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

Volume 2-- Issue 52 Dec 20-26, 2020 Date: December 30, 2020

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 FDSRU February, 2020 in Pakistan. FELTP fellows Alumni teams who conduct daily calls on given contact are actively involved in COVID-19 Surveillance numbers of the travelers to ask about their health throughout Pakistan. Data is being shared with status, advise them for immediate contact at the FDSRU on daily basis and a SITRIP is being issued nearest designated hospital in case of COVID-19 by FEDSD National Institute of Health Islamabad symptoms. Total 96,243 travelers have been traced FDSRU has developed a mechanism for tracking of and contacted by December 26, 2020. travelers from other countries to Pakistan since 02 Table-1: Weekly Surveillance data COVID-19 by December 26, 2020 Province/ Suspected cases Lab Update Hospital Update Region reported

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

AJK 97,135 97,343 8,172 35 7,392 216 Baluchistan 158,779 158,961 18,075 06 17,586 182 GB 64,466 64,855 4,850 04 4,683 101 Islamabad 800,321 803,931 37,117 227 31,895 404 KP 735,587 745,020 57,215 586 51,552 1,602 Punjab 2,373,929 2,387,105 135,665 1,155 121,989 3,900 2,288,857 2,299,897 210,241 771 187,035 3,469 Total 6,519,074 6,557,112 471,335 2,784 422,132 9,874

PDSRU SINDH Total 210,241 confirmed COVID-19 cases were Ghotki (n=4,128). Age group 50-59 has the highest reported from Sindh until Dec 26,2020. Most of these attack rate (1070/100,000) followed by 30-39 years cases were reported from District age group (911/100,000), ≥70 years age group (n=1,44701) followed by District Hyderabad (905/100,000 & 60-69 years age group (845/100,000 (n=8,830), District Sukkur (n=4,326) and District population).

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Volume02 -- Issue 52 Dec 20-26, 2020 Date: December 30, 2020

Figure-1: Sindh - District-wise distribution of COVID-19 cases (Cumulative up to week 52)

Figure-2: Sindh – Age group-wise Attack Rates /100,000 population (Dec 26, 2020)

1200 1070

1000 911 905 826 845 800 639 600

Attack rate/100,000 Attack 400

200 147 44 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 - Baluchistan province

The department of Health Baluchistan has reported (n=416). Age group 30-44 has the highest number of 18,075 positive cases of COVID-19 and 182 deaths COVID-19 cases (n=5,869) followed by age group until Dec 26, 2020. 17,586 cases have recovered. 15-29 (n=5,195) & age group 45-59 (n=2,884). District Quetta has the highest number of confirmed cases(n=12,587) followed by District Kech (n=802), District Khuzdar (n=547) and District Jaffarabad

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Volume02 -- Issue 52 Dec 20-26, 2020 Date: December 30, 2020

Figure-5: Geographical Distribution of COVID-19 Cases in Baluchistan Province (Cumulative up to Week 52)

Figure-6: Baluchistan –Age group wise distribution of COVID-19 positive cases (up to Dec 26,2020)

6300 5869

5400 5195

4500

3600 2884 No. of Cases of No. 2529 2700

1800 1323

900

0 <1-14 15-29 30-44 45-59 60+ Age Groups

PDSRU- Gilgit-Baltistan (GB)

PDSRU GB has reported total 63,401 suspected 19. 4,489 cases have recovered from COVID-19 cases of COVID-19 and out of these 5,714 were lab while 101 cases expired. During current week confirmed COVID-19 up to Dec, 26 and 59 cases highest number of COVID-19 cases were detected in were detected during last week, while no lab results District Gilgit (n=14) followed by District Astore are awaited. 63,061 samples were processed and (n=11) and District Diamer (n=10). 51,302 suspects were declared negative for COVID-

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Volume02 -- Issue 52 Dec 20-26, 2020 Date: December 30, 2020

