Disease Early Warning System and Response in Pakistan

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 3, Issue 3, Wednesday 25 January, 2012

Highlights Priority diseases under surveillance in DEWS Epidemiological week no. 3 (15 to 21 January, 2012) Acute (Upper) Respiratory Infection • In week 3, 2012, total 75 districts including 1 agency provided surveillance data to the DEWS (URTI) on weekly basis from around 1,554 health facilities. Data from mobile teams is reported through Pneumonia sponsoring BHU or RHC. Suspected Diphtheria Suspected Pertussis Acute Watery Diarrhoea • A total of 500,490 consultations were reported through DEWS of which 25% were acute Bloody diarrhoea respiratory infections (ARI); 5% were Skin disease; 6% were acute diarrhoea; and 4% were sus‐ Other Acute Diarrhoea pected malaria. Suspected Enteric/Typhoid Fever Suspected Malaria Suspected Meningitis • A total of 141 alerts with 8 outbreaks were reported: Altogether 69 alerts for Measles; 20 Suspected Dengue fever for Leishmaniasis; 17 for Neonatal tetanus; 10 for Pertussis; 9 for AWD; 4 for Acute Jaundice Suspected Viral Hemorrhagic Fever Syndrome; 2 each for Bloody diarrhoea and DHF; while 8 for others communicable diseases. Pyrexia of Unknown Origin Suspected Measles Suspected Acute Viral Hepatitis • In week 3, 2012, two new type‐1 polio cases, one each from Balochistan (Quetta district) Chronic Viral Hepatitis and Sindh (Mirpur Khas district). As of 23rd January, the total number of polio cases in 2012 is Neonatal Tetanus three; from two infected districts. Acute Flaccid Paralysis Scabies Cutaneous Leishmaniasis Others

Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐3, 2012.

50 AD BD ARI S. Malaria 45

Percentage 25

0 1 3 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

Table 1: Most common communicable diseases syndromes reported in 2011, by province

Disease Wk-48 Wk-49 Wk-50 Wk-51 Wk-52 Wk-1 Wk-2 Wk-3

Acute respiratory infection 242,844 (27%) 192,900 (27%) 241,869 (28%) 240,042 (29%) 215,219 (30%) 90,563 (27%) 107,692 (27%) 126,941 (25%)

Skin diseases 77,057 (9%) 58,406 (8%) 69,079 (8%) 68,422 (8%) 55,185 (8%) 19,737 (6%) 19,582 (5%) 24,370 (5%)

Acute diarrhoea 65,718 (7%) 52,625 (7%) 61,478 (7%) 57,942 (7%) 49,544 (7%) 21,574 (6%) 23,844 (6%) 26,878 (5%)

Bloody diarrhoea 4,912 (0.54%) 4,556 (0.64%) 4,856 (0.57%) 4,332 (0.52%) 4,257 (0.59%) 1,492 (0.44%) 2,204 (0.55%) 2,104 (0.42%)

Suspected malaria 63,826 (7%) 47,753 (7%) 52,040 (6%) 50,480 (6%) 39,991 (6%) 13,887 (4%) 15,050 (4%) 19,482 (4%)

Total consultation 904,948 709,4184 856,582 835,260 717,926 340,073 403,874 500,490

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

• The above table provides the total consultations and proportional morbidity of five disease syndrome. Proportional mor‐ bidity of ARI is highest in KP while acute diarrhoea is highest in Sindh and Balochistan.

• Proportional morbidity of suspected malaria were very high for the year at 9% in Balochistan and 6% in Sindh (Please see provincial trends graphs).

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. 3 (15 to 21 January, 2012) Previous week's (2/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for Bloody diarrhoea, 3 cases were reported from BHU Manakarai. Stool sample was taken and sent to Khyber NIH. Water samples were tested and found to be contaminated. LHWs were involved in active case finding 2 9‐Jan BD Pakhtunk‐ Haripur Village Manakarai 0 3 1 1 more cases were found. Aqua tabs were distributed in the community for disinfection of household water. hwa Health and hygiene sessions were conducted. EDO health was informed of the cases Village Cheejpur, UC Alert for probable Pertussis, 14 suspected cases were found in village, vaccination is not regular, health 12‐Jan Pertussis Sindh Dadu Chorr Qambar, Taluka 4 1 8 1 education imparted, 1 Throat sample taken, EDOH, THO and EPI focal person informed. K.N.Shah Village Long Khoso, UC Alert for probable Pertussis, 7 suspected cases were found in village, Vaccination status is very poor, health 12‐Jan Pertussis Sindh Dadu 2 0 3 2 Gozo, Taluka K.N Shah education imparted, 1 Throat sample taken, EDOH, THO and EPI focal person informed. Village Sangrano, UC Alert for probable Pertussis, 7 suspected cases were found in village, health education imparted, area was 12‐Jan Pertussis Sindh Sanghar Chotiyaryoon, Taluka 0 4 0 3 partially vaccinated, Erythromycin and Cough syrup provided to cases and contacts and EDOH informed. Sanghar

