Weekly Epidemiological Bulletin Disease early warning system and response in

Volume 2, Issue 42, Monday 24 October, 2011

Highlights Priority diseases

under surveillance Epidemiological week no. 42 (14 to 21 October, 2011) in DEWS

Acute Flaccid Paralysis (AFP) • 79 districts and 2 agencies provided surveillance data to the DEWS this week from Acute Jaundice Syndrome (AJS) 2,551 health facilities. • A total of 886,224 consultations were reported through DEWS of which 210,475 (24%) Acute Respiratory Infections (Upper and Lower) (ARI) were acute respiratory infections (ARI), 80,944 (9%) were Skin disease, 73,343 (8%) were acute diarrhoea, and 68,059 (8%) were suspected Malaria. Acute Watery Diarrhoea (AWD)/ Suspected Cholera • A total of 145 alerts with 9 outbreaks were reported in week‐42, 2011: Altogether 56 Acute Bloody Diarrhoea (BD) alerts were for Dengue Fever, 27 for AWD, 19 for Measles, 14 for Neonatal tetanus, 11 for Leishmaniasis, 5 for Malaria, 4 for Pertussis, 2 each for Bloody diarrhoea and Diph‐ Other Acute Diarrhoeas (AD)

theria, while 1 each for Acute jaundice syndrome, CCHF, Meningitis, Mumps and Food Suspected Viral Hemorrhagic poisoning . Fever (VHF)

• National Polio Eradication Initiative reported fourteen new polio cases 7 from Sindh Suspected Malaria (Mal)

(Thatta, Kamber and Karachi); 5 from FATA (Bajour, Waziristan South and Waziristan Suspected Measles (MS) st North), 2 from Balochistan (). As of 21 October, 2011, Pakistan has reported a Suspected Meningitis (MG) total 132 polio cases (130 type‐1 & 2 type‐3) from 41 districts/towns/tribal agencies/ Others areas.

Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 13 October 2011 (Epi week 31, 2010 to week 42, 2011)

35 AD BD ARI S. Malaria 30

25

20 Percentage 15

10

5

0 9 7 5 3 1

13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 11 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 wk wk

Disease Wk-35 Wk-36 Wk-37 Wk-38 Wk-39 Wk-40 Wk-41 Wk-42

Acute respiratory infection 68,736 (18%) 158,580 (18%) 175,906 (19%) 193,771 (19%) 205,597 (21%) 209,436 (21%) 221,144 (22%) 210, 475 (24%)

Acute diarrhoea 40,403 (10%) 96,128 (11%) 109,523 (12%) 110,835 (11%) 105,295 (11%) 97,007 (10%) 92,214 (9%) 73,343 (8%)

Bloody diarrhoea 2,589 (0.66%) 7,387 (0.85%) 7,920 (0.85%) 8,676 (0.86%) 9,393 (0.94%) 8,075 (0.80%) 8,016 (0.78%) 6,007 (0.68%)

Suspected malaria 22,729 (6%) 58,753 (7%) 64,766 (7%) 78,109 (8%) 83,684 (8%) 82,802 (8%) 85,698 (8%) 68,059 (8%)

Total consultation 389,729 864,693 931,318 1,005,251 995,450 1,014,266 1,023,163 886,224

Since July 29, 2010, approximately 49,521,708 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on about 1,000,000 consultations per week, there is a drop in timely reporting due to challenges in accessibility caused by floods, security and infrastructure. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 5 weeks (38 to 42, 2011) acute diarrhoea cases have been decreasing by 3%, while at the same time cases of ARI have been increasing by 5%. Suspected Malaria cases have also shown seasonal increase from week 35 especially from districts in Sindh and Balochistan.

