Weekly Epidemiological Bulletin Flood Response in Pakistan Volume 2, Issue 3 Monday 24 January 2011 Highlights Epidemiological week no 3 (14 to 20 Jan 2011) Between 14 to 20 Jan 2011 (epidemiological week no. 3, 2011), 55 districts in 4 provinces provided surveillance data to the DEWS system. 2,196 fixed health and 11 mobile medical outreach centres provided surveillance data for this week. A total of 629,410 consultations were reported through DEWS of which 33% were acute respiratory infections (ARI), 8% skin disease, 5% acute diarrhoea, and 5% were suspected Malaria. Total 18 alerts in past two weeks were received and responded: 8 were for Measles, 5 for suspected Influenza, while 1 each for Pertussis, Bloody diarrhoea, Hypothermia, Leishmaniasis, and Chickenpox. There were three cases of confirmed poliomyelitis reported this week from flood affected districts. 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 DEWS. Priority diseases under surveillance in the flood affected 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 Diarrhoea (AD) Suspected Hemorrhagic Fever (VHF) Suspected Malaria (Mal) Suspected Measles (Ms) Suspected Meningitis (Mg) Others Figure-1: Weekly trend of leading priority diseases in flood affected districts of Pakistan, 29 July 2010 to 20 January 2011 (Epi week 31, 2010 to week 3, 2011) Table-1: Priority diseases reported during the week 48-2010 to week 3-2011 Diseases Wk 48 Wk 49 Wk 50 Wk 51 Wk 52 Wk 1 Skin Disease 38,022 (9%) 40,533 (8%) 35,686 (8%) 42,813 (8%) 41,435 (8%) 51,910 (8%) Wk 2 55,634 (9%) Wk 3 52,335 (8%) ARI (URI and LRI) 126,265 (29%) 156,168 (30%) 132,185 (30%) 166,801 (31%) 158,048 (31%) 199,912 (32%) 204,639 (32%) 205,962 (33%) Other Acute Diarrhoea (Not Watery) 34,377 (8%) 33,188 (6%) 27,989 (6%) 37,100 (7%) 32,933 (6%) 37,530 (6%) 38,315 (6%) 34,349 (5%) Bloody Diarrhoea 2,972 (1%) 3,943 (1%) 3,098 (1%) 3,925 (1%) 3,076 (1%) 4,055 (1%) 4,229 (1%) 4,145 (1%) Suspected Malaria 30,633 (7%) 31,780 (6%) 27,111 (6%) 35,266 (6%) 25,791 (5%) 35,244 (6%) 35,283 (5%) 31,462 (5%) Total consultation 428,159 522,284 444,112 544,147 509,612 623,374 641,864 629,410 01
Fig-2: Weekly number of reporting health units (Week 33-2010 to week 3-2011) Table-2: Leading causes of seeking health care in the flood affected districts, 29 July 2010 to 20 January 2011 2500 2000 1500 1000 500 0 Mobile Fixed 411 361 375 331 400 215 192 153 128 105 597 702 826 788 758 745 715 655 575 509 81 58 439 502 46 881 26 1259 26 1139 11 1342 8 1627 12 1391 8 11 1960 1939 11 2159 11 11 2295 2196 Diseases Total Skin Diseases 1,715,458 (12%) Acute Respiratory Infection 3,133,699 (23%) Other Acute Diarrhoea (Not Watery) 1,398,246 (10%) Bloody Diarrhoea 137,392 (1%) Suspected Malaria 784,574 (6%) Unexplained Fever 606,689 (4%) Total Consultations 13,749,964 Figure-3: Leading causes of seeking health care in the flood affected districts by province, 29 July 2010 to 20 January 2011 Number of cases 1,200,000 1,000,000 800,000 600,000 400,000 200,000-914,690 1,017,175 996,161 576,480 388,335 156,342 595,554 1,041 464,664 48,507 437,676 79,100 145,055 913,087 264,769 207,276 141,989 116,556 74,000 92,333 60,159 31,425 27,858 25,826 Punjab Sindh Balochistan Skin Ds. ARI AD UF S. Mal BD Figure-5: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 2009, 2010 and 2011 Since July 29, 2010, approximately 3,133,699 Acute Respiratory Infection (both Upper and Lower) patient consultations have been reported to DEWS from the flood affected districts of 4 provinces in Pakistan. 