weekly epidemiological · village rajo lashari, uc dhingano bozdar 2 3 1 1 awd alert, during active...

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. 43 (21 to 27 October, 2011) • 81 districts and 2 agencies provided surveillance data to the DEWS this week from

2,514 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC.

• A total of 802,810 consultations were reported through DEWS of which 192,059 (24%) were acute respiratory infections (ARI); 69,127 (9%) were Skin disease; 62,127 (8%) were acute diarrhoea; and 58,508 (7%) were suspected Malaria.

• A total of 140 alerts with 11 outbreaks were reported in week‐43, 2011: Altogether 33 alerts were for Dengue Fever, 33 for AWD, 28 for Measles, 17 for Neonatal tetanus and Tetanus, 10 for Leishmaniasis, 6 each for Malaria and Pertussis, 1 Bloody diarrhoea, while 6 for other non‐communicable diseases.

• National Polio Eradication Initiative reported 4 new polio cases, 1 each from Sindh (Thatta), FATA (Waziristan North), Balochistan (Pishin) and Khyber Pakhtunkhwa (Swabi). As of 31st October, 2011, Pakistan has reported a total of 136 polio cases (134 type‐1 and 2 type‐3) from 42 districts/towns/tribal agencies/areas. Please see map on page 6.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 43, Monday 31 October, 2011

Priority diseases under surveillance

in DEWS

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 Diarrhoeas (AD)

Suspected Viral Hemorrhagic Fever (VHF)

Suspected Malaria (Mal)

Suspected Measles (MS)

Suspected Meningitis (MG)

Others

Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 27 October 2011 (Epi week 31, 2010 to week 43, 2011)

Disease Wk-36 Wk-37 Wk-38 Wk-39 Wk-40 Wk-41 Wk-42 Wk-43

Acute diarrhoea 96,128 (11%) 109,523 (12%) 110,835 (11%) 105,295 (11%) 97,007 (10%) 92,214 (9%) 73,343 (8%) 62,127 (8%)

Total consultation 864,693 931,318 1,005,251 995,450 1,014,266 1,023,163 886,224 802,810

Suspected malaria 58,753 (7%) 64,766 (7%) 78,109 (8%) 83,684 (8%) 82,802 (8%) 85,698 (8%) 68,059 (8%) 58,508 (7%)

Acute respiratory infection 158,580 (18%) 175,906 (19%) 193,771 (19%) 205,597 (21%) 209,436 (21%) 221,144 (22%) 210,475 (24%) 192,059 (24%)

Bloody diarrhoea 7,387 (0.85%) 7,920 (0.85%) 8,676 (0.86%) 9,393 (0.94%) 8,075 (0.80%) 8,016 (0.78%) 6,007 (0.68%) 5,389 (.67%)

Skin diseases 104,676 (12%) 107,435 (12%) 107,243 (11%) 105,912 (11%) 95,842 (9%) 93,937 (9%) 80,944 (9%) 69,127 (9%)

Since July 29, 2010, approximately 50,324,518 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on about 1,000,000 consultations per week, there is a drop in timely reporting due to challenges in accessibility caused by floods, security and infrastructure. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 6 weeks (38 to 43, 2011) acute diarrhoea cases have been decreased (From 12% to 8%), while at the same time cases of ARI have been increased (From 18% to 24%). Sus‐pected Malaria cases have also shown seasonal increase from week 35 especially from districts in Sindh and Balochistan.

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AD BD ARI S. Malaria

Epidemiological Bulletin: DEWS, Pakistan, Week no. 43 (21 to 27 October, 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, 02

Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

27‐Oct Malaria Balochistan Jhal Magsi BHU Barija 3 8 5 7 Alert for suspected Malaria, 23 cases were reported. 21 samples were taken and 17 verified positive (PF=5,PV=8,and Mix=4); SPR=81%, while FR = 53%. RDTs were distributed and DHO was informed.

