Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 3, Issue 2, Tuesday 17 January, 2012

Highlights Priority diseases under surveillance Epidemiological week no. 2 (8 to 14 January, 2012) in DEWS

• In week 2, 2012, total 74 districts including 2 agencies providing surveillance data to the Acute Flaccid Paralysis (AFP)

DEWS on weekly basis from around 1,399 health facilities. Data from mobile teams is reported Acute Jaundice Syndrome (AJS) through sponsoring BHU or RHC. Acute Respiratory Infections (Upper and Lower) (ARI) • A total of 403,874 consultations were reported through DEWS of which 27% were acute respiratory infections (ARI); 5% were Skin disease; 6% were acute diarrhoea; and 4% were sus‐ Acute Watery Diarrhoea (AWD)/ Sus- pected Cholera pected malaria. Acute Bloody Diarrhoea (BD) • A total of 101 alerts with 5 outbreaks were reported: Altogether 38 alerts for Measles; 18 Other Acute Diarrhoeas (AD) for Neonatal tetanus and tetanus; 17 for Leishmaniasis; 8 for Pertussis; 4 for AWD; 3 for Acute Jaundice Syndrome; 2 for Bloody diarrhoea and 1 for suspected Malaria while 10 for others com‐ Suspected Viral Hemorrhagic Fever (VHF) municable diseases. Suspected Malaria (Mal) • In week 2, 2012, five new type‐1 polio cases were confirmed by the laboratory having date Suspected Measles (MS) of onset of paralysis in 2011; one each from Federally Administered Tribal Areas (Khyber agency), Suspected Meningitis (MG) Khyber Pakhtunkhwa (district Charsadda), Sindh (district Badin), Balochistan (district Khuzdar) and Punjab (district Lahore). This brings the total number of polio cases in 2011 so far to 197 (195 Others type‐1 cases and 2 type‐3 cases) from 60 districts/towns/tribal agencies & areas.

Figure‐1: Weekly trend of Acute diarrhoea and ARI in Pakistan, 2010 and 2011.

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

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

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

‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ wk wk wk wk wk wk wk wk wk wk wk wk wk wk 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 in 2011, by province

Disease Wk-47 Wk-48 Wk-49 Wk-50 Wk-51 Wk-52 Wk-1 Wk-2

Acute respiratory infection 224,061 (26%) 242,844 (27%) 192,900 (27%) 241,869 (28%) 240,042 (29%) 215,219 (30%) 90,563 (27%) 107,692 (27%)

Skin diseases 72,895 (8%) 77,057 (9%) 58,406 (8%) 69,079 (8%) 68,422 (8%) 55,185 (8%) 19,737 (6%) 19,582 (5%)

Acute diarrhoea 62,650 (8%) 65,718 (7%) 52,625 (7%) 61,478 (7%) 57,942 (7%) 49,544 (7%) 21,574 (6%) 23,844 (6%)

Bloody diarrhoea 5,478 (0.64%) 4,912 (0.54%) 4,556 (0.64%) 4,856 (0.57%) 4,332 (0.52%) 4,257 (0.59%) 1,492 (0.44%) 2,204 (0.55%)

Suspected malaria 56,468 (7%) 63,826 (7%) 47,753 (7%) 52,040 (6%) 50,480 (6%) 39,991 (6%) 13,887 (4%) 15,050 (4%)

Total consultation 859,241 904,948 709,4184 856,582 835,260 717,926 340,073 403,874

• The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as percentage of cases out of total consultations reported to DEWS on weekly basis. • In year 2011, approximately 45,510,570 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K with average weekly consultations at 875,204. • The above table provides the total consultations and proportional morbidity of five disease syndrome. Proportional morbidity of ARI is highest in KP while acute diarrhoea is highest in KP and Balochistan. • Proportional morbidity of suspected malaria were very high for the year at 13% in Balochistan and 12% in Sindh (Please see provincial trends graphs).

