Weekly Epidemiological - WHO€¦ · Village Manik Lashari, near Khabri, UC Taib 3 0 2 1 An alert of suspected Measles was notified. During field investigation 4 more suspected cases

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. 23 (3 - 9 June 2012)

• Measles: 168 alerts investigated, respond‐ing to 31 outbreaks involving 415 measles cases.

• CCHF: two new cases reported in week 23; In 2012, total of 27 cases have been re‐ported throughout the country.

• Acute diarrhoea: Trend of acute diarrhoea in on the rise in all provinces. Districts in Sindh and Khyber Pakhtunkhwa are investi‐gating alerts for acute watery diarrhoea/suspected cholera.

• Five new polio cases were reported; As of 11 June 2012, Pakistan has reported a total of 22 polio cases (19 type‐1, 2 type‐3 & 1 mixture type‐1 & 3) from 13 districts/tribal agencies.

• 87 districts have reported in week 23, 2012, Please see map. 2,251 health centres have reported to the Disease Early Warning Sys‐tem (DEWS) in week 23, 2012

• 732,614 patients’ consultations were re‐ported over the week 23 compared to 792,763 consultations reported on week 22, 2012.

Highlights

Disease early warning system and response in Pakistan

01

Volume 3, Issue 23, Wednesday 13 June 2012

• The graph (Figure‐1) shows the weekly trend of Acute diarrhoea as proportional morbidity (percentage of cases out of total consultations) reported to DEWS on weekly basis.

• Proportional morbidity of acute diarrhoea is high in Khyber Pakhtunkhwa, FATA, Sindh and Balochistan; Please see graphs on page 4 and 5.

Disease # of Cases Percentage

Acute diarrhoea 1,112,405 7%

Bloody diarrhoea 71,716 0.48%

ARI 3,071,815 20%

S. Malaria 664,062 4%

Skin Diseases 660,807 4%

Unexplained fever 519,078 3%

Total (All consultations) 15,037,413

Disease # of Cases Percentage

Acute diarrhoea 69,345 9%

Bloody diarrhoea 3,222 0.44%

ARI 112,728 15%

S. Malaria 38,953 5%

Skin Diseases 32,783 4%

Unexplained fever 27,439 4%

Total (All consultations) 732,614

Figure‐2: Weekly trend of Acute diarrhoea in Pakistan Week‐1, 2011 to week‐23, 2012.

Figure‐1: 87 districts reported to DEWS in week 23, 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 Others Major health events reported during the

Epi‐week ‐ 23 (3 ‐ 9 June 2012)

Cumulative number of selected health events reported in Epi‐week 1 ‐ 23 (1 Jan ‐ 9 June 2012)

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Weekly Bulletin: DEWS, Pakistan, Week no. 23 (3 to 9 June 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 (23/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

3‐Jun Measles Balochistan Khuzdar Sarmastani Kurd Abad, UC Lizo 4 0 1 0

1 suspected Measles case was reported from a Private Clinic. During active surveillance 4 more sus‐pected cases were found. Vit A drops provided. Health education imparted. Epi team vaccinated 51 children of <13 years pf age against measles. DHO was informed about the situation.

3‐Jun Measles Balochistan Khuzdar Village Raijj, UC Zeedi 0 0 5 2

1 suspected Measles case was reported from DHQ. On active search 6 more suspected cases were found. Vit A drops were given to all the cases. 1 Blood sample sent to NIH for lab confirmation. DHO informed.

3‐Jun Measles Khyber Pakhtunk‐hwa

Charsadda Battagram 2 3 1 2

An alert of suspected Measles was reported. On active surveillance 8 more of suspected measles cases were found. 9 children were assessed for routine immunization and all of them found unvaccinated against measles. Intensified outreach vaccinated activity conducted. Blood samples taken and sent to NIH for lab testing. Vit. A given to the cases. Health education imparted.

3‐Jun Measles Punjab Bhakkar

Mohallah Masoomabad; Mohallah Farooqa‐bad, Bhakkar

4 1 4 1

7 suspected cases of measles were reported. On active surveillance 3 more suspected cases were found. Total 96 children were assessed for routine immunization and vaccinated (BCG+ Measles). Blood sample was collected and sent to NIH for lab testing.Vit A drops provided to the cases.Health education im‐parted about importance of vaccination. General hygiene and isolation measures were demonstrated to the community. EDO(H) informed.

