weekly epidemiological flood response in pakistan · lady reading hospital, peshawar (uc misri...

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 50 (10 - 16 December 2010) • Between 10 - 16 December 2010 (epidemiological week no. 50), 51 districts in 4 provinces provided

surveillance data to the DEWS system.

• 1,403 medical outreach centres provided surveillance data for this week. As people move back to their homes, the mobile teams are winding down. DEWS Surveillance Officers are establishing new report-ing flows from fixed centers.

• A total of 384,461 consultations were reported through DEWS of which 28% were acute respiratory infections (ARI), 9% skin disease, 6% acute diarrhoea, and 7% were suspected Malaria.

• Total 8 alerts were received and responded in this week: 2 were for Viral Hemorrhagic Fever (VHF), 2 for suspected Diphtheria, and 1 each for Acute Flaccid Paralysis, Suspected Measles, Bloody Diar-rhoea and Suspected Pertussis.

• No case of confirmed poliomyelitis reported this week from the flood affected district

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 1, Issue 20 Monday 20 December 2010

Table-1: Priority diseases reported during the week 42 - 49, 2010

Priority diseases under surveillance

in the flood affected areas

Acute Flaccid Paralysis (AFP)

Acute Jaundice Syndrome (AJS)

Acute Respiratory Infections (ARI)

Acute Watery Diarrhoea/ (AWD) Suspected Cholera

Bloody Diarrhoea (BD)

Acute Diarrhoea (AD)

Suspected Hemorrhagic Fever (VHF)

Suspected Malaria (Mal)

Suspected Measles (Ms)

Suspected Meningitis (Mg)

Others

Diseases Wk‐423 Wk‐44 Wk‐45 Wk‐46 Wk‐47 Wk‐48

Skin Disease 29, 452 (9%) 25, 920 (9%) 27,009 (8%) 23,784 (8%) 29,056 (8%) 38,022 (9%)

ARI (URI and LRI) 78,580 (23%) 72,582 (24%) 93,704 (27%) 79,391 (28%) 98,719 (27%) 126,265 (29%)

Acute Diarrhoea 27,686 (8%) 22,923 (8%) 24,915 (7%) 20,138 (7%) 27,007 (7%) 34,377 (8%)

Bloody Diarrhoea 4,306 (1%) 2,843 (1%) 2,889 (1%) 2,578 (1%) 3,422 (1%) 2,972 (1%)

Suspected Malaria 30,345 (9%) 24,589 (8%) 26,843 (8%) 21,726 (8%) 27,198 (7%) 30,633 (7%)

Total consultation 341,661 300,924 340,761 280,676 364,543 428,159

Wk‐49

40,180 (8%)

154,140 (30%)

32,859 (6%)

3,886 (1%)

31,613 (6%)

516,267

Wk‐50

33,089 (9%)

108,232 (28%)

23,848 (6%)

2,573 (1%)

25,648 (7%)

384,461

Figure-1: Weekly trend of leading priority diseases in flood affected districts of Pakistan, 29 July to 16 December 2010 (Epi week 31 - 50, 2010)

Epidemiological Bulletin: Flood Response in Pakistan

Fig-2: Weekly number of reporting health units (Week 33– 50, 2010)

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 to 16 December 2010

Figure-3: Leading causes of seeking health care in the flood affected districts by province, 29 July to 16 December 2010

Diseases Total

Skin Diseases 1,468,381 (14%)

Acute Respiratory Infection 2,172,356 (20%)

Acute Diarrhoea 1,213,549 (11%) Bloody Diarrhoea 117,380 (1%) Suspected Malaria 619,898 (6%) Unexplained Fever 514,751 (5%)

Total Consultations 10,735,889

18,932 17,001

345,089

72,628

835,139

475,261

117,219

40,762

809,827

649,829606,323

106,377

520,845

399,628

223,348

69,728

368,358

110,460124,88263,123

86,804

1,01626,575 17,161

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Punjab Sindh Khyber Pakhtunkhwa Balochistan

Number of cases

Skin Ds.

ARIAD

UFS. Mal

BD

Since July 29, 2010, a total of 1,213,549 acute diarrhea patient consultations have been reported to DEWS from the flood affected districts of 4 provinces in Pakistan. Proportional Morbidity in Provinces: Khyber Pakhtunkhwa: Remains 7% as compared with last week. Punjab: Remains 5% as compared with last week. Sindh: Remains 6% as compared with last week. Balochistan: 9% (1% decreased) as compared with last week.

