epidemiological weekly

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. 40 (30 Sept - 6 Oct 2012)

• Measles: 68 alerts investigated this week, responding to 13 outbreaks involving 198 measles cases. Vitamin A was provided to cases and EDOs‐H took action to improve vaccination in af‐fected areas (Page 7)

• AWD: 18 alerts investigated this week and 5 outbreaks identified, involving 168 AWD cases, 2 deaths. Outbreaks were controlled by house to house measures to disinfect drinking water and by case management and infection control at health facilities (Page 7)

• 1 new suspected CCHF case reported in week 40, 2012;

• 3 new polio cases were reported in week 40, 2012; (Page 6)

• 82 districts have reported to DEWS in week 40, 2012. 2,295 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week

• 890,297 patients’ consultations were reported in week 40 compared to 960,498 consultations reported in week 39, 2012.

• Altogether 206 alerts were investigated and response was provided to 36 out‐breaks.

Highlights

Disease early warning system and response in Pakistan

01

Volume 3, Issue 40, Wednesday 10 October 2012

• The graph (Figure‐2) shows the comparison of weekly trend of Acute diarrhoea as proportional morbidity (percentage of cases out of total consultations) reported to DEWS each week in year 2011 and 2012.

• Overall weekly trend of acute diarrhoea is stable in all provinces. Districts in Sindh and Khyber Pakhtunkhwa are investigat‐ing alerts for acute watery diarrhoea/suspected cholera.

Disease # of Cases Percentage

Acute diarrhoea 2,478,098 9%

Bloody diarrhoea 139,447 0.5%

ARI 5,210,057 18%

S. Malaria 1,480,869 5%

Skin Diseases 1,354,503 5%

Unexplained fever 1,049,125 4%

Total (All consultations) 29,094,209

Disease # of Cases Percentage

Acute diarrhoea 83908 9%

Bloody diarrhoea 3397 <1%

ARI 173823 20%

S. Malaria 59349 7%

Skin Diseases 40642 5%

Unexplained fever 31311 4%

Total (All consultations) 890297

Figure‐2: Weekly trend of Acute diarrhoea in Pakistan; Week‐1, 2011 to week‐40, 2012.

Figure‐1: 82 districts reported to DEWS in week 40, 2012

Priority diseases under surveillance

in DEWS

Pneumonia Acute Watery Diarrhoea

Bloody diarrhoea Other Acute Diarrhoea

Suspected Enteric/Typhoid Fever Suspected Malaria

Suspected Meningitis Suspected Dengue fever

Suspected Viral Hemorrhagic Fever Suspected Measles

Suspected Diphtheria Suspected Pertussis

Suspected Acute Viral Hepatitis Neonatal Tetanus

Acute Flaccid Paralysis Scabies

Cutaneous Leishmaniasis

Major health events reported during the Epi‐week ‐ 39 (30 Sep ‐ 6 Oct 2012)

Cumulative number of selected health events reported in Epi‐week 1 to 39, 2012 (1 Jan ‐ 6 Oct 2012)

0

5

10

15

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

Percentage

Epi‐week

20112012

Weekly Bulletin: DEWS, Pakistan, Week no. 40 (30 September - 6 October 2012)

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]. 02

Current week's (40/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

5‐Oct AD Balochistan Jaffarabad

Murad Colony, Bhanger colony City of Dera Allah Yar, Tehsil Jhat Pat

‐ ‐ ‐ ‐

A total of 459 Acute Diarrhea cases were reported. All cases are from the same area. Outbreak was declared. Aqua tablets, purification sachet, water filters provided. ORT corner established. Most of the cases presented with mild to moderate diarrhoea. Contaminated water is the main source of high number of cases. DHO informed and requested for further necessary action.

4‐Oct AD Balochistan Nasirabad CNG Station, Tehsil DMJ ‐ ‐ ‐ ‐

A total of 379 (167 male; 212 female) AD cases were reported from fixed medical relief camp . Inves‐tigation was carried out. No case of severe dehydration reported. Treatment as per WHO protocol was provided. Health education imparted. ORT corner was established. DHO was informed and requested for further necessary action.

