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 11, Wednesday 21 March 2012

Highlights Priority diseases under surveillance Epidemiological week no. 11 (11 to 17 March 2012) in DEWS

Acute (Upper) Respiratory Infection • In week 11, 2012, total 85 districts including 3 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 1,947 health facilities. Data from mobile teams is reported Suspected Diphtheria through sponsoring BHU or RHC. Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea • A total of 689,606 consultations were reported through DEWS of which 23% were acute Other Acute Diarrhoea respiratory infections (ARI); 6% were acute diarrhoea; 4% were suspected malaria; while 4% were Suspected Enteric/Typhoid Fever Skin disease. Suspected Malaria Suspected Meningitis Suspected Dengue fever • A total of 204 alerts with 30 outbreaks were reported/identified in week 11, 2012: Alto‐ Suspected Viral Hemorrhagic Fever gether 89 alerts for Measles; 22 for Typhoid; 21 for Leishmaniasis; 17 for ARI; 10 for NNT and Pyrexia of Unknown Origin tetanus; 9 Pertussis; 7 for Scabies; 6 for AWD; 5 for AD; 4 for DF; 3 each for AJS, BD and Malaria; Suspected Measles Suspected Acute Viral Hepatitis 2 each for Diphtheria and Unexplained fever; while 1 for Rabies. Chronic Viral Hepatitis

Neonatal Tetanus • As of 15 March 2012, the total number of polio cases confirmed by the laboratory is 14 Acute Flaccid Paralysis from 10 districts/towns/tribal agencies and areas. Scabies Cutaneous Leishmaniasis Others

Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐11, 2012.

50 AD BD ARI S. Malaria 45

25 Percentage 20

0 1 3 5 7 9 1 3 5 7 9

11 11 13 15 17 19 21 23 25 27 29 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

Table 1: Most common communicable diseases syndromes reported weekly

Disease Wk-4 Wk-5 Wk-6 Wk-7 Wk-8 Wk-9 Wk-10 Wk-11

Acute respiratory infection 137,322 (26%) 114,319 (26%) 138,507 (25%) 159,074 (26%) 153,068 (24%) 157,723 (23%) 154,851 (23%) 155,629 (23%)

Skin diseases 25,639 (5%) 22,020 (5%) 26,786 (5%) 29,199 (5%) 28,807 (4%) 29,411 (4%) 30,904 (4%) 30,460 (4%)

Acute diarrhoea 28,461 (5%) 23,902 (5%) 28,969 (5%) 30,607 (5%) 31,598 (5%) 34,878 (5%) 38,383 (6%) 39,511 (6%)

Bloody diarrhoea 2,665 (0.50%) 2,195 (0.50%) 2,676 (0.49%) 2,730 (0.45%) 2,765 (0.43%) 3,094 (0.46%) 2,874 (0.42%) 3,593 (0.52%)

Suspected malaria 19,817 (4%) 15,582 (4%) 21,752 (4%) 22,883 (4%) 23,483 (4%) 28,265 (4%) 29,610 (4%) 29,779 (4%)

Total consultation 534,412 439,260 547,889 605,633 650,286 679,975 687,708 689,606

• The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as proportional morbidity (percentage of cases out of total consultations) reported to DEWS on weekly basis.

• The above table provides the total consultations for each of the last 8 weeks proportional morbidity of five disease syn‐ drome. Proportional morbidity of ARI is highest in Sindh, KP and FATA while acute diarrhoea is highest in Balochistan and Sindh (please see the graphs for every province in page 5 and 6).

