weekly epidemiological -...

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. 41 (7 - 13 Oct 2012)

• Measles: 74 alerts investigated this week, responding to 10 outbreaks involving 202 measles cases. Vitamin A was provided to cases and EDOs‐H took action to improve vaccination in af‐fected areas (Page 7)

• AWD: 22 alerts investigated this week and 8 outbreaks identified, involving 106 AWD cases, 3 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)

• 2 new suspected CCHF case reported in week 41, 2012; (Page 6)

• 1 new polio cases were reported in week 41, 2012; (Page 6)

• 84 districts have reported to DEWS in week 41, 2012. 2,334 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week

• 961,606 patients’ consultations were reported in week 41 compared to 918,266 consultations reported in week 40, 2012.

• Altogether 201 alerts were investigated and response was provided to 31 out‐breaks.

Highlights

Disease early warning system and response in Pakistan

01

Volume 3, Issue 41, Wednesday 17 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 2,565,451 9%

Bloody diarrhoea 143,446 0.5%

ARI 5,412,225 18%

S. Malaria 1,547,690 5%

Skin Diseases 1,399,547 5%

Unexplained fever 1,082,647 4%

Total (All consultations) 30,088,379

Disease # of Cases Percentage

Acute diarrhoea 85,378 9%

Bloody diarrhoea 3,836 <1%

ARI 197,004 20%

S. Malaria 66,075 7%

Skin Diseases 44,232 5%

Unexplained fever 32,357 3%

Total (All consultations) 961,606

Figure‐2: Weekly trend of Acute diarrhoea in Pakistan; Week‐1, 2011 to week‐41, 2012.

Figure‐1: 84 districts reported to DEWS in week 41, 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 ‐ 41 (7 ‐ 13 Oct 2012)

Cumulative number of selected health events reported in Epi‐week 1 to 41, 2012 (1 Jan ‐ 13 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

2011 2012

Weekly Bulletin: DEWS, Pakistan, Week no. 41 (7 - 13 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 (41/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

12‐Oct AD Balochistan Jaffarabad Civil Hospital Usta Mohammad, UC Usta M I and III

72 131 50 89 342 cases reported from Civil Hospital Usta Mohammad. Investigation was done using telephone as no access is available to the area due to damaged roads and flood water. Cases were not localized but from different location. Essential medicines were provided to DHMT. MO was motivated for establishing ORT corner. DHO was informed.

12‐Oct AD Balochistan Jaffarabad

Relife Medical camp Khan Pur, UC Khan Pur, Tehsil Usta Muhammad

35 98 84 61

278 cases were reported from medical relief camp. Investigation was done using telephone as no access is available to the area due to damaged roads and flood water, team s could not reach to area. Cases were IDPs from different location. Essential medicines were provided to DHMT for the medical camp. MO was motivated for establishing ORT corner. DHO was informed.

12‐Oct AWD Balochistan Chagai Ameenabad, Tehsil Chagai Village 1 2 2 3

8 cases of suspected AWD reported from CD Ameenabad. Response was given on same day. Stool samples were taken and sent to NIH. Patients were rehydrated and advised to use aqua tabs in drinking water. Health and hygiene sessions were conducted in the affected community.

12‐Oct AWD Balochistan lasbela Mitha Goth, UC kehwari, Tehsil Uthal 3 2 1 14

Alert reported from community. Investigation was done along with RRT and 20 suspected cases of AWD were found and presented with typical sign and symptoms. Required medicine was provided. Patients were treated according to plan A and B. Health and hygiene session was conducted, Aqua tab and extra pack of ORS distributed. 2 stool sample and 3 water sample collected and sent to NIH.

11‐Oct Leishmaniasis Balochistan Lasbela Winder, UC Winder, Tehsil Sonmiani 0 7 0 0

4 cases of Leishmaniasis reported. Cases presenting with typical lesions. During active surveillance 3 more cases found. All patients had lesions on their limbs. Inj Glucantime was provided to health facility in charge in outbreak response. Information was shared with district health team.

