Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

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Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 3, Issue 7, Wednesday 7 March, 2012

Highlights Priority diseases under surveillance Epidemiological week no. 7 and 8 (12 to 25 February, 2012) in DEWS

Acute (Upper) Respiratory Infection • In week 7 and 8, 2012, total 81 districts including 2 agencies provided surveillance data to Pneumonia the DEWS on weekly basis from around 1,838 health facilities. Data from mobile teams is re‐ Suspected Diphtheria ported through sponsoring BHU or RHC. Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea • A total of 1,238,577 consultations were reported through DEWS of which 25% were acute Other Acute Diarrhoea respiratory infections (ARI); 5% were acute diarrhoea; 4% were suspected malaria; while 5% were Suspected Enteric/Typhoid Fever Skin disease. Suspected Malaria Suspected Meningitis Suspected Dengue fever • A total of 387 alerts with 43 outbreaks were reported: Altogether 163 alerts for Measles; 41 Suspected Viral Hemorrhagic Fever each for Leishmaniasis and Pertussis; 35 for NNT and tetanus; 27 for Typhoid; 20 for Scabies; 19 Pyrexia of Unknown Origin for ARI; 13 for AWD; 6 for BD; 5 for AD; 4 for DF; 3 each for AJS and Malaria; 2 for Mumps; while Suspected Measles Suspected Acute Viral Hepatitis 1 each for CCHF, Diphtheria, H1N1, Rabies and Unexplained fever. Chronic Viral Hepatitis

Neonatal Tetanus • In As of 25 February, 2012, the total number of polio cases confirmed by the laboratory is 12 Acute Flaccid Paralysis from 10 districts/towns/tribal agencies and areas. Scabies Cutaneous Leishmaniasis Others

Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐8, 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

11 13 15 17 19 21 23 25 27 29 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

Table 1: Most common communicable diseases syndromes reported weekly

Disease Wk-1 Wk-2 Wk-3 Wk-4 Wk-5 Wk-6 Wk-7 Wk-8

Acute respiratory infection 92,846 (27%) 110,049 (27%) 130,371 (25%) 137,322 (26%) 114,319 (26%) 138,507 (25%) 154,230(26%) 152,251(23%)

Skin diseases 19,973 (6%) 19,746 (5%) 24,721 (5%) 25,639 (5%) 22,020 (5%) 26,786 (5%) 28,370(5%) 28,702(4%)

Acute diarrhoea 21,971 (6%) 24,322 (6%) 27,574 (5%) 28,461 (5%) 23,902 (5%) 28,969 (5%) 29,890(5%) 31,395(5%)

Bloody diarrhoea 1,502 (0.44%) 2,225 (0.54%) 2,130 (0.42%) 2,665 (0.50%) 2,195 (0.50%) 2,676 (0.49%) 2,689(0.46%) 2,751(0.42%)

Suspected malaria 13,970 (4%) 15,113 (4%) 20,375 (4%) 19,817 (4%) 15,582 (4%) 21,752 (4%) 22,672(4%) 23,464(4%)

Total consultation 345,403 409,930 511,668 534,412 439,260 547,889 590,424 648,153

• 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 KP while acute diarrhoea is highest in Balochistan and FATA (please see the graphs for every province in page 7 and 8).

17 cases of suspected malaria were reported and all slides were tested out of which 10 verified positive 17‐Feb Malaria Balochistan Jhal Magsi BHU Sarangani 3 7 2 5 (SPR=59%), 7 FP and 03 Mix. Anti Malaria medicins were distributed. 5 suspected cases of measles were reported from DHQ Hospital. All patients were the students of Jamiya Madina Madarsa and belong to Aranji area of Khuzdar. Vaccination status was NIL. Vit‐A and Symptomatic Jamia Madina Madarsa 16‐Feb Measles Balochistan Lasbela 0 13 0 0 treatment was given, 8 other cases found during active search. 6 blood samples were collected and sent to Uthal NIH. All treatment made available, special team appointed for further immunization to surrounding area for affected children.

Alert for measles case from RHC Sinjavi. On field investigation total of 15 cases of measles were found with Killi gavarai, Killi surbot, mixed, post and fresh cases. There is no immunization history in the village. Vitamin A capsule was given to 16‐Feb Measles Balochistan Ziarat 8 1 4 2 UC Sinjavi, Tehsil Sinjavi the cases with the next dose to parents. Sample was taken and sent to NIH. Matter was discussed with the DHO. DHO assured that a team will be sent to do the vaccination.

6 suspected cases of Leishmaniasis were reported from BHU Torkham. The area was visited by WHO/EHA Village Bacha Mina, UC Khyber team and found 36 more cases on active surveillance and line listed. The elders of the area were informed to 15‐Feb Leishmaniasis FATA Torkham, Tehsil Landiko‐ 3 12 5 21 Agency send the cases to the BHU,if they find more.The agency surgeon and PPHI staff was informed about the tal outbreak.The plan is to provide medicine and to take preventive measures in the coming summer season.

Suspected cases of BD reported from BHU Dalola. Deputy EDO H, Coordinator PPHI informed. IV fluids, Khyber Antibiotics, ORS, Aqua tabs provided at BHU. Active surveillance done with coordinator PPHI, EPI coordinator, 17‐Feb BD Pakhtunk‐ Abbottabad Dalola 0 3 0 5 LHS, Medical Technician, EPI worker. 2 stool samples and 3 water samples were taken for testing. Aqua tabs hwa distributed among the villagers and health education given.

Follow up visit conducted, 10 CL Cases were found in surrounding, 3 cases were under treatment from nearby Khyber HF. ITN's, Antiseptic Soaps distributed. onjob training was given to health staff for Intralesional adminstration Village Jelly, UC Munjai, 15‐Feb Leishmaniasis Pakhtunk‐ Lower Dir 0 5 0 5 of Inj Glucantime, 1st dose of Glucantine was given on spot and all were asked to come to HF on same day Tehsil Balmbat hwa next week for 2nd dose. Health & Hygiene sessions conducted, RBM was informed and requested for residual spray before the favorable season for vector breeding and transmission.

3 suspected cases of Measles reported from Women & children hospital and CMH Abbottabad. Sample taken Khyber and sent to NIH. Vitamin A given. On active surveillance along with EI coordinator, concerned EPI worker and Shergan, Pandothana, 14‐Feb Measles Pakhtunk‐ Abbottabad 2 0 0 1 local LHW. No active case found but a younger sister of one suspected Measles case died having sign & Pawa hwa symptoms of Measles according to the parents. 35 children less than 5 years were vaccinated for measles, 3 newly born children were given BCG, OPV & Penta.

Village Gul hassan 6 probable cases of Pertussis were identified in private clinic, during active surveillance 3 out of 6 has BCG 17‐Feb Pertussis Sindh Dadu Laghari, UC Dirgh bala, 2 3 0 1 scar, health awareness education was given, vaccination was done in the village, 19 BCG, 9 Pentavalent, 10 Taaluka Johi Measles and 3 women for T.T, Erythromycin given, EDOH, FP EPI informed and 1 Throat sample taken.

