Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 2, Issue 23, Monday 14 June, 2011

Highlights Priority diseases under surveillance Epidemiological week no. 23 (3 - 9 June, 2011) in DEWS

Acute Flaccid Paralysis (AFP) • 89 districts in 5 provinces, FATA, AJK, and ICT provided surveillance data to the DEWS. This system is gradually expanding to provide information about communicable disease threats in all parts of Acute Jaundice Syndrome (AJS) Pakistan. Currently 76 DEWS surveillance officers are responding to alerts in 104 districts and agen- Acute Respiratory Infections cies. (Upper and Lower) (ARI)

• 3,194 fixed health facilities and 3 mobile medical outreach centres provided surveillance data for this Acute Watery Diarrhoea (AWD)/ week. Suspected Cholera

• A total of 995,760 consultations were reported through DEWS of which 19% were acute respiratory Acute Bloody Diarrhoea (BD)

infections (ARI), 10% acute diarrhoea, 10% skin disease, and 6% were suspected Malaria. Other Acute Diarrhoeas (AD)

• A total of 135 alerts were reported in week-23, 2011: Altogether 70 alerts were for Measles; 33 were Suspected Viral Hemorrhagic for AWD, 10 were for Pertussis, 5 were for Acute diarrhoea, 4 were for Leishmaniasis, 3 each were for Fever (VHF) Dengue Hemorrhagic Fever and Scabies, 2 each were for Malaria and Meningitis, while 1 each for Suspected Malaria (Mal) bloody diarrhoea, Monkeypox and Neonatal Tetanus.

Suspected Measles (MS) • National Polio Eradication Initiative reported no confirmed polio case this week. Total 49 cases have been reported in 2011 from 23 districts. Suspected Meningitis (MG)

Others

Figure‐1: Three years trend of Acute diarrhoea in Pakistan, (2009, 2010 and 2011)

2009 2010 2011

12 Percentage

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Epi‐week

Disease Wk-16 Wk-17 Wk-18 Wk-19 Wk-20 Wk-21 Wk-22 Wk-23

Other Acute Diarrhoea (Not Watery) 92,739 (10%) 90,508 (10%) 85,473 (10%) 94,472 (10%) 102,955 (11%) 106,720 (10%) 102,005 (10%) 98,438 (10%)

Total consultation 966,371 893,017 864,932 904,711 976,358 1,020,071 995,731 995,760

Figure‐1 above represents trend of "proportional morbidity." This is the number of new consultations for acute diarrhea di‐ vided by the total number of consultations. The very dramatic peak starting about week 31, 2010, demonstrates the increase in acute diarrhoea cases from the flood‐affected areas starting in KP the first week of August 2010.

The “proportional morbidity” of diarrhoea in 2011 so far follows the seasonal trend of 2009 and early 2010.

While the overall diarrhea trend so far this year is following the usual proportional morbidity, the cholera cases and outbreaks are above the usual and starting earlier than usual. Last week 17 districts had outbreaks of AWD.

3500 Diseases Total 7 3 7

Mobile Fixed 8 6 7 7 7 6 8

3000 13 6 Skin Diseases 3,283,228 (11%) 6 6 8 8 8

2500 8 8 11 11 8 11 8 Acute Respiratory Infection 7,574,928 (24%) 11 2000 8 12 411 400 375 11 1500 331 215 361 192 3250 26 3215 3196 3194 3120 153 3058 26

3021 3022 Acute Diarrhoea 2,871,227 (9%) 2982 2935 2909 128 2785 2745 105 46 2547 81 2466 2450 2404 58 2349

1000 2322 2262 2255 2251 2199 2022 2021 1797 Bloody Diarrhoea 267,152 (1%) 1680 500 1463 1289 1215 1167 1158 1143 1130 999 1111 1113 967 949 1073 1067 879 854 Suspected Malaria 1,825,523 (6%) 0 9 7 5 3

11 11 13 15 17 19 21 23 33 35 37 39 41 43 45 47 49 51 ‐

Unexplained Fever 1,220,478 (4%) 1

Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Total Consultations 31,198,946 Wk

Focus on: Crimean Congo Haemorrhagic Fever (CCHF) Following the report of two cases of Hemorrhagic Fever from KP with test pending, we would like to send reminder to all clinicians that incidence of Cri‐ mean Congo Haemorrhagic Fever (CCHF) typically has two peaks in Pakistan – June and September ‐ believed to correspond with the movement of live‐ stock to the mountains to graze in the spring and back to the valleys in the winter.

