Weekly Epidemiological · 10‐Nov AWD Jamshoro Mahboob colony, Garibabad, UC Sanwaller 0 1 1 1...
Transcript of Weekly Epidemiological · 10‐Nov AWD Jamshoro Mahboob colony, Garibabad, UC Sanwaller 0 1 1 1...
Weekly Epidemiological Bulletin
This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: [email protected].
Epidemiological week no. 45 (4 to 10 November, 2011)
• 80 districts and 2 agencies provided surveillance data to the DEWS this week from 2,314 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC.
• A total of 397,222 consultations were reported through DEWS of which 97,966 (25%) were acute respiratory infections (ARI); 33,447 (8%) were Skin disease; 31,381 (8%) were acute diarrhoea; and 29,893 (8%) were suspected malaria. The timeliness decreased compared with last week due to EID holidays.
• A total of 59 alerts with 6 outbreaks were reported in week‐45, 2011: Altogether 15 alerts for AWD, 7 for Neonatal tetanus, 6 each for Leishmaniasis and Measles, 2 for Malaria, 1 each for Bloody diarrhoea and Pertussis, while 21 for other non‐communicable diseases.
• National Polio Eradication Initiative reported in this week no new polio case was reported from any district.
Highlights
Disease early warning system and response in Pakistan
01
Volume 2, Issue 45, Monday 14 November, 2011
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 2010 to 27 October 2011 (Epi week 31, 2010 to week 45, 2011)
Disease Wk-38 Wk-39 Wk-40 Wk-41 Wk-42 Wk-43 Wk-44 Wk-45
Acute diarrhoea 110,835 (11%) 105,295 (11%) 97,007 (10%) 93,085 (9%) 74,189 (8%) 62,498 (8%) 65,503 (7%) 31,381 (8%)
Total consultation 1,005,251 995,450 1,014,266 1,033,276 897,598 807,463 877,957 397,222
Suspected malaria 78,109 (8%) 83,684 (8%) 82,802 (8%) 86,326 (8%) 68,441 (8%) 58,552 (7%) 69,281 (8%) 29,893 (8%)
Acute respiratory infection 193,771 (19%) 205,597 (21%) 209,436 (21%) 223,902 (22%) 213,432 (24%) 193,364 (24%) 217,168 (25%) 97,966 (25%)
Bloody diarrhoea 8,676 (0.86%) 9,393 (0.94%) 8,075 (0.80%) 8,107 (0.78%) 6,089 (0.68%) 5,445 (.67%) 5,276 (0.60%) 2,647 (.67%)
Skin diseases 107,243 (11%) 105,912 (11%) 95,842 (9%) 94,167 (9%) 81,161 (9%) 69,317 (9%) 77,697 (9%) 33,447 (8%)
Since July 29, 2010, approximately 51,215,386 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on around 1,000,000 consultations per week, there is a drop in timely reporting due to EID holidays, challenges in accessibility caused by floods, security and infrastructure. 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 (38 to 45, 2011) acute diarrhoea cases have been decreased (From 11% to 8%), while at the same time cases of ARI have been increased (From 19% to 25%). Sus‐pected malaria cases have also shown seasonal increase from week 35 especially from districts in Sindh and Balochistan.
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 45 (3 to 10 November, 2011)
This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, 02
Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken
5‐Nov Malaria Balochis‐tan Jhal Magsi BHU Sarangani 9 11 7 9
Alert for malaria, reported from BHU Sarangani and investigated. All cases were reported from village Sarangani. A total of 36 cases were attended and 32 samples were taken. 19 samples were found positive (P.f. 8, P.v. 8 and mixed 3) (SPR =59.38%; FR = 57.90%) and treated. Malaria representative was informed for further preventive measures.
10‐Nov Malaria Balochis‐tan Jhal Magsi RHC Jhal Magsi 78 93 57 73
Alert for malaria investigated, all cases were reported from town area of Jhalmagsi. A total of 301 suspected cases were reported and 184 samples were tested from which 143 (SPR = 78%) verified positive and treated (P.f. 47, P.v. 56 and mixed 40) (FR = 60.84%). DHO and Malaria representative was informed and briefed about the severity of the disease and requested for preventive measures.