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. 11 (11 to 17 March 2012) previous week's (10/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Outbreak for Leishmaniasis identified at Khaliqabad and adjacent area. Registration found total 75 patients with lesions from one week to one year. DHO and ADHO CDC were in‐ 7‐Mar Leishmaniasis AJK Mirpur Village Khaliqabad 3 7 20 45 formed. Health education sessions held at schools. Healthcare providers trained on treatment guidelines. Alert for AWD, 16 cases were reported and investigated at DHQ hospital Dhadar. During field 5‐Mar AWD Balochistan Bolan Village Brahim bani 4 4 2 6 investigation along with district health team found no more suspected cases. 1 stool swab and 4 water samples were collected and sent to NIH. Aqua‐tabs distributed in the community. Alert for suspected Leishmaniasis, 6 cases were reported from two different locations. Pa‐ tients have no traveling history. Lesions were mostly on legs. No any other case was found Village Winder & Uthal, 6‐Mar Leishmaniasis Balochistan Lasbela 1 4 0 1 during active search. Patients were advised to take proper and regular treatment. Health and Tehsil Uthal hygiene session was conducted with patient family member and community. DHO informed and requested to conduct household spraying. Village Ahmed khan 6 cases of AWD were reported from hospital, active surveillance conducted and 2 stool and 4 Tando Allah 9‐Mar AWD Sindh lashari, UC Pak Singhar 0 2 0 4 water samples taken, hand pump was the source of suspect, Aqua tabs, Zinc tabs and ORS Yar taluka Tando Allahyar distributed in the community, EDOH informed. Alert for 14 cases of Measles, during active surveillance Vitamin (A) given to children, none Village Adam Mallah UC had been vaccinated for measles. Health education imparted regarding routine immuniza‐ 7‐Mar Measles Sindh Thatta Mugal Bin taluka jati 6 2 6 0 district thatta tion, EDOH informed and requested for mop‐up; 8 Blood samples were collected and sent to NIH. 42 probable Pertussis cases were investigated in 2 different locations. During active surveil‐ Village Khuda Buksh lance 57 contact children found in community out of them only 4 were having BCG Scar. 7‐Mar Pertussis Sindh Ghotki Mangrio; Village Abdul 13 6 15 8 Ghani Bozdar Health education given; Erythromycin given to cases and contacts. 3 throat swabs were taken and sent to NIH. DHO and DSV were informed. Probable Pertussis case was reported and investigated in Shah Bhitai hospital. During active GOR Colony, Latifabad # surveillance cluster of 10 houses was taken and found 11 children, out off them 2 were unvac‐ 7‐Mar Pertussis Sindh Hyderabad 1 3 1 1 01 cinated, health education regarding proper hygiene and importance of immunization was imparted, Erythromycin was given and 2 throat swabs were taken and sent to NIH. Probable Pertussis case investigated, during active surveillance in the village, cluster of houses Village Chak # 23, UC was checked and found 22 children none of them were vaccinated, Erythromycin given to the 7‐Mar Pertussis Sindh Sanghar 0 9 3 6 Gujri taluka Sanghar cases, health education was imparted regarding importance of vaccination, EDOH informed and requested for mop‐up the area and 1 throat swab collected and sent to NIH. Two Probable Pertussis cases were reported from DHQ Sujawal. Active surveillance conducted Village Khameeso Khan and found 13 more cases, majority of the children received Anti biotic medicine, four throat 8‐Mar Pertussis Sindh Thatta Pathan UC Ali Bahar 2 3 8 2 Sujawal samples were taken, health education imparted, routine immunization of the area was checked and found <70%, Erythromycin syrup given to cases; EDOH informed. Alert for Typhoid, 1 suspected case admitted in THQ hospital, during active search 5 more Village Sajaee, UC Sob‐ suspected Typhoid cases were found, out of them 1 was Widal positive; Health education 7‐Mar Typhoid Sindh Tharparkar 0 4 1 1 hiar, Taluka Diplo imparted, rain water was the source of suspect; Aqua tabs distributed in the community; while 3 water samples collected and sent to NIH. Current week's (11/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 14 cases of Cutaneous Leishmaniasis were reported. No other case was found during active search. Injection Glucantime provided to health facility incharge and advised to give proper treatment and if new case will vill Mora,Bagla UC Chirala 13‐Mar Leishmaniasis AJK Bagh 1 4 0 9 report then inform. The outbreak was discussed with DHO and requested to distribute bed nets and conduct Tehsil Dhirkot household spraying. Health education session was conducted with the community for their personal protec‐ tion from sand fly as well as screening of doors and windows.

8 cases of Cutaneous Leishmaniasis was reported. HCPs were requested to report any new case of cutaneous Sheikh Zaid hosp Rawala‐ Leishmaniasis report to HF.DOH as well as CDC department were informed. Health education session was 16‐Mar Leishmaniasis AJK Poonch 1 0 1 4 kot conducted with the patients for their personal protection from sand fly as well as screening of doors and windows.

7 cases of Cutaneous Leishmaniasis were reported. Patients were investigated and mostly lesions found on 14‐Mar Leishmaniasis Balochistan Killa Saifullah Village Urgas 0 0 0 7 nose, arms and legs. No travel history. Treatment as per WHO protocol was given. Information shared with DHMT.

Village Notani, UC 5 cases of C Leishmaniasis were investigated and reponded. Cases were presented with typical lesions. Lab 13‐Mar Leishmaniasis Balochistan Khuzdar 0 2 1 2 Baghbana ,Tehsil Khuzdar results came out positive. Injection Glucantime was provided with health and hygiene education. 4 cases of Cutaneous Leishmaniasis were reported from DHQ Hospital. No traveling history found. Injection DHQ Hospital, Village & 12‐Mar Leishmaniasis Balochistan Jhal Magsi 1 1 2 0 Glucantime was advised and provided to DHQ Hospital and guided the patient for completing treatment. UC Gandawah Information was shared with DHMT for further action. Alert was declared through slide positivity rate. Total 11 slides were tested and 8 were positive Village UC & Tehsil 12‐Mar Malaria Balochistan Harnai 0 0 0 0 for P. Falciparum, FPR was 73%. Matter was discussed with the Merlin focal person and DHO Shahrig Harnai. Patients are under treatment. Health education imparted.

Alert was received in weekly DEWS data. Alert was declared through slide positivity rate. Total Village Shahrig, UC 15 slides were tested and 10 were positive for P.falciperum, FPR is 67%. Matter was discussed 12‐Mar Malaria Balochistan Harnai 0 0 0 0 Shahrig, Tehsil Shahrig with the Merlin focal person and DHO Harnai. Patients are under treatment. Health education imparted and follow up planned.

3 cases of Measles alert received from DDHO Ziarat. On field investigation 9 more cases was Village Chawatra, UC found. 3 Samples were taken. none of the child were vaccinated against measles vaccine. 13‐Mar Measles Balochistan Ziarat 1 0 4 4 Zindra, Tehsil Ziarat Vitamin A was provided to suspected cases and to the exposed. Health education imparted. Information was shared with DHO and EPI Incharge.

3 cases of Suspected Measles were reported from private hosp; cases had been admitted with post measles Village Baloch abad, UC complication (Pneumonia and Diarrhea). The cases had received VitA; 3 blood samples were taken and sent to 16‐Mar Measles Balochistan Kech 2 1 1 1 Turbat NIH. Another two cases were found on field investigation. DHO was also informed and requested for vaccina‐ tion to children in surrounding houses. 2 unimmunized children were vaccinated.