Village Mullan Panhwar, 9 probable Pertussis cases were investigated in village, active surveillance done, 1 Throat sample was col‐ 18‐Feb Pertussis Sindh Dadu UC Makhdoom bilawal, 2 4 0 3 lected, 6 out of 9 have no BCG scars, health education imparted, Erythromycin given to all cases, vaccination taluka Dadu done during investigation, EDOH, THO, FP‐EPI and MO BHU informed.

Alert of probable Pertussis cases were reported from MCH centre Ghotki. upon field investigation 20 cases Village More Dayo UC were found. House to house cluster done routine immunization status was found zero. DEWS team re‐ 18‐Feb Pertussis Sindh Ghotki 8 4 7 1 Khawara sponded and given 14 days complete dose of erythromycin to all suspected cases and close contacts. Health education imparted in the village informed EDOH & DSV for vaccination in area/village.

During the field investigation of measles alert 45 cases of suspected pertusis were found. DEWS SO along with Village Laiq Bhurgari, Vil EM & EH local NGO and DHMT team responded 730 tab of erythrocin and cough syrups were distributed 14‐Feb Pertussis Sindh Khairpur Jan M, Vil Irshad, UC 17 6 16 6 among all suspected cases and close contacts. Health & Hygiene session was conducted with the help of Chondiko local NGO, presentation of pertusis was showen to NGO female health workers and comunity. DHMT re‐ quested for vaccination in the area. Probable Pertussis alert was notified by GP from village Razi Dero during field investigation total 8 cases were Village Ghulam Khan 18‐Feb Pertussis Sindh Khairpur 5 1 1 1 found. Complete 14 day dose of erythrocin was provided to all patients and close contacts. Health & Hygiene Lashari UC Agra session conducted, advised for vaccination in the area. 8 probable Pertussis cases were investigated in the community, active surveillance found 70% of children Near main buss stop city 13‐Feb Pertussis Sindh Matiari 1 2 3 2 were vaccinated, health education was imparted, Erythromycin tabs, Priton syp, Paracitamol Syp given, EDOH Matiari informed and request for immunization in the area and 1 Throat sample was taken.

27 probable Pertussis cases were found and investigated in village, active surveillance done, 9/27 were Village Abdul wahid vaccinated and 18 were not vaccinated, health education imparted regarding prevention, isolation and 14‐Feb Pertussis Sindh Mirpur Khas Burguri, UC and Taluka 3 6 3 15 immunization, erythromycin tabs and cough cyrup was given, and medicines arrange for all contact cases, Samaro informed EDOH, TSC, THO, DSM and NGO and 4 Throat swab collected. 4 probable Pertussis cases were investigated in village, 2/4 cases were vaccinated, active search of 30 houses Tando Allah Mustaf colony city Tando was done and found 4 out‐off 26 children were unvaccinated, health education was imparted to villager, 14‐Feb Pertussis Sindh 2 0 2 1 Yar Allahyar Erythromycin, Priton, Calpol syrup was given, due to Antibiotic was given to cases no sample taken and inform EDOH. Village Khair Muhammad Probable case of Pertussis was investigated, 12/26 (55 %) of overall vaccination status, active surveillance Tando Allah 14‐Feb Pertussis Sindh Jarwar, taluka Tando 2 0 4 2 done, health education imparted, Syp Priton, Syp Erythromicine and Syp Calpol distributed, EDOH informed Yar Allahyar and 2 Throat sample collected.

Kumbhar para, near Probable case of Pertussis was investigated, during active surveillance 20 children were checked and found 3 Tando Allah 17‐Feb Pertussis Sindh Ghosia Masjid, city tando 0 3 2 1 unvaccinated, health education imparted regarding importance of vaccination, Syp priton, Erythromycin, syp Yar allahyar calpol given, no sample taken due to medicine was taken and informed EDOH.

Village Deh 23 Jamarao, 6 suspected cases of Typhoid were investigated, active search was done, 4 out of six were typhoid positive, 16‐Feb Typhoid Sindh Sanghar UC Shah Mardanabad, 2 1 1 2 Canal water and supply water was the source of drinking water, health education imparted, announcement Taluka Sinjhoro was done from mosque to drink boiled water, 2 water sample collected and informed EDOH.

Tando Village Haji Muhammad, 8 suspected cases of typhoid was investigated, 5 out of 8 were Typhoid positive, Hand pump was the source 15‐Feb Typhoid Sindh Muhammad UC Saeed amato, Taluka 0 4 0 4 of contaminated water, health education imparted, 2 water sample taken and information share with DHO Khan Bulri shah karim and near by health facility.

Owuch pawer Beroon Alert for Pertussis from ARI Centre DHQ Hospital. 5 patients identified. Provided cough syp 21‐Feb Pertussis Balochistan Nasirabad 2 0 1 2 area Tehsil DMJ and advised routine immunization.

Ghot Mir Muhammad 11 Pertussis patients were reported and investigation was completed. Patient had history of 22‐Feb Pertussis Balochistan Nasirabad Bugti U/C Qubba Sher 9 2 0 0 severe dry cough since long. All the patients were provided Cough syp and routine immuniza‐ Khan amali tion was advised. Alert for 10 cases of Typhoid were received through automated SMS from eDEWS alert gen‐ eration system. No Epidemiological link could be established in any of the cases owing to DHQ Rajanpur, UC different areas of residence (Officer's Colony, Macchi dara, Jaafria Colony, Grid Colony, Moza 21‐Feb Typhoid Punjab Rajanpur Rajanpur Gharbi, Tehsil 0 6 0 4 Rajanpur Kotla Eisan) of the cases. Relative bradycardia was found to be present in 4 cases. Widal test was positive in 7 cases while MP was negative for all. Only 3 patients needed admission in the hospital . Death due to possible Crimean Congo Hemorrhagic fever was investigated by verbal autopsy. According to patient relatives, some Shepherds use to passed by their homes with cattle from Agha Khan Hospital Balochistan, history of case was taken, all family members have asked to check their tempera‐ 20‐Feb CCHF Sindh Karachi (Gulshan‐e‐Aka Khel, 0 0 1 0 Super Highway) ture on daily basis, follow up visit was planned, health education imparted and briefed re‐ garding mode of transmission of CCHF virus and proper health and hygiene at home, informa‐ tion share with infection control surveillance, EDO office and Medical director. Suspected case of Pertussis was informed from village, during active surveillance found 4 Village Haji Wadero more cases and only 4 out of 13 children were vaccinated, health education imparted, Eryth‐ 24‐Feb Pertussis Sindh Badin Mubeen, UC Khorwah 0 2 1 2 Taluka Golarchi romycin given, information share with MO‐RHC, DHMT and HCPs and request for immuniza‐ tion and 1 Throat sample collected. Alert of suspected Pertussis case reported from RHC Jarwar. Upon field investigation 33 Village Mohammad cases were found. House to house cluster done for routine immunization status found only 21‐Feb Pertussis Sindh Ghotki Murad Lund UC Gari 9 4 10 10 one child with BCG scar. DEWS team gave 14 days complete dose of erythromycin to all sus‐ Chakar pected cases and close contacts. Health education imparted in the village informed DHO & DSV for vaccination in area/village. Alert of suspected Pertussis case in 2.5 yrs girl from MCH centre Ghotki. Upon field investiga‐ tion 33 more cases were found from above mentioned village, three nasopharyngeal swabs Village Dad Ji Gari UC II 22‐Feb Pertussis Sindh Ghotki 4 5 11 9 were taken and sent to NIH. DEWS team gave 14 days complete dose of erythromycin to all Ghotki suspected cases and close contacts. Health education imparted in the village informed EDOH & DSV for vaccination in area

Viilage wadi Wani UC 5 cases of probable Pertussis identifies in one village. Erythromycin given to contacts and 23‐Feb Pertussis Sindh Larkana 0 1 3 1 badah‐2 patients. EDO‐H informed.