CCHF is a viral haemorrhagic fever transmitted to humans by the bite of the Hyalomma tick or by di‐ rect contact with blood of an infected animal or hu‐ man. CCHF is a severe disease with a high case fatal‐ ity rate ranging from 2% to 50%. Survival is improved with appropriate treatment with fluids, blood products and Ribavirin (anti‐viral). Universal precautions should be taken to protect against infection from any hemorrhagic case appearing in the ER, for example, with ENT bleeding or acute abdomen.

Prevention strategies focus on prevention of tick bites or handling ticks and careful management of slaughtering to avoid contact with fresh blood.

Further information is available on NIH and WHO Pakistan websites.

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases reported in 2010 is 144 including 120 type-1 cases and 24 type-3 from 40 infected districts/towns/agencies.

Year 2011: The total number of new type-1 polio cases confirmed by the laboratory is 49 till date from 23 districts.

Cases 2010 Cases 2011 Province P1 P3 P1 P3

Punjab 6 1 - -

Sindh 26 1 12 -

Khyber Pakhtunkhwa 19 5 5 -

FATA 63 11 18 -

Balochistan 6 6 13 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 49 -

Date Disease Province District Area M F Action Taken Field investigation conducted. Sample was collected and found positive for V.c. Ogawa. Source of drinking Lower Village Charingo 27 May. AWD KPK 0 1 0 0 water protected Tube well. Poor household and personal hygiene and water handling practice. Provided Dir Lajbook 200 aqua tabs, 20 soap units and IEC material to the affected families and Health education was given. 7 confirmed cases of enteric Fever/Typhoid fever were reported from BHU Bassu Mera. On investigation and active surveillance 3 more positive cases were found. Blood samples were taken from 2 cases for Afghan Refugee typhoid and they also reported positive. Environmental assessment was carried out, 2 out of 4 water 28 May. Typhoid KPK Haripur Camp Bassu Mera‐UC 0 3 0 7 samples were contaminated including source. 2000 Aqua tabs distributed. EDOH and Save the Children Gudwalian were informed and conducted Health and Hygiene sessions for the affected population. Health promotion campaign for all the Afghan refugee camps has been planned. 1 specimen was collected and found positive for V.c. Ogawa. The water sources were examined thor‐ oughly and 6/12 samples were found bacteriological contaminated. A medical relief camp was established (1 Doctor, 2 LHVs and one paramedical staff deployed) 6 were in Basti M. Buksh, Mouza Sikandarabad Rahim Sheikh Wahan Mian‐ 31‐May AD Punjab 0 8 1 10 where 53 AD patients treated on the first day. Staff of RHC Mianwali Qureshian trained in management of Yar Khan wali Qureshian Acute diarrheal diseases and stocks of essential medicine were moved to RHC. Aqua tabs, Jerry Cans, Life straws and Soaps were distributed among residents of all the 03 villages. Health Education sessions were conducted on Safe Drinking Water, use of ORS, use of life straws, and general health and hygiene.

Stool sample was collected and found positive for V.c.Ogawa. 1 out of 2 Drinking water samples from water sources was contaminated. Nearest RHC was visited and briefed on the situation, control measures and importance of awareness among general masses about safe drinking water, food and personal hy‐ Mian‐ 2‐Jun AD Punjab DHQ Hospital ‐Moch 1 5 0 5 giene. EDO(H) Mianwali and MS of DHQ Hospital Mianwali were informed about the situation and provi‐ wali sion of rehydration medicine and support during the patient’s stay in hospital was ensured. In the locality/ area no more cases of AWD were found. Soap, water containers, aqua tabs and IEC materials distributed in community.

Two samples were found positive for V.c. Ogawa. 4/9 water samples tested positive for bacteriological Chongi No. 6, Gul‐ contamination from different sources. Health education session were conducted. MD WASA was met 30‐May AWD Punjab Multan 0 2 0 0 gasht; Rasheedabad and requested for arrangement of filtration plant in the locality. During filed investigation 10 houses were investigated and no more cases found. Soap, Aqua Tabs and IEC distributed in the community.

Village Khuda Bux Active search of cases, Reinforced Case management, Health Education with Proper guidelines, 2 Stool 30‐May AWD Sindh Dadu Laghari,Near Hur 2 1 1 2 samples were collected and found positive for V.c. Ogawa. 4 Water Sample Collected for laboratory test. Pump,UC Bhawalpur Hygiene Kit, Zinc Tab, Aqua Tabs and ORS distributed, Informed EDO‐H

1 stool sample for AWD case was collected and found positive for V.c. Ogawa. The outbreak was re‐ sponded and diarrhoea treatment centre was established with the support of WHO, EDO‐H and the Rapid Village Hingoro‐UC 30‐May AWD Sindh Sukkur 4 1 2 4 Response Team in the district. ORS provided through LHWs. 11 out of 23 water source tested were found Hingoro bacteriological contaminated. Health and hygiene education sessions were conducted in the community, Life straws, jerry cans and aqua tabs distributed in the community.