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

Since July 29, 2010, approximately 2,172,356 Acute Respiratory Infection patient consultations have been reported to DEWS from the flood affected districts of 4 provinces in Pakistan. Proportional Morbidity in Provinces: Khyber Pakhtunkhwa: Remains 38% as compared with last week. Punjab: Remains 23% (4% decreased) as compared with last week. Sindh: Remains 29% (2% increased) as compared with last week. Balochistan: 29% (1% increased) as compared with last week.

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

02468

101214161820

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

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

Table-3: Follow-up alerts reported in week 49, 2010. Epidemiological Bulletin: Flood Response in Pakistan


Date of alert Alert Province District Location (detailed) Age (yr)

Sex Action taken / Notes

3-Dec-10 VHF KP Abbottabad CMH Abbottabad 10 F Sample was declared Positive for DF by CMH. The team shared information regard‐ing case management of DF.

3-Dec-10 AJS KP Haripur Khalabut Township 12, 4 F,M

5 suspected cases of acute viral hepatitis were identified in the community. Two blood samples were collected and found positive for Hepatitis A. Also two water samples out of 11 tested were found positive for biological contamination. Health education sessions were conducted and Aqua tabs were provided to the commu‐nity until the source of water can be cleaned and re‐tested.

3-Dec-10 AJS KP Haripur DHQ Staff Colony Haripur 4 M

3 suspected cases of acute viral hepatitis were identified in the community. One blood sample was collected and found positive for Hepatitis A. Also one water sample out of 4 tested was found positive for biological contamination. Health education sessions were conducted and Aqua tabs were provided to the commu‐nity until the source of water can be cleaned and re‐tested.

5-Dec-10 Diph KP Charsadda Lady Reading Hospital, Peshawar (Miro Kalay-Charsadda) 6 F

Fourth probable diphtheria case from Charsadda, treated at hospitals in Peshawar. Contacts treated prophylactically with antibiotic. EPI coverage in the community is 67%.

6-Dec-10 AFP Sindh Ghotki MCH Centre Ghotki 18m F Suspected AFP case was found. Polio team is investigating the case.

6-Dec-10 Measles Sindh Mirpurkhas MCH Jhudo 6m F Sample collected and sent to NIH. Active surveillance is under way. Sample was negative for Measles.

7-Dec-10 AWD Sindh Ghotki Attur Abro Village - UC Ruk 13m,13m F,M Upon field investigation 2 suspected AWD cases with 1 death were found. Hygiene education conveyed to the community.

8-Dec-10 UXF Sindh Ghotki Attur Abro Village - UC Ruk 2 F During field investigation 1 death due to unexplained fever was found. Health education session was conducted.

8-Dec-10 VHF Sindh Hyderabad LUMHS Hyderabad (CH Tando Allahyar) 2 F

Sample collected and sent to NIH. Raised community awareness regarding mos‐quito control

8-Dec-10 Meningitis Sindh Mirpurkhas CH Mirpurkhas 4, 2, 4 M, F, M Upon field investigation 3 suspected meningitis cases were found. Patients were improving. Health education was given; disinfectant, aqua tabs, gloves, masks and medicines were also provided.

8-Dec-10 Malaria Balochistan Jaffarabad BHU Sohabat pur ** ** 32 blood samples were tested by the health facility and 10 were found positive for Falciparum & 9 were found positive for Vivax. LLINs, RDT Kits and anti malarial medicines have already been distributed.

8-Dec-10 Malaria Balochistan Jaffarabad CH Usta Muhammad ** ** 59 blood samples were tested by the health facility and 30 were found positive for Falciparum. LLINs, RDT Kits and anti malarial medicines have already been distrib‐uted.

8-Dec-10 Malaria Balochistan Jaffarabad CD Hairdin ** ** 61 blood samples were tested by the health facility and 32 were found positive for Falciparum. LLINs, RDT Kits and anti malarial medicines have already been distrib‐uted.

Date of alert Alert Province District Location (detailed) Age (yr)

Sex Action taken / Notes

10-Dec-10 VHF Sindh Ghotki MCH Centre (Taluka Ghotki) 4, 8, 3 F, M, M Samples were negative for DF. Raised awareness in the community for prevention of mosquito bites and early referral of Hemorrhagic cases.

11-Dec-10 VHF KP Abbottabad Ayub Teaching Hospital (Khola Kehal) 16 M Sample collected and sent to NIH. Intervention as above.

11-Dec-10 Measles Punjab Mianwali DHQ Mianwali ** ** Suspected cases were reported but upon field investigation no Measles cases were found.

11-Dec-10 BD Punjab Multan Qasim Bela, Masud-Pur, 5-Faiz ** ** Suspected cases were reported but upon field investigation no BD cases were found.

