Weekly Epidemiological - WHO(17 - 23 June 2012) • Measles: 173 alerts investigated, responding to...

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. 25 (17 - 23 June 2012)

• Measles: 173 alerts investigated, responding to 27 outbreaks involving 418 measles cases.

• CCHF: In 2012, total of 21 confirmed cases have been reported throughout the country. Most of the cases (12) directly reported from Balochistan, 4 each KPK and Sindh and 1 from Punjab.

• 2 AWD outbreaks identified in 2 districts of Sindh and responded few confirmed cases in localities.

• Acute diarrhoea: Trend of acute diarrhoea is stable in all provinces. Districts in Sindh and Khy‐ber Pakhtunkhwa are investigating alerts for acute watery diarrhoea/suspected cholera.

• No new polio case was reported; As of 25 June 2012, Pakistan has reported a total of 22 polio cases (19 type‐1, 2 type‐3 and 1 mixture type‐1 and 3) from 13 districts/tribal agencies.

• 86 districts have reported in week 25, 2012, Please see map. 2,260 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week

• 812,072 patients’ consultations were reported in week 25 compared to 833,414 consultations reported on week 24, 2012.

Highlights

Disease early warning system and response in Pakistan

01

Volume 3, Issue 27, Wednesday 27 June 2012

• The graph (Figure‐1) 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.

• The overall weekly trend of acute diarrhoea remained stable during the last 4 week, however in KP the weekly propor‐tional morbidity of AD shows an upward trend in all the provinces.

Disease # of Cases Percentage

Acute diarrhoea 1,269,435 8%

Bloody diarrhoea 80,391 0.48%

ARI 3,320,196 20%

S. Malaria 755,999 5%

Skin Diseases 736,469 4%

Unexplained fever 581,072 3%

Total (All consultations) 16,721,988

Disease # of Cases Percentage

Acute diarrhoea 75,793 9%

Bloody diarrhoea 4,127 0.51%

ARI 118,507 15%

S. Malaria 45,515 6%

Skin Diseases 36,707 5%

Unexplained fever 29,687 4%

Total (All consultations) 812,072

Figure‐2: Weekly trend of Acute diarrhoea in Pakistan Week‐1, 2011 to week‐25, 2012.

Figure‐1: 86 districts reported to DEWS in week 25, 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 ‐ 25 (17 ‐ 23 June 2012)

Cumulative number of selected health events reported in Epi‐week 1 ‐ 25 (1 Jan ‐ 23 June 2012)

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Weekly Bulletin: DEWS, Pakistan, Week no. 25 (17 to 23 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 (25/2012) Outbreaks: Date Disease Province District Area 5M 5F Action Taken

21‐Jun Leishma‐niasis Balochistan Killa Saifullah Muslim Bagh town area, Tehsil Muslim Bagh

0 6 0 6 12 suspected cases of Leishmaniasis were reported. Patients were investigated and found lesions on face, nose, arms and legs. No travel history have seen in these patient. Treatment as per WHO protocol was given.

19‐Jun Leishma‐niasis Balochistan Pishin Village Kolak, UC Oramzai 0 0 0 6

6 suspected cases of Leishmaniasis were reported. Patients have history of disease since one year but no improvement after treatment. Treatment has provided to the patients.

19‐Jun Malaria Balochistan Awaran Mungli, UC Par‐war, Tehsil Mash‐kai

2 6 5 8 21 cases of malaria were reported and tested for confirmation.11 found positive (SPR=52%) of P.F=2 (FR=55%), P. V=5, Mix=4. Anti malarial treatment provided. Information shared with DHO and requested for bed nets and fogging in the locality.

19‐Jun Malaria Balochistan Chagai BHU Padag, Killi Mohammad Jhan Amuri, UC Padag

3 5 10 12 30 cases of suspected malaria were reported. 30 slides were tested where 19 verified positive (SPR=63%) of pf=8 (FR=42%),pv=11. RDTs and antimalarial medicines were provided. Bed nets not available in the district.

18‐Jun Malaria Balochistan Jaffarabad Goth Mohammd Amin Kanadrani 3 5 3 6 17 cases for suspected malaria were reported. 12 slides were tested using RDTs and all verified positive (SPR 100%). Antimalarial drug provided for treatment. Bed nets and insecticides not available in the district.