Village Muhammad 20 cases of suspected Pertussis were investigated in village, active surveillance done, cluster Yousef Jamali UC of houses was checked and found 7 out of 46 has BCG Scar, 4 Throat sample was collected, 21‐Feb Pertussis Sindh Sanghar 2 14 2 2 Googani taluka Shah Erythromycin and Cough syp was given, health education imparted, EDOH, THO were in‐ Bunder formed. 9 suspected cases of Typhoid were investigate from one village, 3 cases were Widal positive, Village Khandoo, UC Hala, 21‐Feb Typhoid Sindh Matiari 2 2 2 3 hand pump was the source of water, IEC material distributed, health education was imparted Taluka Hala and information shared with EDOH. 3 suspected cases of Typhoid investigated at hospital, during active surveillance found 7 more Mohalla Babu Thebo, UC cases, 5 out‐of 10 were Typhoid positive, hand pump was the source of water, 2 Hygiene kits, 23‐Feb Typhoid Sindh Mirpur Khas Mirwah Ghorchani, 0 7 0 3 Taluka Mirpurkhas 10 jerry cans, 3 Life straw filters and Aqua tabs given, health education was imparted, inform EDOH and DSM‐PPHI

Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

As of 25 February, 2012, the total number of polio cases confirmed by the laboratory is 12 from 10 districts/towns/tribal agencies and areas.

Cases 2011 Cases 2012 Province P1 P3 P1 P1+P3 Punjab 9 ‐ 1 ‐ Sindh 33 ‐ 2 ‐ Khyber Pakhtunkhwa 23 ‐ 4 ‐ FATA 57 2 2 1 Balochistan 73 ‐ 2 ‐ AJ&K ‐ ‐ ‐ ‐ Gilgit‐Baltistan 1 ‐ ‐ ‐ Islamabad ‐ ‐ ‐ ‐ Total 196 2 11 1

16‐Feb Leishmaniasis Tank Ranwal 1 0 0 0 15‐Feb Measles Jamshoro Ghariabad, UC Sonowallar, Taluka Kotri 1 0 0 0 16‐Feb Measles Karachi Machar colony, UC # 4, Gadap colony 5 1 2 1 14‐Feb Measles Abbottabad Shergan, Pandothana, Pawa 2 0 0 1 14‐Feb Measles Khairpur Village Irshad Bhurgari 3 0 1 1 16‐Feb Measles Abbottabad Qalandarabad 1 0 0 0 18‐Feb Measles Larkana Khichi imam bargah murad wahan UC‐9 0 0 1 0 16‐Feb Measles Buner Village kalpani tehsil gagra 0 0 0 1 16‐Feb Measles Shahdadkot Village Filani , UC Dhinagaho Mahesar 0 0 1 0 Village ashraf near Langow tehsil 17‐Feb Measles Shahdadkot Village Bitio , UC Deera Taulka Naserabad 4 0 1 0 17‐Feb Measles Buner 1 0 2 0 Mandan 18‐Feb Measles Benazirabad Village UC. 68 Mori, taluka Daur 1 1 1 0 Village mota near daba nakhthar tehsil 17‐Feb Measles Buner 1 1 1 1 18‐Feb Measles Shikarpur Village Haji Jaffar Banglani, UC Jano 1 0 0 0 thothalai 18‐Feb Measles Sukkur CMH Hospital Pano Akil 1 0 0 0 13‐Feb Measles Charsadda Rajjar Charsadda 1 0 0 0 16‐Feb Measles Tharparkar Kumbhar Para, UC Mithi 0 0 1 0 14‐Feb Measles Charsadda Kashmiryano Kallay 0 0 0 1 16‐Feb Measles Thatta Village Moliv Haji Sulman 1 1 1 0 14‐Feb Measles Charsadda Shekhabad 0 0 1 1 17‐Feb Measles Thatta Village Masoodi Jat, UC Buhara 1 0 1 0

16‐Feb Measles D. I. Khan Budhani, Chashma Road 1 0 0 0 16‐Feb Measles Shahdadkot Massan Mohalla , UC Shahdadkot 2 1 0 0 0 16‐Feb Measles Shahdadkot Village Khair Mohammad Jaegerani 2 0 3 0 13‐Feb Measles Haripur Village Chaintree 1 0 0 0 18‐Feb Measles Shahdadkot Village Hunny , UC Beer Sharif 0 1 0 0 13‐Feb Measles Haripur Village Shah Maqsood 1 0 0 0 17‐Feb Measles Shikarpur Village Sojhro Khan Jatoi UC Thainro 0 0 1 0 Village Muhmmad Zai, UC Muhammad 16‐Feb Measles Kohat 0 0 2 1 13‐Feb NNT Badin Village Ghulam Qadir Bhugio 1 0 0 0 Zai 14‐Feb NNT Larkana Village Shadan Jatoi UC Mahar wada 1 0 0 0 17‐Feb Measles Kohat Afghan refugee Camp , Ghulam Banda 1 0 0 0 14‐Feb NNT Sanghar Village Yaqoob Brohi 1 0 0 0 17‐Feb Measles Kohat Hangu Phaathak, UC Urban II 1 0 0 0 17‐Feb NNT Sukkur SITE area Allahabad colony UC 14 0 0 1 0