4‐Oct AD Balochistan Nasirabad Manjhoo Shori, Tehsil DMJ ‐ ‐ ‐ ‐

An alert of 158 (91 male, 67 female) AD cases were reported. Cases were reported as a result of drinking open contaminated water. All cases presented with mild to moderate diarrhoea. No case of severe dehydration found. Essential medicines provided by WHO and ORT Corner established. DHO requested to communicate with PHED department to ensure safe drinking water.

5‐Oct AD Balochistan Nasirabad Mir Hassan, Tehsil Chatter ‐ ‐ ‐ ‐

An outbreak of 167 AD (69 male; 98 female) cases were reported. Investigation was carried out. Essential medicines provided to the cases. All patients presented with mild to moderate sign and symptoms of diarrhoea. No suspected AWD case was found. Cases were reported as a result of drinking open contaminated water.DHO informed for further necessary action.

5‐Oct AD Balochistan Nasirabad Pat feeder Bridge, Tehsil DMJ ‐ ‐ ‐ ‐

An alert of AD 162 (54 male; 108 female) cases were reported. Stagnant rainy water which might consider a cause of high number of AD cases. Medicines provided. ORT corners are established. District management teams informed for further action.

6‐Oct AD Balochistan Nasirabad Mir wah, Tehsil Tamboo ‐ ‐ ‐ ‐

An outbreak of AD 137 cases (64 male; 73 female) were reported. Medicines provided. No severe case of acute watery diarrhea was found. ORT corner established. Information shared with DHO to ensure provision of safe drinking water in the area.

6‐Oct AD Balochistan Nasirabad Phulegi, Tehsil Chatter ‐ ‐ ‐ ‐

152 cases (65 male; 87 female) of AD reported from fixed medical relief camp. Patients presented with mild symptoms of AD. ORT corner was already established and working properly in presence of skilled medical doctors. Medicines are made available in the medical camp. District health authority informed.

6‐Oct AD Balochistan Nasirabad RD‐75, Tehsil Tam‐boo `‐ ‐ ‐ ‐

An outbreak of AD was reported, 306 cases (163 male; 143 female). Essential medicines were pro‐vided. High number of AD cases is due to stagnant water which is being used for drinking purpose. ORT corners are established. DHO informed and requested for further necessary action.

2‐Oct Leishmaniasis Balochistan Killa Saifullah Muslim Bagh town area Tehsil Muslim Bagh

1 4 0 4 9 cases of Cutaneous Leishmaniasis were reported. Cases were investigated and found lesions on face and arm. No travelling history. Health education session conducted and treatment provided as per WHO protocol. DHO informed.

5‐Oct Leishmaniasis Balochistan Killa Saifullah Kili Nasai UC Nasai Tehsil Muslim Bagh 0 7 0 0 7 cases of Cutaneous Leishmaniasis were reported. Cases were investigated and found lesions on face and arm. 3 patients had travelling history to the endemic area. Health education imparted. Treatment was given as per WHO protocol. DHO informed.

5‐Oct Measles Balochistan Harnai Mian kach, UC Spintangi, Tehsil Harnai

6 0 0 1

An alert of suspected measles was reported. During field investigation, 06 more cases were found including one death. Vitamin A drops provided. Health education imparted. None of the cases were found vaccinated. DHO, PPHI and EPI in charge informed and requested for intensified outreach vaccination in the locality.

5‐Oct Measles Balochistan Jaffarabad

Goth Abdul Ghaffar Jat, UC Noor Pur, Tehsil Sohbat Pur, District Jaffarabad.

2 1 3 0

5 cases of suspected measles were reported. On field investigation, 1 child was also found who died due to complications of measles. Vit A drops provided to the cases. 2 blood samples collected for lab confirmation. 9 children were assessed for routine immunization where 7 children were found vaccinated against measles. Information shared with DHMT for further action.

2‐Oct Typhoid Balochistan Harnai Harnai, UC Harnai urban, Tehsil Harnai 0 7 0 3

An alert of typhoid fever was notified. On field investigation, total 10 cases were found. The cases were epidemiologically linked, and from the same locality of Harnai town. Health education session conducted and advised for safe drinking water. Matter was discussed with DHO and DHQ in charge.