22‐Jun Malaria Balochistan Jhal Magsi Village Khichi, UC Barija 4 12 3 16 Suspected cases of malaria were reported from village. 21 slides tested out of which 14 were found positive (SPR=67%) of pf=7 (FR=48%), pv=4, Mix=3. Information shared with DHMT and requested to take necessary action. ACTs supplied for proper treatment of the patients.

18‐Jun Malaria Balochistan Lasbela DHQ Hospital, Tehsil Uthal 12 9 15 24 60 cases of Malaria were reported. 25 slides tested where 13 were positive (SPR=52%) pf=7 (FR=54%), pv=6. Patients were treated with antimalarial drugs. Information shared with DHO for necessary action.

19‐Jun Measles Balochistan Kech Jamadar Ayoob ward, UC Absar 1 0 3 2

2 suspected cases of measles were reported. During field investigation 4 more suspected cases were found. 23 children were assessed for routine immunization out of which 3 (13%) were not vaccinated against any antigen. Health education session conducted regarding importance of routine immunization. Information shared with DHO.

20‐Jun Measles Balochistan Kech Suthkalbazaar, UC Koshkalat 2 0 3 0

2 suspected cases of measles were reported through community. During field investigation 3 more suspected cases were found.Vit A drops were given to the cases and health education imparted in the community regarding routine immunization. 58 children were assessed for routine immunization out of which 5 were found totally unvaccinated against measles. Information shared with DHO.

17‐Jun Measles Balochistan Khuzdar Baleena Rodeni, UC and Tehsil Surab

6 2 1 4

An alert of suspected measles was reported. On field investigation 12 more suspected cases were found. Vit A drops were given to the cases. Cases were assessed for the routine immunization but none of child found vaccinated against measles. Information shared with DHMT and requested for intensified out‐reach activity in the locality. Health education imparted regarding the routine immunization. 2 blood samples were taken for confirmation.

18‐Jun Measles Balochistan Khuzdar Sat Marlla, UC Zereena Kattan, Tehsil Khuzdar

1 2 3 1

Alert reported through LHW. investigation was done. Patients were presented with typical signs & symp‐toms and had no immunization history. Vit A provided to all suspects. One blood sample was collected and sent to NIH. community was told about routine immunization importance and requested take their children to nearby EPI centre for routine immunization. Information shared with DHO and EPI team. 9 children less then 5 years were checked, 2 confirmed through EPI card while others partially immunized. Measles one dose coverage was 37.5% while second dose was zero.

20‐Jun Measles Balochistan Killa Saifullah Killi Alozai, UC Akhterzai, Tehsil Killa Saifullah

2 0 3 1

6 suspected cases of measles were reported. Vit A drops provided. None of the case were found vacci‐nated against measles. Immunization status of the community was not satisfactory because outreach activity has not been done due to compromised security in the area. DHO was informed about the situa‐tion.

22‐Jun Measles Balochistan Panjgur Mohalla Shapatan, UC Chitkan 4 0 1 0 An alert of measles were reported. During field investigation, 4 more suspected cases were found. Vit A drops were given to the cases. Health education imparted. 5 children were assessed for routine immuni‐zation out of which 4 (80%) were found vaccinated against measles.

18‐Jun Measles Balochistan Pishin Killi samkhail, UC Saranan 4 1 0 0

4 suspected cases and 1 death due to measles were reported. All the cases were found unvaccinated. Vit A drops provided and health education imparted. 35 children were checked for routine immunization and all of them were found unvaccinated against measles. Vaccination done on spot by the support of EPI team.

21‐Jun Measles Balochistan Pishin Village killi Baran‐zai, UC Gulistan. 8 3 0 0

An outbreak of measles was reported from HF. Vit A drops were provided and health education was imparted in the community. During house to house survey, 73 children were assessed for routine immu‐nization and none of them were found vaccinated against measles. Vaccinated these children on spot by the support of EPI team.

17‐Jun Measles Balochistan Ziarat Mana, UC Zindra 1 3 1 0

An alert of suspected measles were reported. On active search 4 more suspected cases were found. None of the case were found vaccinated against measles. Vit A drops provided to all cases. Blood sample was collected and sent to NIH for lab confirmation. Health education imparted. 9 children were assessed for routine immunization where 2 children found completely vaccinated while rest of them were par‐tially vaccinated. 3 children were found vaccinated with Measles 1 (37%).