Date Disease Province District Area <5M >5M <5F >5F Action Taken A 4 year old female of suspected diptheria was reported from Khyber teaching hospital. Khyber Throat swab was taken and sent for confirmation. 50,000 IU of ADS were provided. No vacci‐ Village Kalan Bala Bijlee 13‐Mar Diphtheria Pakhtunk‐ Kohistan 0 0 1 0 nation history. Health education session was given on routine vaccination of children and Ghar Tal hwa prevention of spread of the infection. Prophylactic dose of erythromycin was prescribed. DEWS coordinator informed. Alert for Measles reported from 2 different locations. Active Surveillance conducted, hilly area Village Manogay, UC Koto with total population of 150 and 120 houses, 14 more cases were found in the surrounding, Khyber Tehsil Balmabat; Village routine outreach vaccination conducted in the area by EPI Team and vaccinated 274 children 12‐Mar Measles Pakhtunk‐ Lower Dir Hasil Banda, UC Mayar, 3 1 6 6 (BCG– 12, Measlse‐259, Penta‐ 33). Vit‐A was given, Blood Sample Collected for confirmation hwa Tehsil Samar Bagh, Lower of antibodies, Health education session conducted with the family members and community, Dir patient isolated, EDO‐H & EPI Coordinator were informed & requested for regular outreach immunzation in the area and surounding. Alert for 1 case suspected measles by phone call from community elder of Village Khwar Kele. On investigation 07 children were found with clinical measles in the surrounding 10 Khyber houses,blood samples were taken from 2 children and sent to NIH . A total of 18 children till Village Khwar Kele/UC 13‐Mar Measles Pakhtunk‐ Shangla 1 3 3 0 the age of 15yrs were analysed and unimmunized were vaccinated. Outbreak was declared by Lelonai hwa EDOH and EPI teams were sent to the area for outreach vaccination. Vitamin A was given to the affected and EPI based sessions were taken in the community. No other case has been reported since than. During polio campaign in Afghan Refugee camp Padhinna, 4 cases of suspected measles were identified. The clinical sign and symptoms were suggestive of measles. Suspected cases were given Vit A. When investigated; it was found that these 4 cases were epidemiologically linked Khyber Afghan Refugee camo to outbreak of measles reported in previous week. Vaccination status of other children was 12‐Mar Measles Pakhtunk‐ Haripur 1 0 0 3 Padhinna hwa also checked. Measles mop up campaign is already planned for current week which will in‐ clude children between 6 months and 13 years. Microplans are being made by Save the chil‐ dren. Blood samples were taken and sent to NIH. EDO Health and Save the children were also informed. 9 cases of typhoid fever were reported from THQ Hospital. All cases advised Widal test which came out ‐ve for 8 patients and +ve for one patient. Medication provided to all the patients. 6 THQ Hospital Mankera, patients were from different locations (widal ‐ve) and 3 patients were from same location 13‐Mar Typhoid Punjab Bhakkar UC Mankera, Tehsil 0 6 0 3 (widal +ve for 1 patient). There was epidemiological linkage established in 3 cases. Case Mankera. definitions was discussed in detail with MO. HE imparted at the Health facility. LHW's were mobilized to conduct HE session in community. Aqua tabs, jerry cans and life straws were distributed. EHE took the water sample of area. EDO(H) was informed.

Alert was received for 6 cases typhoid from eDEWS data for week‐10. All cases were diag‐ nosed on clinical signs and symptoms and advised Widal test where 3 cases were confirmed. Except two cases from Tibbi Bhookan, UC Lutkeran, all were residents of different places. All Basti Tibbi Bhookan, cases were treated as OPD patients and treatment was advised. EH & EM availability assess‐ 13‐Mar Typhoid Punjab Muzaffargarh Moza Rakh Khanpur, UC 1 3 0 2 ment was done at DHQ & BHU Dasti Wala. Confirmed case's residence was visited ; patient Lutkeran was found quite improved & afebrile. HE Session was conducted for community . Water sampling was also done. Possible source of infection was consumption of raw cut fruits or ice cream from street vendors. MO agreed to mobilize LHW's to conduct HE session in commu‐ nity. Aqua tabs, jerry cans and water filters were distributed. Alert for AJS from RHC Rahimabad, team was comprised as SO DEWS, MS RHC, vaccinator. During investigation 07 cases were found & line listed. All cases were referred by MS RHC for Village rahiomabad UC laborotary investigation to DHQ lab, IEC material distributed & health promotion session was 13‐Mar AJS Sindh Shikarpur Rahim abad Taluka 0 5 0 2 Khanpur conducted. community was sensitized on personal hygiene & safe drinking water. immuniza‐ tion provided to 2 children< 1 year , 7 children < 2 years & 11 Children >2 years, Report shared with EDH Office.

Village Baboo Makrani; Alerts for two suspected measles cases from 2 different locations, during active surveillance Village Haji Khan Sahib found 20 more cases, Vitamin (A) was given, cluster of houses was checked and found 25 13‐Mar Measles Sindh Thatta 4 2 5 1 Muhammad Ali Nahio UC childrens where immunization status was 60%, health and Hygiene education was imparted, Domani EDOH informed and 7 Blood samples collected.

Alert for suspected measles from NICH, during active surveilliance found 4 more cases, Vita‐ Maripur Grax Kimari min A was given, immunization status was checked and found (Meas 1 52% and Meas 2 48%), 14‐Mar Measles Sindh Karachi 2 0 2 1 Town health education was imparted regarding isolation and vaccination, THMT informed and requested to send outreach team to the area and 1 Blood sample collected.

