Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Home , Kharan (princely state), Lal Qilla Tehsil, Surmo

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 2, Issue 34, Monday 29 August, 2011

Highlights Priority diseases under surveillance Epidemiological week no. 34 (19 - 25 August, 2011) in DEWS • 82 districts and 3 agencies provided surveillance data to the DEWS this week from 2,736 Acute Flaccid Paralysis (AFP) health facilities. Acute Jaundice Syndrome (AJS) • A total of 872,608 consultations were reported through DEWS of which 18% were acute respiratory infections (ARI), 12% skin disease, 11% acute diarrhoea, and 7% suspected Acute Respiratory Infections (Upper and Lower) (ARI) Malaria. • A total of 168 alerts with 29 outbreaks were reported in week-34, 2011: Altogether 65 Acute Watery Diarrhoea (AWD)/ Suspected Cholera alerts were for AWD; 25 for Measles; 19 for DHF; 11 for Neonatal Tetanus and Tetanus; Ten for Pertussis; Nine for Leishmaniasis; Eight for Suspected Malaria; seven for Acute Acute Bloody Diarrhoea (BD)

diarrhoea; Six for Bloody diarrhoea; Three for Chicken pox; Two for Typhoid; while one Other Acute Diarrhoeas (AD) each for Meningitis, Mumps and Scabies. Suspected Viral Hemorrhagic • National Polio Eradication Initiative reported five new type-1 confirmed polio cases this Fever (VHF) week: These include two cases from Federally Administered Tribal Areas (Khyber agency), Suspected Malaria (Mal) one case from Khyber Pakhtunkhwa province (Peshawar district) and two cases from Ba- lochistan province (Quetta and Killa Abdullah districts). Wild poliovirus type-1 was also Suspected Measles (MS) th isolated from a healthy child in Balochistan province (Quetta district). As of 28 August, Suspected Meningitis (MG) Pakistan has reported a total of 77 polio cases (76 type-1 cases & 1 type-3 case) from 28 districts/towns/tribal agencies/areas. Others

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

2009 2010 2011

12 Percentage

1 4 7 101316192225283134374043464952

Epi‐week

Disease Wk-27 Wk-28 Wk-29 Wk-30 Wk-31 Wk-32 Wk-33 Wk-34

Acute Diarrhoea 100,320 (10%) 104,413 (10%) 107,861 (10%) 103,098 (10%) 109,255 (10%) 106,918 (10%) 101,174 (10%) 93,312 (11%)

Total consultation 994,345 1,025,647 1,037,391 1,019,120 1,078,912 1,040,292 988,119 872,608

Since July 29, 2010, approximately 42,404,056 patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week 34, 2011 (19 to 25 August, 2011) reports were received from 2,736 health centers and the major causes for seek‐ ing health care by the communities in almost all of the provinces were diarrheal diseases 93,312 (11%), acute respiratory infec‐ tions 158,253 (18%), skin diseases 106,261 (12%) and suspected malaria 60,122 (7%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 2009, 2010 and 2011 up until now.