Table -2 Detail of number of samples, confirmed Covid-19 cases & Deaths in GB up to December 26, 2020

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

Astore 7821 7018 7813 11 00 382 05 08 Diamer 7418 5889 7417 10 00 263 05 01 Ghanche 3735 3319 3642 02 00 104 04 93 Ghizer 4735 4124 4733 04 00 425 07 02 Gilgit 15057 12685 14973 14 00 1679 39 84 Hunza 9186 4450 9169 01 00 611 03 17 Kharmang 2814 2664 2788 03 00 104 00 26 Nagar 2975 2445 2973 00 00 201 04 02 Shigar 2374 2108 2349 05 00 117 04 25 Skardu 7286 6330 7204 09 00 603 30 82 Grand Total 63401 51032 63061 59 00 4489 101 340

Figure-7: GB-District-Wise distribution of confirmed COVID-19 cases up to December 26, 2020

15 14

12 11 10 9 9

6 5

No.of Cases 4 3 3 2 1 0 0 Astore Diamer Ghanche Ghizer Gilgit Hunza Skardu Shigar Kharmang Tourist Districts

PDSRU-AJK cases have recovered from COVID-19 and 218 cases PDSRU AJK has reported total 97,173 suspected expired due to COVID-19. District Muzaffarabad cases of COVID-19 and out of these 8,215 were lab has the highest number of cases (n=2949) followed confirmed COVID-19 up to Dec 26, 2020 while no by District Mirpur (n=1571), District Kotli (n=1028) lab- results of suspected cases are awaited. 7,469 and District Poonch (n=906).

Table -3: Distribution of suspected and confirmed Covid-19 cases in AJK up to Dec 26,2020

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

97,173 97,686 8,215 528 7,469 218 Figure-8: AJK-District-Wise distribution of confirmed COVID-19 cases up to Dec 26, 2020

3200 2949

2800

2400

2000 1571 1600

No. of Cases of No. 1028 1200 906 800 609 383 400 285 290 142 52 0 Muzaffarabad Mirpur Kotli Poonch Bhimber Bagh Hattian Bala Pallandri Neelum Havaili Districts 4

Volume 2-- Issue 52 Dec 20-26, 2020 Date: December 30, 2020

PDSRU-KPK Swat (n=3536), District Malakand (n=2038) and PDSRU KPK has reported total 735,587 suspected District Mardan (n=1629). Age group 40-49 years cases of COVID-19 and out of these 57,467 were lab has the highest attack rate/100,000 (AR=325) confirmed COVID-19 up to Dec 26, 2020 while 1609 followed by 30-39 years age group (AR=297) and patients expired. District has the highest 50-59 years age group (AR=276). number of cases (n=22542) followed by District

Figure-11: Geographical Distribution of COVID-19 Cases in KPK Province (Cumulative up to Week 52)

Figure-12: KPK –Attack rates /100,000 population in different age groups (up to Dec 26, 2020 350 325 297 300 276 248 250 237 208 200 169

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Attack rate/100,000 Attack 100 40 50 10 0 0 – 9 10 – 19 20 – 29 30 – 39 40 – 49 50 – 59 60 – 69 70 – 79 >80 Age Groups

Communicable Disease Surveillance

Influenza Suspected/Confirmed: Diphtheria Surveillance: In 2018, total 3221 and in 2019 total 100 During 2018 total 464 and during 2019 total 614- Suspected/confirmed Influenza cases reported from suspected cases of Diphtheria were reported. In week PDSRUs/RDSRUs. In week 52, no suspected cases 52, 01 case was reported from KPK. were reported. Volume 2-- Issue 52 Dec 20-26, 2020 Date: December 30, 2020

Dengue Surveillance: CCHF Surveillance: In 2018, total 3204 Dengue cases reported from In 2018, total 63 CCHF (suspected and confirmed) Sindh Total 24,610 cases reported which includes 48 cases were reported from DSRUs and 75 cases have new case reported from Baluchistan. In week 52, 92 been reported in 2019. During week 51, no cases cases reported from Sindh & Baluchistan. reported from all provinces & region.

