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Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for October 12 2010)

Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 23 2010)

Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 23 2010)

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 7 Monday 4 October 2010 (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK). Extracts, edited.]

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 7 Monday 4 October 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: eic.nih@gmail.com


Highlights

Epidemiological week no 39 (25 September - 1 October 2010)

  • Between 25 September - 1 October 2010 (epidemiological week no. 39), 41 of the 78 flood-affected districts provided surveillance data to the DEWS system. Of these 41 districts, 87% reported 6-7 days of the week.
  • 715 fixed health and 192 mobile medical outreach centers provided surveillance data for this week.
  • 433,890 consultations were reported through DEWS of which 19% were acute respiratory infections (ARI), 13% were acute diarrhoea, 13% were skin disease, and 8% were suspected malaria.
  • 16 alerts were received and responded to this week; 6 alerts were for acute watery diarrhoea (AWD), 4 were for Dengue fever, 4 for Bloody diarrhoea, 1 was for measles and 1 was for unexplained fever.
  • 7 deaths were reported to DEWS for this reporting week
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.


Priority diseases under surveillance in the flood affected areas

  • Acute Flaccid Paralysis
  • Acute Jaundice Syndrome
  • Acute Respiratory Infections
  • Acute Watery Diarrhoea/Suspected Cholera
  • Bloody Diarrhoea
  • Other Diarrhoea
  • Suspected Hemorrhagic Fever
  • Suspected Malaria
  • Suspected Measles
  • Suspected Meningitis
  • Unexplained Fever
  • Others

Table-1: Priority diseases reported during the week 31 - 39, 2010 (29 July - 1 October 2010)

[Diseases - Week‐31 - Week‐32 - Week‐33 - Week‐34 - Week‐35 - Week‐36 - Week‐37 - Week‐38 - Week‐39]

  • Acute Diarrhea - 25,689 (13%) - 94,288 (11%) - 182,548 (14%) - 199,607 (14%) - 138,644(13%) - 68,909 (12%) - 57,072 (14%) - 64,925 (13%) - 54,404 (13%)
  • Bloody Diarrhea - 1,449 (1%) - 4,566 (1%) - 7,907 (1%) - 11,024 (1%) - 10,839 (1%) - 9,228 (2%) - 6,705 (2%) - 6,411 (1%) - 5,896 (1%)
  • ARI (URTI & LRTI) - 25,335 (13%) - 92,134 (11%) - 185,546 (15%) - 217,071 (15%) - 187,226(18%) - 96,607 (17%) - 69,969 (1%) - 89,949 (18%) - 81,583 (19%)
  • Suspected Malaria - 3,954 (2%) - 17,348 (2%) - 27,453 (2%) - 45,542 (3%) - 45,652 (4%) - 40,441 (7%) - 32,692 (8%) - 42,759 (9%) - 36,514 (8%)
  • Skin Diseases - 36,383 (19%) - 115,080 (14%) - 246,959 (20%) - 296,441 (21%) - 202,630(19%) - 92,039 (16%) - 56,844 (14%) - 60,704 (12%) - 57,020 (13%)
  • Total consultation - 194,552 - 845,353 - 1,265,912 - 1,424,260 - 1,053,827 - 559,006 - 414,437 - 486,376 - 433,890

Table‐2: Average number of reporting districts per week

[Week 33 Week 34 - Week 35 - Week 36 - Week 37 - Week 38 - Week 39]

  • Balochistan - 6 - 6 - 6 - 6 - 6 - 6 - 6
  • KPK - 8 - 8 - 8 - 8 - 8 - 6 - 6
  • Punjab - 8 - 8 - 9 - 9 - 9 -10 -11
  • Sindh - 18 - 18 - 18 - 18 - 18 - 18 - 18
  • Total - 40 - 40 - 41 - 41 - 41 - 40 - 41

  • 64 districts have DEWS in place and 41 districts reported to DEWS this week; 6 in Balochistan, 6 in KPK, 11 in Punjab and 18 in Sindh. Not all districts are reporting regularly.
  • The average number of districts and health facilities reporting per week are shown in the table 2 and figure 2 above.
  • 87% of reporting districts reported 6‐7 times during the last reporting period, 9% reported between 3‐5 times, 4% reported 1‐2 times.

Table-3: Followup Alerts reported in week 38, 2010.

[Dates - Event - Place/District - Province - Action taken]

  • 20‐Sep‐10 - Meningitis - Dakorak Village/Swat - KPK - Laboratory test negative for Meningitis. Active surveillance in progress.
  • 21‐Sep‐10 - Measles - RHC Alladand Malakand - KPK - Sample in transportation
  • 22‐Sep‐10 - AWD - Kot Addu/Muzaffargarh - Punjab - Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing
  • 23‐Sep‐10 - AWD - Alipur, Bheda Kot/Muzaffargarh - Punjab - Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing
  • 23‐Sep‐10 - AWD - Alipur, Tibbi Arain/Muzaffargarh - Punjab - Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing
  • 23‐Sep‐10 - AWD - BHU Naakband/Kohat - KPK - Hygiene education sessions were conducted at mosque. 8,000 aqua tabs and 1,000 ORS were distributed.
  • 23‐Sep‐10 - AWD - DHQ Timergara, Tangi‐Bajour /Lower Dir - KPK - Previously 3 positive cases were identified so no new sample was taken. Case management and environmental improvement ongoing
  • 23‐Sep‐10 - AWD - DHQ Timergara, Pajigram‐Bajour /Lower Dir - KPK - Previously 3 positive cases were identified so no new sample was taken. Case management and environmental improvement ongoing
  • 23‐Sep‐10 - Malaria - UC Khazana/Lower Dir - KPK - Malaria control program is investigating. Report awaited.
  • 23‐Sep‐10 - Malaria - UC Norakhiel/Lower Dir - KPK - Malaria control program is investigating. Report awaited.
  • 23‐Sep‐10 - AFP - Nishter - Hospital/Multan - Punjab - Polio active surveillance is in progress. Specimen collected and in process.
  • 24‐Sep‐10 - AFP - Nishter Hospital/Muzaffargarh - Punjab - Polio active surveillance is in progress. Specimen collected and in process.
  • 24‐Sep‐10 - AFP - CHC Hospital/Muzaffargarh - Punjab - Polio active surveillance is in progress. Specimen collected and in process.

Table-4: Alerts and Outbreaks (Week 39, 2010)

[Dates - Event Place/District - Province - Action taken]

  • 25‐Sep‐10 - UF - DHQ Timergara/Lower Dir - KPK - Active surveillance and lab investigations are under process.
  • 26‐Sep‐10 - AWD - Wanda Balochan/DI Khan - KPK - Stool sample was collected and lab investigations are under process
  • 27‐Sep‐10 - AWD - Malakhra Ground Camp (Bhit Shah)/Matiari - Sind - Stool sample was negative. Water Samples were collected. TMA Bhit Shah was contacted to provide safe drinking water. Requested to PPHI to provide health education through LHWs.
  • 27‐Sep‐10 - AWD - Shah jo Bagh Relief Camp (Bhit Shah)/Matiari - Sind - Stool sample was negative. Water Samples were collected. TMA Bhit Shah was contacted to provide safe drinking water. Requested to PPHI to provide health education through HWs.
  • 27‐Sep‐10 - DHF - Ayub Teaching Hospital/Abbottabad - KPK - Tragic death of medical doctor confirmed due to CCHF. 14 contacts tested negative for both CCHF and Dengue. 8 samples were reported to be positive for Dengue in private labs.
  • 28‐Sep‐10 - AWD - DHQ Daggar (Kandao Patiy Village)/Buner - KPK - 2 Stool samples were positive for V. Cholera Ogawa. Health Education messages given to the family and aqua tabs/Water Purification Sachets also provided. Importance of use of ORS and hand washing explained to the patient and attendants.
  • 28‐Sep‐10 - AWD - DHQ D.I.Khan (Lakhra Village)/DI Khan - KPK - Stool sample was negative. Hygiene promotion sessions were conducted, line listing was maintained and active surveillance was done.
  • 28‐Sep‐10 - AWD - RHC Munda (Kambat ‐ Samar Bagh)/Lower Dir - KPK - Stool sample was positive for V. Cholera Ogawa. Water samples were collected, antiseptic soaps, HTH chlorine powder, aqua tabs were provided.
  • 28‐Sep‐10 - DHF - SGTH (Kotlai, Kokrai, Chakesar)/Swat - KPK - Suspected cases were found, blood samples were taken. 2 out of 3 were positive for Dengue.
  • 28‐Sep‐10 - DHF - KTH (Lower Dir)/Peshawar - KPK - Patient is isolated, blood sample collected. Patient is positive for Dengue.
  • 28‐Sep‐10 - BD - DHQ Muzaffargarh (Wasendey Wali)/Muzaffargarh - Punjab - Stool sample was negative. Active surveillance was done.
  • 28‐Sep‐10 - BD - DHQ Muzaffargarh (Basti Korewali)/Muzaffargarh - Punjab - Stool sample was negative. Active surveillance was done.
  • 29‐Sep‐10 - DHF - KTH (Polytechnic Colony‐Haripur)/Peshawar - KPK - Sample was collected and found negative for Dengue. Active surveillance is under process.
  • 29‐Sep‐10 - BD - DHQ Muzaffargarh (Basti Karimabad)/Muzaffargarh - Punjab - Stool sample was negative. Active surveillance was done.
  • 29‐Sep‐10 - BD - DHQ Muzaffargarh (Zakrya Colony)/Muzaffargarh - Punjab - Stool sample was negative. Active surveillance was done.
  • 30‐Sep‐10 - Measles - BHU Dhandla/Bhakkar - Punjab - Blood sample was collected and active surveillance is under process

Table-5: List of confirmed Polio Cases from flood affected districts

[S. NO. - Province - Districts - SEX - AGE (m) - Date onset of Paralysis - WPV Type]

  • 1 - KPK - Peshawar - F - 12 - 06/08/2010 - NSL1
  • 2 - KPK - Hangu - F - 05 - 07/08/2010 - NSL1
  • 3 - KPK - Hangu - M - 13 - 27/08/2010 - NSL1
  • 4 - Sindh - Sanghar - F - 144 - 21/08/2010 - NSL1
  • 5 - Sindh - Ghotki - M - 36 - 18/08/2010 - NSL1
  • 6 - Punjab - Muzaffargarh - F - 37 - 26/08/2010 - NSL1
  • 7 - Sindh - Ghotki - F - 60 - 03/09/2010 - NSL1
  • 8 - Punjab - DG Khan - F - 9 - 10/09/2010 - NSL1
  • 9 - Sindh - Ghotki - M - 6 - 15/09/2010 - NSL1
  • 10 - KPK - Peshawar - M - 29 - 14/09/2010 - NSL1

Province KPK

  • 6 out of 17 flood affected districts reported to DEWS from KPK province
  • 48 fixed health centers and 21 mobile medical outreach centers reported to DEWS
  • 87,204 patient consultations were reported during the reporting period of 25 Sept? 1 October, week 39, 2010
  • 9 alerts were received this week; 4 were for AWD, 4 were for Dengue fever and 1 for unexplained fever reported and responded to this week

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 8,770 10%
  • ARI - 15,615 17%
  • Skin Diseases - 5,736 7%
  • Suspected malaria - 1,278 1%
  • others - 54,066 62%
  • Total Consultations - 87,204

Province Punjab

  • 11 out of 12 flood affected districts reported data to DEWS from Punjab province
  • 176 fixed health centers and 45 mobile medical outreach centers reported to DEWS
  • 133,494 patient consultations were reported during this reporting period
  • 5 alerts were received and responded this week, 4 were for BD and 1 was for suspected Measles

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 17,407 13%
  • ARI - 24,365 18%
  • Skin Diseases - 19,023 14%
  • Suspected malaria - 12,546 9%
  • Others - 42,718 32%
  • Total consultations - 133,494

Province Sindh

  • 18 out of 22 flood affected districts reported to DEWS from Province Sindh
  • 464 fixed health centers and 120 mobile medical outreach centers reported to DEWS
  • 190,636 patient consultations were reported during the reporting period of 25 Sept - 1 October, week 39, 2010
  • 2 alerts of AWD were reported for this week from flood affected districts of province Sindh

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 24,661 13%
  • ARI - 38,249 20%
  • Skin Diseases - 32,261 17%
  • Suspected malaria - 18,651 10%
  • Others - 57,190 30%
  • Total consultations - 190,636

Province Balochistan

  • 6 out of 19 flood-affected districts reported to DEWS from province Balochistan
  • 27 fixed health centers and 6 mobile medical outreach centers reported to DEWS
  • 22,556 patient consultations were reported during the reporting period of 25 Sept - 1 October, week 39, 2010
  • No alerts were received from flood affected districts of province Balochistan

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 3,566 16%
  • ARI - 3,354 15%
  • Suspected Malaria - 4,039 18%
  • Unexplained Fever - 737 3%
  • Others - 10,827 48%
  • Total consultations - 22,556

Since July 29, 2010, approximately 6,745,548 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 of the 78 flood affected districts (82%) and reporting is received from 41 of these 64 districts (64%)

The major causes for seeking healthcare by the affected communities continue to be diarrhoel diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI decreased from 18% to 15% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009. (Please see Fig.13)

In Punjab, a higher proportion of suspected malaria was reported this week (8% to 9%), although a peak of malaria

in October reflects seasonal trend of diseases, DEWS officers are collaborating with Malaria Control Program to investigate areas of increased malaria.

