Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Home , Baloch Colony, Jhirk, Kabal Tehsil, Khuda Ki Basti (Karachi), Lakki Marwat District, Usmanabad

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 2, Issue 46, Monday 21 November, 2011

Highlights Priority diseases

under surveillance Epidemiological week no. 46 (11 to 17 November, 2011) in DEWS

• 80 districts and 2 agencies provided surveillance data to the DEWS this week from Acute Flaccid Paralysis (AFP) 2,636 health facilities. Data from mobile teams is reported through sponsoring BHU or Acute Jaundice Syndrome (AJS) RHC. Acute Respiratory Infections • A total of 816,850 consultations were reported through DEWS of which 203,121 (Upper and Lower) (ARI) (25%) were acute respiratory infections (ARI); 72,768 (9%) were Skin disease; 61,792 Acute Watery Diarrhoea (AWD)/ (8%) were acute diarrhoea; and 57,597 (7%) were suspected malaria. Suspected Cholera

• A total of 124 alerts with 10 outbreaks were reported in week‐46, 2011: Altogether Acute Bloody Diarrhoea (BD) 28 alerts for AWD, 23 for Measles; 22 for Neonatal tetanus and tetanus; 18 for Other Acute Diarrhoeas (AD) Leishmaniasis; 7 for Pertussis; 6 each for Malaria and ARI; 4 each for DHF and Acute diarrhoea; 2 for AJS; while 1 each for CCHF, Diphtheria, Typhoid and unexplained fever. Suspected Viral Hemorrhagic Fever (VHF) • In this week nine new polio cases were confirmed by the laboratory, four from Suspected Malaria (Mal) FATA (three from North Waziristan agency and one from Khyber agency); two each Suspected Measles (MS) from Balochistan (Mastung and Barkhan districts) and Punjab (Vehari and Rahim Yar Khan districts); and one from Khyber Pakhtunkhwa (Lakki Marwat district). As of 21st Suspected Meningitis (MG)

November 2011, Pakistan has reported a total of 154 polio cases (152 type‐1 & 2 type‐ Others 3) from 48 districts/towns/tribal agencies and areas.

Figure‐1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 27 October 2011 (Epi week 31, 2010 to week 46, 2011)

50 AD BD ARI S. Malaria 45

25 Percentage 20

0 1 3 5 7 9

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

Disease Wk-39 Wk-40 Wk-41 Wk-42 Wk-43 Wk-44 Wk-45 Wk-46

Acute respiratory infection 205,597 (21%) 209,436 (21%) 223,902 (22%) 213,432 (24%) 193,863 (24%) 217,676 (25%) 101,386 (25%) 203,121 (25%)

Skin diseases 105,912 (11%) 95,842 (9%) 94,167 (9%) 81,161 (9%) 69,393 (9%) 77,842 (9%) 33,869 (8%) 72,768 (9%)

Acute diarrhoea 105,295 (11%) 97,007 (10%) 93,085 (9%) 74,189 (8%) 62,628 (8%) 65,701 (8%) 32,405 (8%) 61,792 (8%)

Bloody diarrhoea 9,393 (0.94%) 8,075 (0.80%) 8,107 (0.78%) 6,089 (0.68%) 5,461 (0.68%) 5,289 (0.60%) 2,751 (0.68%) 5,706 (0.70%)

Suspected malaria 83,684 (8%) 82,802 (8%) 86,326 (8%) 68,441 (8%) 58,613 (7%) 69,408 (8%) 33,8869 (8%) 72,768 (9%)

Total consultation 995,450 1,014,266 1,033,276 897,598 808,954 879,811 407,339 816,850 Since July 29, 2010, approximately 52,456,152 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on around 1,000,000 consultations per week, there is a drop in timely reporting due to EID holidays, challenges in accessibility caused by secu‐ rity situation in some areas. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 8 weeks (39 to 46, 2011) acute diarrhoea cases have been decreased (From 11% to 8%), while at the same time cases of ARI have been increased (From 21% to 25%). A slight fluctuation in the suspected malaria cases have been seen recently after consistent seasonal increase from week 35 especially from districts in Sindh and Balochistan.

