Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 2, Issue 1, Monday 26 December, 2 Highlights Epidemiological week no. 1 (16 to 22 December, 2) 8 districts and 2 agencies provided surveillance data to the DEWS this week from 2,766 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC. A total of 8,6 consultations were reported through DEWS of which 236,614 (29%) were acute respiratory infections (ARI); 68,1 (8%) were Skin disease; 7,27 (7%) were acute diarrhoea; and,8 (6%) were suspected malaria. A total of 7 alerts with outbreaks were reported in week 1, 2: Altogether 39 alerts for Measles; 19 for Neonatal tetanus and tetanus; 14 for ; 9 for AWD; 7 for Pertussis; 4 for Malaria; 2 each for Acute Jaundice Syndrome and Bloody diarrhoea; while 1 for DHF; and 2 alerts for other communicable diseases. In this week 6 new type 1 polio cases were confirmed by the laboratory, two each from Khyber Pakhtunkhwa (Tank and Peshawar) and Punjab (Muzaffargarh and Dera Ghazi Khan) and one each from Federally Administered Tribal Areas (Khyber Agency) and Sindh (Thatta). As of 26th December, Pakistan has reported a total of 181 polio cases (179 type 1 and 2 type 3) from 8 districts/towns/tribal agencies and areas. Priority diseases under surveillance in DEWS Acute Flaccid Paralysis (AFP) Acute Jaundice Syndrome (AJS) Acute Respiratory Infections (Upper and Lower) (ARI) Acute Watery Diarrhoea (AWD)/ Suspected Cholera Acute Bloody Diarrhoea (BD) Other Acute Diarrhoeas (AD) Suspected Viral Hemorrhagic Fever (VHF) Suspected Malaria (Mal) Suspected Measles (MS) Suspected Meningitis (MG) Others Figure 1: Weekly trend of leading priority diseases in Pakistan, 29 July 21 to 1 December 2 (Epi week 31, 21 to week 1, 2) wk 31 wk 33 wk wk 37 wk 39 wk 41 wk 43 wk wk 47 wk 49 wk 1 wk Disease Wk-44 Wk- Wk-46 Wk-47 Wk-48 Wk-48 Wk- Wk-1 Acute respiratory infection 217,676 (%) 13,82 (%) 21,14 (%) 224,61 (26%) 242,844 (27%) 192,9 (27%) 241,869 (28%) 236,614 (29%) Skin diseases 77,842 (9%) 34,276 (8%) 74,134 (9%) 72,89 (8%) 77,7 (9%) 8,46 (8%) 69,79 (8%) 68,1 (8%) Acute diarrhoea 6,71 (8%) 33,7 (8%) 64,26 (8%) 62,6 (8%) 6,718 (7%) 2,6 (7%) 61,478 (7%) 7,27 (7%) Bloody diarrhoea,289 (.6%) 2,764 (.67%) 6,24 (.72%),478 (.64%) 4,912 (.4%) 4,6 (.64%) 4,86 (.7%) 4,2 (.2) Suspected malaria 69,48 (8%) 3,218 (7%) 8,136 (7%) 6,468 (7%) 63,826 (7%) 47,73 (7%) 2,4 (6%),8 (6%) Total consultation 879,8 412, ,736 89,241 94,948 79, ,82 8,6 Since July 29, 21, approximately 6,637,76 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports over 8, consultations per week. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 8 weeks (44 to 1, 2) acute diarrhoea cases have decreased (from 8% to 7%), while at the same time cases of ARI have increased (from % to 29%). A slight fluctuation in the suspected malaria cases have been seen recently after consistent seasonal increase from week especially from districts in Sindh and Balochistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 1

2 Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (16 to 22 December, 2) Previous week's (/2) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 12 Dec Malaria Balochistan Labella Civil Hospital Bela Dec AWD Sindh Badin Current week's (1/2) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 21 Dec AJS AJK Poonch Vill bari UC Bhantani Tehsil Hajira Dec Balochistan Jhal Magsi Gajan UC Patri BHU Gajan Dec Balochistan Jhal Magsi Fateh Pur UC Khari BHU fateh Pur Dec Balochistan Quetta Hazara town, Brewery road Dec Malaria Balochistan Jaffarabad BHU Gandakha Dec Malaria Balochistan Sibi RHC Talli 22 Dec Typhoid Balochistan Chagai 21 Dec Pertussis Sindh Dadu 22 Dec Pertussis Sindh Dadu 22 Dec Pertussis Sindh Ghotki 21 Dec Pertussis Sindh Sanghar Jameel Colony, UC Matli, Taluka Matli Killi Toheed Abad Afghan refugee camp Chagai village Village Ali Nawaz Araein, UC Mitho