4‐Jun Malaria Balochistan Awaran DHQ Hospital 0 0 0 0 105 suspected cases of Malaria were reported. 60 slides were tested and 49 found positive (SPR=82%) pf=2, pv=22, Mix=25; (FR=55%). Anti malarial medicines were given to patients. Information was shared with DHO.

4‐Jun Malaria Balochistan Awaran Jibri, UC Nokjo, Tehsil Mashkai 0 0 0 0

22 suspected cases of Malaria were reported and tested. 20 slides were positive for pf 2, pv 8, Mix 10; (SPR=91%, while FR=60%). Antimalarial drugs were provided. DHO was informed.

4‐Jun Malaria Balochistan Awaran Killi Mungli, UC Parwar 0 0 0 0

34 suspected cases of Malaria reported and tested, 20 were found positive for pf 8, pv 12; (SPR=59%, while P. Falciparum=40%). Anti malarial meds were given. All the information shared with DHO.

4‐Jun Malaria Balochistan Awaran Waja Bagh, UC camp Jhaoo,Tehsil Jhal Jhaoo

0 0 0 0 70 suspected Malaria cases were reported and tested, 54 verified positive of pf 2, pv 15 and Mix 37 (SPR=77%, while FR=72%. Anti malarial meds were provided for treatment. Information shared with DHO.

4‐Jun Malaria Balochistan Jhal Magsi BHU Sabz Ali Umrani, (Sabz Aki umrani)

5 3 8 5 21 suspected Malaria cases were reported. 15 slides were tesed and 10 found positive for pf=10; (SPR=71% and FR=100%). Anti Malarial medicines and RDTs were supplied. Information shared with DHO and district malaria program representative.

4‐Jun Malaria Balochistan Lasbela Civil Hospital, Tehsil Bela 16 21 20 13

75 suspect cases of Malaria were reported. 61 slides were tested of which 31 found positive for pf 10, pv 21 (SPR=51%, while FR=32%). Antimalarial meds were provided to the hospital. DHO was informed.

4‐Jun Measles Balochistan Gwadar DHQ Hospital 3 1 3 2 9 suspected measles cases were reported from DHQ. Most of the cases are from one location. During active surveillance no more cases were found in the locality.

4‐Jun AWD Sindh Tando Allah Yar

Village Vanheil Thebo, taluka Jhando Mari

0 4 1 3 6 cases of AWD/suspected cholera were reported, during active surveillance 2 more cases were found, Aqua tabs, Zinc tabs and ORS distributed, EDOH informed, 1 Stool and 4 water samples collected and sen to NIH for lab testing.

4‐Jun Measles Sindh Mirpur Khas Village Mehboob Farm, UC Jhulri, taluka Mirpurkhas

2 1 1 1

An alert of suspected measles was reported from community, during active surveillance total 5 cases were found. Vitamin(A) dose were given to all cases. Vaccination status were assessed for 6 children out of which Measles1= 4 (76%), Measles2=1 (16%), health education imparted,EDOH informed and 5 Blood samples collected for lab confirmation.

4‐Jun Measles Sindh Shikarpur Village Manik Lashari, near Khabri, UC Taib

3 0 2 1

An alert of suspected Measles was notified. During field investigation 4 more suspected cases were found, vitamin (A) dose given to the cases, immunization status of 16 children were assessed out of which 11 children (68%) were found vaccinated against BCG and rest ofthe children were unvaccinated against all antigens. Information shared with DHMT and 5 Blood samples were collected for lab testing.

4‐Jun Measles Sindh Tando Muhammad Khan

Village Suleman Soomro, UC Moula Katiar, taluka Bulri Shah Karim

4 2 0 1

2 Deaths due to Measles complication were reported from community, on active surveillance 7 more suspected measles cases were found, Vitamin(A) drops provided to the cases, health education im‐parted, 10 children were assessed for routine immunization where Measles=1 4(40%) and none of the child were vaccinated against Measles2. EDOH informed and 6 Blood samples were collected for lab testing.