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. 46 (11 to 17 November, 2011) Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken A Case of suspected AWD was reported, on active surveillance 5 more cases were found in same area with Village Gular, UC & Tehsil severe dehydration, all the patients were referred to DHQ Hospital for IV therapy, Stool samples collected for 11‐Nov AWD KPK Lower Dir 0 2 2 2 Samar Bagh lab confirmation but both found negative for Cholera, Water Samples taken for any fecal contamination, ORS, Hygiene kits & Aqua tabs distributed, Health & Hygiene promotion Session conducted with family members. During active surveillance 2 cases of suspected Pertussis were found having typical Cough with vomiting, 11 Village Sharmakhan‐ more cases were found in the same area but most of them were unimmunized for routine vaccination. some 16‐Nov Pertussis KPK Lower Dir Shontala, UC & Tehsil Samar 7 2 3 1 were already recovered, Erythromycin was provided to all close contacts, Nasophyrangeal swab were taken Bagh from 2 cases for confirmation. Outreach Immunization activity was carried out by EPI team in the area. EDO was Informed. Village Mian Pota, UC 7 cases of suspected acute viral hepatitis investigated, health education imparted, one pregnant women 15‐Nov AJS Sindh Badin 0 5 0 2 Talhar, Taluka Talhar suspected case was give TT vaccine, informed MS RHC and DHMT and 3 blood sample taken and sent to NIH