Babar, Taluka K.N Shah. Laghari Muhalla, New city colony Taluka Johi Village Shafi Muhammad Chachar UC Qadirpur Village Mangio Runhjo, UC Mian Taluka Sanghar Distribution of Wild Polio Virus cases Pakistan 21 and 2 Year 2: As of 26 December, 2, the total number of polio cases confirmed by the laboratory is 181 (179=type 1, and 2=type 3) from 8 districts/towns/tribal agencies and areas. Province Cases 21 Cases 2 P1 P3 P1 P3 Punjab Sindh Khyber Pakhtunkhwa FATA 63 2 Balochistan AJ&K Gilgit Baltistan 1 Islamabad Total Malaria alert was observed as cluster of suspected cases. Total 7 slides were tested out of which 37 were positive (SPR=6%). 29 for P. Falciparum and 8 for P. Vivax (FR=78%). Treatment provided to all patients and information shared with DHO and requested for necessary AWD alert, 1 suspected case was found in hospital, during active surveillance 3 more case were found, hand pump was the source of water, health and hygiene education imparted, Aqua tabs, Zinc tabs and ORS were distributed, EDOH informed and 1 stool sample taken and found positive for V. c. Ogawa. Alert for AJS was reported by Chughtai Medical Comlex Hajira. On field investigation along with DoH 13 cases were found. blood samples were taken and sent to NIH. 2 water sources were being used for drinking purposes, were open sources and were being contaminated from the surroundings. Water sampling was done from both the sources using H2S kits and found contaminated. Health and hygiene sessions were conducted for the community. IEC material and Hygiene kits were distributed among the community. 7 cases of cutaneous reported from the same area. Outbreak investigated, Inj Glucantime was provided and health education was given. EDO H was informed to provide vector control. 9 cases of cutaneous were reported from the same area. Outbreak investigated, Inj Glucantime was provided and health education was given. EDO H was informed to provide vector control. 12 cases of cutaneous were investigated. The alert is the continuation of previous week outbreak. Patients have already been diagnosed and treatment is continued. 46 cases have been reported so far from this center. Malaria alert was observed and 8 patients were checked and treated. RDT tests was carried out and 68% verified positive (P. Falciparum=13, P.Vivax=7, mixed=) SPR= 43%; while FR=72%). Anti malarial drugs along with bed nets were provided. DHO and Malaria representative was informed about alert and requested to take further preventive measures. 17 cases of lab confirmed Malaria reported out of 28 slides tested (SPR=61%) from BHU Sultankot. Falciparum positivity rate was 71%. ACT and RDTs were provided by WHO. DoH was informed and requested for fogging and supply of bed nets. Alert for Typhoid, 6 cases were observed and investigated. Investigation from local lab showed positive. The cases were sensitized to practice boiling water for drinking. Aqua tabs were distributed among the community. Health and hygiene sessions were conducted in community. Alert for probable Pertussis, suspected case was investigated in the village, during active surveillance 4 more cases were found, Throat sample collected, health education imparted, Children were not vaccinated, no routine immunization in the area, 1 Hygiene kit and Erythromycin were distributed, EDOH, DSM PPHI, THO KN Shah, EPI Focal person and PMC Marlin were informed. Alert for probable Pertussis, 13 suspected cases were found in the village during active surveillance, Throat swab was collected and Erythromycin were distributed, health education imparted, EDO H, THO Johi and EPI Focal person informed. The routine immunization of the area planned with district authorities. 16 cases of suspected Pertussis were reported from village Shafi Muhammad chachar UC Qadirpur. House to house cluster done, no routine immunization was found. DEWS team responded and give 14 day doses of erythromycin to all suspected cases and close contacts. Health education imparted in the village, informed EDOH and DSV and requested for vaccination in area/village. 1 cases of Pertussis were found in Village, 2 Throat samples were taken, health education imparted, Erythromycin Tab distributed and EDOH informed. Routine immunization of the area was very low or near to nil, the routine immunization of the area is planned and mopup activity will be conducted soon. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 2