5‐Jun Malaria Balochistan Jhal Magsi BHU Gajan,Killi Gajan, UC Patri 7 4 6 7

24 suspected Malaria cases were reported. 10 slides were tested, 9 found positive for pf 7, Mix 2; (SPR=90% and FR= 100%). Antimalarial medicines and RDTs were supplied. Information was shared with DHO and district malaria program representative.

5‐Jun Measles Balochistan Kech Mohallah Mulli‐basti, UC Absar 1 0 2 2

5 suspected measles cases were reported. During active surveillance 21 children checked for routine immunization out of which 9 were found totally unvaccinated (43%), Vitamin A drops was given to all the cases. Information shared with DHO.


D. I. Khan Haleem (Islamia) Colony, City 2 2 1 1 1

2 deaths due to measles were reported. During active surveillance three more cases of suspected Mea‐sles found. Vit A drops were given to the cases. 30 children below the age of 13 years were assessed for routine immunization and found unvaccinated. DSV EPI vaccinated the children against measles. DHO informed about the situation.


Mardan Village Jauro Dheri, UC Gumbat, Tehsil Mardan

1 1 2 2

An alert for suspected Measles was reported. On field investigation 5 more suspected cases were found. Vitamin A drops were given to the cases. 15 children were checked for routine immunization and found unvaccinated against measles; EPI team vaccinated 80 children with measles vaccine. Health education sessions conducted, EDO‐H, EPI Coordinator and LHS were informed.

5‐Jun Measles Punjab Layyah

Khu Wasti Wala,UC Bait Wasava Shumali, Tehsil Layyah

7 3 5 1

An alert of suspecetd Measles was reported. On active search 7 more suspected cases were found. Vitamin A drops were given to suspected cases and contacts. 35 children were assessed for routine immunization out of which 26 (74%) children were vaccinated against BCG and rest of the children found totally unvaccinated. During intensified outreach activity, 93 children were vaccinated against measles under 15 years of age. 3 blood sample were taken and sent to NIH for lab confirmation. Health education imparted. EDO(H) and DSC was informed.

5‐Jun Measles Punjab Multan Pulbararan, MDA chowk 6 1 2 1

An alert of suspected measles was reported. During active surveillance 7 more suspected cases were found. 4 blood samples were taken and sent to NIH for lab confirmation. Vit A drops were given to the cases. Intensified outreach activity conducted in the locality, 102 children <5 yrs of age were vaccinated for routine immunization. Health and hygiene sessions conducted about the importance of routine vaccination. Information shared with EDO(H), DOH(HQ), DOH, DDOH and DSC. Follow up planned.

5‐Jun Measles Sindh Karachi Chakra Goth Korangi town 5 0 3 0

An alert of suspected measles was received from Tertiary Care Hospital, index case was partially vacci‐nated, during field investigation 7 more suspected cases were found, Vitamin(A) dose were given to all cases, health education imparted, immunization status of 20 children were assessed out of which Mea‐sles1= 15 (74%), Measles2= 12 (58%), DHMT informed and 1 Blood sample sent to NIH.



Cont’d current week's (23/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

6‐Jun Measles Balochistan Pishin Muhammadin colony, UC Yaro 3 1 2 1

1 suspected case of Measles was reported. During active surveillance 6 more suspected cases were found. Vit A drops provided to all cases and Health education imparted in the locality.

6‐Jun Measles FATA Khyber Agency

Village Manz choki,UC Pirok‐hel,Tehsil Landikotal

2 1 5 0 8 suspected cases of measles cases were reported. Vitamin A drops were given to the cases. 2 blood samples were sent to NIH for lab confirmation. 24 children were vaccinated against measles. Health education im‐parted. Report shared with Agency Surgeon and FSMO.


Swabi Private clinic, Seray Charbagh 5 1 1 1

An alert of suspected Measles was reported from a private clinic. During field investigation 7 more suspected cases were found. Vit.A drops were given to the cases, health education sessions conducted, EDO H and EPI coordinator informed.