Baloch Mohalla, Old Wolcut 1 suspected case was found in hospital, on active surveillance 5 more cases with diarrhoea were found in the 16‐Nov AWD Sindh Mirpur Khas Factory, UC # 6, Taluka 2 2 1 1 community. Contaminated water of hand pump was the possible source, health education imparted, Aqua Mirpurkhas tabs, Zinc tabs and ORS distributed, EDO‐H, DSM PPHI informed. 3 Patient were admitted in Hospital, during active surveillance 13 more cases found, Canal was the source of Village Allo Tara, UC Sonda, 17‐Nov AWD Sindh Thatta 3 2 6 5 drinking water, health education imparted, Aqua tabs, Zinc tabs, ORS, Jerry cans and water filter distributed, Taluka Thatta. EDO‐H informed and 2 water sample taken. Suspected Malaria Death reported by health technician at EDOH office Mirpur Mathelo. Field investigation Village Muhammad Khan done and WHO response, DEWS team performed MP tests on RDTs and found 30 positive cases (P. Falcipa‐ 16‐Nov Malaria Sindh Ghotki Shar UC Bairoota Taluka 10 23 8 25 rum 17, P. Vivax 3, Mixed 10) in the village. ACT & bed nets provided, Health education session conducted in Daharki the community, moreover informed EDOH for fumigation and resudal spray. Village Pir Dino Khaskheli, 19‐cases of malaria (7 P. Falciparum and 2 Mix) found confirmed by RDT, health education imparted to family 11‐Nov Malaria Sindh Thatta 6 8 1 4 UC Jhirk, Taluka Thatta members and other neighbor, Anti Malaria medicines and Bed Nets provided and EDO‐H informed. Village Sheikh Muhammad 25‐cases of malaria (8 P. Falciparum and 3 Mix) found confirmed by RDT, health education imparted to family 16‐Nov Malaria Sindh Thatta Ismail, UC Jhirk, Taluka 2 8 4 11 members and other neighbor, Anti Malaria medicines and Bed Nets provided and EDO‐H informed. Thatta Village Bhoongrai Khosa, UC 15 Suspected case investigated, Throat Swab collected, sensitized regarding proper vaccination and Personal 14‐Nov Pertussis Sindh Tharparkar 1 4 2 8 Mitho Dabhro, Taluka Diplo Hygiene, informed EDO‐H, DSM PPHI, MS DHQ regarding the cases and Throat swab taken. Village Baando Kapri, UC 9 case of Pertussis were investigated, History of Patient was taken, Health education imparted regarding 16‐Nov Pertussis Sindh Tharparkar Warawah, Taluka Nagar‐ 4 2 2 Vaccination and Proper health and Hygiene, Anti Biotic and Antipyratic tabs given, inform EDO‐H, DSM‐PPHI, parkar MS THO. Current week's Alerts: Province Sindh Cont’d: Province Sindh Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Naushahro 17‐Nov AD Baladi Mohalla, UC and taluka Kandiyaro 1 1 1 1 14‐Nov Diphtheria Dadu Najab shah Mohalla, UC and Taluka Johi 0 1 0 0 Feroze Village Muhammad Khan Shar UC Bairoota 15‐Nov AJS Badin Village Mian Pota, UC Talhar, Taluka Talhar 0 5 0 2 16‐Nov Malaria Ghotki 10 23 8 25 Taluka Daharki 15‐Nov AJS Benazirabad Police Line Dispensory, UC 1 2 0 1 0 Jhirck City, Mallah Mohalla, UC Jhirk Taluka Village Haji Channesar Jat, Dadar ko Farm, 11‐Nov Malaria Thatta 1 4 0 3 12‐Nov AWD Badin 1 1 0 1 Thatta UC Rahuki Village Pir Dino Khaskheli, UC Jhirk, Taluka Gayoosala, Usmanabad near Bilala Masjid, 11‐Nov Malaria Thatta 6 8 1 4 17‐Nov AWD Hyderabad 0 0 0 3 Thatta UC‐16, Taluka Hyderabad Village Sheikh Muhammad Ismail, UC Jhirk, 12‐Nov AWD Mirpur Khas Rajar Colony, UC #5, Taluka Mirpurkhas 1 2 0 0 16‐Nov Malaria Thatta 2 8 4 11 Taluka Thatta Village Junejo Colony, near Bus Trrminal 16‐Nov AWD Mirpur Khas 0 1 0 0 