special supplement · 5 kamber shahdadkot 145,030 6 khairpur 927,953 7 larkana 300,000 8 mirpurkhas...
TRANSCRIPT
Special Supplement
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].
Highlights
Disease early warning system and response in Sindh
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Issue 2 Wk-35 , Wednesday 07 September, 2011
Table‐1: Total number of alerts and outbreaks reported and investigated with appropriate response
Disease Post Flood 2010 2011 (up till wk 34) Total
A O A O A O A O
Acute Watery Diarrhoea
58 19 307 110 9 2 374 131
Bloody Diarrhoea ‐ ‐ 11 ‐ ‐ ‐ 11 ‐
Measles 23 6 512 56 2 ‐ 537 62
Pertussis 1 ‐ 98 16 ‐ ‐ 99 16
Malaria 2 1 16 3 2 1 20 5
Leishmaniasis 1 ‐ 5 ‐ ‐ ‐ 6 ‐
Others 14 2 143 9 1 ‐ 158 11
Total 118 32 1226 195 23 5 1367 233
Current Week (35)
Acute Jaundice Syndrome
‐ ‐ 2 1 ‐ ‐ 2 1
NNT + Tetanus 4 ‐ 109 ‐ 6 ‐ 119 ‐
Dengue Fever 15 4 23 ‐ 3 2 41 7
• Between 26 August - 1 September 2011 (epidemiological week no. 35), a total of 23 alerts reported and responded from province Sindh.
• Out of total 23 alerts Nine were for AWD; Six for Neonatal Tetanus; Three for Dengue Hemorrhagic Fever; Two each were for Measles and suspected malaria; While one for Acute diarrhoea.
Sporadic cases of dengue fever have been reported from Karachi, Badin and Khairpur districts in Sindh, and WHO‐NIH is collaborating with experts from all the provinces to draft a new national guideline for Clinical Case Management of Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS).
WHO estimates about 2/5 of the world’s population is at risk for DF with about 50 million dengue infections world‐wide every year and about 500,000 (1%) hospitalized for Dengue Hemorrhagic Fever (DHF). In Pakistan in 2010, a total of 15,901 suspected cases and 11,024 confirmed cases of Dengue with 40 deaths were reported in all Pakistan, which was more than all the cases reported from the previous five years together.
Control of mosquitoes is the only prevention strategy and community awareness to remove the mosquito breeding sites in the homes is the first line of action. All standing water in pots, trays, tubs, buckets, coolers, patios, puddles, and any debris around the house should be com‐pletely emptied and dried on daily basis or tight cover applied. Mosquito repellents, mosquito coils and other means should be used to pre‐vent mosquito bites.
Four different dengue viruses, spread by the bite of the Aedes mosquito, can cause the fever, headache and body‐aches typical of DF. When DF cases are infected another year with a different dengue virus, Dengue Hemorrhagic Fever (DHF) may ensue.
If a patient has DF, fluids, rest, sponging with tepid water, and paracetamol (up to 4 doses in 24 hours) are recommended. Aspirin, Brufen, Ponstan and similar meds should not be used as they increase the bleeding tendency. Rise in temperature may continue for two to seven days, and DF patients must be carefully observed for warning signs during that time and for two days after recovery from fever. Patient should be taken to the hospital if the following warning signs are observed: severe abdominal pain, difficulty breathing, bleeding into the skin or from the nose or gums, passage of black stools, vomiting blood, disorientation, and cold skin.
At the hospital, isolation ward is not required but patient should be kept in mosquito‐free area and fluid status carefully monitored with regular blood testing as recommended by national guidelines.
Focus on: Dengue Fever, September 2011
S.NO NAME OF DISTRICTS POPULATION AFFECTED
1 BADIN 1,021,301
2 DADU 12,093
3 GHOTKI 30,000
4 JAMSHORO 5,850
5 KAMBER SHAHDADKOT 145,030
6 KHAIRPUR 927,953
7 LARKANA 300,000
8 MIRPURKHAS 384,423
9 NAUSHEHRO FEROZE 9,099
10 SANGHAR 68,136
11 SHAHEED BENAZIRABAD 9,000,000
12 TANDO ALLAHYAR 159,870
13 TANO MUHAMMAD KHAN
267,368
14 THARPARKAR 127,454
15 THATTA 108,638
16 UMERKOT 180,851
12,748,066 TOTAL
Rain/Flood affected districts in Sindh
Special Supplement: DEWS, Sindh, Week no. 35 (26 August to 1 September, 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]. 02
Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken
26‐Aug AWD Sindh Hyderabad Heerabad, Dau‐latabad, near Ibrahim Khalilullah
1 0 0 0 Alert for AWD, Reinforced case management, Active surveillance done, Aqua tabs, ORS and Jerry cans provided Health education, EDO‐H informed 1 case, Sample sent to NIH was found positive for V.c.Ogawa, 1 water Sample also taken.