6‐Jun Measles Sindh Ghotki Village Pinyio Labano UC Bandh 2 1 2 0

An alert of suspected measles case was reported. On active search 4 more suspected cases were found. 3 blood samples were collected and sent to NIH for lab confirmation. 21 children were assessed for routine immunization out of which four were found vaccinated against BCG and rest of the children were totally unvaccinated. Information shared with DHMT for intensified outreach vaccination activity in the locality.

6‐Jun Pertussis Sindh Shaheed Benazir Abad

Village Nizamudin Dahri, UC Sun sawri 0 0 16 0

An alert of suspected Pertussis was notified from a Private Clinic. During field investigation 15 more sus‐pected cases were found, Erythromycin tabs provided to the cases and contacts, 15 children were assessed for routine immunization where 4 (27%)have BCG scar and 4 (27%) were found vaccinated against penta‐1, rest of the children found totally unvaccinated. Information shared with DHMT.

6‐Jun Pertussis Sindh Tando Allah Yar

Village Daim Khask‐heli, taluka Jhando Mari

2 3 1 1

An alert of suspected Pertussis was reported from community. On active search total 7 suspected cases were found, health education imparted, Erythromycin Syp provided to the cases, vaccination status were assessed for 7 children where BCG 4 (60%) and Penta 3 (50%). EDOH informed and 2 Nasal Swabs were collected for lab confirmation.

6‐Jun Pertussis Sindh Tando Allah Yar

Village Haji Bachal UC Mirabad, taluka Jhando Mari

3 0 5 2

An alert of suspected Pertussis were reported from community. During active search total 10 suspected cases were found, health education imparted, Erythromycin Syp distributed to the cases. Vaccination status were assessed for 10 children where BCG= 6(60%) and Penta= 4(40%) were found. EDOH informed about the situation and 4 Nasal Swabs were collected for lab confirmation.

7‐Jun Measles Balochistan Pishin Village killi Malikayar, UC malikayar

5 1 7 0

13 suspected Measles cases were reported from the village Malikayar. On field investigation 113 children were assessed for routine immunization and none of the child found vaccinated against any antigen. Out‐break investigation and EPI coverage was discussed with DHO and EPI representative. Intensified outreach vaccination activity was planned.

7‐Jun Measles FATA Bajaur Agency

village Koohi sha & Badezaghan‐Shekhano, Tehsil Utmankhel

2 1 3 1

3 suspected cases of measles were reported. During active surveillance 4 more cases were found. Blood samples taken from 2 patients and sent to NIH for lab testing. Health and hygeine sessions conducted. Vita‐min A drops were given to all cases and contacts. Routine immunization status were assessed for 28 children under 5 years of age out of which 6 were found vaccinated for routine and Measles‐1. Agency Surgeon & DSV was informed about the situation. 2 teams sent to the area for Measles coverage.

7‐Jun Measles FATA Khyber Agency

Village Pasid Khel,UC Torkham,Tehsil Landikotal

6 0 4 1

Suspected measles cases were reported by EPI Technician. The affected area was visited. 11 suspected cases were identified on active search. Vitamin A drops were given to cases. 2 blood samples sent to NIH for lab confirmation. 68 children were assessed for routine immunization and all of them found totally unvacci‐nated. Health education imparted. Report shared with Agency Surgeon and FSMO.


Haripur Raja Bagh, UC Tofkian, BHU Tofkian 3 1 1 1

6 suspected measles cases were reported. During field investigation 18 children were assessed for routine immunization and all of them found unvaccinated against measles. Vitamin A drops were given to the cases. Information shared with PEO polio and EPI coordinator about the vaccination status. Intensified outreach vaccination activity scheduled.

7‐Jun Measles Punjab Muzaf‐fargarh

Gali # 1, Safdar Colony, UC City‐3 3 1 1 1

An alert of suspected Measles was reported. On active search 5 more suspected cases were found. Vit A drops were given to all cases. 5 Blood samples were collected and sent to NIH for lab testing. Health educa‐tion imparted. Intensified outreach vaccination activity planned.

