Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 2, Issue 40, Monday 10 October, 2011

Highlights Priority diseases

under surveillance Epidemiological week no. 40 (30 September to 6 October, 2011) in DEWS

Acute Flaccid Paralysis (AFP) • 83 districts and 2 agencies provided surveillance data to the DEWS this week from 2,640 health facilities. Acute Jaundice Syndrome (AJS)

Acute Respiratory Infections • A total of 1,006,302 consultations were reported through DEWS of which 22% were acute (Upper and Lower) (ARI) respiratory infections (ARI), 11% Skin disease, 10% acute diarrhoea, and 6% suspected Malaria. Acute Watery Diarrhoea (AWD)/ Suspected Cholera

• A total of 225 alerts with 20 outbreaks were reported in week-40, 2011: Altogether 114 for Acute Bloody Diarrhoea (BD) DHF; 41 were for AWD; 21 for Measles;19 for Leishmaniasis; 14 for Neonatal Tetanus and Other Acute Diarrhoeas (AD) Tetanus; 4 for Malaria; 3 each for Diphtheria and Pertussis; 2 for Bloody diarrhoea; while 1 each for Acute jaundice syndrome, Acute diarrhoea, Typhoid and Mumps. Suspected Viral Hemorrhagic Fever (VHF)

• National Polio Eradication Initiative reported 11 new type-1 confirmed polio cases this Suspected Malaria (Mal)

week: 2 each from Killa Abdullah and Quetta, while 1 from Pishin (districts in Balochis- Suspected Measles (MS) tan) 2 from North Waziristan (FATA); 1 each from Peshawar, Buner and Nowshera (districts in Khyber Pakhtunkhwa); and 1 from Gaddap (Sindh). As of 10 October, 2011, Suspected Meningitis (MG)

Pakistan has reported a total of 111 polio cases (110 type-1 cases and 1 type-3 case) from 38 Others districts/towns/tribal agencies/areas.

Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 6 October 2011 (Epi week 31, 2010 to week 40, 2011)

50 AD BD ARI S. Malaria 45

25 Percentage

0 1 3 5 7 9

11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 31 33 35 37 39 41 43 45 47 49 51

‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk

Disease Wk-33 Wk-34 Wk-35 Wk-36 Wk-37 Wk-38 Wk-39 Wk-40

Acute Diarrhoea 101,174 (10%) 94,494 (11%) 40,403 (10%) 96,128 (11%) 109,523 (12%) 110,835 (11%) 105,295 (11%) 96,067 (10%)

Total consultation 988,119 880,166 389,729 864,693 931,318 1,005,251 995,450 1,006,302

Since July 29, 2010, approximately 47,604,357 patient consultations have been reported to the DEWS from all provinces and three agencies and state of AJK.

In this week 40, 2011 (30 September to 6 October, 2011) reports were received from 2,640 health facilities and the major causes for seeking health care by the communities in almost all of the provinces were Acute respiratory infections 207,617 (21%), Skin diseases 95,559 (10%), diarrheal diseases 96,067 (10%), and suspected malaria 82,437 (8%). The above graph shows the trend of four major diseases number of cases out of total consultations reported to DEWS.

Malaria alert was reported. 28 Slides were tested and 19 were positive (Vivax= 11 Falciparum=8)‐ SPR 68%; FR Jouzan U/C southern 5‐Oct Malaria Balochistan Kharan 3 13 2 10 42%. Anti Malaria medicines were provided to cases and affected families were advised to take preventive Kharan town measures.

5 cases were investigated and found with typical symptoms. Erythromycin was given to case and contacts. Health Girdi jungle Refugee 6‐Oct Pertussis Balochistan Chagai 1 1 2 1 education promoting infant immunization session, hand washing and cough etiquette was conducted among camp affected families.