In Sindh, proportional morbidity of major health events remained the same when compared to last week.

In Balochistan, reporting remains irregular due to security issues. Suspected malaria continues to make up the largest proportion of consultations. WHO expert team has gone to Balochistan and will conduct outbreak investigation for malaria in collaboration with Malaria Control Program.

Sixteen alerts were raised during this reporting period. Six alerts were for AWD bringing the total number of alerts for AWD to 132. There are currently 57 confirmed cholera cases through DEWS. The laboratory samples were collected from sites, according to case definition and sent to National Institute of Health (NIH) for laboratory confirmation. Relevant public health actions were initiated in the field to arrest potential outbreak.

Please see the Map on next page. In this new form of map, the number in the center of the chart pie is the total number of alerts for the district.


Focus On?.

Crimean-Congo Hemorrhagic Fever (CCHF)

Of three cases testing positive for CCHF in the past month, two have died, and an additional seven have become infected by nosocomial transmission at a Rawalpindi hospital. In Pakistan, the incidence of CCHF peaks in June and October but cases occur throughout the year.

Similar to Dengue Hemorrhagic Fever (DHF), CCHF presents as a fever of 2‐7 days which does not respond to antibiotics or anti‐malarial treatment and is associated with dropping platelets and hemorrhagic signs with case fatality rate as high as 50%. Two main differences are that CCHF is transmissable from the blood of patients with the disease, and it is successfully treated with high dose Ribavirin, while DHF does not respond to antivirals and it is not transmissable directly from the patient.

CCHF is caused by a Nairovirus and transmitted to humans by the bite of the Hyalomma tick or by direct contact with blood of an infected animal or human. The disease was first described in Crimea in 1944 and identified in 1956 in Congo and thus developed the current name for the disease and its causative virus. Population migration with animals contributes to the higher probability of susceptible animals being bitten by infected ticks, thus increasing the risk of transmission to humans who handle the animals.

CCHF was first reported in Pakistan in 1976 but the number of cases has shown a dramatic rise since 2000 with 50‐60 cases being reported annually. It is endemic in Balochistan, but every province has seen a few cases and unfortunately nosocomial outbreaks have occurred in the past in major hospitals in Karachi, Peshawar, Rawalpindi and Quetta.

Guidelines for CCHF are available on NIH website (LINK) and WHO website (LINK)


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.

-
------
 
Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 23 2010)

Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 23 2010)

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 8 Monday 10 October 2010 (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK). Extracts, edited.]

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 8 Monday 10 October 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: eic.nih@gmail.com, WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int.


Highlights

Epidemiological week no 40 (2 - 8 October 2010)

  • Between 2 - 8 October 2010 (epidemiological week no. 40), 48 of the 78 flood-affected districts provided surveillance data to the DEWS system. Of these 48 districts, 90% reported 6-7 days of the week.
  • 655 fixed health and 153 mobile medical outreach centers provided surveillance data for this week.
  • 326,071 consultations were reported through DEWS of which 20% were acute respiratory infections (ARI), 12% were acute diarrhoea, 13% were skin disease, and 8% were suspected malaria.
  • 42 alerts were received and responded to this week: 26 alerts were for acute watery diarrhoea (AWD, Suspected Cholera), 9 were for Viral Hemorrhagic Fever, 4 were for Acute Flaccid Paralysis (AFP, Suspected Poliomyelitis), 2 were for Measles and 1 was for Bloody Diarrhoea.
  • Ongoing malaria surveillance in collaboration with the Malaria Control Program identified districts with higher than usual malaria transmission rates during peak Falciparum season. Districts Layyah, Rajanpur, DG Khan and Muzaffargarh in Punjab; Jacobabad, Larkana, Thatta and Khairpur in Sindh; Naseerabad, Sibi, Zhob and Jhal Magsi in Balochistan.
  • Seven of the 10 cases of poliomyelitis confirmed this week were from the 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.

Priority diseases under surveillance in the flood affected areas

  • Acute Flaccid Paralysis
  • Acute Jaundice Syndrome
  • Acute Respiratory Infections
  • Acute Watery Diarrhoea/Suspected Cholera
  • Bloody Diarrhoea
  • Other Diarrhoea
  • Suspected Hemorrhagic Fever
  • Suspected Malaria
  • Suspected Measles
  • Suspected Meningitis
  • Unexplained Fever
  • Others

Table-1: Priority diseases reported during the week 31 - 40, 2010 (29 July - 8 October 2010)

[Diseases - Week‐31 - Week‐32 - Week‐33 - Week‐34 - Week‐35 - Week‐36 - Week‐37 - Week‐38 - Week‐39 - Week‐40]

  • Acute Diarrhea - 25,689 (13%) - 94,288 (11%) - 182,548 (14%) - 199,607 (14%) - 138,644(13%) - 68,909 (12%) - 57,072 (14%) - 64,925 (13%) - 54,404 (13%) - 37,624 (12%)
  • Bloody Diarrhea - 1,449 (1%) - 4,566 (1%) - 7,907 (1%) - 11,024 (1%) - 10,839 (1%) - 9,228 (2%) - 6,705 (2%) - 6,411 (1%) - 5,896 (1%) -5,253 (2%)
  • ARI (URTI & LRTI) - 25,335 (13%) - 92,134 (11%) - 185,546 (15%) - 217,071 (15%) - 187,226(18%) - 96,607 (17%) - 69,969 (17%) - 89,949 (18%) - 81,583 (19%) - 65,216 (20%)
  • Suspected Malaria - 3,954 (2%) - 17,348 (2%) - 27,453 (2%) - 45,542 (3%) - 45,652 (4%) - 40,441 (7%) - 32,692 (8%) - 42,759 (9%) - 36,514 (8%) - 25,625 (8%)
  • Skin Diseases - 36,383 (19%) - 115,080 (14%) - 246,959 (20%) - 296,441 (21%) - 202,630(19%) - 92,039 (16%) - 56,844 (14%) - 60,704 (12%) - 57,020 (13%) - 41,664 (13%)
  • Total consultation - 194,552 - 845,353 - 1,265,912 - 1,424,260 - 1,053,827 - 559,006 - 414,437 - 486,376 - 433,890 - 326,071

Table‐2: Average number of reporting districts per week

[Province - Week 33 - Week 34 - Week 35 - Week 36 - Week 37 - Week 38 - Week 39 - Week 40]

  • Balochistan - 6 - 6 - 6 - 6 - 6 - 6 - 6 - 5
  • KPK - 8 - 8 - 8 - 8 - 8 - 6 - 6 - 15
  • Punjab - 8 - 8 - 9 - 9 - 9 - 10 - 11 - 11
  • Sindh - 18 - 18 - 18 - 18 - 18 - 18 - 18 - 17
  • Total - 40 - 40 - 41 - 41 - 41 - 40 - 41 - 48

  • 64 districts have DEWS in place and 48 districts reported to DEWS this week; 5 in Balochistan, 15 in KPK, 11 in Punjab and 17 in Sindh. Not all districts are reporting regularly.
  • The average number of districts and health facilities reporting per week are shown in the table 2 and figure 2 above.
  • Almost 90% of reporting districts reported 6‐7 times during the last reporting period, 7% reported between 3‐5 times, 3% reported 1‐2 times.

Table-3: Follow-up alerts reported in week 39, 2010.

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]

  • 2010‐39 - 25‐Sep‐10 - UXF - KPK - Lower Dir DHQ Timergara - ** - ** - Team examined 1700 people; no DF, DHF or CCHF identified in area related to this report.
  • 2010‐39 - 26‐Sep‐10 - AWD - KPK - D.I. Khan Wanda Balochan - 22 - F - Stool sample collected and was found negative. Active surveillance was done.
  • 2010‐39 - 27‐Sep‐10 - AWD - Sind - Matiari Malakhra Ground Camp (Bhit Shah), Shah jo Bagh Relief Camp (Bhit Shah) - ** - ** - Stool sample was negative. Public health response in place with TMA, PPHI, LHWs.
  • 2010‐39 - 27‐Sep‐10 - DHF - KPK - Abbottabad Ayub Teaching Hospital - ** - ** - Tragic death of medical doctor confirmed due to CCHF. 14 contacts tested negative for both CCHF and Dengue. DF and DHF detailed below.
  • 2010‐39 - 28‐Sep‐10 - AWD - KPK - Buner DHQ Daggar (Kandao Patiy Village) - 8,8 M, M - 2 Stool samples were positive for V. Cholera Ogawa. Public health response in place.
  • 2010‐39 - 28‐Sep‐10 - AWD - KPK - D.I. Khan DHQ D.I.Khan (Lakhra Village) - 1.5 - M - Stool sample was negative. Public health response in place.
  • 2010‐39 - 28‐Sep‐10 - AWD - KPK - Lower Dir RHC Munda (Kambat ‐ Samar Bagh) - 30 - F - Stool sample was positive for V. Cholera Ogawa. Public health response in place.
  • 2010‐39 - 28‐Sep‐10 - DHF x 3 - KPK - Shangla SGTH (Kotlai, Kokrai, Chakesar) - 65, 75, 35 - M, F, M - Suspected cases were found, blood samples were taken. 2 out of 3 were positive for Dengue.
  • 2010‐39 - 28‐Sep‐10 - DHF x 2 - KPK - L.Dir, Haripur KTH (Lower Dir), (Polytechnic Colony‐Haripur) - 24, 20 - F, M - Lower Dir case positive for DF, Haripur case negative for DF. Active surveillance continuing.
  • 2010‐39 - 28‐Sep‐10 - BD x 4 - Punjab - Muzaffargarh DHQ Muzaffargarh (Wasendey Wali), (Basti Korewali), (Basti Karimabad Tibba), (Zakrya Colony) - 9, 2, 50, 8 - M, M, M, M - Stool samples were negative for pathogens. Active surveillance was done in four villages and no further cases were found.
  • 2010‐39 - 30‐Sep‐10 - Measles - Punjab - Bhakkar BHU Dhandla - 4 - M - Blood sample was found negative. No further cases were found on active surveillance.
  • 2010‐39 - 1‐Oct‐10 - AWD - KPK - Tank DHQ Tank (Kot Azam) - 1 - F - Stool sample negative. Active surveillance was done and no further cases were found.

Table-4: Alerts and Outbreaks (Week 40, 2010)

(...)


Province KPK

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 4,520 8%
  • ARI - 10,074 17%
  • Skin Diseases - 2,738 5%
  • others - 39,853 67%
  • Total Consultations - 59,482

  • 15 out of 17 flood affected districts reported to DEWS from KPK province
  • 47 fixed health centers and 17 mobile medical outreach centers reported to DEWS
  • 59,482 patient consultations were reported during the reporting period of 2 ? 8 October, week 40, 2010
  • 20 alerts were received and investigated this week; 11 were for AWD, 8 were for suspected DHF, and 1 was for suspected Measles.
  • Regarding Dengue Fever (DF) and Degue Hemorrhagic Fever (DHF), from early September up until 9th October 2010, DEWS teams have identified 137 suspected cases of DF, including 55 cases of suspected DHF, in the districts Haripur, Mansehra and Abbotabad. Of the suspected cases, 97 were male and 40 were female, none were under five years old and five cases were between 5 and 15 years old. During this time, there were nine cinfirmed deaths of cases with fever and hemorrhagic signs but only one was confirmed positive for DF.

