Weekly Epidemiological - WHO · 14 cases of suspected malaria were reported from BHU Belli. 14 slides were tested on RDTs and 8 were found positive (Slide positivity 57%). Distribution

Weekly Epidemiological Bulletin

This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected].

Epidemiological week no. 19 (6 to 12 May 2012)

• In week 19, 2012, total 86 districts including 3 agencies provided surveillance data to the DEWS on weekly basis from around 2,148 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC.

• A total of 735,567 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI); 10% were acute diarrhoea; 5% were suspected malaria; while 4% were Skin disease.

• A total of 239 alerts reported while 26 outbreaks were identified in week 19, 2012: Alto‐gether 143 alerts for Measles; 22 for Typhoid; 19 for Leishmaniasis; 11 for Pertussis; 9 for acute diarrhoea; 7 each for Malaria and AWD; 6 for Bloody diarrhoea; 5 for Scabies; 3 for CCHF; 2 each for AJS and Diphtheria; while 1 each for ARI, DF and Tetanus.

• In this week no new polio case was reported. As of 14 May 2012, Pakistan has reported a total of 16 polio cases (13 type‐1, 2 type‐3 , 1 mix type‐1 and 3) from 10 districts/tribal agencies

Highlights

Disease early warning system and response in Pakistan

01

Volume 3, Issue 19, Wednesday 16 May 2012

Priority diseases under surveillance

in DEWS

Acute (Upper) Respiratory Infection Pneumonia

Suspected Diphtheria Suspected Pertussis

Acute Watery Diarrhoea Bloody diarrhoea

Other Acute Diarrhoea Suspected Enteric/Typhoid Fever

Suspected Malaria Suspected Meningitis

Suspected Dengue fever Suspected Viral Hemorrhagic Fever

Pyrexia of Unknown Origin Suspected Measles

Suspected Acute Viral Hepatitis Chronic Viral Hepatitis

Neonatal Tetanus Acute Flaccid Paralysis

Scabies Cutaneous Leishmaniasis

Others

Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐19, 2012.

• The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as proportional morbidity (percentage of cases out of total consultations) reported to DEWS on weekly basis.

• The above table provides the total consultations for the last 8 weeks proportional morbidity of the leading five disease syndrome. Proportional morbidity of ARI is highest in Khyber Pakhtunkhwa, Sindh and Balochistan, while acute diarrhoea is highest in Khyber Pakhtunkhwa, FATA, Punjab, Sindh and Balochistan (please see the graphs for every province in page 4 and 5).

Table 1: Most common communicable diseases syndromes reported weekly

Disease Wk-12 Wk-13 Wk-14 Wk-15 Wk-16 Wk-17 Wk-18 Wk-19

Acute diarrhoea 41,535 (6%) 51,227 (7%) 52,033 (8%) 61,071 (9%) 63,511 (9%) 70,982 (9%) 64,841 (10%) 70,808 (10%)

Total consultation 681,475 772,042 647,695 713,633 719,570 781,631 641,659 735,567

Suspected malaria 29,521 (4%) 32,888 (4%) 28,298 (4%) 30,938 (4%) 31,615 (4%) 35,236 (5%) 32,171 (5%) 36,917 (5%)

Acute respiratory infection 145,261 (21%) 155,558 (20%) 128,653 (20%) 133,329 (19%) 131,477 (18%) 130,075 (17%) 113,705 (18%) 124,795 (17%)

Bloody diarrhoea 2,890 (0.42%) 3,480 (0.45%) 2,977 (0.46%) 3,338 (0.47%) 3,564 (0.50%) 3,616 (0.46%) 3,426 (0.53%) 3,690 (0.50%)

Skin diseases 28,719 (4%) 31,638 (4%) 28,123 (4%) 28,325 (4%) 28,487 (4%) 31,556 (4%) 27,027 (4%) 31,592 (4%)

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Weekly Bulletin: DEWS, Pakistan, Week no. 19 (6 to 12 May 2012)

This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected]. 02

Current week's (19/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

9‐May Measles AJK Poonch Village Galliat, UC Rawalakot 2 0 2 2

Alert for suspected measles reported from Sheikh Zaid hospital, Rawalakot. During active surveillance 5 more cases found. Blood samples were taken and Vitamin A given to active cases and contacts. DOH was informed and mop up vaccination was arranged for all children < 15 yrs of age. Health education session was conducted.