AWD alert age 25 years, presenting to BHU Maira; Diarrhea onset to severe dehydration 48 h. ; Stool sample sent for analysis, Active surveillance was conducted with DOH/ NPH/PRCS‐GRC/PPHI. Several more cases of AWD were Village Dawut/UC identified all drinking water from one source the spring and a community tank. Outbreak was declared, HUB and 30‐Sep AWD KPK Shangla sarkoo/Tehsil 50 140 42 90 National office informed. Mobile DTC established which treated a total of 322 patients till end of patient intake Chakesar on 5th October, Community tank was examined and shock chlorination performed, Health and hygiene session conducted in the community with 263 participants over 6 days including 106 female attendants. Hygiene kits, aquatabs, and jerry cans distribution have been started. Followup planned. 5 cases and 1 death of measles were reported from village Dharyian UC Nara Amazai. Joint WHO‐DOH team carried out Epidemiological assessment. Blood samples sent to NIH. Active case finding further revealed 23 more Village Dharyian, UC cases that had measles within past month. All the active cases were given VitA. Immunization status was poor. 30‐Sep Measles KPK Haripur 9 11 2 6 Nara Amazai EDO health and EPI coordinator were informed of the outbreak. Health education sessions were carried out on immunization and preventive measures. 3 day mop up campaign for all children under 15 years was planned and executed in the area. 08 Patients with DF reported at Nishter Hospital Multan from different locations of Khanewal district and mostly Nishter Hospital from the rural areas. All of them have history of either travel or stay at Lahore in recent past or an established 6‐Oct DHF Punjab Khanewal Multan (Khanewal 0 7 0 1 epidemilogical link with Dengue patient. Necessary measures at hospital ensured. Respective health authorities City) were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department informed at district Khanewal and provincial level. Follow up is on going. 23 Patients with DF reported at Nishter Hospital Multan from different locations of Tehsil Multan and mostly from the city areas. 18 patients have history of either travel or stay at Lahore in recent past or an established epidemilogical link with Dengue patient. Only 5 cases are indigenous to Multan and no travel history. Necessary Nishter Hospital 6‐Oct DHF Punjab Multan 0 22 0 1 measures at hospital ensured. All the locations were visited one by one by WHO team and DoH staff. Active case Multan, Multan City finding of the area done in the respective localities. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department informed at district and provincial level. vector density survey was conducted at all the 5 places by the Assist. entomologist. Follow up is on going. 11 Patients with DF reported at Nishter Hospital Multan from different locations of Muzaffargarh district and mostly from the rural areas. All of them have history of either travel or stay at Lahore in recent past or an estab‐ Nishter Hospital lished epidemilogical link with Dengue patient. Necessary measures at hospital ensured. Respective health 6‐Oct DHF Punjab Muzaffargarh Multan 0 9 0 2 authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community (Muzaffargarh City) members done. Health department & SO informed at district Muzaffargarh and provincial level. Follow up is on going. Chak No.229/P Tibba P/o Chak No.140/P 3 DHF patients from R.Y.Khan district ‐ one working in Karachi, one from Lahore and one from RYK. Blood samples Tehsil & Distt. sent to IPH. 3 Contact samples from each were collected and screened using ICT. IRS and outdoor fumigation/ Rahim Yar 1‐Oct DHF Punjab R.Y.Khan ; Shah‐ 0 3 0 0 fogging of the house and neighbouring 30‐36 HH was also conducted through CDC program. HH were visited for Khan nawaz Colony City; finding additional cases. Health Education session was also conducted and LHWs mobilized to conduct additional Yousaf Colony Near sessions. Chak NO112/P, 09 Patients with DF reported at Nishter Hospital Multan from different locations of Vehari district and mostly from the rural areas. All of them have history of either travel or stay at Lahore in recent past or an established Nishter Hospital 6‐Oct DHF Punjab Vehari 0 9 0 0 epidemilogical link with Dengue patient. Necessary measures at hospital ensured. Respective health authorities Multan (Vehari City) were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department informed at district Vehari and provincial level. Follow up is on going. 11 Leishmaniasis Cases were reported from UC Pael Padhrar District Khushab. EDOH was informed. IRC who is running a Leishmaniasis control project in the region was engaged to visit location, linelist cases and train health Village Pael,UC Pael 5‐Oct Leishmaniasis Punjab Khushab 0 2 0 9 care providers for leishmaniasis treatment and prevention, Patients were screened by DDOH for IM and IL Padhrar,Khushab injections, Duty of dispenser in RD Pael to collect injections from EDO(H) office, Malaria Program requested for fogging and IRs of the area.

1 AWD case and 9 patients with moderate dehydration and 1 Death reported from hospital, People drinking Village Ghelo Noon‐ 6‐Oct AWD Sindh Hyderabad 5 0 5 0 contaminated water from Hand Pump, convey health education, Provided Aqua tabs, Jerrycans, Family Filters and ari Hygiene kits for health and Hygiene, EDO‐H informed and 2 water sample taken.

Village Panj Moro Uc Alert for diarrhea with 10 cases hospitalized with Moderate dehydration, People drinking contaminated water shahmir Rahoo 6‐Oct AD Sindh Matiari 2 2 1 2 from Hand Pump, conveyed health education, Provided Aqua tabs, Jerrycans, Family Filters, Zinc tabs, IEC Mate‐ Taluka New Saeeda‐ rial and Hygiene kits for health and Hygiene, EDO‐H informed, 1 Stool and 2 water sample taken. bad

Channa Muhallah UC Naushahro 1 death due to AWD confirmed, upon investigation 6 other cases found, WHO team responded alert and pro‐ 5‐Oct AWD Sindh Darbelo, taluka 4 2 1 0 Feroze vided EH material and health & hygiene education to affected community. Kandiyaro

UC‐Darbello ,Channa Naushahro One alert for AWD and 6 cases diarrhea with moderate dehydration, Health hygiene session conducte , Aqua 6‐Oct AWD Sindh Paaro Taluka Kan‐ 1 2 2 2 Feroze tabs, toilet soaps, laundry soaps hygeine kits, IEC material distributed diaro

Village Channesar Alert for 4 deaths from AWD, on Active Surveillance 9 AWD cases were found, health education provided, Aqua 5‐Oct AWD Sindh Sanghar Jamali, UC Mian, 2 6 1 4 tabs, Zinc tabs, Jerrycans and ORS distributed, EDO‐H informed . Taluka Sanghar