Province Punjab

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 13,269 12%
  • ARI - 21,439 19%
  • Skin Diseases - 15,876 14%
  • Suspected malaria - 9,785 9%
  • Others - 37,966 34%
  • Total consultations - 111,665

  • 11 out of 12 flood affected districts reported data to DEWS from Punjab province
  • 187 fixed health centers and 36 mobile medical outreach centers reported to DEWS
  • 111,665 patient consultations were reported during this reporting period
  • 18 alerts were received and investigated this week; 12 were for AWD, 1 was for BD, 1 was for suspected Measles, and 4 were for AFP. Ten cases were confirmed positive for Vibrio cholera Ogawa in Muzaffarabad District and treated successfully at the DTC while teams are in the field to assess and improve the water and sanitation situation. Four districts with highest levels of malaria in Punjab are Layyah, Rajanpur, DG Khan and Muzaffargarh.

Province Sindh

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 16,850 12%
  • ARI - 30,679 23%
  • Skin Diseases - 23,050 17%
  • Suspected malaria - 11,918 9%
  • Others - 36,448 27%
  • Total consultations - 136,129

  • 17 out of 22 flood affected districts reported to DEWS from Province Sindh
  • 390 fixed health centers and 96 mobile medical outreach centers reported to DEWS
  • 136,129 patient consultations were reported during the reporting period of 2 - 8 October, week 40, 2010
  • 4 alerts were received and investigated this week; 3 were for AWD and one was for VHF. 15 cases of suspected DF were identified by DEWS teams in Hyderabad district; 14 were male and 1 was female; 12 were tested DF positive; none were ubder age five years. Jacobabad, Larkana, Thatta and Khairpur districts are experiencing peak Falciparum malaria season.

Province Balochistan

  • Acute Diarrhoea - 2,985 16%
  • ARI - 3,024 16%
  • Suspected Malaria - 3,171 17%
  • Unexplained Fever - 1,093 6%
  • Total consultations 18,795

  • 5 out of 19 flood-affected districts reported to DEWS from province Balochistan
  • 31 fixed health centers and 4 mobile medical outreach centers reported to DEWS
  • 18,795 patient consultations were reported during the reporting period of 2 - 8 October, week 39, 2010
  • No alerts were received from Balochistan but malaria-endemic districts were reporting unusual seasonal peaks of falciparum malaria in Naseerabad and Sibi while Jhal Magsi had high levels of vivax malaria. Zhob is experiencing a unusually high slide positive rate of 52% with mostly falciparum confirmed cases.

Table-5: List of confirmed Polio Cases from flood affected districts since 19 September 2010

[S. NO. - Province - Districts - SEX - AGE (m) - Date onset of Paralysis - WPV Type]

  • 1 - KPK - Swabi - F - 9 - 19/09/2010 - NSL1
  • 2 - Sindh - Ghotki - F - 42 - 20/09/2010 - NSL1
  • 3 - KPK - Lakki Marwat - M - 12 - 20/09/2010 - NSL1
  • 4 - Sindh - Khairpur - F - 18 - 21/09/2010 - NSL1
  • 5 - KPK - Kohat - F - 18 - 21/09/2010 - NSL1
  • 6 - Punjab - Mianwali - M - 36 - 21/09/2010 - NSL1
  • 7 - Sindh - Sukkur - F - 36 - 26/09/2010 - NSL1

Summary of Health Event in Flood affected districts

Since July 29, 2010, approximately 7,035,683 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 (82%) of the 78 flood affected districts and reporting is received from 48 (75%) of these 64 districts.

The major causes for seeking healthcare by the affected communities continue to be diarrheal diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI decreased from 19% to 12% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009. (Please see Fig.13)

In Punjab, a higher proportion of suspected malaria was reported this week (9% to 10%), although a peak of malaria in October reflects seasonal trend of diseases, DEWS officers are collaborating with Malaria Control Program to investigate areas of increased malaria.

In Sindh, proportional morbidity of major health events remained the same when compared to last week.

In Balochistan, reporting remains irregular due to security issues. Suspected malaria continues to make up the largest proportion of consultations. WHO expert team has gone to Balochistan and will conduct outbreak investigation for malaria in collaboration with Malaria Control Program.


Focus on: Malaria

Every year Pakistan records about 4.5 million suspected cases of malaria and has evidence of about 1.6 million confirmed cases. September and October are the months for high transmission of Falciparum Malaria, but out of 47 flood‐affected districts which are endemic for malaria, only nine are experiencing unusually high numbers of confirmed falciparum malaria cases. These districts are Layyah and Rajanpur in Punjab; Jacobabad, Larkana, Thatta, and Khairpur in Sindh; and Naseerabad, Sibi, and Zhob in Balochistan. At the same time, DG Khan, Muzaffargarh and Jhal Magsi are still showing considerable number of vivax malaria cases.

DEWS Teams are collaborating with Malaria Control Dept and other partners to identify the malaria ?hot spots? and bring a rapid response with medicines and appropriate vector control strategy. Preparation for malaria season started with distribution of anti‐malarial medicines in each of the emergency health kits deployed in flood‐affected districts. Provincial Malaria Control Programs undertook indoor residual spraying as a vector control strategy in flood ‐affected districts. WHO sent Rapid Diagnostic Tests (RDT) to the provinces to confirm cases of suspected malaria who were distant from microscopy centers.

Supplies of primaquine tablets were distributed to areas with high vivax transmission while additional tabs of ACT‐SP were distributed to provinces with high numbers of falciparum cases. WHO, UNICEF, and UNHCR have distributed bed nets to the hotspots to increase coverage and protection of the population.

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

(...)
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Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 23 2010)

Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for September 23 2010)

Pakistan Health Cluster - No 20. 12 October 2010 (WHO, edited)


[Source World Health Organization, full PDF Document (LINK). Extracts, edited.]

Floods in Pakistan - Pakistan Health Cluster - No 20. 12 October 2010

(...)


Situation overview

While substantial areas in Sindh, in particular Dadu and Qamber Shahdkot, are still flooded, access to northern districts of Khyber Pakhtunkhwa (KP) continues to improve; the flood is visible only in the destruction it has left behind. As the weeks go by, the ways in which the flood has affected the different areas of the country are becoming more apparent. Partners are designing and implementing activities that respond to these diverse needs and situations.

According to OCHA, in KP and Punjab most internally displaced people (IDPs) have returned home. In Sindh and Baluchistan, where vast areas remain under water, some people have successfully returned home while others are moving to camps closer to their still inaccessible homes. The number of people affected stands at 20.2 million. Around 2.4 million hectares of agriculture have been damaged, and 1.9 million houses have been damaged or destroyed.


Health impact

Acute diarrhoea, acute respiratory infections (ARI,) skin infections and suspected malaria remain the leading causes for seeking health care in the flood-affected areas.


Basic epidemiological update (reporting period 2-8 October)

  • 48 of the 78 flood-affected districts provided surveillance data to the Disease Early Warning and Surveillance (DEWS) system. Of these 48 districts, 90% reported 6-7 days of the week.
  • 655 fixed health facilities and 153 mobile medical outreach centres provided surveillance data for this week.
  • 326 071 consultations were reported through DEWS, of which 20% were for acute respiratory infections (ARI), 12% were for acute diarrhoea, 13% were for skin disease, and 8% were for suspected malaria.
  • A total of 42 alerts were received and responded to this week, of which 26 were for acute watery diarrhoea (AWD, suspected Cholera), nine were for viral haemorrhagic fever, four were for acute flaccid paralysis (AFP, suspected poliomyelitis), two were for measles and one was for bloody diarrhoea.

Upcoming issues

  • In the last two weeks, ten cases of confirmed cholera have been reported in Kot Addu, whith patients coming from a number of villages and camps in the area. Outbreaks of AWD are expected to continue until the end of October.
  • The increase of anecdotal reports of cases of severe acute malnutrition (SAM) is a concern for all health partners. The clinical management of SAM is the responsibility of the Health Cluster. Health Cluster Partners are planning to open stabilization centres in priority locations, and are working with the Nutrition Cluster, which is focusing on community-based responses.
  • In the north, severe cases of ARI-like pneumonia are increasing as winter approaches.
  • Over the last week, Dengue and CCHF have featured prominently in the news in Pakistan. So far, the number of cases remains within the normal range for this time of the year. Dengue is endemic in some areas of Pakistan, Karachi (Sindh) and Haripour (KPK) in particular. CCFH is endemic to Baluchistan. Health authorities in partnership with WHO are studying the potential impact of the flood in the frequency of these fevers. Increased prevention measures will be implemented.
  • During upcoming Eid ul Azha, when massive displacement and slaughtering of the cattle occurs, the risk of humananimal contact causing the Crimean Congo Hemorrhagic disease will be increased. WHO, MoH and FAO are jointly coordinating preventive measures in preparation for that festivity.
  • WHO?s epidemiological bulletin will now be published on a weekly rather than daily basis.
  • In KP, 20 alerts were received and investigated this week, of which 11 were for AWD, eight were for suspected dengue haemorrhagic fever, and one was for suspected measles.
  • In Punjab, 18 alerts were received and investigated this week, of which 12 were for AWD, one was for BD, one was for suspected measles, and four were for AFP. The four districts with highest levels of malaria in Punjab are Layyah, Rajanpur, DG Khan, and Muzaffargarh.
  • In Sindh, four alerts were received and investigated this week, of which three were for AWD and one was for VHF. Jacobabad, Larkana, Thatta, and Khairpur districts are experiencing a peak malaria season.
  • In Baluchistan, no alerts were received, but malaria-endemic districts were reporting higher than usual peaks of falciparum malaria in Naseerabad and Sibi, while Jhal Magsi had high levels of both vivax and falciparum malaria. Zhob is experiencing an unusually high slide positivity rate of 52% with mostly falciparum.
  • Nine new polio cases have been reported over the past week. Apart from one type-3 case, all of them are type-1. They include three cases from the conflict-affected Federally Administered Tribal Areas (FATA) and two from KP. There are three cases from north Sindh and one case from north Punjab. As of 11 October 2010, Pakistan has reported a total of 78 polio cases including 58 type-1 and 20 type-3 cases. There are four new infected districts including Kohat in KP, neighbouring district Mianwali in Punjab, and two districts in north Sindh (Sukkur and Khairpur). The total number of infected districts/towns/tribal agencies is now 27. There are wild polio virus type-1 isolates from environmental samples from Karachi, Rawalpindi and Peshawar.
For a more detailed Epidemiologic report kindly go to (LINK)


Brief Focus on Malaria

Every year Pakistan records about 4.5 million suspected cases of malaria, of which around 1.6 million are confirmed. September and October are the months for high transmission of Falciparum Malaria. To date, however, only nine of the 47 flood-affected districts that are endemic for malaria have experienced unusually high numbers of confirmed falciparum malaria cases. These districts are Layyah and Rajanpur in Punjab; Jacobabad, Larkana, Thatta, and Khairpur in Sindh; and Naseerabad, Sibi, and Zhob in Baluchistan. At the same time, DG Khan, Muzaffarghar and Jhal Magsi are reporting a considerable number of vivax malaria cases.

DEWS teams are collaborating with Pakistan's Malaria Control Department and other partners to identify malaria ?hot spots? and respond rapidly with medicines and vector control measures. Preparations for the malaria season started with the inclusion of anti-malarial medicines in each of the emergency health kits distributed in flood-affected districts.

Provincial malaria control programmes have carried out indoor residual spraying in flood-affected districts. WHO sent rapid diagnostic tests (RDTs) to the provinces, and donated supplies of primaquine tablets to areas with high vivax transmission and additional tabs of ACT-SP to areas with high numbers of falciparum cases. WHO, UNICEF, and UNHCR have distributed bednets to the hotspots to increase coverage and protection of the population.


Government Response

The Prime Minister was fully apprised of the health situation in the flood-affected areas at a special briefing session.

The Federal Secretary for Health presented a detailed overview of current health initiatives and future plans and interventions.

The Federal Secretary for Health chaired the 5th National Steering Committee on Health Emergencies in Islamabad on 7 October 2010. Different provinces gave a district-by-district update on damages to health facilities. The representative from Sindh Province provided an estimate of the cost of rehabilitating the health facilities.

A three-phase mass immunization campaign has been launched in the 77 most affected districts. The first phase, which has been completed, covered 35 districts. The other districts will be covered in the remaining phases. The Ministry of Health (MoH) conducted two trainings-of-trainers courses in psychosocial support, in collaboration with Kings College London and the British Council in Islamabad. A total of 55 psychiatrists from the most affected districts were trained; their names have been provided to provincial governments, who will enlist their help in developing and implementing strategies for providing psychosocial support to those affected by the floods. The MoH held a special meeting with UN agencies to discuss recent alerts for Crimean-Congo haemorrhagic fever and dengue fever. The National Institute of Health will organize a meeting with all stakeholders in this regard. Seven field hospitals donated by the Republic of Italy have been deployed: three in Punjab (Muzzaffargarh (2) and Layyah), two in KP (Dasu and Madyan) one in Gilgit-Baltistan (Ganchee) and one in Baluchistan (Dera Allah yar).


