Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Home , Bandi Sher Khan, Chanesar Goth, Lasbela (Karachi), Nawabad, Pak Singhar, Rohilanwali

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 3, Issue 10, Wednesday 14 March 2012

Highlights Priority diseases under surveillance Epidemiological week no. 10 (4 to 10 March 2012) in DEWS

Acute (Upper) Respiratory Infection • In week 10, 2012, total 84 districts including 2 agencies provided surveillance data to the Pneumonia DEWS on weekly basis from around 1,878 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 672,038 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 5% were Suspected Enteric/Typhoid Fever Skin disease. Suspected Malaria Suspected Meningitis Suspected Dengue fever • A total of 203 alerts with 12 outbreaks were reported in week 10, 2012: Altogether 94 alerts Suspected Viral Hemorrhagic Fever for Measles; 22 for Leishmaniasis; 17 for Typhoid; 14 for Pertussis; 12 for ARI; 11 for NNT and Pyrexia of Unknown Origin Tetanus; 9 for AWD; 8 for Scabies; 5 for AD; 3 for Bloody diarrhoea; while 2 each for AJS, DF, Suspected Measles Suspected Acute Viral Hepatitis Diptheria and Malaria. Chronic Viral Hepatitis

Neonatal Tetanus • As of 10 March 2012, the total number of polio cases confirmed by the laboratory is 13 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‐10, 2012.

50 AD BD ARI S. Malaria 45

25 Percentage

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

wk wk wk wk wk wk wk 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-3 Wk-4 Wk-5 Wk-6 Wk-7 Wk-8 Wk-9 Wk-10

Acute respiratory infection 130,371 (25%) 137,322 (26%) 114,319 (26%) 138,507 (25%) 159,074 (26%) 152,681 (24%) 157,106 (23%) 152,988 (23%)

Skin diseases 24,721 (5%) 25,639 (5%) 22,020 (5%) 26,786 (5%) 29,199 (5%) 28,796 (4%) 29,346 (4%) 30,514 (5%)

Acute diarrhoea 27,574 (5%) 28,461 (5%) 23,902 (5%) 28,969 (5%) 30,607 (5%) 31,551 (5%) 34,668 (5%) 37,812 (6%)

Bloody diarrhoea 2,130 (0.42%) 2,665 (0.50%) 2,195 (0.50%) 2,676 (0.49%) 2,730 (0.45%) 2,765 (0.43%) 3,056 (0.46%) 2,756 (0.41%)

Suspected malaria 20,375 (4%) 19,817 (4%) 15,582 (4%) 21,752 (4%) 22,883 (4%) 23,482 (4%) 28,261 (4%) 29,388 (4%)

Total consultation 511,668 534,412 439,260 547,889 605,633 649,508 671,023 672,038

• 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 KP and FATA while acute diarrhoea is highest in Balochistan and Sindh (please see the graphs for every province in page 5 and 6).

Alert of 7 cases TF was received through weekly DEWS report. On investigation found that the cases are from the same locality, and the water source is the surface water from the dam which they keep in resorvior at RHC Ahmadon, UC Kach, 27‐Feb Typhoid Balochistan Ziarat 1 4 0 2 home. Laboratory testing showed 4 were positive for typhoid 3 cases results were pending. Shortage of Tehsil Ziarat medicine and laboratory facility is felt in the whole UC. Matter was discussed with DHO and RHC incharge. Follow up visit was planned next week.

Alert for Measles, active surveillance conducted, remote area with total population of 150 houses, 7 more Village Kolalano Cham, cases were found in the surrounding and 4 recovered cases were also identified, routine outreach vaccination 27‐Feb Measles KPK Lower Dir UC Asbanrd, Tehsil 1 5 1 1 conducted in the area by EPI Team and vaccinated 40 children for routine immunization, Vit‐A was given, Adenzai Blood Sample Collected for confirmation of antibodies, Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed.

Alert for Measles, active surveillance conducted, remote area with total population of 150 houses, 7 more cases were found in the surrounding, routine outreach vaccination conducted in the area by EPI Team and Village Anderey, UC 1‐Mar Measles KPK Lower Dir 7 0 1 0 vaccinated 33 children for measles, Vit‐A was given, Blood Sample Collected for confirmation of antibodies, Kotto, Tehsil Balmbat Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed.