This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, 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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 42 (14 to 21 October, 2011) Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 8 suspected cases of Bloody Diarrhea were reported from BHU Chamm. Village Khater‐Nar, Stool samples collected for lab confirmation and Shigella isolated. DHO‐H 18‐Oct BD AJK Hattian 2 2 4 0 U.C Chakhama informed. Active surveillance found no other cases, health education given to the community. A suspected case of Dengue Fever (19 years old female) admitted in KATH with complaints of fever and body aches from last 7 days, rash Khyber Dabgran Near Sheik‐ present on the body, PLT counts were 98000, sample taken and sent to NIH 17‐Oct DHF Mansehra 0 0 0 1 Pakhtunkhwa habad Camp for confirmation, Nine cases admitted in hospital from same family with same complaints. EDO Health informed for necessary action and thermal fogging. Health Education session regarding prevention done. Alert for 9 cases of Leishmaniasis, training of health care providers for Kuch,Nasir Leishmaniasis treatment and prevention done by IRC, patients were 19‐Oct Leishmaniasis Punjab Mianwali abad,Potta,UC Kala 1 4 0 4 screened by DDOH for IM and IL injections, Malaria Program requested for Bagh,Issa Khel fogging and IRS of the area. Alert for AWD, 6 suspected cases with severe dehydration found in village Village Wahid Buksh with 3 deaths, village was 12 KM away from RHC and village surround by Mari, UC Isamail rain water. During investigation health education imparted, Aqua tabs, 17‐Oct AWD Sindh Mirpur Khas 2 1 1 2 Kumbhar, Taluka ORS, water filter, Jerry cans and Hygiene kits were distributed, EDO‐H Sindhri inform regarding the alert and deaths and 1 stool sample taken and sent to NIH for confirmation. Village Mir Muham‐ Alert for AWD, 6 cases from one village, active surveillance found no other 20‐Oct AWD Sindh Sanghar mad channa, UC Jaffer 4 2 0 0 cases, health education, Aqua tabs, Zinc tabs, ORS, Hygiene kits were dis‐ khan Laghari tributed, EDO‐H informed and 2 water samples collected. Alert for AWD, 11 cases from one village, investigation complete, health Village Mokhai, UC education provided, hand pump was the source of water, IV fluid, antibi‐ 14‐Oct AWD Sindh Tharparkar Mirwah, Taluka Na‐ 0 6 0 5 otic, Hygiene kit and ORS were distributed, EDO‐H informed. Active surveil‐ garparkar lance found no other cases. Village Ramzan Kho‐ Alert for AWD, 9 cases from one village, Hand pump was the source of 20‐Oct AWD Sindh Thatta man UC Kalri, taluka 1 4 0 4 water, health education, Aqua tabs, Zinc tabs, ORS, Filters and Jerry cans thatta were provided, EDO‐H informed. 2 water samples taken, under process. BHU Chawkandi and 22‐cases of Falciparum investigated, 11 confirmed by RDT (SPR = 50%; FR = 19‐Oct Malaria Sindh Dadu Village Wassei, UC 4 8 5 5 100%) , rain water stagnant near homes, health education imparted and Baid, Taluka KN Shah EDO‐H informed. Village Daro Machi, 23‐cases of Falciparum investigated, 17 confirmed by RDT (SPR = 74%; FR = 20‐Oct Malaria Sindh Dadu UC Kakar, Taluka KN 8 5 5 5 100%), rain water stagnant near homes, health education imparted, WHO Shah. and Merlin team jointly investigated the outbreak , EDO‐H informed. Current week's Alerts: Province Current week's Alerts: Province Balochistan Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 20‐Oct CCHF Haripur Makhan Colony 0 1 0 0 15‐Oct AJS Ziarat Sinjawi 0 0 0 0 Killi Jan Mohammad, CD Ameen Abad, UC 19‐Oct AWD Chagai 2 3 5 8 19‐Oct DHF Abbottabad Sherwan Abbottabad 0 1 0 0 Chagai village 21‐Oct DHF D. I. Khan Gur Wali, Kirri Shamozai, Tehsil Paroa 0 1 0 0 20‐Oct AWD Jaffarabad Karam Shah Muhalla, UC 1, Tehsil Jhat Pat 1 0 1 0 15‐Oct DHF Haripur Nawansher 0 1 0 0 19‐Oct DHF Jaffarabad Yaqoob Muhallah, Tehsil Usta Mohammad 0 1 0 3 17‐Oct DHF Quetta FJ Hospital 0 0 0 1 17‐Oct DHF Haripur Muhallah Golian Mera, Pind Hisham Khan 0 1 0 0 20‐Oct DHF Quetta FJ Hospital 0 1 0 0 18‐Oct DHF Haripur Panian Chawk Haripur city 0 1 0 0 17‐Oct DHF Ziarat Ziarat Town 0 1 0 0 17‐Oct DHF Mansehra Reerh Attershisha 0 1 0 0 20‐Oct Leishmaniasis Jaffarabad Bhati Muhallah, UC 1, Tehsil Jhat Pat 0 0 0 1