Health Cluster Response


  • ARC INTERNATIONAL
    • BALUCHISTAN
      • ARC is working in five health facilities in Sibi (Rural Health Centre (RHC) Talli, BHUs Sultan Kot, Bakhtiarabad, Chandia and Gishkori). A total of 2776 patients were treated over the last week. ARC is also running four diarrhoea treatment centres (DTCs) in Sibi DHQ, Dahdar DHQ, Bolan Medical Complex Quetta and Eastern Bypass DTC, as well as a medical camp. A total of 1392 patients were treated at the DTCs. ARC is also providing health education and psychosocial support.
    • KP
      • ARC is working in seven health facilities in Swat (Civil Hospital Barikot, Civil Dispensary (CD) Ghalagay, Telligram, Basic Health Units (BHUs) Taghma, BaraSamai, Koza Samai, Bishband). Last week a total of 3160 patients (2080 women and 1080 men) were treated. ARC conducted 43 health education sessions, delivered seven babies, referred four patients, and provided psychosocial counseling to 13 patients. RC is donating long-lasting insecticide-treated bednets (LLINs) to pregnant women and children under five.

  • AUSAID/AUSTRALIAN DEFENCE FORCE
    • The joint AusAID/Australian Defense Force static health clinic at Kot Addu continues to see over 250 outpatients daily. Malaria continues to present in over 25% of cases. Malarial rapid detection tests allow the clinic to differentiate Vivax, Falciparum and mixed infections. The positivity rates of rapid diagnostic tests are over 50% daily, and Falciparum cases total 15-25 daily (10%). The clinic has wormed 1445 patients (85%) presenting this week; regrettably, the new DEWS system does not capture numbers wormed. Several cases of AWD were reported last week, although numbers have fallen to one or less daily (down from five per day four weeks ago). Clinic staff report they are seeing a return to more chronic issues and general health care, apart from the obvious ongoing burden of high malaria rates. The clinic plans to close in the next ten days (19 October).

  • CARE INTERNATIONAL PAKISTAN
    • (Reporting period: 24 September to 1 October 2010)
    • KP
      • CARE provided health care through mobile and static facilities to 11 194 people (3523 women, 4269 children and 3402 men), and held 201 health and hygiene sessions for 5424 people. In Upper Swat, where CARE is working through its implementing partner IDEA, 899 patients (216 women, 116 men and 517 children) received health care through BHUs. In other parts of District Swat, 1509 patients (including 424 women and 797 children) received health care through seven mobile clinics. CARE also held 20 health and hygiene awareness raising sessions for 1420 people. In District Charsadda, where CARE is working through its implementing partner, CRDO, 2933 patients (including 994 women and 1095) were treated through 18 mobile clinics. A total 45 health and hygiene sessions were conducted for 735 people.
    • PUNJAB
      • In South Punjab, CARE, in collaboration with AWAZ and CARITAS, provided health care through mobile health clinics to 2073 people in District Rajanpur (including 695 women and 941 children).
    • SINDH
      • CARE provided health care services to 2374 people in Sindh Province and another 216 people in District Kandhkot. In District Sukkur, a total of 170 patients received health care through five mobile health camps. In Shikarpur District, 788 patients (including 291 women and 364 children) received health care through seven health camps. CARE?s activities were supported in these three districts by HANDS, a local implementing partner. In Shahdadkot, 1 542 patients were treated at 11 mobile health clinics conducted by CARE and its partner Takhleeq Foundation.

  • CHURCH WORLD SERVICE (CWS P/A)
    • KP
      • CWS/PA mobile health units in Districts Balakot, Kohistan, Swat and Swabi have treated and provided free medicines to 14 856 patients to date, 82% of whom are women and children. Common complaints include upper respiratory tract infections, watery diarrhoea, skin infections and chronic diseases such as tuberculosis and diabetes. CWS teams have conducted 458 health and hygiene education sessions for 4225 people. CWS/PA is planning to launch additional mobile health units in Kohistan and Shangla Districts.

  • HELPING HAND FOR RELIEF AND DEVELOPMENT (HHRD)
    • HHRD has conducted 400 medical camps so far and treated 72 492 patients all over Pakistan.
    • KP
      • HHRD has established two medical centres in District Nowshera that provide free 24/7 consultations and medicines. Services include ante- and postnatal care, safe delivery services and immunization for children and pregnant women. HRRD is conducting health education sessions and providing outpatient services in BHU batara and Pandair, District Bunair. It has also established a field hospital in Agra Union Council (UC), District Charsadda.
    • PUNJAB
      • HHRD is running an maternal and child health centre in Utrakalan , District Mianwali that provides ante- and postnatal care, safe delivery services and referral services for complicated cases. The centre has ultrasound facilities. HHRD's mobile medical and surgical unit is providing ambulatory medical services in southern Punjab. Lastly, HHRD has established two field hospitals (one in Jampur, District Rajanpur and another in Kotaddu, District Muzaffargarh).
    • SINDH
      • HHRD's medical camp in Larkana provides safe delivery services and general outpatient care. HHRD is establishing three field hospitals in districts Jaccobabad, Kashmor and Shikarpur.

  • IDEA/CARE INTERNATIONAL
    • KP
      • IDEA/CARE International is working in Districts Nowshera and Swat. It has installed five water tanks and 15 latrines in Khema Basti (another 20 are under construction), and has distributed 5760 water purification sachets to 480 families in District Nowshera and 7689 families in Upper Swat (30 sachets per family). In District Peshawar, IDEA/Care International conducted 20 mobile medical camps in various Union Councils (UCs) of District Nowshera, treating a total of 6455 people (2945 female, 1855 male, 1665 children), and held 301 health and hygiene sessions for 3570 people (1530 women, 1389 men and 651 children). It has installed a water purification plant (funded by CARE International) in UC Kheshkai payan, and another 13 small water purification plants (donated by GEO TV Network and the Peshawar Rotary Club) in various UCs.

  • INTERNATIONAL MEDICAL CORPS (IMC)
    • (Reporting period: 1 to 8 October)
    • KP
      • IMC treated a total of 9888 patients in Districts Peshawar, Charsadda and Nowshera. Its psychosocial team treated 700 individuals.
    • PUNJAB
      • IMC teams are working in nine health facilities in four districts (Layyah, Muzaffargarh, Multan and Rajanpur). A total of 2411 patients were treated during the reporting period, mostly for ARI, skin infections, diarrhoea & malaria.
    • SINDH
      • IMC has deployed ten medical teams in four districts (Larkana, Shikarpur, Thatta and Kambar) and is recruiting additional staff. A total of 1965 people received medical care during the reporting period, mostly for ARI, malaria, skin diseases and gastroenteritis. New DTCs will be opened next week.

  • INTERNATIONAL ORGANIZATION FOR MIGRATION (IOM)
    • PUNJAB
      • Following health needs assessments in Muzaffargarh and Rajanpur, IOM has deployed health care workers in both districts and has donated vehicles and ambulances for mobile outreach and health referrals. To date IOM has provided health care to more than 5000 patients, 2000 of whom were treated through mobile outreach services.
    • SINDH
      • Following health needs assessments in Thatta, IOM has deployed ten health care workers to IOM fixed clinics at RHCs Gharo and Chohar Jamali. To date almost 2000 patients have received medical care through these clinics.

  • ISLAMIC HELP PAKISTAN
    • PUNJAB
      • Islamic Help is working in District Muzaffargarh (RHC in Daira Din Pannah and mobile health clinic in Kot Addu) and in Jampur, District Rajan (mobile health clinic). To date it has treated a total of 16 773 patients.
    • SINDH
      • Islamic Help is running a DTC in Civil Hospital Sukkur, where it has treated 7014 patients to date. It has helped restore the hospital, with support from army lady doctors.

NEEDS AND CHALLENGES

Islamic Help reports that damaged medical equipment, poor hospital hygiene and a shortage of ambulances are hampering the delivery of health care services. Damaged roads mean it is difficult to access RHUs and BHUs; however many of these health centres are not operational anyway, as government staff (doctors, cleaners) are reporting for duty only intermittently. These problems are compounded by the lack of female doctors. IDPs living in rural areas do not have access to health facilities.

According to Islamic Help, the Health Cluster should focus more closely on District Thatta, particularly Jati tehsil and rural areas in Sujawal Tehsil, where IDPs are returning home and settling close to their villages, despite the fact the waters have not yet receded.


  • KHYBER AID
    • Khyber Aid has conducted various medical and hygiene mobile camps at UCs Madain, Takhtaband, Kokarai and Jambil, with a total catchment population of around 48 000. Khyber Aid's medical team is composed of a doctor, a dispenser, two health promoters, a lady health visitor and a driver.
  • MARIE STOPES SOCIETY (MSS)
    • MSS is an active member of the Health Cluster's Reproductive Health Task. MSS teams have mobilized organizational and personal resources to respond to the crisis.
    • KP
      • Many patients visiting the MSS camps are complaining of severe flu and cold symptoms. The shortage of blankets, jackets and beds means that patients are at the mercy of the changing weather. The MSS teams have requested medication to treat flu and colds; these medications are in very short supply. The medical teams have also referred patients to secondary/tertiary levels and have dealt with two abortion cases.
    • PUNJAB
      • In Lower Punjab (Layyah, Muzzafargarh, Rajanpur), MSS camps have faced difficulties due to a shortage of medicines, ambulatory services and health staff. In spite of this, the camps have provided quality services, particularly family planning services. MSS teams have provided medicines, treated cases of sexually transmitted infections and infertility, and given psychological counseling. MSS is striving to accommodate all patients, in spite of staffing shortages.
    • SINDH
      • MSS staff has treated a number of respiratory infections, and have distributed health kits to patients. Most consultations are for respiratory problems and skin diseases. MSS medical staff offer one-to-one consultation for female patients, and provide female health workers to assist them. MSS teams' efforts to promote contraceptives have met with resistance, since the men in the area are against contraceptives and forbid women in their households to use them. Health is not a priority for IDPs, whose first needs are basic necessities such as food and water.

  • MEDECINS DU MONDE FRANCE (MDM-FRANCE)
    • KP
      • MDM-France is providing primary health care (PHC) and immunization services in two health facilities (one in district Charsadda and one in district Nowshera). MdM is planning to cease operations by the end of October and make minor repairs to these facilities. It has already closed the DTCs in LMH and DHQ Kohat. A total of 2100 diarrhoea patients have been treated, of whom 300 were severely dehydrated. The district health structure is now able to cope with the normal situation. MdM is providing PHC, ante- and postnatal care, immunization and nutrition services in Kohat, Buner and Swabi.

  • MERLIN
    • KP
      • Merlin is working in Districts Nowshera, Charsadda, Buner and Swat through 33 static clinics , 23 mobile teams and five DTCs. Merlin is providing integrated primary and secondary health care, including referral services, CMAM interventions, family planning and outpatient services, treatment of diarrhoea (mild, moderate and severe dehydration), and malaria diagnosis, management and prevention. Some facilities in Swat and in Buner are hard to access due to the difficult terrain, and security in Shabqader remains a concern.
    • PUNJAB
      • Merlin is working in District Muzaffargarh through two static clinics, two mobile teams and a DTC. Services include integrated primary and secondary healthcare, including referral services, CMAM interventions, family planning and outpatient services, and treatment of diarrhoea (mild, moderate and severe dehydration). Constraints include the need for a NOC for expatriate staff, and a shortage of qualified medical personnel.

