Epidemiological Week No. 47 (18-24 Nov 2006) 30 Nov 06/ Vol. 53/ DEWS 2006-47

Reporting Units...... 2 Total number of consultations ...... 2 DEWS Data, Epidemiological Week N0 47 2006...... 3 DEWS Data, Monthly Summary (Epidemiological Weeks N0 44-47) ...... 4 Acute Watery Diarrhoea ...... 5 Bloody Diarrhoea...... 6 Acute Jaundice Syndrome...... 6 Malaria ...... 7 Measles ...... 7 Acute Respiratory Infection ...... 8 Other Reportable Diseases and Conditions ...... 8 Outbreak Alert and Response ...... 9 Number of reported cases and deaths per District, AJK ...... 10 : Women making Number of reported cases and deaths per District, food at Thori Park Camp. NWFP ...... 11 Picture by Torgrim Halvari

ƒ In the past month (Epidemiological ƒ In week 47, there were five deaths from weeks 44-47 inclusive), 143,834 health acute respiratory infection. events under surveillance were reported including 70 deaths ƒ Four suspected cases of meningitis reported this week, three cases were ƒ This week, there were 291 reporting from Muzaffarabad district and one case units contributing to the report. from district.

ƒ In week 47, Total 82,847 consultations ƒ In this week 47, Malaria cases were were reported, with 21 deaths increased by 2% (from 510 to 519 case).

The Weekly Morbidity and Mortality Report (WMMR) is published by the Ministry of Health of (MOH) and the World Health Organization (WHO). The WMMR is built on surveillance data that health service providers and NGOs transmit on a weekly basis from health facilities and hospitals in those areas affected by the earthquake that struck Pakistan on 8 October 2005.

The WMMR objectives are to monitor the trend of health conditions over a period of time and provide vital information to all health partners. The WMMR is only a snapshot of the health conditions in those facilities where events are registered and data collected and does not necessarily reflect the situation from other health facilities.

The WMMR is a publication that has been developed for emergencies and previously used in other areas such as the Darfur Crisis.

The WMMR is produced with the financial support of AAI Australia, Americares, CIDA, Denmark, DFID, ECHO, Ireland, Italy, Japan, Korea, Monaco, Norway, SIDA, Slovak Republic, Switzerland, Turkey, USAID

The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, House #6, Street #20, F-7/2, Islamabad, Pakistan For More Information, please contact: Dorcas Taylor, Epidemiologist, WHO/EHA/Pakistan; [email protected] or Dr. Birjees Mazher Kazi, Chief, Public Health Laboratories Division, NIH MOH; [email protected] or WHO Webpage: http://www.whopak.org/disaster WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

Reporting Units

The number of sites able to report decreased by 22 this week and the reporting timelines of the DEWS systems has also decreased at the current Epidemiological week compared with last week 46. See Table 1 for summary statistics. Table1. Reported heath facilities by district, Earthquake Affected Areas, Pakistan, 28 Oct - 24 Nov 2006. Reporting Health Facilities Area Population 28 Oct-3Nov 4-10 Nov 11-17 Nov 18-24 Nov Week 44 Week 45 Week 46 Week 47 Muzaffarabad 894,364 99 97 98 73 Bagh 452,532 43 43 44 46 Poonch 633,712 68 63 64 66 Mansehra / 1,154,804 66 65 65 66 Battagram / Shangla 592,256 34 42 42 40 Total 3,727,668 310(95%) 310(95%) 313(96%) 291(90%)

Total number of consultations

In week 47, there was a decrease in the number of reporting sites, but the number of consultations increased to 82,847. The highest number of consultations by district was in Muzaffarabad, with 25,527 and the lowest was in Battagram, at 6,945.

No. Unit Reporting Units and Consultations No. Consult. 200000 300 Reporting Unit Consultation

250 150000

200

100000 150

100 50000

50

0 0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44 W45 W46 W47

Week

Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 – 24 Nov 2006.

2 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

DEWS Data, Epidemiological Week No. 47, 2006

Between 18 and 24 Nov 2006, 82,847 consultations were reported through DEWS. Overall, 24% (20,112) were due to acute respiratory infections (ARI), 6% (5,046) due to acute watery diarrhoea (AWD), 7% (5,654) due to fever of unknown origin (FUO), and 5% (4,296) due to injuries (INJ). ARI accounted for 33% and 21% of consultations in the less than 5 years old and 5 or more years old respectively. All other reportable conditions each represented less than 1% of the total consultations in week 47.