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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 34 (19 to 25 August, 2011) Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Village Sarar, UC Gojra , Cluster of suspected cases of BD were reported from village Sarar Hassanabad. Stool sample collected and sent to NIH. DHO 22‐Aug BD AJK Muzaffarabad 3 4 0 0 Tehsil Muzaffarabad Muzaffarabad informed. Active surveillance found no other cases. Malaria alert was reported. The case were examined clinically and patients were treated. 17 test were positive out of 30 Balochis‐ 23‐Aug Malaria Chagai BHU Sargesha 0 0 0 0 (P.Vivax 10, P.Falciparium 7) SPR = 56.6%, while FR = 41.1%. DHO was informed and requested to provide RDTs, ACT andas tan Bed nets for further prevention. An alert of Malaria was investigated for 64 reported cases. The cases were examined and slides test was taken. 10/17 of the Balochis‐ 25‐Aug Malaria Jaffarabad BHU Cattle form 11 21 9 23 slides verified positive ( P.Falciparium 5, P.Vivax 3, mixed 2) SPR = 58.8%, while FR = 70%. Medicines was provided. DHO was tan requested to provide bednets to the said location as a preventive measures. Malaria alert was reported. Field investigation including RDTs test for suspected cases. 63 cases were reported, 53 samples Balochis‐ 19‐Aug Malaria Jhal Magsi RHC Jhal Magsi 8 33 7 15 were collected and 33 came out positive (P. Falciparum 10, P. Vivax 22, mixed 1) SPR = 66%, while FR = 33.3%. DHO and tan representative of malaria control program was informed and requested to take preventive measures. Malaria alert was reported. Field investigation was done via DEWS focal person. The case were examined clinically and Balochis‐ 24‐Aug Malaria Kharan BHU Sarawan 0 0 0 0 blood test was taken. 20 test came positive out of 38 (9 P.Vivax, 7 P.Falciparium, 4 mixed) patients were treated, SPR = tan 52.6%, while FR = 65%. DHO was requested to provide RDTs, ACT and Bednets for prevention. BHU Allah Dad An alert of Malaria was investigated for 52 reported cases. Health facility was visited 15/22 (68%) found positive, Balochis‐ 25‐Aug Malaria Nasirabad Umrani, Tehsil 8 14 11 19 (P.Falciparium 10, P.Vivax 4, Mixed 1) SPR = 68.18%, while FR = 73.3%. DHO and Merlin representative was informed and tan Manjhi Shoorti requested for distribution of bed nets to the affected community. Village Bubar Two cases of AWD were reported from Aga Khan Health Center Singal. Stool samples taken, Culture sensitivity done and Khutum UC Bubar found positive for V.c. Ogawa ,DHO Ghizer and area Medical Officer informed, Immediate case management procedures Gilgit‐ Tehsil Punial; Village were adopted and patient recovered from acute stage on rehydration, active surveillance done in the area and no other 26‐Aug AWD Ghizer 0 1 0 1 Baltistan Golodas near govt cases were found. Health education session conducted with the patient, family and community notables for better hygienic schoolTehsil Ishko‐ practices. Aqua tab were distributed to the community, drinking water samples from different sources were collected and man sent to Environmental Protection lab. Visceral DHQ hospital Chilas received four patients of suspected visceral Leishmaniasis which were later confirmed on bone marrow Gilgit‐ 23‐Aug Leishma‐ Diamir Hudur Valley 0 0 4 0 biopsy. On field investigation no other case found. Health education session conducted.EDO health and DSM PPHI informed Baltistan niasis about the patients. Glucantime treatment to start. A suspected outbreak of AWD was reported from RHC Khanpur from village Pakh Shahi, Muslimabad as 8 cases were admit‐ Khyber ted with AWD from same village. On active case finding 38 more patients were identified. 2 Stool samples were taken and Village Pakh Shahi, 19‐Aug AWD Pakhtunk‐ Haripur 6 11 17 12 sent to NIH which came back positive for V.c. Ogawa. Water samples were taken which also came back positive for contami‐ UC Muslimabad hwa nation. Aqua tabs, ORS and soaps were distributed. All the cases with AWD were treated and managed on the same day. Health and Hygiene session was conducted for the affected community. EDO Health was informed of the AWD cases. A suspected outbreak of AWD was reported from RHC Ghazi from village Bandi, UC Kothera as 9 cases were admitted with Khyber AWD from same village. On active case finding 16 more patients were identified. Stool samples was taken and sent to NIH. Vilage Bandi, UC 23‐Aug AWD Pakhtunk‐ Haripur 2 8 3 12 Water samples were also taken which came back positive for contamination. Aqua tabs, ORS and soaps were distributed Kothera, Tehsil Ghazi hwa house to house. All the cases with AWD were treated and managed on the same day. Health and Hygiene session was conducted for the affected community. EDO Health was informed of the suspected cases Khyber Village Audigram, AWD alert reported, Four cases identified, active surveillance done, stool sample collected and found positive for V.c. 19‐Aug AWD Pakhtunk‐ Lower Dir Maniyal, UC Lal 1 2 1 0 Ogawa. Water Samples taken for any fecal contamination, ORS, Hygiene kits & Aqua tabs distributed, Health & Hygiene hwa Qilla, Tehsil Balmbat promotion Session conducted with family members, EDO‐H was informed. Khyber Village Kass Kandao, AWD alert reported, 16 cases identified. Active surveillance done, stool sample collected and sent to NIH. Water Samples 23‐Aug AWD Pakhtunk‐ Lower Dir UC Lajbook, Tehsil 1 7 4 4 taken for fecal contamination, ORS, Hygiene kits, Aqua tabs distributed, health and hygiene promotion session conducted hwa Balmbat. with family members, EDO‐H was informed, WASH partners were requested for water Source protection. AWD case was notified from DHQ Timergrah. Active surveillance done in area, 46 cases identified and investigated, stool Khyber Village Shahikoto, sample collected for lab confirmation, Water Samples taken for fecal contamination, ORS, hygiene kits and Aqua tabs 24‐Aug AWD Pakhtunk‐ Lower Dir UC Koto, Tehsil 4 17 4 21 distributed, health and hygiene promotion session conducted with family members, EDO‐H was informed, HRDS was also hwa Balmbat involved during response, other wash partners were requested for interventions. Village Parpety, Khyber AWD alert reported, active surveillance done, 19 cases identified on active surveillance and investigated, stool sample Gombaty, UC 25‐Aug AWD Pakhtunk‐ Lower Dir 3 0 4 12 collected for lab confirmation, Water samples taken for any fecal contamination, ORS, Hygiene kits and Aqua tabs were Kotkay, Tehsil Lal hwa distributed, Health and hygiene promotion session conducted with family members, EDO‐H was informed. Qilla. Elders of Mian Essa Village met the Deputy EDO Health & informed him about a number of diarrhea cases in their village. Mohallah Moham‐ Khyber Suspected cases were investigated by WHO in collaboration with DoH. Sample taken & sent to NIH for confirmation. 11 madi Khel, Village 25‐Aug AWD Pakhtunk‐ Nowshera 0 0 5 6 cases of Acute Diarrhea found in the area. LHW's asked to cover the whole Union Council in two days for delivering hygiene Mian Essa, UC hwa related messages, stressing use of boiled water and distribution of Aqua tabs and ORS. Aqua tabs and ORS provided to Mughalki LHW's. Diarrhea related medicines provided to the health facility. Medical camp being held in the village.

