Weekly Epidemiological Flood Response in Pakistan€¦ · Peshawar (UC Misri Banda‐Nowshera) 8 F...

Weekly Epidemiological Bulletin

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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 51 (17 - 23 December 2010) • Between 17 - 23 December 2010 (epidemiological week no. 51), 56 districts in 4 provinces provided

surveillance data to the DEWS system.

• 1,960 fixed health and 8 mobile medical outreach centres provided surveillance data for this week. As people move back to their homes, the mobile teams are winding down. DEWS Surveillance Officers are establishing new reporting flows from fixed centers.

• A total of 530,551 consultations were reported through DEWS of which 30% were acute respiratory infections (ARI), 8% skin disease, 7% acute diarrhoea, and 7% were suspected Malaria.

• Total 13 alerts were received and responded in this week: 6 were for Measles, 2 for suspected Influ-enza, and 1 each for Acute Flaccid Paralysis, Acute Watery Diarrhoea, Bloody Diarrhoea, suspected Viral Hemorrhagic Fever, and Neonatal Tetanus.

• No case of confirmed poliomyelitis reported this week from the flood affected district

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.

Highlights

Flood Response in Pakistan

01

Volume 1, Issue 19 Monday 27 December 2010

Table-1: Priority diseases reported during the week 44 - 51, 2010

Priority diseases under surveillance

in the flood affected areas

Acute Flaccid Paralysis (AFP)

Acute Jaundice Syndrome (AJS)

Acute Respiratory Infections (ARI)

Acute Watery Diarrhoea/ (AWD) Suspected Cholera

Bloody Diarrhoea (BD)

Acute Diarrhoea (AD)

Suspected Hemorrhagic Fever (VHF)

Suspected Malaria (Mal)

Suspected Measles (Ms)

Suspected Meningitis (Mg)

Others

Diseases Wk‐44 Wk‐45 Wk‐46 Wk‐47 Wk‐48 Wk‐49

Skin Disease 25, 920 (9%) 27,009 (8%) 23,784 (8%) 29,056 (8%) 38,022 (9%) 40,533 (8%)

ARI (URI and LRI) 72,582 (24%) 93,704 (27%) 79,391 (28%) 98,719 (27%) 126,265 (29%) 156,168 (30%)

Acute Diarrhoea 22,923 (8%) 24,915 (7%) 20,138 (7%) 27,007 (7%) 34,377 (8%) 33,188 (6%)

Bloody Diarrhoea 2,843 (1%) 2,889 (1%) 2,578 (1%) 3,422 (1%) 2,972 (1%) 3,943 (1%)

Suspected Malaria 24,589 (8%) 26,843 (8%) 21,726 (8%) 27,198 (7%) 30,633 (7%) 31,780 (6%)

Total consultation 300,924 340,761 280,676 364,543 428,159 522,284

Wk‐50

35,376 (8%)

129,087 (30%)

27,433 (6%)

3,024 (1%)

26,854 (6%)

436,771

Wk‐51

42,449 (8%)

160,928 (30%)

36,423 (7%)

3,818 (1%)

34,655 (7%)

530,551

Figure-1: Weekly trend of leading priority diseases in flood affected districts of Pakistan, 29 July to 23 December 2010 (Epi week 31 - 51, 2010)

Epidemiological Bulletin: Flood Response in Pakistan

Fig-2: Weekly number of reporting health units (Week 33– 51, 2010)

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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]. 02

Table-2: Leading causes of seeking health care in the flood affected districts, 29 July to 23 December 2010

Figure-3: Leading causes of seeking health care in the flood affected districts by province, 29 July to 23 December 2010

Diseases Total

Skin Diseases 1,513,470 (13%)

Acute Respiratory Infection 2,356,167 (21%)

Acute Diarrhoea 1,253,886 (11%) Bloody Diarrhoea 121,706 (1%) Suspected Malaria 655,926 (6%) Unexplained Fever 534,422 (5%)

Total Consultations 11,324,767

Since July 29, 2010, a total of 1,253,886 acute diarrhea patient consultations have been reported to DEWS from the flood affected districts of 4 provinces in Pakistan. Proportional Morbidity in Provinces: Khyber Pakhtunkhwa: Reported 6% (1% decreased) as compared with last week. Punjab: Reported 8% (3% increased) as compared with last week. Sindh: Remains 6% as compared with last week. Balochistan: 8% (1% decreased) as compared with last week.