Village Kevro 6 cases reported from two different locations. 3 Stool samples all found positive for V.c. Ogawa. 2/5 water Tando Lund,UC Dasoori; samples found contaminated, Health Education, ORS, Zinc Tabs, IEC Material, Life straw filters, Aqua Tabs, 30‐May AWD Sindh 0 1 1 4 Allah Yar Village Tharo Jerry Cans provided in the community. 6 Family filter Life straw, 7 Hygiene kits, 25 Jerry cans (10 liters), Laghari,UC 4 1200 Aqua tabs and IEC material distributed in the affected and vulnerable families. 7 AWD cases reported from two different locations, active search for cases, health education, Aqua Tabs, Village Juma Jat,UC ORS provided, Sensitized about Hand Washing Practice, Inform EDO‐H and Environment Team, 2 Stool Darya Khan 30‐May AWD Sindh Thatta 0 1 1 5 samples were collected and 1 found positive for V.c. Ogawa, 2/2 water samples tested and found con‐ Soho,Taluka Mirpur taminated. 10 life straw filters, 600 IEC materials, 16000 aqua tabs, 100 Jerry cans, 10 Hygiene kits were Bathoro; distributed. Active search of cases, health Education Provided, Aqua Tabs Distributed, 1 stool sample collected and 31‐May AWD Sindh Karachi Lyari Town 2 1 1 6 found positive for V.c. Ogawa. Health Staff briefed, health facilities sensitized DHQ Mirpurkhas; Three cases from two different locations, active search of cases in the community, reinforced case man‐ Mirpur 31‐May AWD Sindh Village Lundoo, Deh 0 1 0 2 agement, IEC material, Aqua Tab, Hygiene Kit and ORS distributed, health education, DD and EDO‐H were Khas 256, Taluka KGM informed. 2 Stool and 2 water samples were collected and sent to NIH. One found positive for V.c. Ogawa.

A 7 year old boy admitted in Civil hospital Shikarpur with severe dehydration and watery diarrhea. One stool sample collected and found positive for V.c. Ogawa. Upon field investigation 8 more cases found Shikar‐ Makrani Street, with diarrhea but they got treatment from GPs. 4/6 water samples collected from affected houses con‐ 31‐May AWD Sindh 1 1 1 0 pur Bhatti Mohalla taminated. EHE and EM paid visit for distribution of hygiene kits, aqua tabs and health and hygiene aware‐ ness in community. WHO distributed 100 IEC material of various messages and 500 aqua tabs, 12 jerry cans, 8 hygiene kits. Intensive health education and awareness activities in the community.

Active search of cases, Health Education, 1 stool collected and found positive for V.c. Ogawa.3/3 water Soomra Mohalla,City 1‐Jun AWD Sindh Matiari 0 1 0 0 samples contaminated.ORS, chlorine Tab and Zinc tab, 1000 aqua tabs, 5 life straw, 3 hygiene kits, health Haala and hygiene education, 6 jerry cans, IEC materials were distributed.

Reinforced Case Management, IEC Material, Aqua Tab, Hygiene Kits and ORS Distributed. Health Educa‐ Mirpur 2‐Jun AWD Sindh Ahmdani Colony 0 1 0 0 tion, DD and EDO‐H were Discussed About the case. Training Provided, DOH and SO dews planned Health Khas Education Session, 1 Stool and 2 Water sample collected for lab test and found positive for V.c. Ogawa.

Ba‐ 1 severely dehydrated case was referred to JGQ (H) hub. IV fluid and ORS was given to 5 Patients of sus‐ Mohhala Qasmani, 31‐May AWD lochista Lasbela 2 7 2 5 pected AWD and 11 Patients of AD. Health education was also given in the community about safe drinking Village Sonmiani n water, Sanitation, Food and water proper usage. all the patients were stable. 2 Stool samples were taken

1 case of AWD was reported from Sheikh Zaid Hospital, Rawalakot. Stool sample was collected and found village Batti ne raha 2‐June AWD AJK Poonch 0 0 0 1 positive for V.c. Ogawa. Field investigation was carried out jointly with DOH team and no other active case UC Rehara of AWD was found. Health hygiene sessions were conducted, water sample was taken for testing.