Babu Muhallah; Three suspected cases of DF were reported by DHQ from different locations. Lab investigations revealed thrombocytopenia Khyber Village Jab, UC Jab; and leucopenia. Blood sample was taken and sent to NIH which came back positive for IgM Dengue. No more cases were 20‐Aug DHF Pakhtunk‐ Haripur 0 2 0 1 Chakaai Chappr found on active surveillance. A session on DF spread and prevention was conducted for the affected household. EDO Health hwa Road was informed of the outbreak. Fog spray in the area is underway. Khyber Old Bara Road, Near A suspected case of Dengue was reported from KTH, Peshawar. The Isolated patient was investigated & sample sent to NIH 19‐Aug DHF Pakhtunk‐ Peshawar Thana Kababi, 0 1 0 0 for confirmation which was found positive for Dengue, Relatives of the patients were educated.. The patient had a travel hwa University Town. history to Lahore for his business there before his illness. Health facility reported that there are 11 patients of AWD with varying severity from same family. Stool sample taken from Mohallah Shareef the patient admitted in Health Facility. Water sample was taken for water quality testing. Education about hygiene and 23‐Aug AWD Punjab Mianwali Kheel 2 2 2 5 health given to community, Medicine supplied to near health facility, aqua tabs, soaps and ORS distributed to patients no2,Daudkheel families. Filters and water purification methods are also conveyed. Basti jak Jhanboo, AWD alert from two different locations. ERT had visited the area & suspect's stool swab sample was collected & sent to NIH. Moza Old Qureshi, In the locality/area 20 households were interviewed and 4 more case of simple diarrhea were found & referred to health UC Van Patafi; Basti facility for treatment. Health education to family members in households visited. Distribution of water filters, buckets, 21‐Aug AWD Punjab Muzaffargarh 2 5 3 9 Kot Lashari, Moza soaps, Aqua Tabs, ORS & IEC among them. Nearest RHC Basera SMO joined investigation & was given briefing on the situa‐ Gul qaim Mastoi, UC tion, control measures & importance of awareness among general masses about safe drinking water, food & personal KD qureshi hygiene. Radho Jokhio goth 16 AWD cases reported and 2/3 stool sample taken found positive for V.c. Ogawa. Reinforced case management, Active 19‐Aug AWD Sindh Karachi 0 5 2 9 Gadap tawn surveillance done, Ringer lactate, Novadit, Flagyl inj provided Health education, EDO‐H informed. 13 AWD cases reported, health and hygiene sessions done aqua tabs ,ORS, life straw, IEC, jerry cane distributed, stool and Village gabar UC 20‐Aug AWD Sindh Larkana 0 1 1 11 water samples collected, follow up done reports shred with EDO‐H. Referrals were arranged for severe cases. Environmental Lashari ratodero Health unit arranged chlorination of water source or other appropriate intervention. Village Deh‐164 A, AWD alert, reinforced case management, Active surveillance done, Aqua tabs, Life straw filters, Jerry cans, Bed nets and IEC 22‐Aug AWD Sindh Mirpur Khas UC Paban taluka 1 2 2 4 Material provided Health education EDO‐H informed, 3 cases and 1 stool sample collected Digri Village Wali Muham‐ AWD alert, reinforced case management, Active surveillance done, Aqua tabs, Zinc tabs and ORS distributed Health educa‐ 25‐Aug AWD Sindh Nawabshah mad Mirasi, UC Sun, 2 6 3 7 tion, EDO‐H informed, 18 cases, 2 Stool and 5 Water sample collected in H2S Bottle. Taluka Qazi Ahmed Village mangria Malaria alert, 10 samples were collected and 8 found positive for Malaria (P. falciparum 1, 7 Mix) SPR = 80%, while FR = 21‐Aug Malaria Sindh Larkana 2 4 2 2 Talka bakrani 100%. Investigation done record verified of facility foud correct response is planned for village reported to EDOH. 27 suspected malaria cases were reported, 27 Blood sample collected out of them 18 were positive (P.Falciparium 16, P. Village Khameeso 24‐Aug Malaria Sindh Thatta 2 4 4 8 Vivax 1, Mixed 1) SPE = 66.6%, while Fr = 94.4%. Active surveillance done, Health education and EDO‐H, DSM(PPHI) and samejo Malaria Supervisor informed. Bed nets were distributed, Kerosene oil was sprayed on surrounding stagnant water. 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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 34 (19 to 25 August, 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 34/2011) 29 July 2010 to 25 August 2011, compiled from weekly reports