Figure-4: Acute Diarrhea trends, Disaster affected districts, Pakistan 2009 and 2010

Since July 29, 2010, approximately 2,356,167 Acute Respiratory Infection patient consultations have been reported to DEWS from the flood affected districts of 4 provinces in Pakistan. Proportional Morbidity in Provinces: Khyber Pakhtunkhwa: Reported 41% (3% increased) as compared with last week. Punjab: Reported 24% (1% increased) as compared with last week. Sindh: Remains 29% as compared with last week. Balochistan: reported 32% (3% increased) as compared with last week.

Figure-5: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 2009 and 2010

851,480

494,382

124,033

43,575

849,283

705,600 677,987

123,297

534,140

411,232

234,407

74,107

372,748

24,344

118,276

19,054

133,355

363,437

66,003 93,131

1,016

74,045 27,887 18,758

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Punjab Sindh Khyber Pakhtunkhwa Balochistan

Number of cases

Skin Ds.

ARI

AD

UF

S. Mal

BD

0

2

4

6

8

10

12

14

16

18

20

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

Per

cent

age

Epi-week

2009 2010

0

5

10

15

20

25

30

35

40

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

Per

cent

age

Epi week

2009 2010

Table-3: Follow-up alerts reported in week 50, 2010. Epidemiological Bulletin: Flood Response in Pakistan


Date of alert Alert Province District Location (detailed) Age (yr)

Sex Action taken / Notes

10‐Dec‐10 VHF Sindh Ghotki MCH Centre (Taluka Ghotki)

4, 8, 3 F, M, M

Samples were negative for DF. Raised awareness in the community for prevention of mosquito bites and early referral of Hemorrhagic cases.

11‐Dec‐10 Measles Sindh Kamber IDP Camp Main Primary School

2,5,7,6,5

M,M,M,M,M

Upon field investigation 5 cases including 1 death (2‐year old) were found. From active cases two samples were collected and one was found positive for Measles. Active surveillance was done.

11‐Dec‐10 VHF KP Abbottabad Ayub Teaching Hospital (Khola Kehal)

16 M Sample was declared negative for CCHF by NIH.

11‐Dec‐10 Measles Punjab Mianwali DHQ Mianwali ** ** Suspected cases were reported but upon field investigation no Measles cases were found.

11‐Dec‐10 BD Punjab Multan Qasim Bela, Masud‐Pur, 5‐Faiz

** ** Suspected cases were reported but upon field investigation no BD cases were found.

12‐Dec‐10 Diph KP Nowshera Lady Reading Hospital, Peshawar (UC Misri Banda‐Nowshera)

8 F

Probable diphtheria case diagnosed with post diphtheric neuropa‐thy, case was hospitalized but died. Active surveillance in the field is on going.

13‐Dec‐10 Diph KP Tank KTH (Shabi Khel Koroona, UC Jata Thar ‐ Tank)

15m F

Probable diphtheria case, died on 18 Dec. Field investigation re‐vealed 20 household contacts, sample of one contact collected, and all contacts treated prophylactically with antibiotics.

13‐Dec‐10 AFP KP Haripur DHQ Haripur (Bandi Sher Khan)

16m M Suspected AFP case was found. Polio team is investigating the case.

15‐Dec‐10 Pertussis Sindh Ghotki MCH Center (UC Hussain Beli ‐ Piral Village)

3 M Suspected case was identified and cultured. Contacts treated pro‐phylactically. Active surveillance ongoing in the community.

