%) 3,236 (%) 32,171 (%) 36,917 (%) Total consultation 681,47 772,42 647,69 713, ,7 781, ,69 73,67 The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as proportional morbidity (percentage of cases out of total consultations) reported to DEWS on weekly basis. The above table provides the total consultations for the last 8 weeks proportional morbidity of the leading five disease syndrome. Proportional morbidity of ARI is highest in Khyber Pakhtunkhwa, and Balochistan, while acute diarrhoea is highest in Khyber Pakhtunkhwa, FATA, Punjab, and Balochistan (please see the graphs for every province in page 4 and ). For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 1

2 Weekly Bulletin: DEWS, Pakistan, Week no. 19 (6 to 12 May 212) Current week's (19/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 9May Measles AJK Poonch 11May Leishmaniasis 7May Malaria 7May Malaria Balochistan Lasbela Balochistan Harnai Balochistan Harnai Village Galliat, UC Rawalakot Bela town, UC & Tehsil Bela Belli, UC Spintangi, Tehsil Harnai Shahrag, UC Shahrag, Tehsil Shahrag May Malaria Balochistan Lasbela Civil Hospital Bela May Measles 11May Measles 8May Measles 9May Measles Balochistan Pishin Balochistan Sibi FATA FATA Khyber Agency Khyber Agency UC & Village Killi Lumaran Village Khanul Mari, ward # 1, Sibi town Ali Korona, UC Lowara Mina,Tehsil Mulagori Garhi #1, UC Lowara Mina,Tehsil Mulagori May Leishmaniasis KPK Abbottabad Village Bakot, UC Bakot May Leishmaniasis KPK Shangla 1May Measles KPK Haripur 11May Measles KPK Haripur 8May Pertussis Punjab Rahim Yar Khan 7May Measles Karachi 9May Measles Karachi 8May Measles 9May Measles 11May Measles Qambar Shahdadkot Qambar Shahdadkot Qambar Shahdadkot Village Jatkool, UC Sarkool Aslam Colony, UC Shahmuhammad, BHU Shah Muhammad Monan, UC Ali Khan, BHU Shah Muhammad Village Jan Muhammad Dahar, UC Machko Shah Nawaz Bhutto colony, Line area, Jamshed town Shah Latif Town, UC, Bin Qasim town Datoo Ji Wandh, Jean Abro, Taluka Qambar Pir Jo Goth, UC Rawanti, Taluka Kambar Kalo Makan Mohalla, UC Alert for suspected measles reported from Sheikh Zaid hospital, Rawalakot. During active surveillance more cases found. Blood samples were taken and Vitamin A given to active cases and contacts. DOH was informed and mop up vaccination was arranged for all children < 1 yrs of age. Health education session was conducted. 6 cases of Leishmaniasis were reported and patients with lesions on cheeks, hands and legs were found. During active surveillance no other case was found. The plan is to provide Inj. Glucantime and take preventive measures. 14 cases of suspected malaria were reported from BHU Belli. 14 slides were tested on RDTs and 8 were found positive (Slide positivity 7%). Distribution shows 6 Falciparum and 2 Vivax. Investigation was done and clustering was found. Information was shared with DHO and health partners. RDTs & ACTs have been provided by a health partner. Suspected malaria alert was received from RHC Shahrag and 29 cases were reported. 1 slides were tested on RDTs and 11 were found positive (Slide positivity 73%). Distribution shows 9 Falciparum and 2 Vivax. Investigation revealed that cases are from the same location. Mostly patients are coal mine workers and treatment is provided by a health partner. 4 cases of suspected malaria were reported from CH Bela. 3 slides were tested on RDTs and 18 were found positive (Slide positivity 1%). Distribution shows 4 Falciparum and 14 Vivax. RDTs were distributed. DHO was informed and distribution of anti malarial drugs is planned. Alert for Measles was reported with 24 cases including 2 deaths. All the cases were found unvaccinated. Vitamin A was given and health education was provided. 1 sample was collected. During active surveillance 2 children were vaccinated. Outcome was shared with DHO and DoH. 6 cases of Measles were reported with one death. Active surveillance revealed 31 unvaccinated children and all were vaccinated by EPI team. Health education was imparted and Vitamin A was given. 6 suspected cases of Measles were reported from CH Lawara Mina. During active surveillance no more cases were found. Vitamin A was given to suspected cases. Health education session was conducted. 