7‐Jun Measles Sindh Khairpur Mohalla Zameer Lanj wa, Village Darri, UC Mohabat wah

2 0 7 0

An alert of suspected Measles was reported. During field investigation 8 more suspected cases were found and all were unvaccinated. Vitamin (A) drops provided to all cases, health education imparted, Information was shared with DHMT and request for intensified outreach activity. 5 Blood samples were collected and sent to NIH for lab confirmation.

8‐Jun Measles Balochistan Sibi Village Safi, UC Khurruk 2 1 3 0

1 suspected case of measles was reported. On active search 5 more suspected cases were found. Vit A drops provided to all cases. 21 children less then 5 years were assessed for routine immunization and 16 were found unvaccinated against measles (64%). Health education imparted and parents were advised to visit EPI center for vaccination.

8‐Jun Typhoid Khyber Pakhtunk‐hwa

Haripur Village Kariplian, UC Kariplian 0 4 0 2

6 suspected cases of Enteric Fever were reported. Blood samples were tested and IgM came back positive for S.Typhi, field investigation found possible source as contaminated water supply. 1 case referred to DHQ haripur with complications (pain right illiac fossa and tender abdomen). Water samples from source, homes were taken and assessed for contamination. Health and hygiene sessions were conducted. Water supply operators were requested to ensure chlorinated water supply. Information shared with DHO.

8‐Jun Measles Sindh Khairpur

Village Daim Khan Gopang, near Village Younus Ujjan, UC Mohabat wah

2 1 0 2

An alert of suspected Measles was reported from community, on active search total 5 suspected cases were found. Vitamin (A) provided, 10 children were assessed for routine immunization out of which 2 (20%) chil‐dren were vaccinated against BCG and rest of the children found totally unvaccinated. Information shared with DHMT and request for outreach activity in the area. 1 Blood sample collected for lab testing.

8‐Jun Measles Sindh Khairpur Village Qabool Khan Gopang, UC Moabat wah, taluka Kot Diji.

2 0 2 1

An alert of suspected Measles case was reported. During field investigation total 5 suspected cases were found, vitamin (A) drops were given to all cases.10 children were assessed for routine immunization where 3 (30%)children found with BCG Scar and rest of the children found totally unvaccinated. Information shared with DHMT. 3 Blood samples collected for lab confirmation.

8‐Jun Measles sindh Shaheed Benazir Abad

Village Maroof kaliyar, UC Heaberi 0 1 4 4

An alert of suspected measles case was notified. During field investigation 8 more suspected cases were found. Vitamin (A) drops were given to the cases, health education imparted. 14 children were assessed for routine immunization out of which 4 (28%)were found vaccinated against Measles‐1 and none of the child was vaccinated against measles 2. DHMT informed and 3 Blood samples were collected for lab testing.

8‐Jun Pertussis Sindh Thar‐parkar

Village Kerio Dolat, UC Peelu, taluka Nagarparkar

5 1 1 1

3 suspected cases of pertussis were reported, on field investigation 5 more suspected cases were found. Erythromycin tabs and Syr were distributed to all cases and contacts, immunization status were assessed for 8 children where none of the child found vaccinated, health education imparted, EDOH informed and 5 Nasal Swab were taken for lab confirmation.

9‐Jun Measles Sindh Shikar‐pur

Muhalla Ameen shah chishti, near Mukhtiarkar office, UC‐4

0 0 3 2

An alert of suspected Measles case was notified. On active search 4 more suspected cases were found, vitamin (A) dose were given to all cases, 14 children were assesed for routine immunization where 2 (14%)children had BCG scar and rest of the children found totally unvaccinated. DHMT informed and 5 Blood samples were collected for lab confirmation..



Province Khyber Pakhtunkhwa: 468 health facilities from 17 districts of Khyber Pakhtunkhwa reported to DEWS with a total of 125,745 patients consultations reported in week 23, 2012. Total 72 alerts were received while 6 outbreaks were identified and appropriate measures were taken. Altogether 59 alerts for Measles; 4 each for Leishmani‐asis; 2 each for Bloody diarrhoea and Typhoid; while 1 each for Acute diarrhoea, AWD, CCHF, DF and NNT.