Village Lal Shah UC Mithri 89 cases of suspected Pertussis were investigated in 2 different locations. Samples were not Taluka Khan Garh; Village taken as cases have already taken antibiotics. Erythromycin privided to all suspected cases 13‐Mar Pertussis Sindh Ghotki 17 26 21 25 Drago Chachar, UC and close contacts. 78 children were checked for routine immunization and no one was im‐ Adilpur taluka Ghotki munized. Health education imparted and EDOH & DSV informed.

Village Hoat Khan Chan‐ Suspected case for Pertussis was informed by Community, active surveilliance was done and Qambar 12‐Mar Pertussis Sindh dio , UC kalar , Taulka 7 6 5 4 found 21 more cases, Erythromicine was given, DHMT informed and request for immuniza‐ Shahdadkot Kambar tion.

5 cases of suspected Pertussis were investigated. 2 throat samples were taken. on active Loco Sheed Khanpur, UC surveillance,3 children were vaccinated againt DPT whereas 90% children were vaccinated for 13‐Mar Pertussis Sindh Jamshoro 2 1 1 1 HM Shoro, taluka Kotri BCG and 60 % for Measles. Erythromicine, Priton and Calpol was provided. Health education was imparted and EDOH informed.

Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

As of 15 March 2012, the total number of polio cases confirmed by the labo‐ ratory is 14 from 10 districts/towns/tribal agencies and areas.

Cases 2011 Cases 2012 Province P1 P3 P1 P1+P3 Punjab 9 ‐ 1 ‐ ‐ Sindh 33 ‐ 2 ‐ ‐ Khyber Pakhtunkhwa 23 ‐ 4 ‐ ‐ FATA 57 2 3 1 1 Balochistan 73 ‐ 2 ‐ ‐ AJ&K ‐ ‐ ‐ ‐ ‐ Gilgit‐Baltistan 1 ‐ ‐ ‐ ‐ Islamabad ‐ ‐ ‐ ‐ ‐ Total 196 2 12 1 1

Number o alerts by province, week 11, 2012 Province Khyber Pakhtunkhwa Province Balochistan Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Killi Goargage Girdi Jungle Refugee 13‐Mar AWD Kohat Union Council Dhoda 0 0 1 0 14‐Mar AJS Chagai 0 2 0 1 camp 15‐Mar BD Kohat Union Council Usterzai 1 2 0 3 15‐Mar ARI Bolan BHU Jalbani 12 7 13 4 16‐Mar Diphtheria Hangu Village Togh, UC Togh Saray 0 0 0 0 13‐Mar Diphtheria Kohistan Village Kalan Bala Bijlee Ghar Tal 0 0 1 0 15‐Mar ARI Bolan BHU Mashkaf 16 11 21 9 14‐Mar Leishmaniasis Haripur Ghazi city, UC and Tehsil Ghazi 0 1 0 0 12‐Mar ARI Harnai Village Belli, UC Spintangi, Tehsil Sinjavi 2 3 1 2 15‐Mar Leishmaniasis Haripur Gudwalian, UC Bakka 0 1 0 0 Village Spintangi, UC Spintangi, Tehsil 12‐Mar ARI Harnai 2 2 0 1 16‐Mar Leishmaniasis Nowshera Mohallah: Kasai, Zando Banda 0 1 0 0 Sinjavi 16‐Mar Leishmaniasis Tank Ranwal 0 0 0 1 12‐Mar ARI Ziarat Village Cheena, UC Zindra, Tehsil Ziarat 3 1 2 2 13‐Mar Malaria Nowshera Phase 3, Sector K, Block 12 Jalozai 0 0 0 1 Village Paichi Karez, UC Zindra, Tehsil 12‐Mar ARI Ziarat 3 2 1 1 14‐Mar Measles Bannu Village Baka Khel 1 0 0 0 Ziarat Goth Din Mohammad Masthoi,Tehsil 14‐Mar Leishmaniasis Jaffarabad 0 1 0 0 14‐Mar Measles Bannu Village Sra Darga 1 0 3 0 Usta Mohammad. 13‐Mar Measles Battagram Village Chalonain, UC Rajdhari 1 0 0 0 12‐Mar Leishmaniasis Jhal Magsi DHQ Hospital, Village & UC Gandawah 1 1 2 0 13‐Mar Measles Buner village agarai tehsil mandan 1 0 0 0 DHQ Hospital, UC Saddar Kalat, Tehsil 14‐Mar Leishmaniasis Kalat 0 1 0 0 13‐Mar Measles Buner village maradoo tehsil chagharzai 1 0 0 0 Kalat 15‐Mar Measles Charsadda Prang 1 0 0 0 16‐Mar Leishmaniasis Kech Village Zargapd, UC Koshkalat 0 1 0 0 13‐Mar Measles D. I. Khan Gypsies Tents, Kotla Saidan 1 0 0 0 Village Notani, UC Baghbana ,Tehsil 13‐Mar Leishmaniasis Khuzdar 0 2 1 2 13‐Mar Measles D. I. Khan Jameel Town, Qureshi Morr 0 0 1 0 Khuzdar 13‐Mar Measles D. I. Khan Mangal Village, Darazinda 1 0 0 0 12‐Mar Leishmaniasis Killa Saifullah Villane & UC Muslim Bagh 0 1 0 0