12-Dec-10 Diph KP Nowshera Lady Reading Hospital, Peshawar (UC Misri Banda-Nowshera) 8 F

Probable diphtheria case diagnosed with post diphtheric neuropathy, case was hospitalized but died. Active surveillance in the field is on going.

13-Dec-10 Diph KP Tank KTH, Peshawar (UC Jata Thar - Tank) 15m F

Probable diphtheria case from new district. Contacts treated prophylactically with antibiotics. So far 11 districts have reported suspected diphtheria cases.

13-Dec-10 AFP KP Haripur DHQ Haripur (Bandi Sher Khan) 16m M Suspected AFP case was found. Polio team is investigating the case.

15-Dec-10 Pertussis Sindh Ghotki MCH Center (UC Hussain Beli - Piral Village) 2 M

Suspected case was identified and cultured. Contacts treated prophylactically. Active surveillance ongoing in the community

Table-4: Alerts and Outbreaks (Week 50, 2010)

Table-5: List of confirmed Polio Cases from flood affected districts, week 50-2010

There was no case of confirmed poliomyelitis reported this week from any of the flood affected district. Altogether, polio program has reported 4,969 AFP cases detected in Pakistan this year with 136 confirmed wild polio cases and one death.



Province Khyber Pakhtunkhwa • This week 10 districts reported to DEWS from KP prov-

ince, 232 health centers reported 56,403 patients consul-tations to DEWS.

• ARI is the leading disease in KP province with propor-tional morbidity of 38%.

• Four alerts were received and investigated this week; 2 alerts were for Suspected Diphtheria, 1 was for Viral Hemorrhagic Fever and 1 was for suspected Acute Flac-cid Paralysis.

Province Punjab • 11 districts reported data to DEWS from Punjab prov-

ince

• 540 fixed health centers and 3 mobile medical outreach centers reported to DEWS

• A total of 135,438 patient consultations were reported during this reporting period

• In Punjab, a slightly higher proportion of suspected malaria was reported this week (4%) compared with last week (3%), and a lower proportion of ARI (23%) com-pared with 27% last week. This is consistent with ex-pected seasonal trends.

• Two alerts were reported and responded this week; 1 each for suspected Measles and suspected Bloody Diar-rhoea.

Figure-6: Trend of priority communicable diseases, province KP (31-July - 16 December 2010)

Figure-7: Trend of priority communicable diseases, province Punjab (3 August - 16 December 2010)

Diseases Wk-47 Wk-50

Skin Diseases 4,830 (5%) 2,250 (4%)

ARI (URI and LRI) 32,072 (36%) 21,281 (38%)

Acute Diarrhea 7,626 (9%) 3,763 (7%)

Bloody Diarrhea 945 (1%) 416 (1%)

Total consultations 89,457 56,403

Suspected Malaria 2,563 (3%) 938 (2%)

Wk-48

5,648 (5%)

45,734 (37%)

9,970 (8%)

998 (1%)

2,861 (2%)

124,631

Wk-49

5,135 (4%)

45,965 (38%)

8,440 (7%)

1,142 (1%)

2,761 (2%)

119,749


Skin Diseases 8,395 (8%) 13,491 (10%)

ARI (URI and LRI) 19,607 (19%) 30,854 (23%)

Acute Diarrhea 6,401 (6%) 7,272 (5%)

Bloody Diarrhea 5 23


Suspected Malaria 7,085 (7%) 5,437 (4%)

Wk-48

16,349 (13%)

29,304 (23%)

11,305 (9%)

27

9,119 (7%)

124,881

Wk-49

12,754 (9%)

39,249 (27%)

7,422 (5%)

38

4,587 (3%)

144,799


05


Province Sindh • This week 19 districts reported to DEWS from

Sindh province

• 341 health centers were reported to DEWS this week

• A total of 145,293 patient consultations were reported during the reporting period of week 50.

• In Sindh, proportional morbidity of major health events remained the same when com-pared to last week.

• Two alerts were received and responded this week; 1 each for Viral Hemorrhagic Fever and suspected Pertussis.

Province Balochistan

• In this week, 11 districts reported to DEWS from Balochistan province.

• 278 fixed and 9 mobile medical outreach cen-ters reported to DEWS

• A total of 47,327 patient consultations were reported during the reporting period of week 50, 2010

• High number of Malaria cases were reported from different areas of Jaffarabad district. A total of 183 malaria samples were tested on which 117 were posi-tive. Issue was raised with EDO health, DGHS and Malaria control program. LLINs, RDT kits and anti malarial medicines were already distributed, but strong coordination is needed among all health part-ner organizations at district level.