17‐Feb Measles Kohat Village Zera Mela, UC Jerma 1 0 0 0 13‐Feb NNT Umer Kot Village Naseer Khan Dhonkai 1 0 0 0 Village Tabu‐Sherkhany, UC Hayaserae, 13‐Feb NNT Umer Kot Village Shahzeen farm 1 0 0 0 13‐Feb Measles Lower Dir 2 0 2 0 Tehsil Balmbat 16‐Feb NNT Umer Kot Village Katho Kalar, UC Kaplore 1 0 0 0 16‐Feb Measles Lower Dir Village Noor Banda, UC & Tehsil Khall 2 0 2 0 17‐Feb NNT Umer Kot Village Vehro, near Mian shah Mazar 1 0 0 0 Village Marathay Kalay Near Misri 17‐Feb Pertussis Dadu Village Gul hassan Laghari, UC Dirgh bala 2 3 0 1 13‐Feb Measles Nowshera 1 0 0 0 banda Hospital 17‐Feb Pertussis Dadu Village Ibrahim Lund, UC Muradabad 1 1 0 0 13‐Feb Measles Peshawar Ameen colony Kohat Road 0 1 1 0 18‐Feb Pertussis Dadu Village Mullan Panhwar 2 4 0 3 13‐Feb Measles Peshawar Bana Mari Kohat Road 0 0 1 0 18‐Feb Pertussis Ghotki THQ Colony 0 3 0 1 18‐Feb Pertussis Ghotki Village More Dayo UC Khawara 8 4 7 1 13‐Feb Measles Peshawar LRH (Jalalabad Afghanistan) 0 0 1 0 13‐Feb Pertussis Hyderabad Tando Mir Noor Muhammad Unit # 4 3 0 0 1 13‐Feb Measles Peshawar Ring Road 1 1 0 0 14‐Feb Pertussis Khairpur Village Laiq Bhurgari, Vil Jan M, Vil Irshad 17 6 16 6 14‐Feb Measles Shangla Village Bund Tehsil Alpurai 3 3 2 2 18‐Feb Pertussis Khairpur Village Ghulam Khan Lashari UC Agra 5 1 1 1

14‐Feb Measles swabi BHU Beka 0 1 0 1 13‐Feb Pertussis Matiari Near main buss stop city Matiari 1 2 3 2 14‐Feb Pertussis Mirpur Khas Village Abdul wahid Burguri 3 6 3 15 15‐Feb Measles swabi BHU Zaida, Maghrabi Banda, Balar Khel 0 0 2 0 15‐Feb Pertussis Benazirabad Police Line colony, UC #1 1 1 0 1 17‐Feb Measles swabi Private Clinic, Aka khel, Gaar 7 1 1 1 14‐Feb Pertussis T A Yar Mustaf colony city Tando Allahyar 2 0 2 1 Village Manyar, UC Ghalegay, Tehsil 14‐Feb Measles Swat 0 0 1 0 14‐Feb Pertussis T A Yar Village Khair Muhammad Jarwar 2 0 4 2 Barikot 15‐Feb Pertussis T A Yar Mujahid colony taluka Tando Allahyar 1 0 0 0 Village Parona Bandan, UC Jambel, 14‐Feb Measles Swat 1 0 0 0 Tehsil Babuzai 16‐Feb Pertussis T A Yar Villahe Allah Rakhio Pathan 0 0 3 0 Village Banjoo Malam Jabba near 17‐Feb Pertussis T A Yar Kumbhar para, near Ghosia Masjid 0 3 2 1 15‐Feb Measles Swat 1 0 0 0 Allaho Akbar Jumat, UC Kishawra 18‐Feb Pertussis T A Yar Soomra Mohalla, behind dilbar hotel 0 1 1 0 Village Dadahara Bar Palao, UC Kuz Aba 15‐Feb Measles Swat 0 0 1 0 Khel, Tehsil Kabal 15‐Feb Scabies Khairpur Vil bahar khan solangi 1 8 5 13 Village Tahir Abad Chat Jumat, UC 16‐Feb Scabies Khairpur Village Irshad Bhurgari 3 1 0 4 15‐Feb Measles Swat 1 0 0 0 Band, Tehsil Babuzai 18‐Feb Scabies Khairpur Vil Arzi Mohallah UC Agra 10 4 8 9 Village Koza Bandai Miagano Cham, UC 16‐Feb Measles Swat 1 0 0 0 Kuza Bandai, Tehsil Kabal 18‐Feb Scabies Khairpur Vil Basar Ameer bux Shambani UC Agra 0 8 1 4 Village Qadara Islampur, UC Islampur, 14‐Feb Scabies Larkana Village Balhreja UC Bero Chandio 3 11 1 6 16‐Feb Measles Swat 0 1 0 0 Tehsil Babuzai 18‐Feb Scabies Larkana Village Yar Mohammad Jatoi 3 4 5 3 Village Bara Asala, UC Kotanai, Tehsil 17‐Feb Measles Swat 1 0 0 0 18‐Feb Scabies N. Feroze Village Moley Dino Nagor, Halani 3 2 4 0 Khwazakhela Village Kandao Mangoultan, UC & 13‐Feb Scabies Shahdadkot Vilalge Memon Jo Goth 5 8 2 10 17‐Feb Measles Swat 1 0 0 0 Tehsil Charbagh 16‐Feb Tetanus Badin Village Sono Kohli, UC Garho 0 0 0 0 16‐Feb Measles Tank Gomal 1 0 0 0 17‐Feb Typhoid Larkana New murad wahan muhalla UC‐11 0 1 0 1