This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected]. 01 Special Bulletin: DEWS, Pakistan, Week no. 2 (8 to 14 January, 2012) Previous week's (1/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Abro Mohla & Bhangar Outbreak of 6 cases of Leishmaniasis from one location. Inj Glucantime was provided and health education 5‐Jan Leishmaniasis Balochistan Nasirabad 1 3 2 0 Mohla town area was given. Hazara town, Brewery 6 new cutaneous Leishmaniasis cases were attended in continuation of previous Cases. Treatment started 6‐Jan Leishmaniasis Balochistan Quetta 0 5 0 1 road through MC supported Program. Till date a total of 66 cases reported from this center. 58 cases of suspected Malaria reported from Hospital out of which 24 were positive for P. Falciparum and 7 7‐Jan Malaria Balochistan Lasbela Civil Hospital Bela 0 0 0 0 were P. Vivax (SPR=54%). The treatment was provided to all patients. Information was shared with DHO for necessary action. 17 cases of suspected Malaria reported from RHC out of which 11 were positive 9 for P. Falciparum and 2 for 7‐Jan Malaria Balochistan Lasbela RHC Lakhra 0 0 0 0 mix (SPR=65%). Treatment was provided to all patient as per WHO protocol. All the information was shared with DHO for necessary action. Alert for measles, during active surveillance 7 more cases were found, routine outreach vaccination con‐ Village Navagai, UC ducted in the area by EPI Team, Vit‐A was given, Blood Sample Collected for confirmation of antibodies, 3‐Jan Measles KPK Lower Dir 5 1 2 0 Rabat, Tehsil Balmbat Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed.

Alert for Measles, during active surveillance 5 more cases were found, routine outreach vaccination con‐ Village Shagai, UC Rabat, ducted in the area by EPI Team, Vit‐A was given, Blood Sample Collected for confirmation of antibodies, 4‐Jan Measles KPK Lower Dir 3 2 1 0 Tehsil Balmbat Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed.

Alert for Measles, during active surveillance no more cases found, routine outreach vaccination conducted in Village Ttoru, UC Drangal, the area by EPI Team, Vit‐A was given, Blood Sample Collected for confirmation of antibodies, Health educa‐ 5‐Jan Measles KPK Lower Dir 1 0 0 0 Tehsil Samar Bagh tion session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed. Lower Dir (Village Warri Suspected Measles case reported from OPD‐DHQ Hospital belongs to Upper Dir. The concern S.O informed for 5‐Jan Measles KPK Upper Dir Payeen, UC & Tehsil 1 0 0 0 active surveillance. Blood Sample collected and sent to NIH, Health education session conducted with the Warri) family members. Village Kaloo Khan Suspected case of Pertussis found in hospital, during active surveillance 5 more cases found, Child was not 3‐Jan Pertussis Sindh Dadu Karmani, near Wapda 2 1 2 1 vaccinated, 9 out of 15 children were vaccinated in the community, health education imparted, Erythromycin colony provided, EDOH, THO, DSM, EPI FP inform and 1 throat sample taken.

Suspected cases of Pertussis reported in Village, Active surveillance done, Throat sample taken, vaccination Village Mazar Burguri, UC 4‐Jan Pertussis Sindh Dadu 6 1 5 2 status was not good, 8 out of 20 children were vaccinated in the area, health education session was con‐ Torr Taluka Johi ducted, Erythromycin provided, EDOH, THO, DSM, EPI FP inform and request for immunization. Current week's (2/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for Bloody diarrhoea, 3 cases were reported from BHU Manakarai. Stool sample was taken and sent to Khyber NIH. Water samples were tested and found to be contaminated. LHWs were involved in active case finding 2 9‐Jan BD Pakhtunk‐ Haripur Village Manakarai 0 3 1 1 more cases were found. Aqua tabs were distributed in the community for disinfection of household water. hwa Health and hygiene sessions were conducted. EDO health was informed of the cases

Village Cheejpur, UC Alert for probable Pertussis, 14 suspected cases were found in village, vaccination is not regular, health 12‐Jan Pertussis Sindh Dadu Chorr Qambar, Taluka 4 1 8 1 education imparted, 1 Throat sample taken, EDOH, THO and EPI focal person informed. K.N.Shah

Village Long Khoso, UC Alert for probable Pertussis, 7 suspected cases were found in village, Vaccination status is very poor, health 12‐Jan Pertussis Sindh Dadu 2 0 3 2 Gozo, Taluka K.N Shah education imparted, 1 Throat sample taken, EDOH, THO and EPI focal person informed.