17‐Oct DHF Mansehra Dabgran Near Sheikhabad Camp 0 0 0 1 15‐Oct Leishmaniasis Jhal Magsi DHQ Hospital‐UC Gandawah City 1 0 1 0 19‐Oct Leishmaniasis Kalat Maoli, tehsil Surab 0 1 0 0 18‐Oct DHF Mansehra Shohal Maidan Balakot 0 1 0 0 15‐Oct Leishmaniasis Kech Haji Abdul Salam Mohalla‐ UC 0 1 0 0 16‐Oct Diphtheria Peshawar Village Lamda Jaba Cherat 0 0 1 0 20‐Oct Leishmaniasis Tehsil Khuzdar 0 3 0 0 Village Ajmaira, UC Ajmaira, Tehsil Bata‐ 20‐Oct Measles Battagram 0 1 0 0 19‐Oct Leishmaniasis Lasbela Jhaoo cross Bela 0 3 0 0 gram 20‐Oct Leishmaniasis Panjgur Union Council Kallag, Mohallah Simsori 0 0 0 1 18‐Oct Measles Charsadda Neher Koroona 1 0 0 0 new killi sulamankhail, sarana rd, Killi haikal‐ 20‐Oct Leishmaniasis Pishin 0 1 0 1 21‐Oct Measles D. I. Khan Arra, Tehsil & District D I Khan 1 0 0 0 zai 16‐Oct Leishmaniasis Sibi Sibi Bypass road, almadina hotel 0 1 0 0 21‐Oct Measles D. I. Khan Kokar, Tehsil & District D I Khan 0 0 1 0 20‐Oct Leishmaniasis Ziarat Nask, Pasara (Sinjawi) 0 3 0 0 21‐Oct Measles D. I. Khan Kot Jai, Tehsil Pahar Pur, District D I Khan 0 0 1 0 14‐Oct Measles Awaran Malar UC Teertage 1 0 0 0