Diseases Total 4000 Mobile Fixed 6 6 6

3500 7 2 2 7

Skin Diseases 3 4,606,062 (11%) 8 6 7 7 7 6 8 13

3000 6 6 6 8 8 Acute Respiratory Infection 9,573,311 (23%) 8 8 8 11 2500 11 8 11 8 11

2000 8

Acute Diarrhoea 4,014,012 (9%) 12

411 400 375 331 11 215 3375 361 3363 3354 3329 1500 192 3259 3259 26 3250 3251 3234 3215 3196 153 3156 3142 3120 3109 3058 26 3021 3022 2982 128 2935 2909 2785 2745 105 2736 46 81 2547 2466 2450 58 Bloody Diarrhoea 2404 2349 362,297 (1%) 1000 2322

2262 2255 2251 2199 2022 2021 1797 1680 1463

500 1289 1215 1167 1158 1143 1130 999 1113 1111 967 949 1073 1067 879 Suspected Malaria 2,492,717 (6%) 854 0 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 ‐

Unexplained Fever 1,620,532 (4%) 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 Total Consultations 42,404,056 Wk Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Post Flood 2010 2011 (up till wk 33) Current Week (34) Total Disease A O A O A O A O Acute Watery Diarrhoea 209 85 705 320 65 16 979 421 Acute Jaundice Syndrome 5 2 36 12 ‐ ‐ 41 14 Bloody Diarrhoea 10 1 64 12 6 1 80 14 Measles 48 6 1269 80 25 ‐ 1342 86 Pertussis 1 ‐ 197 21 10 ‐ 208 21 NNT + Tetanus 5 ‐ 141 ‐ 11 ‐ 157 ‐ Malaria 12 7 56 39 8 7 76 53 Leishmaniasis 1 ‐ 93 21 9 1 103 22 Others 156 43 451 47 34 4 641 94 Total 447 144 3012 552 168 29 3627 725 Province Khyber Pakhtunkhwa: Figure-3: Three years trend of Acute diarrhoea, province KPK • This week 20 districts reported to DEWS from 700 health facilities with a total of 153,418 patients con- 25 2009 2010 2011 sultations. 20

• AD cases reported were showing a consistent upward 15 trend and between for 15% - 16% of the total consultations in last 4 weeks. Percentage 10

5 • 44 alerts were reported in this week, 24 were for AWD, 14 for DHF and six for measles. 0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Epi-Week Province Sindh: Figure-4: Three years trend of Acute diarrhoea, province Sindh • This week 21 districts reported to DEWS from 931 health centers with a total of 411,372 patient consul- 25 tations during the reporting period of week 34, 2011. 20 • In Sindh, AD cases reported were 40,510 (10%), same 15 proportional morbidity as compared with last week.

Percentage 10 • 49 alerts were reported from Sindh in this week: 25 were for AWD; Eight were for Measles; Six for NNT 5 and Tetanus; Two each for DHF, Leishmaniasis, Ma- 2009 2010 2011 0 laria and Pertussis; while one each for Bloody diar- 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 rhoea and Chicken pox. Epi‐Week

15 • AD cases reported were 13,973, and stabilized be- Percentage tween 7% - 8% from last four weeks. 10

• 26 alerts were reported in this week from Punjab; 5 Nine for AWD; Six for AD; Four for NNT; Two each for Bloody diarrhoea and DHF; while one each 0 for Measles, Pertussis and Scabies. 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 Balochistan province. 429 health centers reported a 25 total of 68,087 patient consultations. • AD reported in 8,196 (12%) of the total consulta- 20 tions, same proportional morbidity as compared with 15 last week. Percentage • 24 alerts were reported in this week from Balochis- 10 tan, nine were for Leishmaniasis; Four each were for AWD and Pertussis; Three for measles, while one 5 each for chicken pox, malaria, meningitis and Ty- 2009 2010 2011 0 phoid. 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Epi‐week Gilgit Baltistan:

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 25 Aug 2011) • In this week, 71 health centers from 7 districts in 45 AD BD ARI S. Malaria Gilgit Baltistan sent weekly report with a total of 40 23,546 patient consultations. 35 30 • ARI cases reported were 2,786 (12%), while Acute 25

Diarrhoea 4,307 (18%). Percentage 20 15 10 • Nine alerts received and responded this week, Three 5 for AWD; Two for BD, while one each for AD, 0 Leishmaniasis, Malaria and Meningitis. 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

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, weekly report received from 82 health centers from 7 • This week 53 health centers in 3 agencies reported from FATA, districts, with a total of 30,686 patient consultations. with a total of 8,272 patient consultations. • ARI cases reported were 3,504 (11%), while Acute diarrhoea re- • ARI cases reported were 1,406 (16%), while Acute diarrhoea reported 2,036 (7%) cases. ported 1,055 cases (13%) • Six alerts were received and responded this week; Two were for • One alert for AWD received and responded this week. Measles, while one each for AWD, BD, DHF and Chicken pox.

