Islamabad WEEKLY FIELD EPIDEMIOLOGY REPORT

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

Volume 2-- Issue 45 Nov 01-07, 2020 Date: November 11, 2020

Provincial 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 Pakistan 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 72,863 travelers have been traced FDSRU has developed a mechanism for tracking of and contacted by November 07, 2020. travelers from other countries to Pakistan since 02 Table-1: Weekly Surveillance data COVID-19 by November 07, 2020 Province/ Suspected Lab Update Hospital Update Region cases reported

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

AJK 66,671 67,086 4,703 45 3,624 109 Baluchistan 100,738 133,602 16,055 08 15,683 154 GB 45,272 47,355 4,358 10 4,096 93 Islamabad 523,819 530,109 21,557 160 18,971 238 KP 368,350 513,384 40,397 145 38,021 1,288 Punjab 1,600,880 1,670,914 106,577 422 97,614 2,407 Sindh 1,703,818 1,713,813 149,542 277 140,408 2,679 Total 4,409,548 4,676,263 343,189 1,067 318,417 6,968

PDSRU SINDH Total 145,544 confirmed COVID-19 cases were Ghotki (n=3,656). Age group 50-59 has the highest reported from Sindh until Oct 31,2020. Most of these attack rate (820/100,000) followed by 30-39 years cases were reported from Karachi District age group (664/100,000), 40-49 years age group (n=98,860) followed by District Hyderabad (564/100,000) & ≥70 years age group (514/100,000 (n=5,397), District Sukkur (n=3,959) and District population)

Volume02 -- Issue 45 Nov 01-07, 2020 Date: November 11, 2020

Figure-1: Sindh - District-wise distribution of COVID-19 cases (Cumulative up to week 45)

Figure-2: Sindh – Age group-wise Attack Rates /100,000 population (Nov 07, 2020)

900 837 800 682 700 610 600 521 500 447 400

300 221 Attack rate/100,000 Attack 200 123 100 47 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 District Jaffarabad (n=415) and District Khuzdar 16,106 positive cases of COVID-19 and 154 deaths (n=409). Age group 30-44 has the highest number of till Nov 07, 2020. 15,700 cases have recovered. COVID-19 cases (n=5,359) followed by age group District Quetta has the highest number of confirmed 15-29 (n=3,668) & age group 45-59 (n=2,558) cases(n=11,486) followed by District Kech (n=523),

Figure-5: Geographical Distribution of COVID-19 Cases in Baluchistan Province (Cumulative up to Week 45)

Volume02 -- Issue 45 Nov 01-07, 2020 Date: November 11, 2020

Figure-6: Baluchistan –Age group wise distribution of COVID-19 positive cases (up to Nov 07,2020)

6300 5359 5400

4500 3668 3600 2558

No. of Cases of No. 2700 2146

1800 1121 900

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

PDSRU- Gilgit-Baltistan (GB)

PDSRU GB has reported total 46,068 suspected 19. 4,114 cases have recovered from COVID-19 cases of COVID-19 and out of these 4,818 were lab while 93 cases expired. During current week highest confirmed COVID-19 up to Nov, 07 and 159 cases number of COVID-19 cases were detected in District were detected during last week, while no lab results Gilgit (n=37) followed by District Diamer (n=30), are awaited. 45,737 samples were processed and District Ghizer (n=24) and tourist (n=33). 41,371 suspects were declared negative for COVID-

Table -2 Detail of number of samples, confirmed Covid-19 cases & Deaths in GB up to Nov 07, 2020

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

Astore 6052 5667 6044 04 00 368 05 08 Diamer 5475 5206 5474 30 00 234 04 01 Ghanche 2290 2092 2204 01 00 107 04 86 Ghizer 3297 2927 3295 24 00 337 07 02 Gilgit 11474 9804 11390 37 00 1514 35 84 Hunza 6654 6011 6637 20 00 603 03 17 Kharmang 1845 1727 1821 04 00 90 00 24 Nagar 1868 1644 1866 23 00 195 04 02 Shigar 1416 1278 1391 01 00 108 04 25 Skardu 5697 5015 5615 15 00 558 27 82 Grand Total 46068 41371 45737 159 00 4114 93 331 Figure-7: GB-District-Wise distribution of confirmed COVID-19 cases up to Nov 07, 2020

45 37 33 30 30 24

No.of Cases 15 7 4 4 1 1 0 Astore Diamer Ghanche Ghizer Gilgit Hunza Skardu Shigar Kharmang Tourist Districts

Volume02 -- Issue 45 Nov 01-07, 2020 Date: November 11, 2020

PDSRU-AJK cases have recovered from COVID-19 and 109 cases PDSRU AJK has reported total 67,387 suspected expired due to COVID-19. District Muzaffarabad cases of COVID-19 and out of these 4,758 were lab has the highest number of cases (n=2047) followed confirmed COVID-19 up to Nov 07, 2020 while no by District Mirpur (n=727), District Poonch (n=596) lab- results of suspected cases are awaited. 3,654 and District Kotli (n=510).

