Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Home , Badin, Dera Murad Jamali, Ghotki, Khuzdar, Kot Chandna, Mardan Tehsil

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 2, Issue 41, Monday 17 October, 2011

Highlights Priority diseases

under surveillance Epidemiological week no. 41 (7 to 13 October, 2011) in DEWS

Acute Flaccid Paralysis (AFP) • 80 districts and 2 agencies provided surveillance data to the DEWS this week from 2,537 health facilities. Acute Jaundice Syndrome (AJS)

Acute Respiratory Infections • A total of 973,066 consultations were reported through DEWS of which 206,950 (22%) (Upper and Lower) (ARI) were acute respiratory infections (ARI), 91,550 (11%) were Skin disease, 86,882 (10%) were acute diarrhoea, and 83,649 (6%) were suspected Malaria. Acute Watery Diarrhoea (AWD)/ Suspected Cholera

• A total of 188 alerts with 15 outbreaks were reported in week-41, 2011: Altogether 89 for Acute Bloody Diarrhoea (BD) DHF; 27 for AWD; 27 for Measles;17 for Neonatal Tetanus and Tetanus; 11 for Leishma- Other Acute Diarrhoeas (AD) niasis; 8 for Malaria; 2 each for Diphtheria, Meningitis and Pertussis; while 1 each for Acute jaundice syndrome, Bloody diarrhoea and Typhoid. Suspected Viral Hemorrhagic Fever (VHF) • National Polio Eradication Initiative reported eight new polio cases including seven type-1 Suspected Malaria (Mal) cases from Balochistan (two each from Quetta & Pishin and one from Loralai) and FATA (one each from Khyber and South Waziristan agencies) and one type-3 polio case from Suspected Measles (MS)

FATA (Khyber agency). One polio case (from Nowshera district in Khyber Pakhtunkhwa Suspected Meningitis (MG) province) has been reversed by the laboratory based on the results of the genomic sequenc- ing. As of 17th October, Pakistan has reported a total of 118 polio cases (116 type-1 & 2 Others type-3) from 37 districts/towns/tribal agencies/areas.

Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 13 October 2011 (Epi week 31, 2010 to week 41, 2011)

35 AD BD ARI S. Malaria

20 Percentage 15

0 1 3 5 7 9

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

‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 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

Disease Wk-34 Wk-35 Wk-36 Wk-37 Wk-38 Wk-39 Wk-40 Wk-41 Acute diarrhoea 94,494 (11%) 40,403 (10%) 96,128 (11%) 109,523 (12%) 110,835 (11%) 105,295 (11%) 96,749 (10%) 86,882 (9%)

Suspected malaria 60,222 (7%) 22,729 (6%) 58,753 (7%) 64,766 (7%) 78,109 (8%) 83,684 (8%) 82,541 (8%) 83,649 (9%)

Total consultation 880,166 389,729 864,693 931,318 1,005,251 995,450 1,012,744 973,066 Since July 29, 2010, approximately 48,583,865 patient consultations have been reported to the DEWS from all provinces and three agencies and state of AJK. From last 5 weeks (37 to 41, 2011) acute diarrhoea cases have been decreasing by 3%, while at the same time cases of sea‐ sonal suspected malaria have been increasing by 3%. Majority of the malaria cases were reported from districts in Sindh and Balochistan. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS.

Leishmani‐ Balochis‐ Jhal Kotra UC Khari CD Kotra 6 cases were reported. Cases were checked and investigated. Health hygiene Sensitization was 12‐Oct 1 5 0 0 asis tan Magsi Tehsil Gandawah conducted. Treatment was given and DHO was informed.

20 Malaria cases were observed. Slide test was taken and all found positive PF=8 and PV=12 Balochis‐ 11‐Oct Malaria Chagai DHQ Dalbandin town 0 0 0 0 while no for mix (SPR= 100% while FR = 40%). Case management reinforced. RDTs were further tan distributed and DHO was requested for Bed nets. one malaria alert was reported. Investigation was carried out. 53 samples were tested 25 came Balochis‐ Jhal Barija UC Barija BHU 7‐Oct Malaria 11 22 7 13 positive (11 fal,10 viva and 4 mixed). RDTs were provided and issue was also discussed with DHO tan Magsi Barija Tehsil Jhal Magsi for further preventive measures

DHQ hospital Chilas received two patients of suspected Pertussis. On field investigation found 11 more cases. Some cases had months of history and some had history of weeks. Vaccination status assessed and found all children unimmunized. Erythromycin advised to all the cases and DHQ Hospital, village 13‐Oct Pertussis GB Diamir 4 1 7 1 contacts. Health education given about patient care and importance of vaccination. Direct all the Jaleel, Chilas unimmunized children to nearby health facility for vaccination.EDO health informed about the patients.EDO health deployed a vaccination team to the locality for vaccination. Throat swab taken and sent to NIH.