26‐Aug AWD Sindh S. Benazirabad Village Wali Mu‐hammad Mirasi, UC Sun
1 0 1 0 Alert for AWD, Reinforced case management, active surveillance done, 2 stool sample collected both found positive for V.c.Ogawa. Field investigation and response under‐
28‐Aug DHF Sindh Khairpur Gambat City UC & Taluka Gambat 0 1 0 0
Alert for DHF responded, Patient was advised to restrict frequent social activity visits and for isolation by means of using bed net every time, Sample tested positive for IgM Dengue at Agha Khan Hospital Labs, Information shared with EDOH & DO M&PH, Provided bed net through malaria program EDO H office, Malarial spray done at both houses of the patient by malaria team, Planning done with Malaria superintendent
2‐Sep DHF Sindh Khairpur Shaikh Mohallah, Gambat city, UC Gambat
0 1 0 0
Alert for DF notified by THO Gambat Dr Ayub , positive for IgM Dengue, complete history taken from the patient, informed EDOH for intervention, responded and sent team for malarial spray in the patients house and office, Plan was made for fumiga‐tion in Gambat city, bed net was provided to the patient. Anti Dengue test was done at Agha Khan laboratory and it was positive (IgM +ve).
29‐Aug Malaria Sindh Larkana Village Arija BHU Arija 3 1 1 4
Malaria alert, Investigation done, record verified of facility found correct response is planned for village reported to EDOH
Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F
29‐Aug AD Sukkur Village Soofan Buriro 5 4 0 1 26‐Aug AWD Badin Village Master Haq Nawaz, Deh Kandar 1 2 0 1 29‐Aug AWD Dadu Village Gul Muhammad Landree 2 1 0 0 26‐Aug AWD Hyderabad Heerabad, Daulatabad 1 0 0 0 30‐Aug AWD Hyderabad Gujrati mohalla, 0 0 0 1 30‐Aug AWD Hyderabad Taj pur village 0 1 0 0 30‐Aug AWD Hyderabad Village Bhindo sharif, near Tando jam 0 0 0 1 26‐Aug AWD S. Benazirabad Village Wali Muhammad Mirasi, UC Sun 1 0 1 0 27‐Aug AWD TM Khan Pead wards Naseerabad 0 0 1 0 29‐Aug AWD Thatta village Nareeja Makli 2 1 0 1 0 29‐Aug DHF Badin Village Ghulam Hussain Parier, UC Kadia Qazi 0 1 0 1 28‐Aug DHF Khairpur Gambat City UC & Taluka Gambat 0 1 0 0 2‐Sep DHF Khairpur Shaikh Mohallah, Gambat city, UC Gambat 0 1 0 0 29‐Aug Malaria Badin IDP camp government high school, Panghrio 0 0 0 0 29‐Aug Malaria Larkana Village Arija BHU Arija 3 1 1 4 27‐Aug Measles Qambar Shahdadkot Khabri Makan 0 0 1 0 30‐Aug Measles TM Khan Memon hospital, Taluka Matli 0 0 1 0 1‐Sep NNT Ghotki Village Pir Muhammad Khatian UC Dhangro 1 0 0 0 29‐Aug NNT Karachi Neonatal ICU, NICH 0 0 0 0 27‐Aug NNT Qambar Shahdadkot Village Sobho mugheri 1 0 0 0 27‐Aug NNT Shikarpur Village Kiri Atta Mohammad 1 0 0 0 27‐Aug NNT TM Khan Anwar Colony, near Badin Bus stop 0 0 0 0 29‐Aug NNT Thatta Village Mureed Khoso Taluka Jati 1 0 0 0
The chart at the right shows the alerts and outbreaks detected by DEWS in Sindh in the past four weeks. The number of alerts overall is low in week 35 due to the Eid holidays, however, in the three previous weeks, there was an increasing trend for Acute Watery Diarrhea (AWD/ suspected cholera), Measles, Dengue Fever, and Malaria. Typically, in Pakistan, Falciparum Malaria peaks in September and Dengue Fever peaks in Octo‐ber or November. Last year the number of cases reported for both diseases were an all‐time high after the Flood due to in‐creased. DEWS is working toward early identification of out‐breaks in order to focus the vector control efforts on the high risk areas and plan integrated vector control for both diseases.
Regarding AWD, the risks of outbreaks increase as the rains cause the shallow wells to become contaminated with the overflowing sewers. Each family needs to take care to use safe drinking water. Measles outbreaks are another risk as people gather in camps to find shelter when their homes have been destroyed or damaged due to floods. Every camp should have a policy of immunizing the children against measles and polio as they are registered in the camp. So far, more than 9000 children IDPS have been immunized in Sindh.
15
19
26
96
36 6
42
8
213 2 33 2
0
5
10
15
20
25
30
Wk‐32 Wk‐33 Wk‐34 Wk‐35
# of alerts
Epi‐week
Number of alerts detected by week, Sindh (Wk 32 ‐ 35, 2011)
AWD NNT + Tetanus Measles DHF Malaria
Special Supplement: DEWS, Sindh, Week no. 35 (26 August to 1 September, 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
DEWS Alerts and Outbreaks number and type in province Sindh as of week 35, 2011
Special Supplement: DEWS, Sindh Week no. 35 (26 August to 1 September, 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]. 04
Alerts and outbreaks, week 35, 2011