9‐Oct BD FATA Khyber Agency

UC Kam Shal‐man,Tehsil Landiko‐tal

2 3 0 4

An alert of bloody diarrhea were reported from BHU Kam Shalman. The medical technician also gave information of BD cases from different localities of UC Kam Shalman. On active surveillance 9 cases were found. Stool sample was taken and sent to NIH. Water samples were taken and assessed for contamination and found unsafe for drinking. Health and hygiene sessions were conducted for the affected community. Soaps, aqua tabs and hygiene kits were also distributed in the community. Report shared with Agency surgeon and PHHI Coordinator.

13‐Oct Leishmaniasis FATA Khyber Agency

Village Qari Ijaz Lagat khel,UC Khoga khel,Tehsil Landiko‐tal

0 3 1 2 An alert of Leishmaniasis was reported from AHQ Hospital Landikotal.On active surveillance 6 cases were found. Treatment was given in AHQ Hospital Landikotal.Health education was imparted to the parents of the patients. Report was shared with Agency surgeon.

8‐Oct AWD Khyber Pakhtunkhwa Mardan Village Mirwas, UC

Bijligar 1 1 0 0

A suspected AWD alert was reported from ER Unit of DHQ Hospital Mardan, after investigation of suspected cases at hospital, Epidemiological and Environmental assessment was carried out in the area. 2 cases were identified who had developed diarrhea in past week in the community. Field investigation found contaminated water supply as a possi‐ble source. Stool Sample was taken and sent to NIH and was found positive for Cholera. Water samples from source and end users were taken and tested for contamination. Health and hygiene sessions were conducted for affected families. Aqua tabs, soaps, hygiene kits and ORS distributed in the community. EDO health informed about the situation. No more cases reported now.

12‐Oct Malaria Khyber Pakhtunkhwa Swabi Budga UC Kabgani 27 67 18 46

An outbreak of suspected Malaria was reported by local community leaders. The outbreak was investigated by the Joint team. On field investigations, patients presented with high grade fever, headaches, vomiting, rigors and chills, convulsion and body aches. Some patients suspected for dengue. 5 Blood sample was taken and sent to NIH for DF. 35 samples were taken for MP. A session on DF spread and prevention was conducted for the affected household. EDO Health and DSM PPHI were informed. Lab and microscopy results awaited.

10‐Oct Measles Khyber Pakhtunkhwa Battagram

Village Petrol Pump, Masjid e Aqsa Mohallah

2 1 2 2

Two suspected Measles cases were reported from Pediatric Ward, DHQ Hospital Battagram. SO visited the Ward and examined the patient. Vit A was already given. There was no immunization history, no BCG Scar was seen. On active Surveillance 5 more cases of suspected Measles were fond in the same house. Families were refusal to routine immunization. All the five children had no BCG Scar. EPI Technician carried out vaccination at the spot. Vit A was given to all the cases. Total of 21 children below 5 years of age were examined. 11 children were vaccinated for Measles. 1 for BCG, 1 for Penta 1 and 3 for Penta 3. Blood sample was taken from admitted patient and sent to NIH. Detail report was shared with EDO Health and senior Manager Health Battagram.

10‐Oct Measles Khyber Pakhtunkhwa Lower Dir

Village Kotkay Dehrai, Kombar Bazzar UC and Tehsil Lal Qala

2 1 2 0

03 Suspected Measles cases were reported from DHQ Hospital Dir Lower on 10th Oct, 2012. Blood Sample collected and sent to NIH Islamabad. On field investigations, 2 more cases in the family were found. All children missed vaccina‐tion and BCG scar was not present. Health education session was conducted with the community and Vit.A drops given to children. Information was shared with EDO‐H, Coordinator LHWs, coordinator EPI to intensify Mop up campaign in village Kotkay Dehrai, Kombar, UC and Tehsil Lal Qala.