6‐Nov Diphtheria ICT Islamabad Chunggi, Pind Paracha (PIMS Hosp) 0 1 0 0
Probable diphtheria case, 6 years old, not vaccinated except polio, hospitalized on 6 Nov, tracheotomy, ADS 80,000 IU, expired on 7 Nov 11 pm, respiratory distress, 2 siblings and 7 cousins in household also un‐vaccinated, started on prophylactic erythromycin, EPI coverage survey ongoing and vaccination response planned.
6‐Nov Diphtheria ICT Islamabad G‐Sokh, Bharakaho 1 0 0 0
Probable diphtheria case, 20 months old female, not vaccinated except polio drops, hospital‐ized on 6 Nov, ADS 80,000 IU, tracheotomy on 7 Nov, acute renal failure, myocarditis, expired 8 Nov, 6 siblings un‐vaccinated, family moved from Bajaour 6 years ago, erythromycin pro‐vided for all household members, field investigation ongoing, coordination of outreach vacci‐nation planned.
11‐Nov AWD KPK Lower Dir Village Gular, UC & Tehsil Samar Bagh 0 2 2 2
A Case of suspected AWD was reported, on active surveillance 5 more cases were found in same area with severe dehydration, all the patients were referred to DHQ Hospital for IV therapy, Stool samples collected for lab confirmation, Water Samples taken for any fecal contamination, ORS, Hygiene kits & Aqua tabs distributed, Health & Hygiene promotion Ses‐sion conducted with family members. EDO‐H was informed.
4‐Nov Leishmani‐
asis Punjab Mianwali Tolla Mangalli, UC Chapri, Tehsil Issakhel 0 2 0 4
6 New cases of Leishmaniasis reported. No travel history. Clinical diagnosis was confirmed by IRC trained HCPs. Antileishmaniasis IM & IL injections provided. Community visited for active case finding but no more cases found. Health Education was given to the family. Vector con‐trol of the area was advised. Line listing is ensured. BHU Chapri has an HCP trained on Leishmaniasis management.
Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F
11‐Nov AWD Lower Dir Village Gular, UC & Tehsil Samar Bagh 0 2 2 2
4‐Nov DHF Haripur Afghan Refugee camp 20 0 1 0 0
4‐Nov DHF Haripur Village Muradabad 0 1 0 0
7‐Nov DHF Swabi National Program Swabi, Marghuz 0 1 0 0
10‐Nov Measles Haripur Afghan Refugee camp Bassu Mera 1 0 0 0
5‐Nov Measles Swat Village Devlai Darbar Dherai, UC Devlai, Tehsil Kabal 0 0 1 0
5‐Nov Measles Swat Village Natmira, UC and Tehsil Barikot 0 0 1 0
6‐Nov Measles Swat Village and UC Kala Kale near Bus stop 2 0 0 0
Current week's Alerts: Province Balochistan Date Disease District Area <5M >5M <5F >5F
10‐Nov Leishmaniasis Panjgur UC Gwargo Mohallah Gwargo 1 0 0 0
4‐Nov Leishmaniasis Sibi Village Dehpal kolan 0 1 0 1
5‐Nov Leishmaniasis Sibi Shaheed Aziz colony, Allabad, UC 3 0 1 0 0
5‐Nov Malaria Jhal Magsi BHU Sarangani 9 11 7 9
10‐Nov Malaria Jhal Magsi RHC Jhal Magsi 78 93 57 73
10‐Nov Measles Lasbela Hospital Colony, UC Beroot, Bela 3 0 0 0
Current week's Alerts: AJK; FATA; GB and ICT Date Disease District Area <5M >5M <5F >5F
6‐Nov Diphtheria ICT Chunggi, Pind Paracha (PIMS Hosp) 0 1 0 0
6‐Nov Diphtheria ICT G‐Sokh, Bharakaho 1 0 0 0
Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F