Figure-5: Trend of acute diarrhoea diseases, province KPK

Province Sindh:

Figure‐3: Number of alerts received and responded, week 23, 2012 Figure‐4: Number of consultations by age and gender, week 23, 2012

Province Punjab:

Figure-6: Number of alerts received and responded week 20 - 23, 2012, province KPK

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

667 health facilities from 23 districts in province Sindh were reported to DEWS with a total of 299,891 patients consultations in week 23, 2012. Total 56 alerts received while 15 outbreaks were identified and appropriate measure were taken. Altogether 37 alerts for Measles; 7 for AWD; 5 for Pertussis; 4 for Typhoid; while 1 each for Bloody diarrhoea, Malaria and Food poisoning.

Figure-8: Number of alerts received and responded week 20 - 23, 2012, province Sindh

Figure-9: Trend of acute diarrhoea, province Punjab Figure-10: Number of alerts received and responded week 20 - 23, 2012, province Punjab

415 health facilities from 8 districts in province Punjab reported to DEWS with a total of 175,992 patients consultations in week 23, 2012. Total 48 alerts were received while 5 outbreaks were identified and appropriate measures were taken. Altogether 28 alerts for Measles; 5 each for Scabies and Typhoid; 2 each for Acute diarrhoea, ARI, Bloody diarrhoea and Dengue fever, while 1 each for Leishmaniasis and Malaria.

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AWD

DF

Leishmaniasis

Malaria

Measles

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

Male 25073 56161 75035 115041 51693

Female 23285 55126 78162 191646 61392

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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 20 - 23, 2012, province Ba-

476 health facilities from 22 districts in province Balochistan reported to DEWS with a total of 67,094 patients consultations in week 23, 2012. Total 44 alerts reported while 14 outbreaks were identified and appropriate measures were taken in week 23, 2012. Altogether 18 alerts for Measles; 13 for Leishmaniasis; 7 for Malaria; while 1 each for Acute diarrhoea, CCHF, Scabies, Typhoid, Chickenpox and Mumps.

36 health facilities from 4 districts in Gilgit Baltistan reported to DEWS with a total of 16,975 patients consultations in week 23, 2012. No alerts or outbreak for any disease was reported in week 23, 2012.

Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week 20 - 23, 2012, Gilgit Baltistan

Figure-15: Trend of acute diarrhoea, FATA

50 health facilities from 3 agencies in FATA reported to DEWS with a total of 14,211 patients consultations in week 23, 2012. Total 13 alerts reported in week 23, 2012. Altogether 9 for Measles; 3 for NNT; while 1 for Leishmaniasis were reported and appropriated measures were taken.

Figure-16: Number of alerts received and responded week 20 - 23, 2012, FATA

Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 19 - 22, 2012, AJ&K

126 health facilities from 9 districts in AJ&K reported to DEWS with a total of 30,737 patients consultations in week 23, 2012. Total 17 alerts reported in week 23, 2012. Altogether 15 alerts were for Measles; while 2 for Leishmaniasis were reported and appropriate measures were taken.

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CCHF

Leishmaniasis

Malaria

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# of alerts

Leishmaniasis

Measles

Pertussis

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2011 2012

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35

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Measles

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Measles



Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

• In week 23, 2012 five new type‐1 polio cases were reported, 3 from Federally Administered Tribal Areas (one from South Waziristan, two from Khyber Agency) and one each from Punjab (Rajanpur) and Sindh (Larkana) provinces.

• As of 11 June 2012, Pakistan has reported a total of 22 polio cases (19 type‐1, 2 type‐3 & 1 mixture type‐1 & 3) from 13 districts/tribal agencies.

Province Cases 2011 Cases 2012

P1 P3 P1 P1+P3

Punjab 9 ‐ 2 ‐

Sindh 33 ‐ 3 ‐

Khyber Pakhtunkhwa 23 ‐ 4 ‐

FATA 57 2 8 1

Balochistan 73 ‐ 2 ‐

AJ&K ‐ ‐ ‐ ‐

Gilgit‐Baltistan 1 ‐ ‐ ‐

Islamabad ‐ ‐ ‐ ‐

Total 196 2 19 1

P3

‐

‐

‐

2

‐

‐

‐

‐

2

Table‐1: Total number of alerts and outbreaks reported and investigated with appropriate response Disease

