Flood Response in Pakistan

Transcription

1 Weekly Epidemiological Bulletin Flood Response in Pakistan Volume 1, Issue 7 Monday 4 October 2010 Highlights Epidemiological week no 39 (25 September - 1 October 2010) Between 25 September - 1 October 2010 (epidemiological week no. 39), 41 of the 78 flood-affected districts provided surveillance data to the system. Of these 41 districts, 87% reported 6-7 days of the week. 715 fixed health and 192 mobile medical outreach centers provided surveillance data for this week. 433,890 consultations were reported through of which 19% were acute respiratory infections (ARI), 13% were acute diarrhoea, 13% were skin disease, and 8% were suspected malaria. 16 alerts were received and responded to this week; 6 alerts were for acute watery diarrhoea (AWD), 4 were for Dengue fever, 4 for Bloody diarrhoea, 1 was for measles and 1 was for unexplained fever. 7 deaths were reported to for this reporting week Note: All presented data are based on the number of patient consultations and include information on priority diseases under surveillance as well as major health events reported through. Priority diseases under surveillance in the flood affected areas Acute Flaccid Paralysis Acute Jaundice Syndrome Acute Respiratory Infections Acute Watery Diarrhoea/ Suspected Cholera Bloody Diarrhoea Other Diarrhoea Suspected Hemorrhagic Fever Suspected Malaria Suspected Measles Suspected Meningitis Unexplained Fever Others Figure-1: Trend of leading diseases in flood affected districts of Pakistan, 29-July to 1 October 2010 (Epi week 31-39, 2010) Table-1: Priority diseases reported during the week 31-39, 2010 (29 July - 1 October 2010) Week 31 Week 32 Week 33 Week 34 Week 35 Week 36 Week 37 Week 38 Week 39 Acute Diarrhea 25,689 (13%) 94,288 (11%) 182,548 (14%) 199,607 (14%) 138,644(13%) 68,909 (12%) 57,072 (14%) 64,925 (13%) 54,404 (13%) Bloody Diarrhea 1,449 (1%) 4,566 (1%) 7,907 (1%) 11,024 (1%) 10,839 (1%) 9,228 (2%) 6,705 (2%) 6,411 (1%) 5,896 (1%) ARI (URTI & LRTI) Suspected Malaria 25,335 (13%) 92,134 (11%) 185,546 (15%) 217,071 (15%) 187,226(18%) 96,607 (17%) 69,969 (1%) 89,949 (18%) 3,954 (2%) 17,348 (2%) 27,453 (2%) 45,542 (3%) 45,652 (4%) 40,441 (7%) 32,692 (8%) 42,759 (9%) 81,583 (19%) 36,514 (8%) Skin 36,383 (19%) 115,080 (14%) 246,959 (20%) 296,441 (21%) 202,630(19%) 92,039 (16%) 56,844 (14%) 60,704 (12%) 57,020 (13%) Total consultation 194, ,353 1,265,912 1,424,260 1,053, , , , ,890 01

2 Figure-2: Average number of reporting units (fixed and mobile health facilities) by province Table 2: Average number of reporting districts per week Province Week 33 Week 34 Week 35 Week 36 Week 37 Week 38 Balochistan KPK Punjab Sindh Total Week Figure-3: Frequency of reported districts (Week 39, 2010) 64 districts have in place and 41 districts reported to this week; 6 in Balochistan, 6 in KPK, 11 in Punjab and 18 in Sindh. Not all districts are reporting regularly. The average number of districts and health facilities reporting per week are shown in the table 2 and figure 2 above. 87% of reporting districts reported 6 7 times during the last reporting period, 9% reported between 3 5 times, 4% reported 1 2 times. Figure-4: of fixed and mobile reporting units by province (Week 39, 2010) 02