Detailed Investigations done, Case was reported by MDM‐F from DTC running in DHQ hospital, EHA‐Team went to the residence of the patient and carried out detailed investigations, 1 sample Afghan Refugee camp, 7‐Oct AWD KPK Kohat 0 0 1 0 was collected and sent to NIH for confirmation and was found positive for V.c. Ogawa. Health Ghulam Banda and Hygiene session conducted with the family and neighboring households, ORS Sachets pro‐ vided to the affected family, EDO‐H informed and alerted.

Alert for AWD, patient was admitted in DTC, RHC Pattan. Active surveillance was done in Village Village Kuz Sherial, UC Kuz Sheriayl, no more cases were found. EDO‐H was informed. Health and hygiene education 8‐Oct AWD KPK Kohistan 0 0 0 1 Shariyal, Tehsil Palas provided to the households and to the community. 1 stool sample was taken and sent to NIH for lab confirmation. The result was reported positive for V.c Ogawa.

DPO Kohistan was informed about “a Cholera Epidemic” in village Sazeen by SHO Police Station Sazeen. The DPO informed SO DEWS about it. According to the MT of RHC Shatiyal, he has treated five cases from one house of Sazeen village in the last one week. Active surveillance was Village Sazeen, UC 12‐Oct AWD KPK Kohistan 0 2 2 5 done in Village Sazeen (Kot and Dogga). Four more cases were found. Health & hygiene educa‐ Sazeen, Tehsil Dassu tion provided to the household and to the community. EDO‐H was informed about the cases. Aqua Tabs distributed. Sample was taken and sent to NIH for culture and sensitivity and lab confirmation of Cholera. Patients were rehydrated and were stable.

31 patients of suspected Malaria tested with RDT‐kit were positive for PF, MCP with partners like Bajaur Village Talay, Tehsil 12‐Oct Malaria KPK 5 8 7 11 Merlin & ACD is mobilized and a Mass Screening day is carried out in the village for free testing Agency Salarzai and treatment of positive cases.

1 Suspected case was reported, resident of Chaina Wala. On active surveillance no more case Basti Chaina Wali, UC 8‐Oct AWD Punjab Bhakkar 0 1 0 0 was found, Health and hygiene session given, ORS use was explained, rectal swab in carryblair Katchi Shahani sent to NIH which was found positive for V.c. Ogawa, follow up planned.

Alert for Leishmaniasis, patients registered and line list is maintained, Training of health care Leishmani‐ Jallalpoor, kalookhel, Kot provider for Leishmaniasis treatment and prevention done by IRC, Patient were screened by 13‐Oct Punjab Mianwali 0 5 1 3 asis chandna UC DDOH for IM and IL injections, Duty of dispenser in Jallapoor BHU to collect injections from EDO (H) office, Malaria Program requested for fogging and IRs of the area.

3 Suspected cases found with no severe dehydration in field investigation, Reinforced case man‐ Malik Shah Nawaz Land, agement, the source of water is open well, provide IEC material to LHW regarding health and Jam‐ 11‐Oct AWD Sindh UC. A,B Shoro, Taluka 1 1 0 1 Hygiene, Health education was imparted and sensitized regarding Proper hand washing, Aqua shoro Kotri tabs, ORS and Zinc tabs provided, 1 Stool sample collected and found positive for V.c. Ogawa, 2 water sample also collected. Suspected case was found in hospital, active surveillance done, Hand pump was the source of water, health education imparted, Aqua tabs and Hygiene kits provided, 1 case reported. Stool 10‐Oct AWD Sindh TM Khan Naseerabad, UC‐3 0 0 0 1 sample collected and transported to NIH for confirmation which was reported positive for V.c. Ogawa.

19 Suspected cases found with no severe dehydration in field investigation, Reinforced case Village Ghamori, Palli Umer management, provide Aqua tabs, Water filters, Hygiene kits, Jerry cans and ORS to LHW regard‐ 11‐Oct AWD Sindh Mohalla, UC Sabho, 4 5 6 4 Kot ing health and Hygiene, Health education imparted and sensitized regarding Proper hand wash‐ Taluka Umerkot ing, Aqua tabs, ORS and Zinc tabs provided, 1 Stool and 2 water samples collected.

Village Nabi Buksh 9 suspected cases of malaria out of which 8 were confirmed by RDT (SPR = 89%), bed nets distrib‐ 10‐Oct Malaria Sindh Badin Kambo, UC Malan, Taluka 1 3 3 2 uted, Anti Malaria therapy done, Health education imparted, Malaria supervisor, MS DHMT were Matli informed and requested for spray and fumigation.

Malaria outbreak reported, field investigation completed, a total of 142 slides were taken, out of Village Arab Machhi, UC which 24 positive falciparum and 38 Vivax declared (SPR = 44% while FR = 39%). Medical camp 7‐Oct Malaria Sindh Khairpur 50 25 50 25 Kumb, taluka Kot Diji established by EDOH and SDPP teams, more 500 OPD screened, LHW involved for health & hy‐ giene session, IEC were distributed in the affected community. Urgent need of bed nets.