16‐Feb Measles Tank Kirri Nasran 1 0 0 0 14‐Feb Typhoid Mirpur Khas Street # 01, Dhori para 0 1 0 1 14‐Feb Typhoid Mirpur Khas Village Allah Rakhio Gorchani 0 0 1 2 16‐Feb Measles Tank Waranna 1 0 2 1 14‐Feb Typhoid Benazirabad Village Bakhar Jam rahu 1 3 0 0 16‐Feb Measles Tank Wazirabad 1 0 0 0 14‐Feb Typhoid Benazirabad Village Misree khan chandio 1 1 2 0 16‐Feb NNT Bannu Village City Kala 0 0 1 0 15‐Feb Typhoid Benazirabad Police Line, UC #1, Taluka Nawabshah 1 3 0 0 Village Bala Banda, UC Khall, Tehsil 16‐Feb Typhoid Benazirabad Faqir abdul nabi colony, UC Kazi ahmed 1 1 0 0 2 14‐Feb NNT Lower Dir 1 0 0 0 Khall 16‐Feb Typhoid Sanghar Village Deh 23 Jamarao 2 1 1 2 14‐Feb NNT swabi BHU Tandkohi 0 0 1 0 15‐Feb Typhoid T M Khan Village Haji Muhammad 0 4 0 4 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]. 04 Special Bulletin: DEWS, Pakistan, Week no. 7 and 8 (12 to 25 February, 2012) Number o alerts by province, week 7, 2012 Province Balochistan Alerts: Province Punjab Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Rahim Yar 16‐Feb Leishmaniasis Bolan Babu muhalla, Dhadar 0 0 0 1 15‐Feb AD RHC Trinda Mohd Panah, Tesil Liaqatpur 12 41 9 64 Khan 17‐Feb Leishmaniasis Bolan Village Jalbani 1 0 0 0 15‐Feb ARI Bhakkar BHU Litten, UC Litten, Tehsil Mankera 11 4 12 1 16‐Feb Leishmaniasis Jhal Magsi Noshehra UC Khari BHU Noshehra 2 0 1 0 14‐Feb ARI Mianwali BHU Chak 27DB 45 11 38 21 16‐Feb Leishmaniasis Jhal Magsi RHC Jhal Magsi 1 2 0 4 14‐Feb ARI Mianwali BHU Shadia 14 5 23 9 17‐Feb Leishmaniasis Kalat Ziarat UC Chappar Tehsil Kalat 0 1 0 0 15‐Feb ARI Mianwali BHU Hussainwalla 24 9 29 9 15‐Feb ARI Mianwali THQ Piplan 211 121 231 102 18‐Feb Leishmaniasis Kalat Aziz Abad UC Lakhorian Tehsil Surab 0 0 0 1 Basti Tootey Wali, UC Aludey Wali, Tehsil 14‐Feb ARI Muzaffargarh 31 26 97 93 14‐Feb Leishmaniasis Kech Jusak UC Sarikehan, Turbat 0 1 0 0 MZG 16‐Feb Leishmaniasis Kech Marriabad Jusak UC Sarikehan, Turbat. 0 1 0 0 BHU Sumera Nasheb Shumali, UC Kotala 14‐Feb AWD Layyah 5 1 3 1 Haji Shah 17‐Feb Leishmaniasis Kech Dashti bazar UC Malikabad, Turbat 0 1 0 0 Basti Bakhshey Wala, UC Rohillanwali, 14‐Feb Malaria Muzaffargarh 9 6 42 38 18‐Feb Leishmaniasis Kech Chasar UC Malikabad 0 1 0 0 Tehsil MZG Bahawalna‐ 17‐Feb Leishmaniasis Lasbela Bela 0 2 1 1 16‐Feb Measles NHM Multan(haroonabad, Bahawalnagar) 1 0 0 0 gar 18‐Feb Leishmaniasis Lasbela Winder, Lakhra 1 5 0 0 13‐Feb Measles Lahore Sandha Lahore 0 0 1 0 13‐Feb Leishmaniasis Nasirabad Town area of Dera Murad Jamali 0 3 0 1 Mohallah Paran Khellon Walla, Near 18‐Feb Measles Mianwali 1 0 0 0 18‐Feb Leishmaniasis Panjgur UC Gwargo, Mohallah Kahnay ser 0 1 0 0 arayan walli Wandhee Sadaat Colony, Pir Bagga Road, UC KP 17‐Feb Malaria Jhal Magsi BHU Sarangani 3 7 2 5 15‐Feb Measles Muzaffargarh 1 1 1 1 Bagga Sheri 14‐Feb Measles Bolan Village Mashkaf 1 0 0 0 Tibbi Hussain Abad, UC Lutkeran, Tehsil 15‐Feb Measles Muzaffargarh 0 1 0 0 15‐Feb Measles Chagai Killi Gonshan 1 0 1 0 MZG Basti Matoo Wala, UC KP Bagga Sheri, 16‐Feb Measles Muzaffargarh 0 0 1 0 17‐Feb Measles Chagai Killi Mohammad Khan 1 0 2 1 Tehsil MZG 14‐Feb Measles Khuzdar Kehn Tehsil Zehri 0 1 0 0 Moza Asif Abad, Near Dala Adda, Shikar‐ 18‐Feb Measles Rajanpur 0 0 1 0 pur 15‐Feb Measles Khuzdar Taj Abad UC Baleena Kattan 0 0 1 0 Children Hospital Complex Multan(Haidri 15‐Feb NNT D. G. Khan 0 0 1 0 13‐Feb Measles Lasbela Kud Sayan UC Kathore Tehsil Bela 2 1 5 0 chowk, Muzaffar Garh Road) Children Hospital Complex (Mohallah 16‐Feb Measles Lasbela Ahora UC Wayaro 1 0 0 0 14‐Feb NNT Multan 1 0 0 0 Rehmania, Mian Channu) 16‐Feb Measles Lasbela Jamia Madina Madarsa Uthal 0 13 0 0 13‐Feb Pertussis D. G. Khan Basti Bohar UC Mangrotha 0 0 1 0 16‐Feb Measles Panjgur UC Tasp, Mohallah Mestri Bashir 4 1 2 1 16‐Feb Pertussis Rajanpur Basti jhar Bhar, Moza Wang, UC Wang 1 0 0 0 Killi gavarai, Killi surbot, UC Sinjavi, 16‐Feb Measles Ziarat 8 1 4 2 18‐Feb Tetanus Lahore Al Khair town 0 1 0 0 Tehsil Sinjavi 16‐Feb Typhoid Layyah BHU Chak 151, UC Jaman Shah 0 4 1 6 14‐Feb Pertussis Bolan Village Mashkaf 0 0 1 0 Rahim Yar 13‐Feb Typhoid Bangla Manthar 1 2 9 5 13‐Feb Pertussis Lasbela Kud Sayan UC Kathore Tehsil Bela 1 0 2 0 Khan Rahim Yar 16‐Feb Pertussis Ziarat Killi surbot, UC Sinjavi, Tehsil Sinjavi 2 0 2 0 14‐Feb Typhoid RHC Allahabad, Tehsil Liaqatpur 0 1 5 3 Khan