Village Chaudhri AWD cases reported in hospital. Reinforced proper case management, health education regarding hand washing, 6‐Oct AWD Sindh Umer Kot Abdul Rafiq Arain, 3 5 0 3 EDO‐H informed and 11 cases investigated. Water source investigation planned. UC Araro Burghuri

UC‐Bhiria, Relief Naushahro 16 cases (falciparum‐6 & vivax 10) malaria confirmed by RDT , OPD cases treated, hospital treatment arranged 2‐Oct Malaria Sindh camp, primary 2 5 4 5 Feroze for severe cases, 20 bednets distributed by SO‐WHO, request was made to EDO for fumigation. school Bhiria

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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 40 (30 September to 6 October, 2011) Current week's Alerts: Province Sindh Current week's Alerts: Province Punjab Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 3‐Oct AD N Feroze Village Bhimani, deh Kandiaro 6 4 5 4 5‐Oct AWD Bhakkar Chak Number 204 TDA 0 0 0 1 5‐Oct AWD Dadu Village Ahmed Khan Brihmani 3 1 0 0 4‐Oct AWD Rajanpur Basti Lajwani, Near Chitti Mosque 0 0 0 1 6‐Oct AWD Dadu Shafan Abad Colony, Phulji Station 1 1 0 0 6‐Oct DHF Bahawalpur Nishter Hospital Multan 0 1 0 0 2‐Oct AWD Ghotki Village Islam Khan Tagar 0 0 0 1 30‐Sep DHF Bhakkar DHQ Hospital Bhakkar 0 1 0 0 3‐Oct AWD Ghotki Quarban Colony UC III Ghotki 1 0 0 1 4‐Oct DHF D. G. Khan Chah Kotuwala Moza Gadai Sharqee 0 1 0 0 Shakoor abad near pul dat Mohala Shakoora‐ 3‐Oct AWD Hyderabad Phulelli 0 1 0 0 4‐Oct DHF D. G. Khan 0 1 0 0 bad 6‐Oct AWD Hyderabad Liaquat colony near Noorani masjid 0 0 1 1 5‐Oct DHF D. G. Khan GULSHAN REHMAN COLONY 0 1 0 0 6‐Oct AWD Hyderabad Village Ghelo Noonari 5 0 5 0 6‐Oct DHF D. G. Khan Nishter Hospital Multan 0 5 0 1 Mushtaq Bijarani 0 0 1 0 3‐Oct AWD Kashmore Village 6‐Oct DHF Khanewal Nishter Hospital Multan 0 7 0 1 6‐Oct AWD Matiari Village Awal chachar UC Zair Pir 0 2 0 2 6‐Oct DHF Lahore Nishter Hospital Multan 0 2 0 2 6‐Oct AWD Matiari Village Nihal Khoso UC& Taluka 0 2 0 2 2‐Oct DHF Layyah Basti shahnawaz eidgah 0 1 0 0 6‐Oct AWD Matiari Village Panj Moro 2 2 1 2 2‐Oct DHF Layyah Mohalla hasnain abad kot sultan 0 1 0 0 2‐Oct AWD Mirpur Khas Village Girhore Sharif 0 1 0 0 2‐Oct DHF Layyah Railway colony , Layyah 0 1 0 0 6‐Oct AWD Mirpur Khas Village Sogo Rajar 0 2 1 0 2‐Oct DHF Layyah Village shahjamal u/c kot sultan 0 1 0 0 1‐Oct AWD N Feroze UC Kahkat, taluka Moro 0 1 0 0 3‐Oct DHF Layyah District council layyah urban 2 0 0 0 1 1‐Oct AWD N Feroze UC‐Darya khan Mari, Village Kahkat 1 1 1 2 6‐Oct DHF Layyah Bast sooba wala u/c lohanch nasheeb 0 1 0 0 5‐Oct AWD N Feroze Channa Muhallah UC Darbelo 4 2 1 0 6‐Oct DHF Layyah Nishter Hospital Multan (Layyah City) 0 2 0 0 6‐Oct AWD N Feroze UC‐Darbello ,Channa Paaro 1 2 2 2 4‐Oct DHF Mianwali Dhok Pull,Chakrala,Mianwali 0 1 0 0 2‐Oct AWD Sanghar Jatia Paro, Taluka Shahdadpur 0 0 0 0 6‐Oct DHF Multan Multan, Lorali ( Balochistan) 0 1 0 0 5‐Oct AWD Sanghar Village Channesar Jamali, UC Mian 2 6 1 4 6‐Oct DHF Multan Nishter Hospital Multan, Multan City 0 22 0 1 5‐Oct AWD TA Yar Batho Stop, Haji Pir Saleh Shah 0 0 0 1 30‐Sep DHF Muzaffargarh Basti Manjothi, Moza Choudhary Wala 0 1 0 0 5‐Oct AWD TA Yar Ibrahim Colony City Tando Allahyar 0 1 0 0 1‐Oct DHF Muzaffargarh Mohallah Qaim Wala 0 1 0 0 5‐Oct AWD TA Yar Madina Colony 0 0 0 1 4‐Oct DHF Muzaffargarh Mohallah Shaikhupura 0 1 0 0 5‐Oct AWD TA Yar Unar Para City 0 1 0 0 6‐Oct DHF Muzaffargarh Basti Bhambey Wala, Moza Shadi Khan 0 0 0 1 5‐Oct AWD TA Yar Zardari Colony City Tando Allahyar 0 0 0 1 6‐Oct DHF Muzaffargarh Basti Shabbar Wala, Moza Ladha Nagar 0 0 0 1 3‐Oct AWD TM Khan Village Saindad Wassan 0 1 0 0 6‐Oct DHF Muzaffargarh Nishter Hospital Multan 0 9 0 2 6‐Oct AWD Tharparkar Village Keethar 0 1 0 0 6‐Oct DHF Pakpattan Nishter Hospital Multan 0 1 0 0 5‐Oct AWD Thatta Sujawal City Mallah Mohalla 1 1 0 0 30‐Sep DHF RYar Khan Basti Mumtaz Abad 0 1 0 0 6‐Oct AWD Thatta Mirpur Bathoro city , Khawaja Mohalla 0 1 0 0 30‐Sep DHF RYar Khan Chak Abbas Basti Rais Khuda Bux 0 1 0 0 6‐Oct AWD Thatta Village Ahmed Khan Zounr 1 1 0 1 30‐Sep DHF RYar Khan