Ygi;gyu Field Epidemiology and Disease Surveillance Division (FEDSD) National Institute of Health (NIH), Phone: 051- 9255237, Email: [email protected] Weekly Bulletin: Integrated Disease Surveillance and Response (IDSR) 10th June 2021

Highlights of the week 22 (31st May – 06th June 2021)

Figure 1: Most frequently reported cases during week 22, in comparison with pervious weeks,

Cumulative Information: 7,000 W20 W21 W22 5,977 6,000  Maximum cases reported were; ILI (n=5977), Acute Diarrhea (Non 5,000 4,327 Cholera) (n=4327), Malaria (n=1075), 4,000 ALRI< 5 years (n=898), SARI (n=592), B. Diarrhea (n=482), Typhoid (n=334), TB 3,000 (n=313), and suspected Cholera 2,000 (n=246). 1,075 898 1,000 592 482  In comparison with previous week i.e. Cases of Number 334 313 246 WK21, the cases of all above said 0 diseases decreased/ less reported.  Cases of Acute Viral Hemorrhagic fever reported from Balochistan

(n=15), (n=11), and KP (n=02).  Cases of Chickenpox reported from Table 1: Province/Area wise distribution of most frequently reported cases during week 22, Pakistan

Sindh (n=16) and Balochistan (n=02) Diseases AJK Baloch. GB KP ICT Sindh Total  Cases of TB reported from Sindh (n=253), KP (n=58) and Balochistan ILI 3 1,847 24 550 50 3,503 5,977 (n=02) AD (Non-Cholera) 57 881 7 550 97 2,735 4,327

Malaria 3 424 0 345 0 303 1,075 ALRI < 5 years 0 157 26 60 0 655 898

SARI 0 54 1 500 0 37 592

B. Diarrhea 0 162 2 96 0 222 482

Typhoid 0 107 22 105 0 100 334

TB 0 2 0 58 0 253 313 S. Cholera 0 23 2 51 0 170 246

CL 0 127 0 10 0 0 137 VH(B, C & D) 0 9 0 0 0 127 136

Measles 0 31 0 4 1 6 42 AVH 0 15 0 2 0 11 28

Chickenpox 0 2 0 0 0 16 18

Point of Attention:

 Teleconference could not happen for the past 04 weeks due to involvement of IDSRS districts focal

persons in COVID-19 tracing, response and vaccination activities.  There is a need to verify the alerts for early detection and response activities by the IDSR teams and other concerned in their respective provinces and areas.  Cases of Chicken reported more from Sindh which need to be verified, investigated, and responded.  Acute viral hemorrhagic fever cases were reported more from Balochistan and Sindh. This need verification, outbreak investigation and response activities at earliest.  Maximum Typhoid cases reported from Balochistan, KP, Sindh and GB. This need detailed investigation and classification (i.e. MDR or XDR) followed by response activities accordingly.  Malaria cases reported from more from Balochistan, KP and Sindh. Verification, epidemiological investigation and response action is urgently required.  It is proposed to enhance community awareness on water, sanitation and hygiene (WASH) practices

especially for diarrheal diseases and typhoid affected districts.

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Sindh Figure 2: Most frequently reported cases during week 22 in comparison with pervious weeks, Sindh 5,000  Sindh reported maximum cases of ILI 4,500 W20 W21 W22 (n=3,503) followed by AD (Non 4,000 3,503 Cholera) (n=2,735), ALRI< 5 Years 3,500 (n=655), Malaria (n=303), B. Diarrhea 3,000 2,735 (n=222), S. Cholera (n=170), VH (B, C & 2,500 D) (n=127), Typhoid (n=100), and SARI 2,000

(n=37) 1,500 Number of Cases of Number 1,000  District Ghotki reported the maximum 655 500 303 222 cases of ILI, AD (Non Cholera), ALRI <5 170 127 100 37 0 years, Malaria and B. Diarrhea.

 District Hyderabad reported maximum cases of ILI, AD (Non-Cholera), ALRI <5 years, and S. Cholera.

 From Malir maximum cases reported as AD (Non-Cholera), ILI and Table 2: District wise distribution of most frequently reported cases during week 22, Sindh ALRI <5 years.

Karachi Karachi  Shikarpur reported maximum cases of Diseases Ghotki Hyderabad Shikarpur Tharparkar Total AD (Non Cholera), and ALRI <5 years. East Malir

 From Tharparkar maximum cases of ILI 461 2727 0 186 0 129 3,503 ILI, AD (Non-Cholera) and Malaria. AD (Non- 684 977 136 615 165 158 2,735 Cholera)  Decrease in case trend observed in ILI, ALRI < 5 years 192 184 0 118 115 46 655 AD (Non-Cholera) and ALRI <5 years. Malaria 132 25 12 30 10 94 303

Bloody  Cases of Chickenpox, acute viral 133 32 4 27 2 24 222 hemorrhagic fever, Malaria and Diarrhea Mumps need immediate verification, S. Cholera 8 137 25 0 0 170 epidemiological investigations, and VH (B, C & D) 82 11 0 30 0 4 127 response activities. Typhoid 30 10 0 44 0 16 100 SARI 6 20 0 3 8 0 37

Chickenpox 4 5 0 2 2 2 15

Mumps 0 0 0 3 1 0 4

Figure 3: Week wise reported cases of AD (Non-Cholera), ILI, Malaria, Sindh

7000 AD (Non Cholera) ILI ALRI < 5years 6000

5000

4000

Number of Cases 3000

2000

1000

0 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22

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Balochistan Figure 4: Most frequently reported cases during week 22, in comparison with previous weeks, Baluchistan

 1,800 W20 W21 W22 From Balochistan overall ILI (n=1560), 1,560 AD (Non Cholera) (n=748), Malaria 1,600 1,400 (n=400), ALRI <5 years (n=156), B. 1,200 Diarrhea (n=136), CL (n=127), Typhoid 1,000 (n=91), SARI (n=52), S. Cholera (26), 800 748 and Measles (n=24) remained at 600

maximum. Number of Cases 400 400 156 200 136 127 91 52 26 24  District Kech reported maximum cases 0 for ILI, AD (Non-Cholera), Malaria, and ALRI <5 years

 District Killa Abdullah reported maximum cases for ILI, AD (Non-

Cholera), and CL Table 3: District wise distribution of most frequently reported cases during week 22, Baluchistan

 District Lasbella reported maximum Diseases Kech (Turbat) Killa Abdullah Lasbella Pishin Total cases for Malaria followed by SARI, and ALRI <5 years. ILI 287 288 2 180 803 1560

AD (Non- 121 239 30 101 257 748  District Pishin reported more cases for Cholera) ILI, AD (Non-Cholera), and B. Diarrhea Malaria 87 33 247 21 12 400

 District Quetta reported maximum ALRI < 5 years 90 0 42 24 0 156 cases for ILI followed by AD (Non- B. Diarrhea 23 0 4 78 31 136 Cholera). CL 0 80 12 8 27 127  In week22, increase trend observed Typhoid 0 7 9 47 28 91 for ILI, AD (Non-Cholera) and Malaria SARI 1 2 49 0 0 52  Cases of Leprosy, NNT, and Pertusis S. Cholera 0 0 8 16 2 26 need immediate verification, epidemiological investigation and Measles 0 11 0 5 8 24 response actions. Pertussis 0 0 4 9 0 13

NNT 0 0 2 5 0 7 Leprosy 4 0 0 0 0 4

Figure 5: Week wise reported cases of AD (Non-Cholera), ILI, Malaria, Baluchistan

1800 ILI AD (Non Cholera) Malaria 1600

1400

1200 1000

800

Number of Cases 600 400

200

0 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22

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Khyber Pakhtunkhwa Figure 6: Most frequently reported cases during week 22, in comparison with pervious weeks, KP

1000  KP reported the maximum AD (Non W20 W21 W22 Cholera) (n=393), ILI (n=383), SARI 900 (n=342), Malaria (n=315), Typhoid 800 (n=96), ALRI <5years (n=57), B. 700 Diarrhea (n=46), S. Cholera (n=19), CL 600 (n=10) and Meningitis (n=06). 500 393 383 400 342 315

 District remained the most Number of Cases 300 affected district and reported 200 96 maximum cases of all diseases except 100 57 46 19 10 6 Measles which remained same. 0 AD (Non ILI SARI Malaria Typhoid ALRI < 5 B. Cholera CL Meningitis  Cholera) years Diarrhea District Haripur reported 96 cases of SARI this week. Table 4: District wise distribution of most frequently reported cases during week 22, KP  Weekly cases of AD (Non Cholera), ILI, SARI decreased in comparison with the previous week. Diseases Haripur Kohat Total

AD (Non-Cholera) 0 393 393  Cases of Meningitis need immediate verification, epidemiological ILI 0 383 383 investigation and response actions SARI 96 246 342

Malaria 0 315 315

Typhoid 0 96 96

ALRI < 5 years 0 57 57

B. Diarrhea 0 46 46

Cholera 0 19 19

CL 0 10 10 Meningitis 0 6 6

Measles 2 2 4

Figure 7: Week wise reported cases of SARI, AD(Non-Cholera), ILI & Malaria, KP

1600 AD (Non Cholera) ILI SARI

1400

1200

1000

800

600 Number of Csses 400

200

0 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22

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Islamabad (ICT) Figure 8: Most frequently reported cases during week 22, in comparison with pervious weeks, ICT

 Form ICT, most frequent diseases were 120 W20 W21 W22 ARI (69) followed by AWD <5 years 100 (n=50), ILI (n= 50), and AWD >5 years (n=47) 80 69  In WK22 decrease in trend observed 60 for ARI, and AWD (both <5 & >5 years 50 47 50

40 Number of Cases 20

0 ARI AWD < 5years AWD > 5years ILI

Figure 9: Week wise reported cases of ARI and AWD, ICT

700 ARI AWD < 5years AWD > 5years 600 500

400

300 Number of Cases 200

100

0 Baltistan W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22

Figure 10: Most frequently reported cases during week 22, in comparison with pervious weeks, GB  From Gilgit Baltistan, maximum cases 40 reported were ALRI<5 years, Typhoid, W20 W21 W22 ILI, AD (Susp. Cholera and Non 35 Cholera). 30 26 24 25 22  Weekly cases of Typhoid, ALRI<5 years 20 and Typhoid increased in this week in

comparison with the previous week 15 Number Number of Cases (WK 21) 10 7

5

0 ALRI < 5 years Typhoid ILI AD (Non-Cholera)

Figure 11: Week wise reported cases of ILI, ALRI<5 years and Typhoid, GB

90 ALRI < 5years Typhoid ILI 80 70

60

50 40

30 Number Number of Cases 20

10

0 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22

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Figure 12: Most frequently reported cases during week 22, in comparison with pervious weeks, AJK

Azad Jammu & Kashmir 60 W20 W21 W22 50  In AJK, ARI, AWD< 5 years, and AWD 50 46 >5 years remained at maximum. 40  Overall weekly cases of AWD < 5 and AWD >5 years increased in comparison 30 with the previous week (WK 21) 20 Number of Cases 11 10

0 ARI AWD > 5years AWD < 5years

Figure 13: Week wise reported cases of ARI and AWD (Non Cholera), AJK

120 ARI AWD > 5 years 100

80

60

Number of Cases 40

20

0 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10W11W12W13W14W15W16W17W18W19W20W21W22

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Table 5: IDSR reporting districts

Total Number of Total Number of Sites Districts Reporting Sites Province that Reported (%) (ARS/Total) IDSR Participating Districts Haripur 70/70 70 (100%) Kohat 59/59 59 (100%)  100% health facilities from Haripur, Kohat, Ghotki & Azad Jammu Kashmir Mirpur 37/37 29 (78%) Tharparkar reported data. Islamabad Capital Territory Islamabad 23/32 11(48%) 24/24 0 (0%)  Districts Gwadar, NosheroFeroz Kech 34/78 20 (59%) & Tharparkar did not report data this week. Killa Abdullah 18/50 17 (94%) Balochistan Lasbella 82/82 81 (99%) Quetta 20/77 18 (90%)

Pishin 23/118 15 (65%) Hunza 30/30 14 (47%) Gilgit Nagar 22/22 7 (32%)

Hyderabad 63/63 57 (90%)

Karachi-East 14/14 10 (71%) Sindh Karachi-Malir 43/43 35 (81%)

Ghotki 94/94 94 (100%)

Umerkot 30/118 0 (0%) NosheroFeroz 50/50 0 (0%) Tharparkar 20/236 20 (100%)

Shikarpur 21/21 9 (43%) *percentage ={Sites Reported data/Agreed Reporting Sites (ARS)}*100

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