Mirpurkhas, UC Turk Ali Mari 17‐Nov Measles Jacobabad Channa Mohalla, UC Jaffarabad 0 0 1 0 Opposite Bhittai hospital, Baloch Colony, UC 16‐Nov AWD Mirpur Khas 1 0 0 1 15‐Nov Measles Jamshoro Ameer complex UC Nagoline Taluka Kotri 0 0 1 0 #5 Taluka Mirpurkhas Village Faiz Muhammad Laghari, near Near SDA office, Khuda Ki Basti # 3 UC 16‐Nov AWD Mirpur Khas 0 1 0 0 15‐Nov Measles Jamshoro 0 0 1 0 Jamrau Mori, UC Doulat Pur Sonowaller Village Haji Mubarak Khaskheli, Kapri Mo‐ Village Shah Paro, near G. High school, UC 16‐Nov AWD Mirpur Khas 0 1 0 0 17‐Nov Measles Jamshoro 0 0 0 1 halla, UC Mir Ghulam Hussain Talpur Nagoline Baloch Mohalla, Old Wolcut Factory, UC # 6, Siddique Akbar Mohalla, near Al Khidmat 16‐Nov AWD Mirpur Khas 2 2 1 1 14‐Nov Measles Karachi 1 1 2 0 Taluka Mirpurkhas hospital, sector 5‐E, SITE Qambar 12‐Nov AWD Village Norang UC Jean abro 2 1 0 0 17‐Nov Measles Shikarpur Qazi Mohalla, Shikarpur City 0 1 0 0 Shahdadkot Village Potho, Ali Mirshah, UC Kario Ganwer, 17‐Nov AWD Sanghar Village Khairo Kaloi, Taluka Shahdadpur 2 1 0 0 12‐Nov NNT Badin 1 0 0 0 Taluka Golarchi Tando Allah Ashfaq Tawn, UC Pak Singhar, Taluka Tando 11‐Nov AWD 0 1 0 0 Village Hiro Khan Laghari, UC Pat Gul Mu‐ Yar Allahyar 17‐Nov NNT Dadu 1 0 0 0 hammad, Taluka Johi Tando Allah Village Waryam Chachar UC Mithri Taluka 11‐Nov AWD Madina Colony Taluka Tando Allahyar 0 1 0 0 16‐Nov NNT Ghotki 0 0 1 0 Yar Khan Garh Tando Allah Village Sultan Abad, UC Sheikh Musa, Taluka 11‐Nov AWD 0 0 0 1 Neonatal ICU, NICH/Sec 48‐B, Korangi # 2, Yar Tando Allahyar 15‐Nov NNT Karachi 0 0 1 0 Korangi Tawn Tando Allah Village Maqbool memon (Hingorja Mohalla), 12‐Nov AWD 0 4 0 0 Yar UC Missan 17‐Nov NNT Karachi Kachi Abadi, Bhains colony Bin Qasim Town 1 0 0 0 11‐Nov AWD Tharparkar Village Bachal Shah Colony UC Mithi 0 1 0 0 Village Gazi Khan buledi UC Kalar Talka 14‐Nov NNT Khairpur 0 0 1 0 Village Sukhpur, UC Nagarparkar, Taluka Kamber 11‐Nov AWD Tharparkar 1 0 0 0 Nagarparkar 14‐Nov NNT Khairpur Village Muhammad Murad Rind UC Nizamani 1 0 0 0 Village Kuwara, UC Pithapur, taluka Nagar‐ 12‐Nov AWD Tharparkar 1 0 0 0 Village Haji Maheral Alamani UC Kot mir parkar 15‐Nov NNT Khairpur 1 0 0 0 IDP Tent city Naukot, UC Mahrano, Taluka Muhammad Taluka Kingri 13‐Nov AWD Tharparkar 0 0 2 0 Village Haji Khair Muhammad Bhambhro UC Mithi 16‐Nov NNT Khairpur 1 0 0 0 Village Edani, Peer Mohalla, UC Dhaheli, Sikanderabad Taluka Nara 15‐Nov AWD Tharparkar 0 1 0 0 Village Mohabat khan UC Chondiko Taluka Taluka Chachro. 16‐Nov NNT Khairpur 1 0 0 0 Village Jarelo, Rind Mohalla, UC Tar Ahmed, Nara 15‐Nov AWD Tharparkar 0 1 0 0 Taluka Chachro. Village Khuda Bux Brohi, UC Hingoja, taluka 17‐Nov NNT Khairpur 1 0 0 0 14‐Nov AWD Thatta Sonda Citu UC Sonda 0 1 0 0 Sobho Dero Village Gull Mohammed Tunio Taluka 16‐Nov AWD Thatta Village Allah Buksh Tara, UC Sonda 0 1 0 0 16‐Nov NNT Larkana 1 0 0 0 Bakrani 16‐Nov AWD Thatta Village Moosa Merbahar, UC Sonda 1 0 1 1 Qambar Village Gazi Khan buledi UC Kaler talka Village Saleh Muhammad Sheikh, Taluka 14‐Nov NNT 0 0 1 0 16‐Nov AWD Thatta 1 1 1 1 Shahdadkot Kamber Shah Bundar. 17‐Nov AWD Thatta Village Allo Tara, UC Sonda, Taluka Thatta. 