Village Sangrano, UC Alert for probable Pertussis, 7 suspected cases were found in village, health education imparted, area was 12‐Jan Pertussis Sindh Sanghar Chotiyaryoon, Taluka 0 4 0 3 partially vaccinated, Erythromycin and Cough syrup provided to cases and contacts and EDOH informed. Sanghar

Alert for Typhoid from Islamabad for Haripur district. A case of AJS and with Widal positive from village Kot Najibullah. During active surveillance 13 more suspected cases were identified. Medicines were provided to Khyber the CD. 14 LHWs were involved in active case finding and response. 6 water samples were taken and 4 of 12‐Jan Typhoid Pakhtunk‐ Haripur Village Kot Najibullah 0 8 1 6 them were contaminated. 10,000 aqua tabs were distributed in 2 days between 287 houses. Filters and soaps hwa were also distributed. Health and hygiene sessions were also conducted involving LHWs. EDO health was informed of the outbreak. Public Health Engineering has also been informed and intervention is planned for current week

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011 As of 14 January, 2012, the total number of polio cases confirmed by the laboratory is 197 (195=type‐1, and 2=type‐3) from 60 districts/towns/tribal agencies and areas. 1st polio case (type‐1) with onset in 2012 reported from Balochistan (Quetta).

Cases 2010 Cases 2011 Province P1 P3 P1 P3 Punjab 6 1 9 ‐ Sindh 26 1 33 ‐ Khyber Pakhtunkhwa 19 5 23 ‐ FATA 63 11 56 2 Balochistan 6 6 73 ‐ AJ&K ‐ ‐ ‐ ‐ Gilgit‐Baltistan ‐ ‐ 1 ‐ Islamabad ‐ ‐ ‐ ‐ Total 120 24 195 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]. 02 Special Bulletin: DEWS, Pakistan, Week no. 2 (8 to 14 January, 2012) Current week's Alerts: Province Khyber Pakhtunkhwa Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Khalabut Township‐CD KTS 4, CH 13‐Jan AJS Haripur 0 1 1 2 8‐Jan NNT Khairpur Village Tarko Wado, taluka Thari Mirwah 1 0 0 0 Khalabut Qambar 13‐Jan AWD Swabi BHU Sard China 0 2 0 0 8‐Jan Measles Brohi Mohalla Near Public School Kambar 1 0 0 0 Shahdadkot 9‐Jan BD Haripur Village Manakarai 0 3 1 1 Village Zakrya Maheasr UC Kothi Taluka 10‐Jan Leishmaniasis Haripur Village Bandi Sher khan 0 1 0 0 9‐Jan Measles Larkana 0 0 1 0 Larkana 10‐Jan Leishmaniasis Mansehra Pano Dheri 0 0 0 1 Qambar Village Mohbat Khan Brohri, taluka Shahdad‐ 9‐Jan NNT 1 0 0 0 12‐Jan Leishmaniasis Tank Tank City 0 1 0 0 Shahdadkot kot 9‐Jan Measles Abbottabad Mera Muzafar, UC Mirpur 0 1 0 0 S. Benazira‐ 9‐Jan Measles Quarter #7, Block 9, Police line 0 1 0 0 11‐Jan Measles Charsadda Gulshan abad 0 0 0 1 bad 11‐Jan Measles Charsadda Malang Kallay 1 0 0 0 Tando Village Qazi, UC Tando Saindad, Baqir 9‐Jan NNT Muhammad 1 0 0 0 11‐Jan Measles Charsadda Sheikh Mallay Kallay 1 0 0 0 Nizamani 11‐Jan Measles Charsadda Wapda Kallay 1 0 0 0 Khan Village Kundho Mangrio via Seendhal Rasti, 11‐Jan Measles D. I. Khan Tank Road 2 0 0 0 9‐Jan NNT Umer Kot 1 0 0 0 UC Sabho 12‐Jan Measles Kohat Phase III, KDA, Kohat. UC Urban iv 0 0 0 1 Qambar Village Bamboray(Asfand), UC Tarnar, 