19‐Jun Measles Balochistan Ziarat Pasara, UC Sinjawi 3 1 2 1

An alert of suspected measles was reported. On active search 6 more suspected cases were found. Cases were found unvaccinated. Vitamin A drops were given to the cases. Health education imparted. Matter was discussed with DHMT and EPI inchrage. 65 children



Cont’d current week's (25/2012) Outbreaks: Date Disease Province District Area 5M 5F Action Taken

21‐Jun Measles FATA Moh‐mand Agency

Daro bazar‐Anmbar 2 0 1 3

An outbreak of 6 suspected cases of measles was found on active surveillance. Vit A drops provided and health education imparted. During field investigation, 95 children were assessed for routine immunization out of which 81 (85%) were found unvaccinated against measles. Agency Surgeon & EPI Coordinator informed, 84 children were vaccinated against Measles after the intensified outreach vaccination activity in the area.

20‐Jun Measles Khyber Pakhtunk‐hwa

Abbotta‐bad

Murkalan, Nelay p, Mangalar 1 1 2 2

6 suspected cases of measles from the same family were found on active surveillance visit to hospital. Vit A drops provided. During field investigation 10 children were assessed for routine immunization out of which 3 were found totally unvaccinated. Vaccination was done on the spot by the support of EPI.


Mardan Village Qasim, UC Toru, Tehsil Mardan 0 3 2 0 An alert of suspected measles was reported. On active search 4 more suspected cases were found. Vitamin A drops were given to the cases.17 children were assessed for routine immunization but none of the patient were found vaccinated against mea‐sles. Health education session conducted, EDO‐H Focal person & EPI Coordinator were informed.


Shangla Mol Sar UC Butyal 3 1 1 2

3 deaths due to suspected measles were reported. During active surveillance 4 more suspected cases were found. Vitamin A drops provided. The whole of the village has been left unvaccinated for the past 09yrs; reason being life threats from the local community to EPI technician. DEWS‐Team along with DOH gathered the elders and managed to vaccinate 62 children for Measles 01. Blood samples were taken from 02 children and sent to NIH for further analysis. Follow up planned.


Swabi Private Clinic, Bacha Saib Banda, Dand 5 1 4 1 An alert of suspected measles was reported. During field investigation 9 more suspected cases were found in the same locality. EPI Cards were not available with the cases and parents were not able to recall about the vaccination. Vit.A drops provided, health education imparted, EDO H and EPI coordinator Informed. Intensified outreach vaccination activity planned.

22‐Jun AWD Sindh Tando Allahyar

Village Haji Sher Muhammad, taluka Chambar

1 3 1 2 An alert of AWD was reported. On active search 6 more cases were found, Hand pump was the source of water. Aqua tabs, Zinc tabs and ORS were distributed, health education imparted, EDOH informed, 1 Stool and 2 water samples collected for lab confirmation.

18‐Jun Measles Sindh Dadu Hashim Wakeel Muhalla, taluka K.N Shah

1 4 1 0 An alert of suspected measles was reported. During active surveillance 5 more suspected cases were found, Vitamin (A) drops were provided, health education imparted. 7 children were assessed for routine immunization where 4(64%) were found vaccinated for measles1 and 3 (57%) for measles 2. THO and EDOH informed. 2 Blood samples collected for lab testing.

19‐Jun Measles Sindh Dadu Bhittai Muhalla, city and taluka Mehar 3 1 2 0

An alert of suspected measles was reported, On active search 5 more suspected cases were found. Vitamin (A) drops were given to the cases, health education imparted. Routine immunization status were assessed for 6 children where 4(63%) found vaccinated with measles1 and 3(56%) with measles 2. 3 Blood samples were collected for lab confirmation. THO and EDOH informed. Outreach vaccination activity planned.

21‐Jun Measles Sindh Dadu Village Alam Khan Jatoi, UC Murada‐bad, taluka Dadu

2 3 0 0

An alert of suspected measles was reported. During field investigation 4 more suspected cases were found. Vitamin (A) drops provided, health education imparted. Routine immunization status were assessed for 7 children where measles1= 3(47%) and Measles2= 2(29%).EDOH, THO and DSC informed and request outreach vaccination activity in the area. 2 Blood samples col‐lected for lab confirmation.