40 40 AD BD ARI S. Malaria AD BD ARI S. Malaria 30 30

20 20 Percentage Percentage 10 10

0 0 6 7 8 9 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

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

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

19‐Aug Leishmaniasis Khuzdar Chandni Chaowk UC Faiz Abad 0 0 0 1 22‐Aug AD Layyah chak no 91 ml, u/c 90 ml tehsil karoor 15 12 16 12 23‐Aug Leishmaniasis Khuzdar Natwani UC Baghbana Tehsil Khuzdar 0 1 0 0

24‐Aug Leishmaniasis Khuzdar Faiz Abad Chandni Chaowk Khuzdar 0 1 0 0 Rahim Yar Adam Wali, UC Akramabad, Tehsil Ra‐ 24‐Aug AD 7 8 6 5 24‐Aug Leishmaniasis Khuzdar Norgama Tehsil Zehri 1 0 0 0 Khan himyarkhan

22‐Aug Leishmaniasis Lasbela Winder Town 0 2 0 0 Rahim Yar Saadi Sultan, UC Rasoolpur, Tehsil Rahim Yar 24‐Aug AD 6 5 4 7 24‐Aug Leishmaniasis Panjgur Union Council ,Bonistan Mohallah Madresa 0 1 0 0 Khan Khan

23‐Aug Malaria Chagai BHU Sargesha 0 0 0 0 Rahim Yar 25‐Aug AD chak 92 P, UC 228 P, Tehsil Rahimyar Khan 4 8 5 12 25‐Aug Malaria Jaffarabad BHU Cattle form 11 21 9 23 Khan

19‐Aug Malaria Jhal Magsi RHC Jhal Magsi 8 33 7 15 RHC Kot Mithan; UC kot Mithan, Tehsil 25‐Aug AD Rajanpur 40 39 18 26 24‐Aug Malaria Kharan BHU Sarawan 0 0 0 0 Rajanpur

BHU Allah Dad Umrani, Tehsil Manjhi 25‐Aug Malaria Nasirabad 8 14 11 19 Shoorti 23‐Aug AWD Mianwali Mohallah Shareef Kheel no2,Daudkheel 2 2 2 5

23‐Aug Measles Khuzdar Civil colony Khuzdar 2 0 1 0

23‐Aug Measles Khuzdar Pat Mai UC Baghbana Tehsil Khuzdar 0 0 1 0 22‐Aug AWD Multan Khan Pur Qazi UC chack R/S, tehsil Shujabad 0 0 0 1

24‐Aug Measles Khuzdar Moza Gul Bhit UC Zeedi Tehsil Khuzdar 1 0 0 0

24‐Aug Measles Lasbela Mazar goth Beroot 5 1 1 1 Basti jak Jhanboo, Moza Old Qureshi, UC 21‐Aug AWD Muzaffargarh Van Patafi; Basti Kot Lashari, Moza Gul qaim 2 5 3 9 24‐Aug Measles Panjgur UC Chitkan, Mohalla Taar office 0 1 0 0 Mastoi, UC KD qureshi

23‐Aug Measles Quetta BMCH, Brewery Road 0 0 1 0

20‐Aug Measles Sibi Village Dehpal kolan 1 0 1 0 24‐Aug AWD Muzaffargarh Basti Kikryan Wala, UC Bhuttapur 0 0 0 2

23‐Aug Mumps Ziarat Ziarat, Cheena, Pechi 0 3 0 0 Basti Qazi Wala, Moza Laang Malana, UC 24‐Aug AWD Muzaffargarh 1 0 1 1 23‐Aug NNT Nasirabad Nursery ward of DHQ‐ Hospital D.M.J 2 0 0 0 City‐3 24‐Aug Pertussis Jaffarabad Ghot Ali Jamali, U/C Sameji, Tehsil U.M 2 0 0 0

24‐Aug Pertussis Nasirabad Ghot Mir Mohammad Bugti, Tehsil DMJ 2 0 1 0 24‐Aug AWD Muzaffargarh Mohallah Khurshid Abad, UC Lutkeran 0 0 0 1

25‐Aug Pertussis Nasirabad Ghot Sawali Khan Bugti, Tehsil DMJ 0 2 0 1 Rahim Yar Basti Maharan, Mouza chak 92 P, UC 228P 25‐Aug AWD 0 1 0 0 23‐Aug Pertussis Panjgur Union Council Chitkan ,Mohallah Taar 0 0 0 1 Khan Tehsil Rahimyar Khan 23‐Aug Pertussis Panjgur Washbood, Mohallah Madresa/serdar 0 1 1 8 Jaafria Colony, House no. 5, Near Imam 24‐Aug Pertussis Panjgur Union Council Sordo ,Mohallah brohi 0 0 1 0 25‐Aug AWD Rajanpur 0 1 0 0 Bargaah, UC Rajanpur Gharbi 22‐Aug Pertussis Ziarat Ziarat town 1 0 0 0

19‐Aug Typhoid Chagai Killi Dilmurad cha padag 0 2 0 2 23‐Aug BD Layyah Moaza Dollo nasheeb U/c Lohanch nasheeb 0 2 0 1

