Federal Disease Surveillance and Response Unit Field Epidemiology & Disease Surveillance Division National Institute of Health (NIH) Islamabad WEEKLY FIELD EPIDEMIOLOGY REPORT

Volume 2-- Issue 49 Nov 29-Dec 05, 2020 Date: December 09, 2020

P rovincial Technical Officers and fellows of FELTP assigned at the Disease Surveillance, Response Units (DSR U’s) are working with provincial, and district health authorities on event based disease surveillance and outbreak response. DSRUs are sharing the disease surveillance data, outbreak reports and activities of FELTP fellows to the Federal Disease Surveillance and Response Unit (FDSRU) at the Field Epidemiology and Disease Surveillance Division (FEDSD) National Institute of Health (NIH) Islamabad on weekly basis. COVID-19 Surveillance

PDSRUs in Provinces are working with the February 2020. Daily flights data from international provincial department of health on COVID-19 airports in is being shared by the Central surveillance, response and contact tracing since Health establishment (CHE) Islamabad with FDSRU February, 2020 in Pakistan. FELTP fellows Alumni teams who conduct daily calls on given contact are actively involved in COVID-19 Surveillance numbers of the travelers to ask about their health throughout Pakistan. Data is being shared with status, advise them for immediate contact at the FDSRU on daily basis and FEDSD National Institute nearest designated hospital in case of COVID-19 of Health Islamabad is issuing a SITRIP symptoms. Total 80,578 travelers have been traced FDSRU has developed a mechanism for tracking of and contacted by December 05, 2020. travelers from other countries to Pakistan since 02 Table-1: Weekly Surveillance data COVID-19 by December 05, 2020 Province/ Suspected Lab Update Hospital Update Region cases reported

Cumulative tests performed Tested positive Still Discharged/Recovered Expired (Cumulative) cases (Cumulative) admitted

AJK 86,490 87,035 7,278 68 5,629 177 Baluchistan 114,091 150,671 17,440 08 16,663 169 GB 54,401 56,504 4,719 13 4,468 98 Islamabad 691,217 698,069 32,414 326 26,208 340 KP 467,956 637,191 49,220 588 44,167 1,404 Punjab 1,957,120 2,074,339 122,955 1,140 99,310 3,162 2,037,493 2,051,177 182,473 853 158,567 3,011 Total 5,408,768 5,754,986 416,499 2,996 355,012 8,361

PDSRU SINDH Total 184,486 confirmed COVID-19 cases were Ghotki (n=3,910). Age group 50-59 has the highest reported from Sindh until Dec 05, 2020. Most of attack rate (905/100,000) followed by 30-39 years these cases were reported from District age group (788/100,000), ≥70 years age group (n=1,23268) followed by District Hyderabad (777/100,000 & 40-49 years age group (748/100,000 (n=7,963), District Sukkur (n=4,288) and District population)

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Volume02 -- Issue 49 Nov 29-Dec 05, 2020 Date: December 09, 2020

Figure-1: Sindh - District-wise distribution of COVID-19 cases (Cumulative up to week 49)

Figure-2: Sindh – Age group-wise Attack Rates /100,000 population (Dec 05, 2020)

1000 905 900 788 748 777 800 702 700 600 558 500 400

Attack rate/100,000 Attack 300 200 137 100 44 0 <1-9 y 10-19 y 20-29 y 30-39 y 40-49 y 50-59 y 60-69 y 70+ Age Groups

PDSRU - Baluchistan province

The department of Health Baluchistan has reported District Khuzdar (n=468) and District Jaffarabad 17,440 positive cases of COVID-19 and 169 deaths (n=415). Age group 30-44 has the highest number till Dec 05, 2020. 16,663 cases have recovered. of COVID-19 cases (n=5,679) followed by age District Quetta has the highest number of confirmed group 15-29 (n=4,995) & age group 45-59 cases(n=12,347) followed by District Kech (n=640), (n=2,781).

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Volume02 -- Issue 49 Nov 29-Dec 05, 2020 Date: December 09, 2020

Figure-5: Geographical Distribution of COVID-19 Cases in Baluchistan Province (Cumulative up to Week 49)

Figure-6: Baluchistan –Age group wise distribution of COVID-19 positive cases (up to Dec 05,2020)

6300 5679 5400 4995

4500

3600

2781 No. of Cases of No. 2700 2438

1800 1262

900

0 <1-14 15-29 30-44 45-59 60+ Age Groups

PDSRU- Gilgit-Baltistan (GB)