30‐Sep Typhoid Balochistan Kech Shahi tump, UC Koshkalat, Tehsil Turbat

2 6 2 2 12 suspected cases of typhoid fever were reported. After investigation, all cases were found positive and belongs to the same area. 2 water samples collected for lab testing. Health education session conducted at Govt Boy School Shahitump (20 Teachers participated). DHO, DSM PPHI informed.

1‐Oct Measles Khyber Pakhtunkhwa Lower Dir

Vilage Dinjari, Kambat Tehsil Samarbagh Dir lower

1 2 1 3

7 suspected cases of Measles were reported. Vit A drops provided to the cases. Blood Sample col‐lected for lab confirmation. BCG scar was present on suspected cases but none of them were found vaccinated against measles. Health education sessions conducted with the affected community. Information shared with EDO‐H, Coordinator LHWs, Coordinator EPI and requested for intensified outreach vaccination activity in the locality.


Vilage Godar, UC Shalkandai, Tehsil Munda, Dir Lower

4 3 1 1

An alert of suspected Measles was reported. On field investigation, 8 more cases were found. Vit A drops were provided. Blood sample collected for lab confirmation. None of the children were found vaccinated against measles. Health education imparted regarding the importance of routine immuni‐zation. Information shared with EDO‐H, Coordinator LHWs, Coordinator EPI and requested for inten‐sified vaccination activity in the area.


Vilage Muslim Bagh, UC Kharkai, Tehsil Samarbagh, Dir Lower

3 1 2 2

An alert of suspected Measles was reported. On field investigation, 7 more suspected cases were found. Vit A drops were given to the cases. Blood sample collected for lab confirmation. 8 children were assessed for routine immunization where only 1 was fully immunized where as rest were partially immunized. Health education imparted. Information shared with EDO‐H, Coordinator LHWs, Coordinator EPI and requested for intensified vaccination activity in the locality.


Vilage Hajiabad High School, UC Koto, Dir Lower

4 4 1 1

3 suspected cases of Measles were reported. On field investigation, 7 more suspected cases were found. Vit A drops provided to the cases. Blood sample collected for lab confirmation. Suspected cases were not vaccinated against measles however, BCG scar was present. Health education im‐parted regarding the importance of routine immunization. 110 children in total and 66 children under 5 years and 44 children over 5 years were vaccinated during intensified outreach vaccination activity.



Cont’d current week's (40/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

1‐Oct AWD Punjab Rahim Yar Khan

Basti Allah Bukhsh Abbasi, Taranda Gurgage, Tehsil Liaqatpur

1 2 3 3

An alert of AWD was reported. On field investigation, 1 death due to AWD and 7 more cases of AWD were found. The area was affected by recent heavy rains and rain water is still present in the field. The source of drinking water is hand pump. 02 stool samples were collected for lab confirmation. 03 Health education sessions conducted. 02 LHWs were mobilized for further Health education sessions. Aqua tabs, nerox filters and Jerry cans were distributed to ensure safe drinking water supply. EDO‐H informed.

1‐Oct DF Punjab Lahore UC 10 Fruit Mandi Ravi town 0 5 0 2

1 Confirmed, 2 Probable and 4 suspected cases of Dengue fever were notified. Blood sample collected and found positive for dengue specific antibodies. Dengue monitoring cell declared outbreak in this union council. SO along with, CDCO,DDHO, and entomologist visited the area and vector surveillance was carried out. IRS done in the houses of the cases. Health Education session conducted regarding the proper solid waste disposal and improved water storage practices, use of screening, protective clothing and repellents. IEC material distributed by Female sanitary petrol from House to House. ADG(VBD) was informed along with EDO Health.

1‐Oct DF Punjab Lahore UC 113 Raiwind Allama Iqbal Town 0 7 0 4

2 Confirmed and 9 suspected cases of Dengue fever were notified. Blood sample was taken and sent to lab for detection of dengue specific antibodies, result for IgM found positive for 2 cases, NS1 found negative for one case .Dengue monitoring cell declared outbreak in this union council. Vector Surveillance was carried out. larva found inside and outside the houses. IRS done. Health Education imparted. Community ‐ based environmental management and health education campaign for improved water storage practices to remove mosquito breeding sites, IEC material distributed. ADG(VBD) was informed along with EDO Health.