AWD AWD AWD 5% ARI 6% ARI 11% 21% 24% ARI 33% FUO 6% FUO OTH* 7% INJ 43% FUO OTH* 5% OTH* 8% 61% 57% INJ INJ 5% 4% ≥ 5yrs (n=62,275) < 5yrs (n=20,572) All Ages (n=82,847) Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 18-24 Nov 2006. *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance

DEWS Data, Epidemiological Week No. 47, 2006: Consultations by age

Children under 5 are estimated to make up approximately 20% of the population of the earthquake affected districts. When consultations for all reasons are considered by age group, young children are slightly over-represented, at approximately 25% of all consultations. Though there are large fluctuations in the reasons for consultations within the age groups (increases in visits for ARI in the winter months, for example), the age breakdown of all consultations remains very stable over the year. See figure 3.

100%

80%

60% >= 5 40% < 5

20%

0% 2005-42 2005-45 2005-48 2005-51 2006-02 2006-05 2006-08 2006-11 2006-14 2006-17 2006-20 2006-23 2006-26 2006-29 2006-32 2006-35 2006-38 2006-41 2006-44 2006-47 Percent of allconsultations

Week

Figure 3: Proportion of all consultations by age group, by week, Earthquake Affected Areas, Pakistan 15 October 2005 – 24 November 2006.

3 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

DEWS Data, Monthly Summary (Epidemiological Weeks No. 44-47)

In the past four weeks, between 28 Oct to 24 Nov, 2006 (Epidemiological weeks 44-47 inclusive), 143,834 consultations for health conditions under surveillance were reported, out of a total 341,183 consultations. 23% (78,832) of consultations were due to acute respiratory infection (ARI), 6% (21,691) acute watery diarrhoea (AWD), 6% (21,826) unexplained fever (FUO) and 5% (16,957) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 18-24 Nov 2006. Week WEEK 44 WEEK 45 WEEK 46 WEEK 47 TOTAL CFR% Event C D C D C D C D C D AWD 6189 0 5457 1 4999 2 5046 1 21691 4 0.018 BD 569 0 471 0 314 0 333 1 1687 1 0.000 AFP 0 0 2 0 1 0 2 0 5 0 0.000 MAL 797 0 776 0 510 0 519 0 2602 0 0.000 ARI 20636 3 18289 2 19795 3 20112 5 78832 13 0.016 MES 2 0 1 0 3 0 6 0 12 0 0.000 MEN 7 0 8 0 7 1 4 0 26 1 0.000 JAU 78 0 42 0 42 0 34 2 196 2 0.000 TET 0 0 0 0 0 0 0 0 0 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 5700 1 5017 0 5455 0 5654 0 21826 1 0.005 INJ 4417 0 4341 0 3903 0 4296 0 16957 0 0.000 OTH 54950 6 48997 10 46561 20 46841 12 197349 48 0.024 TOTAL 93345 10 83401 13 81590 26 82847 21 341183 70 RU 310 310 313 291

C – Cases, D – Deaths, AWD - Acute Diarrhoea, BD - Bloody Diarrhoea, AFP - Acute Flaccid Paralysis, MAL – Malaria, ARI - Acute Respiratory Infection, MES – Measles, Men - Meningitis, JAU - Acute Jaundice Syndrome, TET - Neonatal Tetanus, AHF Acute Hemorrhagic Fever, FUO –Unexplained fever, INJ – Injuries, OTH – Others, RU – Reporting Units. Please note data from late reporting in previous weeks has been updated. During the same reporting period 86,057 consultations were reported in the less than 5 years old group, (25% of the total consultations), of which 32% (27,456) were due to ARI, 11% (9,264) due to AWD, 7% (6,202) due to FUO and 4% (3,500) were reported as injuries (INJ). Table 3. Total number of reported cases, deaths and monthly Case Fatality Rate (CFR), less than 5 years old, Earthquake Affected Areas, Pakistan 18-24 Nov 2006. Week WEEK 44 WEEK 45 WEEK 46 WEEK 47 TOTAL CFR% Event C D C D C D C D C D AWD 2582 0 2267 1 2190 2 2225 1 9264 4 0.043 BD 198 0 158 0 93 0 103 1 552 1 0.181 AFP 0 0 1 0 1 0 1 0 3 0 0.000 MAL 166 0 183 0 89 0 55 0 493 0 0.000 ARI 7276 3 6455 2 6914 3 6811 5 27456 13 0.047 MES 2 0 1 0 3 0 2 0 8 0 0.000 MEN 1 0 0 0 1 0 1 0 3 0 0.000 JAU 13 0 7 0 9 0 5 1 34 1 0.000 TET 0 0 0 0 0 0 0 0 0 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 1760 0 1361 0 1402 0 1679 0 6202 0 0.000 INJ 957 0 830 0 820 0 893 0 3500 0 0.000 OTH 10736 4 9591 6 9418 5 8797 2 38542 17 0.044 TOTAL 23691 7 20854 9 20940 10 20572 10 86057 36 RU 310 310 313 291

4 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

In the current week, there was a minor increase in the number of cases of AWD with 4,999 last week and 5,046 this week. In the current week, ARI increased in the total number of cases as compared with the previous week, (19,795 last week and 20,112 this week). The weekly proportion of ARI and AWD is shown in figure 4.