Case of probable Pertussis was investigated in hospital. During active surveillance in community found 13 Tando Allah Village Ahmed Khan 27‐Feb Pertussis Sindh 4 4 4 2 more cases. In cluster of 30 houses found 16 children, out of them 9 were unvaccinated, Syp Erythrocin given Yar Lund, Taluka Chambar for treatment and health and hygiene education was given, EDOH informed and 3 Throat swab collected.

34 probable Pertussis cases were investigated, during active surveillance, SO visited health facility to check Qambar Village Lakhtia, UC 28‐Feb Pertussis Sindh 7 11 8 8 EPI center and found 2 days vaccination was available for community, immunization status was 20%, health Shahdadkot Boohar, Taluka Kambar education was imparted regarding importance of vaccination, Erythromycin given and EDOH informed.

Village Ehsan ali Baladi, K.N Shah; Village Ghulam 43 probable Pertussis cases were investigated in 4 different locations in district Dadu. During active surveil‐ Rasool Khushk; Village lance 45 contact children found in community out of them 21 were vaccinated; health education given; 1‐Mar Pertussis Sindh Dadu 14 9 6 14 Bahawalpur Sekhani; Erythromycin given to cases and contacts. 4 throat swabs were taken and sent to NIH. EDOH, focal person EPI Village Hafiz Babar, taluka were informed. Johi

Village Hashim Khaskheli, Alert for Measles, suspected case was admitted in hospital, Vitamin (A) given, health education was imparted, Hyderi Mohalla, UC 1‐Mar Measles Sindh Karachi 11 5 5 1 case was not vaccinated, during active surveillance in community found 22 children none of them was vacci‐ Murad Memon, Gaddap nated, information share with THO and request for Mop‐up the area and 1 Blood sample collected. town

AJS alert: BHU jamro Medical officer reported AJS cases from same location, team was comprised as SO Village saen bux jaffri UC DEWS, MO PPHI, EM & vaccinator. During investigation 18 cases were found & line listed. All cases were 2‐Mar AJS Sindh Shikarpur 2 12 0 4 jamra taluka lakhi referred by MO PPHI for laboratory investigation to DHQ lab. IEC material distributed & health promotion session was conducted. community was sensitized on hygiene & safe drinking water. Current 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 7‐Mar Leishmaniasis AJK Mirpur Village Khaliqabad 3 7 20 45 with lesions from one week to one year. DHO and ADHO CDC were informed. 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 investigation 5‐Mar AWD Balochistan Bolan Village Brahim bani 4 4 2 6 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. Patients have no Village Winder & Uthal, traveling history. Lesions were mostly on legs. No any other case was found during active search. Patients 6‐Mar Leishmaniasis Balochistan Lasbela 1 4 0 1 Tehsil Uthal were advised to take proper and regular treatment. Health and 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 water samples Tando Allah 9‐Mar AWD Sindh lashari, UC Pak Singhar 0 2 0 4 taken, hand pump was the source of suspect, Aqua tabs, Zinc tabs and ORS distributed in the community, Yar taluka Tando Allahyar EDOH informed. Village Adam Mallah UC Alert for 14 cases of Measles, during active surveillance Vitamin (A) given to children, none had been vacci‐ 7‐Mar Measles Sindh Thatta Mugal Bin taluka jati 6 2 6 0 nated for measles. Health education imparted regarding routine immunization, EDOH informed and re‐ district thatta quested for mop‐up; 8 Blood samples were collected and sent to NIH.

Village Khuda Buksh 42 probable Pertussis cases were investigated in 2 different locations. During active surveillance 57 contact 7‐Mar Pertussis Sindh Ghotki Mangrio; Village Abdul 13 6 15 8 children found in community out of them only 4 were having BCG Scar. Health education given; Erythromycin Ghani Bozdar 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 surveillance GOR Colony, Latifabad # cluster of 10 houses was taken and found 11 children, out off them 2 were unvaccinated, health education 7‐Mar Pertussis Sindh Hyderabad 1 3 1 1 01 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 was checked Village Chak # 23, UC and found 22 children none of them were vaccinated, Erythromycin given to the cases, health education was 7‐Mar Pertussis Sindh Sanghar 0 9 3 6 Gujri taluka Sanghar 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 and found 13 Village Khameeso Khan more cases, majority of the children received Anti biotic medicine, four throat samples were taken, health 8‐Mar Pertussis Sindh Thatta Pathan UC Ali Bahar 2 3 8 2 education imparted, routine immunization of the area was checked and found <70%, Erythromycin syrup Sujawal given to cases; EDOH informed.

