Acute Respiratory Infections (ARI) are expected to be a major cause of morbidity and mortality in the earthquake zone in coming winter. According to WHO report released here, between November 5 and December 2, 2005, a total of 28,863 ARI cases with two related deaths were reported from the earthquake-affected areas.
In the current week (epidemiological week 48), 6,334 cases with one related death were reported.
The common acute infections of the upper and lower respiratory tract range from a simple cold or cough, otitis media, sore throat, laryngitis, to bronchitis and pneumonia. Diphtheria and Pertussis (whooping cough) are also respiratory infections. Currently, the disease early warning system (DEWS) is collecting all cases of ARI, including both upper and lower in one category.
The majority of ARI episodes are mild and self-limiting, as in the case of coughs and colds. However, about one in every 30 to 50 episodes of cough will develop into pneumonia. Without treatment, 10 to 20 percent of pneumonia cases will result in death, the report added.
ARI can be attributed to an interaction between the host, the infectious agent, and the environment. Although 80 percent of all cases of pneumonia examined in hospitals in developing countries are caused by two types of bacteria, streptococcus pneumoniae and haemophilus influenzae, most other infections are of viral origin.
Other risk factors that encourage the spread of ARI include low birth weight, malnutrition, poor breast-feeding practices, specific nutritional deficiencies, indoor air pollution (such as smoke from cooking fuels and tobacco), urban air pollution, illiteracy, overcrowding, poor hygiene, lack of access to health services and low socio-economic status.
Many of these risk factors may interact through complex mechanisms to cause subsequent illness.
ARI in 5-year and older represents 73 percent of all reported cases. Although the population under surveillance is not constant in the last four epidemiological weeks due to the different number of reporting units, the ARI cases show a steady pattern in the over 5 years of age group.
The cases under 5 years group show an increase in week 48 compared to the previous week.
In the current week, in all reporting districts, the number of ARI cases over 5 years is greater than the number under 5 years (4,290 and 2044 respectively).
Mansehra district reported 37 percent (2,359/6,334) ARI cases, in which 61 percent (1,687/2,359) were 5 years and older. Bagh and Muzaffarabad districts reported 27 percent and 20 percent respectively.
Measles is also highly communicable viral disease with a high potential of occurrence and rapid spread in disaster conditions. Complications in measles cases may result from viral replication or bacterial super infection, and include otitis media, pneumonia, diarrhea, and encephalitis.
Muzaffarabad district reported 36 petrcent (22/61), followed by Balakot district 23 percent (14/61). In addition, 18 cases of clinically diagnosed measles were detected during an outbreak investigation in Balakot district.
In Balakot District, on the November 19, after several cases of measles were reported through DEWS, an outbreak investigation at the IMC camp in Ghari Habibullah revealed a total of 18 cases of clinically diagnosed measles, who had not been vaccinated as they had just arrived from distant mountain villages.
On the November 20, a team from WHO, Unicef and the Ministry of Health vaccinated a total of 744 children between 6 months and 15 years against measles.
Cases were visited again on November 21 to monitor their condition and administer Vitamin A. Defaulters in the camp were identified and vaccinated. Heightened surveillance for new measles cases was initiated and all new arrivals at the camp were thereafter vaccinated.