Number o alerts by province, week 8, 2012 Province Balochistan Province Punjab Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 19‐Feb ARI Harnai BHU Belli 16 25 9 11 21‐Feb AD Bhakkar THQ Hospital Mankera, UC Mankera 8 7 11 8 19‐Feb ARI Harnai Killi Sazoo 14 28 11 22 22‐Feb AD Bhakkar BHU Daggar Kotli, UC Patti Balanda 6 9 11 7 20‐Feb AD R Y Khan RHC Manthar, Bangla Manthar 5 23 3 28 24‐Feb Leishmaniasis Awaran Mashie Awaran 0 0 0 1 Trinda Sawaye Khan, Tehsil Rahim Yar 22‐Feb Leishmaniasis Jaffarabad BHU, Murad Ali, Tehsil Sohbat Pur 0 1 0 1 20‐Feb AD R Y Khan 14 13 11 16 Khan 20‐Feb Leishmaniasis Lasbela Bela 0 4 1 1 21‐Feb AJS R Y Khan Khanpur THQ, Tehsil Khanpur 1 9 2 6 20‐Feb Leishmaniasis Nasirabad Bedaar area U/ C Bedaar 1 0 0 0 22‐Feb ARI Bhakkar BHU Daggar Kotli, UC Patti Balanda 8 7 9 5 20‐Feb Leishmaniasis Nasirabad U/C Quba Sher Khan Beroon area Tehsil DMJ 0 0 1 0 23‐Feb ARI Bhakkar BHU Dhandla, UC Dhandla Tehsil Bhakkar. 12 24 17 34 25‐Feb Leishmaniasis Nasirabad Ghot Haji Muhammad Panah Lehri 0 0 0 1 24‐Feb ARI Bhakkar BHU Mullan Wali, UC Mullan Wala 11 17 12 8 21‐Feb Leishmaniasis Panjgur UC Chitkan Mohalla Taar Office 0 0 1 0 22‐Feb ARI Layyah BHU Garay wala, UC Garay wala 16 9 19 15 21‐Feb Leishmaniasis Panjgur UC Parome mohalla Madresa 0 1 0 0 23‐Feb ARI Layyah BHU 110 TDA, UC Shahpur, Tehsil Karor 15 14 7 5 22‐Feb Leishmaniasis Panjgur UC Gwargo Mohalla Katagery 0 1 0 0 21‐Feb ARI Mianwali BHU Mari Indus 24 17 29 19 22‐Feb ARI Mianwali RHC Kammar Machani 22 20 20 26 22‐Feb Leishmaniasis Panjgur UC Sabzab near Rakshan kore 0 1 0 0 21‐Feb ARI Muzaffargarh Lasoori Adda, UC Lasoori, Tehsil Kotaddu 13 28 9 17 21‐Feb Leishmaniasis Sibi DHQH Sibi 1 1 0 5 21‐Feb ARI R Y Khan Chak 45 P, Tehsil Khanpur 13 28 9 57 25‐Feb Malaria Jaffarabad BHU Ghareebabad, Tehsil Usta Mohammad 1 3 3 4 22‐Feb ARI R Y Khan Roshan Bhait, 5 NP, Tehsil Sadiqabad 12 47 25 78 24‐Feb Measles Chagai killi Koi Khan U/C Sadder 1 1 1 0 22‐Feb ARI Rajanpur BHU Shikarpur, Moza Asif Abad 16 9 17 10 20‐Feb Measles Jaffarabad CD, Noshki Jadeed, Tehsil Gandakha 4 0 0 1 24‐Feb DHF Khanewal NHM (Moza nand pur, tehsil kabirwala) 0 2 0 1 23‐Feb Measles Jhal Magsi RHC Jhal Magsi 2 0 0 0 22‐Feb DHF Lahore Begum Kot, Shahdara Ravi Town Lahore 0 2 0 0 21‐Feb Measles Karachi Lasbela (Raees Goth) 0 0 1 0 22‐Feb DHF Lahore Feroz Pur Road Nishter Town Lahore 0 1 0 0 20‐Feb Measles Kharan Killi Qambarani U/C Sarawan 1 1 0 0 21‐Feb Measles Lahore Sanda Kallan, Lahore 0 1 0 0 21‐Feb Measles Lasbela Madina colony Zehri street UC Pathra 1 0 2 0 23‐Feb Measles Lahore Jublee Town Lahore 0 1 0 0 22‐Feb Measles Lasbela Ismailiani UC Gadore 1 0 4 3 24‐Feb Measles Lahore Mughal Pura 0 0 0 1 22‐Feb Measles Quetta Bolan Medical Complex Hospital Quetta 0 1 0 0 22‐Feb Measles Mianwali Wandhee Peeran Walli Moch 1 0 0 0 22‐Feb NNT Bolan Jhal Magsi DHQ Hospital Gandawah (Shoran) 1 0 0 0 22‐Feb Measles Muzaffargarh Housing Colony, District Jail, Muzaffargarh 1 0 0 0 24‐Feb NNT Jaffarabad U/C Usta Mohammad 1 0 0 0 22‐Feb Measles Muzaffargarh Moza Chak Mithan 0 0 0 1 23‐Feb Measles Muzaffargarh Basti Zulfiqar Abad 0 1 0 0 20‐Feb NNT Kharan Killi Shawani U/C juda e Kalat. 1 0 0 0 24‐Feb Measles Muzaffargarh Kumhar Basti, UC Jaggatpur 0 0 0 1 23‐Feb NNT Nasirabad Nursery ward DHQ‐Hospital 1 0 0 0 20‐Feb NNT B. nagar Children Hospital Multan 1 0 0 0 23‐Feb Pertussis Chagai Sheernap Girdi jungle refugee camp 1 1 1 0 22‐Feb Pertussis D. G. Khan Nari Janoobi UC Nari 1 0 0 0 20‐Feb Pertussis Jaffarabad Village of Noshki Jadeed, Tehsil Gandakha 0 0 1 1 21‐Feb Tetanus D. G. Khan Samina village UC samina 0 1 0 0 21‐Feb Pertussis Nasirabad Owuch pawer Beroon area Tehsil DMJ 2 0 1 2 20‐Feb Typhoid Bhakkar RHC Dullewala, UC Jhamamt Shumali 0 2 0 2 22‐Feb Pertussis Nasirabad Ghot Mir Muhammad Bugti 9 2 0 0 21‐Feb Typhoid Bhakkar THQ Hospital Mankera, UC Mankera 0 2 0 1 19‐Feb Rabies Harnai DHQ Harnai 2 2 1 2 22‐Feb Typhoid Bhakkar BHU Daggar Kotli, UC Patti Balanda 0 2 0 0 21‐Feb Typhoid Kharan College area U/C Northern Town 0 2 1 0 21‐Feb Typhoid Layyah BHU Laskani wala, UC Basira, Tehsil Karor 0 5 0 8 19‐Feb Typhoid Ziarat RHC Sinjavi 0 5 0 0 21‐Feb Typhoid Rajanpur DHQ Rajanpur, UC Rajanpur Gharbi 0 6 0 4 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. 7 and 8 (12 to 25 February, 2012) Number o alerts by province, week 8, 2012 Province Khyber Pakhtunkhwa Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 20‐Feb AWD Kohat Village Kachai, Union Council Usterzai 0 0 0 0 20‐Feb AJS Larkana Vilage Daro UC badah‐2 0 3 0 0 21‐Feb AWD Kohat Village Gabbari 0 0 0 0 22‐Feb AJS Larkana Viilage Sultan Jumarani 0 3 0 0 21‐Feb AWD Kohat Village khadder Khel 0 0 0 0 22‐Feb AWD T A Yar Akbari colony city Tando Allahyar 1 0 0 1 22‐Feb AWD Kohat UC Bilitang 0 0 0 0 22‐Feb AWD T A Yar Bheel colony, city Tando Allahyar 1 0 0 1 22‐Feb AWD Kohat Village Mir Ahmed Khel 0 0 0 0 21‐Feb BD Kohat Union Council Shakardarra Urban 0 0 0 0 22‐Feb AWD Tharparkar Deep Coal Rock Drilling Point 0 2 0 0 23‐Feb Leishmaniasis Haripur Afghan Refugee Turkman Camp 1 2 0 2 22‐Feb AWD Tharparkar kohli Paro, Village Mubarak 0 0 1 0 20‐Feb Leishmaniasis Nowshera Village Natal, UC Akbarpura 0 1 0 0 21‐Feb BD Matiari Village Hala, UC & Taluka Hala 0 1 0 2 20‐Feb Leishmaniasis Nowshera Village: Manai 0 1 0 0 20‐Feb CCHF Karachi Agha Khan Hospital 0 0 1 0 21‐Feb Leishmaniasis Nowshera Mohallah: Wara Khel 0 0 0 2 23‐Feb Measles Dadu Golimar Mohalla, UC and taluka K.N. Shah 0 0 2 0 23‐Feb Leishmaniasis Nowshera Amir Zada House 0 0 1 0 21‐Feb Measles Hyderabad Block #B, near Mustafa Masjid 0 1 0 0 25‐Feb Leishmaniasis Nowshera Phase: 06, Sector 0 0 0 2 22‐Feb Measles Hyderabad Latif abad # 7 0 1 0 0 24‐Feb Leishmaniasis Tank Mulazai 0 1 0 0 22‐Feb Measles Hyderabad Near HAD Latifabad unit # 9 0 0 1 0 20‐Feb Measles Abbottabad Narian, Cantt 0 0 1 0 25‐Feb measles Jamshoro Allah ho chawk khershhedd colony kotri 0 1 0 0 23‐Feb Measles Buner shangra pass pandair tehsil chagharzai 1 1 2 2 22‐Feb Measles Karachi New Haji Camp, Saddar Tawn 1 0 1 0 23‐Feb Measles Charsadda Lagharya Kallay 1 0 0 0 23‐Feb Measles Charsadda Papra Kallay 1 0 0 0 21‐Feb Measles Kashmore Village Ali GuL mazari, UC sodhi 1 0 0 0 20‐Feb Measles D. I. Khan Kot Zafar, Kulachi 1 0 1 0 24‐Feb Measles Larkana Near peer Murad Shah UC‐4 2 0 2 0 20‐Feb Measles D. I. Khan Paroa 1 0 0 0 21‐Feb Measles Shahdadkot Chajjara , UC Kambar 2 , Taulka Kambar 2 0 0 0 21‐Feb Measles D. I. Khan Jogi Dara Pezu 1 0 0 0 22‐Feb Measles Shahdadkot Village Hesab Magasi , UC Kalar 2 0 0 0 21‐Feb Measles D. I. Khan Wacha Khora, Wana 1 0 0 0 23‐Feb Measles Shahdadkot Village Abdullah Panhwar 0 0 1 0 24‐Feb Measles D. I. Khan Daman Hotel, Darya Khan Road 0 0 0 1 21‐Feb Measles Tharparkar Pasayo Paro, UC Khoruro 0 1 0 0 24‐Feb Measles D. I. Khan Ramak, Paroa Road 0 1 0 0 25‐Feb Measles Tharparkar West Wajeer Mohallah Mithi town 0 0 1 0 23‐Feb Measles Haripur Pind Ghakhr, Tofkian 2 0 0 0 23‐Feb Measles Thatta Village Haji Muhammad Hussan Katyar 1 1 3 5 24‐Feb Measles Haripur Ghazi city 0 1 0 0 23‐Feb Measles Thatta Village Peroz Khaskhali UC Mirpur Sakiro 5 1 2 4 21‐Feb Measles Lower Dir Village Gardai 1 0 0 0 25‐Feb Measles Thatta Thatta City village Noor M. Brohi 1 1 1 0 22‐Feb Measles Lower Dir Village Ashogai 1 2 2 7 23‐Feb Measles Lower Dir Village Baron, UC Munjai 1 0 0 0 23‐Feb Measles Shahdadkot Dur Mohammad 0 0 1 0 23‐Feb Measles Lower Dir Village Darrora, Changal Bazar 0 0 1 0 24‐Feb Measles Shahdadkot Village Ahmed Shabarani 0 1 0 0 23‐Feb Measles Lower Dir Village hayathy, sarkadaro 1 0 0 0 21‐Feb NNT Larkana Village Laal Bux Bugti 1 0 0 0 22‐Feb Measles Mansehra Village Malkana UC Shungli Bandi 2 1 3 0 22‐Feb NNT N. Feroze Naushahroferoze city 1 0 0 0 20‐Feb Measles Nowshera Akhoon Abad 0 1 0 0 23‐Feb NNT Shikarpur Village near village pyaro khan bhayo 1 0 1 0 20‐Feb Measles Nowshera Mohallah Gharay 1 0 0 0 25‐Feb NNT Thatta Village Shaho Magsi 1 0 0 0 21‐Feb Measles Nowshera Khat Kalay, Mohallah 2 0 2 0 22‐Feb NNT Shahdadkot Village Khairpur Juso , UC Khairpur Juso 1 0 0 0 21‐Feb Measles Nowshera Khatako Mohalla Village Aman Garh 1 0 0 0 24‐Feb NNT Shahdadkot Village Parya , UC Thoufchousal 1 0 0 0 21‐Feb Measles Nowshera Mohallah: Mayaro Khel 5 0 1 0 25‐Feb NNT Shahdadkot Village Darghai Khan , UC Ber Sharif 1 0 0 0 21‐Feb Measles Nowshera Village Khaishki Bala 2 0 1 0 24‐Feb Pertussis Badin Village Haji Wadero Mubeen 0 2 1 2 22‐Feb Measles Nowshera Mohallah: Mardankhel 4 0 6 0 23‐Feb Measles Nowshera Mohallah: Akhoon Baba 0 0 0 1 23‐Feb Pertussis Dadu Village Boriri, UC Kakar Taluka K.N. Shah 2 0 1 0 23‐Feb Measles Nowshera Village Aman Garh 1 0 0 0 23‐Feb Pertussis Dadu Village Ladhan, UC and taluka K.N. Shah 3 0 0 1 23‐Feb Measles Nowshera Village Misri Banda 0 0 0 2 21‐Feb Pertussis Ghotki Village Mohammad Murad Lund 9 4 10 10 24‐Feb Measles Nowshera Afrido Kalay, Malang Pul 1 0 2 1 22‐Feb Pertussis Ghotki Bago Wah near Fayaz Medical centre 0 1 0 1 23‐Feb Measles Peshawar Village Jhagra 1 0 0 0 22‐Feb Pertussis Ghotki Village Dad Ji Gari UC II Ghotki 4 5 11 9 23‐Feb Measles Peshawar Village Latifabad 0 0 1 0 21‐Feb Pertussis Hyderabad Old Rajpur house, Block f Latifabad #8 0 0 1 0 19‐Feb Measles Shangla Village Ban Dheray 1 0 0 0 23‐Feb Pertussis Larkana Viilage wadi Wani UC badah‐2 0 1 3 1 19‐Feb Measles Shangla Village Dur Banai 0 2 0 0 21‐Feb Pertussis Sanghar Village Haji Ahmed 0 12 0 0 23‐Feb Measles Shangla Village Ban Khwargai/UC Dherai 1 0 0 0 24‐Feb Pertussis Thatta Village Muhammad Yousef Jamali 2 2 2 2 21‐Feb Measles Swabi Private Clinic, Gani Kot Gabasni 1 2 5 3 24‐Feb Pertussis Thatta Village Rawat Khan Jamali 5 9 1 3 23‐Feb Measles Swabi Private Clinic, Inayath Khel 3 1 2 1 24‐Feb Measles Swabi BHU Zaida, Gaar Side 1 0 1 1 23‐Feb Scabies Khairpur Vil Badal Khuhra UC Khemtia 2 3 1 7 24‐Feb Measles Swabi CD Hemlet, Gala 0 0 1 0 24‐Feb Scabies Khairpur Vil Dilawer Khuhra UC Khemtia 2 6 3 6 20‐Feb Measles Swat Village Kohistan Gat 1 0 0 0 24‐Feb Scabies Khairpur vil Keti mir M Ghumro UC Hadal Shah 3 5 2 7 20‐Feb Measles Swat Village Zawra Barthana 1 0 0 0 21‐Feb Scabies Shahdadkot Chajjara , UC Kambar 2 , Taulka Kambar 5 4 5 6 21‐Feb Measles Swat Village and UC Kalakaley, Tehsil Kabal 0 1 0 0 22‐Feb Tetanus T A Yar Tehrani Farm, UC Pak Singhar 0 0 0 1 21‐Feb Measles Swat Village Spiney Obe Malam Jabba Road 0 0 1 0 23‐Feb Typhoid Badin Ward # 5 taluka Talhar 1 2 0 1 22‐Feb Measles Swat Village and UC Shamozai 0 0 0 1 23‐Feb Typhoid Larkana Faizan Mohammdi madarsa 0 2 0 0 22‐Feb Measles Swat Village Parona, UC Jambe kokarai 0 0 1 0 23‐Feb Typhoid Larkana Shehbaz colony UC‐2 0 2 0 0 22‐Feb Measles Swat Village Terang mian bara lar 0 0 1 0 25‐Feb Typhoid Larkana Murad wahan Muhalla UC‐11 0 1 0 1 21‐Feb Measles Tank AliKhel 1 0 0 0 21‐Feb Typhoid Matiari Village Khandoo, UC Hala, Taluka Hala 2 2 2 3 21‐Feb Measles Tank Waranna 1 0 0 0 22‐Feb NNT D. I. Khan Maleekhi, Tehsil Paroa 0 0 1 0 23‐Feb Typhoid Mirpur Khas Mohalla Babu Thebo 0 7 0 3 23‐Feb Pertussis Charsadda Haseebabad 1 0 0 0 24‐Feb Typhoid Shahdadkot Village Drib Chandio 0 0 0 2 25‐Feb Pertussis Lower Dir Village Kolalano Cham 1 0 1 0 21‐Feb Typhoid Sukkur workshop road UC 6 0 0 0 2