19‐Oct Measles Swabi BMC Swabi, Betakara 4 2 1 3 14‐Oct Measles Awaran Mashkai Gajjar 1 0 0 0 17‐Oct Measles Swat Villge Khem dara, UC & Tehsil Kabal. 1 0 0 0 14‐Oct Measles Awaran Waja Bagh UC camp Jhaoo 1 0 0 0 18‐Oct Measles Swat Village and UC Shalpin, Tehsil Khwazakhela. 0 1 1 0 20‐Oct Measles Lasbela Shah dost Sasoli Village UC Pathra 2 0 1 0 20‐Oct Mumps Jhal Magsi RHC Jhal Magsi (Mait Siddiq & Sarangani) 5 2 1 2 19‐Oct NNT Peshawar Balan Khel Marghoz, District Swabi. 0 0 1 0 18‐Oct NNT Nasirabad Nursery ward of DHQ‐ Hospital D.M.J 3 0 1 0 19‐Oct NNT Peshawar Village Nahakai Kalay, Dist. Charsadda 1 0 0 0 14‐Oct NNT Sibi Village Sangan, UC Sangan 0 0 1 0 19‐Oct Pertussis Charsadda Residential Flats, DHQ hospital 0 0 1 0 20‐Oct Pertussis Kharan Jouzzan village, UC southern town Kharan 0 1 1 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, 02 Epidemiological Bulletin: DEWS, Pakistan, Week no. 42 (14 to 21 October, 2011) Current week's Alerts: Province Sindh Current week's Alerts: Province Punjab Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Village Fazal Wado, Deh Bhoree malkani 14‐Oct AWD Badin 2 1 1 1 17‐Oct DHF DHQ Hospital Bhakkar; Tehsil Bhakkar 0 2 0 1 shareef, Taluka Tando Bago Village Piyaro Khaskheli, Pangrio taluka tando DHQ Mianwali (Chak 27ML, Rakh Kahsoor, 15‐Oct AWD Badin 0 1 0 0 20‐Oct DHF Bhakkar 0 2 0 0 Bago Tehsil kaloor Kot) 14‐Oct AWD Dadu Abra Colony, Piaro station, Taluka Dadu 2 1 0 0 17‐Oct DHF D. G. Khan Mohamadi chowk Block H 0 1 0 0 17‐Oct AWD Hyderabad Bughdadi Masjid, Paretabad 0 0 1 0 17‐Oct DHF D. G. Khan Nishter Hospital ‐ DG Khan 0 4 0 0 17‐Oct AWD Hyderabad Tando Wali Muhammad, Misan Road, UC 16 0 0 0 1 Bastee Tahlee wala Moza Haidar Qureshi 18‐Oct DHF D. G. Khan 0 1 0 0 uc Aaliwala 18‐Oct AWD Jamshoro Village Booto Makan, UC. Ongar 0 1 0 1 14‐Oct DHF Jhang Nishter Hospital Multan‐ Jhang 0 3 0 0 19‐Oct AWD Jamshoro Village Essa dal, UC Bhulari, Taluka Kotri 2 0 0 0 Village Sardarabad UC Haibat, taluka 20‐Oct DHF Khanewal Nishter Hospital Multan‐ Khanewal 0 25 0 3 20‐Oct AWD Kashmore 1 0 0 0 Kandhkot 16‐Oct DHF Nishter Hospital Multan‐ Lahore 0 2 0 0 14‐Oct AWD Matiari Village Chandan 1 0 0 0 14‐Oct DHF Basti Islamabad Choubara 0 1 0 0 18‐Oct AWD Matiari Sain Shah Muhammad Shah, Taluka Hala 0 0 1 0 Zeenat Surgical Hospital; Mohallah Faiza‐ 16‐Oct DHF Layyah 0 3 0 0 20‐Oct AWD Matiari Village Koreja, near Hala City 0 1 0 0 bad Layyah Village Wahid Buksh Mari, UC Isamail Kumb‐ 17‐Oct AWD Mirpur Khas 2 1 1 2 17‐Oct DHF Layyah , Layyah 0 1 0 0 har, Taluka Sindhri S. Benazira‐ 19‐Oct DHF Layyah 0 1 0 0 20‐Oct AWD Village Zakir Hussain Zardari, UC Channesar 2 0 2 0 2 bad 21‐Oct DHF Layyah Chak No. 160/TDA Layyah 0 1 0 0 Village Bahadur Kolai, UC Jatia, Taluka 14‐Oct AWD Sanghar 2 0 2 0 Shahdadpur DHQ Layyah; Sarwar Abad Darya Khan/ 21‐Oct DHF Layyah 0 2 0 0 