Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 3, Issue 15, Wednesday 18 April 2012

Highlights Priority diseases under surveillance Epidemiological week no. 15 (8 to 14 April 2012) in DEWS

Acute (Upper) Respiratory Infection • In week 15, 2012, total 82 districts including 3 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 2,010 health facilities. Data from mobile teams is reported Suspected Diphtheria through sponsoring BHU or RHC. Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea • A total of 684,278 consultations were reported through DEWS of which 19% were acute Other Acute Diarrhoea respiratory infections (ARI); 8% were acute diarrhoea; 4% were suspected malaria; while 4% were Suspected Enteric/Typhoid Fever Skin disease. Suspected Malaria Suspected Meningitis Suspected Dengue fever • A total of 247 alerts reported while 27 outbreaks were identified in week 15, 2012: Alto‐ Suspected Viral Hemorrhagic Fever gether 142 alerts for Measles; 30 for Leishmaniasis; 16 for NNT and Tetanus; 12 for Typhoid; 11 Pyrexia of Unknown Origin for Pertussis; 9 for acute diarrhoea; 7 for Scabies; 5 for ARI; 4 for Acute jaundice syndrome; 3 for Suspected Measles Suspected Acute Viral Hepatitis AWD; 2 each for Bloody diarrhoea and Diphtheria; while 1 each for CCHF, HF, Food poisoning and Chronic Viral Hepatitis Chicken Pox. Neonatal Tetanus Acute Flaccid Paralysis • In this week no new polio cases was reported. As of 16 April 2012, the total number of polio Scabies Cutaneous Leishmaniasis cases confirmed by the laboratory is 15 from 10 districts/towns/tribal agencies and areas. Others

Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐15, 2012.

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

Percentage 20 15 10 5 0 1 3 5 7 9 1 3 5 7 9

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

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

Table 1: Most common communicable diseases syndromes reported weekly

Disease Wk-8 Wk-9 Wk-10 Wk-11 Wk-12 Wk-13 Wk-14 Wk-15

Acute respiratory infection 153,111 (24%) 157,828 (23%) 155,186 (23%) 162,325 (23%) 145,261 (21%) 155,373 (20%) 128,278 (20%) 128,197 (19%)

Skin diseases 28,820 (4%) 29,430 (4%) 30,909 (4%) 31,713 (4%) 28,719 (4%) 31,589 (4%) 28,054 (4%) 27,065 (4%)

Acute diarrhoea 31,623 (5%) 34,918 (5%) 38,427 (6%) 40,950 (6%) 41,535 (6%) 51,104 (7%) 51,780 (8%) 58,121 (8%)

Bloody diarrhoea 2,765 (0.43%) 3,094 (0.45%) 2,874 (0.42%) 3,651 (0.51%) 2,890 (0.42%) 3,480 (0.45%) 2,972 (0.46%) 3,115 (0.46%)

Suspected malaria 23,483 (4%) 28,265 (4%) 29,599 (4%) 30,594 (4%) 29,521 (4%) 32,870 (4%) 28,187 (4%) 29,871 (4%)

Total consultation 650,423 680,221 688,813 717,186 681,475 769,774 645,028 684,278

• 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 each of the last 8 weeks proportional morbidity of five disease syn‐ drome. Proportional morbidity of ARI is highest in Sindh and Khyber Pakhtunkhwa while acute diarrhoea is highest in Ba‐ lochistan and Sindh (please see the graphs for every province in page 6 and 7).