4‐Nov AWD Dadu Marakhpur City Dadu 0 0 1 1
10‐Nov AWD Hyderabad Laloo Lashari, Kali Mori Taluka Hyderabad 0 1 0 0
10‐Nov AWD Hyderabad Near Pathan Colony Hyderabad 0 1 0 0
10‐Nov AWD Jamshoro Mahboob colony, Garibabad, UC Sanwaller 0 1 1 1
10‐Nov AWD Matiari City Nasarpur Taluka Matirai 1 0 0 0
10‐Nov AWD Mirpur Khas Bunglani Muhalla, Village Ali Nawaz Shah 1 1 1 0
6‐Nov AWD T Allah Yar Qubo Stop Taluka Tando Allahyar 0 0 0 1
10‐Nov AWD T Allah Yar Capri Cinema, Tando Adam city 1 0 0 0
10‐Nov AWD T Allah Yar Siddique Akbar Madarsah 0 1 0 0
10‐Nov AWD Tharparkar IDP Camp Naukot, UC Mohrano 0 1 0 0
5‐Nov AWD Thatta Village M. Siddique, UC Chuohar Jamali 1 1 0 1
10‐Nov AWD Thatta UC 2 Makli cement factory, Taluka Thatta 1 0 0 0
10‐Nov AWD Thatta Village Soof Khaskhali UC Chillya 0 0 0 1
10‐Nov AWD Thatta Village Umar Khaskhali UC Kala Kot 1 0 0 0
5‐Nov BD T Allah Yar Village Ghulam Hussain Lashari 2 1 1 1
10‐Nov DHF Sukkur SZH RY Khan 0 1 0 0
10‐Nov Measles Sanghar Village Bochan Keerio, UC Kanahar 4 0 2 0
10‐Nov NNT Karachi 12.No, Baldia Town 1 0 0 0
10‐Nov NNT Karachi Mohalla Firdaus Chali, Quaidabad 0 0 1 0
10‐Nov NNT Kashmore Village Saendad Bhangwar, taluka Tangwani 1 0 0 0
10‐Nov NNT Khairpur Village Allah dino Bhutto, UC Rasool abad 0 0 1 0
10‐Nov NNT Benazirabad Village Nabi Buksh, UC Haber 1 0 0 0
9‐Nov NNT Shikarpur Village Channa Junejo near Madeji 1 0 0 0
10‐Nov NNT Sukkur Village Mohbat Abro, UC Lal Jurio 1 0 0 0
9‐Nov Pertussis Badin Village Dikko, UC Saeedpur, Taluka Talhar 1 0 2 0
Current week's Alerts: Province Punjab Date Disease District Area <5M >5M <5F >5F
4‐Nov AD Bhakkar Chuni Shumali, UC Gadola 2 9 3 10 4‐Nov ARI RY Khan UC Langiwaar, Tehsil Khanpur 31 12 39 23 5‐Nov ARI RY Khan UC Arif Balouch, Tehsil Liaqatpur 19 15 26 21 5‐Nov ARI RY Khan UC Arif Balouch. Tehsil Liaqatpur 21 28 17 30 5‐Nov DHF Bhakkar DHQ Hospital Bhakkar, Chimni Mohallah 0 1 0 0 7‐Nov DHF DG Khan Block 18, Fareed abad Colony 0 1 0 0 10‐Nov DHF Khanewal Nishter Hospital Multan‐Khanewal 0 38 0 2 4‐Nov DHF Multan Nishter Hospital Multan‐Muzaffargarh 0 2 0 0 10‐Nov DHF Multan Nishter Hospital Multan‐Multan City 0 7 0 2 4‐Nov DHF Muzaffargarh Moza Thathi Hamza, Chah Sar wala 0 1 0 0 9‐Nov DHF Pakpattan Nishter Hospital Multan‐Pakpattan 0 3 0 1 10‐Nov DHF RY Khan Sheikh Zaid Hospital‐Mohalla Gharibabad 0 2 0 0
10‐Nov Leishmani‐asis DG Khan Chah Chajrewala, near Basti Jam 0 1 0 0
4‐Nov Leishmani‐asis Mianwali Tolla Mangalli, UC Chapri, Tehsil Issakhel 0 2 0 4
4‐Nov Leishmani‐asis Rajanpur Basti Sontra, Moza Qazi Wala 0 0 0 2
10‐Nov Scabies Muzaffargarh Basti Ahmad Mohana & Basti Jarh 28 41 33 50 9‐Nov UXF Mianwali THQ Kalalbagh, Mohalla Zameerabad 4 42 6 74 10‐Nov UXF Muzaffargarh BHU Usman Koria 2 4 8 5
Epidemiological Bulletin: DEWS, Pakistan, Week no. 45 (3 to 10 November, 2011)
This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: [email protected]. 03
Province Khyber Pakhtunkhwa:
• This week 545 health facilities from 17 districts reported to DEWS with a total of 60,548 patients consultations.
• The proportional morbidity of AD showing 1% higher as compared with last week.
• 8 alerts were reported in this week, 4 were for Measles; 3 for DHF; while 1 for AWD.
• 1 outbreak for AWD from Lower Dir was received and re-sponded this week.
Figure-3: Trend of priority communicable diseases, province KPK
Province Sindh:
• This week 805 health centers from 22 districts reported to DEWS with a total of 177,200 patient consultations.
• In Sindh, AD cases reported were 15,706 (9%), 1% higher proportional morbidity as compared with last week.
• 25 alerts were reported from Sindh in this week: 14 were for AWD; 7 for Neonatal tetanus; while 1 for Bloody diarrhoea, DHF, Measles and Pertussis.
• No outbreak for any disease was received this week.
Figure-4: Trend of priority communicable diseases, province Sindh
Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease
Post Flood 2010 2011 (up till wk 44) Current Week (45) Total A O A O A O A O
Acute watery diarrhoea 209 85 1247 532 15 1 1471 618 Acute jaundice syndrome 5 2 42 14 ‐ ‐ 47 16 Bloody diarrhoea 10 1 90 19 1 ‐ 101 20 Dengue fever 81 32 761 111 ‐ ‐ 842 143 Measles 48 6 1484 88 6 ‐ 1538 94 Pertussis 1 ‐ 243 61 1 ‐ 245 61 NNT + tetanus 5 ‐ 292 ‐ 7 ‐ 304 0 Malaria 12 7 101 67 2 2 115 76 Leishmaniasis 1 ‐ 204 27 6 1 211 28 Others 75 11 509 58 21 2 605 71 Total 447 144 4973 977 59 6 5479 1127
Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 10 November 2011, compiled from weekly reports
Diseases Number of Consultations
Acute respiratory infection 11,532,515 (22%)
Skin diseases 5,525,103 (11%) Acute diarrhoea 4,901,041 (9%) Bloody diarrhoea 433,977 (1%) Suspected malaria 3,196,153 (6%) Unexplained fever 1,980,004 (4%) Total consultations 51,625,840
Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 45/2011)
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 45 (3 to 10 November, 2011) Province Punjab: • This week 469 health facilities from 8 districts reported data to
DEWS from Punjab province with a total of 114,815 patient consultations.
• AD cases reported were 6,310 (6%) and showing same propor-tional morbidity as compared with last week .
• 18 alerts were reported in this week from Punjab; 8 were for DHF; 3 each for Leishmaniasis and ARI; 2 for unexplained fever; while 1 each for Acute diarrhoea and Scabies.
• 1 outbreak of Leishmaniasis was received and responded this week.
Figure-5: Trend of priority communicable diseases, province Punjab
This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: [email protected]. 04
State of Azad Jammu and Kashmir:
• In this week, reports were received from 100 health facilities from 10 districts with a total of 9,299 patient consultations.
• ARI cases reported were 1,577 (17%), while Acute diarrhoea reported 474 (5%) cases.
• No alerts or outbreak was received this week from any area of AJ&K.
• This week 30 health facilities in 2 agencies reported from FATA, with a total of 2,311 patient consultations.
• ARI cases reported were 587 (25%), while Acute diarrhoea was re-ported 211 cases (9%)
• No alerts or outbreak was received this week.
Province Gilgit Baltistan:
• In this week, 55 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 9,69 patient consultations.
• ARI cases reported were 1,940(20%), while Acute diar-rhoea were 706 (7%).
• No alert o outbreak was received week from any area of Gilgit Baltistan.
Figure-7: Trend of priority communicable diseases, Gilgit Baltistan
FATA:
Province Balochistan:
• In this week, 16 districts reported to DEWS from Ba-lochistan province. 310 health centers reported a total of 23,380 patient consultations.
• AD reported in 2,560 (11%) of the total consultations, 1% higher proportional morbidity as compared with the last week.
• 6 alerts were reported in this week from Balochistan, 3 for Leishmaniasis; 2 for Malaria; while 1 for Measles.
• 2 outbreaks for malaria was received and responded this week.
Figure-6: Trend of priority communicable diseases, province Balochistan
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Epidemiological Bulletin: DEWS, Pakistan, Week no. 45 (3 to 10 November, 2011)
This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: [email protected]. 05
Distribution of Wild Polio Virus cases Pakistan 2010 and 2011
Year 2010: The total number of polio cases reported in 2010 is 144 including 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/agencies.
Year 2011: As of 10 November, 2011, the total number of polio cases confirmed by the laboratory is 145 (143=type‐1, and 2=type3) from 44 districts.
Province Cases 2010 Cases 2011 P1 P3 P1 P3
Punjab 6 1 2 - Sindh 26 1 29 - Khyber Pakhtunkhwa 19 5 12 - FATA 63 11 40 2 Balochistan 6 6 59 - AJK - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 143 2
Pakistan Dengue Situation, 5th November 2011 Since the beginning of the year and as of Week 45th 2011; 543,352 cases of suspected dengue fever cases and 22,778 Lab confirmed
cases were reported across the country with 353 deaths (CFR = 1.55%). Over 90% of cases were reported in Punjab province.
Provinces 2011
Suspected Confirmed Deaths
Punjab 540419 20976 329
Sindh 1333 940 16
Islamabad 980 620 2
Khyber Pakhtunkhwa 502 210 6
AJK 99 21 0
FATA 7 6 0
Balochistan 6 3 0
Gilgit Baltistan 6 2 0
Total 543352 22778 353
Focus on: Emergency situation in provinces Sindh, Khyber Pakhtunkhwa and FATA
Sindh:
• Still some health facilities are under water in Badin 04 (RHC Pangrio, GD Saman Sarkar, and GD Hamid Shah and BHU Mataro Man‐dhro). There are 2 GDs under water in Tharparker. In Umarkot there are 3 health facilities under water namely THQ Samaro, BHU Darelo, GD Sajan Chandio. In Mirpurkhas there are 6 health facilities under water including BHU Karam Ali Laghari, BHU Abdul Qaya‐oom Khair, BHU Kot Mir Jan Muhammad, GD Ahori, GD, GD Roshanabad and GD Dengan Bhurgri Rasti. There are 3 BHUs under water in District Sanghar, namely BHU Gujri, BHU Chak 08 and BHU Bassi.
• There are some places in Badin, Tharparker, Umarkot, Mirpurkhas and Sanghar where the people are still surrounded by water like Phat Farm area for Badin and Tharparker, UC Ahori and Roshanabad in Mirpurkhas, Taluka Kunri and Samaro of District Umarkot. In Sanghar UC Mian, UC Kanar, UC Berani, UC Kandiari.
Khyber Pakhtunkhwa and FATA: • Fresh influx of IDPs from Khyber Agency into Jalozai IDP Camp. The health facilities are providing adequate health services to the IDPs
in the camp. 4 BHUs and 2 MCH centers are providing PHC and MCH services in the Jalozai IDP camp (Population = 40,000 individuals approx.) DEWS data is shared regularly with WHO.
• Heavy snowfall in Malakand division (Upper Dir, Lower Dir, Upper Swat, Shangla and Kohistan) resulted in sudden drop in temperature and chilling cold may result in increase in ARI cases in vulnerable groups in the said districts.
Epidemiological Bulletin: DEWS, Pakistan, Week no. 45 (3 to 10 November, 2011)
This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: [email protected]. 06
Alerts and outbreaks, 1 August to 11 November, 2011