27‐Oct CCHF KPK Haripur Village Khidoo 0 1 0 0

Alert for CCHF, one death of a suspected CCHF case was reported from village Khaido, district Haripur. The patient had initially presented with fever and body aches. Lab investigations revealed thrombocytopenia. Blood sample was taken and sent to NIH which came back positive for CCHF. A joint team of WHO and Dept of health visited the area. Epidemiological and environmental assessments were carried out. A session on CCHF spread and prevention was conducted in the community. EDO Health was informed. Residual spray in the area was also carried out.

25‐Oct AWD Sindh Badin Ward # 05, UC Talhar 2 2 0 2 AWD alert, suspected case found in Hospital and investigated during active surveillance 5 more cases were found, health education provided. Aqua tabs, Zinc tabs, ORS and Hygiene kits were distributed. EDO‐H informed, 1 stool and 2 water sample taken.

26‐Oct AWD Sindh Sanghar IDP camp near Village Berwari 2 11 2 7 AWD alert, suspected case with deaths reported from IDP camp, during active surveillance found 21 more cases. Hand pump was the source of water, health education provided, Aqua tabs, Zinc tabs, ORS, Jerry cans and hygiene kits were distributed. EDO‐H and DSM informed, 1 stool and 2 water samples were taken.

24‐Oct AWD Sindh T. Allah Yar Village Rajo Lashari, UC Dhingano Bozdar

2 3 1 1 AWD alert, during active surveillance 7 more cases found with severe dehydration, health education im‐parted. Aqua tabs, Zinc tabs, ORS, Jerry cans and hygiene kits were distributed. EDO‐H informed, 1 stool and 2 water samples were taken.

22‐Oct Malaria Sindh Dadu Village Loolja, UC Kandi chukki

0 0 0 0 Alert for Malaria, 20 cases were investigated, 11 confirmed by RDT, SPR=55%, health education was im‐parted. TMA/TMO, EDO‐H and DOH were informed and requested for fumigation.

23‐Oct Malaria Sindh Tharparkar Tent Village, Nohato Road 1 18 1 10 Alert for Malaria, 30 cases were investigated, 49 RDT conducted out of them 30 were confirmed, SPR=61%, health education imparted. Bed nets were provided to the patients; EDO‐H, Malaria Focal Person were informed.

25‐Oct Pertussis Sindh Ghotki Village Allah Wasayo 7 2 4 1

Alert for probable Pertussis, 14 suspected cases were found during the monitoring of polio campaign at village Allah Wasayo Chachar, UC Qadirpur. House to house search was carried out, routine immunization status was found to be zero. Health education imparted in the village and informed EDOH and DSV and requested for vaccination in the village.

26‐Oct Pertussis Sindh Ghotki Village Khuda Bux Marnas 2 1 1 1

Alert for Pertussis, 5 suspected cases were found during the monitoring of polio campaign at village Khuda Bux Marnas, UC Bago Daho. House to house case searching done, routine immunization status was found to be zero. Health education imparted in the village and informed EDOH and DSV and requested for vaccina‐tion in the village.

27‐Oct AWD Sindh Jamshoro Malik Shah Town, UC Nago‐line

3 2 0 1 AWD alert, suspected case admitted in hospital with Dehydration, during active surveillance found 5 more cases, water supply was the source, health education imparted, Aqua tabs, Zinc tabs, ORS, Jerry cans and IEC material distributed, EDO‐H informed, 1 stool and 2 water samples were taken.

27‐Oct AWD Sindh Mirpur Khas Village Fazil Noohani, Digri City

1 3 1 2

AWD alert, suspected case found in Hospital during active surveillance 6 more cases were found in the village, health education imparted to house hold, Doctors and Paramedic briefed on case definition and reporting. Aqua tabs, Zinc Tabs, ORS and hygiene kits were distributed. Water sample was found contami‐nated.

Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F

27‐Oct AWD Battagram Village Shingli Bala, UC Gijjbori 0 1 0 0

25‐Oct BD Kohat Village Garhi Mawaz Khan 0 2 0 6

27‐Oct CCHF Haripur Village Khidoo, Haripur 0 1 0 0

21‐Oct DHF D. I. Khan Gur Wali, Kirri Shamozai, Tehsil Paroa, 0 1 0 0

26‐Oct DHF D. I. Khan P.O. Kot Jai, Tehsil Pahar Pur 0 1 0 0

24‐Oct DHF Haripur Haripur city 0 1 0 0

25‐Oct DHF Haripur Saidan Kharan, Haripur 0 1 0 0

21‐Oct DHF Lower Dir Village & UC Khungi Sha, Tehsil Timar‐ 0 1 0 0

22‐Oct DHF Lower Dir Village & UC Rabat, Tehsil Timargara 0 1 0 0

27‐Oct DHF Shangla Mohallah Ali Khel , Village Choga 0 1 0 0

23‐Oct Diphtheria Kohistan Village Dhaan (Thapan), UC Ranolia 2 1 0 0

27‐Oct Leishmaniasis Tank Dabarra 1 0 0 0

21‐Oct Measles D. I. Khan Arra, Tehsil & District D I Khan 1 0 0 0

21‐Oct Measles D. I. Khan Kokar, Tehsil & District D I Khan 0 0 1 0

21‐Oct Measles D. I. Khan Kot Jai, Tehsil Pahar Pur, District D I Khan

0 0 1 0

25‐Oct Measles Lower Dir Village Barghando, UC & Tehsil Lal Qilla 0 0 0 1

25‐Oct Measles Lower Dir Village Meergam Payeen, UC Gall & Lal Qilla

0 0 1 0

26‐Oct Measles Lower Dir Village Khan Abad, UC Kotkay, Tehsil 1 1 0 1

27‐Oct Measles Malakand Haybatgram 2 1 2 2

25‐Oct Measles Mardan Mohallah Chachi, Khwaja Ganj Bazar 1 0 0 0

25‐Oct Measles Mardan Mohallah Faujiabad, UC Dagaai Sikan‐dari

1 0 0 0

21‐Oct Measles Swabi BMC Swabi, Shagai Maneri 1 0 2 0

22‐Oct Measles Swat Village and UC Udigram near 0 0 1 0

25‐Oct Measles Tank JannatAbad, ChesanKuch, KirriHaider and UmerAdda

1 2 0 1

27‐Oct NNT Swabi IDH Peshawar 0 0 2 0

Current week's Alerts: Province Balochistan Date Disease District Area <5M >5M <5F >5F

26‐Oct DHF Quetta Fatima Jinnah Chest Hospital 0 2 0 0

26‐Oct Leishmaniasis Awaran wadi UC camp Jhaoo 1 0 0 0

21‐Oct Leishmaniasis Jhal Magsi Balina kotra UC Khari CD Kotra 1 0 0 0

25‐Oct Leishmaniasis Jhal Magsi DHQ Hospital‐Basti Kamal Shah UC Gandawah 1 0 0 0