Chak No.35/A Feroza Liaquatpur 0 1 0 0 6‐Oct AWD Thatta Village Jumo Jat, UC D.K Soho 0 1 0 0 30‐Sep DHF RYar Khan Dera Shamas Near Iqbal Abad 0 1 0 0 6‐Oct AWD Thatta Village Pir Dino Shah 1 1 0 0 30‐Sep DHF RYar Khan Gulshan Iqbal , W Block Scheme #2 0 1 0 0 6‐Oct AWD Umer Kot Village Ch. A. Rafiq Arain 3 5 0 3 30‐Sep DHF RYar Khan Gulshan Iqbal , X‐Block Scheme # 3 0 0 0 1 30‐Sep DHF Hyderabad Civil Hospital 0 4 0 1 30‐Sep DHF RYar Khan Jail Road Shahid Park House # 03 0 1 0 0 1‐Oct DHF RYar Khan Chak No.229/P Tibba P/o Chak No.140/P 0 1 0 0 6‐Oct DHF Kashmore GD Khahi taluka Kashmore 0 1 0 0 1‐Oct DHF RYar Khan Shahnawaz Colony City R.Y.Khan 0 1 0 0 1‐Oct DHF Khairpur Village Haji M. Khan 0 1 0 0 1‐Oct DHF RYar Khan Chak No.74/P P/O Mud Noor Kot Samaba 0 1 0 0 1‐Oct DHF Khairpur Village Kabul Khan 0 1 0 0 1‐Oct DHF RYar Khan Goth Sajawal Dhandho Deh Khowara 0 1 0 0 3‐Oct DHF Khairpur 44 wing head quarter Shahbaz Rangers 0 1 0 0 2‐Oct DHF RYar Khan Yousaf Colony Near Chak NO112/P 0 1 0 0 3‐Oct DHF Khairpur Village Dhanwaro 0 0 0 1 2‐Oct DHF RYar Khan Block Y Scheme # 03 Gulshan e Iqbal 0 1 0 0 3‐Oct DHF Khairpur Village Dilawand 0 1 0 0 2‐Oct DHF RYar Khan Airport Road baghdad Colony Street # 03 0 1 0 0 2‐Oct DHF Larkana Village Lund, Larkana City 0 1 0 0 2‐Oct DHF RYar Khan Chak No.14/P,Khanpur 0 0 0 1 3‐Oct DHF Larkana CMC Larkana 0 1 0 0 2‐Oct DHF RYar Khan Mouza Allah Abad,Liaquatpur Distt 0 1 0 0 1‐Oct DHF N Feroze Village Ishaque Burdi Taluka Mahrabpur 0 1 0 0 2‐Oct DHF RYar Khan Mouza Bakhrani , Murad Khan Basti Khanpur 0 1 0 0 1‐Oct DHF N Feroze Village Peer Wasan, taluka Mehrabpur 0 1 0 0 2‐Oct DHF RYar Khan near District Jail Rahimyarkhan 0 1 0 0 5‐Oct DHF N Feroze Shahbaz Colony, taluka Kandiyaro 0 0 0 1 3‐Oct DHF RYar Khan Basti Sheikhan, Bagho Bahar Khanpur 0 1 0 0 3‐Oct DHF Shikarpur Mirza Band 0 1 0 0 3‐Oct DHF RYar Khan Satlite Town City Rahimyarkhan 0 1 0 0 30‐Sep DHF Sukkur Village Tando Bohran, taluka Rohri 0 0 0 1 4‐Oct DHF RYar Khan Basti Nawab Machi Mouza Mehmooda Abad 0 1 0 0 1‐Oct DHF Sukkur Muhammadi Jamia Masjid, Newpind 1 0 0 0 4‐Oct DHF RYar Khan Basti Cheshtian 0 1 0 0 3‐Oct DHF Sukkur Pathan Colony‐1 1 0 0 0 4‐Oct DHF RYar Khan Mujahid Colony Street # 01 Tehsil Sadiqabad 0 0 0 1 5‐Oct DHF Sukkur Engro foods company, Rohri 0 1 0 0 5‐Oct DHF RYar Khan Basti Peer Shaheedian 0 1 0 0 5‐Oct DHF Sukkur GMC Hospital 0 5 0 0 5‐Oct DHF RYar Khan Chak No.156/P, Tehsil Sadiqabad 0 0 0 1 2‐Oct Malaria N Feroze UC‐Bhiria, Relief camp, primary school Bhiria 2 5 4 5 5‐Oct DHF RYar Khan Mohalla Basti Rashidabad, Tehsil Sadiqabad 0 1 0 0 6‐Oct Malaria N Feroze UC‐Kot Bahdur, village Saand Taluka Bhiria 0 1 1 1 6‐Oct DHF RYar Khan Basti Allah Wasaya Pahor Mouza nonari 0 1 0 0 7‐Oct Measles Ghotki village Arab Kalwar UC Bereri 0 1 0 0 6‐Oct DHF RYar Khan Basti Maheran Mouza Bakhrani 0 1 0 0 30‐Sep NNT Ghotki village Jamal Chachar UC Umar Daho 0 0 1 0 6‐Oct DHF RYar Khan Goth Lal pitafi, Mir Pur Matelo 0 0 0 1 5‐Oct NNT Jacobabad Village Haji Ali. Deh Brohi, UC Garhi Chand 1 0 0 0 5‐Oct DHF Rajanpur Basti Theiri, Barri gali 0 1 0 0 6‐Oct NNT Karachi Quarter No. 2, KMC Compound, Gizri 0 0 1 0 6‐Oct DHF Rajanpur Nishter Hospital Multan 0 2 0 0 6‐Oct NNT Karachi Zia Colony Korangi town 1 0 0 0 6‐Oct DHF Sahiwal Nishter Hospital Multan 0 1 0 0 3‐Oct NNT Q Shahdadkot Gondal Muhalla UC 1 Kamber city 1 0 0 0 6‐Oct DHF Sargodha Nishter Hospital Multan 0 1 0 0 3‐Oct NNT Q Shahdadkot Village Dost Muhammed Jalbani 0 0 1 0 6‐Oct DHF Vehari Nishter Hospital Multan 0 9 0 0 3‐Oct NNT Q Shahdadkot Village Dost Muhammed Mugheri 1 0 0 0 30‐Sep Leish D. G. Khan Basti Lakhee Chuharkot Barkhan 0 1 0 0 3‐Oct NNT Q Shahdadkot Village Mureed Khan Jagrani 1 0 0 0 4‐Oct Leish D. G. Khan Haq Colony near majeed Khakahl 1 0 0 0 30‐Sep Pertussis Ghotki Village Bakhsh Ali lashari 0 0 1 0 5‐Oct Leish Khushab Village Pael,UC Pael Padhrar 0 2 0 9 1‐Oct Tetanus Sukkur Village Shambani 1 0 0 0 4‐Oct Leish Rajanpur Moza Kotla Gamu 0 1 0 0 4‐Oct Tetanus Sukkur Syed Mohalla 1 0 0 0 4‐Oct NNT Bhakkar Moza Mahuta, UC Barranga 1 0 0 0