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]. 01 Special Bulletin: DEWS, Pakistan, Week no. 15 (8 to 14 April 2012) Previous week's (14/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken An alert of suspected Measles case was reported from Private Clinic. It was investigated and responded in the presence of Health department personelle. During investigation 4 more 4‐Apr Measles KPK Swabi Private Clinic, Topi 1 1 2 1 cases found iin the same locality. Vit.A given,health education sessions conducted,EDO H and EPI coordinator Informed, Measles Mopup Vaccination planned in the Relevant Village. WHO EHA and PPHI provided the essential medicines to the relevant Health Facility. An alert of 2 suspected measles cases was generated by BHU. Active surveillance was carried out in the area. 6 more cases were identified who had developed measles in past month and their history suggested measles. 3 children had active measles. Children were given Vit A. Vaccination status was assessed in the surrounding. Out of 12 houses and 38 children were 5‐Apr Measles KPK Haripur Afghan Refugee camp 3 2 1 4 1 assessed, 29% children had no measles 2 vaccine. 8% children had no BCG sca 5% children were totally unvaccinated. The rest were completely vaccinated. Missed children were re‐ ferred to BHU STC 4 for completion of vaccination. Blood samples were taken and sent to NIH. Follow‐up was done. Health session was conducted. EDO H, Save the children and EPI coordi‐ nator were informed of possible outbreak. Alert of suspected measles was notified. Active Surveillance conducted, 5 more cases were found in the same family surounding camp. EPI staff was requested for routine outreach AR Taimar Camp, Timar‐ 6‐Apr Measles KPK Lower Dir 4 0 2 0 vaccination in the area. Vit‐A was given, Blood Sample Collected for confirmation of antibod‐ gara Lower Dir. ies, Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed. An alert of 2 suspected cases of Measles reported by MO BHU. SO along with two EPI vaccina‐ tor visited the area on next day and examined the children presented with signs and symp‐ Kukkoo Mera Shergarh toms of Measles, (runny nose, conjunctivitis, flu, fever and rashes) there were four children in 6‐Apr Measles KPK Mansehra 2 1 1 2 Oghi one house. on house to house visit, two more suspected cases were found in that area. vit A given. Total 52 children vaccinated under 15 years of age in the area only 6 children were not vaccinated before, HE conducted, one sample taken and sent to NIH for confirmation Alert of 2 suspected measles cases were reported by Pediatrician THQ Hospital. Field investi‐ gation revealed that there were 16 more measles cases in the same area. All the cases had a history of fever, rash, conjuctivitis and cough within last 30 days.Vaccination status of 42 Basti Farooqabad, UC 4‐Apr Measles Punjab Rajanpur 4 8 5 1 children was checked randomly. Only 2 children had BCG scar while all others were not vacci‐ Basti Khoja, DG Khan nated at all. 5 Blood samples were collected and sent to NIH. Vit A drops provided. HE session was conducted for the community about importance of routine immunization.Findings were shared EDOH Rajanpur for mop up measles vaccination campaign in the affected area. 2 suspected cases of measles notified by a medical officer of RHC from Village Shakal Chandio. During field investigation, five more suspected cases of measles were found, informed to S Benazira‐ Village shakal khan DHO, DSC and DSV for containment measures, routine immunization was checked for 16 2‐Apr Measles Sindh 1 1 4 1 bad chandio UC kazi ahmed 2 children in which 6 childrens were fully immunized and 5 were partially immunized and 5 were unvaccinated. report shared to DHMT, vitamin A capsules given and also health educa‐ tion imparted. Suspected Pertussis was reported from Villagers, active surveilliance done, childrens were not Village Mamoon Muhalla, vaccinated, Cluster for immunization was assessed, where 8 childrens were checked and 2‐Apr Pertussis Sindh Badin 3 1 0 1 UC Seerani, taluka Badin found unvaccinated, health education imparted, Erythrisine was given, DHMT and HCPs were informed and requested for immunization and 1 Throat sample collected. Suspected case of measles was investigated in village, active surveillance done, Vitamin(A) Village Sher Muhammad drops provided, vaccination status was checked for 27 children where 7 children were found 4‐Apr Measles Sindh Dadu Rustumani, UC T.R Khan, 3 2 3 2 vaccinated against BCG and only 1 child found vaccinated against Measles, health education taluka Johi regarding importance of immunization was delivered, EDOH, FP‐EPI, DSM and MO were informed and 3 Blood sample collected. Alert of suspected Measles case was notified by a community person, active surveillance Village Shah baig Jamali, done, Vitamin(A) was given, cluster for routine immunization was checked and found 4‐Apr Measles Sindh Larkana UC Ratokot, taluka 0 0 0 5 Larkana BCG=67%, Penta=35%, Measles=46%, health education was imparted, community sensitized for routine immunization, EDOH informed and request for routine immunization. Alert of suspected measles case was reported from private practitioner, active surveilliance done and found 4 more cases, Mop‐up was conducted by area vaccinator, Vitamin(A) was Yaqoob Buriro, UC 4‐Apr Measles Sindh Shahdadkot 3 0 2 0 given to cases, immunization status was checked and found BCG=10%, Measles= 0% and Gebidero, taluka Kambar Measles1=0%, sensitized community regarding vaccination, THO informed and 3 Blood sam‐ ple collected. Alert of suspected pertussis case was notified by Dispenser. During active search five more Village Noor Muhammad cases were found. House to House cluster was taken. Only 15% children were found vacci‐ 4‐Apr Pertussis Sindh Ghotki 2 0 2 2 Mahar UC Bereri nated against BCG scar.Complete dose of erythromycin was provided to all patients and close contacts. informed EDOH & DSV for vaccination and health promotion in the area. Suspected cases of pertussis were investigated and all of them found unvaccinated, health Village Malhar Wassan, education regarding importance of immunization was imparted, cluster of 20 houses were 4‐Apr Pertussis Sindh Sanghar UC Shah Sikandarabad, 8 0 0 2 taluka Sanghar taken, 33% of the children had only BCG scar whereas rest found unvaccinated. Erythromycin tabs and Cough syrups was given, EDOH and THO informed and 1 Throat swab collected. Borhi Mohalla Kambar, An alert of 3 suspected measles cases were reproted from Larkana SO as Epilinked Cases, 5‐Apr Measles Sindh Shahdadkot UC Kambar #2, taluka 2 0 3 0 during active surveilliance found 2 more cases, Vitamin (A) given, DHMT were informed for Kambar implementation of routine immunization and 3 blood samples were taken. 2 suspected cases of AJS were admitted in DHQ, active surveillance done in the area and Village Choocha Junejo, found 157 more cases, investigation completed in 2 days, Aqua tabs, Hygiene kits, essential 6‐Apr AJS Sindh Tharparkar UC Harho, taluka Nagar‐ 0 70 0 89 parkar medicines provided, 139 patients got vaccination for Hepatitis B, DEWS team received com‐ plete support from EDOH, 4 blood and 3 water samples were taken. 2 deaths due to post Measles was repoted from community, active surveillance was done and Village M. Urs Mallah, UC 6‐Apr Measles Sindh Karachi 3 1 1 3 found 7 more cases of post Measles, cluster of 10 houses was collected and found all children Ghaghar Bin Qasim unvaccinated, health education imparted, Vit (A) was given, 4 blood samples were collected. An alert of suspected Measles case was reported from GP. On field investigation 4 more cases DO Bulding office colony, were found, Vit (A) drops given to patients, 4 blood samples were collected & handed over to 6‐Apr Measles Sindh Shikarpur 2 1 1 1 khanpur road shikarpur DSC, Routine immunization for 29 children (only 6 had BCG, and no one had Measles vaccina‐ tion), information shared with DHMT. mop up activity is planed for the area.

Kili Lamsak District Killa 06 patients of Leishmaniasis were reported. House to house cluster were taken. The leisions 12‐Apr Leishmaniasis Balochistan Killa Saifullah 3 0 3 0 Saifullah was clinically checked in patients. Health education imparted and medicines were provided.

An alert of measles reported from private clinic. On active surveillance 4 more cases found in the locality. All children found unvaccinated, Vit A drops and symptomatic treatment pro‐ 11‐Apr Measles Balochistan Awaran Waja Bagh Jhaoo 2 1 2 0 vided,1 blood sample was collected for laboratory confirmation, information shared with DHO. Alert of suspected measles case reported from private clinic. During active case finding, found 12‐Apr Measles Balochistan Awaran Marki camp, UC Jhaoo 1 2 2 3 6 more suspected cases. Vit A drops and symptomatic treatment given. 1 blood sample col‐ lected,information shared with DHO for out reach vaccination.

2 cases of suspected measles were reported from Pediatric unit of BMCH. Cases were investi‐ gated, both of them suffering from post measles complication (Pneumonia) and also found Pediatric Unit of BMCH, 12‐Apr Measles Balochistan Quetta 0 6 0 0 unvaccinated. On house to house survey, 4 more suspected cases of measles were found. Vit. Quetta A drops provided. Mop up activity conducted, 35 children under 5 years of age were vacci‐ nated. Information shared with DHO office, PPHI and EPI Program .

8 cases of suspected measles were reported, 3 samples were taken and sent to NIH, Vit. A 12‐Apr Measles Balochistan Sibi Village Sawal Machi, Lehri 5 0 3 0 drops given. 14 children were checked for routine immunization and 86% found vaccinated.

An alert of suspected measles reported from private clinic. 10 more cases were found during active surveillance. 6 blood samples were taken and sent to NIH. Suspected cases found Killi Murdar kach, UC 11‐Apr Measles Balochistan Ziarat 4 2 3 1 unvaccinated. Vitamin A drops and symptomatic treatment provided. 40 children less then 5 Ziarat, Tehsil Ziarat years were assessed, only 5% found vaccinated. Health education imparted. Vaccinator and DSV vaccinated 29 children of the area. Matter was discussed with DHO. Alert of suspected measles case was reported from private clinic. Field investigation was done and found 6 more cases and all of them were unvaccinated. 1 blood sample was collected. Vitamin A drops provided. Health education imparted. House cluster was taken and found 2 12‐Apr Measles Balochistan Ziarat Killi Tangi Dam, UC Zindra 2 2 0 2 cases in post measles phase. 22 children were also assessed and found unvaccinated, all 22 children were vaccinated on the spot. Outreach team was instructed to vaccinate the remain‐ ing children in the area.Matter was discussed with DHO and EPI inchrage 15 Leishmaniasis cases were reported in weekly DEWS report. The report was shared with PPHI. Surveillance visit was arranged with PPHI M& E officer to the affected area. During the Khyber Kam Shalman, Tehsil 9‐Apr Leishmaniasis FATA 5 0 3 1 active surveillance 9 cases were detected and the rest of the cases were already cured with Agency Landikotal medicines.Line list of the cases developed. Health education imparted. Report shared with PPHI and DEWS focal person.The plan is to provide Inj. Glucantime and preventive measures. An alert of suspected measles and a death reported by EPI Tech. On active surveillance 23 cases were found in the affected area including 2 deaths. The situation was discussed with Ghani khel and Sherikhel, Agency Surgeon, FSMO and DSV. Mass measles campaign started on the same day. The cam‐ Khyber 10‐Apr Measles FATA UC Sheikhmal khel, Tehsil 11 4 4 4 paign was started in the area for 5 days and a total of 1258 children were vaccinated. Blood Agency Landikotal samples were taken from 3 suspected children. Vitamin A drops provided. 4 seriously ill chil‐ dren were referred to Hospital. Health education imparted. Report was shared with Agency Surgeon, FSMO and FATA Directorate. Alert of 3 measles cases were reported by EPI Tech. On active surveillance 5 more cases were Village Naik Muhammad, found. Blood sample and VTM throat swab was taken from 2 suspected cases. Vitamin A given Khyber 12‐Apr Measles FATA UC Mian Morcha, Tehsil 5 1 2 0 to all suspected cases. Mass measles campaign of 27 children was done in the houses which Agency Mulagori were left from the last measles campaign. Health education was imparted. Report was shared with DOH. An alert of suspected Measles case was reported from Private Clinic. During investigation 4 Khyber more cases found in the same locality and one suspected measles child was died at LRH, 10‐Apr Measles Pakhtunk‐ Swabi Private Clinic, Checknoda 3 1 1 0 Peshawar. Vit. A given, health education sessions conducted, EDO H and EPI coordinator hwa Informed, Measles Mopup Vaccination planned in the Village. WHO EHA and PPHI provided the essential medicines to the relevant Health Facility. Alert of suspected measles case was reported from Private Clinic. During field investigation Khyber Private Clinic, Dudher, found 5 more cases in the same locality. Vit. A given, health education sessions conducted, 11‐Apr Measles Pakhtunk‐ Swabi 1 3 1 1 Tandkohi hwa EDO H and EPI coordinator Informed, Measles Mopup Vaccination planned in the relevant Village. WHO EHA and PPHI provided the essential medicines to the relevant Health Facility. Seven suspected cases of measles reported. Site was visited & one blood sample was col‐ Block 29 opposite imam lected and sent to NIH. Vitamin A drops were given to the cases. On field investigation, found 11‐Apr Measles Punjab D. G. Khan 2 3 0 2 bargah rizvia 93% children fully vaccinated. Health education session conducted. Provided IEC material. LHWs were mobilized. Outreach vaccination activity planned with the help of Tehsil DDOH Alert of 2 suspected Measles case was investigated. vitamin‐A drops provided. In both index case's BCG scar wasn't evident & mother shared that both hadn't received Measles vaccine. Basti Budhoo Wali, Neighboring 10 HHs were visited & three more similar cases were found. During HH survey, Nearby Muhhamad 50% children age 9 months – 5 years were having BCG scar & 10.8% had received single dose 13‐Apr Measles Punjab Muzaffargarh 3 1 0 1 Chowk, UC Sinanwan, of Measles vaccine. While, 28.7% among age group 5‐15 years had BCG scar & parents also Tehsil Kot Addu couldn’t clearly remind administration of Measles vaccine. DSV was advised by DOH to ar‐ range a mop‐up campaign for all under 15 children. Blood sample of 5 suspected Measles cases were drawn & sent to NIH.

An alert of Measles was notified from PMCH Nawabshah, case was investigated and on field investigation found 4 more suspected measles cases in the same family. 4 Blood samples Shaheed Village Soomar khan 9‐Apr Measles Sindh 0 0 5 0 were collected, vitamin (A) drops provided to all cases, health education imparted. Vaccina‐ Benazirabad Lashari, UC Jhoro shar tion status assessed and out of which 10 out of 12 (83%) children found unvaccinated. Infor‐ mation shared with DHMT for improving routine immunization.

Alert of suspected measles case was notified from RHC, during field investigation found 15 more suspected cases, all cases were line listed, blood samples of 14 cases were drawn. Shaheed 12‐Apr Measles Sindh Village Golo Dahri 0 0 8 8 Vitamin (A) drops provided, health education imparted, cluster for routine immunization was Benazirabad taken, 17 children were assessed out of which 41% found vaccinated. Informed DHMT and request for Mop‐up the area..

Alert of suspected Measles case was reported from private clinic, active search was done and Village Allah Bachayio found 15 more suspected cases of Measles, house to house cluster of (30 houses ) was taken Jokhio, UC choubandi, 13‐Apr Measles Sindh Thatta 5 4 4 3 and found 18 children, all children were found unvaccinated, health education imparted, taluka Mirpur sakiro district thatta Vitamin(A)drops were given to cases, 10 blood samples collected and sent to NIH for lab confirmation, information shared with DHO, THO and TSV & planned for Mopping the area.

Alert of suspected Measles case reported from private clinic, active search was done with TSV Village Haji Ali Muham‐ and area Incharge and found 4 more cases in post measles phase , house to house cluster (30 mad Soomaro, UC 13‐Apr Measles Sindh Thatta 1 2 1 1 houses ) was taken and found 12 children, all of them found unvaccinated, health education Choubandi, taluka Mir pur Sakiro was imparted, Vitamin(A) drops was given, 3 blood samples collected and sent to NIH for lab confirmation, information shared with DHO, THO and TSV and request for mop‐up the area.

Suspected case of Pertussis was informed from village, active surveillance done and found 8 more cases, no travel history. Cluster for immunization were taken in which 11 children were Village Chakar Kaloi, UC 9‐Apr Pertussis Sindh Badin 2 2 2 3 assessed for vaccination, none of the children were fully vaccinated, 6 found totally unvacci‐ Saeed Pur, taluka Talhar nated and rest (5) were partially vaccinated. Health education imparted, Erythromycin was given, Information share with MS and DHMT and 1 Throat Swab was collected.

Suspected cases of Pertussis were reported from MCH Center, active case finding was done in the area, investigation completed, vaccination status was checked for 22 children and all Meerani Muhalla, MCH 10‐Apr Pertussis Sindh Ghotki 3 5 4 2 found un‐vaccinated, health education imparted to community and sensitized regarding Center, Ghotki City importance of vaccination, 14 days complete dose of Erythromycin was given to cases and information share with DOH and requested for Mop‐up in the area.

Suspected case of Pertussis was reported from MCH Center, active surveillance done and found 4 more cases, immunization status for 13 children were assessed and found 11 children Village Sargodha, UC 10‐Apr Pertussis Sindh Ghotki 1 1 1 2 with complete course of routine immunization. 2 found unvaccinated, health education Beriri regarding importance of immunization imparted in the community, 14 days complete dose of Erythromicine was given to cases and close contacts. Information share with DHO.

Suspected Pertussis case was notified by pediatrician of MCH centre, during field investigation 11 more cases were found & investigated, House to House cluster was taken to assess the village Drago Chachar UC 13‐Apr Pertussis Sindh Ghotki 3 1 3 5 routine immunization status. However, none of the child found vaccinated, 14 days complete Adilpur dose of erythromycin was provided to all patients and close contacts, informed EDO‐H & DSV for vaccination and health promotion in the area.

Suspected Pertussis case was notified by Pediatrician of MCH centre, during field investigation Village Gul Bahar Sanghar 5 more cases of Pertussis were found from same house, house to house cluster was taken to 13‐Apr Pertussis Sindh Ghotki 1 3 1 1 UC Bandh assess the routine immunization status. However, none of the child found vaccinated , 14 days complete dose of erythromycin will be provided after sampling.

During investigation 7 Pertussis cases found from same village, immunization status was Village Bazigar, UC Naich, assessed and found (BCG=81%, Penta=45%, Measles=50%), Erythromycin was given to pa‐ 9‐Apr Pertussis Sindh Larkana 3 0 4 0 taluka Bakrani tients as well as to close contacts, health education imparted regarding importance of immu‐ nization and information share with EDOH and requested for improving routine vaccination.

Suspected case was reported from Dr. Nisar Ahmed Mugheri (PPHI), active surveillance done Qambar M.Uris Gabanai , UC and found 14 more cases, vaccination status was checked (BCG=40%, Penta‐1=30%, Penta‐ 12‐Apr Pertussis Sindh 6 2 5 2 Shahdadkot Kalar , Taulka Qambar 2=15%, Penta‐3=10%, Meas 1‐2= 0%), health education imparted, Erythromycin was given to cases and contacts with the support of PPHI.

Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

As of 16 April 2012, the total number of polio cases confirmed by the labora‐ tory is 15 from 10 districts/towns/tribal agencies and areas.

Cases 2011 Cases 2012 Province P1 P3 P1 P3 P1+P3 Punjab 9 ‐ 1 ‐ ‐ Sindh 33 ‐ 2 ‐ ‐ Khyber Pakhtunkhwa 23 ‐ 4 ‐ ‐ FATA 57 2 4 1 1 Balochistan 73 ‐ 2 ‐ ‐ AJ&K ‐ ‐ ‐ ‐ ‐ Gilgit‐Baltistan 1 ‐ ‐ ‐ ‐ Islamabad ‐ ‐ ‐ ‐ ‐ Total 196 2 13 1 1

Number of alerts by province, week 15, 2012 Province Sindh Cont’d Province Sindh Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 10‐Apr AWD Sanghar Village Ahmed Malano, UC Maldasi 2 1 0 0 12‐Apr Measles Umer Kot Ward #249, Qaim Khani Muhalla 1 0 1 0 10‐Apr AWD Tando Allah Yar Ibrahim Colony, UC‐3, city TA Yar 0 1 0 0 13‐Apr NNT Karachi Arkanabad, Korangi town 0 0 1 0 11‐Apr AWD Tando Allah Yar Ibrahim Colony, UC‐1, city TA yar 0 0 0 1 12‐Apr NNT Thatta Mobile Population 1 0 0 0 12‐Apr Measles Badin Village Jan Muhammad Area 1 0 2 0 12‐Apr NNT Thatta Parali Mallah Muhalla 0 0 1 0 9‐Apr Pertussis Badin Village Chakar Kaloi, UC Saeed Pur 2 2 2 3 12‐Apr Measles Dadu Village Mangreja, UC Khudaabad 1 1 1 0 10‐Apr Pertussis Ghotki Meerani Muhalla, MCH Center 3 5 4 2 13‐Apr Measles Dadu Village Ghazi khan Lund 0 0 1 0 10‐Apr Pertussis Ghotki Village Sargodha, UC Beriri 1 1 1 2 13‐Apr Measles Dadu Village Sher Muhammad Solangi 1 0 1 0 13‐Apr Pertussis Ghotki Kalwar Muhalla Adilpur city 0 0 2 0 9‐Apr Measles Ghotki Mehran colony, near Sabzi Mandi 1 0 0 0 13‐Apr Pertussis Ghotki village Drago Chachar UC Adilpur 3 1 3 5 9‐Apr Measles Ghotki Village Fazal Khalique Pathan 0 0 2 0 13‐Apr Pertussis Ghotki Village Gul Bahar Sanghar UC Bandh 1 3 1 1 13‐Apr Measles Ghotki Adilpur city 0 1 0 0 9‐Apr Pertussis Larkana Village Bazigar, UC Naich 3 0 4 0 13‐Apr Measles Ghotki Sundrani Muhalla Qadirpur 0 0 1 0 12‐Apr Pertussis Q Shahdadkot M.Uris Gabanai , UC Kalar 6 2 5 2 13‐Apr Measles Ghotki Village Changlani UC Bereri 1 0 0 0 12‐Apr Pertussis S Benazirabad Village Nagar khan chandio 0 0 2 1 13‐Apr Measles Ghotki Village Gulzar Memon 0 0 0 1 10‐Apr Scabies Badin Village Hoat Machi 2 10 0 13 10‐Apr Measles Hyderabad Near Mustafa Park, UC #16 0 0 1 0 10‐Apr Typhoid TM Khan Muhalla Supari 1 1 0 1 12‐Apr Measles Hyderabad Village Meer Haji Shah 0 1 1 1 Province Balochistan 13‐Apr Measles Hyderabad Block #d‐2, Unit # 11 0 1 0 0 Date Disease District Area <5M >5M <5F >5F 13‐Apr Measles Hyderabad Ujala Garden road 0 0 0 1 Magsi Muhallah, UC Usta M 3, Tehsil 10‐Apr Leishmaniasis Jaffarabad 0 1 0 0 9‐Apr Measles Jamshoro Sehwan Muhalla, UC & Taluka Kotri 0 0 0 1 Usta Mohammad 9‐Apr Measles Karachi Abu Manzil, Police Quarted 2 0 1 0 11‐Apr Leishmaniasis Khuzdar Sath Marlla UC Zereena Kattan 0 3 0 0 10‐Apr Measles Karachi Bath Island, Saddar town 1 0 0 0 12‐Apr Leishmaniasis Killa Saifullah Kili Lamsak District Killa Saifullah 3 0 3 0 11‐Apr Measles Karachi Street #2, UC #4, Kazafi town 0 0 1 0 13‐Apr Leishmaniasis Lasbela Bhawani, UC Khurkhera 0 1 0 2 Ghot Jan Muhammad Jatak Bari Shakh 12‐Apr Measles Karachi Kaghazi Market, Saddar town 1 0 0 0 10‐Apr Leishmaniasis Nasirabad 0 0 0 1 Tehsil Tamboo 13‐Apr Measles Karachi Gulzar colony, Korangi town 1 0 1 0 11‐Apr Leishmaniasis Nasirabad Nuttal Tehsil Dera Murad Jamali 0 0 1 0 9‐Apr Measles Larkana Siddique colony, UC #6, Larkana 2 1 0 1 11‐Apr Leishmaniasis Panjgur Village & UC Essai 0 0 0 1 9‐Apr Measles Larkana Village Bazigar, UC Naich 2 1 0 1 11‐Apr Leishmaniasis Panjgur Villagea Murgap Sradok UC Washbood. 0 1 0 0 12‐Apr Measles Larkana Village Muhammad Usman Jeho 1 1 0 0 13‐Apr Leishmaniasis Quetta BHU Village Aid seryab road, Quetta 0 0 0 0 13‐Apr Measles Larkana Peer Budhal Street, Nazar muhalla 1 0 0 0 9‐Apr Measles Matiari Hunar Mand colony, Bhit shah 0 0 1 0 9‐Apr Leishmaniasis Ziarat Village & UC Sinjavi 0 1 0 0 13‐Apr Measles Matiari Village Haji Fazal Khoso 0 0 1 0 11‐Apr Measles Awaran Bazag Jhaoo 0 3 0 0 9‐Apr Measles Mirpur Khas Abid town, Malik Riaz colony 0 1 0 0 11‐Apr Measles Awaran Waja Bagh Jhaoo 2 1 2 0 9‐Apr Measles Mirpur Khas Lalchandabad, UC# 3 0 0 0 1 12‐Apr Measles Awaran Marki camp, UC Jhaoo 1 2 2 3 Killi Georgage Girdi jungle afghan 9‐Apr Measles Mirpur Khas Village Jan Muhammad Dal 0 1 0 0 9‐Apr Measles Chagai 0 1 1 0 refugee camp. 9‐Apr Measles Q Shahdadkot Muhammad Khan Brohi 1 0 0 0 12‐Apr Measles Jaffarabad Village & UC Shbat Pur 1 0 0 0 9‐Apr Measles Q Shahdadkot Rais Shah Shaikh , UC Lakha 0 0 1 0 9‐Apr Measles Kech Village & UC Nasirabad 1 0 0 0 9‐Apr Measles Q Shahdadkot Yaro Khatayan, UC Abad 1 0 1 0 13‐Apr Measles Kech Kallag UC Sami 0 0 1 0 10‐Apr Measles Q Shahdadkot Lateefabad, UC #1 2 0 0 0 12‐Apr Measles Khuzdar Ismail Abad UC Gazai 0 1 1 0 10‐Apr Measles Q Shahdadkot Noorani Masjid, Qubo Road 1 0 1 0 13‐Apr Measles Killa Saifullah Kili Shinki Baha District Killa Saifulla 1 1 2 0 12‐Apr Measles Q Shahdadkot Haji Hulio, Ber Sharif 1 0 0 0 11‐Apr Measles Nasirabad Village & UC Chatter 0 1 0 0 12‐Apr Measles Q Shahdadkot Wand Usman Joyo, Taulka Qambar 1 0 0 0 12‐Apr Measles Quetta Medical Unit of BMCH, Quetta 0 1 0 0 13‐Apr Measles Q Shahdadkot Sahib Khan Chutto, Abad 1 0 1 0 12‐Apr Measles Quetta Pediatric Unit of BMCH, Quetta 0 6 0 0 13‐Apr Measles Q Shahdadkot Tagar Mohalla, Gologanwas 1 0 0 0 11‐Apr Measles Sibi Village Khajjak 1 0 1 0 9‐Apr Measles S Benazirabad Village Soomar khan Lashari 0 0 5 0 12‐Apr Measles Sibi Village Sawal Machi, Lehri 5 0 3 0 12‐Apr Measles S Benazirabad Village Golo Dahri 0 0 8 8 10‐Apr Measles TM Khan Village Detawah, UC Jhannan 0 0 1 0 10‐Apr Measles Ziarat Killi Ghowash, UC Zindra 0 0 1 0 Killi Murdar kach, UC Ziarat, Tehsil 10‐Apr Measles Tharparkar Bheel Paro, Village Borli Bheel 0 1 0 0 11‐Apr Measles Ziarat 4 2 3 1 Ziarat 12‐Apr Measles Thatta Village Nareeja, UC Makli 1 0 1 0 12‐Apr Measles Ziarat Killi Tangi Dam, UC Zindra 2 2 0 2 13‐Apr Measles Thatta Amri Stop thatta city UC thatta 1 0 0 0 13‐Apr Measles Ziarat Killi Ragha, UC Zindra 0 0 2 0 13‐Apr Measles Thatta Mallah Mohalla, UC Thatta 1 0 0 0 10‐Apr Pertussis Bolan Village Mashkaf, kacchi 1 0 0 0 13‐Apr Measles Thatta Sheedi Mohalla, near Amri Stop 1 1 0 0 Zangi Abad UC Zereena Kattan Tehsil 13‐Apr Pertussis Khuzdar 0 0 1 1 13‐Apr Measles Thatta Village Allah Bachayio Jokhio 5 4 4 3 Khuzdar 13‐Apr Measles Thatta Village Haji Ali Muhammad Soomaro 1 2 1 1 10‐Apr Typhoid Khuzdar Balbal UC Ghat Balbal Tehsil Zehree 0 1 0 1 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]. 05 Special Bulletin: DEWS, Pakistan, Week no. 15 (8 to 14 April 2012) Province Khyber Pakhtunkhwa Province Punjab Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 13‐Apr CCHF D. I. Khan Village Malana, Pakka Malana 0 2 0 0 12‐Apr AD Bhakkar BHU Barkat Wala , UC Daggar Qureshi 9 8 17 3 10‐Apr Diphtheria Shangla Village Mayaro Ser Alpurai 0 0 0 1 9‐Apr AD Layyah BHU Jherkil, UC Samtia, Tehsil Karoor. 11 4 6 2 10‐Apr Diphtheria Shangla Village syed Abad Chakesar 0 0 0 1 9‐Apr AD Layyah BHU Laskani wala, UC Basira, Tehsil Karor. 12 8 15 4 9‐Apr Leishmaniasis Nowshera Chowar Khel, Inzari 0 0 1 0 9‐Apr Leishmaniasis Nowshera Mohallah Bare Khel,Kahi 0 1 0 0 13‐Apr AD Mianwali RHC Wan Bucharan 4 31 6 24 9‐Apr Leishmaniasis Nowshera Mohallah Darbe Khel, Kahi 0 1 0 0 11‐Apr AD Muzaffargarh Muslim Town, Urban Alipur, Tehsil Alipur 36 54 23 78 9‐Apr Leishmaniasis Nowshera Mohallah Karem Khel, Kahi 0 0 0 1 10‐Apr AD RY Khan M Daha, Liaqatpur 17 18 15 28 9‐Apr Leishmaniasis Nowshera Mohallah Kaske Khel, Kahi 1 0 0 0 11‐Apr AD RY Khan Chak Abbass 9 13 6 9 9‐Apr Leishmaniasis Nowshera Mohallah Mula Khel, Inzari 0 0 0 1 10‐Apr AD Rajanpur THQ Jampur, UC jampur Urban 288 102 211 69 9‐Apr Leishmaniasis Nowshera Mohallah Myaz Khel, Inzari 0 2 0 0 11‐Apr AD Rajanpur RHC fazilpur, UC Fazilpur, Tehsil Fazilpur 48 12 31 6 9‐Apr Leishmaniasis Nowshera Mohallah Nasu Khel, Inzari 0 0 0 5 9‐Apr Leishmaniasis Nowshera Mohallah Shain Abad, Inzari 0 0 0 1 13‐Apr AJS Lahore Chungi Amarshadhu 1 1 0 1 9‐Apr Leishmaniasis Nowshera Mohallah Usman Khel, Inzari 0 0 1 0 13‐Apr AJS Mianwali BHU Jalalpur 4 1 1 2 9‐Apr Leishmaniasis Nowshera Mohallah Zanda Khel, Kahi 0 0 0 3 11‐Apr AJS RY Khan UC Trinda Sawaye Khan 1 4 0 1 9‐Apr Leishmaniasis Nowshera Mughal Khel, Kahi 0 0 0 1 11‐Apr ARI Layyah BHU 110 TDA, UC Shahpur, Tehsil Karor 4 7 8 13 9‐Apr Leishmaniasis Nowshera Phase 4, Sector C, Block 6, Tent 48 1 0 0 0 11‐Apr ARI Mianwali BHU Paikhel 31 13 52 14 11‐Apr Leishmaniasis Nowshera Phase 8, Tent 1795 0 0 0 1 9‐Apr ARI Multan Gulzar pur 17 57 5 45 9‐Apr Leishmaniasis Shangla Village Martooba UC Bar Puran 0 1 0 0 10‐Apr Leishmaniasis Shangla Village Banjar UC Alooch 0 1 0 0 9‐Apr ARI Multan Qadir Pur Rawan 27 77 25 83 10‐Apr Measles Abbottabad Mohalla Qasab, Havallian City 1 0 0 0 13‐Apr ARI Rajanpur RHC Kotmitthan, UC Kot Mitthan 57 99 33 75 10‐Apr Measles Abbottabad PMA Quarters, Cant Abbottabad 1 0 0 0 12‐Apr BD RY Khan chak 26NP, Sadiqabad 1 2 0 1 11‐Apr Measles Battagram Village Takkeya, Bandigo, UC Bannia 0 0 1 0 11‐Apr BD Rajanpur BHU Bukahara, UC Bukahra, Tehsil Jampur 1 2 0 1 11‐Apr Measles Charsadda Tobra khel,Prang 0 0 1 0 12‐Apr Chicken Pox Muzaffargarh Mohallah Farooqya, UC KP Bagga Sher 3 3 6 4 12‐Apr Measles Charsadda Muftiabad,Khoray 0 0 1 0 10‐Apr DHF Lahore Samanabad Town 0 0 0 1 10‐Apr Measles D. I. Khan Kulachi 3 0 0 0 10‐Apr Measles D. I. Khan Ramak, Tehsil Paroa 1 0 0 0 10‐Apr Food Poison Rajanpur BHU Islampur, UC Islampur, Tehsil jampur 3 3 2 1 13‐Apr Measles D. I. Khan Bilot Shareef, Tehsil Pahar Pur 0 0 1 0 9‐Apr Leishmaniasis RY Khan Abu Dhabi Colony 0 1 0 0 13‐Apr Measles D. I. Khan Garah Ahmad, Daraban Road 0 0 1 0 10‐Apr Leishmaniasis RY Khan Basti Korai Baloch, Tehsil Liaqatpur 0 1 0 0 13‐Apr Measles D. I. Khan Mardan Pul, Pahar Pur 0 0 1 0 11‐Apr Measles Bhakkar Mandi Town Urban II, Tehsil Bhakkar. 1 0 0 0 13‐Apr Measles D. I. Khan Mohallah Piran Wala, Attal Shareef 1 0 0 0 11‐Apr Measles Bhakkar Mohallah Alamabad Behal Road 1 0 0 0 13‐Apr Measles D. I. Khan Mughal Kot, Darazinda, 1 0 0 0 11‐Apr Measles D. G. Khan Block 29 opposite imam bargah rizvia 2 3 0 2 13‐Apr Measles D. I. Khan Noble Town, City 1, 1 0 0 0 13‐Apr Measles D. I. Khan Village Rohrii, Tehsil Kulachi 1 0 0 0 12‐Apr Measles D. G. Khan Bait Sawae Shadanlund 0 1 1 0 13‐Apr Measles D. I. Khan Zakori Diesel Pump, Pusha Pul 0 0 1 0 12‐Apr Measles D. G. Khan Hero Gharbee 0 0 1 0 9‐Apr Measles Haripur Darband Colony, UC Tarbella 1 0 0 0 11‐Apr Measles Lahore Ferozpur road 0 0 0 1 9‐Apr Measles Haripur Malkiar Road, Muhallah Asifa abad 0 1 0 0 12‐Apr Measles Lahore Wahdat Road 0 0 0 1 10‐Apr Measles Haripur Village Nertopa, Golia Mear 0 0 0 1 9‐Apr Measles Layyah Basti Sheerah, Moaza Shahuwala Khucha 1 0 0 1 11‐Apr Measles Haripur Muhallah Khiva, UC Khalabut 2 1 1 0 12‐Apr Measles Mianwali Wandhi Loharan Wali,Ghilmann,Kalorkot 0 1 0 0 13‐Apr Measles Haripur Afghan Refugee camp UC Panian 1 0 0 0 12‐Apr Measles Kohat Doaba, UC Darsamand 0 0 1 0 13‐Apr Measles Mianwali Mohallah Noorpur,Mianwaly city 1 0 0 0 12‐Apr Measles Kohat Near high school, UC Surgul 0 1 0 0 10‐Apr Measles Muzaffargarh Basti Moharan, UC City‐3 1 0 0 0 12‐Apr Measles Lakki Marwat Village Thal Phar Khel 0 1 0 0 11‐Apr Measles Muzaffargarh Basti Kakwani Wala, UC Ghalwan 0 0 1 0 12‐Apr Measles Lower Dir Village Nway Kalay 0 0 1 0 13‐Apr Measles Muzaffargarh Basti Budhoo Wali 3 1 0 1 9‐Apr Measles Malakand Aladand 2 0 2 0 9‐Apr Measles RY Khan Abdullah colony Sadiqabad 1 0 0 0 10‐Apr Measles Malakand Kashmir Kili 0 0 0 1 9‐Apr Measles RY Khan Basti Jindwali, Mianwali Sheikhan 0 0 1 0 10‐Apr Measles Malakand Thana 0 0 1 0 10‐Apr Measles Malakand Totakan 0 1 0 0 9‐Apr Measles RY Khan UC 38i, City 0 0 0 1 13‐Apr Measles Malakand Pirkhel 0 0 1 0 10‐Apr Measles Rajanpur Mohalla Massan Shah, UC Jampur Urban 1 0 0 0 11‐Apr Measles Mansehra Mohallah Moori Chakiya UC Data 0 1 0 0 12‐Apr Measles Rajanpur Basti Peer Bukhsh, Moza Jamal Shah 2 0 3 1 14‐Apr Measles Mansehra Dab # 1 MC4 0 0 1 0 12‐Apr Measles Rajanpur Mohalla Imam Bargaah, Ward No‐1 2 0 0 0 13‐Apr Measles Mardan Village Shahi Bagh, UC Guli Bagh 1 0 0 0 12‐Apr NNT Multan Dehli Gate, Multan 1 0 0 0 9‐Apr Measles Nowshera Bahram Kalay, BHU Bahram Kalay 0 0 2 0 12‐Apr NNT Muzaffargarh 9‐Apr Measles Nowshera Khweshgi Bala 0 1 1 0 Jinnah Colony, Chak 505/TDA, UC 518/ 1 0 0 0 11‐Apr Measles Nowshera Kurvi, Mohallah: Qazyaan Payaan 0 1 0 0 10‐Apr NNT RY Khan UC Janpur 0 0 1 0 11‐Apr Measles Nowshera Mohallah Miagaan, Village Akbarpura 0 1 0 0 9‐Apr Scabies Layyah BHU Laskani wala, UC Basira, Tehsil Karor. 5 6 3 10 11‐Apr Measles Nowshera Mohallah Saidaan, Village Akbarpura 0 0 0 1 9‐Apr Scabies Multan Qadir Pur Rawan 12 47 1 79 12‐Apr Measles Nowshera Phase 04, B‐5, Tent: 94, Jalozai Camp. 0 0 1 0 11‐Apr Scabies Muzaffargarh THQ Alipur 6 11 4 18 13‐Apr Measles Nowshera Khyber Agency 0 1 0 0 10‐Apr Scabies RY Khan M Daha, Liaqatpur 9 34 11 28 13‐Apr Measles Nowshera Phase 4, Sector B, Block 5, Tent 94 0 0 1 0 13‐Apr Measles Nowshera Registration no. 104786 1 0 0 0 11‐Apr Scabies Rajanpur RHC fazilpur, UC Fazilpur, Tehsil Fazilpur 12 28 16 28 8‐Apr Measles Shangla Alooch Puran 1 0 0 0 13‐Apr Scabies Rajanpur RHC Kotmitthan, UC Kot Mitthan 21 39 18 35 8‐Apr Measles Shangla Bar Puran 0 0 1 0 9‐Apr Tetanus Lahore Khana kacha 0 1 0 0 10‐Apr Measles Swabi Private Clinic, Checknoda 3 1 1 0 10‐Apr Tetanus Lahore Allama Iqbal Town 0 1 0 0 11‐Apr Measles Swabi Private Clinic, Dudher, Tandkohi 1 3 1 1 10‐Apr Typhoid Bhakkar RHC Behal, UC Behal, Tehsil Bhakkar. 0 1 0 3 9‐Apr Measles Swat Village Bama Khela, UC & Tehsil Matta 0 0 1 0 10‐Apr Typhoid Layyah BHU Paharpur, UC Pahar Pur 0 2 0 1 9‐Apr Measles Swat Village Sambat UC Baidara 0 0 1 0 10‐Apr Measles Swat Village Mandal Dag, UC Gwalerai 0 0 1 0 11‐Apr Typhoid Mianwali RHC Daudkheel 2 7 3 7 10‐Apr Measles Swat Village Salanda Manglore 0 1 0 0 10‐Apr Typhoid Multan Nawab pur 0 2 0 0 11‐Apr Measles Swat Village Goray Kale Manglore 0 0 1 0 11‐Apr Typhoid Muzaffargarh RHC Rohillanwali, Tehsil MZG 0 2 1 1 12‐Apr Measles Swat Village and UC Sangota, Tehsil Babuzai 0 0 1 0 11‐Apr Typhoid Muzaffargarh THQ Alipur 1 1 0 1 13‐Apr Measles Tank Maghzai 1 0 1 1 12‐Apr Typhoid Muzaffargarh 632/TDA, Kotaddu 0 2 0 0 13‐Apr Measles Tank Qutab colony 0 1 1 0 12‐Apr Typhoid Muzaffargarh RHC CS Shaheed, Kotaddu 1 2 1 0 10‐Apr NNT Bannu Village Asmat Kala Khujari 0 1 0 0 10‐Apr NNT Bannu Village Sher Gul Khan Kala Khujari 1 0 0 0 11‐Apr Typhoid RY Khan UC Trinda Sawaye Khan 3 7 1 5 11‐Apr NNT Bannu People Bazaar Dowishta 1 0 0 0 9‐Apr Typhoid Rajanpur DHQ Rajanpur, UC Rajanpur Fharbi 2 7 1 5

100000 of Acute diarrhoea 5,851,999 (9%) 75000 Bloody diarrhoea 509,515 (<1%) 50000 number 25000 Suspected malaria 3,927,321 (6%) 0 < 1 yr 1‐4 yr 5‐14 yr 15‐50 yr 50 + yr Unexplained fever 2,483,741 (4%) Male 25566 52332 68568 107500 52168 Female 24651 49135 70624 176023 57711 Total consultations 66,288,691 Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response 2010 2011 2012 (up till week 15) Total Disease A O A O A O A O Acute watery diarrhoea 209 85 1350 543 87 3 1646 631 Acute jaundice syndrome 5 2 51 17 46 4 102 23 Bloody diarrhoea 10 1 98 20 43 4 151 25 Dengue fever 81 32 785 111 24 2 890 145 Measles 48 6 1710 91 1207 78 2965 175 Pertussis 1 0 287 81 193 67 481 148 NNT + tetanus 5 0 399 0 206 0 610 0 Malaria 12 7 131 88 18 7 161 102 Leishmaniasis 1 0 298 33 297 28 596 61 Others 75 11 643 69 452 43 1170 123 Total 447 144 5752 1053 2573 236 8772 1433 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • 465 health facilities from 18 districts of Khyber 50 Pakhtunkhwa reported to DEWS on weekly basis with AD BD ARI S. Malaria a total of 114,713 patients consultations in week 15, 45 2012. 40 35 • 76 alerts were reported in week 15; Altogether 53 for 30 25

Measles; 16 for Leishmaniasis; 4 for NNT; 2 for Diph- Percentage theria; while 1 for CCHF. 20 15 • 2 outbreaks for Measles were identified and appropri- 10 ate measure were taken. 5 0 1 3 5 7 9 1 3 5 7 9

15 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 11 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 Province Sindh: Figure-4: Trend of priority communicable diseases, province Sindh • 491 health facilities from 22 districts in Sindh reported on weekly basis to DEWS with a total of 253,740 patient 50 AD BD ARI S. Malaria consultations in week 15, 2012. 45 40 • 66 alerts were reported; Altogether 49 for Measles; 9 for 35 Pertussis; 3 each for AWD and NNT; while 1 each for 30 25 Typhoid and Scabies. Percentage 20 15 • 11 outbreaks, 7 for Pertussis; 4 for Measles were identi- 10

fied and appropriate measures were taken. 5 0 1 3 5 7 9 1 3 5 7 9

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

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

15 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 11 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 Province Balochistan: Figure-6: Trend of priority communicable diseases, province Balochistan • 425 health facilities from 19 districts in Balochistan reported to DEWS, with a total of 66,869 patient con- 50 AD BD ARI S. Malaria sultations. 45

40 • 31 alerts were reported in week 15 from Balochistan; 35 Altogether 18 for Measles; 10 for Leishmaniasis; 2 for 30 Pertussis; while 1 for Typhoid. 25

Percentage 20

• 7 outbreaks, 6 for Measles; while 1 for Leishmaniasis 15

were identified and appropriate measures were taken. 10

0 2 4 6 8 2 4 6 8

10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 10 12 14

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 Province Gilgit Baltistan:

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan

• 19 health facilities from 2 districts in Gilgit Baltistan 50 reported to DEWS in week 15, with a total of 4,881 pa- 45 AD BD ARI S. Malaria tient consultations. 40 35 • Less number of report were received because of ongo- 30 ing unstable situation in Gilgit Baltistan. 25 Percentage 20 15 • No alerts were received for any disease from any area 10 of Gilgit Baltistan. 5 0 1 2 3 4 5 6 7 8 9

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 10 11 12 13 14 15

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 State of Azad Jammu and Kashmir: FATA:

• 146 health facilities from 10 districts reported to DEWS in this • 52 health facilities from 3 agencies reported from FATA in week with a total of 28,050 patient consultations. this week, with a total of 15,263 patient consultations.

• 2 alerts, 1 each for AJS and Leishmaniasis were received and • 8 alerts, 4 for NNT; 3 for Measles; while 1 for Leishmaniasis appropriated measures were taken. were received and appropriate measures were taken.

50 50 AD BD ARI S. Malaria AD BD ARI S. Malaria 40 40

30 30

20 Percentage Percentage

10 10

0 0 6 8 2 4 6 8

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 10 12 14

10 12 14 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

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

In the youngest infants, the paroxysms may be followed by periods of apnea. Pneumonia is a relatively common complication; seizures and encephalopathy occur more rarely. Untreated patients may be contagious for three weeks or more following onset of the cough. Pertussis can be prevented by immunization.

Estimates from WHO suggest that, in 2008, about 16 million cases of pertussis occurred worldwide, 95% of which were in developing coun‐ tries, and that about 195,000 children died from the disease.

In 2011, WHO‐DEWS team had investigated 287 Alerts and Outbreaks out of which 81 were big outbreaks. In addition, 1477 suspected cases and 5 deaths in children with Pertussis have also been reported. However, Since January to 15 April 2012, 126 alerts and 67 outbreaks of Pertussis have been reported.

Graph given below shows the province wise distribution of the alerts and outbreaks in 2011:

80 Alerts Outbreaks Deaths 68 70 68 62 60

40 36

30 25

10 9 6 7 3 2 3 2 0 Sindh Balochistan KPK Punjab GB FATA AJK

Case Investigation and Response:

Pertussis cases are reported to local or state health departments by physicians, nurses, hospital or laboratory staff, or families. These sus‐ pected cases should be investigated as soon as they are reported. Following is a flow chart of pertussis case and contact investigation:

Identify suspected cases, collect nasopharyngeal swab or aspirate for culture, and start antibiotic treatment

If pertussis is highly suspected, identify and recommend chemoprophylaxis to close contacts. If suspicion of pertussis is low (i.e., spo‐ radic case, no epidemiologic linkage to a confirmed Pertussis case, no paroxysms, etc.), investigators may wait for laboratory confirma‐ tion of the case to initiate contact search and recommendation for prophylaxis.

Implement outbreak control measures appropriate for the setting

Initiate active surveillance and continue for at least 42 days after cough onset of last case