3 Table-3: Followup Alerts reported in week 38, Dates Event Place/District Province Action taken 20 Sep 10 Meningitis Dakorak Village/Swat KPK Laboratory test negative for Meningitis. Active surveillance in progress. 21 Sep 10 Measles RHC Alladand Malakand KPK Sample in transportation 22 Sep 10 AWD Kot Addu/Muzaffargarh Punjab 23 Sep 10 AWD Alipur, Bheda Kot/Muzaffargarh Punjab 23 Sep 10 AWD Alipur, Tibbi Arain/Muzaffargarh Punjab 23 Sep 10 AWD BHU Naakband/Kohat KPK 23 Sep 10 AWD DHQ Timergara, Tangi Bajour /Lower Dir KPK 23 Sep 10 AWD DHQ Timergara, Pajigram Bajour /Lower Dir KPK Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing Hygiene education sessions were conducted at mosque. 8,000 aqua tabs and 1,000 ORS were distributed. Previously 3 positive cases were identified so no new sample was taken. Case management and environmental improvement ongoing Previously 3 positive cases were identified so no new sample was taken. Case management and environmental improvement ongoing 23 Sep 10 Malaria UC Khazana/Lower Dir KPK Malaria control program is investigating. Report awaited. 23 Sep 10 Malaria UC Norakhiel/Lower Dir KPK Malaria control program is investigating. Report awaited. 23 Sep 10 AFP Nishter Hospital/Multan Punjab 24 Sep 10 AFP Nishter Hospital/Muzaffargarh Punjab 24 Sep 10 AFP CHC Hospital/Muzaffargarh Punjab Table-4: Alerts and Outbreaks (Week 39, 2010) Polio active surveillance is in progress. Specimen collected and in process. Polio active surveillance is in progress. Specimen collected and in process. Polio active surveillance is in progress. Specimen collected and in process. Dates Event Place/District Province Action taken 25 Sep 10 UF DHQ Timergara/Lower Dir KPK Active surveillance and lab investigations are under process. 26 Sep 10 AWD Wanda Balochan/DI Khan KPK Stool sample was collected and lab investigations are under process 27 Sep 10 AWD Malakhra Ground Camp (Bhit Shah)/Matiari Sind 27 Sep 10 AWD Shah jo Bagh Relief Camp (Bhit Shah)/Matiari Sind 27 Sep 10 DHF Ayub Teaching Hospital/Abbottabad KPK Stool sample was negative. Water Samples were collected. TMA Bhit Shah was contacted to provide safe drinking water. Requested to PPHI to provide health education through LHWs. Stool sample was negative. Water Samples were collected. TMA Bhit Shah was contacted to provide safe drinking water. Requested to PPHI to provide health education through LHWs. Tragic death of medical doctor confirmed due to CCHF. 14 contacts tested negative for both CCHF and Dengue. 8 samples were reported to be positive for Dengue in private labs. 2 Stool samples were positive for V. Cholera Ogawa. Health Education messages given to the family and aqua tabs/water Purification Sachets 28 Sep 10 AWD DHQ Daggar (Kandao Patiy Village)/Buner KPK also provided. Importance of use of ORS and hand washing explained to the patient and attendants. Stool sample was negative. Hygiene promotion sessions were conducted, line listing was maintained and active surveillance was done. 28 Sep 10 AWD DHQ D.I.Khan (Lakhra Village)/DI Khan KPK Stool sample was positive for V. Cholera Ogawa. Water samples were 28 Sep 10 AWD RHC Munda (Kambat Samar Bagh)/Lower Dir KPK collected, antiseptic soaps, HTH chlorine powder, aqua tabs were provided. Suspected cases were found, blood samples were taken. 2 out of 3 were 28 Sep 10 DHF SGTH (Kotlai, Kokrai, Chakesar)/Swat KPK positive for Dengue. Patient is isolated, blood sample collected. Patient is positive for 28 Sep 10 DHF KTH (Lower Dir)/Peshawar KPK Dengue. 28 Sep 10 BD DHQ Muzaffargarh (Wasendey Wali)/Muzaffargarh Punjab Stool sample was negative. Active surveillance was done. 28 Sep 10 BD DHQ Muzaffargarh (Basti Korewali)/Muzaffargarh Punjab Stool sample was negative. Active surveillance was done. 29 Sep 10 DHF KTH (Polytechnic Colony Haripur)/Peshawar KPK Sample was collected and found negative for Dengue. Active surveillance is under process. 29 Sep 10 BD DHQ Muzaffargarh (Basti Karimabad)/ Muzaffargarh Punjab Stool sample was negative. Active surveillance was done. 29 Sep 10 BD DHQ Muzaffargarh (Zakrya Colony)/Muzaffargarh Punjab Stool sample was negative. Active surveillance was done. 30 Sep 10 Measles BHU Dhandla/Bhakkar Punjab Blood sample was collected and active surveillance is under process Table-5: List of confirmed Polio Cases from flood affected districts S. NO. Province Districts SEX AGE (m) Date onset of Paralysis 1 KPK Peshawar F 12 06/08/ KPK Hangu F 05 07/08/ KPK Hangu M 13 27/08/ Sindh Sanghar F /08/ Sindh Ghotki M 36 18/08/ Punjab Muzaffargarh F 37 26/08/ Sindh Ghotki F 60 03/09/ Punjab DG Khan F 9 10/09/ Sindh Ghotki M 6 15/09/ KPK Peshawar M 29 14/09/2010 WPV Type 03