10‐Jan Measles Village Datoo je wandh, taluka Kambar 0 0 1 0 11‐Jan Measles Lower Dir 1 0 0 0 Shahdadkot Tehsi Chakdara Qambar Village Karam Khan Kandhro, taluka 12‐Jan Measles Lower Dir Village Asigi, UC Rabat 1 1 1 1 10‐Jan NNT 1 0 0 0 Shahdadkot Naseerabad Village Amanvi(Sharona),UC & Tehsil 11‐Jan Measles Shangla 0 0 1 0 Qambar Alpuri 10‐Jan Measles Village Murad Khan Jagirani UC Jean Abro 1 0 0 0 Shahdadkot 10‐Jan Measles Swabi BHU Gani Chatra 4 2 2 0 Qambar 10‐Jan NNT Village Zulfiqar Gurmani, taluka Kambar 1 0 0 0 13‐Jan Measles Swabi RHC Yar Hussain, Sardchina, Baki khel 2 1 2 1 Shahdadkot 13‐Jan Measles Swabi RHC Yar Hussain, Yaqoobi 2 0 0 0 S. Benazira‐ Village Muhammad Hassan Brohi, UC Ghu‐ Village Baidara bejawrey Road, UC 10‐Jan NNT 1 0 0 0 10‐Jan Measles Swat 1 0 0 0 bad lam Hider shah Baidara Tando Allah Village Muhammad Hassan Dal, UC # 1, Village Qamber,mohallah Pir Khel, UC 10‐Jan AWD 2 0 0 1 10‐Jan Measles Swat 0 0 1 0 Yar Taluka Chambar Qamber Tando Allah Village URS Otho, UC 2 Chambar, Taluka Village Shahdara Watkey near Akram 10‐Jan AWD 1 0 0 1 10‐Jan Measles Swat 0 1 1 0 Yar Chambar Jumat, UC Shahdara Village Dadahar Gujar Abad, UC Koz Village Haroon shoro, UC Saeedpur, Taluka 11‐Jan Measles Swat 1 0 0 0 11‐Jan Pertussis Badin 2 1 0 0 Aba Khel Talhar Village Loung Mahesari, UC Karampur, 11‐Jan Measles Swat Village Mian Bela, UC Tall 1 0 0 0 11‐Jan Measles Thatta 1 0 1 2 Taluka MirpurSakiro 12‐Jan Measles Swat Village God Menri, UC Shahdherai 1 0 0 0 Lohanna Mohalla, Tanki road, UC 2 Taluka Village Kuza Bandai Kas Mohallah, UC 11‐Jan AWD Umer Kot 1 0 0 1 12‐Jan Measles Swat 1 0 0 0 Umerkot Bandai 12‐Jan Measles Swat Village Natmira, UC Barikot 1 0 0 0 12‐Jan Tetanus Badin Village Wadero Misri Mandro, UC Seerani 1 0 0 0 12‐Jan Typhoid Haripur Village Kot Najibullah 0 8 1 6 12‐Jan Scabies Badin Village Wadero Misri Mandro, UC Seerani 2 12 4 9 Current week's Alerts: Province Punjab Village Cheejpur, UC Chorr Qambar, Taluka 12‐Jan Pertussis Dadu 4 1 8 1 Date Disease District Area <5M >5M <5F >5F K.N.Shah BHU 67 ML,UC chak No 67 ML, Tehsil Village Long Khoso, UC Gozo, Taluka K.N 9‐Jan ARI Bhakkar 14 28 13 38 12‐Jan Pertussis Dadu 2 0 3 2 Mankera Shah 9‐Jan Scabies Layyah ChakNo. 172/ TDA UC ,172/TDA 0 9 0 57 Village Sangrano, UC Chotiyaryoon, Taluka 12‐Jan Pertussis Sanghar 0 4 0 3 9‐Jan BD Layyah ChakNo. 172/ TDA UC, 172/TDA 0 2 0 5 Sanghar Bilot sharef,Left Bank,UC Kacha Gujrat, Leishmani‐ 9‐Jan NNT Mianwali 1 0 0 0 12‐Jan Shikarpur Village Jano Sharif 0 1 0 0 Piplan asis Manzoor Abad, Near Sharif Pura, Darbar 9‐Jan NNT Multan 1 0 0 0 12‐Jan Measles Thatta Sheikh Mohalla, UC Sajawal. 