Alert for Typhoid, 1 suspected case admitted in THQ hospital, during active search 5 more suspected Typhoid Village Sajaee, UC Sob‐ 7‐Mar Typhoid Sindh Tharparkar 0 4 1 1 cases were found, out of them 1 was Widal positive; Health education imparted, rain water was the source of hiar, Taluka Diplo suspect; Aqua tabs distributed in the community; while 3 water samples collected and sent to NIH.

Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

As of 10 March 2012, the total number of polio cases confirmed by the labo‐ ratory is 13 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 Balochistan 73 ‐ 2 ‐ AJ&K ‐ ‐ ‐ ‐ Gilgit‐Baltistan 1 ‐ ‐ ‐ Islamabad ‐ ‐ ‐ ‐ Total 196 2 12 1

Number o alerts by province, week 10, 2012 Province Khyber Pakhtunkhwa Cont’d Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F Village Muhammad Khawaja, UC 6‐Mar AWD Hangu 3 1 0 1 10‐Mar Measles Haripur Afghan Refugee Camp 4 3 1 4 3 Muhammad Khawaja Mohallah Taj Gul, Village Barh, Union Mohallah Aimal Khel, Village Shaikhaan, 9‐Mar AWD Kohat 0 3 0 2 8‐Mar Measles Kohat 1 0 0 0 Council Nasrat Khel Pindi Road Kohat 9‐Mar Diphtheria Charsadda Shekhabad 1 0 0 0 6‐Mar Measles Lower Dir Village Jaggal, UC Lajbook, Tehsil Balmbat 0 0 2 0 Village Barirai, UC Drangal, Tehsil Samar 5‐Mar Diphtheria Nowshera Village Kana Khel Mandkay Shareef 0 1 0 0 7‐Mar Measles Lower Dir 1 0 3 0 Bagh 8‐Mar Leishmaniasis Buner village khananoderai tehsil mandan 1 3 0 1 7‐Mar Measles Lower Dir Village Kaer Darra, Bebiyour 0 2 0 0 6‐Mar Leishmaniasis Nowshera Jabatar, Saleh Khana 1 0 0 1 Village Gujarano Cham, Kandaona, UC 8‐Mar Measles Lower Dir 1 0 0 0 Asbanrd, Tehsil Adenzai 6‐Mar Leishmaniasis Nowshera Shakot Bala, Saleh Khana 0 0 0 4 9‐Mar Measles Malakand Alladand 0 0 1 0 6‐Mar Leishmaniasis Nowshera Shakot Payan, Saleh Khana 0 0 0 5 9‐Mar Measles Malakand Batkhela 0 0 1 0 6‐Mar Leishmaniasis Nowshera Zao Kalay, Saleh Khana 1 0 0 0 10‐Mar Measles Malakand Mehrdai 1 0 1 1 8‐Mar Leishmaniasis Nowshera Kuja Khel, Kahi 0 1 0 0 Near Sheikhano Jumat, Mohallah Landay 9‐Mar Measles Nowshera 1 0 2 0 8‐Mar Leishmaniasis Nowshera Mohallah Khwaja khel, Kahi 0 0 0 1 Khel, UC Rashakai Phase 05, Sector E, Block 07, Tent 101, 8‐Mar Leishmaniasis Nowshera Mohallah: Kareem Khel, Kahi 0 0 0 1 9‐Mar Measles Nowshera 0 0 1 0 Jalozai IDP's Camp 8‐Mar Leishmaniasis Nowshera Nasu Khel, Kahi 0 1 0 0 Near Zait ur Rahman shop, Mohallah 10‐Mar Measles Nowshera 0 0 3 0 Mandoori, UC Khweshgi Bala 8‐Mar Leishmaniasis Nowshera Shaheen Abad, Kahi 0 0 0 1 7‐Mar Measles Peshawar Pakha Ghulam 1 0 0 0 8‐Mar Leishmaniasis Nowshera Shawa Khan Korona, Maira Misri Banda 0 1 0 0 10‐Mar Measles Peshawar Kohat Road 1 0 1 0 6‐Mar Measles Bannu Village Sra Darga 1 0 0 0 Lower Dir (Village Tangrey Mousa, 10‐Mar Measles Peshawar Latifabad 1 0 0 0 5‐Mar Measles Battagram 0 1 1 0 Battagram, Tehsil Warri) 10‐Mar Measles Peshawar Yakatoot 0 1 0 0 9‐Mar Measles Buner village ghazi khanay tehsil dagar 0 1 0 0 7‐Mar Measles Swabi BHU Beka 1 0 0 1 9‐Mar Measles Buner village sowarai tehsil gagra 0 0 1 0 8‐Mar Measles Swabi CD Bada, Village Pola 1 0 0 2 10‐Mar Measles Charsadda Charsadda 1 0 0 0 Village Parona Chinar near BHU Meragai, 4‐Mar Measles Swat 1 0 0 0 10‐Mar Measles Charsadda Mechanay Shabqadar 1 0 0 0 UC Kokarai, Tehsil Babuzai Village & UC Rang Mohallah,Tehsil Ba‐ 7‐Mar Measles D. I. Khan Potah, Tank Road, D I Khan 0 0 1 0 5‐Mar Measles Swat 0 0 1 0 buzai 7‐Mar Measles D. I. Khan Village Cheena, Tank Road 1 0 0 0 Village Lovi Ban Panar, UC Sangota, Tehsil 5‐Mar Measles Swat 1 0 0 0 Babuzai 9‐Mar Measles D. I. Khan Garah Haya 0 1 0 0 Village Malam khas kasoona, UC Ki‐ 6‐Mar Measles Swat 0 0 1 0 shawra, Tehsil Charbagh 9‐Mar Measles D. I. Khan Lahore City Colony 1 0 0 0 Village Obo tangay chinargay Pararai, UC 7‐Mar Measles Swat 0 1 0 0 9‐Mar Measles D. I. Khan Nasir Abad Colony 0 1 2 0 and Tehsil Barikot Village and UC Allah Abad, Tehsil Char‐ 8‐Mar Measles Dir Upper Village Rokhan, UC Dir urban 1 0 1 0 8‐Mar Measles Swat 0 0 0 1 bagh Mir Khanan Mohallah Karegar jhandi, 6‐Mar Measles Hangu 1 0 0 0 8‐Mar Measles Tank Abizari 0 0 1 0 Union Council Darsamand Zair Khawari banda, Union Council 6‐Mar Measles Hangu 0 0 2 0 8‐Mar Measles Tank ShahZamani 0 1 0 0 Darsamand 5‐Mar NNT Bannu Village Kinger 1 0 0 0 4‐Mar Measles Haripur Village Bandi Sher Khan 0 0 1 0