3 Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (16 to 22 December, 2) Current week's Alerts: Province Khyber Pakhtunkhwa Current week's Alerts: Province Sindh Date Disease District Area <M >M <F >F 19 Dec BD Haripur Afghan Refugee Camp Panian Dec CCHF Swabi BMC Swabi, SWABI 1 22 Dec DHF Peshawar Jalalabad Afghanistan 1 16 Dec H1N1 Swabi BMC Swabi, Punjpir 1 19 Dec H1N1 Swabi BMC Swabi, Jangi Dher 1 19 Dec H1N1 Swabi BMC Swabi, Lahore 1 19 Dec H1N1 Swabi BMC Swabi, Tordher 1 19 Dec Tank Tank city 1 21 Dec Measles Karak Kohat (Village Mumikhel 1 22 Dec Measles Lower Dir Village Golar Shontala, UC Samar Bagh Dec Measles Lower Dir Village Toor Mang Coloney, UC Toor 1 2 Dec Measles Nowshera Village Banda Mulla Khel 1 21 Dec Measles Nowshera Mohalla lala khel khaishkee 1 2 Dec Measles Peshawar Village Khazana Charsadda Road 1 16 Dec Measles Shangla Village Gorkat/UC Ranyal Dec Measles Shangla Village Ambela/UC Shah Pur 2 Dec Measles Shangla Village Shangla Top/Alpurai 1 19 Dec Measles Swabi Private Clinic, Awaranu Mohallah Dec Measles Swabi Village Chota Lahore 1 16 Dec Measles Swat Village Balogram ground kanda 1 16 Dec Measles Swat Village Kandak, UC Kota, Tehsil Barikot 1 19 Dec Measles Swat Madina Colony College Chowk Matta Dec Measles Swat Village Cham Sathal, UC Bahrain Dec Measles Swat Village Matta near Baryam Bridge 1 2 Dec Measles Tank Gomal Bazar 1 2 Dec Measles Tank sagai 1 22 Dec Measles Tank Chadrar 1 Current week's Alerts: Province Punjab Date Disease District Area <M >M <F >F 2 Dec AD Bhakkar BHU Daggar Noon, Tehsil Kalur Kot Dec AD Mianwali BHU Bani Afghan Mianwali Dec AD RY Khan RHC Nawan kot, Tehsil Khanpur Dec AJS Lahore Mohalla Bazzar Suttar Mandi Lahore Dec ARI Mianwali BHU Kallur Shareef,Issa Kheel Dec ARI RY Khan RHC Nawan kot, Tehsil Khanpur Dec ARI Rajanpur BHU Haji Pur, Moza Allah Abad Dec ARI Rajanpur RHC Muhammad Pur, Tehsil Jampur Dec DG Khan Naween Abadi Shadanlund 1 22 Dec Diamir DHQ Hospital Chilas 1 22 Dec Measles Diamir DHQ Hospital Chilas 1 2 Dec RY Khan Faridabad, UC Qadirpur, Tehsil Khanpur 1 UC Trinda Mohd Panah basti Gaman Khan Baloch, Chowk Zahirpir, 21 Dec RY Khan 1 19 Dec Malaria Mianwali BHU Vanjaree,Issa Khail Dec Malaria Muzaffargarh Rungpur Dec Measles Lahore Village Kmyah Nishter Town 1 19 Dec Measles Muzaffargarh Azmat Plaza, Qasba Gujrat, Kotaddu 1 21 Dec Measles Muzaffargarh Basti Pepal Wala, Moza Kamalpur Dec NNT Multan Basti Buzdar,Dakhana Mana Ahmdani 1 21 Dec NNT Rajanpur Moza Wassan Baloch, UC Umer Kot 1 22 Dec Pertussis DG Khan Hadwar Shumali UC Mangrotha 1 21 Dec Pertussis Rajanpur Basti Khuda Bukhsh, Moza Hataila Dec Scabies Bhakkar BHU 73 ML, Tehsil Mankera Dec Scabies Rajanpur BHU Bukhara, Moza Bukhara, UC Bukhara Dec Tetanus Lahore Sultan steert sandha Kalan 1 17 Dec Tetanus Lahore St no Mustafabad Dharam Pura Lahore 1 22 Dec Tetanus Lahore Bank stop Main Ferozpur road 1 2 Dec UXF Rajanpur DHQ Hospital Rajanpur Current week's Alerts: AJK; FATA; GB Date Disease District Area <M >M <F >F 21 Dec AJS Poonch Vill bari UC Bhantani Tehsil Hajira Dec Diphtheria Kurram Agency Sadda Lower Kurram Agency 1 South Waziristan 17 Dec Diphtheria Village Shoobi Khel Boobar 1 Agency 21 Dec NNT Bajaur Agency village Kadok, tehsil Salarzai 1 Date Disease District Area <M >M <F >F 19 Dec AWD Badin