22‐Jun Measles Sindh Dadu Village Dato khan Rodhani, UC Chinni, taluka Johi

2 3 4 2 11 suspected cases of Measles were detected on active surveillance visit. Vitamin (A) drops provided, health education im‐parted. Vaccination status were assessed for 11 children where Measles1= 4(33%), Measles2=2 (21%). EDOH, THO and DSC informed. 2 Blood samples collected for lab testing.

21‐Jun Measles Sindh Kash‐more

Village Huzoor Bux kosh, UC Gheehal pur

1 0 3 1

An alert of suspected measles was notified. During field investigation 4 more suspected cases were found, vitamin (A) drops provided, health education imparted. Vaccination status of 12 children were assessed where 3(24%) children had BCG scar and rest of the children were found totally unvaccinated, information shared with DHMT. 4 Blood samples collected for lab confir‐mation.

19‐Jun Measles Sindh Khairpur Village Dau, UC Therhi, taluka Khairpur

10 1 7 0

An alert of suspected Measles was cross notified from Sukkur. During field investigation 18 more suspected cases were found, vitamin (A) drops provided, 5 blood samples collected for lab confirmation,18 children were assessed for their routine immuni‐zation where none of the child was found vaccinated against measles, information shared with DHMT. Outreach vaccination activity planned.

21‐Jun Measles Sindh Khairpur Village Ghulam Muhammad Khushk, UC Nizamani

3 1 1 0

An alert of suspected measles was notified. During field investigation total 5 suspected cases including 1 death due to measles complications were found. Vitamin (A) drops provided to the cases, 2 blood samples collected and sent to NIH for lab confirma‐tion. 10 children were assessed for routine immunization where none of the child found vaccinated against measles. Informa‐tion shared with DHMT and outreach vaccination activity planned.

20‐Jun Measles Sindh Qambar Shahdad‐kot

Fateh Mohammad Supro , UC Dostli , Taulka Kambar

3 0 1 1

An alert of suspected measles was reported. During field investigation 4 more suspected cases were found, Vitamin (A) drops provided, health education imparted. Vaccination status of 10 children were assessed where BCG=3(30%), Penta1=3(30%), Penta2=2(20%), Penta3=1(10%), Measles1=1(10%), Measles2=(0%), DHMT informed and request for outreach vaccination activity in the area. 3 Blood samples were collected for lab confirmation.

20‐Jun Measles Sindh Shikar‐pur

Village sher dil khakhrani, UC waryaso

6 0 3 0

An alert of suspected Measles was cross notified from Larkana. During field investigation total 9 suspected cases were found, 6 blood samples were collected for lab confirmation, Vitamin (A) drops were given to the cases, health education imparted about the importance of routine immunization. 25 children were assessed for routine immunization where BCG=6(24%) and no history for other antigens. Information shared with DHMT .

22‐Jun Measles Sindh Thatta Village Ali Muham‐mad Mirbahar, UC Kalri

0 5 1 1

An alert of suspected measles was notified. During field investigation 6 more suspected post measles cases were found. Cluster of 30 houses were taken where 21 children were assessed for routine immunization but none of the child were found vacci‐nated. Health education imparted, Vitamin (A) drops provided, 4 blood samples collected for lab confirmation. Informed DHO, THO & TSV. Outreach vaccination activity planned.

22‐Jun Pertussis Sindh Naushahro feroze Village Latif Arain, UC DK Mari 0 0 6 3

An alert of suspected Pertussis was reported. During field investigation total 9 suspected cases were found. Health education imparted. Erythromycin tabs and syrups provided to the cases and contacts, 12 children were assessed for routine immuniza‐tion where BCG= 9(75%), penta1=7(58%), penta‐2=6(50%),penta‐3=5(41%), Measles‐1=3(25%),Measles‐2=(0%). Information shared with DHMT.

20‐Jun Pertussis Sindh Sukkur Village Roshanabad, UC patini, taluka Rohri

3 1 1 1

An alert of suspected Pertussis was reported. During field investigation 5 more suspected cases were found. 03 Nasopharyn‐geal swabs were collected for lab confirmation, Erythromycin tabs and syrups provided to the cases and contacts. Health education imparted. 15 children were assessed for routine immunization where 12 (80%)children were found vaccinated against BCG, while no information provided by parents regarding Pentavalent vaccine. Information shared with DHMT.