2011 2012 (up till week 22) Current week 23, 2012

A O A O A O A O

Acute watery diarrhoea 1350 543 188 11 8 1 196 12

Acute jaundice syndrome 51 17 63 7 0 0 63 7

Bloody diarrhoea 98 20 69 5 5 0 74 5

Dengue fever 785 111 46 2 3 0 49 2

Measles 1708 110 2357 192 168 31 2525 223

Pertussis 287 81 257 101 5 4 262 105

NNT + tetanus 399 0 264 0 4 0 268 0

Malaria 131 88 57 33 9 7 66 40

Leishmaniasis 298 33 427 39 21 0 448 39

Others 645 69 714 59 29 1 743 60

Total 5752 1072 4442 449 252 44 4694 493

Total for 2012 (week 1‐23, 2012)

CCHF: CCHF is a serious viral hemorrhagic fever with up to 70% mortality rate, caused by an RNA virus of family Bunyaviri‐

dae, 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 hos‐pital setting.

In Pakistan, the first known CCHF outbreak oc‐curred during January 1976 at Rawalpindi General Hospi‐tal (RGH) among a surgical team. After above scenario, outbreaks were reported mostly from Balochistan prov‐ince during 1978, 1987, 1994, 1995 and 1999 involving 4 to 9 cases per year.

In 2012, total of 22 suspected cases have been reported throughout the country with 15 confirmed to date and 5 deaths. Out of 15 cases with linked history of Balochistan, 13 cases have been reported from Quetta. Chart at right illustrates current situation of CCHF cases in 2012. CFR is 33%.

Follow up of CCHF, Measles and Dengue

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Table‐1

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

AJ&K 63 4 104 0

Balochistan 203 42 860 8

FATA 92 14 263 4

Gilgit Baltistan 12 0 13 0

ICT 10 2 38 0

Khyber Pakhtunk‐hwa 1051 48 1882 23

Punjab 332 19 599 9

Sindh 762 94 1904 33

Total 2525 223 5663 77

2012 (Week 1 ‐ 23)

Province

Table‐2

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

AJ&K 15 0 15 0

Balochistan 18 7 70 1

FATA 9 3 32 0

Gilgit Baltistan 0 0 0 0

ICT 2 0 8 0

Khyber Pakhtunk‐hwa 59 5 106 5

Punjab 28 5 75 3

Sindh 37 11 109 2

Total 168 31 415 11

Epi‐week 23, 2012

Province

Action taken by WHO‐DEWS team:

1. WHO‐DEWS team is working in close coordination with health department in order to control CCHF outbreaks. 2. Monitoring the cases and their contacts on regular basis. Monitoring the Health staff on regular basis. 3. Monitoring contacts of the cases including family members and health staff for two weeks after exposure 4. Conducting regular meetings with DG Health and CCHF Focal Person DG Health office to update them regarding the situa‐

tion and it is possible outcomes. 5. District health department has planned door‐to‐door distribution of flyers in Quetta to raise awareness of the hazards of

exposure to ticks and fresh blood on butchering. 6. Conducting meetings with DG Livestock along with CCHF Focal person and update him regarding the situation and re‐

quested for intervention from his department. 7. Continuous awareness sessions are being conducted, to prevent tick bite/contact and use of PPE or proper clothing with

gloves, masks and long boots, among high risk groups. Measles: As of 9 June 2012, more measles cases and deaths have been reported in Pakistan than in 12 months last year. Table 1 updates the situation of measles in 2012 and table 2 illustrates about the alerts and outbreaks in week 23 up to 9 June. 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 to the right show the weekly number of confirmed Dengue cases reported by surveillance focal points in the Departments of Health in Sindh and Punjab in 2012. Total number of confirmed dengue cases to date in 2012 is 60 in Sindh and 64 in Punjab. Month of peak incidence in 2010 was November while peak incidence in 2011 was in September and October.

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This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. 08

Alerts and outbreaks, week 23, 2012

Documents

Weekly Epidemiological - WHO€¦ · Village Manik Lashari, near Khabri, UC Taib 3 0 2 1 An alert of suspected Measles was notified. During field investigation 4 more suspected cases