weekly epidemiological flood response in pakistan · suspected malaria (mal) suspected measles (ms)...

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 5 (28 January to 3 February 2011) • Between 28 Jan to 3 Feb 2011 (epidemiological week no. 5, 2011), 58 districts in 4 prov-

inces provided surveillance data to the DEWS system.

• 2,196 fixed health and 8 mobile medical outreach centres provided surveillance data for this week.

• A total of 779,295 consultations were reported through DEWS of which 31% were acute respiratory infections (ARI), 9% skin disease, 6% acute diarrhoea, and 6% were suspected Malaria.

• Total 51 alerts reported in this Bulletin: 13 from week four and 31 from week five, while 7 alerts are from early in week six. 24 were for measles; 6 were for Influenza; 4 were for each Neonatal Tetanus and AFP; 3 were for Pertussis; 2 were for Viral Hemorrhagic Fever and Meningitis; 1 each for Acute Jaundice Syndrome, Acute Watery Diarrhea, Bloody Diarrhea, Chicken Pox, Diphtheria, and Tetanus

• There was no case of confirmed poliomyelitis reported this week 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 5 Monday 7 February 2011

Table-1: Priority diseases reported during the week 50-2010 to week 5-2011

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

Figure-1: Weekly trend of leading priority diseases in flood affected districts of Pakistan, 29 July 2010 to 27 January 2011 (Epi week 31, 2010 to week 4, 2011)

Diseases Wk-50 Wk-51 Wk-52 Wk-1 Wk-2 Wk-3 Wk-4 Wk-5

Skin Disease 35,686 (8%) 42,813 (8%) 41,435 (8%) 50,424 (8%) 55,947 (9%) 52,822 (8%) 67,253 (9%) 68,875 (9%)

ARI (URI and LRI) 132,185 (30%) 166,801 (31%) 158,048 (31%) 194,176 (32%) 208,819 (32%) 212,625 (33%) 231,441 (31%) 243,647 (31%)

Other Acute Diarrhoea (Not Watery) 27,989 (6%) 37,100 (7%) 32,933 (6%) 36,460 (6%) 39,041 (6%) 35,250 (5%) 41,155 (6%) 44,491 (6%)

Bloody Diarrhoea 3,098 (1%) 3,925 (1%) 3,076 (1%) 3,975 (1%) 4,310 (1%) 4,251 (1%) 5,351 (1%) 4,809 (1%)

Suspected Malaria 27,111 (6%) 35,266 (6%) 25,791 (5%) 34,340 (6%) 35,356 (5%) 31,624 (5%) 37,108 (5%) 43,583 (6%)

Total consultation 444,112 544,147 509,612 607,661 651,856 644,796 739,563 779,295

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Epidemiological Bulletin: Flood Response in Pakistan

Fig-2: Weekly number of reporting health units (Week 33-2010 to week 5-2011)

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 3 February 2011

Table-2: Measles Case-based Surveillance Status - Pakistan (2010)

Diseases Total

Skin Diseases 1,851,005 (12%)

Acute Respiratory Infection 3,615,426 (24%) Other Acute Diarrhoea (Not Watery) 1,484,642 (10%)

Bloody Diarrhoea 147,678 (1%) Suspected Malaria 864,613 (6%) Unexplained Fever 658,894 (4%)

Total Consultations 15,281,061

Since July 29, 2010, a total of 1,484,642 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 receiving in 2011 are compared to the reports of 2010 and 2009 from disaster‐affected districts. This week, DEWS received 44,491 reports of acute diarrhea, 6% of total con‐sultations. This is the same proportional morbidity (6%) reported by DEWS in week‐5/2010 and in week‐5/2009.

Figure-4: Acute Diarrhea trends, Disaster affected districts, Pakistan 2009, 2010 and 2011

Since July 29, 2010, approximately 3,615,426 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 receiving in 2011 are compared to the reports of 2010 and 2009 from disaster‐affected districts. This week, DEWS received 243,647 reports of Acute Respiratory Infection, 31% of total consultations, 1% lower than the proportional morbidity reported by DEWS in week‐5/2010 but the same as week‐5/2009.