20‐Jun Pertussis Sindh Thar‐parkar

Village Burkhio, UC Mithrio Charan, taluka Chachro

5 0 1 1 An alert of suspected Pertussis was reported. During field investigation total 7 suspected cases were found, Erythromycin tabs and Syps were given to the cases and contacts, health education imparted, vaccination status were assessed but none of the child were found vaccinated, EDOH informed. 2 Nasopharyngeal swabs were collected for lab confirmation.

12‐Jun AWD Sindh Sukkur Peerzada Muhalla, Farash goth, UC Arain

0 2 0 1 3 AWD cases were reported from Muhalla Peerzada, Farash Goth, active search for more case was carried out, Aqua tabs, Jerry cans, Life straw filters and IEC Material distributed, health education imparted, DHMT informed, 1 stool sample found positive for Cholera, 3 water sample also collected result awaited.

20‐Jun AWD Sindh Dadu Gulshan‐e‐Munir colony, city Dadu 0 1 0 1 AWD case was reported with severe dehydration, vomiting and Fever, during field investigation 1 more AWD case was found, Aqua tabs, Zinc tabs and ORS distributed, health education imparted, EDOH, THO and DSC informed, 1 Stool sample was collected and found positive for Cholera, 2 water sample also collected result awaited.



Province Khyber Pakhtunkhwa: 456 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS with a total of 130,529 patients consultations reported in week 25, 2012. Total 70 alerts were received while 4 outbreaks were identified and appropriate measures were taken. Altogether 52 alerts for Measles; 14 each for Leishma‐niasis; while 1 each for AWD, AFP, Pertussis and Typhoid. Acute diarrhoea shows a slightly upward trend in KP.

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

Province Sindh:

Figure‐3: Number of alerts received and responded, week 25, 2012 Figure‐4: Number of consultations by age and gender, week 25, 2012

Province Punjab:

Figure-6: Number of alerts received and responded week 22 - 25, 2012, province KPK

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

738 health facilities from 23 districts in province Sindh were reported to DEWS with a total of 357,815 patients consultations in week 25, 2012. Total 93 alerts received while 14 outbreaks were identified and appropriate measure were taken. Altogether 60 alerts for Measles; 16 for AWD; 6 for Typhoid; 4 for Pertussis; 3 for NNt; 2 for AFp; while 1 each for AJS and Scabies. The AD shows a steady trend in Sindh.

Figure-8: Number of alerts received and responded week 22 - 25, 2012, province Sindh

Figure-9: Trend of acute diarrhoea, province Punjab Figure-10: Number of alerts received and responded week 22 - 25, 2012, province Punjab

402 health facilities from 8 districts in province Punjab reported to DEWS with a total of 194,456 patients consultations in week 25, 2012. Total 54 alerts were received and appropriate measures were taken. Altogether 30 alerts for Measles; 9 for Acute diarrhoea; 5 for Typhoid; 4 for AWD; while 1 each for AFP, AJS, ARI, Bloody diarrhoea, Leishmaniasis and Scabies. A slightly decline noted in the proportion of AD consultation in Punjab during the last few week.

0

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AWD

CCHF

DF

Leishmaniasis

Malaria

Measles

Pertussis

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2011 2012

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Measles

Pertussis

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Malaria

Measles



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 22 - 25, 2012, province Ba-

490 health facilities from 23 districts in province Balochistan reported to DEWS with a total of 78,219 patients consultations in week 25, 2012. Total 49 alerts reported while 19 outbreaks were identified and appropriate measures were taken in week 25, 2012. Altogether 26 alerts for Measles; 7 each for Leishmaniasis and Malaria; 2 each for CCHF and Typhoid; while 1 each for Acute diarrhoea, AFP, AWD, Pertussis and Scabies..

30 health facilities from 4 districts in Gilgit Baltistan reported to DEWS with a total of 13,080 patients consultations in week 25, 2012. No alerts were reported in week 25, 2012. AD showing upward trend.

Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week 22 - 25, 2012, Gilgit Baltistan

Figure-15: Trend of acute diarrhoea, FATA

53 health facilities from 3 agencies in FATA reported to DEWS with a total of 15,066 patients consultations in week 25, 2012. Total 5 alerts for Measles were reported in week 25, 2012 and appropriated measures were taken.