24‐Oct Leishmaniasis Kalat Khail UC Kalat Saddar Tehsil Kalat 0 1 0 0

27‐Oct Leishmaniasis Khuzdar Tehsil Khuzdar and Nall 0 2 0 0

25‐Oct Leishmaniasis Panjgur UC Washbood, Mohalla Qazi Abad 0 1 0 0

27‐Oct Leishmaniasis Quetta Hazara town, Brewery road 0 0 0 1

27‐Oct Malaria Jhal Magsi BHU Barija 3 8 5 7

25‐Oct Malaria Nasirabad BHU Mir Hassan, Tehsil Chutair 25 70 10 50

27‐Oct Measles Awaran Bigari Zeelag UC Korak Jhaoo 1 0 0 0

25‐Oct Measles Chagai RHC Chagai Village 1 0 2 0

26‐Oct Measles Kalat Langhari UC Iskalkoo Tehsil Kalat 1 3 1 1

26‐Oct Measles Khuzdar Zehri abad UC Feroz Abad Tehsil Khuzdar 1 0 0 0

27‐Oct Measles Khuzdar Nawa UC Baleena Kattan Tehsil Khuzdar 5 0 2 0

27‐Oct Measles Khuzdar Zangi Abad UC Zereena Kattan Tehsil Khuzdar 1 0 0 0

25‐Oct NNT Bolan Village mitiri, tehsil Dhadar 1 0 0 0

25‐Oct Pertussis Chagai RHC Chagai Village 3 0 0 0

24‐Oct Typhoid Chagai gorgage girdi jungle 0 2 1 4


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, 03

Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F

24‐Oct AWD Badin Village Usman Khichi, UC khandaro 0 0 0 0

24‐Oct AWD Badin Village Ghulam Hussain Talpur 0 0 0 0

25‐Oct AWD Badin Village Ahmed Rajo, Golarchi road 0 1 0 0

25‐Oct AWD Badin Ward # 05, UC Talhar, Taluka Talhar 2 2 0 2

26‐Oct AWD Hyderabad Gujrati Para, Tando Yousuf 0 1 0 0

27‐Oct AWD Jamshoro Malik Shah Town, UC Nagoline 3 2 0 1

24‐Oct AWD Mirpur Khas FAP camp, Eidgah Primary school 1 1 0 1

24‐Oct AWD Mirpur Khas Village Ahmedabad, UC Araro Burguri 0 1 0 0

24‐Oct AWD Mirpur Khas Village Patayoon Mohalla, UC Turk Ali Mari 0 1 0 1

24‐Oct AWD Mirpur Khas Village Haji Muhammad Ali Halepotto 0 0 0 1

24‐Oct AWD Mirpur Khas Village Mir Anwar Talpur, neear Jara water 0 1 0 0

25‐Oct AWD Mirpur Khas Village Manhori, UC Girhore Shareef 0 0 1 0

25‐Oct AWD Mirpur Khas Village Naban Shar, Sanghar road, 1 0 0 0

27‐Oct AWD Mirpur Khas Railway Quarters, near Railway station 1 1 0 1

27‐Oct AWD Mirpur Khas Village Fazil Noohani, Digri City 1 3 1 2

27‐Oct AWD Mirpur Khas Village Sobho Khan Laghari, UC Kangoro 0 0 1 0

27‐Oct AWD N Feroze Village Kamal Dero, UC Kamal Dero 2 1 0 1

26‐Oct AWD Sanghar IDP camp near Village Berwari 2 11 2 7

27‐Oct AWD Sukkur Gopang Mohalla, New pind 0 1 0 0

21‐Oct AWD T. Allah Yar Akram Colony, UC3 0 1 0 0

22‐Oct AWD T. Allah Yar Village Piyaro Land 2 1 0 0

22‐Oct AWD T. Allah Yar Village Sarang Hakro, UC Shaikh Musa 1 2 1 0