4 Province KPK 6 out of 17 flood affected districts reported to from KPK province 48 fixed health centers and 21 mobile 87,204 patient consultations were reported during the reporting period of 25 Sept 1 October, week 39, alerts were received this week; 4 were for AWD, 4 were for Dengue fever and 1 for unexplained fever reported and responded to this week Figure-5: Trend of priority communicable diseases, province KPK (31-July - 1 October 2010) % of total consultations Figure-6: Proportional morbidity of priority diseases, KPK province Acute Diarrhoea 8,770 10% ARI 15,615 17% Skin 5,736 7% Suspected malaria 1,278 1% others 54,066 62% Total Consultations 87,204 Province Punjab 11 out of 12 flood affected districts reported data to from Punjab province 176 fixed health centers and 45 mobile 133,494 patient consultations were reported during this reporting period 5 alerts were received and responded this week, 4 were for BD and 1 was for suspected Measles Figure-7: Trend of priority communicable diseases, province Punjab (3 August - 1 October 2010) % of total consultations Figure-8: Proportional morbidity of priority diseases, Punjab province Acute Diarrhoea 17,407 13% ARI 24,365 18% Skin 19,023 14% Suspected malaria 12,546 9% Others 42,718 32% Total consultations 133,494 04

5 Province Sindh 18 out of 22 flood affected districts reported to from Province Sindh 464 fixed health centers and 120 mobile 190,636 patient consultations were reported during the reporting period of 25 Sept - 1 October, week 39, alerts of AWD were reported for this week from flood affected districts of province Sindh Figure-9: Trend of priority communicable diseases, province Sindh (6 August - 1 October 2010) % of total consultations Figure-10: Proportional morbidity of priority diseases, Sindh Acute Diarrhoea 24,661 13% ARI 38,249 20% Skin 32,261 17% Suspected malaria 18,651 10% Others 57,190 30% Total consultations 190,636 Province Balochistan 6 out of 19 flood-affected districts reported to from province Balochistan 27 fixed health centers and 6 mobile 22,556 patient consultations were reported during the reporting period of 25 Sept - 1 October, week 39, 2010 No alerts were received from flood affected districts of province Balochistan Figure-11: Trend of priority communicable diseases, province Balochistan (6 August - 1 October 2010) % of total consultations Figure-12: Proportional morbidity of priority diseases, Balochistan Acute Diarrhoea 3,566 16% ARI 3,354 15% Suspected Malaria 4,039 18% Unexplained Fever 737 3% Others 10,827 48% Total consultations 22,556 05