Figure-16: Number of alerts received and responded week 22 - 25, 2012, FATA

Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 24 - 25, 2012, AJ&K

78 health facilities from 6 districts in AJ&K reported to DEWS with a total of 18,410 patients consultations in week 25, 2012. No alerts reported in week 25, 2012.

0

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20

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Percen

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2011 2012

0

10

20

30

40

50

Wk‐22 Wk‐23 Wk‐24 Wk‐25

# of alerts

AWD

CCHF

Leishmaniasis

Malaria

Measles

Pertussis

0

5

10

15

20

25

30

35

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2011 2012

0

10

20

30

40

50

Wk‐22 Wk‐23 Wk‐24 Wk‐25

# of laerts

Leishmaniasis

Measles

Pertussis

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5

10

15

20

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Percen

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Epi‐week

2011 2012

0

10

20

30

40

50

Wk‐22 Wk‐23 Wk‐24 Wk‐25

# of alerts

Leishmaniasis

Measles

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5

10

15

20

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2011 2012

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30

40

50

Wk‐22 Wk‐23 Wk‐24 Wk‐25

# of alerts

Leishmaniasis

Measles



Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

• In week 24, 2012 no new type‐1 polio case was reported.

• As of 25th 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 24) Current week 25, 2012

A O A O A O A O

Acute watery diarrhoea 1350 543 211 17 22 1 233 18

Acute jaundice syndrome 51 17 66 7 2 0 68 7

Bloody diarrhoea 98 20 74 5 1 0 75 5

Dengue fever 785 111 53 2 0 0 53 2

Measles 1708 110 2707 248 173 27 2880 275

Pertussis 287 81 269 109 6 4 275 113

NNT + tetanus 399 0 273 3 0 276 0

Malaria 131 88 66 40 7 5 73 45

Leishmaniasis 298 33 463 39 22 2 485 41

Others 645 69 765 61 35 0 800 61

Total 5752 1072 4947 528 271 39 5218 567

Total for 2012 (week 1‐25, 2012)

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.

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

In 2012, total of 28 suspected cases have been re‐ported throughout the country with 21 confirmed to date and 6 deaths; (CFR is 30%). 17 cases have been reported from Balochistan; 4 each from KP and Sindh and 3 from Punjab. 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).

Follow up of CCHF, Measles and Dengue

0

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4

6

8

10

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Num

bers

Epi‐week

Number of CCHF cases (week 1 to 25, 2012), Pakistan

Cases Positive Deaths



Table‐1

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

AJ&K 71 4 115 0

Balochistan 239 59 1052 9

FATA 103 17 299 4

Gilgit Baltistan 14 0 15 0

ICT 10 2 38 0

Khyber Pakhtunk‐hwa 1164 60 2116 29

Punjab 400 21 691 13

Sindh 879 112 2204 38

Total 2880 275 6530 93

2012 (Week 1 ‐ 25)

Province

Table‐2

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

AJ&K 0 0 0 0

Balochistan 26 11 113 1

FATA 5 2 20 0

Gilgit Baltistan 0 0 0 0

ICT 0 0 0 0

Khyber Pakhtunk‐hwa 52 4 96 5

Punjab 30 0 30 1

Sindh 60 10 159 2

Total 173 27 418 9

Epi ‐ week 25, 2012

Province

Measles: As of 23 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 up to 23 June; and table 2 illustrates about the alerts and outbreaks in week 25 (17‐23 June, 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 show 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 67 in Sindh and 72 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 rate and Falciparum rate reported in week 25, 2012. Total number of malaria cases tested in week 25, 2012 is 18995, out of which 4030 were found positive.

Balochistan Sindh KP FATA Punjab GB AJK ICT

SPR 22.33 21.97 25.55 24.85 12.64 0 0 0

F. R 51.23 24.17 16.9 0.69 5.78 0 0 0

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Percentage

Malaria slide positivity rate, Week 25, 2012

0 0 0 0

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5

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8

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7

5 5

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7

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6

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5

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8

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

# of cases

Epi week

Weekly trend of positive dengue cases, week 1 to 25, 2012

Punjab Sindh



Alerts and outbreaks, week 25, 2012

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Weekly Epidemiological - WHO(17 - 23 June 2012) • Measles: 173 alerts investigated, responding to...

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Transcript of Weekly Epidemiological - WHO(17 - 23 June 2012) • Measles: 173 alerts investigated, responding to...