16‐Dec‐10 Diph KP Mardan KTH (Mohalla Sikandaray‐ Bar Kanday)

11 M

Probable diphtheria case from new district. Contacts treated pro‐phylactically with antibiotics. So far 12 districts have reported with suspected diphtheria cases.

16‐Dec‐10 Malaria Balochistan

Jaffarabad CD Manjhi Pur

** **

13 blood samples were tested by the health facility and 8 were found positive. LLINs, RDT Kits and anti malarial medicines have already been distributed.

Date of alert Alert Province District Location (detailed) Age (yr) Sex Action taken / Notes

18‐Dec‐10 Measles KP Haripur Afghan Refugee Camp 3 (Khalabut Township) 4 M

Upon field investigation a mild urticaria patient was found which was misdiagnosed as measles.

18‐Dec‐10 AWD KP Haripur Imamia Chowk (Khalabut Sector 4) ** M, F

Upon field investigation a acute diarrhoea patients were found which were misdiagnosed as Cholera.

20‐Dec‐10 AFP Sindh Ghotki MCH Center (UC Qadirpur) 3 F Suspected AFP case was found. Polio team is investigating the case.

21‐Dec‐10 Measles Sindh Dadu TH Johi (UC Tando Rahim Khan)

5,4,*,*,3,5,3,5,3,7,4

F,F,F,F,M, F,F,M, F,F,M

Upon field investigation 11 cases including 5 deaths were found. From active cases 2 samples were collected and sent to NIH. Active surveil‐lance is ongoing.

21‐Dec‐10 BD Punjab Jhang THQ Shorkot 5,45,10,14,3d, 40,5m,4m,10m

,2m

M,F,M,F,M,F, F,M,M,F

Upon field investigation 10 suspected cases were found. From active cases 4 samples were collected and sent to NIH. Active surveillance is ongoing.

21‐Dec‐10 VHF KP Lower Dir DHQ Timergara (Petto Dara Village) 24 M Sample was declared negative for DF by NIH. Intervention as above.

22‐Dec‐10 NNT Sindh Ghotki Jinnah Clinic (Sardar Khan Chachar Village) 14d F

Suspected NNT case was found. TIG has been provided and active surveillance is ongoing.

22‐Dec‐10 Measles KP Malakand CH Thana ‐ Batkhela 2 M Upon field investigation 1 suspected case was found. Sample was collected and sent to NIH. Active surveillance is ongoing.

22‐Dec‐10 Measles KP Mardan MMC (Umerabad ‐ Takht bai) 23 M

Upon field investigation 1 suspected case was found. Sample was collected and sent to NIH. Active surveillance is underway.

23‐Dec‐10 Measles Sindh Kashmore UC Gublo (Mahboob Khan Sundrani Village) 8,6,5,7,8,6,3

F,M,F,M,F,F,M

Upon field investigation 7 cases plus 9 unconfirmed deaths were found. From active cases 3 samples were collected and sent to NIH. Active surveillance is ongoing.

24‐Dec‐10 H1N1 (2009)

KP Swabi BKMC (Kalal Village, Kota Village) 24,41 M,F

Suspected cases were found with typical flu like symptoms. Sample tested at NIH showed positive H1N1 (2009).

24‐Dec‐10 H1N1 (2009)

Punjab Rawal‐pindi

CMH ** ** Suspected case was found with typical flu like symptoms. Sample tested at NIH showed positive H1N1 (2009).

24‐Dec‐10 Measles KP Swabi

BKMC (Panjpir Village) 3 M Upon field investigation 1 suspected case was found. Sample was collected and sent to NIH. Active surveillance is underway.

Table-4: Alerts and Outbreaks (Week 51, 2010)

Table-5: List of confirmed Polio Cases from flood affected districts, week 51-2010

There was no case of confirmed poliomyelitis reported this week from any of the flood affected district. Altogether, polio program has reported a total of 138 confirmed wild polio cases and one death including 2 more cases from Khyber Agency, FATA this week.