Skin Diseases 13,519 (10%) 134,629 (10%)

ARI (URI and LRI) 37,487 (27%) 42,351 (29%)

Acute Diarrhea 8,805 (6%) 8,641 (6%)

Bloody Diarrhea 1,175 (1%) 1,034 (1%)



Wk-48

13,777 (10%)

40,538 (29%)

8, 545 (6%)

863 (1%)

13, 273 (10%)

138,362

Wk-49

20,093 (10%)

56,702 (27%)

12,607 (6%)

1,383 (1%)

18,955 (9%)

208,806

Figure-8: Trend of priority communicable diseases, province Sindh (6 August - 15 December 2010)

Figure-9: Trend of priority communicable diseases, province Balochistan (6 August - 15 December 2010)


Skin Diseases 2,312 (6%) 2,719 (6%)

ARI (URI and LRI) 9,553 (26%) 13,746 (29%)

Acute Diarrhea 4,175 (11%) 4,172 (9%)

Bloody Diarrhea 1,297 (4%) 1,100 (2%)



Wk-48

2,248 (6%)

10,689 (27%)

4,557 (11%)

1,084 (3%)

5,380 (13%)

40,285

Wk-49

2,198 (5%)

12,224 (28%)

4,390 (10%)

1,323 (3%)

5,310 (12%)

42,913


06


The objective of this weekly epidemiological bulletin is to provide a snap shot on selected health events reported from the communities affected by the current flood in Pakistan. While every attempt is made to present the weekly trend of the epidemic prone diseases, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin also includes information collected by DEWS teams established during earlier emergencies, including 2005 earthquake, 2007 floods and 2008 ID crises. The primary focus of DEWS is the early detection of epidemic prone diseases, to facilitate a rapid public health response. We would like to thank all the numerous national and international partners who have contributed to the Disease Early Warning System.

We are pleased to report that a journal article on “The impact of the disease early warning system in responding to natural disasters and conflict crises in Pakistan” has been published in the Eastern Mediterranean Health Jour-nal (Rahim M, Kazi BM, Bile KM, Munir M, and Khan AR, vol 16, supp 2010, S114-S121). The article covers the 2005-2009 introduction of DEWS and “aims to report the DEWS success and substantiate its lead role as a priority emergency health response intervention.” Quoting from the abstract, “the disease early warning system (DEWS) was introduced in the immediate aftermath of the 2005 earthquake in Pakistan, with the objective to undertake prompt investigation and mitigation of disease outbreaks. The DEWS network was repli-cated successfully during subsequent flood and earthquake disasters as well as during the 2008-09 internally dis-placed person’s crisis. DEWS-generated alerts, prompt investigations and timely response had an effective contri-bution to the control of epidemics. Through DEWS, 1368 reported alerts during 2005-09 averted the risk of dis-ease outbreaks through pre-emptive necessary measures, while the 187 confirmed outbreaks were effectively con-trolled. In the aftermath of the disasters, DEWS technology also facilitated the development of a disease-surveillance system that became an integral part of the district health system.” During the reporting period, “among priority epidemic-prone diseases, acute watery diarrhea was the leading health problem with 85 (45%) outbreak events, followed by measles with 33 (18%) outbreaks, dengue fever 21 (11%) outbreaks and acute hepatitis viral infection with 16 (9%) outbreaks (of the confirmed cases, seven were hepatitis E and three were related to hepatitis A), while bloody diarrhea accounted for six (3%) outbreaks.” Other outbreaks which were identified and controlled by DEWS included “avian influena, influenza H1N1, cuta-neous leishmaniasis, chicken pox, food poisoning, mumps, tuberculosis, pertussis, diphtheria and typhoid.” Weekly trend graphs for Acute diarrhea, Acute respiratory tract infection, and Measles over four years 2006 to 2009 are also displayed in the article and form the basis for two of the graphs in our current weekly bulletin.

Focus on: DEWS (Disease Early Warning System)

Cumulative Updates:

Priority Diseases Total alerts

Total con‐firmed alerts

Alerts this week

Total sus‐pected cases

Total Samples

Total con‐firmed cases

Total deaths

Acute Hepatitis 5 2 2 15 3 3 0 AWD 210 86 1 3345 205 104 64 Diphtheria 25 0 1 45 15 0 12 Malaria 9 2 3 309 286 151 4 Measles 36 23 1 149 71 51 16 Neonatal tetanus 3 0 0 26 0 0 17 Total 288 113 8 3889 580 309 113

Confirmed Alerts


weekly epidemiological flood response in pakistan · lady reading hospital, peshawar (uc misri...

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