Alert for Typhoid from Islamabad for Haripur district. A case of AJS and with Widal positive from village Kot Najibullah. During active surveillance 13 more suspected cases were identified. Medicines were provided to Khyber the CD. 14 LHWs were involved in active case finding and response. 6 water samples were taken and 4 of 12‐Jan Typhoid Pakhtunk‐ Haripur Village Kot Najibullah 0 8 1 6 them were contaminated. 10,000 aqua tabs were distributed in 2 days between 287 houses. Filters and soaps hwa were also distributed. Health and hygiene sessions were also conducted involving LHWs. EDO health was informed of the outbreak. Public Health Engineering has also been informed and intervention is planned for current week Current week's (3/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for suspected cases of Dengue hemorrhagic fever reported from Lahore. The cases were investigated and blood sample was taken and sent to lab testing and found positive. The cases were kept in isolation ward Mayo Hospital ‐ Ravi of Teaching hospital. LLINS applied around the bed to prevent spread of infection. There is no Travel History 16‐Jan DHF Punjab Lahore 0 15 0 1 Town of patient. WHO SO along with, CDCO,DDHO, and entomologist visit the area, Vector Surveillance was carried out. Mechanical Eradication of larva was done successfully. Health education session was given to the com‐ munity, the area would be visited again for follow up.

Alert for Typhoid, 10 cases of enteric fever have been reported from Khalabut Township. Blood sample of 2 Khyber patients were taken and found positive for typhidot. Previous alerts have indicated contaminated water and 17‐Jan Typhoid Pakhtunk‐ Haripur Khalabut Township 1 6 0 3 leaked distribution system are the sources of the outbreaks health and hygiene sessions have been conducted hwa for the LHWs which will be replicated in the community. TMA Khalabut was involved and Cleaning and Chlorination of tanks was undertaken. EDO Health was informed of the cases.

Alert for probable Pertussis, 5 suspected cases including 1 death investigated at DHQH. Communication was Jamboo UC Zeedi Tehsil made with DDHO, during active surveillance 20 more cases were found, provided symptomatic treatment 17‐Jan Pertussis Balochistan Khuzdar 12 3 8 2 Khuzdar with health education. 2 swabs were collected and sent to NIH. 51 children were vaccinated for Measles and Pentavalent by EPI team while only 1 child found with BCG Scar. Alert for 6 cases of Leishmaniasis were reported from Different areas of Jhal Magsi village. Each patient was 18‐Jan Leishmaniasis Balochistan Jhal Magsi Village JhalMagsi 1 2 2 1 investigated separately. Medicines were provided and Health education was given to community. DHO was informed about outbreak and requested for preventive measures. Alert for 7 cases of suspected cutaneous Leishmaniasis were reported from one village. The cases were from same family and had a history of travel to Balochistan for harvesting season 4 months ago. The cases were treated with topical and parental antibiotics but were not cured. 2 samples of scrapings were collected from Rahim Yar Nawazabad, Tehsil 18‐Jan Leishmaniasis Punjab 0 2 1 4 the cases and sent to SZH laboratory. The patient were referred to Leishmaniasis treatment center at RHC Khan Sadiqabad Zahirpir. Patients were provided injection Glucantime at RHC. Patients were also prescribed polyfax cream to cover the lesions. The information shared with CDCO and Entomologist Health Department Rahim Yar Khan for sampling and control of vector and permethrin fogging is scheduled. Alert for 6 suspected cases of Leishmaniasis were investigated at DHQH. Cases were reported from different 19‐Jan Leishmaniasis Balochistan Sibi DHQH Sibi 1 0 1 4 areas. There is no travelling of history. Injection Glucantime was provided and advised to come regularly at DHQ Hospital for treatment. Alert for Bloody diarrhoea, 6 suspected cases were admitted in hospital, during active surveillance samples Nagori Mohalla, UC were not collected because the patients were already on antibiotics, health education imparted, Aqua tabs, 20‐Jan BD Sindh Mirpur Khas 4 0 2 0 Jhudo, Taluka Jhudo Zinc tabs, ORS, Jerry cans, Nerox filters, Hygiene kits and IEC material distributed, informed EDOH and DSM‐ PPHI. Alert for probable Diphtheria was received from LRH Peshawar. Patient had history of fever for 10 days, Khyber throat swelling for 5 days and difficulty in swallowing for 3 days. 80,000 IU ADS were provided to the patient. Village Ahmad Nagar 20‐Jan Diphtheria Pakhtunk‐ Nowshera 0 0 1 0 Throat swab was not possible due to serious condition of patient. According to the father patient was fully Kheshki Bala hwa immunized. Health education session given on prophylaxis of diphtheria and prevention of spread of infec‐ tion. Course of erythromycin was prescribed to the contacts. Information shared with EPI.

Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

As of 23 January, 2012, the total number of polio cases confirmed by the laboratory is 3 (type‐1) from 2 districts/towns/tribal agencies and areas. 1st polio case (type‐1) with onset in 2012 reported from Balochistan (Quetta).

Cases 2011 Cases 2012 Province P1 P3 P1 P3 Punjab 9 ‐ ‐ ‐ Sindh 33 ‐ 1 ‐ Khyber Pakhtunkhwa 23 ‐ ‐ ‐ FATA 56 2 ‐ ‐ Balochistan 73 ‐ 2 ‐ AJ&K ‐ ‐ ‐ ‐ Gilgit‐Baltistan 1 ‐ ‐ ‐ Islamabad ‐ ‐ ‐ ‐ Total 195 2 3 ‐ 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]. 02 Special Bulletin: DEWS, Pakistan, Week no. 3 (15 to 21 January, 2012) Current week's Alerts: Province Khyber Pakhtunkhwa Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 16‐Jan AJS Haripur Khalabut Township‐CD KTS 3 1 3 0 1 18‐Jan AJS Benazirabad Village Brohi stop, UC Kump Lema 0 1 0 2 20‐Jan Diphtheria Nowshera Village Ahmad Nagar Kheshki Bala 0 0 1 0 18‐Jan AWD Badin Village Allah Buksh Dall, UC Haji Sawan 1 1 2 0 19‐Jan Leishmaniasis Mansehra Hareer Payen UC Nikka Pani 0 0 0 1 16‐Jan AWD Hyderabad Gareebabad Near Benazir school 1 0 0 0 17‐Jan Measles Abbottabad Urban Kehal 0 0 1 0 16‐Jan AWD Matiari Village Poratho, Taluka Matiari 0 0 1 0 17‐Jan Measles Charsadda Shabara 1 0 0 0 17‐Jan AWD Matiari City Matiari, Taluka Matiari 0 0 1 0 18‐Jan Measles Charsadda Dab banda 1 0 0 0 18‐Jan AWD T Allah Yar Village URS Otho, UC 2 Taluka Chambar 1 0 0 1 15‐Jan Measles D. I. Khan Main Road, Near Ashiq Hotel 0 2 0 0 19‐Jan AWD T Allah Yar Akram Colony Taluka Tando Allahyar 1 0 0 1 19‐Jan Measles D. I. Khan D I KHAN bypass Pull, Qureshi Morr 0 1 0 0 19‐Jan AWD T Allah Yar Village Bachal Sand, UC Dasoori 0 0 0 1 20‐Jan Measles D. I. Khan Marhaba Colony, UC Chehkan 0 0 1 0 21‐Jan AWD Tharparkar Menghwar Paro, UC and Taluka Mithi 1 0 0 1 21‐Jan Measles D. I. Khan House Near Noorani Mosque, Mamrez 1 0 0 0 20‐Jan BD Mirpur Khas Nagori Mohalla, UC Jhudo, Taluka Jhudo 4 0 2 0 21‐Jan Measles D. I. Khan Mohallah Kundi, Near Hafeezullah 1 0 0 0 16‐Jan BD Benazirabad Sono khan Zardari, UC Kazi Ahmed 2 0 2 0 2 21‐Jan Measles D. I. Khan Niazi Chowk, D I Khan (Gypsies) 1 0 0 0 17‐Jan Leishmaniasis N Feroze Ward 6, Bandhi City Jamali Mohalla 0 1 0 0 20‐Jan Measles Haripur Ghazi city, Tehsil Ghazi 1 2 2 1 16‐Jan Measles Dadu Qureshi Mohalla, Shahbaz colony 0 0 0 1 21‐Jan Measles Kohat Noori Bangash Public Health Colony 0 0 1 0 21‐Jan Measles Jamshoro Brohi Para, near Marvi cinema, UC Kotri City 0 1 0 1 16‐Jan Measles Lower Dir