  • SAVE THE CHILDREN
    • Save the Children?s health initiatives focus primarily on maternal, newborn and child health. Its activities range from operating mobile health camps at varying localities to revitalizing damaged health facilities, while at the same time providing support through ambulances for emergency referrals to secondary/tertiary health facilities. Save the Children supports 1300 Lady Health Workers (LHWs) in Sindh and Punjab, who are given a one-time cash incentive of Rs. 5000 as well as kits, medicines, supplies and information materials worth Rs. 15000. The LHW network will be used to distribute newborn, health and hygiene and clean delivery kits, LLINs, and information material. Save the Children also supports DEWS and HMIS in district health departments.
    • PUNJAB
      • Save the Children?s mobile teams in Multan, Muzaffargarh, Rajanpur and Dera Ghazi Khan have been working round the clock since August, and have provided free medicines and medical consultations to 30 696 people. A total of 1525 patients, mostly women and young children, have been treated at two DTCs in Multan. Skin diseases are on the rise while diarrhoea, albeit still a problem, is no longer a major concern. Save the Children is also conducting health and hygiene sessions alongside individual counseling sessions, and has broadened its activities by starting nutrition-related interventions and providing tangible support to static health facilities.
    • SINDH
      • Save the Children's mobile teams are working in Sukkur, Jacobabad and Shikarpur. On average, each team conducts over 80 consultations per day. Save the Children is also running DTCs at DHQ Shikarpur and Taluka Hospital Thul. As the weather cools down and stagnant water continues to be a problem, cases of malaria appear to be on the rise. Similarly, ARI and skin diseases are increasing, while diarrhoea is less of a concern. Save the Children?s teams have begun to incorporate nutrition in their health programme, focusing mainly on treating malnutrition. In Sukkur and Shikarpur, Save the Children has screened 3936 children under five, as well as pregnant women and lactating mothers. Strong emphasis is placed on health education sessions. As far as perceived needs in the province are concerned, the introduction of EPI services and rehabilitation of static health facilities are two pressing requirements, as expressed by the district health departments. With regard to the latter, Save the Children is in the process of acquiring health facilities for support in the future.
    • KP
      • Save the Children is working in Swat, Shangla, Lower Dir and Dera Ismail Khan Districts through mobile teams and static facilities. Around 59 000 medical consultations have been held to date. As Save the Children was working in KP before the floods, its emergency response there has been easier to implement than in Punjab and Sindh, since it had already established outpatient and mother and child health services, together with an efficient referral system. However, it remains difficult to access certain areas, and the need to introduce EPI still exists. Additionally, cases of pneumonia are on the rise with the fast-approaching winter season.

  • USAID/PAIMAN
    • BALUCHISTAN
      • USAID/PAIMAN is working in Sibi, Jaffarabad. Over the past five weeks 6416 people have been treated through 30 health camps, and 1014 people have attended health and hygiene sessions. The health camps have attracted many IDPs, many of whom have received medical treatment for the first time ever (including one mother who is pregnant with her 16th child). USAID/PAIMAN donated 766 water tanks, 8500 jerry cans and 1800 ITNs.
    • KP
      • USAID/PAIMAN is working in Swat, Charsadda and DI Khan. A total of 10 073 people (mainly IDPs) received medical care through 46 health camps conducted in remote, hilly areas. A total of 4188 people attended health and hygiene sessions.
      • USAID/PAIMAN donated 2395 water tanks, 24 274 jerry cans and 2600 ITNs.
    • PUNJAB
      • USAID/PAIMAN is working in DG Khan, where 11 238 people have been treated via 29 health camps, and 2362 people have attended health and hygiene sessions. The team has also transported people needing referral to the nearest health facilities. USAID/PAIMAN has donated 1574 water tanks, 16 227 jerry cans and 1300 ITNs.
    • SINDH
      • USAID/PAIMAN is working in Dadu, Sukkur and Khairpur. Over the past five weeks, a total of 13 249 people have been treated via 70 health camps, and 5279 people have attended health and hygiene sessions. USAID/PAIMAN's NGO implementing partners are working in remote areas to provide emergency health care. USAID/PAIMAN has donated 3403 water tanks, 39 702 jerry cans and 3300 insecticide-treated bedbets. Field assessments conducted by USAID/PAIMAN in Sukkur and Khairpur found that while the district administration has been able to accommodate almost all internally displaced people (IDPs) in camps and tents, some camps are unstaffed, meaning that the IDPs have no-one to turn to for relief assistance or in the event of an emergency. The authorities in Khairpur have requested warm clothes and blankets to see the IDPs through the hard winter ahead.

  • WORLD VISION (WV)
    • KP
      • WV is supporting nine static health facilities and nine mobile teams in Amankot, Muhib Banda and Taru Jabba in Nowshera and Majuki UC MC?2, UC MC?4 and UC Meraprang in Charsadda, and Koto, Kandaro, Munjai in Lower Dir. During the reporting period, 3299 people were seen at health facilities supported by WV. The DTC at THQ Chakdara treated 266 cases of acute diarrhoea, and 777 men and 1242 women participated in community health education sessions. A total of 17 508 individuals have consulted the health teams to date. Four Women and Infant Friendly Spaces (WAIFS) are being established in Nowshera and Charsadda.
    • PUNJAB
      • WV is providing health, nutrition and psychosocial support services in BHUs at UCs Kharak, Nohanwala, Kotaddu, Bet Mir Hazzar, Jatoi, Jaggatpur, Belay Wala and Beit mulla wala. Two OTPs are functional at static and five at mobile health posts. Two WAIFs have been opened and another three are being established, linked to health facilities. A total of 250 women and infants have participated in WAIF activities.
      • WHO is currently supporting the MoH Essential Medicines and NGO partners including NAGE Pakistan, IR, CCHD, Merlin, AMTF, ADRA, Al-Shifa, Save the Children, World Vision, IOM, Muslim Aid and EMED. Furthermore trainings on LSS (Inventory Management Software) / Drug Demand Quantification Methods for DOH & Implementing Partners has been conducted in Multan. for the EDO H technical staff as well as WHO essential medicines supported partners. The training on Inventory Management (Logistic Support System) which helps in managing the drugs inventory and also help in reporting like consumptions was given as well as Drug Demand Quantification Methods (Which helps in preparing the internal and external medicines requests)
    • SINDH
      • WV has established three static and four mobile teams, together with two WAIFs to provide, health nutrition and psychosocial support services at Nooraja, Khairpur, Kot Diji, UC Saddar Ji, Bhatyoon, Saddar G Bhatti and UC Layari (catchment population: 165 263). A total of 2470 individuals sought treatment during the reporting period, and 993 women and 904 men attended health education sessions.

  • UNHCR
    • Union Aid for Afghan Refugees (UAAR) an IP of UNHCR, is providing emergency health services to the Afghan refugees population affected by the floods in the KP districts of Peshawar, Nowshera & Charsaddha through its health facilities and mobile health teams. Around 6,479 patients have been treated so far.
    • All refugee camps in the affected districts of KP and Punjab, participated in the ongoing immunization campaigns organized by the department of health. UAAR assisted immunization campaign in three districts of KP where 2,928 refugee children received immunization against measles and 3,269 for polio.

  • WHO
    • WHO is organizing social mobilization training courses which will take place in Multan hub on 13 October as part of the early recovery strategy.
    • There are 62 DTCs currently set up and operated by partners. A focal point in each hub is monitoring the DTCs. Clusters of cases arriving at DTCs from the same area are promptly investigated.
    • To date, WHO has distributed medicines, including 236 000 diarrhoea treatments, for a total population coverage of 5.2 million.
    • In collaboration with Sindh University of Jamshoro, WHO conducted a brief health education training course for 100 university students (volunteers) who will be working with IDPs in Sehwas and Shahbaz Colony camps of Jamshoro.
    • Key health messages in Sindhi were made available. This type of training is an easy way to ensure that simple hygiene messages are conveyed that have the potential to reduce morbidity and mortality.
    • WHO, the MoH, Ministry of Agriculture and FAO are meeting on 11 October 2010 to discuss the new outbreaks of fever and design a preventive campaign for the forthcoming EID day, on which one million animals are expected to be slaughtered.
    • Rapid water and sanitation assessments at DHQ hospital Nowshera, Civil Hospital Akora Khattak and the Children's hospital Peshawar showed these hospitals were facing serious water and sanitation problems. WHO rehabilitated the water supply system in DHQ Hospital Nowshera (repairing the main water source and the distribution network and cleaning the water storage facilities serving a catchment population of 3.4 million).
    • In Peshawar hub, WHO is helping WASH and Health partners build their capacity to undertake critical water quality improvement measures, prevent and control waterborne diseases, investigate and respond to disease alerts, comply with WASH SPHERE standards and undertake emergency water disinfection techniques. A total of 216 persons from TMA, PHED and DoH have been trained on emergency environmental health issues.
    • Four new DTCs are being established in the Sukkur Hub, one in Nowsheroferoz at THQ Moro, Second at RHC Khan Pur district Shikar Pur, third at THQ Dokri in Larkana and fourth at THQ Shahdad Kot in district Kambar.
    • In Hyderabad, six stabilization centres have been planned in response to acute malnutrition cases reported in that area. A meeting with main stakeholders, including WFP and the health authorities, was held to discuss an integrated multisectoral strategy for the area.

Health Cluster Coordination

Coordination at Provincial & Hub levels:

Health cluster meetings are regularly taking place in Peshawar, Multan, Sukker and Hyderabad to coordinate the health cluster response. A close coordination system is in place with PDMA, DoH, OCHA, NGOs and other UN agencies.

Multan

  • The 8th cluster coordination meeting has been held.
  • Over 60 agencies (UN, NGOs, etc) are working in the health sector and registered in the Who is Doing What and Where database.
  • A health focal coordination cell has been established in five districts.
Peshawar

  • WHO is working in close collaboration with WASH Cluster partners and local WASH authorities at district and provincial levels, highlighting the health risks associated with contaminated water, poor sanitation and hygiene issues confronting the flood- affected communities. It has guided provincial and district WASH clusters in identifying feasible locations in which to install water filtration plants in Charsadda, Nowshera and Swat. WHO regularly monitors diarrhoea prevalence in the flood-affected districts and investigates and responds to AWD alerts. WHO's environmental health team regularly chlorinates and disinfects drinking water supplies and mobilizes resources for the provision of water collection and storage facilities, hygiene kits, non-food items and health education and awareness-raising materials.
Sukkur

  • The district coordination cell has been activated in two districts Khair Pur & Larkana, WHO team participated in both meetings and nominated two Surveillance Officers as representatives for the respective districts for future participation.
Hyderabad

  • The inter-cluster meeting focused on (1) the creation of District Coordination Cells, and (2) McRAM ? where 15 000 settlements (including camps and schools) have been or will be mapped with GPS coordinates. An assessment of villages, including the status of health facilities, will be conducted and posted on a web site accessible to all.
  • Each cluster present (Education, Food, Shelter, WASH, Nutrition, and Health) provided a brief update and identified their gaps, with the objective of identifying action points.
  • The Nutrition Cluster meeting on 6 October focused on the nutrition survey in flood-affected areas, the Who, What, and Where (3W) matrix partners update, and the Integrated Survival Strategy.

Key Principles for Operationalizing the Survival Strategy

The four clusters (Health, WASH, Nutrition and Food) have agreed on the following key principles governing the design and implementation of the joint survival strategy:

  • Focus on evidence-based, high-impact interventions to ensure survival: these include water disinfection, mass measles immunization campaigns (associated with polio vaccination, vitamin A distribution and de worming), communication and support for life-saving behavior changes (such as hand-washing with soap, exclusive breastfeeding for the first six months), and appropriate treatment interventions;
  • Target the most vulnerable: in addition to prioritizing the most affected districts for those activities which will have general coverage (such as the provision of safe water supplies and sanitation facilities, and access to basic health services), specific life-saving interventions should target particularly vulnerable populations such as women, especially pregnant women, neonates, children under five, and to the extent possible, the elderly and disabled;
  • Ensure an integrated outbreak response to strengthen the complementarity of interventions and ensure a continuum of care: from having a more sensitive DEWS for communicable diseases of epidemic potential, to ensuring that case management at the health care facility level is combined with large-scale preventive measures at community level, including proper early detection and referral of severe cases, provision of treated water, sanitation and shelter, as well as food and nutrition;
  • Identify and maximize opportunities for synergies between all players, through enhanced coordination and joint planning at provincial/hub and particularly district levels. Strong commitment from all partners is essential to operationalize the strategy; opportunities to engage non-traditional partners from civil society, youth associations and women?s groups, as well as traditional and religious leaders should be sought;
  • Work in coordination with and support of Government authorities at all levels, using existing systems to implement the response wherever possible, through the reinforcement or the establishment of effective local coordination mechanisms such as the District Coordination Cells;
  • Ensure real-time monitoring and evaluation of the strategy's implementation, to support district-level planning and adjustments as needed to ensure high coverage of the selected priority interventions in the target areas and to allow progress to be documented.
  • ?Hot spots? communities (with high incidence of acute diarrhea and/or malaria) have been identified in the most flood affected districts. WHO and the health cluster partners used the daily epidemiological data to identify these communities. In addition it was agreed with the WASH cluster partners should prioritize these communities as part as their criteria of intervention. As part of the unified response between Health, WASH and Nutrition clusters these communities will also be targeted for the health and hygiene promotion, health education and awareness raising on water related issues.