6‐Mar Measles Haripur Muhallah Iryar, Sikandarpur 1 0 0 0 9‐Mar NNT Bannu Village Zindi Falak Sher Sra Darga 1 0 0 0

6‐Mar Measles Haripur Village Rata, Bana, Bagra 1 0 0 0 9‐Mar Pertussis Swabi BMC Swabi, Dwa Jangi, Bachai 1 0 0 0

7‐Mar Measles Haripur Toheedabad, Sarai Saleh 1 0 0 0 5‐Mar Scabies Nowshera CAMP Health Post Catchment area 0 0 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]. 03 Special Bulletin: DEWS, Pakistan, Week no. 10 ( 4 to 10 March 2012) Province Sindh Province Balochistan Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 7‐Mar AWD Matiari Kachi Paro Mohalla, city Matiari 0 1 0 0 5‐Mar ARI Harnai Harnai city, UC Harnai Urban 2 6 3 4 5‐Mar ARI Ziarat Poi, UC Poi, Tehsil Sinjavi 2 0 3 0 5‐Mar AWD Tando Allah Yar Mansoor colony city Tando Allahyar 0 0 0 1 5‐Mar AWD Bolan Village Brahim bani 4 4 2 6 9‐Mar AWD Tando Allah Yar Madina Colony, UC 3 0 0 0 1 5‐Mar BD Harnai Shahrig, UC Shahrig, Tehsil Harnai 2 11 1 5 9‐Mar AWD Tando Allah Yar Village Ahmed khan lashari 0 2 0 4 7‐Mar Leishmaniasis Killa Saifullah DHQ Killa Saifullah 0 1 0 0 6‐Mar AWD Tharparkar Village Salar ji Dhani, UC Vajiar 0 1 0 0 8‐Mar Leishmaniasis Killa Saifullah Haji Bhang Burma & Kili Barowala 0 0 1 1 6‐Mar BD Q Shahdadkot Allah Rakhio Junejo, UC Dostly 0 0 0 3 6‐Mar Leishmaniasis Lasbela Village Winder & Uthal, Tehsil Uthal 1 4 0 1 5‐Mar Leishmaniasis S Benazirabad village Allah Bux Lashari 0 0 0 1 10‐Mar Leishmaniasis Panjgur Village Tasp UC Tasp Bazar 0 1 0 0 9‐Mar Leishmaniasis S Benazirabad Village Long khoso 0 0 0 1 10‐Mar Leishmaniasis Panjgur Villagea Kalla Kore UC Parome 0 1 0 0 8‐Mar Measles Dadu Soorajabad Muhalla 1 0 0 0 10‐Mar Leishmaniasis Quetta BHU New Pashtoon Abad 0 0 0 0 6‐Mar Leishmaniasis Ziarat Village Shotcut, UC & Tehsil Sinjavi 0 0 1 0 9‐Mar Measles Ghotki Kolachi Muhalla, UC I 2 0 0 0 5‐Mar Malaria Harnai Khidrani, UC Harnai Urban 4 3 2 3 9‐Mar Measles Ghotki Mehran colony near Subzi Mandi 1 0 0 0 5‐Mar Malaria Harnai Killi Shore, UC Shahrig 4 2 1 3 5‐Mar Measles Hyderabad Sachal Sarmast colony, Behar Colony 1 0 0 0 7‐Mar Measles Bolan Village Mashkaf 1 0 0 0 7‐Mar Measles Hyderabad Block C, Latifabad # 07 0 0 1 0 8‐Mar Measles Chagai Village Toheedabad, girdi jungle 1 0 0 0 8‐Mar Measles Hyderabad Block B, Latifabad #7 0 0 1 0 7‐Mar Measles Gwadar Village Nawabad UC & Tehsil Gwadar 0 2 3 3 6‐Mar Measles Jamshoro Maskeen colony UC Sonowaller 2. 0 1 0 0 6‐Mar Measles Jaffarabad Town area of Usta Mohammad 2 0 0 0 8‐Mar Measles Jamshoro Gharibabad KotriTaluka Kotri 0 0 1 0 4‐Mar Measles Kech Village Shahitump, UC Gokdan 0 1 0 0 8‐Mar Measles Jamshoro Village Palandi, site area, UC A.B Shoro 0 1 0 0 6‐Mar Measles Khuzdar Masjid road UC Lizo Tehsil Khuzdar 0 0 1 0 7‐Mar Measles Khuzdar killi Sher jan, UC & Tehsil Wadh 1 0 0 0 5‐Mar Measles Karachi daryaabad, near Noorani Masjid 1 1 0 0 5‐Mar Typhoid Ziarat Jungle Bandat, UC Kach, Tehsil Ziarat 0 2 0 1 6‐Mar Measles Karachi Gali Number 1, Kumhar waro 1 0 0 0 Alerts: Province Punjab 6‐Mar Measles Karachi Hazara Colony, Lyari town 1 0 0 0 Date Disease District Area <5M >5M <5F >5F 7‐Mar Measles Karachi Masjid Quarter, Tall wali gali 0 0 1 0 6‐Mar AD Bhakkar BHU Hassan Shah, UC Angra 14 6 13 7 8‐Mar Measles Karachi Hill area, Chanesar goth, Jamshed town 0 1 2 0 5‐Mar AD Layyah DHQ Layyah, UC Urban2, Tehsil Layyah. 