Figure-3: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 2009, 2010 and 2011

Province Total estimated population Number of suspected measles cases reported including from outbreaks

Number of specimen col‐lected and sent for lab confirmation

Number of Lab confirmed measles cases

% of specimen collection for lab confirmation (min: 80%)

Punjab 89,039,776 480 474 154 99%

Sindh 37,992,536 1,645 1,396 961 85%

KP 22,259,944 1,729 359 175 21%

FATA 3,411,082 83 7 3 8%

Balochistan 8,033,664 25 25 18 100%

AJK 3,514,728 14 14 2 100%

GB 1,506,313 27 27 6 100%

ICT 1,338,944 10 10 6 Na

Total 167,096,987 4,013 2,312 1,325 58%

597 702

826

788

758

745

715

655

575

509

439

502 88

1 1259

1139 1342 162

7

1391 19

60

1939 2159

2295

2196

2190

2196361

375411

331400215192

153128

10581 58

46

2626

11

8

12

8 11

1111 11 8 8

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1000

1500

2000

2500 Mobile Fixed

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200920102011

02468

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2010

2011

Table-3: Alerts reported in week 4 and week 5 of 2011. Epidemiological Bulletin: Flood Response in Pakistan


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

17-Jan-11 Measles Sindh Kashmore BHU Jahan Khan 5,5 F,F Upon field investigation 2 suspected cases were found. Samples were collected and found positive. Cases were treated with two doses of vitamin A and unimmunized children in community were vaccinated.

22-Jan-11 Measles Khyber Pakhtunkhwa

Upper Dir SHC Darora 6 F Upon field investigation 1 suspected case was found. Sample was collected and found positive for Measles. Case was treated with two doses of vitamin A and unimmunized children in the community were vaccinated.

22-Jan-11 AWD Sindh Kamber Shahda Kot

village Abdul Wahid Chandio uc Dost Ali taluka Kamber

7,3,30 M,M,F Alert was reported by NGO. Team responded and found diarrhea cases but none meeting definition of AWD/suspected cholera. HE session conducted. Aqua tab and Hygene kit were distributed.

22-Jan-11 Measles Sindh Kashmore BHU Azim Golo 3,6 M,F Upon field investigation 1 suspected case and 1 death of 3 year old child has been reported from suspected Measles. Case was treated with two doses of vitamin A and unimmunized children in the community were vaccinated.

22-Jan-11 Measles Sindh Kashmore BHU Din Muhammad 3, 3, 2, 4, 2, 2

F, F, M, M, M, M

Upon field investigation 6 Suspected cases were found. No sample was collected due to refusal. Vitamin A was also offered but refused. Mass vaccination is planned for the area.

24-Jan-11 Diphtheria Khyber Pakhtunkhwa

Peshawar LRH (Muhalla Gulab Ahmed Khel) 5 M

Alert was reported by LRH. ADS was administered and patient is improving. Throat swab was cultured at NIH and found positive for Corynebacterium Diphtheriae.

26-Jan-11 Measles Sindh Jacobabad Thul City, UC Thul I - Private Clinic 18m, 6 F, F

Upon field investigation 2 Suspected cases were found. These patients were missed during the campaign. Vitamin A was given to the patients. 2 Samples were collected and sent to NIH. Unimmunized children in the community were vaccinated.

26-Jan-11 AFP Sindh Ghotki

THQ Ghotki (Village MirBahar, UC Hussain Beli; Village Chodri Nazir, UC Sardar MK Ghoto; Drig Mallok Wali)

5, 1.5, 2 M, M, M AFP cases reported by Pediatrician THQ. Stool samples collected. Investigation underway.

26-Jan-11 VHF Sindh Jacobabad Hindu Muhalla Thull City Jacobabad 24 M

Alert from Jacobabad, patient traveled to Sukkur for treatment, Dengue test was negative.

27-Jan-11 Measles Sindh Badin Umer Wadho Village - UC Dubi

2, 11, 10, 3, 5, 4, 3, 2, 1, 5, 3,

4

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

Upon field investigation 12 Suspected cases were found. 1/4 samples collected were positive for Measles. Vit.A doses were administered to all patients. Health education was imparted. Unimmunized children in the community were vaccinated, but due to size of outbreak vaccination campaign is planned.