For corrections and corrigendum please contact the following:

Alfred Dube, Health Cluster Coordinator, email: dubeal@pak.emro.who.int, Telephone: 0300 400 5934

Mohammad Shafiq, Health Cluster Coordination Officer, email : Shafiqm@pak.emro.who.int, Telephone: 0303 555 2270

Maria Anguera de Sojo, Communications Officer, email: sojom@pak.emro.who.int, Telephone: 0301 855 1459

Syed Haider Ali, Communications Officer, email: alisy@pak.emro.who.int, Telephone: 0300 400 5944

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Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for October 12 2010)

Flood Response in Pakistan - Volume 1, Issue 9 Monday 17 October 2010 (10/20/10, edited)


[Source: World Health Organization, full PDF Document: (LINK). Extracts, edited.]

Weekly Epidemiological Bulletin

Flood Response in Pakistan - Volume 1, Issue 9 Monday 17 October 2010


Priority diseases under surveillance in the flood affected areas

  • Acute Flaccid Paralysis
  • Acute Jaundice Syndrome
  • Acute Respiratory Infections
  • Acute Watery Diarrhoea/Suspected Cholera
  • Bloody Diarrhoea
  • Other Diarrhoea
  • Suspected Hemorrhagic Fever
  • Suspected Malaria
  • Suspected Measles
  • Suspected Meningitis
  • Unexplained Fever
  • Others

Highlights

Epidemiological week no 41 (9 - 15 October 2010)

  • Between 9 - 15 October 2010 (epidemiological week no. 41), 38 of the 78 flood-affected districts provided surveillance data to the DEWS system. Of these 38 districts, 90% reported 6-7 days of the week.
  • 575 fixed health and 128 mobile medical outreach centers provided surveillance data for this week.
  • 306,799 consultations were reported through DEWS of which 19% were acute respiratory infections (ARI), 10% were acute diarrhoea, 11% were skin disease, and 8% were suspected malaria.
  • 11 alerts were received and responded to this week: 6 alerts were for Dengue hemorrhagic fever (DHF), 3 were for Acute watery diarrhoea, 1 each for Bloody diarrhoea (BD) and suspected Measles (MS).
  • Malaria outbreak control in collaboration with the Malaria Control Program is being implemented in districts Layyah, Rajanpur, DG Khan and Muzaffargarh in Punjab; Jacobabad, Larkana, Thatta and Khairpur in Sindh; Naseerabad, Sibi, Zhob and Jhal Magsi in Balochistan.
  • Five of the 10 cases of poliomyelitis confirmed this week were from the 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.

Table-1: Priority diseases reported during the week 31 - 40, 2010 (29 July - 8 October 2010)

[Diseases - Week‐31 - Week‐32 - Week‐33 - Week‐34 - Week‐35 - Week‐36 - Week‐37 - Week‐38 - Week‐39 - Week‐40 - Week‐41]
  • Acute Diarrhea - 25,689 (13%) - 94,288 (11%) - 182,548 (14%) - 199,607 (14%) - 138,644 (13%) - 68,909 (12%) - 57,072 (14%) - 64,925 (13%) - 54,404 (13%) - 37,624 (12%) - 29,570 (10%)
  • Bloody Diarrhea - 1,449 (1%) - 4,566 (1%) - 7,907 (1%) - 11,024 (1%) - 10,839 (1%) - 9,228 (2%) - 6,705 (2%) - 6,411 (1%) - 5,896 (1%) - 5,253 (2%) - 4,426 (1%)
  • ARI (URTI & LRTI) - 25,335 (13%) - 92,134 (11%) - 185,546 (15%) - 217,071 (15%) -187,226 (18%) - 96,607 (17%) - 69,969 (17%) - 89,949 (18%) - 81,583 (19%) - 65,216 (20%) - 56,991 (19%)
  • Suspected Malaria - 3,954 (2%) - 17,348 (2%) - 27,453 (2%) - 45,542 (3%) - 45,652 (4%) - 40,441 (7%) - 32,692 (8%) - 42,759 (9%) - 36,514 (8%) - 25,625 (8%) - 24,768 (8%)
  • Skin Diseases - 36,383 (19%) - 115,080 (14%) - 246,959 (20%) - 296,441 (21%) - 202,630 (19%) - 92,039 (16%) - 56,844 (14%) - 60,704 (12%) - 57,020 (13%) - 41,664 (13%) - 33,293 (11%)
  • Total consultation - 194,552 - 845,353 - 1,265,912 - 1,424,260 - 1,053,827 - 559,006 - 414,437 - 486,376 - 433,890 - 326,071 - 306,799

Table‐2: Average number of reporting districts per week

[Province - Wk 33 - Wk 34 - Wk 35 - Wk 36 - Wk 37 - Wk 38 - Wk 39 - Wk 40 - Wk 41]

  • Balochistan - 6 - 6 - 6 - 6 - 6 - 6 - 6 - 5 - 6
  • KPK - 8 - 8 - 8 - 8 - 8 - 6 - 6 - 15 - 5
  • Punjab - 8 - 8 - 9 - 9 - 9 - 10 - 11 - 11 - 11
  • Sindh - 18 - 18 - 18 - 18 - 18 - 18 - 18 - 17 - 16
  • Total - 40 - 40 - 41 - 41 - 41 - 40 - 41 - 48 - 38

Table-3: Leading causes of seeking health care in the flood affected districts as of 15 Oct 2010

[Diseases - Total]

  • Skin Diseases - 1,243,346 (17%)
  • Acute Respiratory Infection - 1,177,886 (16%)
  • Acute Diarrhoea - 963,326 (13%)
  • Bloody Diarrhoea - 74,033 (1%)
  • Suspected Malaria - 343,481 (<5%)
  • Unexplained Fever - 367,488 (5%)
  • Total Consultations - 7,357,826

Table-4: Follow-up alerts reported in week 40, 2010.

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]

  • 2010‐40 - 2‐Oct‐10 - AWD - Punjab - Muzaffargarh - DHQ Muzaffargarh (Sharif Shajra P.O) - 50 - M - Stool sample positive for V. Cholera Ogawa. - Active surveillance ongoing.
  • 2010‐40 - 3‐Oct‐10 - AWD - Punjab - Multan - THQ Shujabad - 12 - F - Stool sample negative for pathogens. Active surveillance revealed no further cases
  • 2010‐40 - 4‐Oct‐10 - Measles - Punjab - Multan - Rasheed Hospital ‐ Private - 4,6 - M,F - Blood sample was negative for measles and rubella.
  • 2010‐40 - 4‐Oct‐10 - AWD - Sind - Jacobabad - DHQ Jacobabad (UC Dashti) - 35 - F - Stool sample negative for pathogens. Active surveillance revealed no further cases
  • 2010‐40 - 4‐Oct‐10 - AWD x 5 - KPK - Mardan - DHQ Mardan (Toot Kaley, Guli Bagh, Kochian, Sikandari, Janday Takhtbhai) - 4m, 6m, 60y, 6m, 45y - M,F,F,F,F - Cases admitted to DTC, stool samples were negative for pathogens. No further cases were found during active surveillance
  • 2010‐40 - 4‐Oct‐10 - Measles - KPK - Swabi - Bacha Khan Medical Complex - 2.5 - F - Blood sample was positive for measles. Further investigation planned
  • 2010‐40 - 4‐Oct‐10 - AWD x 3 - Punjab - Muzaffargarh - Australian Medical Camp (Nigad abad, Chah Langar Wala, Khoo Kukanwala) - 32, 26, 25 - M, M, M - Stool samples were negative for pathogens, active surveillance revealed no further cases
  • 2010‐40 - 5‐Oct‐10 - AWD x 2 - KPK - Lower Dir - RHC Munda (Ganderey‐Mayar, Gambir‐Mayar) - 40, 46 - M, M - Stool sample was positive for V. Cholera Ogawa. Active surveillance carried out, health education was given and IEC material was provided. DTC health staff, hygiene promotors were trained on case management.
  • 2010‐40 - 5‐Oct‐10 - AWD - KPK - D.I. - Khan Madina Colony - 5 - F - Stool sample was positive for V. Cholera Ogawa. Active surveillance ongoing
  • 2010‐40 - 6‐Oct‐10 - AWD - KPK - D.I. Khan - Chah Faqir Wala - 25 - F - Stool sample positive for V. Cholera Ogawa, active surveillance ongoing
  • 2010‐40 - 6‐Oct‐10 - AWD x 14 - Punjab - Muzaffargarh - DTC‐MSF Kot Addu (Chowk Munda, Ward # 8, Kot Addu, Mirpur Bhagal), Village Sinawan, Village Rakhpattan, Pnora, Mouza Chaudry, Manhan, Village Gourmani, Rojewala, Village Kita Lonwala, Pul88, Village Sheikh Umah - 8m to 25 years - 11M, 4F - 10 positive Ogawa patients treated at DTC. Active surveillance ongoing. Response in collaboration with WASH Cluster. Distributed filters and soaps to affected families
  • 2010‐40 - 7‐Oct‐10 - AWD - KPK - Swat - THQ Matta - 40 - M - Stool sample positive for V. Cholera Ogawa, active surveillance is under progress for the two UCs.
  • 2010‐40 - 7‐Oct‐10 - DHF - KPK - Swat - SGTH (Mian Bela) - 60 - M - Blood sample negative, no further cases found during active surveillance
  • 2010‐40 - 7‐Oct‐10 - DHF - KPK - Haripur - Muhalla Syed Abad - 18, 28 - M, F - Blood sample collected and active surveillance is under progress .
  • 2010‐40 - 7‐Oct‐10 - AFP - Punjab - RY Khan - UC Nawazabad - 3 - F - Stool sample collected and sent to NIH, Active surveillance is under process
  • 2010‐40 - 8‐Oct‐10 - DHF - KPK - Swat - SGTH (Topseen Village) - 18 - M - Blood sample negative, active surveillance revealed no further cases
  • 2010‐40 - 8‐Oct‐10 - DHF - KPK - Swat - SGTH (Aspand‐Lower Dir) - 13 - M - Blood sample negative, active surveillance revealed no further cases

Table-5: Alerts and Outbreaks (Week 41, 2010)

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]

  • 2010‐41 - 9‐Oct‐10 - DHF - KPK - Mansehra - Khaki - 38 - M - Blood sample collected and active surveillance is under progress .
  • 2010‐41 - 10‐Oct‐10 - DHF - KPK - Mansehra - UC Jallu - 65, 42 - M,F - Blood sample collected and active surveillance is under progress. Health education was provided, Mosquito Nets were provided. MS DHQ Mansehra was informed.
  • 2010‐41 - 10‐Oct‐10 - AWD - Punjab - Muzaffargarh - AMT (KAPCO‐Wapda Office) - 5 - M Stool sample collected and sent to NIH, active surveillance is under process.
  • 2010‐41 - 10‐Oct‐10 - DHF - KPK - Charsadda - Harichand Bangla (IPD‐Malakand) - 18 - F - Blood sample collected and found negative. Active surveillance was done.
  • 2010‐41 - 10‐Oct‐10 - Measles - KPK - Nowshera - IDP Camp Jalozai Phase V - 5 - M - Blood sample collected and active surveillance is under progress .
  • 2010‐41 - 11‐Oct‐10 - DHF - KPK - Swat - Mangarkot Charbagh - 18 - M - Blood sample collected and found negative. Active surveillance was done. Patient was isolated, bed net was provided and health education was given. WHO, Merlin & DoH combined response is planned. EDO Health was informed.
  • 2010‐41 - 12‐Oct‐10 - AWD - KPK - Nowshera - IDP Camp Jalozai Phase III‐Pabbi - 3,5,10 - M,F, M - Stool sample collected and found positive, active surveillance was done.
  • 2010‐41 - 12‐Oct‐10 - DHF - KPK - Swat - Sersenai Village‐Kabal - 55 - F - Blood sample collected and active surveillance is under progress . Patient is isolated, ITNs were given and health education was provided. Medical camp was established and active surveillance was done.
  • 2010‐41 - 12‐Oct‐10 - BD - Punjab - Muzaffargarh - AMT (Basti Ghurki) - 18 - M - Stool sample collected and sent to NIH, active surveillance is under process.
  • 2010‐41 - 13‐Oct‐10 - AWD - Punjab - Muzaffargarh - AMT (Kot Addu) - 25 - F - Stool sample collected and sent to NIH, active surveillance is under process.
  • 2010‐41 - 14‐Oct‐10 - DHF - KPK - Swat - Shahdam Kaley - 13 - M - Blood sample collected and sent to NIH, active surveillance is under process. Patient is isolated, ITNs were given and health education was provided.