% Consultation ARI and AWD percent of total consultations 40 ARI AWD 35 30 25 20 15 10 5 0 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44 W45 W46 W47

Week

Figure 4. Weekly trend of percent of consultations for ARI and AWD, Earthquake Affected Areas, Pakistan, 5 November 2005 - 24 November 2006.

Acute Watery Diarrhoea

In week 47 there were 5,046 cases of AWD reported, with one associated death, in a patient under 5 in Mansehra. Though the rate of AWD has declined in both age groups, the decline in the under fives was faster through September and early October, and is now stable, whereas the rate in the five and over age group is continuing to decrease slowly. See Figure 5.

20 18 16 14 12 < 5 10 >= 5 group 8 6 4 2 AWD as a percent of all AWD

consultations within age age within consultations 0 2006-36 2006-37 2006-38 2006-39 2006-40 2006-41 2006-42 2006-43 2006-44 2006-45 2006-46 2006-47

Week

Figure 5: Trend in AWD by district, Earthquake Affected Areas, Pakistan, September 2 – November 24, 2006

5 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

Bloody Diarrhoea

I week 47, there were 333 cases of bloody diarrhoea reported, an increase over week 46. There was one associated death in a child under five years old in Mansehra. The rate of bloody diarrhea varies considerably by district, with Muzaffarabad and Battagram having the highest rate and greatest fluctuation week on week, while Masehra, and Poonch have remained relatively stable at a lower rate, and Bagh had a steep decline in rate, but has since risen. See figure 6

1.80 1.60 1.40 BAGH 1.20 BATTAGRAM 1.00 MANSERA 0.80 0.60 MUZAFFARABAD 0.40 POONCH

of consultations all 0.20 0.00 2006-36 2006-37 2006-38 2006-39 2006-40 2006-41 2006-42 2006-43 2006-44 2006-45 2006-46 2006-47 Bloody diarrhea as a percent as Bloodydiarrhea

Week

Figure 6: Trend in bloody diarrhoea cases as a percent of all consultations, by district, Earthquake Affected Areas, Pakistan, 2 September – 24 November 2006

Acute Jaundice Syndrome

In week 47 there were 34 cases of suspected hepatitis, a decrease of 8 cases over week 46. There were two associated deaths, one in a child under 5 in Mansehra, and one in a patient five years or older in Poonch. There have been only 10 deaths from suspected hepatitis since the beginning of data collection. Poonch has had the fewest cases of suspected hepatitis in the earthquake affected districts, while Mansehra has had the highest, and the highest percentage of cases in children under 5. See figure 7.

100% 80% 638 60% 509 376 710 190 >=5 40% <5 20% 401 91 216 54

cases 104 0% BAGH BATTAGRAM MANSERA MUZAFFARABAD POONCH Percent of suspectedhepatitis

District

Figure 7: Suspected hepatitis cases by age group and district, Earthquake Affected Areas, Pakistan, October 15 2005 – November 24, 2006

6 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

Malaria

In week 47, there were 519 malaria cases reported, with no associated deaths. The rate of malaria varies by district. Poonch has reported the highest rate, hitting a maximum of 5 cases per reporting site. Bagh has the lowest rate at approximately one case for every two reporting sites. The rates in Mansehra had Battagram have almost declined to the level seen in Bagh as the weather has cooled. See figure 8.

6.0 5.0 BAGH 4.0 BATTAGRAM 3.0 MA NSERA site 2.0 MUZAFFARABAD POONCH 1.0 0.0 2006-36 2006-37 2006-38 2006-39 2006-40 2006-41 2006-42 2006-43 2006-44 2006-45 2006-46 2006-47 Malaria per reporting cases

Week

Figure 8: Trend in malaria cases per reporting site, by district, Earthquake Affected Areas, Pakistan, September 2 – November 24, 2006

Measles

There were 6 cases of measles reported in week 47, 2 in Battagram and 4 in Muzaffarabad. The increase in measles cases, particularly the continued number of cases seen in Battagram, all reported from the same area, is of concern, and investigations have been undertaken. See figure 9.