29-Jan-11 AJS Khyber Pakhtunkhwa

Haripur Baji Dara Village-UC Kundi

6, 4, 5, 5, 3

M, M, F, M, M

Alert for AJS was reported from BHU Kundi, Haripur. Upon visiting the adjacent village Baji Dara, UC Kundi 20 suspected cases were found with typical jaundice symptoms. 5 samples were collected and all found positive for Hepatitis A. Health education was given. 360 Antiseptic soaps, 41 family straw filters, 30 Nerox filters and 32,000 aqua tabs were provided. IEC material was also provided to the community.

30-Jan-11 BD Khyber Pakhtunkhwa

Haripur BHU Kothera

18, 9, 10, 13, 8m,

7m, 11m, 6m

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

Alert for bloody diarrhea was reported from BHU Kothera, Haripur. Upon field visit 8 suspected cases were found. No samples were collected as all patients were on antibi‐otics and were recovering. 4/5 water samples were collected and bacteriological contamination was found. Health education was given. Antiseptic soaps, straw filters and aqua tabs were provided. IEC material was also distributed.


Swabi Kunda More 4, 2, 3.5 F, F, M

Upon field investigation 3 Samples were collected from suspected measles cases and all found positive. Vit. A was given. Unvaccinated children of the community were vaccinated. Health education session was conducted. During active surveillance no other active cases were found.

31-Jan and 3 Feb-2011 Measles Sindh Mirpur Khas

Karam Ali Laghari Village; Village Azeem Leghari

7, 4, 3 M, M, F Upon field investigation 3 Suspected cases were identified from 2 UCs and tested positive for measles. Vitamin A doses, vaccination in community, and health education was complete, while active case finding is ongoing.

31-Jan-11 VHF Sindh Ghotki Kalu Sangi Village-UC Bandh 6 F

Suspected case was reported but field investigation revealed misdiagnosed case. Patient is improved.

31-Jan-11 NNT Sindh Ghotki

K. Bux Mahar Vill-T Khangarh; MCH(UC Ruk); MCH (Suleman Pahore Vill-UC Bhand)

12 days, 8days, 8days

M, F, M

Suspected case of NNT went LAMA from MCH centre. Field visit revealed that patient expired due to complications. 2nd case 2 days later also expired. Field investigation underway. 3rd case on 4 Feb treated with TIG and improving. Mother was not vacci‐nated against TT.

31-Jan-11 H1N1 (2009) Khyber Pakhtunkhwa

Peshawar KTH (Karkhano Market) 50 F Alert was reported from KTH, Peshawar. Suspected case was found with flu like symp‐toms. Sample was found negative for Influenza.


Swat

THQ Matta (Nehar-UC Matta); CH Kabal (Damgar Shahi Bagh-UC Dherai)

11m, 7 F, F 2 Suspected cases were reported from health facilities. Samples were collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized chil‐dren in the community were vaccinated.

27-Jan-11 Measles Sindh Badin Sher Muhammad Nuhrio Village - UC Gharo

3, 5, 5, 7, 6, 4, 1.5,

4, 5

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

F

Upon field investigation 9 Suspected cases were found. 4/5 samples collected were positive for Measles. Vit.A doses were administered to all patients. Health education was imparted. Unimmunized children in the community were vaccinated, but due to size of outbreak vaccination campaign is planned.


Mardan

DHQ Mardan (Moh. Rasoolabad, village Mayar/ Moh. Badragai, village Mohabat Khan Shergarh

2m, 45 days F, M

Alert was reported from DHQ Mardan. Suspected cases were found with flu like symptoms. Samples were found negative for Influenza.


Swabi

BKMC (Balar Khel -Zaida; Village Kala-Hostel; Quaid-e-Azam Hostel-Private; Mankai Mohalla-Kirki; Totali-Bunir)

11, 19, 18, 25, 18

F, M, M, F, M

Alert was reported from BKMC, Swabi. Suspected cases were found with flu like symptoms. All samples were found negative for Influenza.

29-Jan-11 NNT Sindh Ghotki Khawand Bux Mahar Vilage-Taluka Khangarh 12days M

Suspected case of NNT went LAMA from MCH center, Ghotki. Field visit revealed that patient expired due to complications.

27-Jan-11 H1N1 (2009) Punjab DG Khan Commerce College 28 F Hopitalized case of influenza‐like illness, sampl collected and sent to NIH.

29-Jan-11 Meningitis Sindh Mirpur Khas Civil Hospital (DHQ) 6 F Reinforced case management, isolation, health education, CFR DR revealed bacterial meningitis, culture negative due to pre‐tx with antibiotics.

29 to 31 Jan-2011 Measles Sindh Jamshoro

Jan Muhammad Behr-mani, Burfat Muhala, Taluka Kotri

14m, 8m F, F Alert was investigated and, after active case search, found false. Suspected measles case identified next day at different UC. Blood sample sent to NIH, Vitamin A doses, Isolation, Health education, Active Surveillance ongoing.

Epidemiological Bulletin: Flood Response in Pakistan Table-4: Alerts reported in week 4 and week 4 of 2011. (Cont’d)

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

31-Jan-11 Measles ICT Islamabad

Children's Hosp, PIMS (Muhalla Mullan-Saray Kharboza)

4.5, 3.5, 3.5 F, F, M

Alert was reported from CH PIMS, Islamabad and 3 cases were reported. Vit.A was given. Sample was collected from 1 patient and found positive for Measles. CDA was notified for mass vaccination and 1100 children were vaccinated.

1-2-Feb-11 Pertussis Sindh Ghotki

Azeem Oghai Village - UC; Hussain Beli; Sindhi Primary School, Mathelo Chowk

2, 5 M, M Upon field investigation a suspected case was found in UC Hussain Beli. Active surveillance found no other cases. Later alert from school was foun to be rumor.

1-Feb-11 Measles Balochistan Jaffarabad Kaliri Village - BHU Gandakha

3, 3, 16m, 17m, 5,

14m, 4, 7, 4, 15

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

F

Alert was reported from BHU Gandakha, Jaffarabad and upon field visit 10 cases were reported. Samples were collected from 3 patients and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated.

1-Feb-11 H1N1 (2009) Khyber Pakhtunkhwa

Mardan KTH (UC Maday Baba) 55 M

Alert was reported from KTH, Peshawar. Suspected case was found with flu like symptoms. Sample was found negative for Influenza.

1-Feb-11 Measles Khyber Pakhtunkhwa

Mardan DHQ Mardan (Afridi Mohalla-Sugar Mill Road)

2.5, 4m M, F 2 Suspected cases were reported from health facility. Samples were col‐lected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated.


Haripur BHU Tofkian 3.5 M

1 Suspected case was reported from health facility. Sample was collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. No other new cases were found.

1-Feb-11 Measles Sindh Khairpur BHU Bachal Bhambroo 18m, 5 F, F

2 Suspected cases were reported from health facility. Samples were col‐lected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated.

1-Feb-11 AFP Khyber Pakhtunkhwa

Shangla Shadad Mohalla-Dandai Village 54m M AFP case was notified. Stool samples collected. Investigation underway.

1-Feb-11 Tetanus Sindh Jacobabad CMC Hospital Larkana (Garhi Khairo Taluka)

9 M Upon field investigation a suspected case was found. TIG was provided by WHO. Patient is improving.

2-Feb-11 Pertussis Sindh Naushahro Feroze

Chakar Chandio Village -UC Abad 6, 4, 10, 10 M, M, M,

M Upon field investigation 24 suspected cases were found. 4 samples were collected and sent to NIH. Hygiene education sessions were conducted.

2-Feb-11 NNT Balochistan Bolan DHQ Sibi (Kachhi-Bolan) 15days M

Upon field investigation 1 Suspected case was found at DHQ Sibi. Patient expired the same day. Mother had no TT vaccination. Infant delivered at home without clean delivery kit.

3-Feb-11 Chicken Pox Khyber Pakhtunkhwa

Haripur RHC Sirikot (Bottigram) 9, 5, 11, 11 M, M, F,

F

Alert was reported for suspected measles cases. Upon field investigation, physical examination revealed chicken pox cases. During active surveil‐lance no other cases were found.

3-Feb-11 Measles Balochistan Quetta BHU Pashtoona-bad 14m, 5, 4 M, M, M

Upon field investigation 3 samples were collected from suspected measles cases and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated. No other cases were found.

3-Feb-11 AFP Balochistan Sibi DHQ Sibi (Kut-mundai) 8m M

During active surveillance an AFP case was notified. Stool sample collected and sent to NIH. Investigation is underway.

3-Feb-11 AFP Sindh Mirpur Khas Civil Hospital (DHQ) 8m, 12, 6 F, M, F AFP cases were notified. Stool samples collected. Investigation underway.


Upper Dir Barawal (DHQ Timargara-Lower Dir)

11m M Alert was reported from DHQ Timergara, Lower Dir. Suspected case was found with typical measles symptoms. Sample was collected and sent to NIH. Vit. A was given, Hygiene education session was conducted.

4-Feb-11 Measles Sindh Ghotki Mandar Mohalla - Mirpur Mathelo 3.5, 3 F, M

2 Measles cases were found and treated with two doses of vitamin A. Investigation is underway.

4-Feb-11 Meningitis Sindh Ghotki MCH Center-UC Khanpur Mahar 6 F

Alert was reported from health facility. Investigation is under way and followup is planned.

5-Feb-11 Measles Sindh Ghotki Habibullah Gabol Village-UC Garhi Chakar

2.5, 1, 15, 4

F, M, M, F

Upon field investigation 17 suspected cases were found and 1 death was reported. 4 samples were collected and sent to NIH. Vit.A was given to active cases. Mopping activity in the 5Km area is planned with the help of district authorities.

5-Feb-11 Measles Sindh Ghotki Gul Muhammad Gabol Village-UC Garhi Chakar

5 M Upon field investigation 7 suspected cases were found. 1 sample was collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated.

5-Feb-11 Measles Sindh Hyderabad Shah Latif, Lalo Lashari Colony 11, 9m F, F

During active surveillance 2 Measles cases were found. 2 samples were collected and sent to NIH. Cases were treated with two doses of vitamin A and unimmunized children in the community were vaccinated.

1-Feb-11 H1N1 (2009) Punjab Multan Shadab Colony, MDA Chowk 60 M

Hospitalized case of influenza‐like illness, sample collected and sent to NIH.




Province Khyber Pakhtunkhwa • This week 14 districts reported to DEWS from

KP province, 506 health centers reported 141,901 patients consultations to DEWS.

• ARI is the leading disease in KP province. ARI cases reported 57,733 (41%), 1% less propor-tional morbidity as compared with last week.

• 15 alerts are reported in this Bulletin for weeks 4 and 5; of which 6 were for Measles, 4 were for Influenza, while 1 each for Diphtheria, Acute Jaundice syndrome, Bloody diarrhoea, Acute Flaccid Paralysis, and Chicken Pox.

Province Punjab • 11 districts reported data to DEWS from Punjab

province

• 753 fixed health centers reported a total of 185,273 patient consultations during this report-ing period

• ARI cases reported were 49,952 (27%), 1% lower as compared with last week.

• Two hospitalized cases were found with influ-enza like illness. Throat swabs were collected and sent by reverse cold chain to NIH for proc-essing

• Malaria cases are still reported from flood af-fected districts. This week a total of 6,752 ma-laria samples were tested of which 204 were posi-tive (slide positivity rate 3.0%), while falciparum rate was 52.4%.

Figure-5: Trend of priority communicable diseases, province KP (31-July 2010 to 3 February 2011)

Figure-6: Trend of priority communicable diseases, province Punjab (3 August 2010 to 3 February 2011)

Diseases Wk-2 Wk-5

Skin Diseases 5,618 (4%) 5,862 (4%)

ARI (URI and LRI) 65,714(44%) 57,733 (41%)

Other Acute Diarrhoea (Not Watery) 8,332 (6%) 8,590 (6%)

Bloody Diarrhea 1,064 (1%) 1,072 (1%)

Total consultations 147,751 141,901

Suspected Malaria 1,995 (1%) 2,040 (1%)

Wk-3

5,470 (4%)

60,125(42%)

8,040 (6%)

906 (1%)

1,584 (1%)

143,081

Wk-4

5,908 (4%)

64,368 (42%)

9,148 (6%)

951 (1%)