2 blood specimens were collected. During mass measles vaccination 7 children were vaccinated. Report was shared with Agency Surgeon and FSMO. 2 suspected Measles cases were reported from Garhi #1. On active surveillance 9 more cases were found, 2 samples were collected. Vitamin A was given to the suspected cases and health education session was conducted. Mass measles vaccination of 99 children was done. Reports were shared with the Agency Surgeon and FSMO. 6 suspected Leishmaniasis cases were reported from BHU Bakot. Patients were investigated and health education was imparted to the affected families. EDO Health was informed and necessary action is planned for indoor insecticide spray, provision of bed nets and further health education sessions. Alert for Leishmaniasis was received from non endemic area. On active surveillance 13 suspected cases of cutaneous Leishmaniasis were found. All the cases were given first dose of intralesional injections. EDOH was informed and response team comprising of 2 MO's, 3 MT's, 1 spray men, 13 Social organizers has been sent for proper response. 1 suspected measles case was reported to BHU. Active surveillance carried out and 4 more cases were identified. During field investigation found that 13 children were not vaccinated for measles 1st dose and 6 were missing the measles 2nd dose. Missed children were sent to nearest health facility for vaccination. Vitamin A was given and blood sample was taken. Outreach vaccination is scheduled. 2 suspected measles cases were reported to BHU Shah Muhammad. Active surveillance carried out and 4 more cases were identified. Field investigation revealed 7 children not vaccinated for measles 1st dose and 4 were missing measles 2nd dose. Missed children were sent to nearest health facility for vaccination. Vitamin A was given and blood sample was taken. Outreach vaccination is scheduled. During field surveillance of village found 6 suspected Pertussis cases. Immunization status of the children were assessed where all were found partially vaccinated. Health education was imparted, complete dose of Erythromycin was given to all cases. Information was shared with SMOBHU Rawant, EDOH and request for mopup the area. Suspected case of Measles was reported from NICH. Investigations showed that case was unvaccinated, history of Fever, Rashes in body and severe Pneumonia. During active surveillance found more cases were found. Routine immunization status of 17 children were assessed and Vitamin A dose was given to all and 1 Blood sample was collected. Health education was imparted, THMT informed and requested for immunization. Suspected case of Measles was reported from a private hospital. Investigations showed that patient has fever, rashes in Body and was unvaccinated. During active search found more cases, Vitamin A was given, immunization status was checked where 21 children were assessed. Health education was imparted, THMT informed and 3 blood samples were collected. 1 suspected Measles case was reported from a private clinic; during active surveillance found 6 more cases. Health education was imparted, Vitamin A doses were given to all cases and blood samples were collected. Immunization status was checked, informed DHMT for implementation of routine immunization. A suspected Measles case was reported from a private practitioner and more cases were found during active surveillance. Immunization status collected and information was shared with DHMT. Vitamin A was given, health education imparted and blood samples were collected. 1 suspected Measles case was reported from a private clinic and during active surveillance found 4 more cases. Vitamin A was given to all cases, health education imparted and 4 blood samples were collected. Immunization status was checked and information was shared with DHMT. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 2