30‐Sep AWD Lower Dir Village Kass Payeen, UC Lajbook 0 1 0 0 1‐Oct BD Bolan BHU Sanni 0 0 0 0

30‐Sep AWD Lower Dir Village Taimar Qilla 0 1 0 2 3‐Oct DHF Quetta Fatima Jinnah Chest Hospital 0 0 0 1

4‐Oct AWD Lower Dir Village Malakand Payeen 1 3 0 1 6‐Oct DHF Quetta Fatima Jinnah Chest Hospital 0 1 0 0

6‐Oct AWD Peshawar Village Achnai, Peshawar 0 1 0 0 3‐Oct DHF Zhob D.I Khan (Zhob) 0 0 1 0

30‐Sep AWD Shangla Village Dawut 50 140 42 90 5‐Oct Leishmaniasis Awaran Bigari Zeelag UC camp Jhaoo 1 0 0 0

30‐Sep DHF Abbottabad Qalandarabad 0 1 0 0 5‐Oct Leishmaniasis Jaffarabad Mashhoq Chowck, Murad colony 0 1 1 0

30‐Sep DHF Abbottabad Soban Gali, Sherwan road 0 1 0 0 5‐Oct Leishmaniasis Jaffarabad Village Mohammad Khan, U/C Noor Pur 0 0 1 0

1‐Oct DHF Abbottabad Dalola 0 1 0 0 1‐Oct Leishmaniasis Khuzdar Koshk UC Gazgi Tehsil Khuzdar 0 1 0 0

1‐Oct DHF Abbottabad Jhangra Kashka 0 1 0 0 1‐Oct Leishmaniasis Khuzdar Mayyi UC Tootak Tehsil Khuzdar 1 0 0 0

2‐Oct DHF Abbottabad Kehal 0 1 0 0 4‐Oct Leishmaniasis Khuzdar Norgama Qadeem UC Norgama Tehsil Zehri 0 1 0 0