3 2 6 5 17‐Nov NNT Sanghar Daper Colony, UC‐2, Taluka Sanghar 1 0 0 0 Khoso Paro, near Ali Nawaz Khaskheli house, Village Bhoongrai Khosa, UC Mitho Dabhro, 15‐Nov AWD Umer Kot 1 1 1 0 14‐Nov Pertussis Tharparkar 1 4 2 8 UC 2, Taluka Umerkot Taluka Diplo Village Waryam Rajar, Bheel Paro, UC Atta Village Baando Kapri, UC Warawah, Taluka 15‐Nov AWD Umer Kot 0 1 0 2 16‐Nov Pertussis Tharparkar 4 1 2 2 Muhammad Pali Nagarparkar 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, 02 Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 (11 to 17 November, 2011) Current week's Alerts: Province Balochistan Current week's Alerts: Province Punjab Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Leishmani‐ DHQ Bhakkar‐Mohallah Jhakkar 11‐Nov Khuzdar UC Zereena Kattan & UC Khand 0 3 0 0 11‐Nov DHF Bhakkar 0 2 0 0 asis Alamabad‐ Chak 217/TDA Leishmani‐ Rabat, UC Goani Grehsa; Lope; Kanak, 12‐Nov Khuzdar 0 3 0 0 asis UC Gazgi Leishma‐ Mohala Duleani Tiba near CH Sakhi 11‐Nov D. G. Khan 0 1 0 0 niasis Sarwar 12‐Nov NNT Quetta Bolan Medical Complex Hospital 0 0 1 0 Faisal Colony, Choti Road, UC Basti 11‐Nov NNT Rajanpur 0 0 1 0 12‐Nov Tetanus Quetta Bolan Medical Complex Hospital 1 0 0 0 Rindan Nawa, UC Baleena Kattan, Tehsil THQ Jampur, Basti Mushtaq Khosa, 14‐Nov Pertussis Khuzdar 1 0 0 0 11‐Nov NNT Rajanpur 1 0 1 0 Khuzdar UC Basti Foja Killi georgage, Girdi jungle Refugee 15‐Nov Typhoid Chagai 0 2 0 3 camp 12‐Nov DHF Mianwali Nai Abadi Kotchandna, Isa Kheel 0 1 0 0 Muzaffar‐ Basti New Qadir Pur & Thatha Sharif, 15‐Nov Pertussis Kharan Wapda road, UC Northern town 0 1 1 1 12‐Nov AD 16 10 9 12 garh UC Qadirpur Chajra Leishmani‐ 15‐Nov Kalat Chashma, UC Lakhorian, Tehsil Surab 1 0 0 0 asis 14‐Nov UXF Mianwali BHU Chak 5‐6 ml, piplan 0 5 1 4 Nasira‐ 16‐Nov NNT DHQ‐Dera Murad Jamali 1 0 0 0 Muzaffar‐ Basti Darkhan Wala, BHU Usman bad 14‐Nov AD 6 4 9 7 garh Koria, UC Kharak Leishmani‐ 16‐Nov Bolan Mohalla Ghulam Bolak, Dhadar 0 0 1 0 Muzaffar‐ asis 14‐Nov Malaria BHU Usman Koria 5 7 4 3 garh 16‐Nov CCHF Quetta Fatima Jinnah Chest Hospital 0 2 0 0 Chak No. 79/EB, Darya Ding, Tehsil 14‐Nov DHF Pakpattan 0 2 0 0 Leishmani‐ Jaffara‐ Arif 16‐Nov Cattle farm colony, Tehsil Jhat Pat 0 1 0 0 asis bad Leishma‐ Rahim Yar Basti Ahmed abad, Malik pur, UC Jaja 14‐Nov 0 1 0 0 17‐Nov Pertussis Kech Khuda Yousuf Mahallah, UC Absar 0 1 0 0 niasis Khan Abasian, tehsil Khanpur Leishma‐ Rahim Yar 17‐Nov Measles Quetta Bolan Medical Complex Hospital 0 1 1 2 14‐Nov UC Khanbela, Tehsil Liaqatpur 0 1 0 0 niasis Khan Leishmani‐ 17‐Nov Kech Akram Ward, UC Absar 0 1 0 0 Rahim Yar BHU Allah Jiwaya Lar, Tehsil Liaqat‐ asis 14‐Nov ARI 7 18 11 23 Leishmani‐ Khan pur 17‐Nov Lasbela Mangya UC Sheh Tehsil Lakhra 0 1 1 1 asis Rahim Yar Leishmani‐ UC Khudabadan East, Mohallah Sara‐ 14‐Nov ARI RHC Zahir Pir, Tehsil Khanpur 3 9 5 13 17‐Nov Panjgur 0 1 0 0 Khan asis wan Leishmani‐ 15‐Nov AD Mianwali BHU PaiKheel 3 5 4 3 17‐Nov Panjgur UC Washbood, Mohallah Faqeer Abad 1 0 0 0 asis Leishmani‐ Rahim Yar 17‐Nov pishin Grid colony, UC bazar e khona 0 1 0 0 15‐Nov ARI BHU 87/A, Tehsil Liaqatpur 4 7 6 10 asis Khan Leishmani‐ 17‐Nov Quetta Hazara town, Brewery road 0 2 1 2 Rahim Yar asis 15‐Nov ARI BHU Haroonabad, Tehsil Liaqatpur 2 7 3 8 Khan Leishmani‐ 17‐Nov Quetta Pashtoon Abad 0 1 0 0 Muzaffar‐ asis 15‐Nov Malaria RHC Sinanawan 40 31 33 16 Leishmani‐ garh 17‐Nov Sibi Mohala Allabad, UC 3 & Ghareebabad 0 0 0 2 asis Moza Dharam Pura, Inshallah Nurs‐ 15‐Nov DHF Vehari 0 1 0 1 17‐Nov Pertussis Ziarat Kawas sharki 0 2 0 1 ery, Gali No. 2, Tehsil Mailsi Leishmani‐ Leishma‐ 17‐Nov Ziarat Pasara, Cheena 0 1 0 0 16‐Nov Khushab Village Payel, Khushab 0 2 0 3 asis niasis