6 Since July 29, 2010, approximately 6,745,548 patient consultations have been reported to from the flood affected provinces in Pakistan. is currently in place in 64 of the 78 flood affected districts (82%) and reporting is received from 41 of these 64 districts (64%) Figure-13: AD trends, KPK, 2009 and 2010 Weekly pattern of acute diarrhea, IDP crisis and hosting districts, Khayber Pakhtunkhwa ( ) The major causes for seeking healthcare by the affected communities continue to be diarrhoel diseases, acute respiratory infections, skin diseases and suspected malaria. Percentage In KPK, ARI decreased from 18% to 15% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from (Please see Fig.13) Epi week Figure-14: AWD alerts and confirmed cholera cases since July 29, 2010 In Punjab, a higher proportion of suspected malaria was reported this week (8% to 9%), although a peak of malaria in October reflects seasonal trend of diseases, officers are collaborating with Malaria Control Program to investigate areas of increased malaria. In Sindh, proportional morbidity of major health events remained the same when compared to last week. In Balochistan, reporting remains irregular due to security issues. Suspected malaria continues to make up the largest proportion of consultations. WHO expert team has gone to Balochistan and will conduct outbreak investigation for malaria in collaboration with Malaria Control Program. Sixteen alerts were raised during this reporting period. Six alerts were for AWD bringing the total number of alerts for AWD to 132. There are currently 57 confirmed cholera cases through. The laboratory samples were collected from sites, according to case definition and sent to National Institute of Health (NIH) for laboratory confirmation. Relevant public health actions were initiated in the field to arrest potential outbreak. Please see the Map on next page. In this new form of map, the number in the center of the chart pie is the total number of alerts for the district. Focus On. Crimean-Congo Hemorrhagic Fever (CCHF) Of three cases testing positive for CCHF in the past month, two have died, and an additional seven have become infected by nosocomial transmission at a Rawalpindi hospital. In Pakistan, the incidence of CCHF peaks in June and October but cases occur throughout the year. Similar to Dengue Hemorrhagic Fever (DHF), CCHF presents as a fever of 2 7 days which does not respond to antibiotics or anti malarial treatment and is associated with dropping platelets and hemorrhagic signs with case fatality rate as high as 50%. Two main differences are that CCHF is transmissable from the blood of patients with the disease, and it is successfully treated with high dose Ribavirin, while DHF does not respond to antivirals and it is not transmissable directly from the patient. CCHF is caused by a Nairovirus and transmitted to humans by the bite of the Hyalomma tick or by direct contact with blood of an infected animal or human. The disease was first described in Crimea in 1944 and identified in 1956 in Congo and thus developed the current name for the disease and its causative virus. Population migration with animals contributes to the higher probability of susceptible animals being bitten by infected ticks, thus increasing the risk of transmission to humans who handle the animals. CCHF was first reported in Pakistan in 1976 but the number of cases has shown a dramatic rise since 2000 with cases being reported annually. It is endemic in Balochistan, but every province has seen a few cases and unfortunately nosocomial outbreaks have occurred in the past in major hospitals in Karachi, Peshawar, Rawalpindi and Quetta. Guidelines for CCHF are available on NIH website and WHO website (whopak.org/pdf/guidelines_for_cchf.pdf) The objective of this weekly epidemiological bulletin is to provide a snap shot on selected health events reported from the communities affected by the current flood in Pakistan. While every attempt is made to present the weekly trend of the epidemic prone diseases, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin also includes information collected by teams established during earlier emergencies, including 2005 earthquake, 2007 floods and 2008 ID crises. The primary focus of is the early detection of epidemic prone diseases, to facilitate a rapid public health response. We would like to thank all the numerous national and international partners who have contributed to the Disease Early Warning System. Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. WHO: Tel : , Fax : , wr@pak.emro.who.int. or 06

7 Alerts of Acute watery diarrhoea (31 July to 1 October 2010) 07