8‐Oct Measles Khyber Pakhtunkhwa Mardan Village Aarzi Abad,

UC Par Hotti 0 2 1 2

A suspected Measles alert was reported from Isolation unit of DHQ Hospital Mardan. Patient was found unimmunized for measles vaccination. Epidemiological assessment was carried out in the area and surroundings. Within same family 2 more clinical cases and 2 cases from surrounding were identified. Vitamin A capsules were given. All children of less then 5 years were sent to near by HF for vaccination. EPI team was informed and requested for outreach immunization in the area soon after ongoing SIAD. Health education session was conducted with the family members and community, LHW's working in the area was involved. EDO‐H Focal person & EPI Coordinator were informed.

11‐Oct AWD Punjab Muzaffargarh Basti Mandorey, Moza Kharak, UC Kharak

1 4 0 7

RRT was activated & team visited basti Mandorey where 30 households were interviewed & ten more similar cases were found & were referred to RHC Khangarh. Health education to family members in households visited. Distribu‐tion of ORS, hygiene kits, water filters, soaps, Aqua Tabs, ORS, jerry cans, buckets & IEC among them. Drinking water sources sampling was also done along with their disinfection. SMO RHC Khangarh sensitized. Along with continuous strict surveillance continuous HE sessions were suggested. EM assessment was done & required medicines were shifted from pre‐positioned DDK in EDOH office stores.

7‐Oct DF Punjab Lahore UC 113 Raiwind Allama Iqbal Town 0 13 0 5

1 Confirmed, 1 Probable and 16 suspected cases of Dengue fever notified on dash board from Jinnah Hospital Lahore. The cases were investigated and blood sample was taken and sent to laboratory for detection of dengue specific antibodies, result for IgM and IgG is positive for 1 cases. Dengue monitoring cell declared outbreak in this union council after reviewing the data. There is no travel history by confirmed patient. SO along with CDCO, DDHO and entomologist visited the area and case investigation & Vector Surveillance was carried out. Mechanical Larviciding at two places and chemical Larviciding was done at one place. IRS done in the house of positive case as well as neighboring houses. Health Education session was given to the community focusing on Proper solid waste disposal, improved water storage practices, use of screening, protective clothing and repellents. IEC material was distributed by Female sanitary petrol in the houses. ADG(VBD) and EDO Health Lahore were informed and updated about the response.

8‐Oct DF Punjab Lahore UC 116 Johar town Allama Iqbal Town 0 20 0 8

1 Confirmed, 1 Probable and 26 suspected cases of Dengue fever notified on dashboard from Teaching Hospitals of Lahore. The cases were investigated and blood sample were taken and sent to laboratory for detection of dengue specific antibodies, results for IgM and IgG are positive for one case. Dengue monitoring cell declared outbreak in this union council. There is no Travel History for confirmed patient. SO along with CDCO,DDHO and entomologist visited the area. Vector Surveillance was carried out. Larva was found positive in one container so mechanical Larviciding was done. IRS done in the houses of Patients. Health Education session was given to the community on Proper solid waste disposal, improved water storage practices, use of screening, protective clothing and repellents. IEC material distributed by Female sanitary petrol in the community. ADG(VBD) and EDO Health Lahore were informed.

9‐Oct DF Punjab Lahore UC 71 Bilal Ganj Data Ganj Bukhsh Town

0 4 0 2

1 Confirmed, 1 Probable and 4 suspected cases of Dengue fever notified on dashboard from Mayo hospital and DHQ hospital Lahore. The cases were investigated and blood samples were taken and sent to lab for detection of dengue specific antibodies, results for IgM and IgG are positive for one case. Dengue monitoring cell declared outbreak in this union council. There is no Travel History of any confirmed case patient. SO along with CDCO,DDHO and ento‐mologist visited the area. Vector Surveillance was carried out. IRS done in the houses of Patients. Health Education session was given to the community on Proper solid waste disposal, improved water storage practices use of screen‐ing, protective clothing and repellents. IEC material distributed by Female sanitary petrol in the community. ADG(VBD) and EDOH Lahore were informed. The response teams were guided for correct uploading of vector data.