6‐Oct DHF Abbottabad Baren Gali 0 1 0 0 5‐Oct Leishmaniasis Panjgur Union Council ,Washbood Mohallah Madresa 0 1 0 0 30‐Sep Leishmaniasis Quetta Hazara town, Brewery road 0 1 0 2 2‐Oct DHF D. I. Khan Madina Colony 0 0 1 0 30‐Sep Leishmaniasis Quetta New Pashtoon Abad 1 1 0 1 6‐Oct DHF D. I. Khan Mohallah Saidan Wala 0 2 0 0 7‐Oct Leishmaniasis Quetta Hazara town, Brewery road 0 1 0 0 3‐Oct DHF Haripur Muhallah Garhi, vilage Panian 0 0 0 1 30‐Sep Leishmaniasis Sibi Ghareeb abad, Sibi UC#3 0 0 0 1 5‐Oct DHF Haripur Village Gahar Khan 0 0 0 1 30‐Sep Leishmaniasis Ziarat Aghbargh 0 0 0 1 6‐Oct DHF Haripur Village Bareela 0 1 0 0 5‐Oct Leishmaniasis Ziarat Aghbargh/Shinleiz 0 1 0 1 6‐Oct DHF Haripur Village Dobandi 0 0 0 1 7‐Oct Malaria Jhal Magsi Barija UC Barija BHU Barija Tehsil Jhal Magsi 11 22 7 13 7‐Oct DHF Haripur Village Bagra 0 1 0 0 5‐Oct Malaria Kharan Jouzan U/C southern Kharan town 3 13 2 10 1‐Oct DHF Mansehra Bela Kotkay 0 1 0 0 6‐Oct Measles Awaran Waja Bagh UC camp Jhaoo 0 1 2 1 1‐Oct DHF Mansehra Dara # 1 Mansehra 0 1 0 0 4‐Oct Measles Quetta Agriculture collage, Balely road 1 0 0 1 1‐Oct DHF Mansehra Khaki Mansehra 0 0 0 1 Union Council ,besema Mohallah leveez 5‐Oct Measles Washuk 3 3 3 0 1‐Oct DHF Mansehra Ogra Mansehra 0 0 0 1 colony

4‐Oct DHF Mansehra Jaloo Mansehra 0 0 0 1 6‐Oct Mumps Kech Koshkalat U/C Koshkalat, Turbat. 0 6 1 3 Village Qadir Khan, UC Haji shehr, Tehsil 4‐Oct DHF Mansehra Khaki Camp # 2 Mansehra 0 1 0 0 30‐Sep NNT Bolan 0 0 1 0 Dhadar 4‐Oct DHF Mansehra Miswal Mansehra 0 0 0 1 6‐Oct Pertussis Chagai Girdi jungle Refugee camp 1 1 2 1

4‐Oct DHF Mansehra Oghi 0 0 0 1 4‐Oct Tetanus Khuzdar Jhalaro UC Sun Chakoo tehsil Karkh 0 1 0 0

4‐Oct DHF Mansehra Phagora Shungli Bandi Oghi 0 1 0 0 5‐Oct Typhoid Chagai Killi khan jan Town Dalbandin 0 1 1 2 4‐Oct DHF Mansehra Rog Gran UC Sher Garh Oghi 0 1 0 0 Current week's Alerts: AJK; FATA; GB and ICT 6‐Oct DHF Mansehra Jeskot UC Dilbori Oghi 0 1 0 0 Date Disease District Area <5M >5M <5F >5F Village Narran , U.C Panjkot, Tehsil 6‐Oct DHF Mansehra Mera Bhogar UC Mang 0 1 0 0 4‐Oct AWD Muzaffarabad 2 1 1 0 & District Muzaffarabad

6‐Oct DHF Mansehra Sera Gali Mohar 0 0 0 1 5‐Oct DHF Bagh Vill Jahala UC Mallot Tehsil Dhirkot 0 1 0 0

7‐Oct DHF Nowshera Near: PTCL Exchange 0 0 1 0 6‐Oct DHF Bagh DHQ hosp bagh UC town 0 2 0 0

3‐Oct DHF Swat Rang Mohallah Mingoar 0 1 0 0 VILLAGE JANDALA TEHSIL SAMANI 6‐Oct DHF BHIMBER 0 1 0 0 DISTRICT BHIMBER 4‐Oct DHF Swat Village Chail 0 1 0 0 Vill Doghi Nara Bangoin UC Ban‐ 6‐Oct DHF Poonch 0 1 0 0 7‐Oct Diphtheria Nowshera Mohalla Gilda Khel 0 0 1 0 goinTehsil Rawalakot

5‐Oct Diphtheria Peshawar Village Nasir Pur 0 0 0 1 Vill Bandi Pader UC Rangla Tehsil 5‐Oct Measles Bagh 1 0 0 0 Dhirkot 6‐Oct Measles Buner Village mir abbas khel 0 0 0 1 Vill Hillan Pader UC Rangla Tehsil 5‐Oct Measles Bagh 0 0 1 0 6‐Oct Measles Buner village sorray bazargay 0 0 1 0 Dhirkot