Village Kawarey‐Malakand 0 0 2 0 17‐Jan Measles Karachi Khamosh Colony, Liaquatabd Tawn Karachi 1 1 2 0 17‐Jan Measles Lower Dir Village Jaggal‐Darmal, UC Laj book 0 0 0 2 18‐Jan Measles Karachi Hijrat Colony, Saddar tawn Karachi 0 0 4 0 18‐Jan Measles Lower Dir Village Anderey, UC & Tehsil Balmbat 1 0 0 0 17‐Jan Measles Larkana Nazar Muhalla near railway line UC 4 1 0 0 0 18‐Jan Measles Lower Dir Village Bargholey, UC Rabat 1 0 0 0 20‐Jan Measles Mirpur Khas Village Kambhoo Kolhi 4 0 7 1 19‐Jan Measles Lower Dir IDH Peshawar (Lower Dir ) 0 0 1 0 15‐Jan Measles Shahdadkot Village Dafar, taluka Shahdadkot 1 0 0 0 19‐Jan Measles Lower Dir Village Golar‐shontala, UC Samar Bagh 1 0 1 1 15‐Jan Measles Shahdadkot Village Shapar Chadio, UC Boohar 2 1 4 2 19‐Jan Measles Lower Dir Village Kotkay, UC Rabat 1 0 1 0 20‐Jan Measles Shahdadkot Buriro Colony, taluka Kambar 0 0 1 0 20‐Jan Measles Lower Dir Village Sanga Para, UC Miskenay 1 0 1 1 20‐Jan Measles Shahdadkot Village Golo Ganwas, Kambar 0 0 1 0 18‐Jan Measles Nowshera Akora Khattak 0 0 1 0 20‐Jan Measles Shahdadkot Village Khan jo goth near Haji Shah Ismail 0 0 1 0 19‐Jan Measles Nowshera Village Kheshki 1 0 0 0 21‐Jan Measles Shahdadkot Village Chajara, taluka Kambar 0 0 1 0 18‐Jan Measles Peshawar Village Phandu 1 0 0 0 19‐Jan Measles Benazirabad Village Ramzan Dahiri, UC Bhoora 0 0 0 0 19‐Jan Measles Peshawar Mohalla Mahboob Dheri Akhunabad 0 0 0 1 16‐Jan Measles Thatta Hyderi Chawk, Makli Thatta, near DHQ 0 1 0 0 16‐Jan Measles Swabi BHU Zaida, Maghrabi Banda, Tandkohi 3 1 3 0 16‐Jan Measles Thatta Village Khudai, Thatta Ward # 2 1 0 2 0 20‐Jan Measles Swabi Private Clinic, Khadar Banda 1 3 1 2 18‐Jan Measles Thatta Muhammad Faqeer Mallah, Ward # 2 3 4 4 0 16‐Jan Measles Swat Village Dadahar Jabar Shah, UC Koz 1 0 0 0 19‐Jan NNT Dadu Chandio Mohalla Taluka Dadu 1 0 0 0 16‐Jan Measles Swat Village Devli Fazal Abad, UC Devli 0 0 1 0 16‐Jan NNT Ghotki Village Bahadar Soomro, UC Ali Bag, Ghotki 1 0 0 0 17‐Jan Measles Swat Village and UC Tindo Dag 1 0 0 0 21‐Jan NNT Khairpur Village Kalro, UC Mandan 1 0 0 0 17‐Jan Measles Swat Village Kadow Marghuzar 0 0 1 0 17‐Jan NNT Larkana Village Bareja District Jhal Magsi 1 0 0 0 17‐Jan Measles Swat Village Ragistone Velemy 0 1 0 0 17‐Jan NNT Larkana Village Gahi Mahesar, Mehar City 1 0 0 0 18‐Jan Measles Swat Village Afsar Abad Saidu Sharif 0 0 1 0 19‐Jan NNT N Feroze Village Gazi Khan Bhurgiri 1 0 0 0 18‐Jan Measles Swat Village Bara Bandai , Tehsil Kabal 0 0 