Table-6: List of confirmed Polio Cases from flood affected districts, week 41-2010

[S. NO. - Province - Districts - SEX - AGE (m) - Date onset of Paralysis - WPV Type]

  • 1 - Sindh - Ghotki - Female - 72 - 22‐09‐2010 - NSL1
  • 2 - KPK - Lakki Marwat - Female - 20 - 20‐09‐2010 - NSL1
  • 3 - Sindh - Kamber - Female - 16 - 25‐09‐2010 - NSL1
  • 4 - Sindh - Ghotki - Female - 12 - 01‐10‐2010 - NSL1
  • 5 - Sindh - Ghotki - Female - 156 - 26‐09‐2010 - NSL1

Province KPK

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 3,928 6%
  • ARI - 12,256 17%
  • Skin Diseases - 3,090 4%
  • others - 47,575 68%
  • Total Consultations - 70,046

  • This week 5 out of 17 flood affected districts reported to DEWS from KPK province
  • 36 fixed health centers and 14 mobile medical outreach centers reported to DEWS
  • 70,046 patient consultations were reported during the reporting period of 9 ? 15 October, week 41, 2010
  • 8 alerts were received and investigated this week; 6 were for DHF, 1 was for Measles, and 1 was for AWD.
  • Regarding Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF), from early September up until 15th October 2010, DEWS teams have identified 188 suspected cases of DF in the districts Haripur, Mansehra and Abbotabad. Of the suspected cases, 131 were male and 57 were female. No case was under age five years. During this time, there were nine confirmed deaths of cases with fever and hemorrhagic signs but only one was confirmed positive for DF.

Province Punjab

  • 11 out of 12 flood affected districts reported data to DEWS from Punjab province
  • 192 fixed health centers and 28 mobile medical outreach centers reported to DEWS
  • 96,624 patient consultations were reported during this reporting period
  • 3 alerts were received and investigated this week; 2 were for AWD, and 1 was for BD. DEWS officers are following up the AWD cases in Kot Addu reported last week.
  • In Punjab, a higher proportion of suspected malaria was reported this week (10% to 11%), although a peak of malaria in October reflects seasonal trend of diseases, DEWS officers are collaborating with Malaria Control Program to investigate areas of increased malaria.
[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 9,915 10%
  • ARI - 19,132 20%
  • Skin Diseases - 12,277 13%
  • Suspected malaria - 8,732 9%
  • Others - 33,157 34%
  • Total consultations - 96,624

Province Sindh

  • 16 out of 22 flood affected districts reported to DEWS from Province Sindh
  • 310 fixed health centers and 81 mobile medical outreach centers reported to DEWS
  • 115,903 patient consultations were reported during the reporting period of 9 - 15 October, week 41, 2010
  • In Sindh, proportional morbidity of major health events remained the same when compared to last week.
  • No alerts were received this week
  • A Dengue surveillance and response cell has been established in Hyderabad to address increasing numbers of cases of Dengue Fever.
[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 12,157 10%
  • ARI - 21,346 18%
  • Skin Diseases - 17,580 15%
  • Suspected malaria - 11,834 10%
  • Others - 41,257 36%
  • Total consultations - 115,903

Province Balochistan

  • 6 out of 19 flood-affected districts reported to DEWS from province Balochistan
  • 37 fixed health centers and 5 mobile medical outreach centers reported to DEWS
  • 24,226 patient consultations were reported during the reporting period of 9 - 15 October, week 41, 2010
  • Suspected malaria has declined as a proportion of total consultations across the province but certain hot spots are still experiencing outbreak levels of malaria cases. Malaria outbreaks in districts Naseerabad, Sibi, Zhob and Jhal Magsi are being addressed in collaboration with the Malaria Control Program.
  • No alerts were received from Balochistan
[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 3,570 15%
  • ARI - 4,257 18%
  • Suspected Malaria - 3,358 14%
  • Unexplained Fever - 1,173 5%
  • Total consultations - 24,226

Summary of Health Event in Flood affected districts

Since July 29, 2010, approximately 7,357,826 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 (82%) of the 78 flood affected districts and reporting is received from 38 (59%) of these 64 districts.

The major causes for seeking healthcare by the affected communities continue to be diarrheal diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI increased from 12% to 14% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009. (Please see Fig.13)


Focus on: Dengue Fever and Dengue Hemorrhagic Fever

So far about 2,443 cases of suspected Dengue Fever (DF) have been reported in Pakistan with about 1,082 confirmed cases. Karachi in the south and Haripur in the north are the endemic areas. Control of mosquitoes is the only primary prevention strategy.

Four different dengue viruses, spread by the bite of the urban Aedes aegypti mosquito, can cause the headache or flu‐like symptoms with fever called Dengue Fever. When DF cases are infected another year with a different dengue virus, Dengue Hemorrhagic Fever (DHF) is a potentially deadly complication.

DHF often begins with a sudden rise in temperature accompanied by facial flush and other flu‐like symptoms. The fever usually continues for two to seven days and can be as high as 41?C, possibly with convulsions and other complications. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock, or quickly recover following appropriate medical treatment.

WHO currently estimates about 2/5 of the world?s population is at risk for Dengue Fever (DF) with about 50 million dengue infections worldwide every year and about 500,000 (1%) hospitalized for Dengue Hemorrhagic Fever (DHF). In a recent study of DF in Pakistan from 2003‐2007, there were 15,040 patients with suspected DF during that time with 3,952 (26%) testing positive for dengue IgM antibody, and 209 hospitalized of whom 45 were diagnosed as DHF. In this review, 63% of suspected DF cases were male and 37% were female. The median age declined over the study period from 32 in 2003 to 24 in 2007.

The first confirmed outbreak of DF in Pakistan was in 1994 and found due to DF virus serotype DV‐2. The current annual epidemic trend began in September to December 2005, when a sudden rise in DHF patients was noted at major hospitals in Karachi apparently due to introduction of serotype DV‐3 in the country. During the outbreak of DHF in 2006, both DV‐2 and DV‐3 serotypes were found to be circulating.

All dengue patients must be carefully observed for complications for at least 2 days after recovery from fever because life threatening complications often occur during this phase. Patients and households should be informed that severe abdominal pain, passage of black stools, bleeding into the skin or from the nose or gums, sweating, and cold skin are danger signs. If any of these signs is noticed, the patient should be taken to the hospital. Please use only paracetamol for pain and fever as other medicines may increase the bleeding tendency.

Due to rises in incidence of DF and DHF, WHO‐Geneva has established a unit for prevention and control of Viral Hemorrhagic Fevers. WHOEMRO and Pakistan Country Office are in coordination with them to bring resources to Pakistan to address the issues here such as improving case management of DHF in hospitals and improving vector control in community level.

Khan E, Kisat M, Khan N, Nasir A, Ayub S, Hasan R. Demographic and Clinical Features of Dengue Fever in Pakistan from 2003?2007: A Retrospective Cross‐Sectional Study. PLoS One. 2010; 5(9): e12505. Published online 2010 September 13. doi: 10.1371/journal.pone.0012505. PMCID: PMC2938342
World Health Organization. Dengue and Dengue Hemorrhagic Fever. Fact Sheet No. 117. March 2009. http://www.who.int/mediacentre/factsheets/fs117/en/. Accessed on 17 October 2010.


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

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: eic.nih@gmail.com
WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int.

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Re: Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for October 12 2010)

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 10 Monday 25 October 2010 (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK). Extracts, edited.]

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 10 Monday 25 October 2010


Priority diseases under surveillance in the flood affected areas

  • Acute Flaccid Paralysis
  • Acute Jaundice Syndrome
  • Acute Respiratory Infections
  • Acute Watery Diarrhoea/Suspected Cholera
  • Bloody Diarrhoea
  • Other Diarrhoea
  • Suspected Hemorrhagic Fever
  • Suspected Malaria
  • Suspected Measles
  • Suspected Meningitis
  • Unexplained Fever
  • Others

Highlights

Epidemiological week no 42 (16 - 22 October 2010)

  • Between 16 - 22 October 2010 (epidemiological week no. 42), 50 out of 64 districts in 4 provinces provided surveillance data to the DEWS system.
  • 509 fixed health and 105 mobile medical outreach centres provided surveillance data for this week.
  • 257,980 consultations were reported through DEWS of which 18% were acute respiratory infections (ARI), 9% were acute diarrhoea, 11% were skin disease, and 11% were suspected malaria.
  • 21 alerts were received and responded to this week: 12 alerts were for Dengue Hemorrhagic Fever (DHF), 7 were for Diphtheria, and 2 for Acute Watery Diarrhoea (AWD) .
  • Four of the 9 cases of poliomyelitis confirmed this week were from the flood-affected districts
  • Emergency conditions exist for over 35,000 people in Dadu District of Sindh who are stranded without food or shelter on bits of land surrounded by water. AWD alert was received on 23 October of 50 year old male with diarrhea and serious dehydration in Tent City Kakar at Dadu.
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.


Table-1: Priority diseases reported during the week 31 - 42, 2010 (29 July - 22 October 2010)

[Diseases - Wk‐31 - Wk‐32 - Wk‐33 - Wk‐34 - Wk‐35 - Wk‐36 - Wk‐37 - Wk‐38 - Wk‐39 - Wk‐40 - Wk‐41 - Wk‐42]
  • Skin Disease - 36,383(19%) - 115,080(14%) - 247,88(20%) - 296,441(21%) - 202,922(19%) - 92,210(16%) - 56,982(14%) - 61,845(12%) - 57,977(13%) - 42,325(13%) - 33,966(11%) - 27,522(11%)
  • ARI (URI and LRI) - 25,335(13%) - 92,134(11%) - 186,808(15%) - 217,071(15%) - 187,623(18%) - 97,352(17%) - 70,396(17%) - 93,291(19%) - 83,840(19%) - 67,045(20%) - 58,464(19%) - 46,015(18%)
  • Acute Diarrhoea - 25,689(13%) - 94,286(11%) - 183,118(14%) - 199,916(13%) - 139,391(13%) - 69,900(12%) - 57,421(14%) - 67,156(13%) - 57,954(13%) - 38,925(12%) - 30,637(10%) - 23,335(9%)
  • Bloody Diarrhoea - 1,449(1%) - 4,566(1%) - 8,019(1%) - 11,024(1%) - 10,847(1%) - 9,274(2%) - 6,766(2%) - 6,493(1%) - 5,907(1%) - 5,262(2%) - 4,435(1%) - 3,237(1%)
  • Suspected Malaria - 3,954(2%) - 17,348(2%) - 27,503(2%) - 45,542(3%) - 45,717(4%) - 40,483(7%) - 32,795(8%) - 43,121(9%) - 36,531(8%) - 24,825(8%) - 27,956(11%)
  • Total consultation - 194,551 - 845,353 - 1,270,525 - 1,422,503 - 1,056,106 - 563,426 - 417,643 - 502,282 - 444,948 - 333,690 - 313,429 - 257,980

Table-2: DTCs functioning with WHO and health partners support

[Province - Targeted Districts - Functioning - Handed Over - In Progress - Remarks]

  • KPK - 16 - 21 - 7 - 0 - 7 handed over to MS Hospital for pediatric pneumonia patients
  • Punjab - 8 - 12 - 2 - 1 - 2 handed over to MS Hospital, 1 in progress
  • Balochistan - 7 - 10 - 0 - 3 - 3 were started on 25th October
  • Sindh - (Sukkur) - 7 - 10 - 0 - 0 - ...
  • Sindh - (Hyderabad) - 5 - 3 - 0 - 2 - 1 will be started on 26th October
  • Gilgit Baltistan - 2 - 2 - 0 - 0 - ...
  • Total - 45 - 58 - 9 - 6 - ...

Table-3: Leading causes of seeking health care in the flood affected districts as of 22 Oct 2010

[Diseases - Total]

  • Skin Diseases - 1,271,541 (17%)
  • Acute Respiratory Infection - 1,225,374 (16%)
  • Acute Diarrhoea - 987,728 (13%)
  • Bloody Diarrhoea - 77,279 (1%)
  • Suspected Malaria - 371,494 (5%)
  • Unexplained Fever - 371,686 (5%)
  • Total Consultations - 7,622,436

Table-4: Follow-up alerts reported in week 41, 2010.