Village Mir Muhammad channa, UC Jaffer bhakkar 20‐Oct AWD Sanghar 4 2 0 0 khan Laghari 18‐Oct DHF Mianwali Chidru, Kalabagh Tehsil Isakhel 0 2 0 0 Village Bheel near Magsi farm & khesana 17‐Oct AWD T Allah Yar 1 1 0 1 mori 17‐Oct DHF Multan Nishter Hospital Multan‐Multan 0 18 0 3 Village Shahnawaz Mohajir UC Dasoori 17‐Oct AWD T Allah Yar 2 2 0 0 18‐Oct DHF Muzaffargarh Nishter Hospital Multan‐ Muzaffargarh 0 3 0 2 Talukas Jhando Mari Village Ismail Maharani, near wadodar, UC 19‐Oct DHF Muzaffargarh Mohallah Khokhar, UC Phullan, Alipur 0 2 0 0 20‐Oct AWD T Allah Yar 2 1 1 1 Bukera sharif 19‐Oct DHF Nishter Hospital Multan‐ Pakpattan 0 8 0 1 Soomro Khan Lashari, Taluka Tando Ghulam 18‐Oct AWD TM Khan 0 0 0 1 Awami Colony; Chowk Mahi; Teh Sadiqa‐ Haider. 14‐Oct DHF RY Khan 0 2 0 0 Village Mokhai, UC Mirwah, Taluka Nagar‐ bad 14‐Oct AWD Tharparkar 0 6 0 5 parkar Basti Katli Hakim; Chak No.129/1‐L; Basti 16‐Oct DHF RY Khan 0 3 0 0 Village Mondro, UC Nagarparkar, Taluka Bhand Bloach, Tehsil Khanpur 19‐Oct AWD Tharparkar 1 0 1 0 Nagarparkar Chak No.184/P; Chak No 188 P ,Teh 16‐Oct DHF RY Khan 0 2 0 0 14‐Oct AWD Thatta Islampur Mohalla, Thatta City 0 1 0 2 Sadiqabad Village Ramzan Khoman UC Kalri, taluka 16‐Oct DHF RY Khan Old Sadiqabad Road; Madina Town 0 3 0 0 20‐Oct AWD Thatta 1 4 0 4 thatta Chak No.111/P;Chak NO.150/P; Mouza 17‐Oct DHF RY Khan 0 2 0 1 20‐Oct AWD Thatta Village Darvesh Khan, UC Ghorabari 1 0 0 1 Reng pur Village Muhammad Mallah UC Karampur , Ada Sardar Garh; D Block ,Gulshan ‐i‐ Iqbal; 20‐Oct AWD Thatta 1 1 1 0 18‐Oct DHF RY Khan 0 2 0 1 taluka Mirpur Sakiro Abbasia Town ,Sidique Block City RYK Basti Moran ; Arif Twon Sadiq Abad Distt. 14‐Oct BD Matiari Village Haji Rind, near Khyber 3 1 0 1 18‐Oct DHF RY Khan 0 3 0 0 RYK 14‐Oct DHF Ghotki Village Sachal Mirbahar, Near Mahesar 1 0 0 0 Chak 135/P; Chak 52/P Sunny Pul tehsil 18‐Oct DHF RY Khan 0 2 0 0 17‐Oct DHF Ghotki Village Saifal Khan Kolachi, UC Bandh 1 0 0 0 RYK SZ Hospital (Ghot Sardar Zulfiqar,Tehsil Chak No 87 p Tehsil Distt, RYK 17‐Oct DHF Jacobabad 0 1 0 0 19‐Oct DHF RY Khan 0 2 0 0 Thoil) Basti Elahi Buksh jallan, Tehsil RYK 19‐Oct DHF Khairpur Village Aftab Ahmed, taluka Kotdiji 0 1 0 0 19‐Oct DHF RY Khan Mouza Thakal ,U/c Juren Tehsil Khan pur 1 1 0 0 Village phul poto UC saidudero Talka rato‐ 17‐Oct DHF Larkana 0 1 0 0 19‐Oct DHF RY Khan Tranda Muhammad pana Tehsil Liaqatpur 0 1 0 0 dero Naushahro 20‐Oct DHF Rajanpur Nishter Hospital Multan‐Rajan Pur 0 3 0 0 17‐Oct DHF Bhiria city, civil hospital Karachi 0 1 0 0 Feroze 15‐Oct DHF Sahiwal Nishter Hospital Multan‐ Sahiwal 0 2 0 0 Naushahro 17‐Oct DHF Mehrabpur City 0 1 0 0 Feroze SZ Hospital RY Khan (Chak No .11 Gujjaran‐ 15‐Oct DHF Sahiwal 0 1 0 0 14‐Oct DHF Tharparkar DHQ Mithi, Diplo Town 0 0 0 1 wali, Chechawatni) Food 20‐Oct DHF Vehari Nishter Hospital Multan‐ Vehari 0 21 0 