1,719 (1%)

155,340

Diseases Wk-2 Wk-3 Wk-4 Wk-5

Skin Diseases 15,719 (10%) 14,516 (9%) 15,613 (8%) 15,862(9%)

ARI (URI and LRI) 40,123 (25%) 49,926 (29%) 53,761 (28%) 49,952 (27%)

Other Acute Diarrhoea (Not Watery) 10,636 (7%) 7,981 (5%) 10,410 (5%) 9,590 (5%)

Suspected Malaria 6,005 (4%) 4,557 (3%) 4,851 (2%) 5,288 (3%)

Total consultations 162,834 170,424 194,134 185,273

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Province Sindh

• This week 21 districts reported to DEWS from Sindh province, and 631 health centers re-ported a total of 385,172 patient consultations during the reporting period of week 5, 2011.

• In Sindh, ARI cases reported were 114,907 (30%), 2% higher as compared with last week

• 30 alerts are reported in this Bulletin for weeks 4 and 5: 16 were for suspected Measles; 3 were for each Neonatal Tetanus and Pertussis; 2 were for each Viral Hemorrhagic Fever, Acute Flaccid Paralysis, and Meningitis; while 1 was for each Acute Watery Diarrhea and Tetanus

Province Balochistan

• In this week, 11 districts reported to DEWS from Balochistan province. 302 fixed and 8 mobile medical outreach centers reported to DEWS

• A total of 63,522 patient consultations were reported during the reporting period of week 5, 2011.

• In Balochistan, ARI cases reported were 19,133 (30%), same proportional morbidity as com-pared with last week.

• 3 alerts were reported for weeks 4 and 5 in this Bulletin: one alert each of NNT from Bolan and AFP from Sibi and a suspected Measles outbreak in Jafferabad.

Diseases Wk-2 Wk-5

Skin Diseases 29,818 (11%) 43,499 (11%)

ARI (URI and LRI) 82,340 (30%) 114,907 (30%)


Bloody Diarrhea 1,418 (1%) 1,964 (1%)



Wk-3

28,254 (11%)

76,167 (30%)

13,895 (5%)

1,281 (1%)

18,617 (7%)

253,862

Wk-4

40,191 (13%)

89,402 (28%)

16,679 (5%)

2,123 (1%)

23,485 (7%)

314,655

Figure-7: Trend of priority communicable diseases, province Sindh (6 August 2010 to 3 February 2011)

Figure-8: Trend of priority communicable diseases, province Balochistan (6 August 2010 to 27 January 2011)

Diseases Wk-2 Wk-5

Skin Diseases 4,714 (8%) 3,591 (6%)

ARI (URI and LRI) 19,067 (30%) 19,133 (30%)


Bloody Diarrhea 1,807 (3%) 1,769 (3%)



Wk-3

4,504 (6%)

24,144 (33%)

5,079 (7%)

2,044 (3%)

6,865 (9%)

73,556

Wk-4

4,936 (8%)

19,095 (30%)

4,550 (7%)

2,213 (3%)

6,808 (11%)

63,648

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Islamabad Capital Territory

• This week Islamabad is reporting from four health centers, and a total of 3,427 patient consultations.

• ARI cases reported were 1,922 (56%), 6% higher as compared with last week, but overall higher than other areas.

Figure-9: Trend of priority communicable diseases, Islamabad (1 - 27 January 2011)


Focus on: Tetanus and Neonatal Tetanus

Diseases Wk-2 Wk-5

Skin Diseases 78 (3%) 61 (2%)

ARI (URI and LRI) 1,575 (58%) 1,922 (56%)

Other Acute Diarrhoea (Not Watery) 236 (9%) 302 (9%)

Bloody Diarrhea 21 (1%) 4


Suspected Malaria 18 (1%) 9

Wk-3

78 (2%)

2,263 (58%)

255 (7%)

13

1

3,873

Wk-4

44 (1%)

1,950 (51%)

104 (3%)