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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]. 03 Epidemiological Bulletin: DEWS, Pakistan, Week no. 23 (3 - 9 June, 2011) Current week's Outbreaks: Date Disease Province District Area M F Action Taken Killi Malik Murad Balochis‐ Khan Ammen 29 cases were reported for malaria, 15 found positive (P. falciparum 9, P. Vivax 6). The RDT 6‐June Malaria Chagai 3 2 11 13 tan Abad, Chagai kits were distributed to the affectees. DHO and requested for the provision of ACT. village 16 cases suspected Pertussis were reported. Erythromycin distributed and Health educa‐ Killi khan Mazar Pertus‐ Balochis‐ tion was given to the affectees, DHO informed and requested for preventive measures. 6‐June Chagai Posti Karaiz, UC 5 11 0 0 sis tan The reported case are coming from a locality on the Pak‐Afghan Border and highly security Chilghazi compromise and difficult to reach area. Clinically diagnosed case of Pertussis was reported. On investigation it was revealed that the child’s sister had recently died of Pertussis in AMC Abbottabad and 4 other children of same house hold are also being treated for Pertussis. Patient's village was visited and on Pertus‐ Village Nellor UC active surveillance 6 more cases were found in the area. No routine immunization in the 4‐June KPK Haripur 4 3 3 1 sis Beer area. 15 children were assessed only 2 had BCG scar. EPI Coordinator and EDO H informed. Sample collected from 1 patient but found negative for Pertussis. Vaccination campaign was launched on 8th June. 22 children were immunized with pentavalent vaccine, 9 with BCG, 11 with measles, 15 with TT vaccine. Medical camp was established in the community for treatment of acute diarrhea cases. Essential Medicines were provided to the BHU for treatment of diarrheal case. EH Supplies Basti Sandeela, Baha‐ distributed in the area. 3 cases with severe dehydration were reported. Stool samples of 3‐June AD Punjab Moza Manic 5 12 4 27 walpur one patinet taken and sent to NIH. 4/12 water samples contaminated. Health Education Noshera Session conducted by SO DEWS, EHE, LHS and LHWs of the area. Daily follow up at commu‐ nity and HF level was ensured through district supervisory team. Shahnawaz Col‐ Active surveillance, Reinforced Case Management, IEC Material, Aqua Tab, Hygiene Kits & ony Near Railway 3‐June AWD Sindh Dadu 1 1 0 0 ORS distributed, Health Education, 1 Stool sample collected and found positive for V.c. Station,Bhan Ogawa, water samples also collected. Saeedabad Mirpur Missan, Jhando Reinforced Case Management, Health Education, 1Stool sample was collected and found 4‐June AWD Sindh 0 1 0 0 Khas Marri positive for V.c . Ogawa. Tando Kahmir Colony UC Active Surveillance, Reinforced Case Management, IEC Material, Aqua Tab, Hygiene Kits 6‐June AWD Sindh Allah 2,City Tando Alla‐ 0 0 0 1 and ORS distributed, Health Education, Stool collected and found positive for V.c. Ogawa. Yar hyar Tando UC 1, Village Van‐ Active Surveillance, Reinforced Case Management, IEC Material, Aqua Tab, Hygiene Kits 7‐June AWD Sindh Allah giUtho,Taluka 0 0 0 1 and ORS distributed, Health Education, Stool sample collected and found positive for V.c. Yar Chamber Ogawa. Village Hemari,UC Pertus‐ Thar‐ Case isolation, health education, active case finding, reinforced case management, erythro‐ 7‐June Sindh Satidera,Taluka 18 9 9 9 sis parkar mycin to contacts, EDOH informed Nagarparkar Village Dadoon,UC TM Janan Liaison with hospital, reinforced case definitions, notifying cases to DEWS, and proper case 7‐June DHF Sindh 0 1 0 1 Khan Soomro,Taluka management and sample collection BSK Current week's Alerts: Province Balochistan Current week's Alerts: AJK; FATA; GB and ICT M F Date Disease District Area M F Date Disease District Area Khosa colony, ward # 03, Tehsil Jhat 5-Jun Measles Jaffarabad 1 0 0 0 Pat Village Choki UC Gorah-Raiki 4-Jun Measles Sudhnuti 1 0 0 0 Leishmani- Killi Moghalzai, UC Kalat saddar, Garala 9-Jun Kalat 0 0 0 1 asis Tehsil Kalat Haji Mazari Killi, Mandatho Leishmani- Zeedi, Meezawal UC Zeedi, Tehsil Khyber 9-Jun Khuzdar 0 1 0 0 6-Jun Measles Kotai, Jamrud Khyber Agency 0 0 3 0 asis Khuzdar Agency Ghundai Aziz Abad Kanak, UC Gazgi, Tehsil 9-Jun Measles Khuzdar 2 0 0 0 Khuzdar 3-Jun Measles Ghizer Village Golodas Tehsil Ishkoman 0 0 1 0 Leishmani- 4-Jun Lasbela Main Town, Uthal 0 1 0 0 asis