Cont’d current week's (41/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

11‐Oct DF Punjab Lahore UC 130 Kot lukh put Nishter town 0 5 0 2

1 Confirmed and 6 suspected cases of Dengue fever notified on dashboard from Jinnah Hospital and General Hospitals of Lahore. The cases were investigated and blood sample were taken and sent to laboratory testing, result for IgM and IgG positive for one case. Dengue monitoring cell declared outbreak in this union council. There is no Travel History of any confirmed case patient. SO along with CDCO,DDHO and entomologist visited the area. Vector Surveillance was carried out. Larva was found positive in one container, mechanical Larviciding was done. IRS done in the houses of Pa‐tients. Health Education session was given to the community on Proper solid waste disposal, im‐proved water storage practices, use of screening, protective clothing and repellents. IEC material distributed by Female sanitary petrol in the community. ADG(VBD) and EDOH Lahore were informed.

12‐Oct DF Punjab Lahore UC 126, Garden town Allama Iqbal Town

0 6 0 1

1 Confirmed and 6 suspected cases of Dengue fever notified on dashboard from Teaching Hospitals of Lahore. The cases were investigated and blood sample was taken and sent to laboratory for detection of dengue specific antibodies, results for IgM and IgG are positive for one case. Dengue monitoring cell declared outbreak in this union council. There is no Travel History of confirmed patient. SO along with CDCO,DDHO and entomologist visited the area. Vector Surveillance was carried out. Larva was found positive in one container so mechanical Larviciding was done. IRS done in the houses of Patients. Health Education session was given to the community on Proper solid waste disposal, improved water storage practices, use of screening, protective clothing and repel‐lents. IEC material distributed by Female sanitary petrol in the community. ADG(VBD) and EDO Health Lahore were informed.

11‐Oct AWD Sindh Matiari Village Allah Dino Sand, UC AD Sand, taluka Matiari

1 9 4 2 AWD case was admitted at THQ Matiari with severe dehydration. During field investigation 15 more cases were found and investigated. Aqua tabs, Zinc tabs and ORS distributed. Health education imparted. EDOH informed and 1 Stool with 2 water samples collected. Lab results awaited.

11‐Oct AWD Sindh Matiari Village Zulfiqar Shah ji Wasi, UC and taluka Matiari

1 3 3 1 AWD case was admitted at THQ Matiari with severe dehydration. During field investigation 7 other cases were found and investigated. Water from the Hand pump was the source of contamination. Aqua tabs, Zinc tabs and ORS distributed. Health education imparted. EDOH informed.

6‐Oct AWD Sindh Qambar Shahdadkot

Loung Brohi, UC Mastoi, taluka Sajawal

1 2 2 2

One death due to AWD reported from private Practioner of Shahdadkot. During field Investigation found 6 more AWD recovered cases from same location. Hand pump was the source of water. Health education imparted regarding hand washing and health and Hygiene. Aqua tabs, ORS and life straw filters were distributed. DHMT informed and 3 water samples collected.

10‐Oct AWD Sindh Qambar Shahdadkot

Koore Datoo , UC Seelera , Taulka Shahdadkot

1 3 2 1

Suspected AWD case was reported from THQ Shahdadkot. During field Investigation 6 more sus‐pected AWD recovered cases from same location. Source of water is Hand pump. Health education imparted regarding hand washing and health and Hygiene. Aqua tabs, ORS and life straw filter dis‐tributed. DHMT informed. One stool sample collected and sent to NIH and 3 water samples col‐lected .

11‐Oct BD Sindh Sukkur Village Thariri, UC Arrore. Taluka Rohri 1 2 0 4

5 cases of BD reported from BHU Thariri. Alert was verified as all cases were from same location. Field investigation conducted along with MO and found 2 more cases. Source of water was Hand pump. One Rectal swab collected. 5 water samples collected. Health education imparted to the affected families & community on personal hygiene, frequent hand washing with soap, use of aqua tabs and boiling of water. Aqua tabs & jerry cans distributed to affected families & contacts and all information shared with DHO & DHMT.

8‐Oct Measles Sindh Dadu Village Mureed Dero, UC Pat Gul, taluka Johi

4 1 6 1

Suspected case of Measles was reported by THO Johi. During field investigation 11 more cases were found, out of them 6 children had BCG+ve, 4 were Measles‐1 vaccinated and 3 were Measles‐2 vaccinated. Vitamin (A) dose given to all cases. Health education imparted. Vaccination status of 22 children were assessed. BCG=10(45%), Penta1=8(36%), Penta2=5(22%), Penta3=7(18%), Measles1=9(40%), Measles2=6(27%). EDOH informed about the cases and 1 Blood sample collected.