3 Cont d Current week's (19/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 11May Measles 9May Pertussis Larkana 11May Pertussis 8May Pertussis 8May Pertussis 11May Pertussis Tando Village Haji Allah Warayo, Muhammad UC Nazarpur Khan Naushahro Feroze Village Sabzal Shar, UC Kothi, Taluka Larkana Village Sadhuja, UC Sadhuja, Taluka Naushahro feroze Shaheed Village khanan Shah, UC Benazir Abad Amur Ji Shaheed Village Mir Hassan Dahri, Benazir Abad UC Amur Ji Tando Allah Yar 9May Pertussis Tharparkar Village Bachal Mari, UC Mirabad Village Salar Ji Dhani, UC Vejhiar, Taluka Chachro Weekly Bulletin: DEWS, Pakistan, Week no. 19 (6 to 12 May 212) Suspected Measles case was reported from community and during active surveillance found more cases. Immunization status was checked and EDOH was informed. Vitamin A was given to all cases, health education imparted and 6 blood samples were collected. Alert for suspected Pertussis was received from a private clinic and during active search found 4 more cases. Erythromycin was given to cases and contacts and proper treatment of patient was assured. Routine immunization status was assessed, EDOH informed for mopup in the village. A suspected Pertussis case was notified and during active search found more cases. Cluster for routine immunization was checked from 1 houses where 13 children were assessed. Erythromycin was given, health education was imparted and information was shared with DHMT. Pertussis case was notified and during field investigation other cases were found from same family. Erythromycin was given, health education was imparted and information was shared with DHMT. Routine immunization assessment was also done. A Pertussis alert was notified and during field investigation 7 other cases were found from same family. Routine immunization assessment for 12 children was done. Erythromycin was given, health education was imparted and information was shared with DHMT. Suspected case of Pertussis was reported from community and during investigation found 16 more cases. Health education was imparted, Erythromycin tabs, Priton Syrup, Cough Syrup and IEC material was distributed, 4 samples were also collected. Immunization status was checked and EDOH was informed with the situation. 2 Suspected cases of Pertussis were found at THQ Chachro and during active surveillance 2 more cases were found. All children were found un vaccinated. Vaccination was done, health education imparted and complete dose of erythromycin was given to all the patients and close contacts. samples for culture were also collected. Information is shared with EDOH. Table2: Province wise number of alerts and outbreaks reported and investigated with appropriate response, week 19, 212 Diseases AJK Balochistan FATA Gilgit Baltistan KPK Punjab Total A O A O A O A O A O A O A O A O Acute diarrhoea 9 9 Acute jaundice syndrome 2 2 Acute respiratory infection 1 1 Acute watery diarrhoea Bloody diarrhoea CCHF Dengue fever 1 1 Diphtheria 2 2 Leishmaniasis Malaria Measles Pertussis Scabies Tetanus 1 1 Typhoid Total Table3: Total number of alerts and outbreaks reported and investigated with appropriate response Disease (up till week 19) Total A O A O A O A O Acute watery diarrhoea Acute jaundice syndrome Bloody diarrhoea Dengue fever Measles Pertussis NNT + tetanus Malaria Leishmaniasis Others Total For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 3

4 Weekly Bulletin: DEWS, Pakistan, Week no. 19 (6 to 12 May 212) Figure2: Distribution of consultations by diseases, Week 19, 212 Figure3: Number of consultations by age and gender, week 19, 212 Number of consultations by disease AD 1% BD <1% 2 1 ARI 17% # of cases 1 Others 9% S. Malaria % Skin Ds. 4% UF 4% < 1 yr 14 yr 14 yr 1 yr + yr Male Female Province Khyber Pakhtunkhwa: 498 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS on weekly basis with a total of 13,46 patients consultations in week 18, alerts were reported in week 18; Altogether 44 for Measles; 8 for Leishmaniasis; 2 for Diphtheria; while 1 each for Bloody diarrhoea, DF and Scabies. 4 outbreaks, 2 each for Measles and Leishmaniasis were identified and appropriate measure were taken. Figure-4: Trend of priority communicable diseases, province KPK wk wk 1 wk 1 3 Province : 611 health facilities from 23 districts in reported on weekly basis to DEWS with a total of 289,923 patient consultations in week 19, alerts were reported; Altogether 7 for Measles; 9 for Pertussis; 6 for Typhoid; for AWD; while 1 each for CCHF and Scabies. 