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, 02 Epidemiological Bulletin: DEWS, Pakistan, Week no. 41 (7 to 13 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 7‐Oct AWD Dadu Village Bhai Khan Lashari, UC Syal 1 3 0 1 13‐Oct AJS Layyah TDA colony 1 0 0 2 8‐Oct AWD Bhakkar Basti Chaina Wali, UC Katchi Shahani 0 1 0 0 10‐Oct AWD Dadu Village Sim, UC Torr, Taluka Johi 0 0 0 0 12‐Oct AWD Bhakkar Nazir Town, UC Bhakkar Urban II 0 1 0 0 12‐Oct AWD Dadu Najam Colony City Dadu 0 0 0 1 Chah Lahoree wala Moza Samina Gharbee uc 10‐Oct AWD DG Khan 0 0 0 1 Samina 11‐Oct AWD Hyderabad Chistiya Masjid, Block D, Latifabad #2 0 0 0 1 12‐Oct AWD RY Khan Jamal Din Wali 0 0 0 2 Tanga Stand, Diyaldas Compound Phuleli, UC‐ 11‐Oct AWD Hyderabad 0 1 0 0 12‐Oct AWD RY Khan UC Kot Karam Khan 0 0 0 1 3 Malik Shah Nawaz Land, UC. A,B Shoro, 7‐Oct DHF Bhakkar DHQ Hospital Bhakkar, Nalka Chadranwala 0 1 0 0 11‐Oct AWD Jamshoro 1 1 0 1 DHQ Hospital Bhakkar‐Chak # 24/TDA Taluka Kotri 10‐Oct DHF Bhakkar 0 0 0 1 UC‐Ghanghra, Village Mohamed bux Mangrio Daryakhan Bhakkar 8‐Oct AWD N Feroze 0 0 1 1 DHQ Hospital Bhakkar‐Chak # 33/TDA Taluka kandiaro 10‐Oct DHF Bhakkar 0 0 1 0 Village Niaz Khan Boldani, UC Jatia, Taluka Bhakkar. 7‐Oct AWD Sanghar 1 2 0 0 DHQ Hospital Bhakkar, Basti Qurashianwala Shahdadpur 11‐Oct DHF Bhakkar 0 1 0 0 Karoor Chak # 24/TDA 8‐Oct AWD Shikarpur Near Public School, Rustam road 2 0 0 1 DHQ Hospital Bhakkar, Chak # 67/TDA 11‐Oct DHF Bhakkar 0 1 0 0 10‐Oct AWD TM Khan Naseerabad, UC‐3 0 0 0 1 Sarai Muhajir Bhakkar 11‐Oct DHF Bhakkar DHQ Hospital Bhakkar, Mandi Town Bhakkar 0 1 0 0 Village Sahib Khan Laghari, UC Tando Allahyar 12‐Oct AWD TM Khan 1 0 0 0 turk 11‐Oct DHF Bhakkar DHQ Hospital Bhakkar, Moza Dargolla 0 1 0 0 9‐Oct AWD Tharparkar Village Mondro, UC Nagarparkar 1 0 0 0 13‐Oct DHF DG Khan Nishter Hospital Multan‐ DG Khan 0 3 0 0 13‐Oct DHF DG Khan Village Sokar uc sokar Tehsil Taunsa 0 1 0 0 10‐Oct AWD Tharparkar Chandio Paro Mondro Thar 1 0 0 0 13‐Oct DHF Jhang Nishter Hospital Multan‐ Jhang 0 2 0 0 8‐Oct AWD Thatta Sujawal City 0 2 0 0 13‐Oct DHF Khanewal Nishter Hospital Multan‐ Khanewal 0 8 0 0 FAP Tent Village, near Village Araro Burguri, 13‐Oct DHF Lahore Nishter Hospital Multan‐ Lahore 0 0 0 2 8‐Oct AWD Umer Kot 0 0 0 0 UC Araro Burguri, Taluka Samaro. 7‐Oct DHF Layyah Basti ehsan pur u/c pharpur 0 1 0 0 Village Ghamori, Palli Mohalla, UC Sabho, 11‐Oct AWD Umer Kot 4 5 6 4 9‐Oct DHF Layyah 150 TDA layyah 0 1 0 0 Taluka Umerkot 9‐Oct DHF Layyah Chak no 217 TDA Fatehpur 0 1 0 0 8‐Oct DHF Ghotki Peer Qasim Mohalla 0 0 0 1 10‐Oct DHF Layyah Basti shahnawaz 0 1 0 0 7‐Oct DHF Jacobabad DHQ Jacobabad 0 1 0 0 11‐Oct DHF Layyah Peer jagi more u/c ladhana 0 1 0 0 12‐Oct DHF Layyah Chak no 134 Tda 0 1 0 0 12‐Oct DHF Karachi Chakiwara, Lee Market, Saddar Town 0 1 0 0 13‐Oct DHF Layyah Mohallah eidgah urban 2 city 0 1 0 0 Gazar Abad, Street 