1 0 21‐Jan NNT Shikarpur Village and UC Gaheja, Shikarpur 1 0 0 0 19‐Jan Measles Swat Village and UC Shamozai Khazan 1 0 0 0 21‐Jan NNT Shikarpur Village Maari, UC Sher Kot, Shikarpur 1 0 0 0 21‐Jan Measles Swat Mohalla Malik Hafiz Qabal 0 0 1 0 18‐Jan NNT Thatta Village Haji Ghani Jat UC Doulat pur 1 0 0 0 21‐Jan Measles Tank Wadana Village 0 1 0 0 17‐Jan Pertussis Badin Nizamani Mohalla, near Jama Masjid 1 2 0 0 16‐Jan NNT D. I. Khan Village Khokar, Daraban Kalan 0 0 1 0 19‐Jan Pertussis Dadu Hakim Laghari Mohalla, New colony 0 0 1 0 16‐Jan NNT Haripur Village Panian 1 0 0 0 16‐Jan Pertussis Hyderabad Latifabad # 11, near Moti Masjid. 0 0 1 0 20‐Jan NNT Lower Dir Village Tangi Shah Gambir, UC Mayar 0 0 1 0 16‐Jan Pertussis Hyderabad Old Wahadat Colony, Kachi Abadi 0 0 1 0 17‐Jan Scabies Haripur Village Dheenda 0 0 0 16 Current week's Alerts: Province Balochistan 17‐Jan Typhoid Haripur Khalabut Township 1 6 0 3 Date Disease District Area <5M >5M <5F >5F Current week's Alerts: Province Punjab 19‐Jan Chicken pox Panjgur UC Tasp Bazar District Panjgur 0 1 2 2 Date Disease District Area <5M >5M <5F >5F 18‐Jan Leishmaniasis Bolan BHU Mashkaf 1 1 1 0 17‐Jan AJS Lahore Sadar Bazar Lahore 0 1 0 2 16‐Jan Leishmaniasis Gwadar RHC Jewani 1 1 0 0 18‐Jan AJS Lahore Malik Park Band road Lahore 0 1 0 2 18‐Jan Leishmaniasis Jhal Magsi Village JhalMagsi 1 2 2 1 17‐Jan ARI Bhakkar BHU Karlu Wala, UC Litten 7 14 9 7 19‐Jan Leishmaniasis Jhal Magsi village Barija UC & BHU Barija 1 2 0 0 20‐Jan ARI Bhakkar RHC Behal, UC Behal 29 59 35 76 21‐Jan Leishmaniasis Jhal Magsi Pach UC Khari CD Kotra 2 0 1 0 16‐Jan ARI Layyah ChakNo.90 MLTDA, UC 90 ML (Tibbi) 5 24 8 32 17‐Jan Leishmaniasis Kech Gulshanabad, malikabad 0 1 0 0 19‐Jan AWD RY Khan Basti Thaheem, mouza Mahand 0 2 0 2 20‐Jan Leishmaniasis Kech UC Koshkalat 0 1 0 0 16‐Jan DHF Lahore Mayo Hospital ‐ Ravi Town 0 15 0 1 20‐Jan Leishmaniasis Kech Village Absar, UC Absar 0 1 0 1 1‐Civil Colony; 2‐Longave Abad; 3‐Damb UC 20‐Jan DHF Lahore Lahore General Hospital 0 2 0 0 16‐Jan Leishmaniasis Khuzdar 0 3 0 1 Hazar Gangi; 4‐Bhit UC Baghbana 19‐Jan Leishmaniasis Bhakkar Kuhawar Kalan city near Railway Line 0 0 1 1 18‐Jan Leishmaniasis Lasbela RHC Winder , Oba Lakhra 0 3 0 0 20‐Jan Leishmaniasis Mianwali Chapri, Issa Kheel 2 0 1 2 16‐Jan Leishmaniasis Nasirabad Ghot Ghulam Rasool U/C Shah pur 0 0 0 1 18‐Jan Leishmaniasis RY Khan Nawazabad, Tehsil Sadiqabad 0 2 1 4 17‐Jan Leishmaniasis Nasirabad Ghot Solangi U/C Jhudair South