0 20‐Oct Sukkur Military Road 12 5 2 6 Poisoning 14‐Oct Diphtheria DG Khan Khoo kotowala uc Mana Ahmedani 0 1 0 0 Village Mitho Junejo, Deh paneero, UC Haji 19‐Oct Malaria Badin 8 11 6 7 Leishmani‐ Kuch,Nasir abad,Potta,UC Kala Bagh,Issa Sawan 19‐Oct Mianwali 1 4 0 4 Village Hajji Mohammad Bux Jatoi , UC asis Khel 20‐Oct Malaria Badin 2 6 0 0 Basti Gopang, Moza Rakh Qadira, UC Kotla Golarchi 15‐Oct Malaria Rajanpur 3 11 0 10 BHU Chawkandi and Village Wassei, UC Baid, Hassan Shah 19‐Oct Malaria Dadu 4 8 5 5 Taluka KN Shah 20‐Oct Measles DG Khan Pathan Kot Taunsa city 1 0 0 0 Village Daro Machi, UC Kakar, Taluka KN 20‐Oct Malaria Dadu 8 5 5 5 Basti Marri Wala, Moza Kot Janu, UC Kot Shah. 20‐Oct Measles Rajanpur 2 0 1 0 Tahir, Tehsil Jampur, District Rajanpur 15‐Oct Measles Ghotki Plot # 7 Ahmedki, UC Umer Daho 1 0 0 0 Colony Mama Hotel, Moza Kot Tahir, UC 20‐Oct Measles Rajanpur 1 0 1 1 19‐Oct Measles Hyderabad Village Gul Muhammad Chalgari 1 5 2 3 Kot Tahor, Tehsil Jampur, District Rajanpur Qambar Mohallah Seyallan Wala, UC Darya Khan 20‐Oct Measles Noonari Muhalla, UC Naseerabad 0 0 1 0 15‐Oct NNT Bhakkar 1 0 0 0 Shahdadkot Urban II, Tehsil Darya Khan, Dist Bhakkar Basti Ser Bagh Khan Wali, MOZ & UC Qasba 14‐Oct Meningitis Tharparkar Village Habasar, Taluka Nagarparkar 1 0 0 0 16‐Oct NNT Muzaffargarh 1 0 0 0 Gujrat 19‐Oct NNT Karachi Neonatal ICU 1 0 0 0 Moza Jhandi, Basti Ahmed Bukhsh Lolai, Village Din Mohammad Kosh, taluka Kash‐ 14‐Oct Pertussis Rajanpur 1 0 0 0 19‐Oct NNT Kashmore 0 0 1 0 UC Miranpur, Tehsil Rojhan more Current week's Alerts: AJK; FATA; GB and ICT 20‐Oct NNT Khairpur Village Mohammad Ali Shah 0 0 1 0 Date Disease District Area <5M >5M <5F >5F Village soni faqirani UC Saidureo Talka 17‐Oct NNT Larkana 1 0 0 0 ratodero 18‐Oct BD Hattian Village Khater‐Nar, U.C Chakhama 2 2 4 0 Qambar Village Sandok, U.C Ashkot, Tehsil 17‐Oct NNT Village rozi Khan Magsi UC 11 Talka Kamber 1 0 0 0 19‐Oct Pertussis Neelum 2 3 1 5 Shahdadkot Atthmuqam 18‐Oct NNT Shikarpur Village Peroze Khan Rind, UC Gaggan 1 0 0 0 19‐Oct DHF South Waziristan Nishter Hospital Multan‐ South 0 1 0 0 20‐Oct NNT Shikarpur Wazir Jo Goth, near Dhani Bux, UC Wazirabad 1 0 0 0 South Waziristan 21‐Oct DHF D I Khan (Sheerana, Wana) 0 1 0 0 Nao Mail Stop, Dargha Jey Shah, UC Saeed‐ Agency 17‐Oct NNT TM Khan 1 0 0 0 pur 15‐Oct Measles Bajaur Agency Village Umaray, Tehsil Mamoond 1 0 0 0 This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, 03 Epidemiological Bulletin: DEWS, Pakistan, Week no. 42 (14 to 21 October, 2011) Table‐1: Leading causes of seeking health care in flood affected districts, Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 42/2011) 29 July 2010 to 21 October 2011, compiled from weekly reports Diseases Total 4000 Mobile Fixed 6 6 3500 6 7 2 2 7 3 Acute Respiratory Infection 11,018,302 (24%) 8 6 7 7 7 6 8