PDSRU GB has reported total 55,262 suspected 19. 4,482 cases have recovered from COVID-19 cases of COVID-19 and out of these 5,421 were lab while 98 cases expired. During current week highest confirmed COVID-19 up to Dec, 05 and 152 cases number of COVID-19 cases were detected in District were detected during last week, while no lab results Gilgit (n=31) followed by District Ghizer (n=30) and are awaited. 54,931 samples were processed and District Skardu (n=25). 50,199 suspects were declared negative for COVID-

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Volume02 -- Issue 49 Nov 29-Dec 05, 2020 Date: December 09, 2020

Table -2 Detail of number of samples, confirmed Covid-19 cases & Deaths in GB up to December 05, 2020

Total Samples District Number of Negative Positive Awaited Recovered Expired Samples Processed Samples Discarded

Astore 7119 6699 7111 21 00 386 05 08 Diamer 6510 6192 6509 24 00 288 05 01 Ghanche 2956 2752 2870 03 00 111 04 86 Ghizer 4005 3568 4003 30 00 398 07 02 Gilgit 13461 11666 13377 31 00 1642 38 84 Hunza 8242 7567 8225 09 00 646 03 17 Kharmang 2219 2095 2195 04 00 96 00 24 Nagar 2485 2258 2483 02 00 219 04 02 Shigar 1801 1656 1776 03 00 113 04 25 Skardu 6464 5746 6382 25 00 583 28 82 Grand Total 55262 50199 54931 152 00 4482 98 331

Figure-7: GB-District-Wise distribution of confirmed COVID-19 cases up to December 05, 2020

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30 31 30 24 25

21 No.of Cases 15 9 4 3 3 2 0 Astore Diamer Ghanche Ghizer Gilgit Hunza Skardu Shigar Kharmang Nagar Districts

PDSRU-AJK cases have recovered from COVID-19 and 181 cases PDSRU AJK has reported total 87,593 suspected expired due to COVID-19. District Muzaffarabad cases of COVID-19 and out of these 7,356 were lab has the highest number of cases (n=2817) followed confirmed COVID-19 up to Dec 05, 2020 while no by District Mirpur (n=1381), District Kotli (n=911) lab- results of suspected cases are awaited. 5,698 and District Poonch (n=824).

Table -3: Distribution of suspected and confirmed Covid-19 cases in AJK up to Dec 05,2020

Total Suspected Cases Lab Tests Conducted Lab Confirmed Cases Active Cases Recovered Total Deaths

87,593 87,689 7,356 1,477 5,698 181 Figure-8: AJK-District-Wise distribution of confirmed COVID-19 cases up to Dec 05, 2020

3200 2817 2800

2400

2000

1600 1381 No. of Cases of No. 1200 911 824 800 504 343 400 224 174 132 46 0 Muzaffarabad Mirpur Kotli Poonch Bhimber Bagh Hattian Bala Pallandri Neelum Havaili Districts 4

Volume 2-- Issue 49 Nov 29-Dec 05, 2020 Date: December 09, 2020

PDSRU-KPK Swat (n=3371), District Malakand (n=1881) and PDSRU KPK has reported total 467,956 suspected District Mardan (n=1422). Age group 40-49 years cases of COVID-19 and out of these 49,676 were lab has the highest attack rate/100,000 (AR=281) confirmed COVID-19 up to Dec 05, 2020 while 1413 followed by 30-39 years age group (AR=256) and patients expired. District has the highest 50-59 years age group (AR=239). number of cases (n=18980) followed by District

Figure-11: Geographical Distribution of COVID-19 Cases in KPK Province (Cumulative up to Week 49)

Figure-12: KPK –Attack rates /100,000 population in different age groups (up to Dec 05, 2020 300 281 256 250 239 214 205 200 182 146 150

100

Attack rate/100,000 Attack 50 34 9 0 0 – 9 10 – 19 20 – 29 30 – 39 40 – 49 50 – 59 60 – 69 70 – 79 >80

Age Groups

Communicable Disease Surveillance

Influenza Suspected/Confirmed: Diphtheria Surveillance: In 2018, total 3221 and in 2019 total 100 During 2018 total 464 and during 2019 total 614- Suspected/confirmed Influenza cases reported from suspected cases of Diphtheria were reported. In week PDSRUs/RDSRUs. In week 48, no suspected cases 48, no case reported from any province or region. were reported. Volume 2-- Issue 49 Nov 29-Dec 05, 2020 Date: December 09, 2020

Dengue Surveillance: CCHF Surveillance: In 2018, total 3204 Dengue cases reported from In 2018, total 63 CCHF (suspected and confirmed) Sindh Total 24,610 cases reported which includes 48 cases were reported from DSRUs and 75 cases have new case reported from Baluchistan. In week 48, 282 been reported in 2019. During week 48, no cases cases reported from Sindh, ICT & Baluchistan. reported from all provinces & region.