2‐Oct DF Punjab Lahore UC 130 Kot Lakhpat Gulberg town 0 8 0 3

1 Confirmed, 2 Probable and 8 suspected cases of Dengue fever were notified. Blood sample was taken and sent to lab for detection of dengue specific antibodies, result for IgM and IgG positive for one case. Dengue monitoring cell declared outbreak in this union council. Vector Surveillance was carried out. IRS done. Health Education session was given to the community Proper solid waste disposal and improved water storage practices use of screening, protec‐tive clothing and repellents. IEC material distributed. ADG(VBD) was informed along with EDO Health. The Area would be visited again on daily basis.

2‐Oct DF Punjab Lahore UC 29 Androon Bhatti Gate Ravi town Lahore

0 6 0 1

1 Confirmed, 1 Probable and 4 suspected cases of Dengue fever were notified. The cases were investigated and blood sample was taken and sent to lab for detection of dengue specific antibodies, result for IgM and IgG positive for one case. Dengue monitoring cell declared outbreak in this union council. Vector Surveillance was carried out. IRS done. Health Education imparted. Community ‐ based environmental management and health education campaign for improved water storage practices to remove mosquito breeding sites, IEC material distributed by Female sanitary petrol from House to House. ADG(VBD) was informed along with EDO Health.

5‐Oct DF Punjab Lahore UC 7 Shahdara, Ravi town 0 8 0 1

2 Confirmed, 2 Probable and 5 suspected cases of Dengue fever notified on dashboard from different Health Facilities of Lahore. The cases were investigated and blood sample was taken and sent to lab for detection of dengue specific antibodies, result for IgM and IgG positive for two cases, NS1 found Negative .Dengue monitoring cell declared outbreak in this union council. Vector Surveillance was carried out. IRS done. Health Education session imparted. IEC material distributed. ADG(VBD) was informed along with EDO Health. The area would be visited on daily basis.

4‐Oct AWD Sindh Hyderabad Staff mill colony, Al Madina society, taluka Hyderabad

0 2 1 3 An alert of AWD was reported. On active surveillance, 5 more cases of AD were found. Hand pump was the source of drinking water. 2 stool and 2 water samples collected for lab testing. Aqua tabs, soaps and Life straw filter distrib‐uted. Health education imparted. DHO informed.

3‐Oct AWD Sindh Kashmore

Village Sher Mohammad Bhang‐war, UC and taluka Kandh kot

2 6 4 6

1 death due to AWD was reported. During field investigation, death of child was verified and other cases with com‐plain of diarrhea were examined, 5 cases were found with severe dehydration and 11 cases with some dehydration. 1 Rectal swab was collected for lab confirmation and community was sensitized on safe drinking water and personal hygiene. Aqua tabs, jerry can, soaps, ORS, Pure sachet & IEC material were distributed. Water sample was taken from source of drinking water & result was unfit. Information shared with DHO, PPHI, Local NGOs for intervention & also WASH partners.

4‐Oct AWD Sindh Khairpur Village Rasool Pur UC Mandan Taluka Tharri mir wah

5 11 4 15

An alert of AWD was reported. On field investigation, total 35 cases of AD were found. 2 stool samples collected for lab confirmation. Aqua tabs, Hygiene kits, jerry cans, Life straw filter, zinc tabs, ORS, IEC material & toilet soaps were provided to the affected communities. Health & Hygiene sessions conducted especially regarding hand washing practice. Information shared with DHMT.

4‐Oct AWD Sindh Khairpur Village Waatni Wada UC Ranipur Taluka Sobho Dero

7 31 5 23

A case of AWD was reported. On field investigation, 32 cases of AD were found. 2 stool samples collected for lab confirmation. Aqua tabs, hygiene kits, jerry cans, life straw filter, zinc tabs, ORS, IEC material & toilet soaps were provided. In follow up visit, total 66 cases of AD were found during last two days, all cases were recovered and no death occurred. Health & Hygiene sessions conducted with the affected families. Information shared with DHMT.

5‐Oct Measles Sindh Hyderabad Noorani Basti, near Mustafa Park, taluka Hyderabad

3 0 2 0

An alert of suspected measles was reported. On active search, 4 more cases were found. Vitamin (A) drops provided. Blood sample collected for lab testing. Health education imparted. 10 children were assessed for routine immuniza‐tion where BCG=8(80%), Penta1=4(40%), Penta2=4(40%), Penta3=4(40%), Measles1=5(50%), Measles2=2(20%). Information shared with DHO, DSC, Measles focal person and DO Admin preventive and requested for intensified outreach vaccination activity in the locality.