16 14 12 POONCH 10 MUZAFFARABAD 8 MA NSERA 6 BATTAGRAM 4 BAGH 2 0 Count of measles cases Count 2006-36 2006-37 2006-38 2006-39 2006-40 2006-41 2006-42 2006-43 2006-44 2006-45 2006-46 2006-47 Week

Figure 9: Trend in measles cases by district, Earthquake Affected Areas, Pakistan, September 2 – 24 November 2006.

7 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

Acute Respiratory Infection

In week 47, there were 20,112 consultations for ARI. There were five associated deaths, 4 in Mansehra and one in Poonch, all in children under five years old. The rate of ARI is increasing in both age groups, though the increase in rate in children under five is slightly greater, and the overall rate is consistently higher. See figure 10

35.0 30.0 25.0 20.0 <5 15.0 >= 5 group 10.0 5.0

ARI as a percent of all 0.0 consultations within age 2006-36 2006-37 2006-38 2006-39 2006-40 2006-41 2006-42 2006-43 2006-44 2006-45 2006-46 2006-47 Week

Figure 10: Trend in ARI as a percent of all consultations, by age group, Earthquake Affected Areas, Pakistan, September 2 - November 24, 2006

Other Reportable Diseases and Conditions

There were 4 cases of suspected meningitis in week 47, 1 in Mansehra and 3 in Muzaffarabad. There were two cases of acute flaccid paralysis also in Mansehra and Muzaffarabad. There were no cases of tetanus or hemorrhagic fever. There were 5,654 cases of fever of unknown origin, and 4,296 injuries.

Suspected meningitis cases have been increasing, and reached a peak in week 45. Muzaffarabad is the district that has most consistently been reporting suspected meningitis in the past 12 weeks. See figure 11.

12 10 POONCH 8 MUZAFFARABAD 6 MA NSERA 4 BATTAGRAM BAGH 2 0 Suspected meningitiscases 2006-36 2006-37 2006-38 2006-39 2006-40 2006-41 2006-42 2006-43 2006-44 2006-45 2006-46 2006-47 Week

Figure 11: Trend in suspected meningitis cases, by district, Earthquake Affected Areas, Pakistan, 2 September – 24 November 2006.

8 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

Outbreak Alert and Response1

Measles: Battagram An alert for a suspected case of measles was received from PPA DHQ Hospital, Battagram. The investigation took place the same day. The patient was a 7 year old girl from village Chapper Gram. The child had typical clinical features of measles, but a blood sample was taken for confirmation. The following day her home village was visited to find further cases. No others were found in Chapper Gram nor in a nearby village she had visited in the previous 10 days. A vaccination campaign is planned for the area.

Muzaffarabad Four cases of measles, in patients 27, 10, 8 and 3 years old, were reported from Nalla Jageer at Chiliana BHU. Investigation could not take place due to weather conditions, but will be undertaken when possible.

Acute Flaccid Paralysis: Muzaffarabad One case of acute flaccid paralysis in a 20 month old boy was reported from Barrian, district Neelum. The child had been ill from 22nd September with fever, vomiting, and diarrhea. He later developed lower limb weakness. He was admitted to AIMS hospital, where he is under investigation. Stool samples were sent for confirmation, but the pediatrician believes that he is suffering from Guillain-Barre syndrome.

Meningitis: Muzaffarabad

Three cases of suspected meningitis were reported from Muzaffarabad district in week 47.

A 28 day old child from Hattian was admitted to Hospital. He had had a history of fever since he was two days old and had been treated for a chest infection previously. The hospital did not have the facility for a lumbar puncture, and the diagnosis was made on clinical examination. He is being treated with antibiotics and has improved.

A 10 year old girl from Hattian Bala was admitted on 21st November, suffering from fits and fever for the last day. Her CSF examination was normal. She did not respond well to antibiotics, and further investigation to determine the cause of her illness is ongoing.

The third patient was a 10 year old girl from Ghari Dopatta, with suspected tuberculosis meningitis or military Koch’s. Her condition was too unstable to do a lumbar puncture, and she died on the 22nd of November.