Table-4: Weekly and Cumulative Diseases Updates Dec 05, 2020 Disease Total Cases in 2019 Nov 29-Dec 05, 2020 Total Cases in 2020 1 CCHF 75 0 19 2 Varicella 1,264 0 235 3 Dengue 24,547 187 3619 4 Chikungunya 0 0 0 5 Measles 6,781 14 1816 6 Diphtheria 614 0 135 7 Suspected / confirmed Seasonal 100 0 9 Influenza

Table 5: Dengue cases reported in 2017, 2018, month-wise distribution in 2019 & current week (All provinces and regions)

Month KPK Sindh AJK ICT TDs - KP Baluch Punjab Total Jan–Dec 2017 18,857 2,884 6 120 406 86 579 22,938 Jan-Dec 2018 332 2088 1 0 175 69 539 3204 Jan-Dec 2019 5214 2937 506 2847 1484 2841 8826 24547

Total 24403 7909 513 2967 2065 3057 9944 50750

05-12-2020 0 173 0 5 0 9 0 187 Total (2020) 03 2365 2 184 0 445 38 3,137

Extensive drug Resistant (XDR) Typhoid Fever Surveillance in Sindh Province In Karachi total 13,402 cases of extensive drug reported in the age group 0-4 years. The overall resistance typhoid fever were reported from January attack rate was 67/100,000. The age group 0-4 years 01, 2017 to Dec 05, 2020. During current week total was the most affected (attack rate 191/100,000) 35 cases of XDR typhoid fever were reported from followed by age group 5-9 years (AR 141/100,000). different hospitals in Karachi. The XDR Typhoid Females have higher attack rate 76/100,000 cases were reported mostly among the children and compared to Males. maximum number of XDR cases 5145 (39%) were

Table-6: Number of XDR Typhoid fever cases Karachi from January 1, 2017 to Dec 05, 2020 Year Year XDR Cases Jan to December 2017 175 Jan to December 2018 3712 Jan to December 2019 7088 January 01, to Dec 05,2020 2020 2427

Total 13,402

Volume02 -- Issue 49 Nov 29-Dec 05, 2020 Date: December 09, 2020

Figure 13: Week-wise number of XDR Typhoid fever cases in Karachi, from January 1, 2017 to Dec 05, 2020

300

250

200

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No. of cases ofNo. 100

50

0

Week Week 2 Week 5 Week 8 Week 1 Week 4 Week 7

Week Week 11 Week 14 Week 17 Week 20 Week 23 Week 26 Week 29 Week 32 Week 35 Week 38 Week 41 Week 44 Week 47 Week 50 Week 10 Week 13 Week 16 Week 19 Week 22 Week 25 Week 28 Week 31 Week 34 Week 37 Week 40 Week 43 Week 46 Week 49 Week 52

WEEK 42 WEEK WEEK 03 WEEK 06 WEEK 09 WEEK 12 WEEK 15 WEEK 18 WEEK 21 WEEK 24 WEEK 27 WEEK 30 WEEK 33 WEEK 36 WEEK 39 WEEK 45 WEEK 48 WEEK Feb Mar Apr May JuneJuly Aug Sept Oct Nov Dec Jan Feb MarApril May JuneJulyAugustSept Oct Nov Dec Jan Feb Mar Apr MayJune July Aug Sept Oct NovDec 2019 2020 Epidemiological Months and Weeks

XDR Typhoid Surveillance Data Sindh-Province (Excluding Karachi) Total 6943 Salmonella Typhoid cases reported from affected age group was 0 to 4 years (n=1400) with November 2016 to Dec 05, 2020 from different attack rate 47.4 per/10000 population followed by 5- districts of Sindh province (excluding Karachi). 9 years of age group (n= 1040) with attack rate Among these cases 5295 were Extensive Drug 35.5/10000 population. Over all attack rate is Resistant cases. Out of these cases n=3696 (69.9%) 16.9/10000 population (n=3696). were reported from District Hyderabad. The most

Table 7: Extensive drug Resistant (XDR) Typhoid Fever Surveillance Hyderabad and other districts Year Hyderabad Other District Total

2016 12 0 12

2017 485 4 489 2018 891 207 1098 2019 1645 998 2643

January 01 – Nov 28, 2020 652 385 1037

Current week - Nov 29-Dec 05, 11 5 16 2020 Total 3,696 1,599 5,295

Figure 14:XDR Typhoid Cases District Hyderabad Nov-2016 to Dec 05, 2020

250

200

150

100 No cases No of

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0 N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D Year Year-17 Year -18 Year-19 Year-20 -16 Month wise cases

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