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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
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]. 03
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.
19-Jan-11 Measles Khyber Pakhtunkhwa
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.
22-Jan-11 Measles Khyber Pakhtunkhwa
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
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]. 04
Epidemiological Bulletin: Flood Response in Pakistan
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
Epidemiological Bulletin: Flood Response in Pakistan
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%)
Other Acute Diarrhoea (Not Watery) 9,394 (6%) 13,895 (5%)
Bloody Diarrhea 933 (1%) 1,281 (1%)
Total consultations 150,594 253,862
Suspected Malaria 11,332 (8%) 18,617 (7%)
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%)
Other Acute Diarrhoea (Not Watery) 4,342 (8%) 5,079 (7%)
Bloody Diarrhea 1,394 (3%) 2,044 (3%)
Total consultations 53,887 73,556
Suspected Malaria 5,192 (10%) 6,865 (9%)
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
Epidemiological Bulletin: Flood Response in Pakistan
Confirmed Alerts
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]. 07