Table-4: Weekly and Cumulative Diseases Updates Dec 26, 2020 Disease Total Cases in 2019 Dec 20-26, 2020 Total Cases in 2020 1 CCHF 75 0 19 2 Varicella 1,264 0 235 3 Dengue 24,547 92 4024 4 Chikungunya 0 0 0 5 Measles 6,781 95 1986 6 Diphtheria 614 0 140 7 Suspected / confirmed Seasonal 100 0 9 Influenza

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

Total 24403 7909 513 2967 2065 3057 9944 50750

26-12-2020 0 76 0 0 0 16 0 92 Total (2020) 03 2722 2 184 0 493 38 3,442

Extensive drug Resistant (XDR) Typhoid Fever Surveillance in Sindh Province In Karachi total 13,485 cases of extensive drug reported in the age group 0-4 years. The overall resistance typhoid fever were reported from January attack rate was 67/100,000. The age group 0-4 years 01, 2017 to Dec 26, 2020. During current week total was the most affected (attack rate 192/100,000) 23 cases of XDR typhoid fever were reported from followed by age group 5-9 years (AR 141/100,000). different hospitals in Karachi. The XDR Typhoid Females have higher attack rate 77/100,000 cases were reported mostly among the children and compared to Males. maximum number of XDR cases 5233 (39%) were

Table-6: Number of XDR Typhoid fever cases Karachi from January 1, 2017 to Dec 26, 2020 Year Year XDR Cases Jan to December 2017 175 Jan to December 2018 3712 Jan to December 2019 7088 January 01, to Dec 26,2020 2020 2510

Total 13,485

Volume02 -- Issue 52 Dec 20-26, 2020 Date: December 30, 2020

Figure 13: Week-wise number of XDR Typhoid fever cases in Karachi, from January 1, 2017 to Dec 26, 2020

300

250

200

150

No.of No.of cases 100

50

0

Week Week 2 Week 5 Week 8 Week 1 Week 4 Week 7

Week 10 Week 43 Week Week 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 13 Week 16 Week 19 Week 22 Week 25 Week 28 Week 31 Week 34 Week 37 Week 40 Week 46 Week 49 Week 52

WEEK 24 WEEK WEEK 03 WEEK 06 WEEK 09 WEEK 12 WEEK 15 WEEK 18 WEEK 21 WEEK 27 WEEK 30 WEEK 33 WEEK 36 WEEK 39 WEEK 42 WEEK 45 WEEK 48 WEEK 51 WEEK Feb Mar Apr May JuneJuly Aug Sept Oct Nov Dec Jan Feb MarApril May JuneJulyAugust Sept Oct Nov Dec Jan Feb Mar Apr MayJune July Aug Sept Oct Nov Dec 2019 2020 Epidemiological Months and Weeks

XDR Typhoid Surveillance Data Sindh-Province (Excluding Karachi) Total 7004 Salmonella Typhoid cases reported from affected age group was 0 to 4 years (n=1407) with November 2016 to Dec 26, 2020 from different attack rate 47.7 per/10000 population followed by 5- districts of Sindh province (excluding Karachi). 9 years of age group (n= 1046) with attack rate Among these cases 5343 were Extensive Drug 35.6/10000 population. Over all attack rate is Resistant cases. Out of these cases n=3729 (69.8%) 17.1/10000 population (n=3729). 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

January 01 – Dec 19, 2020 685 399 1084

Current week -Dec 20-26, 2020 11 6 17 Total 3,729 1,614 5,343

Figure 14:XDR Typhoid Cases District Hyderabad Nov-2016 to Dec 26, 2020

250

200

150

100 No of cases of cases 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 Year Year-17 Year -18 Year-19 Year-20 -16 Month wise cases

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