DMJ 0 1 0 0 16‐Jan Measles Mianwali Mohallah Islamabad,Wan Buchraan UC 1 0 0 0 17‐Jan Leishmaniasis Nasirabad Hat Mahhla Town area Dera Murad Jamali 0 0 1 0 18‐Jan Measles Mianwali Dera Khano Khellan wala,Gandha, Isa Khel 0 0 0 1 20‐Jan Leishmaniasis Nasirabad Ghot Faiz Mohd Jamali U/C Quba Sher Khan 0 0 1 1 18‐Jan Measles Mianwali Near Masjid Phool Shan,Pai Khel 0 0 1 1 19‐Jan Leishmaniasis Sibi DHQH Sibi 1 0 1 4 19‐Jan Measles Mianwali Qadirabad,naeen abadi Mianwali 1 0 0 0 18‐Jan Measles Bolan Village Mashkaf 0 0 1 0 19‐Jan Measles Muzaffargarh Basti Sheikh Mehmood Wali 0 0 1 0 19‐Jan Measles Bolan Village Khanwa 0 0 0 1 17‐Jan Measles RY Khan Chak 103‐1L, UC Bahisti 0 2 0 0 20‐Jan Measles Khuzdar Kehn UC Norgam Tehsil Zehri 1 0 0 0 17‐Jan Measles Rajanpur Manjootha Colony, near Bilal Mosque 0 0 1 0 16‐Jan Measles Lasbela Peer Muhammad Goth, Kanraj 3 4 0 6 18‐Jan NNT Bhakkar Mohallah Mosiliyaan Wala Dullewala 0 0 1 0 17‐Jan Measles Lasbela Kachi abadi near jute Mill Akram colny 0 0 1 0 16‐Jan NNT Rajanpur Basti Shekhani, Near Head Hamid 0 0 1 0 18‐Jan Measles Lasbela Akram Colony UC Baroot 1 0 0 0 15‐Jan Pertussis D. G. Khan Pitafee UC Jhakkar Imam Shah 1 0 0 0 19‐Jan Measles Panjgur UC Chitkan District Panjgur 2 0 2 0 20‐Jan Pertussis D. G. Khan Thata Leghari UC Kot Qaisrani 0 0 2 0 20‐Jan Measles Quetta Sandeman Provincial Hospital Quetta 0 0 2 0 Current week's Alerts: ICT; AJK; FATA; GB 18‐Jan Mumps Jhal Magsi Dadh UC Barija BHU Barija 0 2 0 3 Date Disease District Area <5M >5M <5F >5F 17‐Jan NNT Nasirabad DHQ Hospital Dera Murad Jamali 3 0 0 0 Village Chinagai, Tehsil Mamoond 16‐Jan Measles Bajaur Agency 1 0 2 0 19‐Jan NNT Quetta neonatal unit, BMCH, 1 0 0 0 (Wara) 20‐Jan Pertussis Chagai Killi Qasim Khan U/C Town Dalbandin 1 1 1 0 18‐Jan Measles Bajaur Agency Village Chilargam, Tehsil Salarzai 1 0 0 0 17‐Jan Pertussis Khuzdar Jamboo UC Zeedi Tehsil Khuzdar 12 3 8 2 20‐Jan NNT Bajaur Agency Village Tang Khata, Tehsil Khar 1 0 0 0 21‐Jan Pertussis Nasirabad Ghot Moj Din Bughti U/C Quba Sher Khan 2 0 0 0 19‐Jan Measles Astore CH Eidgha 1 0 0 0 21‐Jan Pertussis Nasirabad Ghot Soofi Jamali Rabbi beroon DMJ 1 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. 3 (15 to 21 January, 2012) Table‐1: Leading causes of seeking health care in districts, Wk‐31, 2010 to Figure‐2: Number of alerts by disease, week 3, 2012 Wk 3, 2012, compiled from weekly reports Number of Diseases 80 Consultations 69 70 Acute respiratory infection 13,431,283 (23%) 60