6‐Oct Measles Buner village sowawai near bagh 1 0 0 1 South Waziristan Post office Umer Khel Ladha Tehsil 2‐Oct Diphtheria 0 1 0 0 Agency Makeen South Waziristan 4‐Oct Measles Charsadda Sadaat Kallay 1 0 0 0 Leishmani‐ 4‐Oct Bajaur Agency Jar, Banda, Tehsil Khar 0 2 0 1 5‐Oct Measles Charsadda Pakistan Kallay 1 0 0 0 asis

30‐Sep Measles Haripur Village Dharyian 9 11 2 6 Village:Bar Khalozo, Tehsil Ma‐ 6‐Oct Pertussis Bajaur Agency moond & Village Malasaid Banda, 1 0 1 0 1‐Oct Measles Haripur Village Halli 1 0 0 0 Tehsil Salarzai 5‐Oct Measles Lower Dir Village Golar 0 0 0 1 Abbas abad oro UC kumra Tehsil 6‐Oct BD Skardu 0 0 0 1 6‐Oct Measles Lower Dir Village Kakkad 1 0 0 0 Skardu 5‐Oct DHF Gilgit DHQ Hospital Gilgit 0 2 0 1 1‐Oct Measles Swat Village Chongai 0 0 1 0 Leishmani‐ 4‐Oct Diamer DHQ Hospital Chilas 1 1 0 0 1‐Oct Measles Swat Village Nawey Kale 0 0 1 0 asis

2‐Oct Measles Swat Village and UC Udigram 1 0 1 0 3‐Oct Measles Diamer DHQ Hospital Chilas 1 0 0 0

6‐Oct Measles Swat Village and UC Qambar 1 0 0 0 Gazi abad Kachura U/C Kachura 4‐Oct Measles Skardu 0 1 0 0 5‐Oct NNT Tank D.I Khan, Gomal 1 0 0 0 District skardu

3500 7 2 2 7 3 Acute Respiratory Infection 10,584,864 (22%) 8 6 7 7 7 6 8

3000 13 6 6 6 8 8 Skin Diseases 5,169,031 (11%) 8

8 8 11 2500 11 8 11 8 11

2000 8 Acute Diarrhoea 4,573,445 (10%) 12 411 400 375 331 11 3375 3363 3354 215 3329 361 1500 192 3259 3259 3251 3250 3234 26 3215 3196 3156 3142 153 3120 3109 3058 26 3022 3021 2982 2935 128 2909 2785 2752 2745 105 2648 2640 46 2564 2547 2532 2522 81 2466 Bloody Diarrhoea 2450 2404 406,345 (1%) 58 2349

2322

1000 2262 2255 2251 2199 2022 2021 1797 1680 1488 1463

500 1289 1215 1167 1158 1143 1130 1113 999 1111 967 1073 1067 949 879 Suspected Malaria 2,883,295 (6%) 854 0 3 5 7 9

11 33 35 37 39 41 43 45 47 49 51 Unexplained Fever 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 ‐

1,822,502 (4%) 1 Wk Wk Wk Wk

Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Total Consultations 47,604,357 Wk Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Post Flood 2010 2011 (up till wk 39) Current Week (40) Total Disease A O A O A O A O Acute Watery Diarrhoea 209 85 1082 483 41 7 1332 575 Acute Jaundice Syndrome 5 2 39 14 1 0 45 16 Bloody Diarrhoea 10 1 80 14 2 0 92 15 Dengue Fever 81 32 445 104 114 7 640 143 Measles 48 6 1368 85 21 1 1437 92 Pertussis 1 ‐ 219 24 3 1 223 25 NNT + Tetanus 5 ‐ 217 0 14 0 236 0 Malaria 12 7 76 52 4 3 92 62 Leishmaniasis 1 ‐ 145 23 19 1 165 24 Others 75 11 471 53 6 0 552 64 Total 447 144 4142 852 225 20 4814 1016 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • This week 739 health facilities from 20 districts reported to DEWS with a total of 173,371 patients consultations. 50 45 • The proportional morbidity of AD showing gradual decline 40 during the last 4 weeks after a consistent higher proportion 35 (16%) for almost 10 weeks. 30 25 20

• 51 alerts were reported in this week, 29 were for DHF, 13 Percentage 15 for Measles, 6 for AWD, 2 for Diphtheria, while 1 for Neo- 10 natal Tetanus. 5 0 1 3 5 7 9

31 33 35 37 39 41 43 45 47 49 51 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

• 2 outbreaks 1 each for AWD and Measles were identified wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk and responded. wk AD BD ARI S. Malaria

Province Sindh: Figure-4: Trend of priority communicable diseases, province Sindh • This week 727 health centers from 20 districts reported to DEWS with a total of 425,927 patient consultations.

50 • In Sindh, AD cases reported were 45,301 (11%), propor- 45 AD BD ARI S. Malaria 40 tional morbidity lower by 1% as compared with last week. 35 30

• 65 alerts were reported from Sindh in this week: 32 were for Percentage 25 20 AWD; 18 for DHF; 8 for Neonatal tetanus; 2 each for Ma- 15 laria and Tetanus, while 1 each for Acute diarrhoea, Measles 10 and Pertussis. 5 0 1 3 5 7 9

11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 31 33 35 37 39 41 43 45 47 49 51

• 7 outbreaks 6 for AWD and 1 for Malaria were identified wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk and responded. wk wk wk wk wk wk wk wk wk wk wk

week . Percentage 20 15 • 66 alerts were reported in this week from Punjab; 59 10 were for DHF; 4 for Leishmaniasis; 2 for AWD while 5 0 1 for Neonatal Tetanus. 9 7 5 3 1

11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 31 33 35 37 39 41 43 45 47 49 51

wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk • 8 outbreaks 7 for DHF and 1 for Leishmaniasis were wk wk wk wk wk wk wk wk wk wk wk identified and responded. AD BD ARI S. Malaria Province Balochistan: Figure-6: Trend of priority communicable diseases, province Balochistan • In this week, 18 districts reported to DEWS from Balochis-

tan province. 477 health centers reported a total of 86,735 50 patient consultations. 45

40 • AD reported in 9,242 (11%) of the total consultations, 1% 35 higher proportional morbidity as compared with the last 30 week. 25

Percentage 20 • 28 alerts were reported in this week from Balochistan, 13 15 10 were for Leishmaniasis; 3 each were for DHF and Measles; 2 5 for Neonatal tetanus and Tetanus; while 1 each for AJS, 0 Bloody diarrhoea, Pertussis, Typhoid and Mumps. 1 3 5 7 9

31 33 35 37 39 41 43 45 47 49 51 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk • 3 outbreaks 2 for Malaria and 1 for Pertussis were identi- wk fied and responded. AD BD ARI S. Malaria Province Gilgit Baltistan:

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan • In this week, 81 health centers from 7 districts in 45 AD BD ARI S. Malaria Gilgit Baltistan sent weekly report with a total of 40 26,925 patient consultations. 35

30 • ARI cases reported were 5,648 (21%), while Acute 25

Diarrhoea 3,725 (14%). Percentage 20

15 • 5 alerts received and responded this week, 2 were for 10 Measles, while 1 each for DHF, Bloody diarrhoea, 5 and Leishmaniasis. 0 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13

wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk

State of Azad Jammu and Kashmir: FATA:

• In this week, reports received from 111 health facilities from 10 • This week 36 health facilities in 2 agencies reported from FATA, districts with a total of 36,422 patient consultations. with a total of 8,137 patient consultations. • ARI cases reported were 5,439 (15%), while Acute diarrhoea re- • ARI cases reported were 1,754 (22%), while Acute diarrhoea reported 1,875 (5%) cases. ported 687 cases (8%) • 7 alerts 4 for DHF, 2 for Measles and 1 for AWD were received and • 3 alerts 1 each for Diphtheria, Leishmaniasis and Pertussis were responded this week. received and responded this week.

45 AD BD ARI S. Malaria 40 40 35 AD BD ARI S. Malaria 30 30 25

20 Percentage 20 15 Percentage 10 10 5 0 0 9 8 7 6

10 39 11 40 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13

wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk

Focus on: Malaria Floods may indirectly lead to an increase in vector‐borne diseases through the expansion in the number and range of vector habitats. Standing water caused by heavy rainfall or overflow of rivers can act as breeding sites for mosquitoes, and therefore enhance the potential for exposure of the disaster‐affected population and emergency workers to infections such as dengue and malaria. Flooding may initially flush out mosquito breeding, but it comes back when the waters recede. The lag time is usually around 6‐8 weeks before the onset of a malaria epidemic.

The risk of outbreaks is greatly increased by factors related to disasters: increased exposure to mosqui‐ toes of displaced persons sleeping outside and disruptions to health care and disease control activities. Malnutrition and other concurrent infections can leave displaced populations particularly vulnerable to malaria infection as well.

Pakistan is a malaria endemic country; the estimated numbers of malaria cases which may occur annually are as high as 1.6 million. However the reported confirmed cases from the public sector health facilities (microscopy centers) in 2009 were 167,579 cases, with 71,970 cases due to P. falciparum (39%). After the 2010 Flood, malaria was found in more districts and there were almost double the number of cases re‐ ported overall (287,870) and of P. falciparum (116,105).

Although the risk of transmission of malaria can increase in the context of an emergency, effective control and the reduction of transmission is possible. There may still be time to implement preventive measures such as indoor residual spraying and distribution of insecticide‐treated nets, as effective options in areas where their use is well‐known. This will also have an effect on other mosquito‐borne diseases. The most important intervention is to have adequate diagnostic facilities, whether microscopy units or rapid diag‐ nostic tests, and to effectively treat all confirmed cases.

DEWS teams have responded to malaria alerts in the following districts since 1st September 2011: (Thatta, Badin, Larkana, Sukkur and Naushahro Feroze in Sindh and Chagai, Ziarat, Kech, Kharan and Jhal Magsi in Balochistan).

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases reported in 2010 is 144 includ‐ ing 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/ agencies. Year 2011: As of 10 October, 2011, the total number of polio cases con‐ firmed by the laboratory is 111 (110=type‐1, and 1=type3) from 38 districts.

Province Cases 2010 Cases 2011 P1 P3 P1 P3 Punjab 6 1 2 -

Sindh 26 1 20 -

Khyber Pakhtunkhwa 19 5 12 -

FATA 63 11 28 1

Balochistan 6 6 47 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 110 1