13‐Mar Measles D. I. Khan Wacha Khora, Wana, SWA 0 0 1 0 14‐Mar Leishmaniasis Killa Saifullah Muslim Bagh 0 1 0 1 16‐Mar Measles D. I. Khan Noble Town, Eid Gah Road 0 0 0 7 14‐Mar Leishmaniasis Killa Saifullah Village Urgas 0 0 0 7 16‐Mar Measles D. I. Khan Village Fateh 1 0 0 0 16‐Mar Measles D. I. Khan Village Kala Gorh, Rang Pur 1 0 0 0 13‐Mar Leishmaniasis Nasirabad Ghot Juma khan Umrani, UC Manjhoti 1 0 0 0 Abro Mahla, Town area, Tehsil Dera 12‐Mar Measles Haripur Afghan Refugee camo Padhinna 1 0 0 3 16‐Mar Leishmaniasis Nasirabad 0 0 0 2 Murad Jamali 12‐Mar Measles Lower Dir Village Darmal Payeen, UC Lajbook 1 0 0 0 13‐Mar Leishmaniasis Sibi Town area, Tehsil Sibi 1 2 0 1 12‐Mar Measles Lower Dir Village Manogay, UC Koto 2 0 2 5 Village Shahrig, UC Shahrig, Tehsil 13‐Mar Measles Lower Dir Village Dandona Surano 1 0 0 0 12‐Mar Malaria Harnai 0 0 0 0 Shahrig 13‐Mar Measles Lower Dir Tehsil Samar Bagh, Lower Dir 1 0 2 0 12‐Mar Malaria Harnai Village UC & Tehsil Shahrig 0 0 0 0 14‐Mar Measles Lower Dir Village Hasil Banda, UC Mayar 1 1 4 1 14‐Mar Measles Lower Dir Village Kar Kabanj, UC Khagram 1 0 0 0 12‐Mar Measles Chagai Killi Jamak, UCAmuri 1 0 0 1 15‐Mar Measles Lower Dir Village Qazi Abad, UC Koto 2 0 1 1 13‐Mar Measles Gwadar Village Kurmi Dasht, UC Suntsar 0 1 0 2 16‐Mar Measles Lower Dir Village Markhanai, UC Beshigram 1 0 0 0 Village Nushki Jadeed, Tehsil Gan‐ 13‐Mar Measles Jaffarabad 5 0 2 0 12‐Mar Measles Nowshera Phase 1, Sector C, Block 12, Jalozai 1 0 0 0 dakha 13‐Mar Measles Nowshera District Nowshera 0 0 1 0 16‐Mar Measles Kech Village Baloch abad, UC Turbat 2 1 1 1 13‐Mar Measles Nowshera Risalpur 1 0 0 0 13‐Mar Measles Killa Saifullah Village Ghebzai 0 1 0 2 13‐Mar Measles Peshawar Dalazak Road 1 0 0 0 16‐Mar Measles Lasbela Near shah pump, UC Beroot Hub 1 0 0 0 13‐Mar Measles Peshawar Yousaf Khel Kohat Road 0 0 1 0 Village Chawatra, UC Zindra, Tehsil 13‐Mar Measles Ziarat 1 0 4 4 13‐Mar Measles Shangla Village Khwar Kele/UC Lelonai 1 3 3 0 Ziarat 15‐Mar Measles Swat Village Chamtalai, UC Janu 0 1 0 0 Killi Zahoor Colony, UC Sadder Dal‐ 15‐Mar Pertussis Chagai 1 1 1 0 15‐Mar Measles Swat Village Chinkolai, UC Mashkumai 0 0 0 1 bandin 16‐Mar Measles Swat Village Maloch, UC Hazara, Tehsil Kabal 0 1 0 0 15‐Mar Rabies Chagai Killi Station, UC Taftan 1 8 0 5 15‐Mar Measles Upper Dir Village Baradog, UC Dogdara 1 0 0 0 14‐Mar Typhoid Bolan Civil Hospital Mach 0 2 0 1 15‐Mar Measles Upper Dir Village Shaw, UC Dir Urban 1 0 0 0 13‐Mar Typhoid Chagai Killi Baz Mohammad, UC Sadder 0 2 0 2 14‐Mar NNT Karak Village Lwargee banda , UC Jandri 1 0 0 0 13‐Mar Typhoid Sibi DHQ Hospital Sibi 0 3 1 1 16‐Mar NNT Lakki Marwat Mohallah Sayed Khel 1 0 0 0 16‐Mar NNT Lakki Marwat Village ozhaiki 1 0 0 0 13‐Mar Typhoid Sibi RHC Lehri 0 3 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; E-mail: [email protected]. 04 Special Bulletin: DEWS, Pakistan, Week no. 11 (11 to 17 March 2012) Province Sindh Province Punjab Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F BHU Kotla Jam, UC Daggar Aulakh, Tehsil 13‐Mar AJS Shikarpur Village rahiomabad UC Rahim abad 0 5 0 2 12‐Mar AD Bhakkar 13 6 9 2 Bhakkar. 13‐Mar AWD Jamshoro UC Sonowallar 1 0 1 1 1 16‐Mar AD Mianwali BHU Mari Indus 21 6 23 4 12‐Mar AWD Tando Allah Yar Mujahid Colony city Tando Allahyar 0 0 0 1 Rahim Yar 12‐Mar AD Ahmedpur Lamma, Tehsil Sadiqabad 9 14 11 16 Khan 13‐Mar AWD Tando Allah Yar Madina Colony city Tando Allahyar 0 0 0 1 Rahim Yar 12‐Mar AD Kot Haq Nawaz, tehsil RYKhan 6 7 9 11 14‐Mar AWD Tando Allah Yar Chambar Naka city Tando Allahyar 0 0 0 1 Khan THQ Jampur, UC jampur Urban, Tehsil 15‐Mar AWD Tharparkar Village Hemari taluka Nagarparkar 2 0 0 0 14‐Mar AD Rajanpur 31 102 22 68 jampur 16‐Mar Leishmaniasis Karachi Haji Yaqoob shah Basti 0 0 0 1 13‐Mar AJS Muzaffargarh DHQ, UC City‐2, Tehsil MZG 1 3 1 2 13‐Mar Leishmaniasis Shikarpur Village rahiomabad UC Rahim abad 0 1 0 1 BHU Daggar Noon, UC Malana Daggar, 16‐Mar ARI Bhakkar 14 22 18 11 Tehsil KalurKot. 13‐Mar Measles Dadu New Plot area, city Radhan 1 0 0 0 14‐Mar ARI Layyah BHU 120 TDA, UC Tail Indus, Tehsil Layyah 7 10 6 22 16‐Mar Measles Dadu Lund Muhalla, Chanoshah abad 1 0 0 0 14‐Mar ARI Mianwali BHU Shadia 18 9 21 5 16‐Mar Measles Dadu Near Karam Shah Clinic 1 0 0 0 15‐Mar ARI Mianwali RHC Daudkheel 101 32 81 52 16‐Mar Measles Dadu Shahbaz colony near Azeem hotel 1 0 0 0 16‐Mar ARI Mianwali BHU Mari Indus 45 28 56 37 12‐Mar ARI Multan Khokharan 13 32 4 31 16‐Mar Measles Ghotki Ghota Market near railway Band 0 0 1 0 13‐Mar ARI Multan Buch Khosrobad 1 37 2 30 16‐Mar Measles Ghotki Kolachi Muhalla UC I Ghotki 1 0 0 0 14‐Mar ARI Multan Tateypur, mullan faqir 3 19 5 7 12‐Mar Measles Hyderabad Street # 06 Pathan colony 0 0 1 0 Kamalpur Patni, UC Kamalpur Patni, Tehsil 13‐Mar ARI Muzaffargarh 9 21 6 10 14‐Mar Measles Hyderabad Wahid town, near Ali Palace 0 0 1 0 MZG Rahim Yar 13‐Mar ARI Aminabad, Tehsil Liaqatpur 13 9 11 8 16‐Mar Measles Hyderabad Near Afzal Ground, Unit # 10, Latifabad 0 0 1 0 Khan Rahim Yar 16‐Mar Measles Hyderabad Panhwar Goth, Latifabad 1 0 1 0 13‐Mar ARI Ghouspur, tehsil Khanpur 33 28 36 39 Khan 13‐Mar Measles Jamshoro Sikandar Abad UC H.M Shoro 1 0 0 0 14‐Mar BD Mianwali RHC Kammar Machani 2 0 1 0 16‐Mar Measles Jamshoro Bhatti colony, UC Sonowallar 1 0 0 1 0 15‐Mar BD Mianwali RHC Daudkheel 2 3 1 0 12‐Mar Measles Karachi Manzoor colony, Jamshed town 0 0 1 0 11‐Mar DHF Lahore Wahga Town 0 0 0 1 12‐Mar DHF Lahore Data ganj Baksh town 0 1 0 0 14‐Mar Measles Karachi Gul Badshah building 0 0 1 1 13‐Mar DHF Lahore Ravi Town 0 1 0 3 14‐Mar Measles Karachi Maripur Grax Kimari Town 2 0 2 1 15‐Mar DHF Multan NHM ‐ Ghanta ghar 0 2 0 1 12‐Mar Measles Mirpur Khas Dhak Para near telephone exchange 3 0 0 0 Khoo Sikhani wala Gadai Sharqi near 12‐Mar Leishmaniasis D. G. Khan 0 1 0 0 14‐Mar Measles Mirpur Khas Ahmedani colony, Taluka Mirpurkhas 0 0 1 0 Shanza School Samina Chowk UC Gadai Chak Number 9 TDA, UC Angra, Tehsil 12‐Mar Measles Bhakkar 1 0 0 0 12‐Mar Measles Q Shahdadkot Bhano Khan Chandio, UC Dostlai 1 0 0 0 Darya Khan. sarwar bodla colony Jampur road 13‐Mar Measles Q Shahdadkot Muhammad Siddique Magsi 1 0 0 0 13‐Mar Measles D. G. Khan 0 0 1 0 DGKhan 13‐Mar Measles Q Shahdadkot Tapal Dera, UC Ber 0 0 1 0 near Madrisa Markazalaloom Hero 15‐Mar Measles D. G. Khan 0 2 1 0 13‐Mar Measles Q Shahdadkot Village Meena, UC Rawanti 2 0 0 0 Gharbee UC Hero 14‐Mar Measles Lahore Chah Meeran Lahore 0 1 0 0 16‐Mar Measles Q Shahdadkot Village Gologanwa, UC Deera 0 0 1 0 15‐Mar Measles Lahore Paracha colony Shadhara lahore 0 1 0 0 13‐Mar Measles Sanghar Village Muachora, UC Sarhari 1 0 2 0 Mianwali; Kacha Malli Kheel, Chashma, 12‐Mar Measles Mianwali 0 0 1 0 14‐Mar Measles Sanghar Village Gul Muhammad Thaim 2 0 2 0 Dera Ismail Khan, KPK 16‐Mar Measles Mianwali Noon Dagar,Moulana Dagar 1 0 0 0 16‐Mar Measles Shikarpur Village Khahi UC kabalo 0 0 1 2 13‐Mar Measles Multan Muzafargarh 0 0 0 1 13‐Mar Measles Sukkur Lala mension mochi bazar 0 0 0 1 Basti Nawan Naseera, Moza Deenpur, UC 16‐Mar Measles Muzaffargarh 0 1 0 0 15‐Mar Measles Sukkur Shah Faisal colony 1 0 0 0 Jaggatpur, Tehsil MZG Rahim Yar 16‐Mar Measles Tharparkar Pasayo Paro, UC Sobhyar 2 2 0 0 14‐Mar Measles Ajmal Town, Sadiqabad 0 0 1 0 Khan 13‐Mar Measles Thatta Village Baboo Makrani 4 2 5 1 Rahim Yar Basti Qutabdin, Taj Garh, UC kot mehdi 14‐Mar Measles 0 1 0 0 Khan Shah, Tehsil RYKhan 14‐Mar Measles Thatta Village Arbab Sultan Bukero 0 1 1 1 Rahim Yar 16‐Mar Measles Chak 56/P, UC 105P 0 1 0 0 14‐Mar Measles Thatta Village Gul Bukero, UC Mirpur Saliro 1 1 0 0 Khan Rahim Yar Nawankot Road, Riaz Colony, UC 73 E, 16‐Mar Measles Thatta Village Muhammad Ali Nahio 4 1 3 2 16‐Mar Measles 0 0 1 0 Khan Khanpur 13‐Mar NNT Badin taluka Talhar 0 0 0 0 14‐Mar NNT Lahore Barki Road Lahore 1 0 0 0 14‐Mar NNT Dadu Village Mureed Dero 1 0 0 0 Basti Raseed Wali, Moza & UC Pattal 14‐Mar NNT Muzaffargarh 0 0 1 0 Kotaddu, Tehsil Kotaddu 14‐Mar Pertussis Dadu Village Chor UC Chor taluka K.N Shah 2 1 1 0 near masjid Lashari Mohalla Jataa urban 15‐Mar Pertussis D. G. Khan 1 0 0 0 15‐Mar Pertussis Dadu Village Hamzo Khan Khushk 1 0 2 1 Taunsa 12‐Mar Pertussis Ghotki Village Drago Chachar 0 11 4 9 14‐Mar Scabies Layyah BHU 120 TDA, UC Tail Indus, Tehsil Layyah 6 21 7 31 Rahim Yar 12‐Mar Scabies Mianwali Qureshian, tehsil RYKhan 12 29 9 26 13‐Mar Pertussis Ghotki Village Lal Shah UC Mithri 17 15 17 16 Khan 12‐Mar Pertussis Jamshoro Maskeen Colony Sonowaller 2 1 2 0 1 12‐Mar Tetanus Lahore Mansoora Lahore 0 1 0 0 THQ Hospital Mankera, UC Mankera, 13‐Mar Pertussis Jamshoro Loco Sheed Khanpur 2 1 1 1 13‐Mar Typhoid Bhakkar 0 6 0 3 Tehsil Mankera. 12‐Mar Pertussis Q Shahdadkot Village Hoat Khan Chandio 7 6 5 4 RHC DulleWala, UC Jhamamt Shumali, 14‐Mar Typhoid Bhakkar 0 1 0 1 12‐Mar Scabies Badin Village Lakha dino thebo 4 9 4 11 Tehsil Darya Khan. BHU Daggar Kotli, UC Patti Bilanda, Tehsil 15‐Mar Typhoid Bhakkar 1 1 1 1 13‐Mar Scabies Umer Kot Baloch Para, UC Nabisar taluka Kunri 2 3 2 2 Mankera . 13‐Mar Scabies Umer Kot Magwar para, Rahimor, Nabisar 0 5 0 3 12‐Mar Typhoid Layyah BHU Laskani wala, UC Basira, Tehsil Karor. 0 2 0 4 14‐Mar Scabies Umer Kot Village Talib ja Hari, UC Araro burguri 2 3 1 4 14‐Mar Typhoid Mianwali RHC Kammar Machani 4 9 5 3 15‐Mar Typhoid Mianwali RHC Daudkheel 3 8 1 5 15‐Mar Scabies Umer Kot Village Chiroli, UC Dhoro Naro 2 4 0 5 15‐Mar Typhoid Multan Muhammad pur, qadir pur lar 0 2 0 0 12‐Mar Typhoid Hyderabad North Amil colony 0 1 0 0 Basti Tibbi Bhookan, Moza Rakh Khanpur, 13‐Mar Typhoid Muzaffargarh 1 3 0 2 16‐Mar Typhoid Larkana Allah Abad Muhalla 2 1 0 0 UC Lutkeran Mandi Moweshi, UC Kotaddu City‐2, 13‐Mar Typhoid Muzaffargarh 1 1 0 1 16‐Mar Typhoid Larkana Hyderi Muhalla 1 1 0 0 Tehsil Kotaddu 12‐Mar Typhoid Mirpur Khas Hameed Pura colony # 02 1 0 2 0 13‐Mar Typhoid Rajanpur DHQ Rajanpur, UC Rajanpur Fharbi 1 11 0 5 13‐Mar Typhoid Umer Kot UC Nabisar taluka Kunri 0 2 0 1 13‐Mar Typhoid Rajanpur RHC Fazilpur, UC Fazilpur, Tehsil Rajanpur 0 5 0 2 12‐Mar UXF Layyah DHQ Layyah, UC Urban2, Tehsil Layyah. 0 18 0 14 13‐Mar Typhoid Umer Kot Magwar Para, Rahmore 0 2 0 1 THQ Kot Sultan, UC Kot Sultan, Tehsil 13‐Mar UXF Layyah 0 26 0 16 13‐Mar Typhoid Umer Kot Magwar Para, UC Nabisar, taluka Kunri 0 1 0 2 Layyah. 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 Special Bulletin: DEWS, Pakistan, Week no. 11 (11 to 17 March 2012) Table‐1: Leading causes of seeking health care in districts, Wk‐31, 2010 to Figure‐2: Number of consultations by age and gender, week 11, 2012 Wk 11, 2012, compiled from weekly reports Number of Diseases 200000 Consultations 180000 Acute respiratory infection 14,613,423 (23%) 160000 140000 Skin diseases 6,289,516 (10%) 120000 100000 Acute diarrhoea 5,647,911 (9%) 80000 consultations

of 60000 Bloody diarrhoea 497,000 (<1%) # 40000 Suspected malaria 3,806,068 (6%) 20000 0 < 1 yr 1‐4 yr 5‐14 yr 15‐50 yr 50 + yr Unexplained fever 2,384,249 (4%) Male 23978 54511 70534 107714 51765 Female 23597 50023 74036 175249 58199 Total consultations 63,479,068 Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response 2010 2011 2012 (up till week 11) Total Disease A O A O A O A O Acute watery diarrhoea 209 85 1350 543 71 2 1630 630 Acute jaundice syndrome 5 2 51 17 33 2 89 21 Bloody diarrhoea 10 1 98 20 30 3 138 24 Dengue fever 81 32 785 111 17 1 883 144 Measles 48 6 1710 91 759 21 2517 118 Pertussis 1 0 287 81 154 51 442 132 NNT + tetanus 5 0 399 0 168 0 572 0 Malaria 12 7 131 88 18 7 161 102 Leishmaniasis 1 0 298 33 218 23 517 56 Others 75 11 643 69 312 41 1030 121 Total 447 144 5752 1053 1780 151 7979 1348 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • 482 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS on weekly basis with 50 AD BD ARI S. Malaria a total of 122,122 patients consultations in week 11, 45 2012. 40 35 • 45 alerts were reported in week 11; Altogether 33 for 30 25

Measles; 4 for Leishmaniasis; 3 for NNT; 2 for Diph- Percentage theria; while 1 each for AWD, BD and Malaria. 20 15 • 5 outbreaks, 4 for Measles; while 1 for Diphtheria were 10 identified and appropriate measure were taken. 5 0 1 3 5 7 9 1 3 5 7 9

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

wk wk wk wk wk wk wk wk 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 • 435 health facilities from 23 districts in Sindh reported on weekly basis to DEWS with a total of 258,825 patient 50 AD BD ARI S. Malaria consultations in week 11, 2012. 45 40 • 61 alerts were reported; Altogether 32 for Measles; 7 35 each for Pertussis and Typhoid; 5 each for AWD and 30 25 Scabies; 2 each for Leishmaniasis and NNT; while 1 for Percentage 20 AJS. 15 10 • 8 outbreaks, 4 for Pertussis; 3 for Measles; while 1 for 5 AJS were identified and appropriate measures were 0 1 3 5 7 9 1 3 5 7 9

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

taken. wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk

5 • 7 outbreaks for Typhoid were identified and appropri- 0 1 3 5 7 9 1 3 5 7 9

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

ate measures were taken. wk wk wk wk wk wk wk wk 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 • 415 health facilities from 18 districts in Balochistan reported to DEWS, with a total of 66,782 patient con- 50 AD BD ARI S. Malaria sultations. 45

40 • 33 alerts were reported in week 11 from Balochistan; 35 Altogether 11 for Leishmaniasis; 7 for Measles; 6 for 30 ARI; 4 for Typhoid; 2 for Malaria, while 1 each for AJS, 25 Percentage Pertussis and Rabies. 20

15 • 8 outbreaks, 3 each for Leishmaniasis and Measles; 10 while 2 for Malaria were identified and appropriate 5 measures were taken. 0 1 3 5 7 9 1 3 5 7 9

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

wk wk wk wk wk wk wk wk 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

50 AD BD ARI S. Malaria • 34 health facilities from 4 districts in Gilgit Baltistan 45 reported to DEWS in week 11, with a total of 14,959 40 patient consultations. 35 30 • No alert was received for any disease from any area in 25 20

Gilgit Baltistan. Percentage 15 10 5 0 9 8 7 6 5 4 3 2 1

10 11 48 49 50 51 52 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

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

• 144 health facilities from 10 districts reported to DEWS in this • 46 health facilities from 3 agencies reported from FATA in week with a total of 31,310 patient consultations. this week, with a total of 11,529 patient consultations.

• 3 alerts including 2 outbreaks were identified and appropriate • 6 alerts, 4 for Measles; while 2 for NNT were reported this measures were taken. week and appropriate measures were taken.

50 50 AD BD ARI S. Malaria 45 AD BD ARI S. Malaria 40 40 35 30 30 25 20 20 Percentage

15 Percentage 10 10 5 0 0

… … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … …

9 1 2 3 4 5 6 7 8 9

1 2 3 4 5 6 7 8 9 42 43 44 45 46 47 48 49 50 51 52 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 10 11

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