Skin diseases 6,065,020 (10%) 50 alerts

of 40 Acute diarrhoea 5,389,558 (9%) 30 Number 20 Bloody diarrhoea 474,338 (1%) 17 20 10 9 10 Suspected malaria 3,613,779 (6%) 4 3 2211111 0 Unexplained fever 2,222,454 (4%) Total consultations 58,610,323 Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response 2010 2011 2012 (up till week 3) Total Disease A O A O A O A O Acute watery diarrhoea 209 85 1350 543 16 0 1575 628 Acute jaundice syndrome 5 2 51 17 10 2 66 21 Bloody diarrhoea 10 1 98 20 4 2 112 23 Dengue fever 81 32 785 111 2 1 868 144 Measles 48 6 1710 91 136 5 1894 102 Pertussis 1 0 287 81 26 6 314 87 NNT + tetanus 5 0 399 0 49 0 453 0 Malaria 12 7 131 88 3 2 146 97 Leishmaniasis 1 0 298 33 52 5 351 38 Others 75 11 643 69 28 6 746 86 Total 447 144 5752 1053 326 29 6525 1226 Province Khyber Pakhtunkhwa: Figure-3: Trend of priority communicable diseases, province KPK • 366 health facilities from 13 districts of Khyber Pakhtunkhwa reported to DEWS on weekly basis with 50 AD BD ARI S. Malaria a total of 80,598 patients consultations in week 3. 45 40 • 43 alerts were reported in this week; Altogether 35 for 35 Measles; 3 for NNT; while 1 each for AJS; Diphtheria; 30 Leishmaniasis; Scabies and Typhoid. 25 Percentage 20 • 2 outbreaks, 1 each for Diphtheria and Typhoid re- 15 ceived this week and appropriate measures were taken. 10 5 0 1 3 5 7 9 1 3

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

Province Sindh: Figure-4: Trend of priority communicable diseases, province Sindh • 390 health facilities from 23 districts in Sindh reported

on weekly basis to DEWS with a total of 194,571 patient 50 AD BD ARI S. Malaria consultations in this week. 45 40 • 41 alerts were reported; Altogether 16 for Measles, 9 for 35 30 Neonatal tetanus; 8 for AWD; 4 for Pertussis; 2 for 25 Percentage Bloody diarrhoea; while 1 each for Leishmaniasis and 20 Acute Jaundice Syndrome. 15 10 • 1 outbreak for Bloody diarrhoea was also received and 5 0 1 3 1 3 5 7 9

appropriate measure was taken. 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

10 • Two outbreaks, 1 each for DF and Leishmaniasis were 5 reported and appropriated measures were taken. 0 1 3 5 7 9 1 3

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

Province Balochistan: Figure-6: Trend of priority communicable diseases, province Balochistan • 322 health facilities from 17 districts in Balochistan reported to DEWS, with a total of 60,515 patient consul- 50 AD BD ARI S. Malaria tations. 45 40 • 31 alerts were reported in this week from Balochistan; 35 Altogether 15 for Leishmaniasis; 8 for Measles; 4 for 30 Pertussis; 2 for NNT; while 1 each for Chicken Pox 25 Percentage and Mumps. 20

15 • Three outbreaks, 2 for Leishmaniasis and 1 for Pertus- 10 sis were received and appropriate measures were taken. 5 0 1 3 5 7 9 1 3

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 Province Gilgit Baltistan:

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

50 • 17 health facilities from 4 districts in Gilgit Baltistan 45 AD BD ARI S. Malaria reported to DEWS in this week; with a total of 4,450 patient consultations. 40 35 30 • 1 alert for Measles was reported this week and appro- 25 priate measure was taken. 20 Percentage • No outbreak was received this week from any area in 15 Gilgit Baltistan. 10 5 0 1 2 3

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

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

• 95 health facilities from 9 districts reported to DEWS in this • 20 health facilities 1 agency reported from FATA in this week with a total of 16,393 patient consultations. week, with a total of 3,958 patient consultations.

• No alert or outbreak was received this week from any area in • 3 alerts; 2 for Measles and 1 for Neonatal tetanus reported AJ&K. this week and appropriate measure 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 1 2 3

7 8 9 1 2 3 47 48 49 50 51 52 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 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