11‐May Leishmaniasis Balochistan Lasbela Bela town, UC & Tehsil Bela 2 0 2 2

6 cases of Leishmaniasis were reported and patients with lesions on cheeks, hands and legs were found. During active surveillance no other case was found. The plan is to provide Inj. Glucantime and take preventive measures.

7‐May Malaria Balochistan Harnai Belli, UC Spintangi, Tehsil Harnai 0 0 0 0

14 cases of suspected malaria were reported from BHU Belli. 14 slides were tested on RDTs and 8 were found positive (Slide positivity 57%). Distribution shows 6 Falciparum and 2 Vivax. Inves‐tigation was done and clustering was found. Information was shared with DHO and health partners. RDTs & ACTs have been provided by a health partner.

7‐May Malaria Balochistan Harnai Shahrag, UC Shahrag, Tehsil Shahrag 0 0 0 0

Suspected malaria alert was received from RHC Shahrag and 29 cases were reported. 15 slides were tested on RDTs and 11 were found positive (Slide positivity 73%). Distribution shows 9 Falciparum and 2 Vivax. Investiga‐tion revealed that cases are from the same location. Mostly patients are coal mine workers and treatment is provided by a health partner.

11‐May Malaria Balochistan Lasbela Civil Hospital Bela 5 15 15 10 45 cases of suspected malaria were reported from CH Bela. 35 slides were tested on RDTs and 18 were found positive (Slide positivity 51%). Distribution shows 4 Falciparum and 14 Vivax. RDTs were distributed. DHO was informed and distribution of anti malarial drugs is planned.

8‐May Measles Balochistan Pishin UC & Village Killi Lumaran 7 6 8 3

Alert for Measles was reported with 24 cases including 2 deaths. All the cases were found unvaccinated. Vitamin A was given and health education was provided. 1 sample was collected. During active surveillance 200 children were vaccinated. Outcome was shared with DHO and DoH.

11‐May Measles Balochistan Sibi Village Khanul Mari, ward # 10, Sibi town 2 0 4 0

6 cases of Measles were reported with one death. Active surveillance revealed 31 unvaccinated children and all were vaccinated by EPI team. Health education was imparted and Vitamin A was given.

8‐May Measles FATA Khyber Agency

Ali Korona, UC Lowara Mina,Tehsil Mulagori 3 1 2 0

6 suspected cases of Measles were reported from CH Lawara Mina. During active surveillance no more cases were found. Vitamin A was given to suspected cases. Health education session was conducted. 2 blood specimens were collected. During mass measles vaccination 75 children were vaccinated. Report was shared with Agency Surgeon and FSMO.

9‐May Measles FATA Khyber Agency

Garhi #1, UC Lowara Mina,Tehsil Mulagori 7 0 2 2

2 suspected Measles cases were reported from Garhi #1. On active surveillance 9 more cases were found, 2 samples were collected. Vitamin A was given to the suspected cases and health education session was conducted. Mass measles vaccination of 99 children was done. Reports were shared with the Agency Surgeon and FSMO.

9‐May Leishmaniasis KPK Abbottabad Village Bakot, UC Bakot 1 0 1 4

6 suspected Leishmaniasis cases were reported from BHU Bakot. Patients were investigated and health education was imparted to the affected families. EDO Health was informed and necessary action is planned for indoor insecticide spray, provision of bed nets and further health education sessions.

11‐May Leishmaniasis KPK Shangla Village Jatkool, UC Sarkool 0 5 0 8

Alert for Leishmaniasis was received from non endemic area. On active surveillance 13 sus‐pected cases of cutaneous Leishmaniasis were found. All the cases were given first dose of intralesional injections. EDOH was informed and response team comprising of 2 MO's, 3 MT's, 10 spray men, 13 Social organizers has been sent for proper response.

10‐May Measles KPK Haripur Aslam Colony, UC Shahmuhammad, BHU Shah Muhammad

1 0 2 2

1 suspected measles case was reported to BHU. Active surveillance carried out and 4 more cases were identified. During field investigation found that 13 children were not vaccinated for measles 1st dose and 6 were missing the measles 2nd dose. Missed children were sent to near‐est health facility for vaccination. Vitamin A was given and blood sample was taken. Outreach vaccination is scheduled.