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]. 06 Special Bulletin: DEWS, Pakistan, Week no. 7 and 8 (12 to 25 February, 2012) Table‐1: Leading causes of seeking health care in districts, Wk‐31, 2010 to Figure‐2: Number of alerts by disease, week 7 and 8, 2012 Wk 8, 2012, compiled from weekly reports Number of Diseases Consultations 180 159 160 Acute respiratory infection 14,135,982 (23%) 140 120 Skin diseases 6,197,288 (10%) 100 80 Acute diarrhoea 5,533,746 (9%) 60 41 41 38 40 27 Bloody diarrhoea 487,371 (<1%) 20 19 13 20 6 5 44332 1111 Suspected malaria 3,718,105 (6%) 0 Unexplained fever 2,312,245 (4%) Total consultations 61,393,025 Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response 2010 2011 2012 (up till week 8) Total Disease A O A O A O A O Acute watery diarrhoea 209 85 1350 543 48 0 1607 628 Acute jaundice syndrome 5 2 51 17 24 2 80 21 Bloody diarrhoea 10 1 98 20 21 3 129 24 Dengue fever 81 32 785 111 8 1 874 144 Measles 48 6 1710 91 465 17 2223 114 Pertussis 1 0 287 81 106 34 394 115 NNT + tetanus 5 0 399 0 133 0 537 0 Malaria 12 7 131 88 11 4 154 99 Leishmaniasis 1 0 298 33 145 18 444 51 Others 75 11 643 69 178 24 896 104 Total 447 144 5752 1053 1139 103 7338 1300 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • 463 health facilities from 17 districts of Khyber Pakhtunkhwa reported to DEWS on weekly basis with 50 AD BD ARI S. Malaria a total of 226,464 patients consultations in week 7 and 45 8, 2012. 40 35 • 112 alerts were reported in week 7 and 8; Altogether 86 30 25