Village Latif Panhwer, UC Tando Ghulam ali Dec AWD Matiari Village Poratho Taluka Matiari 1 22 Dec AWD Mirpur Khas Opposite Rotaty club, Lal chand bagh 1 16 Dec AWD TA Yar Bheel colony, UC Dec AWD TA Yar Mithal Shah Colony 1 16 Dec AWD TA Yar Shahbaz Colony 1 18 Dec AWD TA Yar Akram colony Taluka Tando Allahyar 1 22 Dec AWD TM Khan Bathoro Road Tando Muhammad Khan 1 21 Dec AWD Umer Kot Village Rana Jagir, UC Khararo Syed 1 2 Dec BD Matiari Village Muhammad Junejo, UC Sahib Samo Dec Measles Jamshoro Darya abad, UC Nagoline, Taluka Kotri 3 18 Dec Measles Khairpur Village Misri Khan, UC Drib Mehar Shah Dec Measles SBenazirabad Village Char, UC Daulatpur 1 19 Dec Measles Thatta UC Keti Bundar Dec Measles Thatta Achar Malla Mohalla, Gharo city Dec Measles Thatta Village Wahid Buksh Lashari Dec Measles Thatta Village Mirza Gabol UC Karampur Sakiro Dec Measles Thatta Village Muhammad Khan Gabol Dec NNT Jacobabad Village Allah abad, taluka Garhi Khairo 1 21 Dec NNT Karachi NICH Karachi and Khyber Cha 17 Dec NNT Kashmore Village Jangu Khan Rind, taluka tangwani 1 18 Dec NNT Khairpur Pir jo goth, taluka Kingri 1 18 Dec NNT Khairpur Village Haji Mohammad Mithal Bhambro 1 19 Dec NNT Larkana Village Masood kalhoro UC Badah 1 22 Dec NNT Larkana Village Bahadur Khan talka ratodero 1 2 Dec NNT Qambar Village Faiz Mohammad Khokhar 1 2 Dec NNT Qambar Village Hakim Shah Magasi 1 17 Dec NNT Thatta Village Noor Machi UC Mehar Shah 1 2 Dec Pertussis Badin Village Ashraf abad, UC Muhammad Khan Dec Pertussis Dadu Village Ali Nawaz Araein, UC Mitho Babar Dec Pertussis Dadu Laghari Muhalla, New city colony Taluka Johi Dec Pertussis Ghotki Village Shafi Muhammad Chachar Dec Pertussis Sanghar Village Mangio Runhjo, UC Mian Current week's Alerts: Province Balochistan Date Disease District Area <M >M <F >F 21 Dec ARI Harnai Harnai 21 Dec Chicken Pox Panjgur UC Washbood Mohallah Madresa Dec Jhal Magsi Gajan UC Patri BHU Gajan Dec Jhal Magsi Fateh Pur UC Khari BHU fateh Pur Dec Khuzdar UC Khand, UC Faiz Abad, UC Zereena Kattan 3 19 Dec Killa Saifullah Killa Saifullah 1 22 Dec Killa Saifullah Haji Hanan Burma Nasai Dec Lasbela Uthal and Winder Dec Panjgur UC Chitkan Mohallah Chitkan Bazar Dec Quetta Hazara town, Brewery road Dec Quetta Village aid Dec Malaria Jaffarabad BHU Gandakha Dec Malaria Sibi RHC Talli 2 Dec Measles Chagai Killi Koi Khan U/C town Dalbandin Dec Measles Goth Ali Nawaaz Langow, near to Mohabbat Jaffarabad Shakh, Tehsil Dera Allah Yar Dec Measles Killa Saifullah Kashmir District 1 19 Dec Measles Lasbela Abdullah Goth Bagar 1 19 Dec Measles Lasbela Phota Goth UC Gadani 1 21 Dec Measles Lasbela Raja Waqas Goth,Uc Pathra Dec Measles Loralai Killi Gul Baran U/C Gharbi Luni Tehsil Dukki Dec Measles Panjgur UC Chitkan Mohallah College 1 22 Dec NNT Bolan Village Nigari 1 2 Dec NNT Jaffarabad NICH Karachi 1 17 Dec NNT Quetta Bolan Medical Complex Hospital 1 22 Dec Typhoid Chagai Killi Toheed Abad Afghan refugee camp Chagai village 3 3 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 3

4 Table 1: Leading causes of seeking health care in flood affected districts, 29 July 21 to 22 December 2, compiled from weekly reports Diseases Number of Consultations Acute respiratory infection 12,887,44 (23%) Skin diseases,9,829 (%) Acute diarrhoea,267,1 (9%) Bloody diarrhoea 464,21 (1%) Suspected malaria 3,,247 (6%) Unexplained fever 2,16,19 (4%) Province Khyber Pakhtunkhwa: Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (16 to 22 December, 2) Figure 2: Weekly number of reporting health facilities (Wk 33/21 to Wk 1/2) Number of HFs Total consultations 6,637,76 Epi week Table 2: Total number of alerts and outbreaks reported and investigated with appropriate response Mobile Disease Post Flood 21 2 (up till wk ) Current Week (1) 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 Fixed Figure-3: Trend of priority communicable