3000 13 6 6 6 8

Skin Diseases 8 5,344,195 (11%) 8 8 8 11 2500 11 8 11 8 11

Acute Diarrhoea 4,739,942 (10%) 2000 8 12 411 400 375 331 11 3375 3363 3354 215 3329 361

1500 192 3259 3259 3251 3250 3234 26 3215 3196 3156 3142 153 3120 3109 3058 26 3021 3022 2982 2935 128 2909 2785 2752 2745 105 2681 Bloody Diarrhoea 2671 420,436 (1%) 2648 46

2564 2551 2547 2532 2522 81 2466 2450 2404 58 2349 1000 2322 2262 2255 2251 2199 2022 2021 1797 1680 1488 1463

500 1289

Suspected Malaria 1215 1167 1158

3,037,417 (6%) 1143 1130 1111 1113 999 967 1073 1067 949 879 854 0 Unexplained Fever 1,897,935 (4%) 3 5 7 9

11 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 ‐

1

Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Total Consultations 49,521,708 Wk Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Post Flood 2010 2011 (up till wk 41) Current Week (42) Total Disease A O A O A O A O Acute Watery Diarrhoea 209 85 1153 509 27 5 1389 599 Acute Jaundice Syndrome 5 2 41 14 1 0 47 16 Bloody Diarrhoea 10 1 83 14 2 1 95 16 Dengue Fever 81 32 647 110 56 1 784 143 Measles 48 6 1415 88 19 0 1482 94 Pertussis 1 ‐ 224 26 4 0 229 26 NNT + Tetanus 5 ‐ 248 0 14 0 267 0 Malaria 12 7 88 60 5 2 105 69 Leishmaniasis 1 ‐ 174 26 11 1 186 27 Others 75 11 481 54 6 0 562 65 Total 447 144 4554 901 145 10 5146 1055 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • This week 735 health facilities from 19 districts reported to

DEWS with a total of 160,207 patients consultations. 50

45 • The proportional morbidity of AD showing gradual decline 40 during the last 5 weeks after a consistent higher proportion 35 (16%) for almost 10 weeks. 30 25

Percentage 20 • 23 alerts were reported in this week, 9 were for Measles; 9 15 for DHF, 2 for Neonatal Tetanus while 1 each for CCHF, 10 Diphtheria and Pertussis. 5

0 1 3 5 7 9

• 1 outbreak for DHF was received and responded. 41 39 37 35 33 31 29 27 25 23 21 19 17 15 13 51 11 49 47 45 43 41 39 37 35 33 31

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

Province Sindh: Figure-4: Trend of priority communicable diseases, province Sindh • This week 702 health centers from 20 districts reported to DEWS with a total of 354,222 patient consultations. 50 AD BD ARI S. Malaria 45 • In Sindh, AD cases reported were 33,225 (9%), proportional 40 35 morbidity lower by 1% as compared with last week . 30

25

• 50 alerts were reported from Sindh in this week: 25 were for Percentage 20 AWD; 8 for Neonatal tetanus; 7 for DHF, 4 for Malaria, 3 15 for Measles, while 1 each for Bloody diarrhoea, Meningitis 10 and Food Poison. 5 0 1 3 5 7 9

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

• 6 outbreaks 4 for AWD and 2 for Malaria were received and wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk responded. wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk

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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 42 (14 to 21 October, 2011) Province Punjab: Figure-5: Trend of priority communicable diseases, province Punjab

• This week 483 health facilities from 8 districts reported data 50 AD BD ARI S. Malaria to DEWS from Punjab province with a total of 238,893 45 patient consultations. 40

35 • AD cases reported were 14,806 and showing proportional 30 morbidity lower same as compared with last week . 25 20 Percentage • 45 alerts were reported in this week from Punjab; 36 were 15 for DHF; 3 for Measles, 2 for Neonatal Tetanus; while 1 10 5 each for Diphtheria, Leishmaniasis, Malaria and Pertussis. 0 9 7 5 3 1

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

1 outbreak for Leishmaniasis was received and responded. wk wk wk wk • wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk

Province Balochistan: Figure-6: Trend of priority communicable diseases, province Balochistan • In this week, 15 districts reported to DEWS from 50 Balochistan province. 399 health centers reported a AD BD ARI S. Malaria total of 67,598 patient consultations. 45 40 • AD reported in 6,232 (9%) of the total consultations, 35 1% lower proportional morbidity as compared with 30 25 the last week. 20

Percentage • 25 alerts were reported in this week from Balochis- 15 tan, 10 were for Leishmaniasis; 4 each for Measles 10 5 and DHF; 2 each for AWD and Neonatal tetanus; 0 while 1 each for AJS, Pertussis and Mumps. 1 3 5 7 9

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

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

Province Gilgit Baltistan:

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

45 • In this week, 78 health centers from 7 districts in AD BD ARI S. Malaria Gilgit Baltistan sent weekly report with a total of 40 26,289 patient consultations. 35 30 • ARI cases reported were 6,125 (23%), while Acute 25 Diarrhoea were 2,694 (10%). 20

Percentage 15 • No alerts received this week from any area of Gilgit 10 Baltistan. 5 0 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

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

State of Azad Jammu and Kashmir: FATA:

• In this week, reports were received from 113 health facilities from • This week 41 health facilities in 2 agencies reported from FATA, 10 districts with a total of 31,654 patient consultations. with a total of 7,361 patient consultations. • ARI cases reported were 5,657 (18%), while Acute diarrhoea re- • ARI cases reported were 1,780 (24%), while Acute diarrhoea was ported 1,179 (4%) cases. reported 528 cases (7%) • Two alerts 1 each for Bloody diarrhoea and Pertussis were received • No alert was received this week from any area of FATA. and responded.

45 40 AD BD ARI S. Malaria 40 35 AD BD ARI S. Malaria 30 30 25 20 20 Percentage

15 Percentage 10 10 5 0 0 6 7 8 9

39 40 41 42 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 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

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

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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 42 (14 to 21 October, 2011) Update on DTC’s: 21 DTCs have been established, 8 in Khyber Pakhtunkhwa (2 in Swat, 1 each in Shangla, Buner, Mardan, Abbotta‐ bad, Mansehra, Battagram); 8 in Sindh (1 each in Umerkot, Tharparkar, Sanghar, Badin, Thatta, TM Khan, S. Bena‐ zirabad, and Tando Allah Yar; 3 in Balochistan (1 each in Kalat, Khuzdar and Jaffarabad), while 2 in Punjab (Bhakkar and Muzaffargarh)

Trained staff including doctors, staff nurses, ward boys and sanitary workers were appointed in DTCs. A dedicated trained doctor was appointed for each shift. One staff nurse was assigned to look after 10 patients while one ward boy along with one sanitary worker was deputed/ appointed in each shift. Admissions and treatment of all severely dehydrated patients in isolation ward is ensured in accordance with Standard Treatment Protocols. Daily report is submitted by each DTC, using the standard format. Strict infection control measures were ensured for the patients and the attendants at the entry/exit point of DTC’s, as well as during patients’ stay in the ward. For exam‐ ple, washing and cleaning of patients’ linen and bed with disinfectants or boiling water and proper disposal of pa‐ tients’ waste (vomit and excreta), setting‐up of separate latrines for patients, proper personal hygiene measures for the health care providers (hand‐washing with soap and washing of shoes) with disinfectants is ensured. Edu‐ cating the families and attendants of patients on preventive measures to be taken at the household level is pro‐ moted and ensured.

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Cases 2010 Cases 2011 Province Year 2010: The total number of polio cases reported in P1 P3 P1 P3 2010 is 144 including 120 type‐1 cases and 24 type‐3 from Punjab 6 1 2 - 40 infected districts/towns/agencies. Sindh 26 1 27 - Khyber Pakhtunkhwa 19 5 11 - Year 2011: As of 21 October, 2011, the total number of FATA 63 11 35 2 polio cases confirmed by the laboratory is 132 (130=type‐ Balochistan 6 6 54 - 1, and 2=type3) from 41 districts. AJK - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 130 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, 06