24‐Oct AWD T. Allah Yar Village Rajo Lashari, UC Dhingano Bozdar 2 3 1 1

26‐Oct AWD T. Allah Yar Village Gul Mohd Lashari, UC Dhingano 0 1 0 0

21‐Oct AWD TM Khan Village Dadoon, UC Jinan Soomro 1 0 2 0

21‐Oct AWD TM Khan Village Rashidani, UC‐3 0 0 1 0

22‐Oct AWD Tharparkar Village Doongari, UC Nagarparkar 0 1 0 1

25‐Oct AWD Thatta Village Kala Kot, UC Domani 0 1 0 0

26‐Oct AWD Thatta Village Ghulam Hussain Lakhetio 1 1 0 0

27‐Oct AWD Thatta Village Jongi Peryer, UC Darya Khan Soho 0 1 0 1

27‐Oct DHF Khairpur Village Mudd, UC Mudd 0 1 0 0

21‐Oct DHF Sukkur Village Nehal Khan Khoso 0 0 0 1

25‐Oct DHF Sukkur Village Rahooja, site area Sukkur 0 1 0 0

27‐Oct DHF Sukkur Village Garho Goth, UC Kandhra 1 0 0 0

22‐Oct Malaria Badin Village Taj Mohammad Shah 1 3 0 5

21‐Oct Malaria Dadu Village Sodo Solangi, UC Allahabad 6 3 11 2

22‐Oct Malaria Dadu Village Loolja, UC Kandi chukki 0 0 0 0

23‐Oct Malaria Tharparkar Tent Village, near Village Sandino Khaskheli 1 18 1 10

25‐Oct Measles Ghotki Village Changlani, UC Bereri 0 0 1 0

27‐Oct Measles Jacobabad Garhi Khairo City 2 0 1 0

22‐Oct Measles Jamshoro Ameer complex, UC Nagoline 0 1 0 0

26‐Oct Measles Jamshoro Khaskheli Mohalla, UC Nagoline 0 1 0 0

27‐Oct Measles Karachi Street # 5, Manzoor Colony 1 0 0 0

22‐Oct Meningitis Benazirabad Dado Jhandi, UC 7 1 0 0 0

26‐Oct NNT Ghotki Village Haji Muhammad Sadique Lashari 1 0 0 0

26‐Oct NNT Karachi Neonatal ICU, NICH 0 0 1 0

26‐Oct NNT Karachi Juma Goth, Malir # 5 1 0 0 0

26‐Oct NNT Kashmore Village Wali Mohammad Kosh 1 0 0 0

22‐Oct NNT Larkana Rasool abad Muhalla 1 0 0 0

22‐Oct NNT Larkana Village chakro 0 0 1 0

22‐Oct NNT Qambar Shahdadkot

Village wadi drib 1 0 0 0

24‐Oct NNT Qambar Village Kheo mugheri, UC Behram 1 0 0 0

27‐Oct NNT Qambar Village Raban Gadhi, Taluka Nasirabad 1 0 0 0

24‐Oct NNT Shikarpur Village Daud ji Waandh, 1 0 0 0

27‐Oct NNT TM Khan Village Bakar Nizamani 1 0 0 0

25‐Oct Pertussis Ghotki Village Allah Wasayo 7 2 4 1

26‐Oct Pertussis Ghotki Village Khuda Bux Marnas 2 1 1 1

25‐Oct PUO Tharparkar Village Waqar Colony Noukot 0 1 0 0

21‐Oct Scabies Badin Village Mitho Junejo, UC Haji Sawan 1 4 1 1

25‐Oct Tetanus Sukkur New pind 0 1 0 0

Current week's Alerts: Province Punjab Date Disease District Area <5M >5M <5F >5F

25‐Oct AWD Bhakkar Mohallah Khemtoon Wala, UC Darya Khan Urban I

0 0 0 1

27‐Oct AWD D. G. Khan Y block D.G.Khan city 0 1 0 0

23‐Oct DHF Bhakkar DHQ Hospital Bhakkar (Bharmi Nawab, Muslim Kot)

0 3 0 0

26‐Oct DHF D. G. Khan Nishter Hospital Multan (DG Khan) 0 2 0 0

24‐Oct DHF Jhang Nishter Hospital Multan (Jhang) 0 2 0 1

27‐Oct DHF Khanewal Nishter Hospital Multan (Khanewal) 0 23 0 2

21‐Oct DHF Layyah Chak No. 160/TDA Layyah 0 1 0 0

21‐Oct DHF Layyah DHQ Layyah; Sarwar Abad Darya Khan/ bhakkar

0 2 0 0

27‐Oct DHF Mianwali Hernoli Tehsil Piplan 0 1 0 0

27‐Oct DHF Mianwali Bani Afghan, Isakhel 0 0 0 2

27‐Oct DHF Multan Nishter Hospital Multan (Multan) 0 8 0 1

23‐Oct DHF Muzaffargarh Nishter Hospital Multan (Muzaffargarh) 0 4 0 0

26‐Oct DHF Muzaffargarh Chak Number 137 & UC Shah Jamal 0 1 0 1

25‐Oct DHF Pakpattan Nishter Hospital Multan (Pakpattan) 0 8 0 0

21‐Oct DHF Rahim Yar Khan

Jinnah Park St, No 10; Ittahad Colony Gulshan ‐i‐Usman

0 5 0 0


Basti Masurain, Mouza Ghot Juda Chak 165/P

0 1 0 2


Fatehpur Punjabina, Golor Maso Khan, Chak No 50 /P

0 2 0 1


Ranger H/Q, Sunni Pul Chak No 83/P 0 2 0 0


Chak No 124 Bagho Bahar 0 1 0 0


Muhalla Fasialabad, Near Fire Birgrade Station, Sadiqabad

0 1 0 0

25‐Oct DHF Sahiwal Nishter Hospital Multan (Sahiwal) 0 8 0 0

24‐Oct DHF Vehari Nishter Hospital Multan (Vehari) 0 1 0 1

27‐Oct Leishmani‐

asis Rahim Yar Khan

Basti Khair Mohammad Khosa, UC Chandia, Tehsil Khanpur

0 1 0 0

21‐Oct Measles Muzaffargarh Basti Joiya Wala, Moza Ruken Wali, UC Binda Ishaq

1 0 0 0

26‐Oct Measles Rajanpur Basti Sawan Wala, Moza Allah Abad Sharqi, UC Allah Abad

2 0 1 0

26‐Oct Measles Rajanpur Basti Khameesa Abad, Moza Allah Abad Gharbi, UC Allah Abad

1 0 0 1

26‐Oct Measles Rajanpur Mohalla Lashaarian, Near Alipur Bazar, UC Jampur Urban

0 0 1 0

26‐Oct NNT D. G. Khan Chabree bala UC Chabree 0 0 1 0

27‐Oct NNT D. G. Khan Basti Malah UC Kot Qaisrani Taunsa 1 0 0 0

27‐Oct Pertussis D. G. Khan Dab Jhan Nee Baghalchor UC Mubarkee 1 0 0 0

27‐Oct Pertussis Rajanpur Basti Maywa Dareshak, UC Fateh Pur, Tehsil Rajanpur

2 0 0 0

27‐Oct Pertussis Rajanpur Moza Fateh Pur, UC fateh Pur, Tehsil Rajanpur

0 0 1 1

26‐Oct Tetanus D. G. Khan Samina village UC Samina 1 0 0 0

Current week's Alerts: AJK; FATA; GB and ICT Date Disease District Area <5M >5M <5F >5F

21‐Oct DHF South Waziristan Agency

D I Khan (Sheerana, Wana) 0 1 0 0

25‐Oct Measles Bajaur Agency village tohid abad, UC Arang, Tehsil Utmankhel

1 0 0 0

23‐Oct Leishmani‐ Diamir DHQ Hospital Chilas 1 0 0 0


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

Province Khyber Pakhtunkhwa: • This week 658 health facilities from 19 districts reported to

DEWS with a total of 135,005 patients consultations.

• The proportional morbidity of AD is showing gradual de-cline during the last 6 weeks after a consistent higher pro-portion (16%) from week 35, 2011.

• 25 alerts were reported in this week, 12 were for Measles; 7 for DHF, while 1 each for AWD, BD, CCHF, Diphtheria, Leishmaniasis and Neonatal tetanus.

• 1 outbreak for CCHF was received and responded.

Figure-3: Trend of priority communicable diseases, province KPK

Province Sindh:

• This week 750 health centers from 22 districts reported to DEWS with a total of 329,253 patient consultations.

• In Sindh, AD cases reported were 27,855 (8%), proportional morbidity lower by 1% as compared with last week.

• 60 alerts were reported from Sindh in this week: 30 were for AWD; 12 for Neonatal tetanus and tetanus; 5 for Measles, 4 each for DHF and Malaria, 2 for Pertussis, while 1 each for Meningitis, Scabies and Unexplained fever.

• 9 outbreaks 5 for AWD and 2 each for Malaria and Pertussis were received and responded.

Figure-4: Trend of priority communicable diseases, province Sindh

Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease

Post Flood 2010 2011 (up till wk 42) Current Week (43) Total

A O A O A O A O Acute Watery Diarrhoea 209 85 1186 520 33 5 1428 610 Acute Jaundice Syndrome 5 2 42 14 ‐ ‐ 47 16 Bloody Diarrhoea 10 1 85 15 1 ‐ 96 16 Dengue Fever 81 32 700 111 33 ‐ 814 143 Measles 48 6 1432 88 28 ‐ 1508 94 Pertussis 1 ‐ 229 57 6 2 236 59 NNT + Tetanus 5 ‐ 262 ‐ 17 ‐ 284 ‐ Malaria 12 7 93 62 6 3 111 72 Leishmaniasis 1 ‐ 185 27 10 ‐ 196 27 Others 75 11 489 55 6 1 570 67

Total 447 144 4703 949 140 11 5290 1104

Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 27 October 2011, compiled from weekly reports

Diseases Number of

Consultations

Acute Respiratory Infection 11,210,361 (22%)

Skin Diseases 5,413,322 (11%)

Acute Diarrhoea 4,802,069 (10%)

Bloody Diarrhoea 425,825 (1%)

Suspected Malaria 3,095,925 (6%)

Unexplained Fever 1,929,266 (4%)

Total Consultations 50,324,518

Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 43/2011)

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Epidemiological Bulletin: DEWS, Pakistan, Week no. 43 (21 to 27 October, 2011) Province Punjab:

• This week 480 health facilities from 8 districts reported data to DEWS from Punjab province with a total of 221,295 patient consultations.

• AD cases reported were 12,837 and showing proportional morbidity same as compared with last week .

• 33 alerts were reported in this week from Punjab; 20 were for DHF; 4 for Measles, 3 for Neonatal tetanus and tetanus; 3 for Pertussis, 2 for AWD; while 1 Leishmaniasis.

• No outbreak for any disease was received this week.

Figure-5: Trend of priority communicable diseases, province Punjab


State of Azad Jammu and Kashmir:

• In this week, reports were received from 112 health facilities from 10 districts with a total of 28,322 patient consultations.

• ARI cases reported were 5,832 (21%), while Acute diarrhoea re-ported 965 (3%) cases.

• No alert for any disease was received this week.

• This week 43 health facilities in 2 agencies reported from FATA, with a total of 6,327 patient consultations.

• ARI cases reported were 1,459 (23%), while Acute diarrhoea was reported 532 cases (8%)

• Two alerts 1 each for DHF and Measles were received and re-sponded this week.

Province Gilgit Baltistan:

• In this week, 79 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 20,616 patient consultations.

• ARI cases reported were 5,055 (25%), while Acute Diarrhoea were 1,893 (9%).

• 1 alert for Leishmaniasis received and responded this week.

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan

FATA:

Province Balochistan:

• In this week, 15 districts reported to DEWS from Balochistan province. 392 health centers reported a total of 61,992 patient consultations.

• AD reported in 5,764 (9%) of the total consultations, same proportional morbidity as compared with the last week.

• 19 alerts were reported in this week from Balochis-tan, 7 for Leishmaniasis; 6 for Measles; 2 for Malaria; while 1 each for DHF, Neonatal tetanus, Pertussis and Typhoid.

• 1 outbreak for malaria was reported and responded this week.

Figure-6: Trend of priority communicable diseases, province Balochistan

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Focus on: Dengue fever, November 2011

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases reported in 2010 is 144 including 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/agencies.