Killi Mulla Abdullah, Nalli Rabbaat, 3-Jun Measles Gilgit Usmanabad Baseen 1 0 0 0 7-Jun Measles Loralai 1 0 3 0 Killi Dukki

UC Gramkan, Village Noke Abad 8-Jun Measles Panjgur 0 1 0 0 Gramkan 3-Jun Measles Gilgit Wahdat Colony Jutial 1 0 0 0

Chicken 4-Jun Sibi Railway colony 2 0 0 1 Pox 6-Jun Measles Gilgit Village Bargo Bala UC Shikyote 1 0 0 0

4-Jun Measles Sibi Mohhala Allahabad 1 1 0 0

4-Jun Measles Sibi Village Bakhra gulam bolak 0 1 0 0 6-Jun Measles Gilgit Village Jutal Khari UC Danyore 1 0 0 0

4-Jun Pertussis Sibi Railway colony 1 0 0 0

9-Jun Mumps Ziarat Susun Mana 2 2 1 0 10-Jun AWD ICT CH PIMS (G 6/3 ) 0 0 1 2

10-Jun Pertussis Ziarat Susun Mana 0 1 0 0 CH PIMS (Bari Imam, new 7-Jun Measles ICT 1 0 2 0 10-Jun Scabies Ziarat Cheena 0 1 2 0 Sakrial)

6-Jun AWD Charsadda Vill. Wino Dheri, UC Aagra 0 0 1 0 4-Jun Measles Ghotki Village Dring Malook Wali 1 0 0 0

3-Jun DHF Haripur Village Mang Union Council Mang 0 0 0 1 Village Drig Malook wali UC Bago Daho 5-Jun Measles Ghotki 1 0 0 0 Muhallah Sayedan, Union Council Tarbella Taluka Ghotki 7-Jun Measles Haripur 1 0 2 2 Haripur 7-Jun Measles Ghotki Village Nabi Bux Lakho UC Bandh 0 0 1 0 9-Jun AWD Mansehra Vill Dara # 1 0 1 0 0 Mohalla Akakhel, Gulamo Machine, Katlang 11-Jun Measles Ghotki Village Nibaho Chachar UC Mithri 1 0 0 0 4-Jun AWD Mardan 0 0 0 1 road DHQ Mirpurkhas (Goth khudadad, Tando 3-Jun NNT Hyderabad 0 0 1 0 9-Jun AWD Mardan Mohallah Gulshanabad, UC Lund khwar 0 0 1 0 Jam Mohammad) 7-Jun Measles Mardan Mohallah Baja Nari, Village Muqam mandi 0 1 0 0 9-Jun AWD Jacobabad Village Mirpur Buriro, Thull 2 0 0 0 7-Jun Measles Mardan Mohallah Beland khel, Landaki Chatow 1 0 0 0 6-Jun Measles Jacobabad Moosani Kot, Mirpur Buriro 1 0 0 0 7-Jun Measles Mardan Mohallah Jaber, Village Sawal Dher 0 1 0 0 7-Jun AWD Karachi Haroonabad,SITE Town & NICH 0 0 0 2 7-Jun Measles Mardan Mohallah Rag nary, near military farm 1 0 0 0 7-Jun AWD Karachi Shetan Chawk,Korangi Town and NICH 0 1 2 0 9-Jun Measles Mardan Mohallah Janabad, Charsadda road 1 0 0 0

9-Jun Measles Mardan Mohallah Sherpur, Mohabatabad phatak 1 0 0 0 6-Jun Measles Karachi R-36,Shaban Tawn,UC-7,Malir Tawn Karachi 0 0 0 1

7-Jun DHF Peshawar Hazar Khwani, Jabba Sohail Abad 0 1 0 0 6-Jun Measles Karachi S 2/738,UC 3 Saudabad,Malir Tawn karachi 0 0 1 0

9-Jun AWD Shangla Village Maira Thoka Besham 0 1 0 0 6-Jun Measles Karachi Shah Faisal Town 1 0 0 0 9-Jun AWD Shangla Village Maira Thoka Besham 0 0 1 0 7-Jun Measles Karachi 1728/141,Arab Muhalla UC-8,Baldia Town 0 0 1 0 6-Jun Measles Swabi DHQ Swabi, Junda 1 0 1 0 3-Jun AWD Khairpur Babarloi Near Police Station 0 1 0 0 7-Jun Measles Swabi BHU Shah Mansoor 0 0 1 0 3-Jun AWD Khairpur Village Lal Bux Kandhero, Tehsil Kingri 1 0 0 0 7-Jun Measles Swabi Private clinic, Salim Khan 2 2 3 2 Village Ghulam Jaffer UC Gadeji, Tehsil 8-Jun Measles Khairpur 1 0 0 0 8-Jun Measles Swabi DHQ Swabi, Bengra UC Kalabat 2 1 1 1 Sobho Dero 7-Jun Measles Swat Vill Chail, UC Madyan 1 0 0 0 9-Jun Pertussis Matiari Village Piyaro Khoso,UC Bhenkhan 2 1 2 1 8-Jun Measles Swat Village Balogram 0 0 1 0 9-Jun Pertussis Matiari Village Shyan Muhammad shah,UC Oderolal 0 2 0 1 8-Jun Measles Swat Village Mian Baba, Marghuzar road 0 0 0 1 4-Jun AWD Mirpur Khas Zahid Abad 0 1 0 0 9-Jun Measles Swat College colony Matta 1 0 0 0 6-Jun AWD Mirpur Khas Mirwah city, UC Mirwah 0 2 0 0 9-Jun Measles Swat Village Qalagay 0 1 0 0 Naushahro 8-Jun Pertussis Tank Tank City 0 0 1 0 8-Jun AWD Village Rajper, near Padidan 1 0 0 0 Feroze Vill. Janbatai-UC Ganorai & Vill. Mena dag- 8-Jun AWD Upper Dir 1 0 1 0 Naushahro UC Dogdara 4-Jun Measles Sochi Para, Jalal Ji Road, Padidan 0 0 1 0 Feroze

Current week's Alerts: Province Punjab Naushahro 4-Jun Measles Village Sochi Para,UC Padydan 0 0 0 1 Feroze Date Disease District Area M F Naushahro 8-Jun Measles Padidan 2 0 2 0 8-Jun AD Bahawalpur Basti Rehman, UC Urban KPT 3 2 4 7 Feroze

8-Jun Measles Bahawalpur Chak 275, Fort Abbas 0 1 0 0 Village Muhammad Chandio,Near Jhalo 7-Jun Measles Nawabshah 0 1 0 0 Masjid Stop,UC Thatta Kanjoo Chowk, Rafi Qamar Road, near 9-Jun Measles Bahawalpur 2 4 1 0 Satellite Town-C, UC 15 Qambar Mehmood Colony, Near Sooji Mill, Multan 6-Jun Measles Village Kot Ghulam Shah, UC Rawanti 0 0 1 0 9-Jun Measles Bahawalpur 1 0 0 0 Shahdadkot Road UC-27 Street No.2, Near Mosq Haji Ahmed Din, Qambar 9-Jun Measles Bahawalpur 2 1 5 2 8-Jun Meningitis Village Qabool Teevino, Naseerabad 0 0 1 0 Shahdra Chowk, UC-6 Shahdadkot Daggar Wagra Chak 16 TDA, UC Darya 9-Jun Meningitis Bhakkar 0 1 0 0 5-Jun AD Shikarpur Paeds ward, DHQ Shikarpur 2 1 0 0 Khan Urban II BHU Barkat Wala, Grid Station Colony, UC 8-Jun Scabies Bhakkar 3 4 2 5 7-Jun AD Shikarpur BHU Dadloi, Tehsil Pano Akil 2 1 3 0 Daggar Qureshi SHC Chak no 13 TDA, UC Darya Khan Village Amir Jeha, near primary school & 9-Jun Scabies Bhakkar 1 7 0 10 6-Jun Measles Shikarpur 0 0 1 0 Urban-II mosque, UC Dhakan 7-Jun AD D. G. Khan Phaloo wala uc Ghausabad tehsil DGKhan 0 11 0 10 8-Jun Measles Shikarpur Village Allaf Shah Shaheed 1 0 0 0 Tauqeer s/o Dur Muhammad Khoo Tare 6-Jun Measles D. G. Khan wala Haji Kaman uc Jhakkar Imama Shah 1 0 0 0 9-Jun Measles Shikarpur Hindu Mohalla Madeji 0 1 0 0 Tehsil DGKhan Waqar s/o Abdul Jabbar Rukanabad Colony 6-Jun Measles D. G. Khan 1 0 0 0 3-Jun AWD Sukkur GMC hospital Sukkur 2 0 0 0 Pul Dat uc 4 Tehsil DGKhan 6-Jun BD Khushab UC Noshera 0 2 0 0 4-Jun Measles Sukkur THQ Rohri 1 0 0 0

4-Jun Malaria Layyah Union council jhakar pacca 1 11 1 20 8-Jun Measles Sukkur Mahar Mohalla New Pind 0 0 1 0

Leishmani- Tando Allah DHQ Mirpurkhas (Goth fareed khoso, UC 8-Jun Mianwali Village Jhanda Khel,UC Vanjaree 0 2 0 3 3-Jun AWD 1 0 0 0 asis Yar Missan) Children Hospital Complex Multan, Majeeda- 9-Jun Measles Multan 0 1 0 0 Tando Allah bad Colony 6-Jun AWD Lahmir Colony UC 2,Taluka Tando Allahyar 0 1 0 0 Children Hospital Complex Multan, Majeeda- Yar 8-Jun Monkey Pox Multan 1 0 0 0 bad Colony Tando Allah 7-Jun AWD UC Bengan Janwan,Taluka Chuen 0 0 0 2 8-Jun AWD Muzaffargarh UC Baseera 1 0 0 0 Yar

Tando Allah Village Fareed Khoso,UC Missan 3-Jun Measles Muzaffargarh Lutkera, City-3 0 0 1 0 8-Jun AWD 0 5 3 2 Yar Wadi,Taluka Jhando Mari 3-Jun Measles Muzaffargarh UC City-3 0 0 1 0 Tando Allah Village Mohsin Dago,UC Missan Wadi,Taluka 8-Jun AWD 0 2 0 3 3-Jun Measles Muzaffargarh UC Lutkeran 1 0 0 0 Yar Jhando mari Tando Allah Village Muhammad Ali Pryar,UC Daad 3-Jun Measles Muzaffargarh UC Muradabad 1 0 0 0 3-Jun Measles 1 10 0 9 Yar Jarvan,Taluka Chamber

6-Jun Measles Muzaffargarh UC Beeley Wala 1 0 0 0 Village Khariryoon,UC Jesy jo par,Taluka 6-Jun AWD Tharparkar 0 6 6 17 Chachro 6-Jun Measles Muzaffargarh UC Jatoi Shumali 1 0 0 0 Rahim Yar Village Chandero Mallah,UC Bello,Taluka 3-Jun AWD THQ Hospital Liaqatpur, UC Allahbad 3 0 0 0 7-Jun Measles Thatta 3 1 8 0 Khan Sajawal 6-Jun Pertussis Rajanpur Chak Branda,Mauza Dhundi, UC Fatehpur 4 0 0 0 3-Jun AWD TM Khan Village Gul Mallah,Fateh Bagh UC Nazarpur 0 1 0 0

3-Jun Measles Rawalpindi CH PIMS (airport road ) 0 0 0 1 Village Dadoon,UC Janan Soomro,Taluka 7-Jun DHF TM Khan 0 1 0 1 BSK 4-Jun Measles Rawalpindi CH PIMS (Bagh Sardaran) 1 0 0 0 Village Sahiban-jo-kot and Hari Of Hanif 6-Jun AWD Umer Kot 5 0 2 3 9-Jun Measles Rawalpindi CH PIMS (Jhangi Syedan) 1 0 0 0 Abro,UC Atta Muhammad Palli

Table‐3: Total number of alerts and outbreaks reported and investigated with appropriate response (*Post Flood (29 July - 31 Dec 2010) 2011 (1 Jan - 2 June 2011); Current Week (3 - 9 June, 2011) A= Alerts; 0= Outbreak) Post Flood 2010 2011 Current Week Total Disease A O A O A O A O Acute Watery Diarrhoea 209 85 157 54 33 2 399 141 Acute Jaundice Syndrome 5 2 20 10 ‐ ‐ 25 12 Bloody Diarrhoea 10 1 34 8 1 ‐ 45 9 Measles 50 7 758 65 70 ‐ 878 72 Pertussis 2 ‐ 110 10 10 3 122 13 NNT + Tetanus 6 ‐ 65 ‐ 1 ‐ 72 ‐ Malaria 12 7 34 23 2 1 48 31 Leishmaniasis 1 ‐ 33 14 4 ‐ 38 14 Others 156 43 260 34 16 1 432 78 Total 451 145 1471 218 137 7 2059 370 Province Khyber Pakhtunkhwa: Figure-3: Three years trend of Acute diarrhoea, province KPK • This week 19 districts reported to DEWS from KP province • 703 health facilities reported 171,289 patients consultations 20 to DEWS. 16 • ARI cases reported were 42,419 (25%), an increase by 1% in proportional morbidity compared with last week. 12

• AD is showing a consistent upward trend and accounted for Percentage 8 13% - 14% of the total consultations in last 4 weeks. • 30 alerts were reported in this week from Khyber 4 Pakhtunkhwa, 17 were for Measles, 8 were for AWD, 3 2009 2010 2011 were for Pertussis, while 2 were for Dengue Hemorrhagic 0 Fever. 1 4 7 101316192225283134374043464952 Epi‐Week Province Punjab Figure-4: Trend of acute diarrhoea, province Punjab (3 August 2010 to 9 June 2011) • 12 districts reported data to DEWS from Punjab province, 887 health facilities reported a total of 255,350 patient consultations during this reporting period 20

• ARI cases reported were 46,241 (18%) and leading cause of consulta- 16 tions. 12 • 29 alerts were reported in this week from Punjab; 16 were for Measles, 3 were for Acute Diarrhoea, 2 each were for AWD and 8

Scabies, while 1 each for Bloody diarrhoea, Leishmaniasis, Malaria, Percentage Meningitis, Monkeypox and Pertussis. 4 • Increased number of confirmed malaria cases from 10 districts. 161 0 from Muzaffargarh, 57 were from Sargodha, 39 from DG Khan, 22 2 3 4 5 6 7 8 9 31 01 ‐ ‐ 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Jhang, 14 were from Layyah, 9 were from Rajanpur, 7 were from 10 11 12 13 14 15 16 17 18 19 20 21 22 Mianwali, 5 were from Bahawalpur, while 2 from Khushab. 2010 2011 Epi‐Week

Province Sindh

Figure-5: Three years trend of Acute diarrhoea, province Sindh • This week 22 districts reported to DEWS from 1,032 health centers with a total of 445,531 patient consul- 20 tations during the reporting period of week 23, 2011.

• In Sindh, ARI cases reported were 83,519 (19%), 1% 16

lower proportional morbidity as compared with last 12

week. Percentage

8 • 53 alerts were reported from Sindh in this week: 23 were for Measles, 22 were for AWD, 3 were for Per- 4 tussis, 2 were for Acute Diarrhoea, while 1 each for 2009 2010 2011 Dengue Hemorrhagic Fever, Meningitis and Neona- 0 tal Tetanus. 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Epi‐Week

Province Balochistan Figure-6: Three years trend of Acute diarrhoea, province Balochistan • In this week, 17 districts reported to DEWS from Balochis- tan province. 411 fixed and 2 mobile medical outreach cen- 30

ters reported a total of 60,383 patient consultations. 25

• ARI reported in 9,495 (16%) of the total consultations 1% 20

lower proportional morbidity as compared with last week. 15 While AD showing consistent trend and accounted for 15% 10 of patients visits. Percentage 5 • 14 alerts were reported in this week from Balochistan, 6 2009 2010 2011 were for Measles, 3 each were for Leishmaniasis and Pertus- 0 1 4 7 101316192225283134374043464952 sis, while 1 each for Malaria and Scabies. Epi‐week Gilgit Baltistan Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 2 June 2011) • In this week, 41 health centers from Gilgit Baltistan sent weekly report with a total of 18,420 patient consultations. 50 45 • ARI cases reported were 2,550 (13%), while Acute Diar- 40 35 rhoea (Not Watery) 1,556 (8%). The DEWS network has 30 been recently introduced in Gilgit Baltistan and is being 25 20 Percentage established. 15 10 • Five alerts for Measles received and responded this week. 5 0 wk 13 wk 14 wk 15 wk 16 wk 17 wk 18 wk 19 wk 20 wk 21 wk 22 wk 23 AD BD ARI S. Malaria

FATA Figure-8: Trend of priority communicable diseases, FATA (4 February to 2 June 2011) • This week 45 health centers reported from FATA, 50 with a total of 10,161 patient consultations. 45 40 35 • ARI cases reported were 2,104 (21%), while Acute 30 25 20

diarrhoea reported 1,292 cases (13%) Percentage 15 10 • One alert for Measles were received and responded 5 0

this week. 6 7 8 9

23 22 21 20 19 18 17 16 15 14 13 12 11 10

wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk AD BD ARI S. Malaria

State of Azad Jammu and Kashmir Figure-9: Trend of priority communicable diseases, AJK (25 March to 2 June 2011) • In this week, weekly report received from 72 health 50 centers with a total of 30,606 patient consultations. 45 40 35 30 • ARI cases reported were 4,554 (15%), while Acute 25

Percentage 20 diarrhoea reported 2,052 (7%) cases 15 10 5 • One alert for measles was received and responded 0 this week. wk 13 wk 14 wk 15 wk 16 wk 17 wk 18 wk 19 wk 20 wk 21 wk 22 wk 23 AD BD ARI S. Malaria

Islamabad Capital Territory

Figure-10: Trend of priority communicable diseases, Islamabad (1 January to 2 June 2011) • This week 4 health facilities are reporting through DEWS with a total of 4,020 patient consultations. 60 50 • ARI cases reported were 824 (20%), while Acute Diar- 40 rhoea (Not Watery) 767 (19%). Fluctuation in rates was 30 Percentage due to difficulties in collecting reports as the system is 20

being established. 10

0 1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 • Two alerts one for Measles and one for AWD received 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 this week. AD BD ARI S. Malaria