40 35 30 In the graph at right, DEWS reports received in 2010 are compared to the reports of 2009 from disaster affected districts. Percentage 25 20 15 2009 This week, DEWS received 205,962 reports of Acute Respiratory Infection, 33% of total consultations. This is the same proportional morbidity reported by DEWS in January 2010 and in January 2009. 10 5 0 2010 2011 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epi week Figure-4: Acute Diarrhea trends, Disaster affected districts, Pakistan 2009, 2010 and 2011 Since July 29, 2010, a total of 1,398,246 acute diarrhea patient consultations have been reported to DEWS from the flood affected districts of 4 provinces in Pakistan. In the graph at right, DEWS reports received in 2010 are compared to the reports of 2009 from disaster affected districts. This week, DEWS received 34,349 reports of acute diarrhea, 5% of total consultations. This is the 1% lower proportional morbidity reported by DEWS in January 2010 lower than in January 2009. Percentage 20 18 16 14 12 10 8 6 4 2 0 2009 2010 2011 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epi week 02
Table-3: Alerts reported in week 2 and week 3 of 2011. Date of alert Alert Province District Location (detailed) Age (yr) Sex Action taken / Notes 9-Jan-11 Mardan Rauf Khan Amo Khel Village - Mayar 20 F Suspected case was found with flu like symptoms but sample tested at NIH was found negative for. 10-12 Jan 2011 Swabi BKMC (Col. Sher Khan Kalle, Mohalla Ismail Khel, Kala Village, Mohalla Taju Khel - Tandkhoi, UC Lahore East) 39, 32, 23, 60, 25 M, F, F, F, M Suspected cases were found with typical flu like symptoms. 5 Samples tested at NIH and all were reported positive for. 13-Jan-11 Swabi KTH (Ayub Khel Mohalla - UC Chota Lahore) 55 M Suspected case was hospitalized with flu like symptoms. Sample tested at NIH found positive. 15-Jan-11 Haripur Chungi Bandi - Mori 45 M Patient with chronic illness and confirmed, hospitalized in Islamabad, was treated for five days but expired. No other suspected cases were found on investigation of home village. 15-Jan-11 Peshawar KTH (Nadir Street,Danishabad & Hashim Quarters - Peshawar Cantt.) 55, 63 M,M Suspected cases were found with flu like symptoms. 1/2 samples was found positive for. 7-Jan-11 Measles Sindh Ghotki MCH Center (UC Bhand Jeewan Kolachi VIllage), Janib Chachar Village UC Qadipur 1.5, 2,2 F,F,F Three suspected cases were found. 2/3 samples were positive for Measles. Cases were treated with Vitamin A and vaccination of eligible children was initiated. 10-Jan-11 Measles Sindh Kashmore Kando Chachar Village - UC Gublo 1, 8, 7, 4, 25, 8 F, F, F, F, M, F Upon field investigation 21 suspected cases were found. 6 Blood samples were collected 5 were found positive for Measles and 1 was positive for Rubella. Mass vaccination is planned. 11-Jan-11 Measles Nowshera Jalozai IDP Camp I - Merlin Health Post 6 M Sample on one suspected case was positive. Case was treated with Vitamin A and vaccination of eligible children was initiated. 11-Jan-11 Measles Sindh Jamshoro Dato Kaloi Village - Taluka Manjahand 2 F Two suspected cases were found. Sample was negative for Measles. 