Year 2011: As of 31 October, 2011, the total number of polio cases con‐firmed by the laboratory is 136 (134=type‐1, and 2=type3) from 42 districts.

Province Cases 2010 Cases 2011 P1 P3 P1 P3

Punjab 6 1 2 - Sindh 26 1 28 - Khyber Pakhtunkhwa 19 5 12 - FATA 63 11 36 2 Balochistan 6 6 55 - AJK - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 134 2

Pakistan has been facing an epidemic of Dengue Fever causing to date 16,580 confirmed cases and 257 deaths reported in La‐hore, and nearly 5000 cases and 60 deaths reported from the rest of the country. While all the evidence has not been confirmed, expert entomologists believe that early rains and warmer weather in Lahore gave Aedes mosquito population a head start this year, explaining why Dengue Fever cases started to be re‐ported in August, two months before the usual trans‐mission season. Expert clinicians believe that the virus also was a new serotype for the Lahorians, explaining why more cases were hospitalized and more patients died of severe Dengue Hemorrhagic Fever than in the past five years. WHO Pakistan has provided and is continuing to pro‐vide technical assistance, standard guidelines, and ca‐pacity building in planning and implementation in all three areas of prevention and control of Dengue Fever – Vector Control, Case Management, and Community Awareness ‐ to all three provinces with Dengue cases – Punjab, Sindh, and Khyber Pakhtunkhwa. Vector Control WHO vector control specialist has provided technical advice and guidelines to the Provincial Health Departments to initiate the implementation of the following:

• Notification of provincial level task force for dengue control in the province.

• Constitution of district level dengue control groups

• Procurement of insecticides (adulticides and larvicides) from WHOPES prequalified manufacturers along with concrete plans for vector control targeting both adult mosquitoes and the larvae;

• Training of field staff in the use of equipments and application of insecticides.

• Prioritization of major breeding sites in and around houses and open spaces and tire yards and cemeteries.

Clinical Case Management

• From 20 October – 3 November 2011, WHO fielded a mission by experts in Dengue case management from the WHO Collaboration Centre in Thailand. They conducted a series of workshops in Sindh, Punjab, and Islamabad Capital Territory for the training of

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Reported Dengue Fever: Suspected, Confirmed and Death Cases, Pakistan 2006 to 28 Oct 2011

Suspected cases Lab confirmed cases Deaths


nurses and doctors in treatment of hospitalized cases of dengue fever. Their recommendations include:

• Establishment of fever counters in all hospitals with trained staff round the clock.

• Using low wbc and low platelets as one criteria for admission.

• Providing clear patient education about warning signs if patient is sent home.

• Careful monitoring of admitted patients with vital signs, Hematocrit and measuring urine output every six hours.

• Using calculated amount of fluids over 48 hours; no use of prophylactic platelet transfusions.

Following evidence‐based guidelines on clinical case management of patients including management of acidosis, hypocalce‐mia, bleeding, and blood sugar fluctuations. Community Awareness Community awareness helps the control of dengue fever in two ways – the community can remove vector breeding sites and prevent mosquito bites, and the patients can be brought to the hospital at the right time when the community knows the warning signs. WHO adapted a globally tested Teachers’ Resource Manual on Dengue for use in Pakistan, translated it from English to Urdu and printed 10,000 copies for use in Pakistan schools to train school teachers to mobilize students in elimination of Aedes breeding sites from houses and workplaces. Three hundred teachers have been trained in using this resource in Karachi, and 33,000 students have been mobilized to eliminate mosquito breeding sites in and around their homes. WHO and CDA col‐laborated in training 60 teacher trainers on 2 November 2011 in Islamabad.


Epidemiological Bulletin: DEWS, Pakistan, Week no. 43 (21 to 27 October, 2011) Alerts and outbreaks, week 43, 2011


weekly epidemiological · village rajo lashari, uc dhingano bozdar 2 3 1 1 awd alert, during active...

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