1 0 0 0 Ishan Shah Wali Gali 9‐Jan AD Muzaffargarh Basti Kikran Wali, UC Bhuttapur 6 4 16 16 12‐Jan Pertussis Thatta Villahe Khameeso Khan Pthan, UC Ali Bahar 1 1 0 0 Basti Eidu Jindwani, Moza Kotla Naseer, 9‐Jan Leishmaniasis Rajanpur 0 0 0 2 Tehsil Rajanpur 14‐Jan Measles Thatta Village Hamza Khaskheli, UC Keenjhar 1 0 0 0 10‐Jan AJS Lahore Hussain Abad Gulberg 3 0 1 0 2 Current week's Alerts: Province Balochistan Basti Murad Gorchani, Moza Allah Abad 10‐Jan NNT Rajanpur 1 0 0 0 <5M >5M <5F >5F Gharbi, UC Allah Abad Date Disease District Area Khoo Majhee wala geedar wala bypass, Goth Haji Chutta Khan, Umrani Paryani, 11‐Jan Tetanus D. G. Khan 0 0 0 1 8‐Jan Measles Jaffarabad 0 0 1 0 UC Drahma Mirwah 11‐Jan AJS Lahore D2 Sector Green Town 0 1 0 2 8‐Jan Leishmaniasis Sibi DHQ Hospital 0 2 0 0 Basti Qum Ali, Moza UC Kot Mithan, Tehsil 9‐Jan Leishmaniasis Lasbela RHC Winder, Sukan 0 4 0 2 11‐Jan NNT Rajanpur 0 0 1 0 Rajanpur 10‐Jan Leishmaniasis Awaran Koto Jhaoo 0 0 0 1 BHU Punjgirain, UC Punjgirain, Tehsil 12‐Jan ARI Bhakkar 11 13 4 8 Darya Khan 10‐Jan Leishmaniasis Awaran Kundi Jhaoo 1 0 0 0 Mohalla sheikhan wala near masjid gore 12‐Jan Measles D. G. Khan 1 0 0 0 10‐Jan Leishmaniasis Awaran Wadi Goth camp Jhaoo 0 1 0 0 wali, UC urban taunsa 10‐Jan Scabies Chagai Killi Sargaisha U/C Chilgazi 0 14 0 11 Basti Deney Wala, UC Urban Jatoi, Tehsil 12‐Jan AD Muzaffargarh 28 31 110 90 Heenaro UC Gresha, Kherawa killi Ababaki Jatoi 10‐Jan Leishmaniasis Khuzdar 1 1 1 0 Basti Jahanpur Wali, UC Urban Jatoi, UC Zereena Kattan, Malghozar UC Lizo 12‐Jan Malaria Muzaffargarh 4 6 30 21 Tehsil Jatoi 10‐Jan Measles Lasbela Jam colony UC Pathra 1 1 0 0 12‐Jan ARI Muzaffargarh THQ Alipur 21 14 41 30 10‐Jan Measles Quetta Sandeman Provincial Hospital Quetta 0 0 3 0 BHU Yousaf Shar, UC Yousaf Shah, Tehsil 13‐Jan AD Bhakkar 3 6 1 4 11‐Jan NNT Bolan Village Hedkar, Tehsil Sanni 1 0 0 0 Bhakkar 13‐Jan Tetanus Lahore Iqbal park walton road 0 0 1 0 11‐Jan Measles Lasbela Akram(pathan) colony UC Beroot Hub 2 0 4 0 13‐Jan Measles Mianwali Mohallah Saifull Kheel ,Gulmerri 0 0 1 0 11‐Jan Leishmaniasis Sibi Village Marghzani 0 0 0 1 Basti Jamilabad, Moza Langer Saraey, UC Nawa Shaher, Sheernap, Tehsil Mastung, 13‐Jan Pertussis Muzaffargarh 1 0 0 0 13‐Jan Pertussis Mastung 0 1 0 2 Muradabad Mastung 14‐Jan Leishmaniasis Mianwali Sheikhan Dera Chhidru 0 0 0 1 14‐Jan NNT Jaffarabad BHU Gandakha 1 0 0 0 Chowk Shahbaz, Moza Taraf Daira Suraj 14‐Jan NNT Multan 1 0 0 0 14‐Jan Leishmaniasis Jhal Magsi Hathyari UC and BHU hathyari 2 0 1 0 Kund Road, Umar Colony 14‐Jan Measles Nasirabad Goth Allah dad, Tehsil DMJ 1 0 0 0 Current week's Alerts: ICT; AJK; FATA; GB 14‐Jan Measles Nasirabad Goth Haji Chutta Khan Umrani, Tehsil DMJ 0 0 1 0 Date Disease District Area <5M >5M <5F >5F 14‐Jan Measles Bajaur Agency Village Kasai of Tehsil Salarzai 0 0 1 0 14‐Jan Leishmaniasis Panjgur Umer abad UC Sordo 0 1 0 0 14‐Jan NNT Bajaur Agency Village Khazana of Tehsil Khar 1 0 0 0 14‐Jan Leishmaniasis Quetta Shafi Colony, UC Kaichi bag, Saryab Road 0 0 0 1 This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected]. 03 Special Bulletin: DEWS, Pakistan, Week no. 2 (8 to 14 January, 2012) Table‐1: Leading causes of seeking health care in districts, Wk‐31, 2010 to Figure‐2: Number of alerts reported, week 2, 2012 Wk 2, 2012, compiled from weekly reports Number of Diseases 45 Consultations 38 40