12‐Oct Measles Sindh hyderabad UC Hatree, taluka Hyderabad 2 0 2 1

Suspected case was reported by research officer from AKU. During field investigation, 4 more cases were found. Vitamin (A) dose was given. Health education imparted. Vaccination status of 21 chil‐dren were assessed. BCG=17(81%), Penta1=16(76%), Penta2=16(76%), Penta3=16(76%), Measles1=9(55%), Measles2=(0%). THMT informed about the case and 3 Blood samples collected.

12‐Oct Measles Sindh Kashmore Village Haji Aalam Balkani, UC Akhero 6 0 3 0

Measles alert was cross notified by SO DEWS Sukkur. During field investigation 8 more cases were found. Cases were not vaccinated. Blood sample was collected. Vitamin (A) drops given to cases. Health session was imparted on importance of routine immunization. EPI status: 28 children were assessed & only 6(21%) Children had BCG scars. THMT informed and 2 Blood sample collected.

12‐Oct Measles Sindh Khairpur Village Ali Murad Shaikh UC Belharo Taluka Gambat

20 2 21 0

Suspected Measles case was reported from THO Gambat. On field investigations, 43 cases were found in the village. All cases were line listed. Vitamin A was provided and sample sent to NIH Is‐lamabad. EPI cluster was taken and out of 50 children 26 children were found without BCG scar. All information was shared with DHMT. Mop up activity regarding routine immunization was advised. Planning has been done after NID Oct this exercise will be done.

9‐Oct Measles Sindh Larkana Near Dargah Mashori, UC Pathan, taluka Bakrani

2 0 3 0

Suspected case of Measles reported from private Clinic. Case was BCG +ve and not vaccinated for other antigens. During active search 4 more cases were found. Vitamin (A) dose was given to all cases. Health education imparted. Vaccination status of 11 children were assessed. BCG=5(45%), Penta1=4(36%), Penta2=3(27%), Penta3=(0%), Measles1=4(36%), Measles2=(0%). DHO informed about the case and 5 Blood samples collected.

10‐Oct Measles Sindh Larkana

Noonari Muhalla, Waris Dino Machi, UC Waris Dino Machi, taluka Ratodero

2 0 3 0

Suspected case of Measles reported from private clinic Ratodero. During field investigation 4 more cases were found. Vitamin (A) dose was given to all cases. Health education imparted. Vaccination status of 9 children were assessed. BCG=5(55%), Penta1=5(55%), Penta2=2(22%), Penta3=(0%), Measles1=3(33%), Measles2=(0%). DHO informed about the case and 3 Blood samples collected.

10‐Oct Measles Sindh Sukkur Village Dhughar Laghari, UC Junas, Taluka Panoakil

5 0 4 1

One Death due to suspected Measles reported from GMC teaching hospital. Field investigation conducted along with TSV Panoakil & vaccinator of the area, where found 9 more suspected cases. Vitamin A given to all cases. Health education imparted to cases & contacts on personal hygiene & importance of routine immunization. Eight cases had BCG scar & 07 were vaccinated for Measles‐1. Cluster of routine immunization checked where out of 10 children. BCG=(100%), Measles‐1=(40%) & Measles‐2=(0%). Information shared with DHO & DHMT and 1 Blood sample collected.

12‐Oct Pertussis Sindh Ghotki

Village M Bachal Faqeer Lund UC Yaro Lund Taluka Mirpur Mathelo

6 1 5 9

Pertussis alert received from community. On filed investigation, 21 suspected cases were found. 14 doses complete course of erythrosine provided to all patients and close contacts. No sample was taken as all cases had received Antibiotics. Routine immunization status was observed zero. No child had BCG scar. Information was shared with DHMT and requested for vaccination in the area.