5‐Oct Measles Sindh Jacobabad Village Daur UC Thull New Taluka Thull 6 1 2 1

An alert of suspected measles was reported. During field investigation, 9 more cases were found. Vit A drops were given to the cases. 4 blood samples collected for lab confirmation. 13 children were assessed for routine immuniza‐tion where all the children were found fully unvaccinated. Health education imparted regarding the importance of routine immunization. Information shared with DHMT and requested for intensified outreach vaccination activity in the locality.

4‐Oct Measles Sindh Khairpur

Village Arbab Ali Chandio UC Baqi Khan Taluka Thari Mir wah

2 2 1 0

Death due to suspected measles was reported from community. On field investigation, 4 more suspected cases were found. Vit A drops provided. Blood sample collected for lab confirmation. 10 children were assessed for routine immunization where none of the children were found vaccinated against measles. 35 children were vaccinated for measles in the intensified outreach vaccination activity. Information shared with DHMT.

2‐Oct Measles Sindh Shikarpur Village Ahmed pur, UC Lodra 5 0 6 0

An alert of suspected Measles was notified. On field investigation, 11 suspected cases including 2 deaths due to measles were found. Vitamin (A) drops were given to the cases. 3 blood samples collected for lab confirmation. Health education imparted regarding the importance of routine immunization. Information shared with DHMT and requested for intensified outreach vaccination in the locality.

2‐Oct Measles Sindh Sukkur

Near Pepsi cola company, Allahabad colony, SITE area, taluka New Sukkur

4 1 3 0

An alert of suspected measles was reported. On field investigation, 7 more suspected cases were found. 2 doses of vitamin (A) provided. 1 Blood sample collected for lab confirmation. Health education imparted regarding the impor‐tance of routine immunization. None of the cases were found vaccinated against measles. 14 children were assessed for routine immunization where BCG(10%) and Measles‐1‐2=(0%). Information shared with DHO & DHMT and re‐quested for outreach vaccination in the locality.

5‐Oct Measles Sindh Sukkur

Chohan Muhalla at Allahabad colony, near city point. UC Bachal Shah Miyani, taluka New Sukkur

6 0 3 1

1 death due to Measles was reported from community. During field investigation, 9 more suspected cases were found. None of the case were found vaccinated. Vitamin (A) drops provided. Health education imparted regarding the importance of routine immunization. Cluster of routine immunization was taken where 12 children were assessed and found fully unvaccinated. Information shared with DHO & DHMT and requested for intensified outreach vaccina‐tion in the locality.

2‐Oct Measles Sindh Tando Muhammad Khan

Ahmed Khan Tegani 2 0 3 0

An alert of suspected measles was reported. On active search, 4 more cases were found. Vitamin (A) drops were given to the cases. 2 Blood samples collected for lab testing. Health education imparted. 9 children were assessed for routine immunization where BCG=6(66%), Penta1=2(22%), Penta2=2(22%), Penta3=1(11%), Measles1=1(11%), Measles2=(0%). Information shared with DHO and requested for outreach vaccination activity in the locality.

4‐Oct Pertussis Sindh Dadu Village Jafar Chan‐dio, UC Mangwani, taluka Mehar

5 6 5 4

3 cases of probable Pertussis were reported. During field investigation, 17 more suspected cases were found. 13 cases were found with BCG scar, 10 with Penta‐1, 8 with Penta‐2 and 7 with Penta‐3. Health education imparted regarding importance of routine immunization. Erythromycin tabs and syrups were given to the cases and contacts. House cluster were taken where 32 children were assessed for routine immunization where BCG=18(77%), Penta1=20(62%), Penta2=14(43%), Penta3=10(31%), Measles1=15(46%), Measles2=11(34%). EDOH, MO BHU, and THO in‐formed and requested for outreach vaccination activity in the locality.