Current week's Alerts: Province Khyber Pakhtunkhwa 17‐Nov NNT D. G. Khan Gohra, UC Tuman Qaisrani 0 0 1 0 Date Disease District Area <5M >5M <5F >5F Village Gular, UC & Tehsil Samar Rahim Yar BHU 5/NP, Roshan Bhait, Tehsil 11‐Nov AWD Lower Dir 0 2 2 2 17‐Nov ARI 4 3 6 9 Bagh Khan Sadiqabad 11‐Nov Measles Swabi BMC Swabi, Kadi and Baja 2 0 0 0 11‐Nov Measles Swat Village & UC Kabal, Tehsil Kabal 0 0 0 1 Rahim Yar 17‐Nov ARI BHU Bhong, Tehsil Sadiqabad 26 98 31 67 Village Mehak UC Kala Kale, Khan 11‐Nov Measles Swat 0 0 1 0 Tehsil Kabal Village Sabar Shah & Serai, UC Current week's Alerts: AJK; FATA; GB and ICT 12‐Nov Measles Lower Dir 4 1 5 2 Tazagram, Tehsil Adenzai Date Disease District Area <5M >5M <5F >5F Village Shirkhanai, UC Hayaserai, 12‐Nov Measles Lower Dir 0 0 1 0 village rashakai, tehsil Tehsil Balmbat. 15‐Nov NNT Bajaur Agency 0 0 1 0 Nawagai 14‐Nov Measles Charsadda Azizkhel 0 0 1 0 village gabaray, tehsil 14‐Nov Measles Swat Village Chinar Baba Khwazakhela 0 0 1 0 17‐Nov NNT Bajaur Agency 1 0 0 0 Village Dherai, Mohallah Alfalah, Mamoond 14‐Nov Measles Swat 1 0 0 0 UC Kanju, Tehsil Kabal Mohmand 17‐Nov Measles Kasai 1 0 0 0 15‐Nov Measles Charsadda Dab Kallay 1 0 0 0 Agency 15‐Nov Measles Charsadda Munda camp 1 0 0 0 15‐Nov Measles Swabi Private Clinic, Narangi 2 0 1 0 Village & UC Shahderai,mohallah 15‐Nov Measles Swat 1 0 0 0 thana, Tehsil Kabal 16‐Nov Measles Haripur Tarbella Cant, tehsil Ghazi 1 0 0 0 Village Shontala, UC & Tehsil 16‐Nov Measles Lower Dir 3 0 2 0 Samar Bagh 16‐Nov Measles Swabi BHU Fazal Abad, Tel Banda 0 0 1 0 Village Sharmakhan‐Shontala, UC 16‐Nov Pertussis Lower Dir 7 2 3 1 & Tehsil Samar Bagh 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, 03 Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 (11 to 17 November, 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 46/2011) 29 July 2010 to 10 November 2011, compiled from weekly reports Number of Diseases Number of HFs Consultations 4000 Mobile Fixed 6 6 6