25‐Aug Typhoid Chagai Zahoor Colony Dalbandin 0 2 0 2 Current week's Alerts: AJK; FATA; GB and ICT 24‐Aug BD Layyah Moaza jhakar U/c Jhakar pakka 1 0 2 0 Date Disease District Area <5M >5M <5F >5F Village Cham , P.O Chanari, Tehsil Hattiyan Nishter Hospital; Y Block Multan, Chowk 23‐Aug AWD Hattian 0 1 0 1 22‐Aug DHF Multan 0 5 0 0 Bala Ghanta Ghar Muzaffara‐ Village Sarar, UC Gojra , Tehsil Muzaffara‐ 22‐Aug BD 3 4 0 0 bad bad Rahim Yar Sh. Zayed Hospital‐Church Road RY Khan & 22‐Aug DHF 0 2 0 0 24‐Aug Chicken Pox Kotli chak nasru sersawa kotli 0 2 0 0 Khan Jetha Bhutta 25‐Aug DHF Bhimber DHQ Bhimber‐Kot Jamel Barnala 0 2 0 1

22‐Aug Measles Bagh vill chalandrat UC Rangla tehsil Dhirkot 0 0 1 0 23‐Aug Measles D. G. Khan UC Urban 3 0 1 0 0 24‐Aug Measles Bagh Vill Saliyan UC Dharay Tehsil Bagh 0 2 0 1 Bajaur village Jabbare, Manu dherai Tehsil Ut‐ 23‐Aug AWD 1 0 0 0 Agency mankhel 24‐Aug NNT D. G. Khan Ban Dhola uc Fazla Kach tehsil Tribal 1 0 0 0 24‐Aug AD Diamir Civil hospital Darrel 30 62 36 55

Village Bubar Khutum UC Bubar Tehsil 25‐Aug NNT D. G. Khan Chabree Bala uc Yaroo 1 0 0 0 26‐Aug AWD Ghizer Punial; Village Golodas near govt 0 1 0 1 schoolTehsil Ishkoman 25‐Aug AWD Gilgit Gilgit Town area 0 1 0 1 25‐Aug NNT Layyah U/c Shergarh tehsil choubhara 1 0 0 0 23‐Aug BD Ghanche Village Surmo UC Gorsy Khaplu 0 0 0 1

22‐Aug BD Skardu Village GhaziAbad Kachura 0 0 0 1 24‐Aug NNT Multan Lutfabad, Mouza Jarh 0 0 1 0 Leishmani‐ 23‐Aug Diamir Hudur Valley 0 0 4 0 asis 24‐Aug Malaria Diamir FAP Gayyal 3 2 4 1 25‐Aug Pertussis D. G. Khan Basti Gadi Shumali uc Sokar tehsil Taunsa 1 0 0 0 22‐Aug Meningitis Skardu Village Sadat colony Gamba 0 1 0 0

23‐Aug AWD Islamabad FG Polyclinic 0 1 0 1 25‐Aug Scabies Bhakkar Sial city, UC Sial, Tehsil Bhakkar 2 10 1 7 19‐Aug Measles Islamabad CH PIMS (bari Imam) 1 0 1 0

22‐Aug AWD Ghotki Village Budho Bozdar UC jarwar 0 1 0 0 19‐Aug AWD Haripur Village Pakh Shahi, UC Muslimabad 6 11 17 12 19‐Aug AWD Hyderabad Hali road Sabzi Mandi, Near BHU Hali road 1 0 2 0 22‐Aug AWD Haripur Peshawar Adda, Near Afaq Hotel 0 0 1 0 24‐Aug AWD Hyderabad Latifabad 0 1 0 0