Province Khyber Pakhtunkhwa

• This week 14 districts reported to DEWS from KP prov-ince, 447 health centers reported 118,745 patients con-sultations to DEWS.

• ARI is the leading disease in KP province with propor-tional morbidity of 41%.

• Seven alerts were received and investigated this week; 4 alerts were for Suspected Measles, 1 each was for Influ-enza, Viral Hemorrhagic Fever, and Acute Watery Diar-rhoea.

Province Punjab • 11 districts reported data to DEWS from Punjab prov-

ince

• 759 fixed health centers and 3 mobile medical outreach centers reported to DEWS

• A total of 166,799 patient consultations were reported during this reporting period

• In Punjab a higher proportion of ARI (24%) was re-ported compared with 23% last week. This is consistent with expected seasonal trends.

• Two alerts were reported and responded this week; 1 each for suspected Bloody Diarrhoea, and Influenza.

Figure-6: Trend of priority communicable diseases, province KP (31-July - 23 December 2010)

Figure-7: Trend of priority communicable diseases, province Punjab (3 August - 23 December 2010)

Diseases Wk-48 Wk-51

Skin Diseases 5,648 (5%) 4,174(4%)

ARI (URI and LRI) 45,734 (37%) 48,781(41%)

Acute Diarrhea 9,970 (8%) 7,145(6%)

Bloody Diarrhea 998 (1%) 804(1%)

Total consultations 124,631 118,745

Suspected Malaria 2,861 (2%) 1,507(1%)

Wk-49

5,488(4%)

47,993(38%)

8,769(7%)

1,199(1%)

2,928(2%)

125,766

Wk-50

4,537(4%)

42,136(38%)

7,348(7%)

867(1%)

2,144(2%)

108,713

Diseases Wk-48 Wk-49 Wk-50 Wk-51

Skin Diseases 16,349 (13%) 12,754 (9%) 13,491 (10%) 16,341 (10%)

ARI (URI and LRI) 29,304 (23%) 39,249 (27%) 30,854 (23%) 39,456 (24%)

Acute Diarrhea 11,305 (9%) 7,422 (5%) 7,272 (5%) 13,295 (8%)

Suspected Malaria 9,119 (7%) 4,587 (3%) 5,437 (4%) 8,473 (5%)

Total consultations 124,881 144,799 135,438 166,799


05


Province Sindh • This week 20 districts reported to DEWS from

Sindh province

• 441 health centers were reported to DEWS this week

• A total of 191,328 patient consultations were reported during the reporting period of week 51.

• In Sindh, proportional morbidity of major health events remained the same when com-pared with last week.

• Four alerts were received and responded this week; 2 were for suspected Measles, while 1 each was reported for Acute Flaccid Paralysis, and Neonatal Tetanus.

Province Balochistan

• In this week, 11 districts reported to DEWS from Balochistan province.

• 313 fixed and 5 mobile medical outreach cen-ters reported to DEWS

• A total of 53,679 patient consultations were reported during the reporting period of week 51, 2010

• High number of Malaria cases were reported from different areas of Jaffarabad district. A total of 1,027 malaria samples were tested on which 427 were posi-tive (slide positivity rate 41.5%). Falciparum Rate was 64.4%.


Skin Diseases 13,777 (10%) 19,121 (10%)

ARI (URI and LRI) 40,538 (29%) 55,771 (29%)

Acute Diarrhea 8, 545 (6%) 11,604 (6%)

Bloody Diarrhea 863 (1%) 1,417 (1%)


Suspected Malaria 13, 273 (10%) 18,348 (10%)

Wk-49

20,093 (10%)

56,702 (27%)

12,607 (6%)

1,383 (1%)

18,955 (9%)

208,806

Wk-50

14,629 (10%)

42,351 (29%)

8,641 (6%)

1,034 (1%)

14,271 (10%)

145,293

Figure-8: Trend of priority communicable diseases, province Sindh (6 August - 23 December 2010)