52, Mehrunesa Manzil, 12‐Oct DHF Karachi 0 1 0 0 7‐Oct DHF Mianwali Mohallah Hashim Shah 0 1 0 0 Sadar Town 7‐Oct DHF Mianwali Mohallah Phatoon Khela wala, Shadia 0 1 0 0 Garden West, Near Mohammadi Masjid, 13‐Oct DHF Karachi 0 0 0 1 Sadar Town. 8‐Oct DHF Mianwali Paka Ganjera,Wam Bucharan 0 1 0 0 12‐Oct DHF Mianwali Ban Hafiz,chakrala 0 1 0 0 13‐Oct DHF Karachi Momin Abad, Street 4/F, Orangi Town 0 1 0 0 13‐Oct DHF Multan Nishter Hospital Multan‐Multan City 0 10 0 3 13‐Oct DHF Karachi Street 2/C, Landi Town, N‐Karachi 0 1 0 0 12‐Oct DHF Muzaffargarh Mohallah Khurshid Abad, UC Lutkeran 0 1 0 0 Basti Chavind Wali, Moza & UC Qasba Gujrat, 9‐Oct DHF Kashmore Village Khahi, taluka Kashmore 0 1 0 0 13‐Oct DHF Muzaffargarh 0 1 0 0 Kotaddu 8‐Oct DHF Khairpur GIMS taluka Gambat 0 2 0 0 13‐Oct DHF Muzaffargarh Nishter Hospital Multan‐ Muzaffargarh 0 7 0 1 10‐Oct DHF Khairpur Village Mohal, Garhi Yaseen 0 0 0 1 13‐Oct DHF Pakpattan Nishter Hospital Multan‐ Pakpattan 0 2 0 0 7‐Oct DHF RY Khan Azeem Town, Sadiqabad 0 1 0 0 8‐Oct DHF N Feroze GIMS taluka Gambat 0 1 0 0 7‐Oct DHF RY Khan Chak no.35/A Liaquatpur 0 1 0 0 9‐Oct DHF N Feroze UC‐DK Maree, DK, Mari city 0 0 0 1 7‐Oct DHF RY Khan Mohala Imam Bargha Sadiqabad 0 1 0 0 8‐Oct DHF Benazirabad Taj Colony UC. 6, Taluka Nawabshah 0 1 0 0 7‐Oct DHF RY Khan Zafar Colony, St. No.01 0 0 0 1 8‐Oct DHF RY Khan Jamal Din Wali Road Chongi No.8 Latif Abad 0 1 0 0 8‐Oct DHF Benazirabad Village Ghulam Jeelani, 68 Mori, Taluka Daur 0 1 0 0 8‐Oct DHF RY Khan Khai Khair Shah Khanpur 0 1 0 0 11‐Oct DHF Benazirabad Pir Zakiri, UC Pir Zakiri, Taluka Sakrand 0 1 0 0 8‐Oct DHF RY Khan Mian Mad Darbari St.No.21 0 1 0 0 Basti Ghulam Sarwar Marazi, Mouza Kacha 10‐Oct DHF Shikarpur DHQ Shikarpur 1 0 0 0 9‐Oct DHF RY Khan 0 1 0 0 Chowhan 8‐Oct DHF Sukkur GMC Hospital 0 1 0 0 Street NO.7 Azizabad, near Rehmat Science 9‐Oct DHF RY Khan 0 1 0 0 High School 10‐Oct DHF Sukkur GMC Sukkur 0 3 1 0 9‐Oct DHF RY Khan Street. NO.10 Jinnah Park City 0 1 0 0 Village Nabi Buksh Kambo, UC Malan, Taluka 10‐Oct Malaria Badin 1 3 3 2 10‐Oct DHF RY Khan Chak No.159/P Tehsil Sadiqabad 0 0 0 1 Matli 10‐Oct DHF RY Khan Chak NO.79/A Ferroza Tehsil Liaqatpur 0 1 0 0 10‐Oct Malaria Badin Village Qadar Bux colony, UC Matli 2 2 1 2 House No.94/A Mouhalla Islam Pura, Sher 10‐Oct DHF RY Khan 0 0 0 1 Village Mir Muhammad Shaikh, UC Khorwah, Ghar Road Mailsi 12‐Oct Malaria Badin 3 2 2 2 Taluka Golarchi 10‐Oct DHF RY Khan Vilage Haji Ali Murad Kazani Tehsil Mathal 0 1 0 0 7‐Oct Malaria Khairpur Village Arab Machhi, UC Kumb, taluka Kot Diji 50 25 50 25 11‐Oct DHF RY Khan Chak Abbass 0 1 0 0 11‐Oct DHF RY Khan Chak No.188/P Tehsil Sadiqabad 0 1 0 0 8‐Oct Malaria Tharparkar Village Keetar, UC Kheensar, Taluka Chachro 0 0 0 0 11‐Oct DHF RY Khan Mujahid Colony Street # 04 Tehsil Sadiqabad 0 1 0 0 7‐Oct Measles Ghotki village Arab Kalwar UC Bereri 0 1 0 0 11‐Oct DHF RY Khan