11‐May Measles KPK Haripur Monan, UC Ali Khan, BHU Shah Muhammad 2 1 2 1

2 suspected measles cases were reported to BHU Shah Muhammad. Active surveillance carried out and 4 more cases were identified. Field investigation revealed 7 children not vaccinated for measles 1st dose and 4 were missing measles 2nd dose. Missed children were sent to nearest health facility for vaccination. Vitamin A was given and blood sample was taken. Outreach vaccination is scheduled.

8‐May Pertussis Punjab Rahim Yar Khan

Village Jan Muhammad Dahar, UC Machko 4 0 2 0

During field surveillance of village found 6 suspected Pertussis cases. Immunization status of the children were assessed where all were found partially vaccinated. Health education was im‐parted, complete dose of Erythromycin was given to all cases. Information was shared with SMO‐BHU Rawant, EDOH and request for mop‐up the area.

7‐May Measles Sindh Karachi Shah Nawaz Bhutto colony, Line area, Jamshed town

2 0 4 0

Suspected case of Measles was reported from NICH. Investigations showed that case was un‐vaccinated, history of Fever, Rashes in body and severe Pneumonia. During active surveillance found 5 more cases were found. Routine immunization status of 17 children were assessed and Vitamin A dose was given to all and 1 Blood sample was collected. Health education was imparted, THMT informed and requested for immunization.

9‐May Measles Sindh Karachi Shah Latif Town, UC‐5, Bin Qasim town 5 0 1 0

Suspected case of Measles was reported from a private hospital. Investigations showed that patient has fever, rashes in Body and was un‐vaccinated. During active search found 5 more cases, Vitamin A was given, immuni‐zation status was checked where 21 children were assessed. Health education was imparted, THMT informed and 3 blood samples were collected.

8‐May Measles Sindh Qambar Shahdadkot

Datoo Ji Wandh, Jean Abro, Taluka Qambar 4 0 3 0

1 suspected Measles case was reported from a private clinic; during active surveillance found 6 more cases. Health education was imparted, Vitamin A doses were given to all cases and 5 blood samples were collected. Immunization status was checked, informed DHMT for imple‐mentation of routine immunization.


Pir Jo Goth, UC Ra‐wanti, Taluka Kambar 5 0 1 0

A suspected Measles case was reported from a private practitioner and 5 more cases were found during active surveillance. Immunization status collected and information was shared with DHMT. Vitamin A was given, health education imparted and 5 blood samples were col‐lected.


Kalo Makan Mohalla, UC‐3 1 1 3 0

1 suspected Measles case was reported from a private clinic and during active surveillance found 4 more cases. Vitamin A was given to all cases, health education imparted and 4 blood samples were collected. Immunization status was checked and information was shared with DHMT.



Cont’d Current week's (19/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

11‐May Measles Sindh Tando Muhammad Khan

Village Haji Allah Warayo, UC Nazarpur 2 2 1 1

Suspected Measles case was reported from community and during active surveillance found 5 more cases. Immunization status was checked and EDOH was informed. Vitamin A was given to all cases, health education imparted and 6 blood samples were collected.

9‐May Pertussis Sindh Larkana Village Sabzal Shar, UC Kothi, Taluka Larkana 2 0 3 0

Alert for suspected Pertussis was received from a private clinic and during active search found 4 more cases. Erythromycin was given to cases and contacts and proper treatment of patient was assured. Routine immunization status was assessed, EDO‐H informed for mop‐up in the village.

11‐May Pertussis Sindh Naushahro Feroze

Village Sadhuja, UC Sadhuja, Taluka Naushahro feroze

0 0 3 3

A suspected Pertussis case was notified and during active search found 5 more cases. Cluster for routine immunization was checked from 10 houses where 13 children were assessed. Erythromycin was given, health education was imparted and information was shared with DHMT.

8‐May Pertussis Sindh Shaheed Benazir Abad

Village khanan Shah, UC Amur Ji 0 0 3 3

Pertussis case was notified and during field investigation 5 other cases were found from same family. Erythromycin was given, health education was imparted and information was shared with DHMT. Routine immunization assessment was also done.