14-Jan-11 Measles Sindh Badin Mushtaq Lund Village - Taluka Matli 5, 3, 5 F, F, F Upon field investigation 3 suspected cases were found and all were diagnosed as positive for Measles. Cases were treated with Vitamin A and vaccination of eligible children was initiated. 16-Jan-11 Measles Punjab D. G. Khan BHU Kot Haibat 9, 4, 4.5, 1.5, 5 M, F, M, M, F Upon field investigation 6 suspected cases were found and 1 death was reported. Investigation did not identify any clinical measles case and no unvaccinated child was found. 19-Jan-11 Measles Mardan DHQ Mardan (ABU Rehman Banda; Bagh-e-Erum; Shik Maltoon Town) 1, 14m, 4 M, F, F Samples of three cases of clinical measles were collected and sent to NIH. Cases were treated with Vitamin A and vaccination of eligible children was initiated. 22-Jan-11 Measles Upper Dir SHC Darora 6 F Sample from a case of clinical measles was collected and sent to NIH. Case was treated with Vitamin A and vaccination of eligible children was initiated. 12-Jan-11 Pertussis Sindh Ghotki MCH Centre (Saindino Ghoto Village) 3, 4, 18m, 3 F, F, M, M During active surveillance, 4 suspected cases were found. All the Patients were improving. Health education was imparted. 12-Jan-11 BD Haripur Afghan Refugee Camp 4, 18m, 5, 2, 18m, 3, 7m M, M, F, M, M, M, F According to facility reports, 7 suspected cases were found. Samples collected and sent to NIH were negative for shigella and cholera. Water samples were collected and tests are under process. 11-Jan-11 Chicken Pox Haripur TIP Colony ** ** 5 children reported to have chicken pox living in adjacent houses. Families counseled to give relevant symptomatic treatment. 13-Jan-11 Hypothermia Sindh Dadu UC Khan Jo Goth 16, 5, 55, 80 F, M, F, M Upon field investigation 4 deaths were found during cold weather. Further investigation found they were patients with epilepsy, pneumonia, and likely stroke and one with probable hypothermia due to exposure. Partners are requested to assist with food and shelter. 20-Jan-11 Leishmaniasis Lower Dir BHU Asigi-Rabit ** ** Upon field investigation, 46 patients were found with typical signs and symptoms of Cutaneous Leishmaniasis in one village. Health education was given. Vector control activities are planned. 500 doses of Glucantine inj provided to hospital to treat the cases. Table-5: List of confirmed Polio Cases from flood affected districts, week 3-2011 Three cases of confirmed poliomyelitis reported this week, 2 were from and 1 from Balochistan province. S. NO. Province Districts SEX AGE (m) Date onset of Paralysis WPV Type 1 Agency M 27 29 12 2010 NSL1 2 Mohmand Agency F 11 30 12 2010 NSL1 3 Balochistan Pishin M 14 02 01 2011 NSL1 03
Province This week 13 districts reported to DEWS from KP province, 481 health centers reported 131,568 patients consultations to DEWS. ARI is the leading disease in KP province. ARI cases reported 55,725 (42%), 4% lower as compared with last week. Eleven alerts were received and investigated this week; 5 were for Influenza, 3 alerts were for Measles, while 1 each for Bloody Diarrhoea, Leishmaniasis, and Chickenpox. Figure-6: Trend of priority communicable diseases, province KP (31-July 2010 to 20 January 2011) Diseases Wk-52 Wk-1 Wk-2 Wk-3 Skin Diseases 4,876 (4%) 5,028 (4%) 5,383 (4%) 5,061 (4%) ARI (URI and LRI) 50,203 (45%) 57,092 (46%) 63,109 (45%) 55,725 (42%) Other Acute Diarrhoea (Not Watery) 6,852 (6%) 7,041 (6%) 7,842 (6%) 7,394 (6%) Bloody Diarrhea 731 (1%) 809 (1%) 1,004 (1%) 813 (1%) Suspected Malaria 2,002 (2%) 1,764 (1%) 1,940 (1%) 1,423 (1%) Total consultations 113,012 125,259 140,454 131,568 Province Punjab 11 districts reported data to DEWS from Punjab province 764 fixed health centers and 3 mobile medical outreach centers reported a total of 170,424 patient consultations during this reporting period ARI cases reported were 49,926 (29%), 4% higher as compared with last week. One alert of suspected measles was received and responded this week. Malaria cases are still reported from flood affected districts. This week a total of 4,467 malaria samples were tested of which 226 were positive (slide positivity rate 5.06%), while falciparum rate was 47.3%. Figure-7: Trend of priority communicable diseases, province Punjab (3 August 2010 to 20 January 2011) Diseases Wk-52 Wk-1 Wk-2 Wk-3 Skin Diseases 17,489 (9%) 15,486 (9%) 15,719 (10%) 14,516 (9%) ARI (URI and LRI) 39,921 (21%) 37,922 (22%) 40,123 (25%) 49,926 (29%) Other Acute Diarrhoea (Not Watery) 12,345 (6%) 11,378 (6%) 10,636 (7%) 7,981 (5%) Suspected Malaria 7,265 (4%) 5,160 (3%) 6,005 (4%) 4,557 (3%) Total consultations 192,119 175,275 162,834 170,424 04
Province Sindh This week 20 districts reported to DEWS from Sindh province and 614 health centers. A total of 253,862 patient consultations were reported during the reporting period of week 3, 2011. In Sindh, ARI cases reported were 76,167 (30%), remain same as compared with last week Six alerts were received and responded this week; 4 were for suspected Measles, while 1 each for Pertussis, and hypothermia. Figure-8: Trend of priority communicable diseases, province Sindh (6 August 2010 to 20 January 2011) Diseases Wk-52 Wk-1 Wk-2 Wk-3 Skin Diseases 15,473 (10%) 27,627 (10%) 29,818 (11%) 28,254 (11%) ARI (URI and LRI) 48,288 (32%) 83,766 (32%) 82,340 (30%) 76,167 (30%) Other Acute Diarrhoea (Not Watery) 9,394 (6%) 14,974 (6%) 15,169 (5%) 13,895 (5%) Bloody Diarrhea 933 (1%) 1,423 (1%) 1,418 (1%) 1,281 (1%) Suspected Malaria 11,332 (8%) 22,769 (9%) 21,521 (8%) 18,617 (7%) Total consultations 150,594 264,631 276,026 253,862 Province Balochistan In this week, 11 districts reported to DEWS from Balochistan province. 337 fixed and 8 mobile medical outreach centers reported to DEWS A total of 73,556 patient consultations were reported during the reporting period of week 3, 2011. In Balochistan, ARI cases reported were 24,144 (33%), 3% higher as compared with last week. Malaria cases are still reported from different areas of Jaffarabad, Naseerabad and Kech districts. A total of 416 malaria samples were tested of which 114 were positive (slide positivity rate 27.4%). Falciparum Rate was 78.07%. Figure-9: Trend of priority communicable diseases, province Balochistan (6 August 2010 to 20 January 2011) Diseases Wk-52 Wk-1 Wk-2 Wk-3 Skin Diseases 3,597 (7%) 3,769 (6%) 4,714 (8%) 4,504 (6%) ARI (URI and LRI) 19,636 (36%) 21,132 (36%) 19,067 (30%) 24,144 (33%) Other Acute Diarrhoea (Not Watery) 4,342 (8%) 4,137 (7%) 4,668 (7%) 5,079 (7%) Bloody Diarrhea 1,394 (3%) 1,823 (3%) 1,807 (3%) 2,044 (3%) Suspected Malaria 5,192 (10%) 5,551 (10%) 5,817 (9%) 6,865 (9%) Total consultations 53,887 58,209 62,550 73,556 05
Confirmed Alerts 07