1 Outbreak Investigation and response of Suspected Viral Hepatitis, Malaria, and Bloody Diarrhoea and Watery Diarrhoea would only take place when a cluster of cases is identified or there is an increase in the incidence of the disease. (Note: Single death due to Diarrhoea and single case of reported severe dehydration among >5 years would be investigated) 9 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53/ DEWS 2006 -47

Number of reported cases and deaths per District, AJK

Table 6. Number of reported cases and deaths, , Earthquake Affected Areas, Pakistan, 18 - 24 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 44 535 0 35 0 0 0 65 0 3301 0 0 0 1 0 20 0 0 0 0 0 428 0 504 0 10565 0 45 314 0 44 0 0 0 41 0 1981 0 0 0 0 0 11 0 0 0 0 0 188 0 662 0 10257 0 46 416 0 27 0 0 0 21 0 2937 0 0 0 0 0 5 0 0 0 0 0 161 0 610 0 10846 3 47 470 0 46 0 0 0 23 0 2692 0 0 0 0 0 3 0 0 0 0 0 240 0 605 0 8336 4 Total 1735 0 152 0 0 0 150 0 10911 0 0 0 1 0 39 0 0 0 0 0 1017 0 2381 0 40004 7

Table 7. Number of reported cases and deaths, Poonch District, Earthquake Affected Areas, Pakistan, 18 - 24 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 44 1338 0 31 0 0 0 340 0 3716 1 0 0 0 0 2 0 0 0 0 0 2159 0 854 0 8105 1 45 1207 0 25 0 0 0 302 0 3343 1 0 0 0 0 0 0 0 0 0 0 1670 0 703 0 6052 5 46 1070 0 13 0 0 0 196 0 3396 0 1 0 0 0 0 0 0 0 0 0 1601 0 646 0 5854 4 47 1414 0 30 0 0 0 257 0 3946 1 0 0 0 0 3 1 0 0 0 0 2111 0 726 0 7654 3 Total 5029 0 99 0 0 0 1095 0 14401 3 1 0 0 0 5 1 0 0 0 0 7541 0 2929 0 27665 13

Table 8. Number of reported cases and deaths, Muzaffarabad District, Earthquake Affected Areas, Pakistan, 18 - 24 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 44 2373 0 387 0 0 0 256 0 7425 1 0 0 6 0 19 0 0 0 0 0 1534 0 2164 0 16932 4 45 2292 0 270 0 0 0 243 0 7248 0 0 0 7 0 17 0 0 0 0 0 1687 0 2094 0 15328 4 46 1921 1 172 0 0 0 169 0 7372 1 0 0 7 1 12 0 0 0 0 0 1483 0 1910 0 14026 8 47 1630 0 158 0 1 0 168 0 6900 0 4 0 3 0 13 0 0 0 0 0 1531 0 2214 0 12816 5 Total 8216 1 987 0 1 0 836 0 28945 2 4 0 23 1 61 0 0 0 0 0 6235 0 8382 0 59102 21

10 WMMR Weekly Morbidity and Mortality Report Pakistan 30 Nov 2006 / Vol. 53 DEWS 2006 -47

Number of reported cases and deaths per District, NWFP

Table 9. Number of reported cases and deaths, Battagram District, Earthquake Affected Areas, Pakistan, 18 - 24 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 44 526 0 52 0 0 0 48 0 1150 0 2 0 0 0 24 0 0 0 0 0 482 0 284 0 3480 0 45 574 0 61 0 0 0 67 0 1704 0 1 0 0 0 6 0 0 0 0 0 514 0 304 0 3775 1 46 514 0 49 0 0 0 41 0 1681 0 2 0 0 0 12 0 0 0 0 0 479 0 251 0 2964 1 47 595 0 47 0 0 0 26 0 1792 0 2 0 0 0 9 0 0 0 0 0 587 0 204 0 3683 0 Total 2209 0 209 0 0 0 182 0 6327 0 7 0 0 0 51 0 0 0 0 0 2062 0 1043 0 13902 2

Table 10. Number of reported cases and deaths, *, Earthquake Affected Areas, Pakistan, 18 - 24 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 44 1417 0 64 0 0 0 88 0 5044 1 0 0 0 0 13 0 0 0 0 0 1097 1 611 0 15868 1 45 1070 1 71 0 2 0 123 0 4013 1 0 0 1 0 8 0 0 0 0 0 958 0 578 0 13585 0 46 1078 1 53 0 1 0 83 0 4409 2 0 0 0 0 13 0 0 0 0 0 1731 0 486 0 12871 4 47 937 1 52 1 1 0 45 0 4692 4 0 0 1 0 6 1 0 0 0 0 1185 0 547 0 14352 0 Total 4502 3 240 1 4 0 339 0 18158 8 0 0 2 0 40 1 0 0 0 0 4971 1 2222 0 56676 5

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