12 outbreaks, 6 each for Measles and Pertussis were identified and appropriate measures were taken. Figure-: Trend of priority communicable diseases, province wk wk 1 wk 1 3 Province Punjab: Figure-6: Trend of priority communicable diseases, province Punjab 382 health facilities from 8 districts reported data to DEWS in Punjab with a total of 181,743 patient consultations. A total of 9 alerts were reported in this week; Altogether 18 for Measles; 1 for Typhoid; 9 for Acute diarrhoea; 4 for Bloody diarrhoea; 3 for Scabies; 2 each for Acute jaundice syndrome, CCHF, and Pertussis; while 1 each for AWD, ARI, Malaria and Tetanus. 1 outbreak, for Pertussis was identified and appropriate measures were taken wk wk 1 wk 1 3 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. 19 (6 to 12 May 212) Figure-7: Trend of priority communicable diseases, province Balochistan 442 health facilities from 21 districts in Balochistan reported to DEWS, with a total of 68,991 patient consultations alerts were reported in week 19 from Balochistan; Altogether 8 for Measles; 7 for Leishmaniasis; 6 for Malaria; while 1 for AWD. 6 outbreaks, 3 for Malaria; 2 for Measles; while 1 for Leishmaniasis were identified and appropriate measures were taken wk Province Gilgit Baltistan: 36 health facilities from 4 districts in Gilgit Baltistan reported to DEWS in week 19, with a total of 14,66 patient consultations. 2 alerts, 1 each for Measles and Typhoid were received and appropriate measures were taken. FATA: 4 health facilities from 3 agencies reported from FATA in this week, with a total of 13,49 patient consultations. 12 alerts, 8 for Measles; 4 for Leishmaniasis were reported and appropriated measures were taken. 2 outbreaks for Measles were identified and appropriate measures were taken. Figure-8: Trend of priority communicable diseases, Gilgit Baltistan wk wk 1 wk Figure-9: Trend of priority communicable diseases, AJ&K wk State of Azad Jammu and Kashmir: 12 health facilities from 9 districts reported to DEWS in this week with a total of 31,33 patient consultations. 8 alerts, 7 for Measles; while 1 for Bloody diarrhoea were received and appropriated measures were taken. 1 out break for Measles was identified and appropriate measure were taken. Figure-1: Trend of priority communicable diseases, AJ&K wk For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

6 Distribution of Wild Polio Virus cases Pakistan 211 and 212 In this week 19, 212, no new polio case was reported. As of 14 May 212, the total number of polio cases confirmed by the laboratory is 16 from 1 districts/ towns/tribal agencies and areas. Province Cases 211 Cases 212 P1 P3 P1 P3 P1+P3 Punjab Khyber Pakhtunkhwa 23 4 FATA Balochistan 73 2 AJ&K GilgitBaltistan 1 Islamabad Total Distribution of Dengue cases in Pakistan, 212 Weekly Bulletin: DEWS, Pakistan, Week no. 19 (6 to 12 May 212) Trends of Dengue lab confirm cases, 21 (Pakistan) and 211, 212(Punjab) s 3 c a s e f o2 # EpiWeek 2 1 s c a s e f1 # Trend of positive dengue cases, week 1 18, 212 Punjab Epiweek The above chart compares the trend of dengue confirmed cases in 21 and 211. Month of peak incidence in 21 was November while peak incidence in 211 was in September and October. The second chart above and table to the right show the weekly number of confirmed cases reported by surveillance focal points in the Depts of Health in and Punjab. Total number of confirmed dengue cases to date in 212 is 4 in and 8 in Punjab. Characteristics: Dengue fever is a acute fever illness that affects infants, young children and adults, but seldom causes death. Dengue should be suspected when a high fever (4 C/ 14 F) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for 2 7 days, after an incubation period of 4 1 days after the bite from an infected mosquito. Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Warning signs occur 3 7 days after the first symptoms in conjunction with a decrease in temperature (below 38 C/ 1 F) and include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, blood in vomit. The next hours of the critical stage can be lethal; proper medical care is needed to avoid complications and risk of death. Treatment: There is no specific treatment for dengue fever. For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives decreasing mortality rates from more than 2% to less than 1%. Maintenance of the patient's body fluid volume is critical to severe dengue care. Messages for the community Clear sites where mosquitoes breed Cover water containers Remove or destroy containers where mosquitoes breed Proper waste disposal Protect yourself from mosquito bites Wear proper clothes (long sleeves and pants; not black) to minimize the chance of being bitten by mosquitoes Use mosquito repellants and kill mosquitoes in the home Weekly reported Dengue cases Epiweek Punjab For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 6

7 Focus on: Measles Weekly Bulletin: DEWS, Pakistan, Week no. 19 (6 to 12 May 212) In this week, DEWS team successfully responded 143 alerts and 13 outbreaks for measles. Increase in the number of cases this year compare to last year indicates that the children are not vaccinated against measles as no such campaigns have been planned this year. However, last year measles immunization campaign was organized in Feb 211 which had reduced the significant number of cases. Measles is a killer childhood disease. One in 1 people have complications with measles, and one in 1 will die of it, but two doses of measles vaccine will protect people against the disease. WHO has set the target for measles elimination for 21 which would require that more than 9% of the world children are covered by two doses of measles vaccine. In 211, 178 alerts and 11 outbreaks had investigated by WHODEWS team with the collaboration with department of health. 389 measles cases and 64 deaths due to measles had been reported; while up till 12 May 212, a total of 1787 alerts reported and 142 outbreaks identified in which 447 cases and 48 deaths had been reported. Proper case management during outbreaks: It is imperative that during outbreak situations proper case management is ensured in order to minimize measles related deaths and measles related complications. The treatment of measles patients with Vitamin A will dramatically reduces their risk of deaths. Two doses of Vitamin A will be given to all identified cases (active and old) during housetohouse investigation, unless it was already received as part of the treatment in the health facility. One dose to be given by the health worker on the day of investigation and the 2nd dose to the parents advising to give on next day. The therapy will be given regardless of previous vitamin A prophylaxis. If the investigation team observes complications, the patient should be referred to the nearest health facility for specific treatment of these complications. Measles Prevention: Provincewise Measles number of alerts and outbreaks, week 119, 212 Province # of Alerts # of OB's AJK 22 2 Balochistan FATA 63 1 GilgitBaltistan 7 ICT 1 Khyber Pakhtunkhwa Punjab Total Routine measles vaccination for children; combined with mass immunization campaigns in countries with high case and death rates, is key public health strategy to reduce global measles mortality rates. The measles vaccine has been in use for over 4 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles. Measles vaccine is provided by the Pakistan EPI programme to children at 9 months and 1 months. Children who are vaccinated against measles before 9 months of age must receive a 2nd measles vaccination at 9 months age ensuring a gap of one month between both vaccinations. Moreover, any child who received measles vaccine should also receive OPV. Priority should be placed to immunize children 6 months to years old, regardless of vaccination status or history of disease. Auto destructible syringes and safety boxes are recommended and safe disposal of used sharps and safety of injection during immunization should be ensured. Let s remind all our neighbours, friends and colleagues to be sure their children are immunized against measles. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 7

8 Alerts and outbreaks, week 19, 212 Weekly Bulletin: DEWS, Pakistan, Week no. 19 (6 to 12 May 212) For Correspondence: NIH: WHO: Tel : , Fax : ; wr@pak.emro.who.int. 8