8‐May Pertussis Sindh Shaheed Benazir Abad

Village Mir Hassan Dahri, UC Amur Ji 0 0 3 5

A Pertussis alert was notified and during field investigation 7 other cases were found from same family. Routine immunization assessment for 12 children was done. Erythromycin was given, health education was imparted and information was shared with DHMT.

11‐May Pertussis Sindh Tando Allah Yar

Village Bachal Mari, UC Mirabad 5 6 4 2

Suspected case of Pertussis was reported from community and during investigation found 16 more cases. Health education was imparted, Erythromycin tabs, Priton Syrup, Cough Syrup and IEC material was distributed, 4 samples were also collected. Immunization status was checked and EDOH was informed with the situation.

9‐May Pertussis Sindh Tharparkar Village Salar Ji Dhani, UC Vejhiar, Taluka Chachro 14 2 8 3

2 Suspected cases of Pertussis were found at THQ Chachro and during active surveillance 25 more cases were found. All children were found un vaccinated. Vaccination was done, health education imparted and complete dose of erythromycin was given to all the patients and close contacts. 5 samples for culture were also collected. Information is shared with EDOH.

AJK Balochistan FATA Gilgit Baltistan KPK Punjab Sindh Total

A O A O A O A O A O A O A O A O

Acute diarrhoea ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 9 ‐ ‐ ‐ 9 0

Acute jaundice syndrome ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 2 ‐ ‐ ‐ 2 0

Acute respiratory infection ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 ‐ ‐ ‐ 1 0

Acute watery diarrhoea ‐ ‐ 1 ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 ‐ 5 ‐ 7 0

Bloody diarrhoea 1 ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 ‐ 4 ‐ ‐ ‐ 6 0

CCHF ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 2 ‐ 1 ‐ 3 0

Dengue fever ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 ‐ ‐ ‐ ‐ ‐ 1 0

Diphtheria ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 2 ‐ ‐ ‐ ‐ ‐ 2 0

Leishmaniasis ‐ ‐ 7 1 4 ‐ ‐ ‐ 8 2 ‐ ‐ ‐ ‐ 19 3

Malaria ‐ ‐ 6 3 ‐ ‐ ‐ 1 ‐ ‐ ‐ 7 3

Measles 7 1 8 2 8 2 1 44 2 18 ‐ 57 6 143 13

Pertussis ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 2 1 9 6 11 7

Scabies ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 ‐ 3 ‐ 1 ‐ 5 0

Tetanus ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 ‐ ‐ ‐ 1 0

Typhoid ‐ ‐ ‐ ‐ ‐ ‐ 1 ‐ ‐ ‐ 15 ‐ 6 ‐ 22 0

Total 8 1 22 6 12 2 2 57 4 59 1 79 12 239 26

Diseases

Table‐3: Total number of alerts and outbreaks reported and investigated with appropriate response Disease

2010 2011 2012 (up till week 19) Total A O A O A O A O

Acute watery diarrhoea 209 85 1350 543 148 10 1707 638 Acute jaundice syndrome 5 2 51 17 56 6 112 25 Bloody diarrhoea 10 1 98 20 64 5 172 26 Dengue fever 81 32 785 111 34 1 900 144 Measles 48 6 1708 110 1787 142 3543 258 Pertussis 1 0 287 81 228 85 516 166 NNT + tetanus 5 0 399 0 245 649 0 Malaria 12 7 131 88 34 13 177 108 Leishmaniasis 1 0 298 33 378 35 677 68 Others 75 11 645 69 637 54 1357 134 Total 447 144 5752 1072 3611 351 9810 1567

Table‐2: Province wise number of alerts and outbreaks reported and investigated with appropriate response, week 19, 2012



Province Khyber Pakhtunkhwa:

• 498 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS on weekly basis with a total of 135,465 patients consultations in week 18, 2012.

• 57 alerts were reported in week 18; Altogether 44 for Measles; 8 for Leishmaniasis; 2 for Diphtheria; while 1 each for Bloody diarrhoea, DF and Scabies.

• 4 outbreaks, 2 each for Measles and Leishmaniasis were identified and appropriate measure were taken.

Figure-4: Trend of priority communicable diseases, province KPK

Province Sindh:

• 611 health facilities from 23 districts in Sindh reported on weekly basis to DEWS with a total of 289,923 patient consultations in week 19, 2012.