Table -3: Distribution of suspected and confirmed Covid-19 cases in AJK up to Nov 07,2020

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

67,387 67,547 4,758 995 3654 109 Figure-8: AJK-District-Wise distribution of confirmed COVID-19 cases up to Nov 07, 2020

2400 2047 2100

1800

1500

1200

No. of Cases of No. 900 727 596 600 510 270 307 300 102 29 81 89 0 Muzaffarabad Hattian Bala Kotli Poonch Bagh Havaili Pallandri Mirpur Bhimber Neelum

Districts

PDSRU-KPK District Swat (n=3211), District Malakand (n=1683) PDSRU KPK has reported total 368,350 suspected and District Mardan (n=1308). Age group 40-49 cases of COVID-19 and out of these 40,657 were lab years has the highest attack rate/100,000 (AR=230) confirmed COVID-19 up to November o7, 2020 followed by 30-39 years age group (AR=210) and while 1288 patients expired. District Peshawar has 50-59 years age group (AR=195). the highest number of cases (n=15138) followed by

Figure-11: Geographical Distribution of COVID-19 Cases in KPK Province (Cumulative up to Week 45)

Volume02 -- Issue 45 Nov 01-07, 2020 Date: November 11, 2020

Figure-12: KPK –Attack rates /100,000 population in different age groups (up to Nov 07, 2020) 250 230 210 195 200 175 168 150 150 120

100 Attack rate/100,000 Attack 50 28 7 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 45, no suspected cases 45, 01 case was reported from KPK. were reported. 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 45, 258 been reported in 2019. During week 45, no cases cases reported from Sindh, ICT, Baluchistan & AJK. reported from all provinces & regions

Table-4: Weekly and Cumulative Diseases Updates Nov 07, 2020 Disease Total Cases in 2019 Nov 01-07, 2020 Total Cases in 2020 1 CCHF 75 0 19 2 Varicella 1,264 0 235 3 Dengue 24,547 258 2184 4 Chikungunya 0 0 0 5 Measles 6,781 36 1762 6 Diphtheria 614 1 135 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

07-11-2020 0 199 2 19 0 38 0 258 Total (2020) 03 1462 2 142 0 337 38 1,984

Extensive drug Resistant (XDR) Typhoid Fever Surveillance in Sindh Province In Karachi total 13,242 cases of extensive drug different hospitals in Karachi. The XDR Typhoid resistance typhoid fever were reported from January cases were reported mostly among the children and 01, 2017 to Nov 07, 2020. During current week total maximum number of XDR cases 5129 (39%) were 14 cases of XDR typhoid fever were reported from reported in the age group 0-4 years. The overall

Volume02 -- Issue 45 Nov 01-07, 2020 Date: November 11, 2020

attack rate was 64/100,000. The age group 0-4 years Females have higher attack rate 75/100,000 was the most affected (attack rate 188/100,000) compared to Males. followed by age group 5-9 years (AR 138/100,000).

Table-6: Number of XDR Typhoid fever cases Karachi from January 1, 2017 to Nov 07, 2020 Year Year XDR Cases Jan to December 2017 175 Jan to December 2018 3712 Jan to December 2019 7088 January 01, to Nov 07,2020 2020 2267

Total 13,242

Figure 13: Week-wise number of XDR Typhoid fever cases in Karachi, from January 1, 2017 to Nov 07, 2020 300

250

200

150

100 No. of cases of No. 50

Week2 Week5 Week8 Week1 Week4 Week7

Week32 Week25 Week49 Week11 Week14 Week17 Week20 Week23 Week26 Week29 Week35 Week38 Week41 Week44 Week47 Week50 Week10 Week13 Week16 Week19 Week22 Week28 Week31 Week34 Week37 Week40 Week43 Week46 Week52

WEEK42 WEEK03 WEEK06 WEEK09 WEEK12 WEEK15 WEEK18 WEEK21 WEEK24 WEEK27 WEEK30 WEEK33 WEEK36 WEEK39 WEEK45 FebMarApr MayJuneJuly Aug Sept Oct Nov Dec Jan FebMarAprilMayJuneJulyAugustSept Oct Nov Dec Jan Feb Mar AprMayJune July 2019 2020 Epidemiological Months and Weeks

XDR Typhoid Surveillance Data Sindh-Province (Excluding Karachi) Total 6830 Salmonella Typhoid cases reported from affected age group was 0 to 4 years (n=1389) with November 2016 to Nov 07, 2020 from different attack rate 47.1 per/10000 population followed by 5- districts of Sindh province (excluding Karachi). 9 years of age group (n= 1034) with attack rate Among these cases 5242 were Extensive Drug 35.3/10000 population. Over all attack rate is Resistant cases. Out of these cases n=3659 (69.8%) 16.7/10000 population (n=3659). 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 – Oct 31, 2020 613 369 982

Current week (Nov 1-7, 2020) 13 5 18 Total 3,659 1,583 5,242

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Figure 14:XDR Typhoid Cases District Hyderabad Nov-2016 to Nov 07, 2020

250

200

150

100 No cases No of 50

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 Year Year-17 Year -18 Year-19 Year-20 -16 Month wise cases