Figure-9: Trend of priority communicable diseases, province Balochistan (6 August - 23 December 2010)


Skin Diseases 2,248 (6%) 2,813(5%)

ARI (URI and LRI) 10,689 (27%) 16,920(32%)

Acute Diarrhea 4,557 (11%) 4,379(8%)

Bloody Diarrhea 1,084 (3%) 1,597(3%)


Suspected Malaria 5,380 (13%) 6,327(12%)

Wk-49

2,198 (5%)

12,224 (28%)

4,390 (10%)

1,323 (3%)

5,310 (12%)

42,913

Wk-50

2,719 (6%)

13,746 (29%)

4,172 (9%)

1,100 (2%)

5,002 (11%)

47,327


06


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 DEWS teams established during earlier emergencies, including 2005 earthquake, 2007 floods and 2008 ID crises. The primary focus of DEWS 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.

While most children in the flood-affected districts were immunized against Measles in campaigns soon after the flood, unfortu-nately some areas were not accessible, and we are seeing measles outbreaks in some areas of Sindh.

• From August to December in Pakistan, DEWS has investigated 43 Measles alerts from 18 districts. • There were 24 alerts where lab-confirmed cases were identified involving 140 confirmed cases from 11 districts in two provinces – KP and Sindh. • After investigation, 5 outbreaks were evident with five or more cases in 4 districts, involving 103 cases with

18 deaths – all Sindh. • Two more outbreaks under investigation involve 18 clinical cases and 5 deaths in 2 districts of Sindh.

The confirmed outbreaks are as follows:

Week 42, UC Khawand Bux Sundrani, Ghotki District, Sindh: 14 cases, 3 deaths Week 45, Village Kabil Khan Bhayo, Kashmore District, Sindh: 11 cases, 0 deaths Week 46, UC Mounder, Taulka Dadu, Dadu District, Sindh: 20 cases, 10 deaths Week 48, UC Qadarpur, Ghotki District, Sindh: 52 cases, 3 deaths Week 50, IDP Camp Main Primary School, Kamber District, Sindh: 6 cases, 2 deaths

Outbreaks of clinical measles waiting lab confirmation:

Week 51, UC Tando Rahim Khan, Taulka Johi, Dadu District, Sindh: 11 cases, 5 deaths Week 51, UC Gublo, Kashmore District, Sindh, 7 cases, plus 9 unconfirmed deaths

Confirmed cases have also been identified in one other district of Sindh:

Week 46, Nowsheroferoz, Sindh: 3 cases While Ghotki, Kamber and Kashmore were among the districts covered in the first phase of the campaign, Phase 2 of the Mass Immunization Campaign is planned for Dadu, MirpurKhas, Jacobabad, Sanghar, Tando M Khan, Tando Allahyar, Tharparkar, and Umer Kot districts during 5-15 January 2011. In addition, measles immunization campaigns have been conducted in the IDP camps in Dadu and villages surrounding affected areas in Ghotki. For measles cases, vitamin A can be life-saving. Make sure that all patients with measles receive 2 doses of vitamin A

• Give the first dose in the clinic • Give parents one dose to give at home the next day • Use the following chart to determine the dosage. For example, if you have 100,000 IU capsules, one dose for an

infant 6-12 months old would be one capsule. • Show the mother how to open the capsule and place the drops in the child’s mouth. Give her the second capsule(s)

to give the child the next day at home.

Dose for each age and each type of Vitamin A capsule

Age Cap 200,000 IU Cap 100,000 IU Cap 50,000 IU

Up to 6 months 1/2 capsule 1 capsule

6 months up to 12 months 1/2 capsule 1 capsule 2 capsules

12 months up to 5 years 1 capsule 2 capsules 4 capsules

Focus on: Response to Measles Outbreak

Weekly Epidemiological Flood Response in Pakistan€¦ · Peshawar (UC Misri Banda‐Nowshera) 8 F...

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