• 79 alerts were reported; Altogether 57 for Measles; 9 for Pertussis; 6 for Typhoid; 5 for AWD; while 1 each for CCHF and Scabies.

• 12 outbreaks, 6 each for Measles and Pertussis were identified and appropriate measures were taken.

Figure-5: Trend of priority communicable diseases, province Sindh

Figure‐2: Distribution of consultations by diseases, Week 19, 2012 Figure‐3: Number of consultations by age and gender, week 19, 2012

Province Punjab:

• 382 health facilities from 8 districts reported data to DEWS in Punjab with a total of 181,743 patient con-sultations.

• A total of 59 alerts were reported in this week; Alto-gether 18 for Measles; 15 for Typhoid; 9 for Acute diar-rhoea; 4 for Bloody diarrhoea; 3 for Scabies; 2 each for Acute jaundice syndrome, CCHF, and Pertussis; while 1 each for AWD, ARI, Malaria and Tetanus.

• 1 outbreak, for Pertussis was identified and appropriate measures were taken.

Figure-6: Trend of priority communicable diseases, province Punjab

AD10%

BD<1%

ARI17%

S. Malaria5%

Skin Ds.4%

UF4%

Others59%

Number of consultations by disease

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

Male 25662 56067 76655 114693 54620

Female 25305 53612 77126 189600 62227

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State of Azad Jammu and Kashmir:

• 125 health facilities from 9 districts reported to DEWS in this week with a total of 31,330 patient consulta-tions.

• 8 alerts, 7 for Measles; while 1 for Bloody diarrhoea were received and appropriated measures were taken.

• 1 out break for Measles was identified and appropriate meas-ure were taken.

• 54 health facilities from 3 agencies reported from FATA in this week, with a total of 13,459 patient con-sultations.

• 12 alerts, 8 for Measles; 4 for Leishmaniasis were re-ported and appropriated measures were taken.

• 2 outbreaks for Measles were identified and appropri-ate measures were taken.

Province Gilgit Baltistan:

• 36 health facilities from 4 districts in Gilgit Baltistan reported to DEWS in week 19, with a total of 14,656 patient consultations.

• 2 alerts, 1 each for Measles and Typhoid were received and appropriate measures were taken.

Figure-8: Trend of priority communicable diseases, Gilgit Baltistan

FATA:

Province Balochistan:

• 442 health facilities from 21 districts in Balochistan reported to DEWS, with a total of 68,991 patient consul-tations.

• 22 alerts were reported in week 19 from Balochistan; Altogether 8 for Measles; 7 for Leishmaniasis; 6 for Malaria; while 1 for AWD.

• 6 outbreaks, 3 for Malaria; 2 for Measles; while 1 for Leishmaniasis were identified and appropriate meas-ures were taken.

Figure-7: Trend of priority communicable diseases, province Balochistan

Figure-10: Trend of priority communicable diseases, AJ&K

Figure-9: Trend of priority communicable diseases, AJ&K

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Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

In this week 19, 2012, no new polio case was reported. As of 14 May 2012, the total number of polio cases confirmed by the laboratory is 16 from 10 districts/towns/tribal agencies and areas.

Province Cases 2011 Cases 2012

P1 P3 P1 P1+P3

Punjab 9 ‐ 1 ‐

Sindh 33 ‐ 2 ‐

Khyber Pakhtunk‐hwa

23 ‐ 4 ‐

FATA 57 2 4 1

Balochistan 73 ‐ 2 ‐

AJ&K ‐ ‐ ‐ ‐

Gilgit‐Baltistan 1 ‐ ‐ ‐

Islamabad ‐ ‐ ‐ ‐

Total 196 2 13 1

P3

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2

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Distribution of Dengue cases in Pakistan, 2012

The above chart compares the trend of dengue confirmed cases in 2010 and 2011. Month of peak inci‐dence in 2010 was November while peak incidence in 2011 was in September and October. The second chart above and table to the right show the weekly number of confirmed cases reported by surveillance focal points in the Depts of Health in Sindh and Punjab. Total number of confirmed dengue cases to date in 2012 is 45 in Sindh and 85 in Punjab. Characteristics: Dengue fever is a acute fever illness that affects infants, young children and adults, but seldom causes death. Dengue should be suspected when a high fever (40°C/ 104°F) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for 2–7 days, after an incubation period of 4–10 days after the bite from an infected mosquito. Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Warning signs occur 3–7 days after the first symptoms in conjunction with a decrease in temperature (below 38°C/ 100°F) and include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, blood in vomit. The next 24–48 hours of the critical stage can be lethal; proper medical care is needed to avoid complications and risk of death.