0 27 0 20 6‐Mar Measles Larkana Nazar Muhalla near Police Chawki 1 0 0 0 5‐Mar AD R Y Khan Nawazabad, Tehsil Sadiqabad 6 11 7 16 10‐Mar Measles Larkana Ali abad Muhalla 0 0 1 0 7‐Mar AD R Y Khan Dera Faridi, Tehsil Liaqatpur 10 14 9 18 8‐Mar Measles Matiari Village Ghulam Ali Laghari 1 1 0 0 7‐Mar AD R Y Khan Zamin Shah, Tehsil Liaqatpur 6 10 7 13 10‐Mar Measles Mirpur Khas Village Darya khan kaloi 3 0 0 1 5‐Mar AJS Lahore Ghamay Shah Ravi Town Lahore 0 1 0 2 9‐Mar Measles N Feroze Village ghulam Abas solangi 0 1 0 0 7‐Mar AJS Lahore Walton Road Lahore 0 2 0 1 5‐Mar Measles Q Shahdadkot Bhatti Mohalla behind Wapda office 1 0 0 0 6‐Mar ARI Bhakkar BHU Barkat Wala, UC Daggar Qureshi 1 22 3 17 8‐Mar Measles Q Shahdadkot Nomades, behind Lalu Raunk 2 3 1 0 6‐Mar ARI Mianwali BHU Toll Bangi Kheel 33 11 49 17 9‐Mar Measles Q Shahdadkot Taqee Imam bargha Mohalla 0 2 0 0 8‐Mar ARI Mianwali BHU Shadia 21 9 29 7 6‐Mar Measles Sukkur BHU newpind & Haidery muhalla 0 0 4 0 9‐Mar ARI Muzaffargarh Qandrani Mohallah, Dasti Wala 11 26 8 19 7‐Mar Measles Sukkur BHU newpind & Chacher muhalla 0 1 0 0 5‐Mar ARI R Y Khan Ahmedpur Lamma, Tehsil Sadiqabad 51 45 43 68 5‐Mar Measles T M Khan Village Fateh khan Lund 1 0 0 0 5‐Mar ARI R Y Khan Nawazabad, Tehsil Sadiqabad 52 112 67 98 7‐Mar Measles T M Khan Dars Muhalla, Rajo Khanani 1 0 0 0 6‐Mar ARI R Y Khan Chak 1 P , Jetha Bhutta, Tehsil Khanpur 34 67 45 78 7‐Mar Measles Thatta Village Adam Mallah 6 2 6 0 6‐Mar ARI R Y Khan Chak 94 NP, Tehsil Khanpur 33 41 36 39 8‐Mar Measles Thatta Kachi Abadi Near Badshahi Masjid 1 1 0 1 7‐Mar ARI R Y Khan Chak 25 A, Tehsil Liaqatpur 32 24 25 48 7‐Mar ARI Rajanpur THQ Jampur, UC Jampur Urban 189 41 173 33 9‐Mar Measles Thatta Village Ahmed Amdani 0 0 1 3 5‐Mar AWD Layyah BHU Lohanch Nasheeb 2 3 2 1 9‐Mar Measles Thatta Village Juho UC Gahro taluka Ghorabari 1 0 1 0 7‐Mar BD Mianwali RHC Daudkheel 4 0 4 0 4‐Mar NNT Ghotki village Abdullah Ghoto UC Hussain Beli 1 0 0 0 8‐Mar DHF Lahore Iqbal Town 0 1 0 0 8‐Mar NNT Ghotki Village Jumo Bhutto 0 0 1 0 9‐Mar DHF Rajanpur Band Road Rajanpur, UC Rajanpur 0 0 0 1 9‐Mar NNT Ghotki village Jamal chachar 1 0 0 0 6‐Mar Leishmaniasis Mianwali BHU Vanjaree 1 2 0 4 9‐Mar NNT Q Shahdadkot Village Jarwar Ghulam Mustafa 1 0 0 0 7‐Mar Measles Chakwal LRH Peshawar (Village Chungi Jhelum) 1 0 0 0 7‐Mar NNT Shikarpur Village chohaan uc chak taluka lakhi 1 0 1 0 6‐Mar Measles D. G. Khan Block 16 Urban DGKhan 0 1 0 0 9‐Mar Pertussis Dadu Ground Makhdoon talib Moula School 0 1 1 0 8‐Mar Measles