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]

  • 2010‐41 - 9‐Oct‐10 - DHF - KPK - Mansehra - Khaki, UC Julla - 38,65,42 - M,M, F - 2 out of 3 Blood samples were positive for DF, bed nets were provided, health education given, Active surveillance was done
  • 2010‐41 - 10‐Oct‐10 - AWD - Punjab - Muzaffargarh - Australian Medical Team (KAPCO ‐ Wapda Office) - 5 - M - Stool sample was positive for V. Cholera Ogawa. Active surveillance was done.
  • 2010‐41 - 10‐Oct‐10 - DHF - KPK - Charsadda - Harichand Bangla (IPD ‐ Malakand) - 18 - F - Blood sample was negative for DF. Active surveillance was done. Patient was isolated.
  • 2010‐41 - 10‐Oct‐10 - Measles - KPK - Nowshera - Jalozai Phase V - 5 - M - Blood sample was positive for measles, child was guest in camp. Active surveillance was done. No other cases were found in the camp
  • 2010‐41 - 11‐Oct‐10 - DHF - KPK - Swat - Mangarkot Charbagh - 18 - M - Blood sample was negative for DF. Active surveillance was done. Patient was isolated. WHO, Merlin & DoH combined response is planned. EDO Health was informed.
  • 2010‐41 - 12‐Oct‐10 - AWD - KPK - Nowshera - Jalozai Phase III ‐ Pabbi - 3,5,10 - M,F,M - Stool sample collected and found positive for V. Cholera Ogawa, active surveillance was done. Health education session conducted, soaps and aqua tabs were distributed.
  • 2010‐41 - 12‐Oct‐10 - DHF - KPK - Swat - Sersenai Village‐ Kabal - 55 - F - Blood sample was negative for DF. Patient was isolated, ITNs were given and health education was provided. Medical camp was established and active surveillance was done.
  • 2010‐41 - 12‐Oct‐10 - BD - Punjab - Muzaffargarh - Australian Medical Team (Basti Ghurki) - 18 - M - Stool sample collected and found negative, active surveillance was done.
  • 2010‐41 - 13‐10‐10 - AWD - Punjab - Muzaffargarh - Australian Medical Team (Kot Addu) - 25 - F - Alert was reported and investigated by Australian medical team.
  • 2010‐41 - 13‐10‐10 - Malaria - Punjab - Muzaffargarh - Australian Medical Team (KAPCO) - ** - ** - 87 blood samples were tested by Australian Medical Team and 23 were found positive for Falciparum, 31 for Vivax, cases were treated, community was prioritized for bed nets distribution.
  • 2010‐41 - 14‐10‐10 - DHF - KPK - Swat - Shahdam Kaley - 13 - M - Blood sample was negative for DF, active surveillance was done. Patient is isolated, ITNs were given and health education was provided.
  • 2010‐41 - 14‐10‐10 - AWD - KPK - Mardan - Rashakai - 5 - M - Stool sample was positive for V. Cholera Ogawa. Active surveillance was done.

Table-5: Alerts and Outbreaks (Week 42, 2010)

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]

  • 2010‐42 - 17‐10‐10 - DHFx3 - Punjab - Rahim Yar Khan - Sheikh Zaid Hospital ‐ Swaitra Basti, Sadiqabad, Allama Iqbal Town, Stadium Road - 25,20, 30 - M,M,F - Blood samples were sent to IPH Lahore and were found positive for DF, active surveillance was done.
  • 2010‐42 - 17‐10‐10 - DHFx2 - Punjab - Rahim Yar Khan - Sheikh Zaid Hospital ‐ Kot Faiz, Ghotki, Mouza Ahsanpur - 12, 22 - M, M - Blood samples were sent to IPH Lahore and were found negative for DF, active surveillance was done.
  • 2010‐42 - 17‐10‐10 - DHF - KPK - Swat - Banr Charbagh - 40 - M - Blood sample was found positive for DF, active surveillance was done.
  • 2010‐42 - 19‐10‐10 - AWD - Sindh - Ghotki - DTC Ghotki ‐ Malook Kolachi - 10,3,10m - F,F,F - Stool samples collected and active surveillance is under progress .
  • 2010‐42 - 20‐10‐10 - AWD - Balochistan - Washuk - DHQ Washuk - ** - ** - About 100 cases of acute diarrhea and 2 deaths confirmed. Investigation revealed that source of water was contaminated Karez (irrigation canal). ORS, intravenous fluids and medicines provided to patients. Household water purification by aqua tabs established. No further cases reported
  • 2010‐42 - 20‐10‐10 - DHF - Punjab - Rahim Yar Khan - Sheikh Zaid Hospital ‐ Khan Bela - 30 - M - Blood sample was found positive for DF at Sheikh Zaid Hospital.
  • 2010‐42 - 20‐10‐10 - DHF - KPK - Swat - SGTH (UC Kuzabakhel) - 40 - F - Blood sample was found negative for DF, active surveillance was done.
  • 2010‐42 - 21‐10‐10 - DHF - Punjab - Rahim Yar Khan - Sheikh Zaid Hospital ‐ Adda Fatehpur Punjabian - 20 - M - Investigations are under process at Sheikh Zaid Hospital.
  • 2010‐42 - 21‐10‐10 - DHF - Sindh - Ghotki - UC Qadir Pur - ** - ** - Blood samples collected and sent to NIH, active surveillance is under process
  • 2010‐42 - 21‐10‐10 - DHF - Sindh - Khairpur Jeelani Mohalla - ** - ** - Blood samples collected and sent to NIH, active surveillance is under process
  • 2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - KTH (Bajour) - 4 - M - Death of patient with probable diphtheria , residential details are not known.
  • 2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - Lady Reading Hospital (Charsadda) - 7 - M - Patient with probable diphtheria discharged from Lady Reading Hospital. Lost to followup
  • 2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - KTH (Karak) - 3,3,7 - F,M,M - 3 cases probable diphtheria, 1 death, investigation and response continuing in Karak
  • 2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - KTH (Lakki Marwat), LRH, Peshawar - 10,6,2.5 - M,M,M - 2 deaths probable diphtheria, residential details unknown
  • 2010‐42 - 22‐10‐ 10 - Diph - KPK - Peshawar - KTH (South Waziristan) - 3 - M - Probable diphtheria case, discharged from KTH. Residential details unknown
  • 2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - Lady Reading Hospital (Upper Dir) - 7 - M - Probable diphtheria case, discharged from LRH. Residential details unknown
  • 2010‐42 - 22‐10‐10 - DHF - Punjab - Lahore - Wapda Hospital - 50 - F - Blood sample was found negative for DF, active surveillance was done.

Table-6: List of confirmed Polio Cases from flood affected districts, week 42-2010

[S. NO. - Province - Districts - SEX - AGE (m) - Date onset of Paralysis - WPV Type]

  • 1 - KPK - Nowshera - Female - 54 - 25‐09‐2010 - NSL1
  • 2 - Sindh - Kashmore - Male - 35 - 28‐09‐2010 - NSL1
  • 3 - Sindh - Ghotki - Male - 8 - 29‐09‐2010 - NSL1
  • 4 - Sindh - Sanghar - Female - 96 - 06‐10‐2010 - NSL1

Province KPK

This week 14 out of 24 flood affected districts reported to DEWS from KPK province

  • 47 fixed health centers and 14 mobile medical outreach centers reported to DEWS
  • 51,175 patient consultations were reported during the reporting period of 16 ? 22 October, week 42, 2010
  • 8 alerts were received and investigated this week; 6 were for Diphtheria while 2 were for Dengue Hemorrhagic Fever.
  • Regarding Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF), from early September up until 15th October 2010, DEWS teams have identified 311 suspected cases of DF in the districts Haripur, Mansehra and Abbotabad. Of the suspected cases, 87 were confirmed for DF, 100 were negative for DF and 124 are pending. During this time, there were nine confirmed deaths of suspected DHF. There were five confirmed cases of CCHF including one death.

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 2,330 5%
  • ARI - 7,772 15%
  • Skin Diseases - 1,999 4%
  • Others - 37,885 74%
  • Total Consultations - 51,175

Province Punjab

11 out of 11 flood affected districts reported data to DEWS from Punjab province

  • 197 fixed health centers and 22 mobile medical outreach centers reported to DEWS
  • 103,588 patient consultations were reported during this reporting period
  • 8 alerts were received and investigated this week; all were for Dengue Fever, 7 alerts were reported from districts Rahim Yar Khan while 1 alert was received from Lahore city.
  • In Punjab, a higher proportion of suspected malaria was reported again this week (11% to 13%), although a peak of malaria in October reflects seasonal trend of diseases, DEWS officers are collaborating with Malaria Control Program to investigate areas of increased malaria, providing rapid diagnostic test and appropriate medicines.

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 9,447 9%
  • ARI - 20,339 20%
  • Skin Diseases - 11,673 11%
  • Suspected malaria - 13,447 13%
  • Others - 38,142 37%
  • Total consultations - 103,588

Province Sindh

17 out of 17 flood affected districts reported to DEWS from Province Sindh

  • 227 fixed health centers and 64 mobile medical outreach centers reported to DEWS
  • 77,547 patient consultations were reported during the reporting period of 16 - 22 October, week 42, 2010
  • In Sindh, proportional morbidity of major health events remained the same when compared to last week.
  • 3 alerts were received and responded this week; 2 for Dengue Fever and 1 alert was for Acute Watery Diarrhoea
  • A Dengue surveillance and response cell has been established in Hyderabad to address increasing numbers of cases of Dengue Fever.

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 8,479 11%
  • ARI - 13,070 17%
  • Skin Diseases - 11,554 15%
  • Suspected malaria - 9,888 13%
  • Others - 25,944 33%
  • Total consultations - 77,547

Province Balochistan

8 out of 12 flood-affected districts reported to DEWS from province Balochistan

  • 38 fixed health centers and 5 mobile medical outreach centers reported to DEWS
  • 25,670 patient consultations were reported during the reporting period of 16 - 22 October, week 42, 2010
  • 1 alert of Acute Watery Diarrhoea was received and responded this week
  • Certain hot spots are still experiencing higher than usual levels of malaria cases. Malaria outbreaks in districts Naseerabad, Sibi, Zhob and Jhal Magsi are being addressed in collaboration with the Malaria Control Program.

[Diseases - Number - % of total consultations]

  • Acute Diarrhoea - 3,079 12%
  • ARI - 4,834 19%
  • Suspected Malaria - 3,794 15%
  • Unexplained Fever - 1,150 4%
  • Total consultations - 25,670

Summary of Health Event in Flood affected districts

Since July 29, 2010, approximately 7,622,436 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 (82%) of the 78 flood affected districts and reporting is received from 50 (78%) of these 64 districts. The major causes for seeking healthcare by the affected communities continue to be diarrheal diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI increased from 12% to 14% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009. (Please see Fig.13)


Focus on: Dengue Fever and Dengue Hemorrhagic Fever

So far about 4,363 cases of suspected Dengue Fever (DF) have been reported in Pakistan with about 2,062 confirmed cases and 15 deaths. As Dengue Fever cases are on the rise in many places across the country, Pakistan joins 40% of the global community who are at risk for Dengue, the most widespread mosquito‐borne infection in human beings.

The only way to prevent Dengue Fever is to prevent mosquito bites. Dengue is not spread by droplets or blood. Dengue mosquitoes bite during the daytime. To protect yourself wear full‐sleeve clothes and long trousers, avoid wearing black color, use repellents, use mosquito coils and electric vapor mats, use bednets for children and elderly who may rest in bed during the day.

To control Dengue in the community, we must reduce the places where mosquitoes live and breed: drain out the water from all unused tanks, barrels, drums, and buckets and cover all stored water containers. Remove garbage piles where water collects in discarded containers.

As 95% of Dengue Fever can be treated at home, when someone falls ill with a fever and headache, pain behind the eyes, or body aches and no other symptoms, the best advice is to

  • rest at home in bed,
  • take plenty of fluids like soup, water, milk and juice, and
  • take paracetamol (Panadol, Calpol, etc) for pain.
All dengue patients must be carefully observed for complications for at least 2 days after recovery from fever because life threatening complications often occur during this phase. Patients and households should be informed that severe abdominal pain, passage of black stools, bleeding into the skin or from the nose or gums, sweating, and cold skin are danger signs. If any of these signs is noticed, the patient should be taken to the hospital. Please use only paracetamol for pain and fever as other medicines may increase the bleeding tendency.

At the hospital, the patient is monitored with frequent blood pressure readings, tests of hematocrit and platelets to determine when to give intravenous fluid and how much to give. Blood or platelets may need to be given if the patient is actively bleeding. The four WHO criteria for diagnosis of Dengue Hemorrhagic Fever, fever with headache or body aches; evidence of bleeding or positive tourniquet test; platelet count less than 100,000; and evidence of leaky capillaries such as >20% rise in hematocrit, have been found to be 62% sensitive and 92% specific for identification of dengue illness requiring intervention.

Srikiatkhachorn A, et al. Dengue Hemorrhagic Fever: The Sensitivity and Specificity of the WHO Definition for Identification of Severe Cases of Dengue in Thailand, 1994?2005. Clinical Infectious Diseases 2010;50:1135?1143


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.

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: eic.nih@gmail.com. WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int.
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