Treen Colony, House No.27 0 1 0 0 Mohallah Hussain Abad , St, No.1 Tehsil 8‐Oct Measles Shikarpur Wazirabad, taluka Lakhi 0 0 1 0 12‐Oct DHF RY Khan 0 1 0 0 Sadiqabad 8‐Oct Measles Tharparkar Village Chachi, UC Chachro, Taluka Chachro 1 0 0 3 12‐Oct DHF RY Khan Rao Town, Tehsil Sadiqabad 0 1 0 0 12‐Oct DHF RY Khan Shafi Town, Shahbaz Pur Raod 0 0 0 1 11‐Oct NNT Badin Village Rahuki, Taluka Golarchi 1 0 0 0 12‐Oct DHF RY Khan Tareen Colony, Sui Gas 0 1 0 0 Village Mino Bozdar, UC Jarwar, taluka 9‐Oct NNT Ghotki 1 0 0 0 Mirpur Mathelo 13‐Oct DHF RY Khan Nursing Hostel, Sheikh Zayed Hospital 0 0 0 1 13‐Oct DHF Sahiwal Nishter Hospital Multan‐Sahiwal 0 2 0 0 12‐Oct NNT Ghotki Village Mevo Bozdar, UC Jarwar 1 0 0 0 13‐Oct DHF Vehari Nishter Hospital Multan‐Vehari 0 11 0 1 10‐Oct NNT Karachi Neonatal ICU, NICH, Jamshed Tawn 1 0 0 0 Leishma‐ 13‐Oct Mianwali Jallalpoor, kalookhel, Kot chandna UC 0 5 1 3 niasis 13‐Oct NNT Karachi Neonatal ICU, NICH 0 0 1 0 11‐Oct NNT Muzaffargarh Basti Bhatian, UC Noohan Wali 1 0 0 0 8‐Oct NNT Benazirabad Village Maqsoodo Rind, Taluka Shahdadpur. 1 0 0 0 Basti Shah Wala, Moza Robella, UC Alurid, 11‐Oct NNT Muzaffargarh 1 0 0 0 Qambar Village Achar Magsi, UC Hazarwah, taluka Kotaddu 8‐Oct Tetanus 0 1 0 0 Basti Deero Dildar, Moza Sargaani, UC Urban Shahdadkot Qubo Saeed Khan 13‐Oct NNT Rajanpur 1 0 0 0 Qambar Rojhan 11‐Oct Tetanus Village Chajjra, taluka Qambar 0 0 0 1 Shahdadkot 13‐Oct NNT Rajanpur Basti Math Wah, Chak Dilbar, UC Rojhan 1 0 0 0 Qambar Basti Jam Iqbal, Moza Patni, UC Muhammad 12‐Oct Tetanus Village Qaim Khan Lanjwani, taluka Sijawal 1 0 0 0 13‐Oct Tetanus Rajanpur 0 1 0 0 Shahdadkot Pur 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, 03 Epidemiological Bulletin: DEWS, Pakistan, Week no. 41 (7 to 13 October, 2011) Current week's Alerts: Province Khyber Pakhtunkhwa Current week's Alerts: Province Balochistan Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 7‐Oct AWD Kohat Afghan Refugee camp, Ghulam Banda 0 0 1 0 12‐Oct Leishmaniasis Jhal Magsi Kotra UC Khari CD Kotra Tehsil Gandawah 1 5 0 0 8‐Oct AWD Kohistan Kohistan 0 0 0 1 Pach UC Khari DHQ Hospital Gandawah Tehsil 13‐Oct Leishmaniasis Jhal Magsi 0 1 0 0 8‐Oct AWD Kohistan Village Kuz Sherial, UC Shariyal, Tehsil Palas 0 0 0 1 Gandawah 12‐Oct AWD Kohistan Village Sazeen, UC Sazeen, Tehsil Dassu 0 2 2 5 9‐Oct Leishmaniasis Kech Sahahitump UC Koshkalat 0 1 0 0 7‐Oct AWD Shangla Village Basi kelay 0 1 0 1 11‐Oct Leishmaniasis Khuzdar Tehsil Khuzdar 0 2 1 0 12‐Oct AWD Shangla Village Pagorai/UC Mian Kele 0 0 0 1 7‐Oct Leishmaniasis Quetta Hazara town, Brewery road 0 1 0 0 11‐Oct DHF Battagram Jaba Chanar, UC Ajmera 0 1 0 0 13‐Oct Leishmaniasis Quetta Hazara Town 0 1 0 3 11‐Oct DHF Battagram Maidan Matta, UC Ajmaira, Tehsil Batagram 0 1 0 0 11‐Oct DHF D. I. Khan Band Kurai, Tehsil Paharpur 0 0 1 0 13‐Oct Leishmaniasis Quetta Pashtoon abad 1 0 1 1