D. G. Khan Chanan Cowk Block 45 uc 1 1 0 1 2 9‐Mar Pertussis Dadu Village Chutto Mastoi, Dadu 0 1 1 2 8‐Mar Measles D. G. Khan Shahzada Sultan Town uc 2 1 1 1 2 7‐Mar Pertussis Ghotki Village Khuda Buksh Mangrio 10 5 10 8 9‐Mar Measles D. G. Khan opposite Generation school uc 2 1 0 0 0 8‐Mar Pertussis Ghotki Village Abdul Ghani Bozdar 3 1 5 0 4‐Mar Measles Lahore Village Hanjarwal Multan Road Lahore 0 1 0 0 8‐Mar Pertussis Ghotki Village Abdul Mir Bahar 0 3 1 0 8‐Mar Measles Mianwali Shahnawaz wala, Chashma 1 0 0 0 7‐Mar Pertussis Hyderabad GOR Colony, Latifabad # 01 1 3 1 1 8‐Mar Measles Muzaffargarh Cheena Basti, Near Fareed Acedamy 0 1 0 0 10‐Mar Pertussis Matiari Piyaro Lund city taluka Jhando Mari 0 0 1 0 8‐Mar Measles Muzaffargarh Farid Colony, Near Boys Degree College 0 0 0 1 9‐Mar Pertussis Q Shahdadkot Muskeen Shahd Mohalla 0 0 3 0 8‐Mar NNT Lahore Kot lakhPat Lahore 1 0 0 0 7‐Mar Pertussis Sanghar Village Chak # 23 0 9 3 6 9‐Mar NNT Multan Ranawhain basti people wali 1 0 0 0 7‐Mar Pertussis Sukkur GMC Hospital 2 0 1 0 8‐Mar NNT Rajanpur Basti Abdul Karim mazari 1 0 0 0 7‐Mar Pertussis Thatta Village Haji Rasool Bux Brohi 0 0 1 3 9‐Mar Pertussis D. G. Khan Basti Litra uc Litra 1 0 0 0 6‐Mar Scabies Muzaffargarh Mohallah Shah Wala, UC Daira Din Panah 4 23 7 12 8‐Mar Pertussis Thatta Village Khameeso Khan Pathan 2 3 8 2 5‐Mar Scabies R Y Khan Ahmedpur Lamma, Tehsil Sadiqabad 9 19 13 26 6‐Mar Scabies Badin Village Muhammad Sadiq Jat 0 8 1 8 6‐Mar Scabies R Y Khan Chak 25 A, Tehsil Liaqatpur 6 11 5 13 7‐Mar Scabies Badin Village Murad Ali Shah 3 15 3 21 6‐Mar Tetanus Lahore Youhanabad Lahore 0 1 0 0 8‐Mar Scabies Q Shahdadkot Village Gogharo , UC Gogharo 1 8 0 9 6‐Mar Typhoid Layyah RHC Chowk Azam, UC Chowk Azam City 0 0 0 3 5‐Mar Scabies Umer Kot Karia Para, UC Nabisar 2 5 4 3 5‐Mar Typhoid Mianwali RHC Kammar Machani 20 25 18 21 6‐Mar Typhoid Hyderabad Latiabadabad Unit#08 0 0 2 1 7‐Mar Typhoid Mianwali BHU Thathi 0 3 0 1 6‐Mar Typhoid Larkana Village Mithal Chandio, UC Akil 0 0 0 2 7‐Mar Typhoid Mianwali RHC Daudkheel 3 4 3 4 9‐Mar Typhoid Larkana Ayoob colony City Larkana 0 2 0 1 6‐Mar Typhoid Muzaffargarh THQ Kotaddu, Tehsil Kotaddu 0 1 0 1 9‐Mar Typhoid Larkana Village sultan shaikh 0 1 0 1 7‐Mar Typhoid Muzaffargarh Basti Bakhshey Wala, UC Rohilanwali 1 1 0 1 7‐Mar Typhoid Tharparkar Village Sajaee, UC Sobhiar 0 4 1 1 7‐Mar Typhoid Muzaffargarh Near Jamia Masjid, Urban Seerpur 0 2 0 1 5‐Mar Typhoid Umer Kot Al Faisal colony, UC Nasibar 1 0 1 1 7‐Mar Typhoid Muzaffargarh Rohilanwali Adda, Khangarh, MZG 0 1 0 1 5‐Mar Typhoid Umer Kot Prem Nagar colony, UC Nasiber 0 0 0 3 7‐Mar Typhoid Rajanpur THQ Jampur, UC Jampur Urban 0 2 0 4 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. 10 ( 4 to 10 March 2012) Table‐1: Leading causes of seeking health care in districts, Wk‐31, 2010 to Figure‐2: Number of alerts by disease, week 10, 2012 Wk 10, 2012, compiled from weekly reports