Province Khyber Pakhtunkhwa: 500 health facilities from 18 districts of Khyber Pakhtunkhwa sent reports to DEWS with a total of 124,624 patients consultations reported in week 40, 2012. Total 44 alerts were received and appropriate measures were taken. Altogether 31 alerts for Measles; 5 for AWD; 4 for DF; 3 for Leishmaniasis; while 1 for Malaria. Acute diarrhoea trend shows a minor increase as compared with last week.

Figure-5: Trend of acute diarrhoea diseases, province Khyber Pakhtunkhwa

Province Sindh:

Figure‐3: Number of alerts received and responded, week 37 ‐ 40, 2012 Figure‐4: Number of consultations by age and gender, week 40, 2012

Province Punjab:

Figure-6: Number of alerts received and responded week 37 - 40, 2012, province KPK

Figure-7: Trend of trend of acute diarrhoea, province Sindh

868 health facilities from 23 districts in Sindh province reported to DEWS with a total of 461,545 patients consultations in week 40, 2012. Total 52 alerts re‐ceived while 12 outbreaks were identified and appropriate measures were taken. Altogether 24 alerts for Measles; 11 for AWD; 8 for NNT; 4 for Pertussis; 2 for Leishmaniasis; while 1 each for DF, Typhoid and Scabies. Acute Diarrhoea shows an stable trend in last few weeks.

Figure-8: Number of alerts received and responded week 37 - 40, 2012, province Sindh

Figure-9: Trend of acute diarrhoea, province Punjab Figure-10: Number of alerts received and responded week 37 - 40, 2012, province Punjab

420 health facilities from 9 districts in province Punjab reported to DEWS with a total of 206,409 patients consultations in week 40, 2012. Total 60 alerts were received and appropriate measures were taken. Altogether 14 alerts for ARI; 11 for Typhoid; 10 for Acute diarrhoea; 6 for Dengue fever; 5 for Measles; 4 for Bloody diarrhoea; 3 for Scabies; 2 each for AWD, Leishmaniasis and Malaria; while 1 for AJS. AD shows a Stable trend in last few weeks.

69 95 67 68

0

10

20

30

40

50

Wk‐37 Wk‐38 Wk‐39 Wk‐40

# of alerts

Measles

AWD

Leishmaniasis

Typhoid

Pertussis

Malaria

CCHF

0

5

10

15

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

Percentage

2011 20120

10

20

30

40

50

Wk‐37 Wk‐38 Wk‐39 Wk‐40

# of alerts

Measles

AWD

Leishmaniasis

Pertussis

CCHF

Malaria

Typhoid

0

10

20

30

40

50

Wk‐37 Wk‐38 Wk‐39 Wk‐40

# of alerts

Measles

AWD

Pertussis

Typhoid

Leishmaniasis

0

5

10

15

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

Percentage

20112012

0

5

10

15

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

Percentage

20112012

0

10

20

30

40

50

Wk‐37 Wk‐38 Wk‐39 Wk‐40

# of alerts

Measles

Typhoid

AWD

Malaria

Leishmaniasis

< 1 yr 1‐4 yr 5‐14 yr 15‐50 yr 50 + yr

Male 28943 79092 101622 146631 60701

Female 27628 69746 103010 205754 67170

0

50000

100000

150000

200000

250000

# of con

sultatio

ns



State of Azad Jammu and Kashmir:

Province Gilgit Baltistan:

FATA:

Province Balochistan:

Figure-11: Trend of acute diarrhoea, province Balochistan Figure-12: Number of alerts received and responded week 37 - 40, 2012, Balochistan

325 health facilities from 18 districts in province Balochistan reported to DEWS with a total of 52,292 patients consultations in week 40, 2012. Total 38 alerts reported and 14 outbreaks were identified and appropriate measures were taken in week 40, 2012. Altogether 11 for Acute diarrhoea; 10 for Leishmaniasis; 9 for Measles; 2 each for Bloody diarrhoea and Typhoid; while 1 each for AWD, CCHF, Malaria and NNT. A decrease noted in AD trend from last few weeks.

16 health facilities from 2 districts in Gilgit Baltistan reported to DEWS with a total of 7,716 patients consultations in week 40, 2012. No alert reported in week 40, 2012. AD showing decrease in week 40 in last few weeks.

Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week 37 - 40, 2012, Gilgit Baltistan

Figure-15: Trend of acute diarrhoea, FATA

54 health facilities from 3 agencies in FATA reported to DEWS with a total of 16,259 patients consultations in week 40, 2012. 10 alerts; 4 for Measles; 3 for Leishmaniasis; 2 for NNT; while 1 for Mumps were reported in week 40, 2012 and appropriate measures were taken. A minor increase in AD is noted this week.

Figure-16: Number of alerts received and responded week 37 - 40, 2012, FATA

Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 37 - 40, 2012, AJ&K

106 health facilities from 8 districts in AJ&K reported to DEWS with a total of 19,003 patients consultations in week 40, 2012. 2 alerts for Measles were reported in week 40, 2012. An increase noted for AD as compare with last week.

0

5

10

15

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

Percentage

2011 2012

0

10

20

30

40

50

Wk‐37 Wk‐38 Wk‐39 Wk‐40

# of alerts

Leishmaniasis

Measles

Malaria

CCHF

Typhoid

AWD

Pertussis

0

5

10

15

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

Percentage

20112012

0

10

20

30

40

50

Wk‐37 Wk‐38 Wk‐39 Wk‐40

# of alerts

Measles

0

5

10

15

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

Percentage

20112012

0

10

20

30

40

50

Wk‐37 Wk‐38 Wk‐39 Wk‐40

# of alerts

Measles

Leishmaniasis

0

5

10

15

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

Percentage

20112012

0

10

20

30

40

50

Wk‐37 Wk‐38 Wk‐39 Wk‐40

# of alerts

Measles

AWD

Leishmaniasis



Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

• In week 40, 2012 three type‐1 polio cases were reported; one each from Khyber Pakhtunk‐hwa (Dir Upper district), Federally Administered Tribal Areas (Kurram Agency) and Sindh (Naushero Feroz district).

• As of 28 September 2012, Pakistan has reported a total of 43 polio cases including 40 type‐1, 2 type‐3 and 1 mixture type‐1 and 3 polio cases from 26 districts/tribal agencies.

Province Cases 2011 Cases 2012

P1 P3 P1 P1+P3

Punjab 9 ‐ 3 ‐

Sindh 33 ‐ 4 ‐

Khyber Pakhtunkhwa 23 ‐ 17 ‐

FATA 57 2 12 1

Balochistan 73 ‐ 3 ‐

AJ&K ‐ ‐ ‐ ‐

Gilgit‐Baltistan 1 ‐ 1 ‐

Islamabad ‐ ‐ ‐ ‐

Total 196 2 40 1

P3

‐

‐

‐

2

‐

‐

‐

‐

2

Table‐1: Number of alerts and outbreaks reported and investigated with appropriate response

CCHF: CCHF is a serious viral hemorrhagic fever with up to 50% case fatality rate, caused by an RNA virus of family Bunyaviridae, genus

Nairovirus, carried by Hyalomma species of ticks. Human beings become infected by tick bites or crushing the ticks, which are usually found on sheep, cattle, goats or camels, and their slaughtered skins. They may also be exposed to the virus in blood or tissues of a viremic animal during its slaughter and butchering; or by contact with infected blood or secretions of acute human cases in home or hospital setting. 1 new suspected case of CCHF in week 40. In 2012, a total of 52 suspected cases have been reported throughout the country with 39 confirmed to date and 14 deaths; (CFR is 35.90%). 21 confirmed cases have been reported from Balochis‐tan; 7 from Sindh; 6 from Khyber Pakhtunkhwa and 5 from Pun‐jab. Chart at right illustrates current situation of CCHF cases in 2012.

Approximately all the cases have contact history with

animal trading/handling, tick bite, contact with patient, tannery worker, butcher/animals slaughtering, a traditional practice of wearing fresh animal skin (posti) to treatment ailment. These animals and their skins have continuous movement!intra Pakistan and between neighboring countries (Afghanistan and Iran).

Any contact of a CCHF patient should monitor his/her temperature for 14 days and see a doctor if fever develops. The anti viral medicine Ribavirin has been effective in saving lives of patients who report early to the health facility.