3500 7 2 2 7 3 Acute respiratory infection 11,740,063 (22%) 8 6 7 7 7 6 8

3000 13 6 6 6 8 8 Skin diseases 5,598,514 (11%) 8

8 8 11

2500 11 8 11 8 11

2000 8

Acute diarrhoea 12 4,964,185 (9%) 411 400 375 331 11 215 361 3375 192 3363

1500 3354 3329 26 3259 3259 3251 3250 3234 153 3215 3196 3156 3142 3120 3109 26 3058 3021 3022 128 2982 2935 2909 2785 105 2752 2745 2716 2706 46 2671 2648 2636 2597 81 2564 2550 2547 2532 2522 2466 58 2455 Bloody diarrhoea 2450 439,816 (1%) 2404 1000 2349

2322 2262 2255 2251 2199 2022 2021 1797 1680 1488 500 1463 1289 1215 1167 1158 1143 1130 999 1113 1111 967 949 1073 1067 879 Suspected malaria 3,254,132 (6%) 854 0 3 5 7 9

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

Unexplained fever 1,185,306 (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 Wk Wk Wk Wk Wk Wk Wk Total consultations 52,456,152 Epi‐week Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Post Flood 2010 2011 (up till wk 45) Current Week (46) Total Disease A O A O A O A O Acute watery diarrhoea 209 85 1261 533 28 3 1498 621 Acute jaundice syndrome 5 2 42 14 2 1 49 17 Bloody diarrhoea 10 1 91 19 0 0 101 20 Dengue fever 81 32 774 111 4 0 859 143 Measles 48 6 1490 88 23 0 1561 94 Pertussis 1 ‐ 244 61 7 3 252 64 NNT + tetanus 5 ‐ 299 22 0 326 0 Malaria 12 7 103 69 6 3 121 79 Leishmaniasis 1 ‐ 210 28 18 0 229 28 Others 75 11 518 60 14 0 607 71 Total 447 144 5032 983 124 10 5603 1137 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK This week 607 health facilities from 16 districts reported to • 50 DEWS with a total of 138,635 patients consultations. 45

40 • The proportional morbidity of AD dropped by 1% as com- 35 pared with last week. 30

25 20

• 17 alerts were reported in this week, 15 were for Measles; while Percentage 1 each for AWD and Pertussis. 15 10 • 2 outbreaks, 1 each for AWD and Pertussis both were from 5 0 Lower Dir were received and responded this week. 9 7 5 3 1

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

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 AD BD ARI S. Malaria

Province Sindh: Figure-4: Trend of priority communicable diseases, province Sindh • This week 882 health facilities from 23 districts reported a 50 total of 360,852 patient consultations. AD BD ARI S. Malaria 45 • In Sindh, AD cases reported were 28,686 (8%), 1% lower pro- 40 portional morbidity as compared with last week. 35 30 25

57 alerts were reported from Sindh in this week: 27 were for Percentage • 20 AWD; 14 for Neonatal tetanus; 6 for Measles, 4 for Malaria, 2 15 each for Pertussis and AJS, while 1 each for AD and Diphthe- 10 ria. 5 0 • 9 outbreaks, 3 for Malaria, while 2 each for AWD and Pertus- 9 7 5 3 1

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

wk wk wk wk sis, while 1 for AJS were received and responded this week. 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

40 • AD cases reported were 11,974 (6%) and showing 1% higher 35 proportional morbidity as compared with last week . 30

25 23 alerts were reported in this week from Punjab; 6 were for 20

• Percentage ARI; 4 each for DHF and Leishmaniasis; 3 each for AD and 15 NNT; 2 for Malaria; while 1 for unexplained fever. 10

5 • No outbreak for any disease was received this week. 0 1 3 5 7 9

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

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

Province Balochistan: Figure-6: Trend of priority communicable diseases, province Balochistan • In this week, 18 districts reported to DEWS from Ba-

lochistan province. 459 health centers reported a total 50 AD BD ARI S. Malaria of 71,851 patient consultations. 45

40 • AD reported in 6,761 (9%) of the total consultations, 2% 35 lower proportional morbidity as compared with the last 30 week. 25

Percentage 20 • 24 alerts were reported in this week from Balochistan, 15 14 for Leishmaniasis; 4 for Pertussis; 3 for Neonatal 10 tetanus and tetanus; while 1 each for CCHF, Measles 5 and Typhoid. 0

1 3 5 7 9

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

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

Province Gilgit Baltistan:

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan

• In this week, 47 health centers from 5 districts in Gilgit 50 AD BD ARI S. Malaria Baltistan sent weekly report with a total of 16,668 pa- 45 tient consultations. 40 35 • ARI cases reported were 2,760 (17%), while Acute diar- 30 rhoea were 1,297 (8%). 25 20 • No alert or outbreak was received in this week from Percentage 15 10 any area of Gilgit Baltistan. 5 0 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 42 43 44 45 46

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:

• In this week, reports were received from 118 health facilities from 10 • This week 39 health facilities in 2 agencies reported from FATA, districts with a total of 26,151 patient consultations. with a total of 6,858 patient consultations. • ARI cases reported were 5,313 (20%), while Acute diarrhoea reported • ARI cases reported were 1,695 (25%), while Acute diarrhoea was 969 (4%) cases. reported 512 cases (7%) • No alerts or outbreak was received this week from any area of AJ&K. • 3 alerts, 2 for Neonatal tetanus and 1 for Measles were received and responded this week.

50 50 AD BD ARI S. Malaria AD BD ARI S. Malaria 40 40

30 30 Percentage

Percentage 20 20

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 35 36 37 38 39 40 41 42 43 44 45 46 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 42 43 44 45 46

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

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011 Year 2010: The total number of polio cases reported in 2010 is 144 including 120 type‐1 cases and 24 type‐3 from 40 in‐ fected districts/towns/agencies.

Year 2011: As of 18 November, 2011, the total number of polio cases confirmed by the laboratory is 154 (152=type‐1, and 2=type3) from 48 districts.

Cases 2010 Cases 2011 Province P1 P3 P1 P3 Punjab 6 1 4 - Sindh 26 1 29 - Khyber Pakhtunkhwa 19 5 13 - FATA 63 11 44 2 Balochistan 6 6 61 - AJ&K - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 152 2

Pakistan Dengue Situation, 5th November 2011 Since the beginning of the year and as of Week 46th 2011; 554,663 cases of suspected dengue fever cases and 23,019 Lab confirmed cases were reported across the country with 356 deaths (CFR = 1.55%). Over 90% of cases were reported in Punjab province.

2011 Provinces Suspected Confirmed Deaths

Punjab 551663 21177 331

Sindh 1400 980 17

Islamabad 980 620 2

Khyber Pakhtunkhwa 502 210 6

AJK 99 21 0

FATA 7 6 0

Balochistan 6 3 0

Gilgit Baltistan 6 2 0

Total 554663 23019 356