7‐Oct DHF Haripur Village Bagra, UC bagra 0 1 0 0 12‐Oct Leishmaniasis Sibi Allahabad UC#3 0 1 0 0 8‐Oct DHF Haripur Naseem Town Haripur city 0 1 0 0 13‐Oct Leishmaniasis Sibi Bolan Market UC#2 0 1 0 0 10‐Oct DHF Haripur Afghan Refugee camp 15 0 1 0 0 12‐Oct Leishmaniasis Ziarat Chutair 0 1 0 0 11‐Oct DHF Haripur Village Khaido, UC Syria 0 3 1 0 12‐Oct DHF Haripur Village Sikandarpur UC Sikandarpur 0 1 0 0 11‐Oct Malaria Chagai DHQ Dalbandin town 0 0 0 0

13‐Oct DHF Haripur Village Bagra, UC Bagra 0 1 0 0 7‐Oct Malaria Jhal Magsi Barija UC Barija BHU Barija Tehsil Jhal Magsi 11 22 7 13 10‐Oct DHF Mansehra Bajna 0 1 0 0 11‐Oct Measles Khuzdar Koshk UC Gazgi Tehsil Khuzdar 0 0 1 0 10‐Oct DHF Mansehra Dhodial 0 1 0 0 13‐Oct Measles Lasbela Jam Colony UC Pathra, HUB 2 0 0 0 10‐Oct DHF Mansehra Hassa Balakot 0 1 0 0 Union Council ,Chitkan Brohi Mohallah 10‐Oct DHF Mansehra Kary Nawaz abad UC Sachan 0 1 0 0 10‐Oct Measles Panjgur 0 2 0 0 Gareeb Abad District Panjgur 10‐Oct DHF Mansehra Mohallah Balyani Balakot 0 1 0 0 Union Council Essai Mohalla Sandhay ser, 10‐Oct Measles Panjgur 0 0 0 1 District Panjgur 10‐Oct DHF Mansehra Shamdara Oghi 0 1 0 0 13‐Oct Measles Quetta Gulistan road, SBBH, Quetta 1 0 0 0 7‐Oct DHF Nowshera Near: PTCL Exchange, Risalpur 0 0 1 0 Reported from Children ward DHQ Hospital 13‐Oct DHF Shangla Village Derai Belkanai, Tehsil Alpurai 0 1 0 0 12‐Oct Meningitis Loralai Loralai. Address:‐ Killi Duki, Tehsil Duki 1 0 0 0 12‐Oct Diphtheria Buner UC sorray tehsil chagharzai 0 0 1 0 District Loralai. Mohalla Gilda Khel Village Speen Kanay 12‐Oct NNT Chagai killi toughie, Chagai village 1 0 0 0 7‐Oct Diphtheria Nowshera 0 0 1 0 Cherat District Nowshera 03072689877 12‐Oct Malaria Bajaur Agency Village Talay, Tehsil Salarzai 5 8 7 11 7‐Oct NNT Nasirabad DHQ, Dera Murad Jamali 0 0 1 0 12‐Oct Measles Battagram Village Kund, UC Jambaira, Tehsil Allai 0 1 0 0 10‐Oct Typhoid Chagai Girdi jungle, refugee camp, killi gorgage 4 0 2 0 11‐Oct Measles Buner village arra near jowar pir baba road 0 1 0 0 village zyarat kalay dewana baba tehsil 13‐Oct Measles Buner 0 0 0 1 Global Hand washing day, Activity summary from district Kamber Shahdadkot, Sindh gagra 11‐Oct Measles Charsadda Landay Bazar Prang 1 0 0 0 12‐Oct Measles Charsadda Ashraf Mian Kallay 0 0 0 1 12‐Oct Measles Charsadda Fatmakhel 0 0 1 0 Gali Bagh Wali, Opposite Laghari, Masood 12‐Oct Measles D. I. Khan 1 0 0 0 Colony Mohallah Mohib Banda Near Jalil House 7‐Oct Measles Mardan 0 1 0 0 Tehsil & District Mardan. 9‐Oct Measles Mardan Mohallah Spin Kary near Ghalader Mardan 0 1 0 0 Mohallah Khuday Noor Kali Shankar Kat 10‐Oct Measles Mardan 1 0 0 0 Lang Road Mardan Tehsil & District Mardan. 11‐Oct Measles Swabi BMC swabi, Charbagh 1 0 0 0 On the Friday the 14th of October 2011, Premiere Urgence and Aide 12‐Oct Measles Swabi BHU Checknoda, Mohallah zamindar cham 2 0 1 1 Medicale Internationale (PU‐AMI) celebrated Global Hand Washing Village and UC Chuprial near RHC Chuprial, 11‐Oct Measles Swat 0 0 1 0 Day in collaboration with the World Health Organization (WHO) Tehsil Matta with a grand festival at Warah Boys High School, district Kamber Village Sambat, UC Baidara Koz Cham, 11‐Oct Measles Swat 1 0 0 0 Tehsil Matta Shahdadkot, Sindh.