Follow up of CCHF, Measles and Dengue

Disease 2011 2012 (up till week 39) Current week 40, 2012

A O A O A O A O

Acute watery diarrhoea 1350 543 536 132 18 5 554 137

Acute jaundice syndrome 51 17 96 18 1 0 97 18

Bloody diarrhoea 98 20 98 7 6 0 104 7

Dengue fever 785 111 124 17 11 5 135 22

Measles 1708 110 4520 461 68 13 4588 474

Pertussis 287 81 336 137 4 1 340 138

NNT + tetanus 399 0 412 0 10 0 422 0

Malaria 131 88 113 60 4 0 117 60

Leishmaniasis 298 33 658 60 20 2 678 62

Others 645 69 1236 91 54 10 1290 101

Total 5752 1072 8129 983 196 36 8325 1019

Total for 2012 (week 1‐40, 2012)

0

2

4

6

8

10

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

# of cases

Epi‐week

Number of CCHF cases (week 1 to 38, 2012), Pakistan

Suspeceted Positive



Table‐1

# of Alerts # of Outbreaks # of Cases # of Deaths

AJ&K 143 4 224 0

Balochistan 370 100 1524 20

FATA 163 24 459 13

Gilgit Baltistan 21 0 22 0

ICT 20 2 55 0

Khyber Pakhtunkhwa 1735 89 3072 33

Punjab 686 30 1109 15

Sindh 1450 225 3804 68

Total 4588 474 10269 149

2012 (Week 1 ‐ 40)

Province

Table‐2


AJ&K 0 0 0 0


FATA 3 0 3 0


ICT 0 0 0 0


Punjab 5 0 7 0

Sindh 24 7 94 4

Total 68 13 198 6

Epi ‐ week 40, 2012

Province

Measles: As of 6 October 2012, more measles cases and deaths have been reported in Pakistan than in 12 months last year. Table 1 summa‐rizes the situation of measles in 2012 up to 6 October; and table 2 illustrates the alerts and outbreaks in week 40 (30 September to 6 Octo‐ber, 2012). As it is shown in the above table that majority of the measles cases have been reported from Sindh and Khyber Pakhtunkhwa provinces. Both of these provinces have announced the EPI facilities will be providing measles vaccine twice a week for all children under age 5.

Dengue:

The chart at right showing the weekly num‐ber of confirmed Dengue cases reported by surveil‐lance focal points from the Departments of Health in Sindh and Punjab in 2012. Total number of con‐firmed dengue cases to date in 2012 is 198 in Sindh and 298 in Punjab. Month of peak incidence in 2010 was November while peak incidence in 2011 was in September and October.

Malaria:

The chart at right shows the Malaria slide positivity and Falciparum rate reported in week 40, 2012. Total number of malaria cases tested in this week is 21075, out of which 3369 were found posi‐tive; 2233 for P. Vivax; 930 for P. Falciparum; while 206 for Mixed (SPR = 15.99%; F. R = 33.72%). AWD: • The surveillance definition for a case of “Acute Watery Diar‐

rhoea” (AWD) or suspected cholera in an endemic area, is any case over age 2 years with severe dehydration or death due to diarrhoea of 3 or more stools in 24 hours.

• An AWD outbreak is defined as a cluster of 6 or more cases of AWD or any number of cases with at least one confirmed case of Vibrio cholera.

• The table at right summarizes the situation of AWD in last four weeks, 9 September to 6 October 2012. During the period, a total of 81 AWD alerts were reported and 14 confirmed AWD out breaks were identified and were responded very efficiently and in systematic manner.

• The Surveillance Officers in the districts with the close coordi‐nation of trained rapid response teams from Department of Health and partners address the outbreaks.

AWD


AJ&K 1 0 5 0


FATA 0 0 0 0


ICT 0 0 0 0


Punjab 8 1 18 1

Sindh 40 19 269 1

Total 81 28 391 3

Week 37 ‐ 40, 2012

Province

Outbreaks with

confirmed V. cholera

0

0

0

0

0

7

0

7

14

0

20

40

60

80

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

# of cases

Weekly trend of positive Dengue cases reported from Sindh and Punjab, week 1 to 40, 2012

Punjab Sindh

0

10

20

30

40

50

Sindh Balochistan FATA Punjab KPK GB AJK ICT

Percen

tage

Malaria slide positivity and falciparum rate, week 40, 2012

SPR FR



Alerts and outbreaks, week 40, 2012

epidemiological weekly

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