24‐Aug AWD Hyderabad Noorani Basti near Mustafa Park 0 0 0 1 22‐Aug AWD Haripur Village Razayaian, Bagra#2, UC Bagra 0 1 1 0 22‐Aug AWD Jamshoro Railway colony Kotri 0 0 1 0 23‐Aug AWD Haripur Vilage Bandi, UC Kothera, Tehsil Ghazi 2 8 3 12 22‐Aug AWD Jamshoro Telegraph colony Kotri 1 0 1 0 Village Audigram, Maniyal, UC Lal Qilla, Tehsil 19‐Aug AWD Karachi Radho Jokhio goth Gadap tawn 0 5 2 9 19‐Aug AWD Lower Dir 1 2 1 0 Balmbat 20‐Aug AWD Larkana Village gabar UC Lashari ratodero 0 1 1 11 Village Kass Kandao, UC Lajbook, Tehsil 23‐Aug AWD Lower Dir 1 7 4 4 19‐Aug AWD Mirpur Khas IDP Camp, Village Daulat Laghari 0 0 0 0 Balmbat. Village daulat Laghari, Khaskheli Mohalla, UC 24‐Aug AWD Lower Dir Village Shahikoto, UC Koto, Tehsil Balmbat 4 17 4 21 19‐Aug AWD Mirpur Khas 0 0 0 0 Daulatpur Village Parpety, Gombaty, UC Kotkay, Tehsil 25‐Aug AWD Lower Dir 3 0 4 12 22‐Aug AWD Mirpur Khas Village Deh‐164 A, UC Paban taluka Digri 1 2 2 4 Lal Qilla. Village Khaskheli mohalla, UC Girhore Sharif Mohallah Mohammadi Khel, Village Mian 23‐Aug AWD Mirpur Khas 0 0 0 0 25‐Aug AWD Nowshera 0 0 5 6 Taluka Digri Essa, UC Mughalki Naushahro 24‐Aug AWD Shangla Village Basi Bagh/ Tehsil Alpurai 0 2 0 1 23‐Aug AWD Village Darya Khan Jalbani 2 0 0 0 Feroze Village Wali Muhammad Mirasi, UC Sun, 19‐Aug AWD Swabi RHC Yar Hussain, Mohallah Shaheen Abad. 1 3 0 2 25‐Aug AWD Nawabshah 2 6 3 7 Taluka Qazi Ahmed 24‐Aug AWD Swabi RHC Yar Hussain, Village Qadame, Yar Hussain 0 1 0 0 19‐Aug AWD Shikarpur Balouch Mohalla Pipal wala Khanpur 0 1 0 0 Village wali Dhino khooharo, UC Dadloi 19‐Aug AWD Swat Village and UC Chuprial, Tehsil Matta 0 1 0 0 19‐Aug AWD Sukkur 0 1 0 2 Talluka Panoakil Village Shank Madyan, UC Chail, Tehsil Tando Allah 19‐Aug AWD Swat 0 0 0 1 22‐Aug AWD Village Bado Machi, UC 1 Taluka Chamber 0 1 0 0 Bahrain Yar 19‐Aug AWD Swat Village Zor Kale, UC and Tehsil Bahrain 0 0 0 1 Tando Allah 22‐Aug AWD Village Bahar khan mirjat, UC Tando Soomro 1 0 0 0 Yar Village Chatai Kale Fazal Abad, UC & Tehsil 20‐Aug AWD Swat 0 0 0 1 Matta IDP Camp behind Naukot forte, UC 19‐Aug AWD Tharparkar 0 1 0 0 Village Kala Kale Mehak Road, UC Kala Kale, Mohrano, Taluka Mithi 20‐Aug AWD Swat 1 0 0 0 Tehsil Kabal IDP Camp, Naukot qila, UC Mahrano Taluka 19‐Aug AWD Tharparkar 0 1 0 0 Mithi 22‐Aug AWD Swat Village and UC Kuz Shawar, Tehsil Matta 0 0 0 1 20‐Aug AWD Tharparkar Village Diplo tawn, UC & Taluka Diplo 0 1 0 0 Village Barthana near Mosque, UC Barthana, 22‐Aug AWD Swat 0 0 0 1 Tehsil Matta Village Haji Abbas charan, UC Qadin dino 22‐Aug AWD Thatta 0 0 0 1 Village Kuz Shawar Saland, UC Kuz Sha‐ shah, Taluka Shah Bundar 22‐Aug AWD Swat 0 0 0 1 war,Tehsil Matta 25‐Aug AWD Thatta Haji Muhammad Ali Chandio 2 0 1 1 23‐Aug AWD Swat Village Sambat, UC Baidara, Tehsil Matta 0 1 0 0 20‐Aug BD Badin IDP Camp GD & UC Shadi Lodge 0 2 0 2 Mohala Madai, Village and UC Shakardara, Chicken 24‐Aug AWD Swat 0 0 1 0 21‐Aug Thatta Chuk‐153 Gul Muhad Baran Jati 1 1 0 0 Tehsil Matta Pox Abbotta‐ 19‐Aug DHF Banda Saad, UC Dhamtor 0 1 0 0 19‐Aug DHF Badin Army Welfare Sugar mill 0 1 0 0 bad Village Gul Baig Gadani UC Dhangro Taluka Abbotta‐ 19‐Aug DHF Ghotki 0 0 1 0 24‐Aug DHF Village: Akora, Qalandarabad 0 1 0 0 Mirpur Mathelo bad Leishma‐ 25‐Aug DHF Battagram Village Jahangirabad 0 0 0 1 20‐Aug Larkana Allah abad muhalla goli mar street larkana 0 1 0 0 niasis 20‐Aug DHF Haripur Awan Colony Near Afaq Hotel 0 0 0 1 Leishma‐ Qambar 22‐Aug Village bhuthi behram talka Miro khan 0 1 0 0 niasis Shahdadkot Babu Muhallah; Village Jab, UC Jab; Chakaai 20‐Aug DHF Haripur 0 2 0 1 21‐Aug Malaria Larkana Village mangria Talka bakrani 2 4 2 2 Chappr Road Near Poly Technique college, saraiSaleh UC 24‐Aug Malaria Thatta Village Khameeso samejo 2 4 4 8 22‐Aug DHF Haripur 0 1 0 0 Sarai saleh 22‐Aug Measles Ghotki Village Chaglani UC bereri 0 1 0 0 Railway Line New Abbadi Kangra Colony UC 22‐Aug DHF Haripur 0 1 0 0 24‐Aug Measles Ghotki Langah Muhalla village chaglani UC bereri 0 0 1 0 Panian 25‐Aug Measles Karachi Shershah Kemari tawn 1 0 0 1 23‐Aug DHF Haripur Village Alam, UC Dheenda 0 1 0 0 24‐Aug Measles Mirpur Khas Village Kot Mirs 0 1 0 0 24‐Aug DHF Haripur BHU Mang, UC Mang 0 1 0 0 22‐Aug Measles Thatta Village Sirdar Shoro, UC Jhampir 1 0 1 1 24‐Aug Measles Thatta Village Hussain Mirbahar 3 0 1 1 24‐Aug DHF Haripur Choar Shareef 0 1 0 0 KTH Peshawar (House No 15, Sector 2, Kan‐ 24‐Aug Measles Thatta Village Soomar Meerbahar 4 0 0 0 26‐Aug DHF Haripur 0 1 0 0 graa Colony) 25‐Aug Measles Thatta Abdullah Gandro 0 1 3 2 Old Bara Road, Near Thana Kababi, University 19‐Aug DHF Peshawar 0 1 0 0 24‐Aug NNT Ghotki Village Pathan Mahar UC Bhaitoor 1 0 0 0 Town. Abbotta‐ 22‐Aug NNT Jacobabad Village Sargani near Jhal Magsi 1 0 0 0 25‐Aug Measles Village Samlala, UC Langra 1 0 0 0 bad 25‐Aug NNT Karachi Neonatal ICU, NICH 1 0 1 0 23‐Aug Measles Buner bagra village gokand dagar 4 3 0 0 22‐Aug NNT Khairpur Village Tando Shah UC & taluka Kot Diji 1 0 0 0 22‐Aug Measles Charsadda Ahmad Ustaaz Kalllay 1 0 0 0 21‐Aug NNT Thatta Shedi Mohalla, Chohar Jamali 1 0 0 0 Villaage Dharam Kohli, UC Makhan Samoo 22‐Aug Measles Charsadda Ocha Muslimabad 0 1 0 0 24‐Aug Pertussis Mirpur Khas 2 0 4 1 taluka Mirpurkhas 23‐Aug Measles Charsadda Qalarai Kallay 1 0 0 0 22‐Aug Pertussis Tharparkar Village Jetrar, UC Tar ajmed Taluka Chachro 2 0 2 1

19‐Aug Tetanus Shikarpur Shahi Bagh 0 1 0 0 25‐Aug Measles Haripur Afgha Refugee Camp Padhinna 0 0 0 1

Focus on:

While March and April are usually the 80 Province wise number of Pertussis cases by week,Pakistan (Wk 1 ‐ 34, 2011) months for pertussis outbreaks and 70 more pertussis cases were reported 60 from Sindh during this time, outbreaks 50 40 cases

of pertussis have continued in Sindh # 30 throughout 2011 up until now. Please 20 see chart at right. Outbreaks of pertus‐ 10 0 33 31 29 27 25 23 21 19 17 15 13 11 09 07 05 03 sis started in KP and Balochistan in May 01 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk and have also continued up until now. Epi‐week Wk Punjab has had scattered cases since Sindh Balochistan Khyber Pakhtunkhwa Gilgit‐Baltistan Punjab May and Gilgit‐Baltistan had an outbreak of 30 cases in August. Prevention of pertussis depends on main‐ tenance of high coverage of routine immunization of all children under age one year.

Pertussis, or whooping cough, is caused by bacteria called Bordatella pertussis and B parapertussis that live in the mouth, nose, and throat and spread very easily from child to child in droplets produced by coughing or sneezing. Following an incubation period of 9–10 days (range 6‐20 days), patients develop runny nose and cough. In the course of 1–2 weeks, coughing paroxysms ending in the characteristic whoop occur and may last four to eight weeks. The disease is most dangerous in infants, who should be hospitalized to ensure adequate oxygenation and nutrition.

Estimates from WHO suggest that, in 2008, about 16 million cases of pertussis occurred worldwide, 95% of which were in developing countries, and that about 195,000 children died from the disease.

Pertussis is prevented by vaccination with at least 3 primary doses of pentavalent vaccine (DPT‐HepB‐ Hib), given by the intramuscular route at ages 6 weeks, 10 weeks and 14 weeks in the EPI Pakistan sched‐ ule.

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases reported in 2010 is 144 includ‐ ing 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/ agencies. Year 2011: The total number of polio cases confirmed by the laboratory is 77 (76=type‐1, and 1=type3) till date from 28 districts.

Province Cases 2010 Cases 2011 P1 P3 P1 P3

Punjab 6 1 - -

Sindh 26 1 14 -

Khyber Pakhtunkhwa 19 5 7 -

FATA 63 11 23 1

Balochistan 6 6 31 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 76 1