Village Kokarai Janam Khel mashogai china, 12‐Oct Measles Swat 0 0 1 0 UC Kokarai, Tehsil Babuzai The manifestation with almost 2000 students started with a warm Village Udigram Mohallah Jalal Abad, UC 12‐Oct Measles Swat 1 0 0 0 welcome from the principal and a traditional Sindh welcome dance. Udigram, Tehsil Babuzai After explaining the importance of this day and hand washing by Village Devlai fazal abad, UC Devlai, Tehsil 13‐Oct Measles Swat 1 0 0 0 Kabal Ghulam Muhiuddin‐ WASH engineer, Dr Liaquat – S.O from WHO Village Melaga Mohallah Barsarona,UC 13‐Oct Measles Swat 1 0 0 0 and Adnan Wahab, medical coordinator assistant and Noortje Van Kotlai, Tehsil Kabal Langen, HHP program manager from PU‐AMI, all the students AHQ Hospital(kaga, Lashora, Shahnaray, 13‐Oct NNT Bajaur Agency 3 0 1 0 Arkanai) joined in a Hand Washing Rally through the city of Warah to spread Current week's Alerts: AJK; FATA; GB and ICT the key messages all over the community.

Date Disease District Area <5M >5M <5F >5F In the afternoon the festivities continued with a hand washing dem‐ 11‐Oct BD skardu Satellitetown 1 0 0 0 onstration for all the students, which was followed with great en‐ 11‐Oct Meningitis Ghanche Mohalla Gongma Bara UC Bara 0 0 0 1 thusiasm. At a hygiene workshop, the students could bring their knowledge into practice in small groups. To encourage the student 10‐Oct DHF Gilgit DHQ Hospital Gilgit 0 1 0 0 to adopt the right hand washing practices, soaps and IEC materials 8‐Oct Measles Diamir DHQ Hospital Chilas 1 0 0 0 were distributed. Apart from activities, the day became extra excit‐ 13‐Oct Pertussis Diamir DHQ Hospital Chilas 1 0 1 0 ing with a big hand washing quiz.

13‐Oct Pertussis skardu Ranga UC, shagri khurd 0 1 0 0

Diseases Total 4000 Mobile Fixed 6 6 6

3500 7 2 2

Acute Respiratory Infection 7 10,793,228 (22%) 3 8 6 7 7 7 6 8

3000 13 6 6 6

Skin Diseases 5,260,835 (11%) 8 8 8 8 8 11 2500 11 8 11 8 11

Acute Diarrhoea 4,661,009 (10%) 2000 8 12 411 400 375 331 11 3375 3363 215 3354 361 3329

1500 192 3259 3259 3250 3251 26 3234 3215 3196 153 3156 3142 3120 3109 3058 26 3021 3022 2982 2935 128 2909 2785 2752 2745 Bloody Diarrhoea 105 2667 413,564 (1%) 2648 46 2564 2547 2537 2532 81 2522 2466 2450 2404 58 2349 1000 2322 2262 2255 2251 2199 2022 2021 1797 1680 1488 1463

500 1289

Suspected Malaria 1215 1167 1158

2,967,048 (6%) 1143 1130 999 1111 1113

967 1073 1067 949 879 854 0 Unexplained Fever 9 7 5 1,859,743 (4%) 3

11 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 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 Total Consultations 48,583,865 Wk Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Post Flood 2010 2011 (up till wk 40) Current Week (41) Total Disease A O A O A O A O Acute Watery Diarrhoea 209 85 1126 496 27 8 1362 589 Acute Jaundice Syndrome 5 2 40 14 1 ‐ 46 16 Bloody Diarrhoea 10 1 82 14 1 ‐ 93 15 Dengue Fever 81 32 558 110 89 8 728 150 Measles 48 6 1388 87 27 ‐ 1463 93 Pertussis 1 ‐ 222 25 2 1 225 26 NNT + Tetanus 5 ‐ 231 ‐ 17 ‐ 253 ‐ Malaria 12 7 79 54 8 5 99 66 Leishmaniasis 1 ‐ 163 24 11 2 175 26 Others 75 11 476 53 5 1 556 65 Total 447 144 4365 877 188 25 5000 1046 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • This week 618 health facilities from 17 districts reported to DEWS with a total of 132,761 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 • 45 alerts were reported in this week, 18 were for Measles; Percentage 15 17 for DHF, 6 for AWD, 2 for Diphtheria, while 1 each for 10 Neonatal Tetanus and Malaria. 5 0

1 3 5 7 9

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

• 4 outbreaks 3 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 wk wk wk wk wk wk wk wk wk wk wk wk and responded. AD BD ARI S. Malaria

Province Sindh: Figure-4: Trend of priority communicable diseases, province Sindh • This week 782 health centers from 22 districts reported to

DEWS with a total of 440,075 patient consultations. 50

45 • In Sindh, AD cases reported were 44,783 (10%), propor- 40 tional morbidity lower by 1% as compared with last week. 35 30 25 Percentage • 51 alerts were reported from Sindh in this week: 18 were for 20 DHF; 16 for AWD; 9 for Neonatal tetanus and Tetanus; 5 15 for Malaria and 3 for Measles. 10

5 • 5 outbreaks 3 for AWD and 2 for Malaria were identified 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 41

and responded. 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 AD BD ARI S. Malaria

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

• 2 outbreaks 1 each for AWD and Leishmaniasis were re- 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 ceived and responded. AD BD ARI S. Malaria

Province Balochistan: Figure-6: Trend of priority communicable diseases, province Balochistan • In this week, 16 districts reported to DEWS from Balochis-

tan province. 421 health centers reported a total of 78,510 50 patient consultations. 45 40 AD reported in 8,053 (10%) of the total consultations, 1% • 35 lower proportional morbidity as compared with the last 30 week. 25 20 Percentage • 21 alerts were reported in this week from Balochistan, 10 15 were for Leishmaniasis; 5 for Measles; 2 each for Malaria 10 and Neonatal tetanus; while 1 each for Meningitis and Ty- 5 phoid. 0 1 3 5 7 9

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

• 3 outbreaks 2 for Malaria and 1 for Leishmaniasis was iden- 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 tified and responded. AD BD ARI S. Malaria

Province Gilgit Baltistan:

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan • In this week, 78 health centers from 7 districts in 45 Gilgit Baltistan sent weekly report with a total of AD BD ARI S. Malaria 40 25,973 patient consultations. 35

30 • ARI cases reported were 5,583 (21%), while Acute 25 Diarrhoea were 2,817 (11%). 20

Percentage 15 • 6 alerts received and responded this week, 2 were for 10 Pertussis, while 1 each for Bloody diarrhoea, Menin- 5 gitis, DHF and Measles. 0 41 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

• 1 outbreak for Pertussis was received and responded. 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 were received from 117 health facilities from • This week 42 health facilities in 2 agencies reported from FATA, 10 districts with a total of 29,351 patient consultations. with a total of 7,772 patient consultations. • ARI cases reported were 4,795 (16%), while Acute diarrhoea re- • ARI cases reported were 1,706 (22%), while Acute diarrhoea was ported 1,212 (4%) cases. reported 541 cases (7%) • No alert was received this week from any area of AJK. • No alert was received this week from any area of FATA.

40 AD BD ARI S. Malaria 40 AD BD ARI S. Malaria 30 30

20 20 Percentage Percentage 10 10

0 0 6 7 8 9 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 39 40 41

10 11 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 39 40 41

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 wk wk

Focus on: Health situation in province Sindh, Week 41/2011

Regarding the health situation in Sindh, we would like to provide an update to the partners:

• Rain water is evacuated from DHQ Mirpurkhas and it became functional. • DHQ Sanghar is still under water and nonfunctional; in its place a field hospital established by Muslim Aid is functioning. • DTCs have started functioning at 08 sites, namely DHQ Thatta, THQ Golarchi District Badin, DHQ Tando Mu‐ hammad Khan, THQ Sakrand District Shaheed Benazirabad, DHQ Tando Allahyar, THQ Shahdadpur District Sanghar, THQ Kunri District Umarkot, THQ Nagar Parker District Tharparker. DTC at Civil Hospital Mirpurk‐ has will be functional within two to three days; the delay was due to water inside the hospital now it is de‐ watered. • There were total 51 Alerts and outbreaks from Sindh from 19 districts. There was an outbreak of AWD in Umarkot District in which 19 cases and one death reported. After inter‐ ventions the condition is under control. No more cases and deaths are reported. There was outbreak of Malaria in village Arab Solangi District Khairpur from where 71 were confirmed out of 142 suspected cases and falciparum ratio was 46. • The Dengue was on the top and contributing 34% of all alerts, followed by AWD 28%, malaria 12%, NNT 6%. • Falciparum ratio is high in Thatta 63%, followed by Badin 45%, Jacobabad 44%, Hyderabad 33%, and Lar‐ kana is 30%. The slide positivity rate is high in Matiari i.e. 85%, followed by Tharparker 33%, Umarkot 23%, Larkana and Mirpurkhas 16% each. Slide positivity ratio for whole Sindh is 12 and FR is 23. th • Till 15 October a total of 668 dengue positive cases were reported from Sindh, out of which 530 belong to Karachi and 138 to rest of Sindh. Total of 10 deaths occurred, 9 from Karachi and one from Ghotki. th • Global Hand Washing day October 15 , 2011 was celebrated in Hyderabad, Shaheed Benazirabad, Tando Allahyar, Badin, Tando Muhammad Khan, and Jamshoro from southern Sindh, and in Shikarpur, Ghotki and Larkana in northern Sindh.

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 17 October, 2011, the total number of polio cases con‐ firmed by the laboratory is 118 (116=type‐1, and 2=type3) from 37 districts.

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

Sindh 26 1 20 -

Khyber Pakhtunkhwa 19 5 11 -

FATA 63 11 30 2

Balochistan 6 6 52 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 116 2