for Measles; 11 for Leishmaniasis; 5 for AWD; 4 for Percentage NNT; 2 each for BD and Pertussis; while 1 each for 20 Diphtheria and H1N1, . 15 10 • 3 outbreaks, 1 each for BD, Leishmaniasis and Measles 5 were received appropriate measure were taken. 0 1 3 5 7 9 1 3 5 7

11 13 15 17 19 21 23 25 27 29 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 Province Sindh: Figure-4: Trend of priority communicable diseases, province Sindh • 459 health facilities from 23 districts in Sindh reported

on weekly basis to DEWS with a total of 482,900 patient 50 AD BD ARI S. Malaria consultations in week 7 and 8, 2012. 45 40 • 128 alerts were reported; Altogether 36 for Measles, 28 35 for Pertussis; 17 for NNT and tetanus; 17 for typhoid; 30 15 Scabies; 7 for AWD; 2 each for AJS, BD and Mumps; Percentage 25 while 1 each for CCHF and DF. 20 15 10 • 27 outbreaks, 17 for Pertussis; 4 for Typhoid; 3 for Sca- 5 bies; 2 for Mumps; while 1 for CCHF were received and 0 1 3 5 7 1 3 5 7 9

51 49 47 45 43 41 39 37 35 33 31 29 27 25 23 21 19 17 15 13 appropriate measure were taken. 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

11 13 15 17 19 21 23 25 27 29 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 Province Balochistan: Figure-6: Trend of priority communicable diseases, province Balochistan • 384 health facilities from 17 districts in Balochistan reported to DEWS, with a total of 116,275 patient con- 50 AD BD ARI S. Malaria sultations. 45 40 • 61 alerts were reported in week 7 and 8 from Balochis- 35 tan; Altogether 25 for Leishmaniasis; 18 for Measles; 7 30 for Pertussis; 4 for NNT; 2 each for ARI, Typhoid and 25 Percentage 20 Malaria; while 1 for Rabies. 15 • 9 outbreaks, 3 for Leishmaniasis; while 2 each for Mea- 10 5 sles, Pertussis and Malaria were received and appropri- 0 1 3 5 7 1 9 3 5 7

ate measure was taken. 11 13 15 17 19 21 23 25 27 29 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

Province Gilgit Baltistan:

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

50 AD BD ARI S. Malaria • 29 health facilities from 3 districts in Gilgit Baltistan 45 reported to DEWS in week 7 and 8; with a total of 40 13,483 patient consultations. 35 30 • No alert for any disease was reported from any area in 25 20

Gilgit Baltistan. Percentage 15 10

5 0 1 2 3 4 5 6 7 8

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 42 43 44 45 46 47 48 49 50 51 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

State of Azad Jammu and Kashmir: FATA:

• 137 health facilities from 10 districts reported to DEWS in this • 32 health facilities from 2 agencies reported from FATA in week with a total of 46,322 patient consultations. this week, with a total of 12,753 patient consultations.

• 5 alerts, 2 each for Leishmaniasis and Measles, while 1 for • 15 alerts; 7 for NNT; 5 for Measles; while 3 for Leishmaniasis Pertussis were received and appropriate measures were taken. were reported this week and appropriate measure were taken.

50 50 AD BD ARI S. Malaria 45 AD BD ARI S. Malaria 40 40 35 30 30 25 20 20 15 Percentage Percentage 10 10 5 0 0 1 2 3 4 5 6 7 8

9 1 2 3 4 5 6 7 8 48 49 50 51 52 47 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 14

42 43 10 44 11 45 12 46 13 47 14 48 15 49 16 50 17 51 18 52 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 wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk