Federal Disease Surveillance and Response Unit Field Epidemiology & Disease Surveillance Division National Institute of Health (NIH) Islamabad WEEKLY FIELD EPIDEMIOLOGY REPORT

Volume 3—Issue 28 Jul 04-10, 2021 Date: July 14, 2021

P rovincial Technical Officers and fellows of FELTP assigned at the Disease Surveillance, Response Units (DSRU’s) are working with provincial, and district health authorities on event based disease surveillance and outbreak response. DSRUs are sharing the disease surveillance data, outbreak reports and activities of FELTP fellows to the Federal Disease Surveillance and Response Unit (FDSRU) at the Field Epidemiology and Disease Surveillance Division (FEDSD) National Institute of Health (NIH) Islamabad on weekly basis. COVID-19 Surveillance

PDSRUs in Provinces are working with the February 2020. Daily flights data from international provincial department of health on COVID-19 airports in is being shared by the Central surveillance, response and contact tracing since Health establishment (CHE) Islamabad with February, 2020 in Pakistan. FELTP fellows Alumni FDSRU teams who conduct daily calls on given are actively involved in COVID-19 Surveillance contact numbers of the travelers to ask about their throughout Pakistan. Data is being shared with health status, advise them for immediate contact at FDSRU on daily basis and a SitRep is being issued the nearest designated hospital in case of COVID- by FEDSD National Institute of Health Islamabad 19 symptoms. Total 141,131 travelers have been FDSRU has developed a mechanism for tracking of traced and contacted by July 10, 2021. travelers from other countries to Pakistan since 02 Table-1: Weekly Surveillance data COVID-19 by July 10, 2021 Province/ Suspected cases Lab Update Hospital Update Region reported

Cumulative Tests performed Tested positive cases Currently Discharged/Recovered Expired (Cumulative) (Cumulative) admitted

AJK 221,971 221,971 21,067 42 19,657 594 Baluchistan 230,988 310,163 27,961 23 26769 317 GB 135,580 137,309 6,851 52 6,101 111 Islamabad 1,708,645 1,708,645 83,647 110 81278 783 KP 1,872,830 2,177,508 139,313 459 133,220 4,359 Punjab 5,754,805 5,827,053 348,085 882 328767 10819 4,674,138 4,674,138 346,360 822 317411 5599 Total 14,598,957 15,056,787 973,284 2,390 913,203 22,582

PDSRU SINDH Total 348,368 confirmed COVID-19 cases were (n=6,569) and District Ghotki (n=5,913). Age group reported from Sindh until July 10,2021. 317,884 ≥70 has the highest attack rate (1991/100,000) cases have recovered while 5,644 cases expired due followed by 50-59 years age group (1822/100,000), to COVID-19. Most of these cases were reported 60-69 years age group (1581/100,000) & 30-39 years from District (n=219,494) followed by age group (1430/100,000 population). District Hyderabad (n=21,049), District Sukkur

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Volume03 -- Issue 28 Jul 04-10, 2021 Date: July 14, 2021

Figure-1: Sindh - District-wise distribution of COVID-19 cases (Cumulative up to week 28)

Figure-2: Sindh – Age group-wise Attack Rates /100,000 population (Jul 10, 2021)

2500

1991 2000 1822 1581 1430 1500 1375

1004 1000 Attack rate/100,000 Attack 500 250 18 0 <1-9 y 10-19 y 20-29 y 30-39 y 40-49 y 50-59 y 60-69 y 70+ Age Groups

PDSRU Punjab PDSRU Punjab has reported total 5,771,932 Lahore has the highest number of confirmed cases suspected cases of COVID-19 and out of these (n=1,79,744) followed by District Rawalpindi 348,3095were lab confirmed COVID-19 cases up to (n=26,787), District Faisalabad (n=21,474), District July 10, 2021. 328,838 cases have recovered and Multan (n=17,958) and District Gujranwala 10,822 cases expired due to COVID-19. District (n=8,323) respectively.

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Volume03 -- Issue 28 Jul 04-10, 2021 Date: July 14, 2021

Figure-3: Geographical Distribution of COVID-19 Cases in Punjab Province (Up to week 28)

PDSRU - Baluchistan province

The department of Health Baluchistan has reported (n=1,552), District Khuzdar (n=1,047) and District 27,994 positive cases of COVID-19 and 317 deaths Lasbela (n=760). Age group 30-44 has the highest until July 10, 2021. 26,834 cases have recovered. number of COVID-19 cases (n=8,844) followed by District Quetta has the highest number of confirmed age group 15-29 (n=7,942) & age group 45-59 cases (n=19,127) followed by District Kech (n=4,751).

Figure-4: Geographical Distribution of COVID-19 Cases in Baluchistan Province (Cumulative up to Week 28)

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Volume03 -- Issue 28 Jul 04-10, 2021 Date: July 14, 2021

Figure-5: Baluchistan –Age group wise distribution of COVID-19 positive cases (up to July 10,2021)

10000 8844 9000 7942 8000 7000 6000 4751 5000 3781 4000 No. of Cases of No. 3000 2676 2000 1000 0 1-14y 15-29 30-44 45-59 60+ Age Groups

PDSRU- Gilgit-Baltistan (GB)

PDSRU GB has reported total 136,245 suspected COVID-19. 5,959 cases have recovered from cases of COVID-19 and out of these 8,511 were lab COVID-19 while 111 cases expired. During current confirmed COVID-19 up to July 10,2021 and 608 week highest number of COVID-19 cases were cases were detected during last week, while no lab detected in District Gilgit (n=325) followed by results are awaited. 135,899 samples were processed District Skardu (n=90) and District Hunza (n=62). and 119,410 suspects were declared negative for

Table -2 Detail of number of samples, confirmed Covid-19 cases & Deaths in GB up to July 10,2021

Total Samples District Number of Negative Positive Awaited Recovered Expired Samples Processed Suspects Discarded

Astore 14721 13830 14713 62 00 419 05 08 Diamer 17124 15530 17123 12 00 326 05 01 Ghanche 8652 8168 8556 11 00 158 06 96 Ghizer 9912 9208 9910 22 00 452 07 02 Gilgit 32829 29123 32745 325 00 2561 40 84 Hunza 17905 10866 17888 62 00 666 03 17 Kharmang 5735 5546 5709 06 00 140 00 26 Nagar 6509 5954 6507 08 00 218 04 02 Shigar 5559 5220 5531 10 00 182 04 28 Skardu 17299 15965 17217 90 00 837 37 82 Grand Total 136245 119410 135899 608 00 5959 111 346

Figure-6: GB-District-Wise distribution of confirmed COVID-19 cases, July 04-10,2021

350 325

300

250

200

150

No. of Cases of No. 90 100 62 62 50 22 12 11 6 8 10 0 Astore Diamer Ghanche Ghizer Gilgit Hunza Kharmang Nagar Shigar Skardu Districts

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Volume 03-- Issue 28 July 04-10, 2021 Date: July 14, 2021

PDSRU-AJK cases have recovered from COVID-19 and 594 cases PDSRU AJK has reported total 222,671 suspected expired due to COVID-19. District Muzaffarabad cases of COVID-19 and out of these 21,180 were lab has the highest number of cases (n=5,372) followed confirmed COVID-19 up to July 10, 2021 while no by District Mirpur (n=3,619), District Poonch lab-results of suspected cases are awaited. 19,700 (n=3,612) and District Kotli (n=2,821).

Table -3: Distribution of suspected and confirmed Covid-19 cases in AJK up to July 10,2021

Total Suspected Cases Lab Tests Conducted Lab Confirmed Cases Active Cases Recovered Total Deaths

222,365 222,671 21,180 886 19,700 594 Figure-7: AJK-District-Wise distribution of confirmed COVID-19 cases up to July 10,2021

6000 5372 5400 4800 4200 3619 3612 3600 2821 3000 2400 1861

No. of Cases of No. 1800 1437 1216 1200 798 600 309 134 0 Muzaffarabad Mirpur Poonch Kotli Bhimber Bagh Pallandri Hattian Bala Neelum Havaili Districts

PDSRU-KPK District Mardan (n=8,938), District Swat (n=8,376) PDSRU KPK has reported total 1,872,830 suspected and District Nowshera (n=5,820). Age group 60-69 cases of COVID-19 and out of these 1,39,463 were years has the highest attack rate/100,000 (AR=982) lab confirmed COVID-19 up to July 10, 2021 while followed by 40-49 years age group (AR=902) and 4,352 patients expired. District has the 50-59 years age group (AR=766). highest number of cases (n=50,913) followed by

Figure-8: Geographical Distribution of COVID-19 Cases in KPK Province (Cumulative up to Week 28) Volume 03-- Issue 28 July 04-10, 2021 Date: July 14, 2021

Figure-9: KPK –Attack rates /100,000 population in different age groups (up to July 10, 2021) 1200 982 1000 902 766 800 655 607 562 600 460 400 Attack rate/100,000 Attack

200 95 29 0 0 – 9 10 – 19 20 – 29 30 – 39 40 – 49 50 – 59 60 – 69 70 – 79 >80 Age Groups

Communicable Disease Surveillance

Measles Surveillance: Diphtheria/Pertussis Surveillance: In 2020, total 1986 confirmed Measles cases During 2018 total 464 and during 2019 total 614- reported from all PDSRUs/RDSRUs. In week 28, suspected cases of Diphtheria were reported. In week 117 cases of measles were reported from KPK & 28, no cases of diphtheria/pertussis was reported. Baluchistan. Dengue Surveillance: CCHF Surveillance: In 2018, total 3204 Dengue cases reported from In 2018, total 63 CCHF (suspected and confirmed) Sindh. In 2019 total 24,610 cases reported which cases were reported from DSRUs and 75 cases have includes 48 new case reported from Baluchistan. In been reported in 2019. During week 28, 05 new cases week 28, 150 cases were reported from Baluchistan were reported from Baluchistan. & Sindh.

Table-4: Weekly and Cumulative Diseases Updates July 10, 2021

Disease Total Cases in 2020 Jul 04-10, 2021 Total Cases in 2021 1 CCHF 19 5 9 2 Varicella 235 0 0 3 Dengue 4024 150 2129 4 Chikungunya 0 0 0 5 Measles 1986 117 3505 6 Diphtheria/Pertussis 140 0 34 Suspected / confirmed 7 9 0 0 Seasonal Influenza 8 NNT 150 2 26

Table 5: Dengue cases reported in 2017, 2018, month-wise distribution in 2019 & current week (All provinces and regions) Month KPK Sindh AJK ICT TDs - KP Baluch Punjab Total

Jan–Dec 2017 18,857 2,884 6 120 406 86 579 22,938

Jan-Dec 2018 332 2088 1 0 175 69 539 3204

Jan-Dec 2019 5214 2937 506 2847 1484 2841 8826 24547 Jan-Dec 2020 3 2722 2 184 0 493 38 3,442 Total 24406 10631 515 3151 2065 3489 9982 54131 10/07/2021 0 90 0 0 0 60 0 150

Total (2021) 0 1113 0 0 0 1016 0 2129

Volume03 -- Issue 28 Jul 04-10, 2021 Date: July 14, 2021

Extensive drug Resistant (XDR) Typhoid Fever Surveillance in Sindh Province In Karachi total 14,946 cases of extensive drug reported in the age group 0-4 years. The overall resistance typhoid fever were reported from January attack rate was 74/100,000. The age group 0-4 years 01, 2017 to July 10, 2021. During current week total was the most affected (attack rate 229/100,000) 80 cases of XDR typhoid fever were reported from followed by age group 5-9 years (attack rate different hospitals in Karachi. The XDR Typhoid 158/100,000). Females have higher attack rate cases were reported mostly among the children and 82/100,000 as compared to Males. maximum number of XDR cases 6252 (42%) were

Table-6: Number of XDR Typhoid fever cases Karachi from January 1, 2017 to June 19, 2021

Year Year XDR Cases

Jan to December 2017 175

Jan to December 2018 3712

Jan to December 2019 7088

Jan to December 2020 2510 Till July 10, 2021 2021 1461 Total 14,946 Figure 10: Week-wise number of XDR Typhoid fever cases in Karachi, from January 1, 2017 to July 10, 2021 300

250

200

150

100 No. of Cases of No.

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0 Week 1 Week 4 Week 7 Week 3 Week 6 Week 9 Week Week 10 Week 13 Week 16 Week 19 Week 22 Week 25 Week 28 Week 31 Week 34 Week 37 Week 40 Week 43 Week 46 Week 49 Week 52 Week 12 Week 15 Week 18 Week 21 Week 24 Week 27 Week 30 Week 33 Week 36 Week 39 Week 42 Week 45 Week 48 Week 51 Week 02 Week 05 Week 08 Week 11 Week 14 Week 17 Week 20 Week 23 Week 26 Week 29 Week 32 Week 35 Week 38 Week 41 Week 44 Week 47 Week 50 Week 01 Week 04 Week 07 Week 10 Week 13 Week 16 Week 19 Week 22 Week 25 Week 28 Week Epi Weeks

XDR Typhoid Surveillance Data Sindh-Province (Excluding Karachi) Total 7640 Salmonella Typhoid cases reported from affected age group was 0 to 4 years (n=1491) with November 2016 to July 10, 2021 from different attack rate 50.5/10000 population followed by 5-9 districts of Sindh province (excluding Karachi). years of age group (n= 1115) with attack rate Among these cases 5833 were Extensive Drug 38.1/10000 population. Over all attack rate is Resistant cases. Out of these cases n=4051 (69.5%) 18.5/10000 population (n=4051). were reported from District Hyderabad. The most

Table 7: Extensive drug Resistant (XDR) Typhoid Fever Surveillance Hyderabad and other districts

Year Hyderabad Other District Total 2016 12 0 12 2017 485 4 489 2018 891 207 1098 2019 1645 998 2643 2020 708 415 1123 January 01 – July03, 2021 297 148 450 Current week Jul 04-10, 2021 13 5 18

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Total 4051 1777 5833

Figure 11:XDR Typhoid Cases District Hyderabad Nov-2016 to July 10, 2021

250

200

150

100 No of cases cases of No

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0 N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J Year - Year-17 Year -18 Year-19 Year-20 Year-21 16 Month wise cases

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