Number of 100 Diseases 94 Consultations 90 Acute respiratory infection 14,454,927 (23%) 80 70 Skin diseases 6,258,590 (10%) 60 50 Acute diarrhoea 5,607,572 (9%) 40

30 22 Bloody diarrhoea 493,251 (<1%) 17 14 20 12 11 9 8 5 Suspected malaria 3,776,062 (6%) 10 3 2222 0 Unexplained fever 2,359,656 (4%) Total consultations 62,764,062 Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response 2010 2011 2012 (up till week 10) Total Disease A O A O A O A O Acute watery diarrhoea 209 85 1350 543 63 2 1622 630 Acute jaundice syndrome 5 2 51 17 30 2 86 21 Bloody diarrhoea 10 1 98 20 27 3 135 24 Dengue fever 81 32 785 111 12 1 878 144 Measles 48 6 1710 91 664 19 2422 116 Pertussis 1 0 287 81 143 47 431 128 NNT + tetanus 5 0 399 0 158 0 562 0 Malaria 12 7 131 88 15 4 158 99 Leishmaniasis 1 0 298 33 197 22 496 55 Others 75 11 643 69 255 33 973 113 Total 447 144 5752 1053 1564 133 7763 1330 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • 448 health facilities from 17 districts of Khyber Pakhtunkhwa reported to DEWS on weekly basis with 50 AD BD ARI S. Malaria a total of 114,325 patients consultations in week 10, 45 2012. 40 35 • 63 alerts were reported in week 10; Altogether 44 for 30 25

Measles; 11 for Leishmaniasis; 2 each for AWD, Diph- Percentage theria and NNT; while 1 each for Pertussis and Sca- 20 bies. 15 10 • No outbreak for any disease was identified from any 5 0 1 3 5 7 9 area in Khyber Pakhtunkhwa. 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

wk wk wk wk wk wk wk 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 • 437 health facilities from 23 districts in Sindh reported on weekly basis to DEWS with a total of 249,642 patient 50 AD BD ARI S. Malaria consultations in week 10, 2012. 45 40 • 66 alerts were reported; Altogether 30 for Measles, 12 35 for Pertussis; 7 for Typhoid; 5 each for AWD and NNT; 30

4 for Scabies; 2 for Leishmaniasis; while 1 for Bloody Percentage 25 diarrhoea. 20 15 • 7 outbreaks, 4 for Pertussis; while 1 each for Measles, 10 AWD and Typhoid were identified and appropriate 5 0 9 7 5 3 1 9 7 5 3 1

measures were taken. 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

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 Punjab. wk wk 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 • 394 health facilities from 18 districts in Balochistan reported to DEWS, with a total of 62,470 patient con- 50 AD BD ARI S. Malaria sultations. 45 40 • 21 alerts were reported in week 10 from Balochistan; 35 Altogether 7 each for Leishmaniasis and Measles; 2 30 each for ARI and Malaria; while 1 each for AWD, BD 25 Percentage and Typhoid. 20

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

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 Province Gilgit Baltistan:

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

50 • 33 health facilities from 4 districts in Gilgit Baltistan AD BD ARI S. Malaria 45 reported to DEWS in week 10, with a total of 12,251 40 patient consultations. 35 30 • No alert was received for any disease from any area in 25

Gilgit Baltistan. Percentage 20 15 10 5 0 1 2 3 4 5 6 7 8 9

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 10 48 49 50 51 52

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

• 128 health facilities from 10 districts reported to DEWS in this • 43 health facilities from 3 agencies reported from FATA in week with a total of 25,149 patient consultations. this week, with a total of 8,111 patient consultations.

• 1 alert/outbreak for Leishmaniasis was identified and appro- • 3 alerts for Measles were reported this week and appropriate priate measures were taken. measures were taken.

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

20 Percentage 20

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

10 10 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 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 47 48 49 50 51 52 42 43 44 45 46 47 48 49 50 51 52

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