6

10

3,810

DEWS has had alerts from November 2010 to this month from Balochistan and Sindh for cases of both Tetanus and Neonatal Tetanus. It is likely that there are other un-reported cases of both of these diseases in other areas of Pakistan as well due to low levels of immunity. Teta-nus is not spread by human to human contact so it is not occurring in epidemics but it may occur in geographic clusters where the population is unimmunized and it has overall a 45% mortality rate. Tetanus is caused by a toxin produced by the bacteria Clostridium tetani which live predominantly in the soil. It is easy to get this infection whenever a break in the skin is not cleaned properly. For instance, anyone who has not been immunized against tetanus in the last ten years and sustains a deep wound or any dirty puncture, cut or abrasion during flood clean-up is susceptible to tetanus.1

Similarly, Neonatal Tetanus affects a newborn when the mother is not adequately vaccinated against tetanus and if the infant’s umbilical cord is not kept clean or if non-sterilized instruments or dressings are used on the cord. Confirmation of neonatal tetanus is entirely clinical and does not depend upon bacteriological confirmation. The Confirmed Case Definition is any neonate with a normal ability to suck and cry during the first two days of life and who, between the ages of 3 and 28 days cannot suck normally and becomes stiff or has convulsions or both.2 Tetanus signs and symptoms in older children and adults include: sardonic smile (mocking smile), lock jaw (cannot open the mouth), opist-hotonos (stiff arched back), and rigid abdomen. Other symptoms include elevated temperature, sweating, elevated blood pressure, and epi-sodic rapid heart rate. In tetanus, noise, bright light, touching the body or moving part of the body will trigger muscle spasms. Spasms last for several minutes and may occur frequently, interfering with breathing when they affect the larynx and muscles of respiration. Therapeutic objectives of treatment of tetanus include prevention of further spasms by killing Clostridium tetani to stop further toxin pro-duction (antibiotic); neutralising circulating toxin (tetanus immunoglobulin – TIG); administering muscle relaxants; and provision of suppor-tive care till spasms cease completely. A suspected case of tetanus or neonatal tetanus should always be admitted to the hospital. WHO recommendations are to use Human Tetanus Immunoglobulin (TIG) for tetanus treatment: Adults and Children: 150 units/kg (or 3000-6000 units) IM, single dose; Neonates: 500 units IM, single dose. TIG provides protection longer than antitoxin of animal origin (ATS) and causes few adverse reactions. Tetanus disease does not induce immunity; patients without a history of primary TT vaccination should receive a second dose 1–2 months after the first dose and a third dose 6-12 months later. 1Trenwith, C. Flood clean-up strains medical supplies. Brisbane times. http://www.brisbanetimes.com.au/queensland/flood-cleanup-strains-medical-supplies-20110119-19w2w.html. 2NIH, Pakistan. Case Definitions and Standard Procedures… August 2009. 3Dire, D. Tetanus: Treatment & Medication. Medscape article. Sep 16, 2010. http://emedicine.medscape.com/article/786414-treatment

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Year 2011: In week-4 two new type-1 polio cases were confirmed by the laboratory from Khyber Pakhtunkhwa - KP (Peshawar district) and Federally Administered Tribal Areas - FATA (Khyber Agency). The total number of infected districts/towns/agencies is 3 to date.

Province Cases 2010 Cases 2011

P1 P3 P1 P3

PUNJAB 6 1 - -

SINDH 26 1 - -

KHYBER-PAKHTUNKHWA 19 5 1 -

FATA 63 11 2 -

BALOCHISTAN 6 6 - -

AJK - - - -

GILGIT-BALTISTAN - - - -

ISLAMABAD - - - -

PAKISTAN 120 24 3 -

Maps: Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases in 2010 so far is 144 including 120 type-1 cases and 24 type-3 cases and the total number of infected districts/towns/agencies is 40 to date.


To support the national commitment to polio eradication, we are dedicating one page to polio eradication activities every week in the Weekly Epidemiologic Bulletin.

On 31 January 2011 a sub-national polio immunization campaign began in 56 districts/ towns/ agencies of the country, targeting 13.13 million children aged below five years. Please see following map (Pakistan).

Campaign in Sindh will start on 2nd February. DEWS Surveillance Officers are also participating in the campaigns and the polio eradication effort.

Confirmed Alerts Epidemiological Bulletin: Flood Response in Pakistan


weekly epidemiological flood response in pakistan · suspected malaria (mal) suspected measles (ms)...

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