diseases, province KPK Wk 33 Wk Wk 37 Wk 39 Wk 41 Wk 43 Wk Wk 47 Wk 49 Wk 1 Wk 1 Wk 3 Wk Wk 7 Wk 9 Wk Wk 13 Wk 1 Wk 17 Wk 19 Wk 21 Wk 23 Wk Wk 27 Wk 29 Wk 31 Wk 33 Wk Wk 37 Wk 39 Wk 41 Wk 43 Wk Wk 47 Wk 49 Wk 1 This week 66 health facilities from 19 districts reported to DEWS with a total of 142,247 patients consultations. The proportional morbidity of AD (7%) 1% lower as compared with last week. 27 alerts were reported in this week, 19 were for Measles; 4 for H1N1, while 1 each for Bloody diarrhoea, CCHF, DHF, and. No outbreak for any disease was received this week from any area in Khyber Pakhtunkhwa wk Province Sindh: This week 1,9 health facilities from 22 districts reported a total of 376,863 patient consultations. In Sindh, AD cases reported were 28,18 (7%), 1% lower proportional morbidity as compared with last week. 33 alerts were reported from Sindh in this week: 1 for Neonatal tetanus; 9 for AWD; 8 for Measles; for Pertussis; while 1 for Bloody diarrhoea. 4 outbreak for Probable Pertussis were received and appropriate response were taken. Figure-4: Trend of priority communicable diseases, province Sindh wk For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 4

5 Province Punjab: This week 483 health facilities from 8 districts reported data to DEWS from Punjab province with a total of 194,7 patient consultations. AD cases reported were,294 (6%) and showing same proportional morbidity as compared with last week. 26 alerts for were reported in this week from Punjab, for Neonatal tetanus and tetanus; 4 for ARI; 3 each for Acute diarrhoea; ; and Measles; 2 each for Malaria; Pertussis and Scabies; while 1 each for Acute Jaundice Syndrome and Un-explained fever. No outbreak for any disease was received this week. Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (16 to 22 December, 2) Figure-: Trend of priority communicable diseases, province Punjab wk Province Balochistan: In this week, 16 districts reported to DEWS from Balochistan province. 48 health centers reported a total of 66,177 patient consultations. AD reported in,123 (8%) of the total consultations, same proportional morbidity as compared with the last week. alerts were reported in this week from Balochistan, 9 for ; 8 for Measles; 3 for Neonatal tetanus; 2 for Malaria; while 1 each for ARI; Typhoid and Chicken Pox. 6 outbreaks, 3 for ; 2 for Malaria; while 1 for Typhoid were received and appropriate response were taken.s week. Figure-6: Trend of priority communicable diseases, province Balochistan wk Province Gilgit Baltistan: Figure-7: Trend of priority communicable diseases, Gilgit Baltistan In this week, 44 health centers from districts in Gilgit Baltistan sent weekly report with a total of 8,84 patient consultations. ARI cases reported were 2,748 (34%), while Acute diarrhoea were 899 (%). No alert for any disease was received this week from any area in Gilgit and Baltistan. State of Azad Jammu and Kashmir: wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 wk 48 wk FATA: In this week, reports were received from 123 health facilities from 1 districts with a total of 3,27 patient consultations. ARI cases reported were 7,34 (24%), while Acute diarrhoea reported 1,173 (4%) cases. 1 alert for AJS was received and appropriate response was taken. This week 39 health facilities in 2 agencies reported from FATA, with a total of 6,849 patient consultations. ARI cases reported were 2,1 (31%), while Acute diarrhoea was reported 391 cases (6%). No alert for any disease was reported this week wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 wk 48 wk wk wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 wk 48 wk For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

6 Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (16 to 22 December, 2) Alerts and outbreaks, week, 2 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 6