Treatment: There is no specific treatment for dengue fever. For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives – decreasing mortal‐ity rates from more than 20% to less than 1%. Maintenance of the patient's body fluid volume is critical to severe dengue care.

Messages for the community

• Clear sites where mosquitoes breed

• Cover water containers

• Remove or destroy containers where mosquitoes breed

• Proper waste disposal

• Protect yourself from mosquito bites

• Wear proper clothes (long sleeves and pants; not black) to minimize the chance of being bitten by mosquitoes

• Use mosquito repellants and kill mosquitoes in the home

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Trend of positive dengue cases, week 1 ‐ 18, 2012

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Epi‐week Punjab Sindh

1 14 2

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14144 0 1 2 3 5 4 8 3 1 2 7 5 5 4 3 0

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Trends of Dengue lab confirm cases, 2010 (Pakistan) and 2011, 2012(Punjab)

2012 2011 2010

Focus on: Measles

In this week, DEWS team successfully responded 143 alerts and 13 outbreaks for measles. Increase in the number of cases this year compare to last year indicates that the children are not vaccinated against measles as no such campaigns have been planned this year. However, last year measles immunization campaign was organized in Feb 2011 which had reduced the significant number of cases. Measles is a killer childhood disease. One in 15 people have complications with measles, and one in 1000 will die of it, but two doses of measles vaccine will protect people against the disease. WHO has set the target for measles elimination for 2015 which would require that more than 95% of the world children are covered by two doses of measles vaccine. In 2011, 1708 alerts and 110 outbreaks had investigated by WHO‐DEWS team with the collaboration with department of health. 3890 measles cases and 64 deaths due to measles had been re‐ported; while up till 12 May 2012, a total of 1787 alerts reported and 142 outbreaks identified in which 4047 cases and 48 deaths had been reported. Proper case management during outbreaks:

It is imperative that during outbreak situations proper case management is ensured in order to minimize measles related deaths and measles related complications. The treatment of measles patients with Vitamin A will dramatically reduces their risk of deaths. Two doses of Vitamin A will be given to all identified cases (active and old) during house‐to‐house investigation, unless it was already received as part of the treatment in the health facil‐ity. One dose to be given by the health worker on the day of investigation and the 2nd dose to the parents advising to give on next day. The therapy will be given regardless of previous vitamin A prophylaxis. If the investigation team observes complications, the patient should be referred to the nearest health facil‐ity for specific treatment of these complications. Measles Prevention:

Routine measles vaccination for children; combined with mass immunization campaigns in countries with high case and death rates, is key public health strategy to reduce global measles mortality rates. The measles vac‐cine has been in use for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immu‐nize a child against measles. Measles vaccine is provided by the Pakistan EPI programme to children at 9 months and 15 months. Chil‐dren who are vaccinated against measles before 9 months of age must receive a 2nd measles vaccination at 9 months age ensuring a gap of one month between both vaccinations. Moreover, any child who received measles vaccine should also receive OPV. Priority should be placed to immunize children 6 months to 5 years old, regardless of vaccination status or history of disease. Auto destructible syringes and safety boxes are recommended and safe disposal of used sharps and safety of injection during immunization should be ensured. Let’s remind all our neighbours, friends and colleagues to be sure their children are immunized against measles.



Province # of Alerts # of OB's

AJK 22 2

Balochistan 140 27

FATA 63 10

Gilgit‐Baltistan 7 0

ICT 5 1

Khyber Pakhtunkhwa 785 34

Punjab 223 10

Sindh 542 58

Total 1787 142

Province‐wise Measles number of alerts and outbreaks, week 1‐19, 2012



Alerts and outbreaks, week 19, 2012

Documents

Weekly Epidemiological - WHO · 14 cases of suspected malaria were reported from BHU Belli. 14 slides were tested on RDTs and 8 were found positive (Slide positivity 57%). Distribution