weekly epidemiological flood response in pakistan · mushtaq lund village - taluka matli 5, 3, 5 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 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, Leishma-niasis, 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.

Highlights

Flood Response in Pakistan

01

Volume 2, Issue 3 Monday 24 January 2011

Table-1: Priority diseases reported during the week 48-2010 to week 3-2011

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

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%)

ARI (URI and LRI) 126,265 (29%) 156,168 (30%) 132,185 (30%) 166,801 (31%) 158,048 (31%) 199,912 (32%)

Other Acute Diarrhoea (Not Watery) 34,377 (8%) 33,188 (6%) 27,989 (6%) 37,100 (7%) 32,933 (6%) 37,530 (6%)

Bloody Diarrhoea 2,972 (1%) 3,943 (1%) 3,098 (1%) 3,925 (1%) 3,076 (1%) 4,055 (1%)

Suspected Malaria 30,633 (7%) 31,780 (6%) 27,111 (6%) 35,266 (6%) 25,791 (5%) 35,244 (6%)

Total consultation 428,159 522,284 444,112 544,147 509,612 623,374

Wk‐2

55,634 (9%)

204,639 (32%)

38,315 (6%)

4,229 (1%)

35,283 (5%)

641,864

Wk‐3

52,335 (8%)

205,962 (33%)

34,349 (5%)

4,145 (1%)

31,462 (5%)

629,410

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)

Epidemiological Bulletin: Flood Response in Pakistan

Fig-2: Weekly number of reporting health units (Week 33-2010 to week 3-2011)

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 2010 to 20 January 2011

Figure-3: Leading causes of seeking health care in the flood affected districts by province, 29 July 2010 to 20 January 2011

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

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 con‐sultations. This is the 1% lower proportional morbidity reported by DEWS in January 2010 lower than in January 2009.

Figure-4: Acute Diarrhea 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.

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 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.

Figure-5: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 2009, 2010 and 2011

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

Percentage

Epi week

2009

2010

2011

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

Percentage

Epi‐week

2009

2010

2011

914,690

595,554

145,055

60,159

1,017,175 996,161

913,087

207,276

576,480

464,664

264,769

92,333

388,335

48,507

141,989

27,858

156,342

437,676

74,000 116,556

1,041

79,100 31,425 25,826

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Punjab Sindh Khyber Pakhtunkhwa Balochistan

Number of cases

Skin Ds.ARIADUFS. MalBD

597

702 826

788

758

745

715

655

575

509

439

502

881 1259

1139

1342 1627

1391

1960

1939

2159

2295

2196

361375

411331 400

215 192153

128105

81 58

46

2626

11

8

12

8 11

11

11 11

0

500

1000

1500

2000

2500Mobile Fixed

Table-3: Alerts reported in week 2 and week 3 of 2011. Epidemiological Bulletin: Flood Response in Pakistan


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

9-Jan-11 H1N1 (2009)

Khyber Pakhtunkhwa

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 H1N1 (2009).

10-12 Jan 2011 H1N1 (2009)

Khyber Pakhtunkhwa

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 H1N1 (2009).

13-Jan-11 H1N1 (2009)

Khyber Pakhtunkhwa

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 H1N1 (2009)

Khyber Pakhtunkhwa

Haripur Chungi Bandi - Mori 45 M Patient with chronic illness and confirmed H1N1, hospitalized in Islamabad, was treated for five days but expired. No other suspected cases were found on investigation of home village.

15-Jan-11 H1N1 (2009)

Khyber Pakhtunkhwa

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 H1N1 (2009).

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 Khyber Pakhtunkhwa

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.


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.


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 Khyber Pakhtunkhwa

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

Khyber Pakhtunkhwa

Haripur TIP Colony ** ** 5 children reported to have chicken pox living in adjacent houses. Families counseled to give relevant symptomatic treatment.

13-Jan-11 Hypother-mia 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 hypo‐thermia due to exposure. Partners are requested to assist with food and shelter.

20-Jan-11 Leishmani-asis

Khyber Pakhtunkhwa

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 Khyber Pakhtunkhwa and 1 from Balochistan province.

S. NO. Province Districts SEX AGE (m) Date onset of Paralysis WPV Type

1 Khyber Pakhtunkhwa Khyber Agency M 27 29‐12‐2010 NSL1

2 Khyber Pakhtunkhwa Mohmand Agency F 11 30‐12‐2010 NSL1

3 Balochistan Pishin M 14 02‐01‐2011 NSL1



Province Khyber Pakhtunkhwa • 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 com-pared 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.

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 pa-tient 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 af-fected districts. This week a total of 4,467 ma-laria samples were tested of which 226 were posi-tive (slide positivity rate 5.06%), while falcipa-rum rate was 47.3%.

Figure-6: Trend of priority communicable diseases, province KP (31-July 2010 to 20 January 2011)

Figure-7: Trend of priority communicable diseases, province Punjab (3 August 2010 to 20 January 2011)

Diseases Wk-52 Wk-3

Skin Diseases 4,876 (4%) 5,061 (4%)

ARI (URI and LRI) 50,203 (45%) 55,725 (42%)

Other Acute Diarrhoea (Not Watery) 6,852 (6%) 7,394 (6%)

Bloody Diarrhea 731 (1%) 813 (1%)

Total consultations 113,012 131,568

Suspected Malaria 2,002 (2%) 1,423 (1%)

Wk-1

5,028 (4%)

57,092 (46%)

7,041 (6%)

809 (1%)

1,764 (1%)

125,259

Wk-2

5,383 (4%)

63,109 (45%)

7,842 (6%)

1,004 (1%)

1,940 (1%)

140,454

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

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].

05


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.

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%.

Diseases Wk-52 Wk-3

Skin Diseases 15,473 (10%) 28,254 (11%)

ARI (URI and LRI) 48,288 (32%) 76,167 (30%)


Bloody Diarrhea 933 (1%) 1,281 (1%)



Wk-1

27,627 (10%)

83,766 (32%)

14,974 (6%)

1,423 (1%)

22,769 (9%)

264,631

Wk-2

29,818 (11%)

82,340 (30%)

15,169 (5%)

1,418 (1%)

21,521 (8%)

276,026

Figure-8: Trend of priority communicable diseases, province Sindh (6 August 2010 to 20 January 2011)

Figure-9: Trend of priority communicable diseases, province Balochistan (6 August 2010 to 20 January 2011)

Diseases Wk-52 Wk-3

Skin Diseases 3,597 (7%) 4,504 (6%)

ARI (URI and LRI) 19,636 (36%) 24,144 (33%)


Bloody Diarrhea 1,394 (3%) 2,044 (3%)



Wk-1

3,769 (6%)

21,132 (36%)

4,137 (7%)

1,823 (3%)

5,551 (10%)

58,209

Wk-2

4,714 (8%)

19,067 (30%)

4,668 (7%)

1,807 (3%)

5,817 (9%)

62,550


Confirmed Alerts


weekly epidemiological flood response in pakistan · mushtaq lund village - taluka matli 5, 3, 5 f,...

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