Province Khyber Pakhtunkhwa: 484 health facilities from 18 districts of Khyber Pakhtunkhwa sent reports to DEWS with a total of 132,418 patients consultations reported in week 41, 2012. Total 39 alerts were received and appropriate measures were taken. Altogether 26 alerts for Measles; 4 for AWD; 3 for DF; 2 for ARI; while 1 each for BD, Leishmaniasis, Malaria and Typhoid. Acute diarrhoea trend shows a decrease 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 38 ‐ 41, 2012 Figure‐4: Number of consultations by age and gender, week 41, 2012

Province Punjab:

Figure-6: Number of alerts received and responded week 38 - 41, 2012, province KPK

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

906 health facilities from 23 districts in Sindh province reported to DEWS with a total of 534,657 patients consultations in week 41, 2012. Total 65 alerts re‐ceived while 13 outbreaks were identified and appropriate measures were taken. Altogether 27 alerts for Measles; 14 for NNT; 13 for AWD; 4 for Typhoid; 3 for Pertussis; while 2 each for BD and Leishmaniasis. Acute Diarrhoea shows an stable trend in last few weeks.

Figure-8: Number of alerts received and responded week 38 - 41, 2012, province Sindh

Figure-9: Trend of acute diarrhoea, province Punjab Figure-10: Number of alerts received and responded week 38 - 41, 2012, province Punjab

463 health facilities from 9 districts in province Punjab reported to DEWS with a total of 202,723 patients consultations in week 41, 2012. Total 53 alerts were received and appropriate measures were taken. Altogether 10 alerts for Dengue fever; 9 for ARI; 8 for Measles; 7 for Typhoid; 4 each for AD, Scabies and NNT; 2 each for AWD and BD; while 1 each for AJS, Leishmaniasis and Meningitis. AD shows a Stable trend in last few weeks.

95 67 75 74

0

10

20

30

40

50

Wk‐38 Wk‐39 Wk‐40 Wk‐41

# of alerts

Measles

AWD

Leishmaniasis

Typhoid

Pertussis

Malaria

CCHF

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

Male 31298 83620 109612 155469 67014

Female 30330 76736 111864 221606 74057

0

50000

100000

150000

200000

250000

# of con

sultatio

ns

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‐38 Wk‐39 Wk‐40 Wk‐41

# of alerts

Measles

AWD

Leishmaniasis

CCHF

Malaria

Pertussis

Typhoid

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‐38 Wk‐39 Wk‐40 Wk‐41

# of alerts

Measles

AWD

Typhoid

Pertussis

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‐38 Wk‐39 Wk‐40 Wk‐41

# of alerts

Measles

Typhoid

AWD

Leishmaniasis

Malaria



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 38 - 41, 2012, Balochistan

293 health facilities from 20 districts in province Balochistan reported to DEWS with a total of 44,858 patients consultations in week 41, 2012. Total 27 alerts reported and 4 outbreaks were identified and appropriate measures were taken in week 41, 2012. Altogether 6 each for Acute diarrhoea and Leishmaniasis; 5 for Measles; 4 for ARI; 3 for AWD; while 1 each for NNT, Pertussis and Typhoid. A decrease noted in AD trend from last few weeks.

6 health facilities from 1 district in Gilgit Baltistan reported to DEWS with a total of 6,412 patients consultations in week 41, 2012. One alert for measles was reported in week 41, 2012. AD showing decrease from last few weeks.

Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week 38 - 41, 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 11,150 patients consultations in week 41, 2012. 11 alerts; 4 each for Leishmaniasis and Measles; 2 for BD; while 1 for NNT were reported in week 41, 2012 and appropriate measures were taken. An increase in AD is noted this week.

Figure-16: Number of alerts received and responded week 38 - 41, 2012, FATA

Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 38 - 41, 2012, AJ&K

121 health facilities from 9 districts in AJ&K reported to DEWS with a total of 23,805 patients consultations in week 41, 2012. 5 alerts, 3 for Measles; while 1 each for AJS and DF were reported in week 41, 2012. A decrease noted for AD as compare with last few weeks.

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‐38 Wk‐39 Wk‐40 Wk‐41

# of alerts

Leishmaniasis

Measles

Malaria

CCHF

AWD

Typhoid

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

2011

2012

0

10

20

30

40

50

Wk‐38 Wk‐39 Wk‐40 Wk‐41

# 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‐38 Wk‐39 Wk‐40 Wk‐41

# 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‐38 Wk‐39 Wk‐40 Wk‐41

# of alerts

Measles

AWD

Leishmaniasis



Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

• In week 41, 2012 one new type‐1 polio cases was reported Federally Administered Tribal Areas (Bajour Agency).

• As of 13 October 2012, Pakistan has reported a total of 44 polio cases including 41 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 13 1

Balochistan 73 ‐ 3 ‐

AJ&K ‐ ‐ ‐ ‐

Gilgit‐Baltistan 1 ‐ 1 ‐

Islamabad ‐ ‐ ‐ ‐

Total 196 2 41 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. 2 new suspected cases of CCHF in week 41. In 2012, a total of 54 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 40) Current week 41, 2012

A O A O A O A O

Acute watery diarrhoea 1350 543 559 141 22 8 581 149

Acute jaundice syndrome 51 17 97 18 2 0 99 18

Bloody diarrhoea 98 20 104 7 7 2 111 9

Dengue fever 785 111 135 22 14 9 149 31

Measles 1708 110 4595 474 74 10 4669 484

Pertussis 287 81 340 138 4 1 344 139

NNT + tetanus 399 0 423 0 20 0 443 0

Malaria 131 88 117 60 1 1 118 61

Leishmaniasis 298 33 678 62 14 2 692 64

Others 645 69 1291 101 43 4 1334 105

Total 5752 1072 8339 1023 201 37 8540 1060

Total for 2012 (week 1‐41, 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 41

# of cases

Epi‐week

Number of CCHF cases (week 1 to 41, 2012), Pakistan

Suspeceted Positive



Table‐1

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

AJ&K 148 4 229 0

Balochistan 376 100 1542 21

FATA 168 24 467 13

Gilgit Baltistan 22 0 23 0

ICT 20 2 55 0

Khyber Pakhtunkhwa 1764 92 3120 33

Punjab 694 30 1119 15

Sindh 1477 232 3930 71

Total 4669 484 10485 153

2012 (Week 1 ‐ 41)

Province

Table‐2


AJ&K 3 0 3 0


FATA 4 0 4 0


ICT 0 0 0 0


Punjab 8 0 10 0

Sindh 27 7 126 3

Total 74 10 202 4

Epi ‐ week 41, 2012

Province

Measles: As of 13 October 2012, more measles cases and deaths have been reported in Pakistan than in 12 months last year. Table 1 sum‐marizes the situation of measles in 2012 up to 13 October; and table 2 illustrates the alerts and outbreaks in week 41 (7 to 13 October, 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 number of con‐firmed Dengue cases reported by surveillance focal points from the Departments of Health in Sindh and Punjab in 2012. Total number of confirmed dengue cases to date in 2012 is 233 in Sindh and 319 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 41, 2012. Total number of malaria cases tested in this week is 19885, out of which 3573 were found positive; 2348 for P. Vivax; 938 for P. Falcipa‐rum; while 287 for Mixed (SPR = 17.97%; F. R = 34.28%). AWD: • The surveillance definition for a case of “Acute Watery

Diarrhoea” (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, 16 September to 13 October 2012. During the period, a total of 83 AWD alerts were reported and 27 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 9 2 28 2

Sindh 39 14 248 3

Total 83 27 366 5

Week 38 ‐ 41, 2012

Province

Outbreaks with

confirmed V. cholera

0

0

0

0

0

9

0

3

12

0102030405060708090

100

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41

# of cases

Weekly trend of positive Dengue cases reported from Sindh and Punjab, week 1 to 41, 2012 Punjab Sindh

0

10

20

30

40

50

Balochistan Sindh FATA Punjab KPK GB AJK ICT

Percen

tage

Malaria slide positivity and falciparum rate, week 41, 2012

SPR FR



Alerts and outbreaks, week 41, 2012

weekly epidemiological -...

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