Acute respiratory infection 13,304,342 (23%) 35 Skin diseases 6,040,650 (10%) 30

alerts 25

of 17 Acute diarrhoea 5,362,680 (9%) 20 15 15 Bloody diarrhoea 472,234 (1%) Number 8 10 4 33333 Suspected malaria 3,594,297 (6%) 5 2 11 0 Unexplained fever 2,208,037 (4%) Total consultations 58,109,833 Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response 2010 2011 2012 (up till week 2) Total Disease A O A O A O A O Acute watery diarrhoea 209 85 1350 543 5 0 1564 628 Acute jaundice syndrome 5 2 51 17 6 2 62 21 Bloody diarrhoea 10 1 98 20 2 1 110 22 Dengue fever 81 32 785 111 0 0 866 143 Measles 48 6 1710 91 67 4 1825 101 Pertussis 1 0 287 81 16 5 304 86 NNT + tetanus 5 0 399 0 22 0 426 0 Malaria 12 7 131 88 3 2 146 97 Leishmaniasis 1 0 298 33 32 2 331 35 Others 75 11 643 69 20 1 738 81 Total 447 144 5752 1053 173 17 6372 1214 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • 349 health facilities from 13 districts of Khyber

Pakhtunkhwa reported to DEWS on weekly basis with 50 AD BD ARI S. Malaria a total of 88,457 patients consultations in week 2. 45

40 • 28 alerts were reported in this week; Altogether 21 for 35 Measles; 3 for Leishmaniasis; while 1 each for AJS; 30 AWD; Bloody diarrhoea and Typhoid. 25

Percentage 20 • 2 outbreaks, 1 each for Bloody diarrhoea and Typhoid 15 received this week and appropriate measures were 10 taken. 5 0 1 1 3 5 7 9

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

wk wk wk wk wk wk wk wk wk wk wk wk wk wk 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 • 285 health facilities from 22 districts in Sindh reported on weekly basis to DEWS with a total of 111,092 patient 50 consultations in this week. 45 AD BD ARI S. Malaria 40 • 26 alerts were reported; Altogether 8 for Measles, 8 for 35 Neonatal tetanus and tetanus; 5 for Pertussis; 3 for 30 25 AWD; while 1 each for Leishmaniasis and Scabies. 20 Percentage 15 • 3 outbreaks for Pertussis were also received and appro- 10 priate response were taken. 5 0 1 1 3 5 7 9

45 47 49 51 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 43

wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk

45 47 49 51 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 43

wk wk wk wk wk wk wk wk wk wk wk wk wk wk 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 • 304 health facilities from 19 districts in Balochistan reported to DEWS, with a total of 50,818 patient consul- 50 AD BD ARI S. Malaria tations. 45 40 • 20 alerts were reported in this week from Balochistan; 35 Altogether 10 for Leishmaniasis; 6 for Measles; 2 for 30 Neonatal tetanus; while 1 each for Pertussis and Sca- 25 Percentage bies. 20

15 • No outbreaks were received this week for any disease 10 from any area of Balochistan. 5 0 9 7 5 3 1 1

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

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

• 15 health facilities from 4 districts in Gilgit Baltistan 50 AD BD ARI S. Malaria reported to DEWS in this week; with a total of 7,505 45 patient consultations. 40 35 30 • No alerts and outbreaks were reported this week for 25 any disease from any area of Gilgit Baltistan. 20 Percentage 15 10 5 0 1 2

52 51 50 49 48 47 46 45 44 43 42 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

wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk 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:

• 90 health facilities from 9 districts reported to DEWS in this • 19 health facilities 1 agency reported from FATA in this week, week with a total of 15,765 patient consultations. with a total of 4,126 patient consultations.

• 2 alerts, 1 each for Leishmaniasis and Pertussis were reported • 2 alerts; 1 each for Measles and Neonatal tetanus reported this week from AJ&K. this week from AJ&K.

50 50 45 AD BD ARI S. Malaria AD BD ARI S. Malaria 40 40 35 30 30 25 20 20 Percentage Percentage 15 10 10 5 0 0 1 2 1 2 7 8 9

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 42 43 44 45 46

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 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 wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk