Epidemiological Week No. 44 (28 Oct-3 Nov 2006) 9 Nov 06/ Vol

Epidemiological Week No. 44 (28 Oct-3 Nov 2006) 9 Nov 06/ Vol. 50/ DEWS 2006-44

Reporting Units...... 2 Total number of consultations ...... 2 DEWS Data, Epidemiological Week N0 44 2006...... 3 DEWS Data, Monthly Summary (Epidemiological Weeks N0 41-44) ...... 4 Acute Watery Diarrhoea ...... 5 Bloody Diarrhoea...... 6 Acute Jaundice Syndrome...... 6 Malaria ...... 7 Measles ...... 7 Acute Respiratory Infection ...... 8 Other Reportable Diseases and Conditions ...... 8 Outbreak Alert and Response ...... 9 Number of reported cases and deaths per District, AJK ...... 11 Number of reported cases and deaths per District, NWFP ...... 12 Muzaffarabad Picture by Dr. Hammam Elsakka

In the past month (Epidemiological In week 44, there was three deaths from weeks 41-44 inclusive), 120,870 health acute respiratory infection. events under surveillance were reported including 61 deaths Six suspected cases of meningitis reported this week, five cases from This week, there were 291 reporting Muzaffarabad district and one case units contributing to the report. from Bagh district

In week 44, Total 85,742 consultations This week, there were Seven hundred were reported, with 10 deaths and ninety-four Malaria cases reported this week.

The Weekly Morbidity and Mortality Report (WMMR) is published by the Ministry of Health of Pakistan (MOH) and the World Health Organization (WHO). The WMMR is built on surveillance data that health service providers and NGOs transmit on a weekly basis from health facilities and hospitals in those areas affected by the earthquake that struck Pakistan on 8 October 2005.

The WMMR objectives are to monitor the trend of health conditions over a period of time and provide vital information to all health partners. The WMMR is only a snapshot of the health conditions in those facilities where events are registered and data collected and does not necessarily reflect the situation from other health facilities. The WMMR is a publication that has been developed for emergencies and previously used in other areas such as the Darfur Crisis.

The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, House #6, Street #20, F-7/2, Islamabad, Pakistan For More Information, please contact: Dorcas Taylor, Epidemiologist, WHO/EHA/Pakistan; [email protected] or Dr. Birjees Mazher Kazi, Chief, Public Health Laboratories Division, NIH MOH; [email protected] or WHO Webpage: http://www.whopak.org/disaster WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44

Reporting Units

The number of sites able to report increased by 49 this week and the reporting timelines of the DEWS systems has also increased at the current Epidemiological week compared with week 43. See Table 1 for summary statistics. Table1. Reported heath facilities by district, Earthquake Affected Areas, Pakistan, 28 Oct - 3 Nov 2006. Reporting Health Facilities Area Population 7 – 13 Oct 14 – 20 Oct 21-27 Oct 28 Oct-3Nov Week 41 Week 42 Week 43 Week 44 Muzaffarabad 894,364 100 100 66 80 Bagh 452,532 31 36 35 43 Poonch 633,712 72 67 52 68 Mansehra / Balakot 1,154,804 70 69 64 66 Battagram / Shangla 592,256 38 37 25 34 Total 3,727,668 311(96%) 309(95%) 242(74%) 291(89%)

Total number of consultations

In week 44, there were an increase in the number of reporting sites, and the number of consultations also increased to 85,742. The highest number of consultations by district was in Mansehra, with 24,202 and the lowest was in Battagram, at 6,048. The decline in the number of consultations in week 43 was related to Eid-ul-Fitr leave. A similar drop can be seen in week 2, which corresponded with Eid-ul-Fitr last year.

No. Unit Reporting Units and Consultations No. Consult. 200000 300 Reporting Unit Consultation

250 150000

200

100000 150

100 50000

0 0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44

Week

Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 – 3 Nov 2006.

2 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44

DEWS Data, Epidemiological Week No. 44, 2006

Between 28 Oct to 3 Nov 2006, 85,742 consultations were reported through DEWS. Overall, 22% (61,077) were due to acute respiratory infections (ARI), 8% (21,659) due to acute watery diarrhoea (AWD), 7% (18,858) due to fever of unknown origin (FUO), and 5% (14,147) due to injuries (INJ). ARI accounted for 31% and 19% of consultations in the less than 5 years old and 5 or more years old respectively. All other reportable conditions each represented less than 1% of the total consultations in week 44.

AWD AWD ARI ARI 7% AWD 5% 22% 11% 19% ARI 31% FUO 6% FUO 6% INJ OTH* 5% INJ 44% FUO OTH* OTH* 5% 8% 64% 59% INJ 4% ≥ 5yrs (n=64,414) < 5yrs (n=21,328) All Ages (n=85,742) Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 28 Oct-3 Nov 2006. *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance

DEWS Data, Epidemiological Week No. 43, 2006: Consultations by age

ARI is the single most common reason for children under five to seek a consultation. With cooling weather, the rate of consultation for ARI has increased in almost all districts, but the pattern of increase differs by district. Mansehra and Poonch have seen a gradual increase from a relatively low rate (in comparison to the other districts), while Battagram and Bagh have seen much more fluctuation in their rates, week to week. See figure 3.

45.0 40.0 35.0 BAGH 30.0 BATTAGRAM 25.0 MA NSERA 20.0 years MUZAFFARABAD 15.0 10.0 POONCH 5.0 ARI as a percent of all all of percent a as ARI 0.0 consultations inconsultations children < 5 2006- 2006- 2006- 2006- 2006- 2006- 2006- 38 39 40 41 42 43 44 Week

Figure 3: Trend in ARI in patients under five years old, by district, Earthquake Affected Areas, Pakistan 16 September, – 3 November 2006.

3 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44

DEWS Data, Monthly Summary (Epidemiological Weeks No. 41-44)

In the past four weeks, between 7 Oct to 3 Nov, 2006 (Epidemiological weeks 41-44 inclusive), 120,373 consultations for health conditions under surveillance were reported, out of a total 281,870 consultations. 22% (61,077) of consultations were due to acute respiratory infection (ARI), 8% (21,695) acute watery diarrhoea (AWD), 7% (18,858) unexplained fever (FUO) and 5% (14,147) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 7Oct – 3 Nov 2006. Week WEEK 41 WEEK 42 WEEK 43 WEEK 44 TOTAL CFR% Event C D C D C D C D C D AWD 7793 0 5198 0 3035 1 5669 0 21695 1 0.005 BD 636 0 367 0 228 0 556 0 1787 0 0.000 AFP 1 0 1 0 1 0 0 0 3 0 0.000 MAL 724 0 733 0 282 0 794 0 2533 0 0.000 ARI 19190 3 16543 1 6511 1 18833 3 61077 8 0.013 MES 2 0 1 0 0 0 2 0 5 0 0.000 MEN 3 1 2 0 3 0 6 0 14 1 0.000 JAU 86 0 58 0 30 0 78 0 252 0 0.000 TET 0 0 0 0 2 0 0 0 2 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 5947 0 5337 0 2251 0 5323 1 18858 1 0.005 INJ 4557 0 3919 0 1754 0 3917 0 14147 0 0.000 OTH 52136 21 44991 11 13806 12 50564 6 161497 50 0.031 TOTAL 91075 25 77150 12 27903 14 85742 10 281870 61 RU 311 309 242 291

C – Cases, D – Deaths, AWD - Acute Diarrhoea, BD - Bloody Diarrhoea, AFP - Acute Flaccid Paralysis, MAL – Malaria, ARI - Acute Respiratory Infection, MES – Measles, Men - Meningitis, JAU - Acute Jaundice Syndrome, TET - Neonatal Tetanus, AHF Acute Hemorrhagic Fever, FUO –Unexplained fever, INJ – Injuries, OTH – Others, RU – Reporting Units. Please note data from late reporting in previous weeks has been updated. During the same reporting period 68,348 consultations were reported in the less than 5 years old group, (24% of the total consultations), of which 30% (20,355) were due to ARI, 13% (8,655) due to AWD, 8% (5,662) due to FUO and 4% (2,920) were reported as injuries (INJ). Table 3. Total number of reported cases, deaths and monthly Case Fatality Rate (CFR), less than 5 years old, Earthquake Affected Areas, Pakistan 7Oct – 3 Nov 2006. Week WEEK 41 WEEK 42 WEEK 43 WEEK 44 TOTAL CFR% Event C D C D C D C D C D AWD 2977 0 2298 0 1072 1 2308 0 8655 1 0.012 BD 237 0 123 0 57 0 196 0 613 0 0.000 AFP 0 0 1 0 0 0 0 0 1 0 0.000 MAL 137 0 156 0 47 0 164 0 504 0 0.000 ARI 5795 3 5716 1 2159 1 6685 3 20355 8 0.039 MES 1 0 0 0 0 0 2 0 3 0 0.000 MEN 1 1 2 0 0 0 0 0 3 1 0.000 JAU 24 0 16 0 7 0 13 0 60 0 0.000 TET 0 0 0 0 2 0 0 0 2 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 1759 0 1596 0 685 0 1622 0 5662 0 0.000 INJ 923 0 819 0 330 0 848 0 2920 0 0.000 OTH 9119 6 8222 6 2739 3 9490 4 29570 19 0.064 TOTAL 20973 10 18949 7 7098 5 21328 7 68348 29 RU 311 309 242 291

4 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44

In the current week, there was an increase in the number of cases of AWD with 3,035 last week and 5,669 this week. In the current week, ARI also increased in total number of cases as compared with the previous week, (6,511 last week and 18,833 this week). The weekly proportion of ARI and AWD is shown in figure 4.

% Consultation ARI and AWD percent of total consultations 40 ARI AWD 35 30 25 20 15 10 5 0 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44

Week

Figure 4. Weekly trend of percent of consultations for ARI and AWD, Earthquake Affected Areas, Pakistan, 5 November 2005 - 3 November 2006.

Acute Watery Diarrhoea

In week 44 there were 5,669 cases of AWD reported, with no associated deaths. Several districts had seen a sudden rise in acute watery diarrhea as a percent of all consultations in week 43, however, the rate has fallen again in these districts in week 44, to a rate similar to that seen in week 42. The number of cases in Battagram in week 43 was adjusted considerably, after a data entry error was recognised and fixed. See Figure 5.

18.0 16.0 14.0 BAGH 12.0 BATTAGRAM 10.0 MA NSERA 8.0 MUZAFFARABAD 6.0

consultations 4.0 POONCH 2.0 AWD as a percentAWD of all 0.0 2006- 2006- 2006- 2006- 2006- 2006- 2006- 38 39 40 41 42 43 44 Week

Figure 5: Trend in AWD by district, Earthquake Affected Areas, Pakistan, September 16 – November 3, 2006

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Bloody Diarrhoea

I week 44, there were 556 cases of bloody diarrhoea reported. There were no associated deaths. The rate of bloody diarrhea has been gradually declining since the end of the monsoon season. See figure 6

3.0

2.5

2.0

1.5

1.0 reporting site 0.5

Bloody diarrheaBloody cases per 0.0 2006- 2006- 2006- 2006- 2006- 2006- 2006- 2006- 2006- 2006- 35 36 37 38 39 40 41 42 43 44 Week

Figure 6: Trend in bloody diarrhoea cases per reporting site, Earthquake Affected Areas, Pakistan, 26 August – 3 November 2006

Acute Jaundice Syndrome

In week 44 there were 78 cases of suspected hepatitis, with no associated deaths. Suspected hepatitis is not common in either age group, fluctuating between 0.06 and 0.12 percent of all consultations, however in a majority of weeks since the end of the monsoon, there has been a higher percentage of acute jaundice in patients less than five, as a percent of all consultations within that age group, than in patients five and over. See figure 7.

0.14 0.12 0.10 0.08 <5 0.06 >=5 0.04

within group age 0.02

Suspected hepatitis as a hepatitis a as Suspected 0.00 percent of all of percent consultations 2006- 2006- 2006- 2006- 2006- 2006- 2006- 2006- 2006- 36 37 38 39 40 41 42 43 44 Week

Figure 7: Trend in suspected hepatitis cases as a percent of all consultations within age group, by age group, Earthquake Affected Areas, Pakistan, October 1 – November 3, 2006

6 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44

Malaria

In week 44, there were 794 malaria cases reported, with no associated deaths. Malaria rates, as measured by cases per reporting site, differ considerably by district, with Poonch having the highest rate in week 44, at 5 cases per reporting site, and Mansehra the lowest, and 1.3 cases per reporting site. See figure 8.

6 5 4 3 2 1 0 BAGH BATTAGRAM MANSERA MUZAFFARABAD POONCH Malaria per cases reporting site

District

Figure 8: Malaria cases per reporting site by district, Earthquake Affected Areas, Pakistan, October 28 – November 3, 2006

Measles

There were two cases of suspected measles reported in week 44, both in Battagram district. Though measles cases vary considerably by district, they also vary by tehsil within district. See figure 9.

300

250

200

150

100 Measles cases

0 OGHI ALLAI BAGH DASSU HAJIRA PATTAN HATTIAN DHIRKOT KHAUTTA BALAKOT SHANGLA MANSERA ABBASPUR ATHMUQAM BATTAGRAM RAWALAKOT MUZAFFARABAD BAGH BA TTA GRA M MA NSERA MUZA FFA RA BA D POONCH District and Tehsil

Figure 9: Measles cases by district and tehsil, Earthquake Affected Areas, Pakistan, 15 October 2005 – 3 November 2006.

7 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44

Acute Respiratory Infection

In week 44, there were 18,833 consultations for ARI. There were three associated deaths, one each in Mansehra, Muzaffarabad, and Poonch, all in children under five years old. Though the trend in ARI is very similar between districts, the rate by tehsil varies considerably. Even within a district, different tehsils have very different rates. See figure 10

35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 OGHI ALLAI BAGH HAJIRA DASSU PATTAN HATTIAN BALAKOT DHIRKOT KHAUTTA SHANGLA MANSERA ABBASPUR ARIpercentas a of all consultations ATHMUQAM BATTAGRAM RAWALAKOT MUZAFFARABAD BAGH BATTAGRAM MANSERA MUZAFFARABAD POONCH District and Tehsil

Figure 10: ARI as a percent of all consultations, by district and tehsil, Earthquake Affected Areas, Pakistan, October 28 - November 3, 2006

Other Reportable Diseases and Conditions

There were 6 cases of suspected meningitis in week 44, 5 in Muzaffarabad, and 1 in Bagh. There were no cases of tetanus, acute flaccid paralysis, or hemorrhagic fever. There were 5,323 cases of fever of unknown origin, and 3,917 injuries.

Though injuries were a significant issue in the immediate aftermath of the earthquake, within a few weeks of the earthquake the rate of injuries had become relatively constant. See figure 11.

30.0

25.0 20.0 15.0

10.0 consultations 5.0

Injuries as a percentof all 0.0 2005-42 2005-45 2005-48 2005-51 2006-02 2006-05 2006-08 2006-11 2006-14 2006-17 2006-20 2006-23 2006-26 2006-29 2006-32 2006-35 2006-38 2006-41 2006-44

Week

Figure 11: Trend in injuries as a percent of all consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 – 3 November 2006.

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Outbreak Alert and Response1

Special Report: Dengue Fever in Pakistan There has been a dengue fever outbreak in Pakistan, largely centred in Sindh province, but with cases throughout the country. The outbreak is considered the second spike of an epidemic that began in 2005. The case fatality rate in the epidemic last year was approximately 7%, while it has declined to approximately 1.2% this year, within international norms. There have been no cases reported through the DEWS EQ district system thus far, with the exception of the unconfirmed case in Abbottabad outlined below. Though the system does not include dengue fever on the list of conditions under surveillance, patients with dengue hemorrhagic fever would be captured within the hemorrhagic fever category.

The cases seen in Pakistan, as of the end of week 44, are given in Table 4

Table 4: Summary of Dengue Fever Cases Reported as of 3rd November 2006 Province Area Suspected Cases Laboratory Deaths Confirmed Cases Islamabad Islamabad 190 74 0 Punjab Rawalpindi 213 73 0 Chakwal, 107 17 0 Khushab, Lahore Sindh Karachi, 2250 733 31 Hyderabad, Larkana, Umer Kot, Sukkur NWFP Peshawar, 14 4 1 Abbottabad, Khyber Agency AJK Kotli 12 4 0 Total 2786 905 32

Measles: Bagh On 23rd October, the MSF-B team clinically diagnosed a case of measles in Mallot BHU, in a patient from Channat Village. The WHO team was informed on 28th October, and the investigation was undertaken on 30th October. On investigation, four children of one household were discovered to have had measles; three no longer active, one active. A fifth child from another household was also identified with active measles in the early stages. The children ranged from 6 to 12 years old, four were girls, and one a boy. Despite the fact that there had been a vaccination campaign in the area in November 2005, 4 of the children had not been vaccinated, and the vaccination status of the fifth was unknown. A mass vaccination campaign was organized and began on 31st October. A sample was also taken for confirmation of the disease. Further activities in response to this outbreak are the assessment of vaccine coverage in tehsil Dhirkot, the evaluation of the cold chain equipment, electricity, and knowledge of vaccinators, and monitoring of the EPI programme.

1 Outbreak Investigation and response of Suspected Viral Hepatitis, Malaria, and Bloody Diarrhoea and Watery Diarrhoea would only take place when a cluster of cases is identified or there is an increase in the incidence of the disease. (Note: Single death due to Diarrhoea and single case of reported severe dehydration among >5 years would be investigated)

9 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44

Acute Jaundice Syndrome: Muzaffarabad One suspected hepatitis cases from RHC Abbaspur was investigated. The case was a 19 year old woman from Dhok Mohammad Gali village. No other family members were ill, though she had full symptoms of hepatitis. A sample was taken for confirmation.

Viral Hemorrhagic Fever: Mansehra A case of suspected hemorrhagic fever was reported from Ayub Medical Complex, Abbottabad, outside the DEWS surveillance area (and therefore not reflected in the DEWS data). The patient was a 32 year old man, from Havelian, Abbottabad. He developed a fever on 9th of October, and further developed epistaxis and bleeding from gums on 16th October. On 29th October, he also developed petechiae, and was admitted to the Ayub Medical Complex. The surveillance team saw the patient within three hours of the report on October 30th. The patient was in the early recovery phase. A sample was taken for confirmation.

10 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44

Number of reported cases and deaths per District, AJK

Table 6. Number of reported cases and deaths, Bagh District, Earthquake Affected Areas, Pakistan, 7 Oct - 3 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 41 328 0 23 0 0 0 61 0 2863 0 1 0 0 0 23 0 0 0 0 0 349 0 477 0 7361 0 42 252 0 9 0 0 0 21 0 1672 0 1 0 0 0 6 0 0 0 0 0 270 0 419 0 5510 0 43 78 0 2 0 0 0 10 0 946 0 0 0 0 0 8 0 1 0 0 0 160 0 177 0 2802 0 44 535 0 35 0 0 0 65 0 3301 0 0 0 1 0 20 0 0 0 0 0 428 0 504 0 10565 0 Total 1193 0 69 0 0 0 157 0 8782 0 2 0 1 0 57 0 1 0 0 0 1207 0 1577 0 26238 0

Table 7. Number of reported cases and deaths, Poonch District, Earthquake Affected Areas, Pakistan, 7 Oct - 3 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 41 1721 0 21 0 0 0 321 0 3513 0 0 0 0 0 3 0 0 0 0 0 2130 0 836 0 7494 6 42 1565 0 30 0 0 0 328 0 3482 12 0 0 0 0 5 0 0 0 0 0 2227 0 784 0 7525 10 43 591 0 8 0 0 0 119 0 1232 0 0 0 0 0 0 0 0 0 0 0 806 0 265 0 2434 5 44 1338 0 31 0 0 0 340 0 3716 1 0 0 0 0 2 0 0 0 0 0 2159 0 854 0 8105 1 Total 5215 0 90 0 0 0 1108 0 11943 13 0 0 0 0 10 0 0 0 0 0 7322 0 2739 0 25558 22

Table 8. Number of reported cases and deaths, Muzaffarabad District, Earthquake Affected Areas, Pakistan, 7 Oct - 3 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 41 3388 0 399 0 0 0 218 0 6421 0 1 0 2 0 15 0 0 0 0 0 1433 0 1976 0 17199 10 42 1583 0 193 0 0 0 189 0 5409 0 0 0 2 0 5 0 0 0 0 0 743 0 1647 0 12691 0 43 1484 1 190 0 0 0 111 0 2603 0 0 0 3 0 6 0 0 0 0 0 656 0 811 0 4046 6 44 1853 0 374 0 0 0 253 0 5622 1 0 0 5 0 19 0 0 0 0 0 1157 0 1664 0 12546 4 Total 8308 1 1156 0 0 0 771 0 20055 1 1 0 12 0 45 0 0 0 0 0 3989 0 6098 0 46482 20

11 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50 DEWS 2006 -44

Number of reported cases and deaths per District, NWFP

Table 9. Number of reported cases and deaths, Battagram District, Earthquake Affected Areas, Pakistan, 7 Oct - 3 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 41 629 0 61 0 0 0 45 0 1510 0 0 0 0 0 12 0 0 0 0 0 591 0 398 0 4155 2 42 600 0 51 0 0 0 47 0 1687 0 0 0 0 0 21 0 0 0 0 0 570 0 322 0 3682 1 43 245 0 5 0 0 0 12 0 432 0 0 0 0 0 3 0 0 0 0 0 129 0 144 0 727 0 44 526 0 52 0 0 0 48 0 1150 0 2 0 0 0 24 0 0 0 0 0 482 0 284 0 3480 0 Total 2000 0 169 0 0 0 152 0 4779 0 2 0 0 0 60 0 0 0 0 0 1772 0 1148 0 12044 3

Table 10. Number of reported cases and deaths, Mansehra District*, Earthquake Affected Areas, Pakistan, 7 Oct - 3 Nov 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 41 1727 0 132 0 1 0 79 0 4883 3 0 0 1 1 33 0 0 0 0 0 1444 0 870 0 15927 3 42 1198 0 84 0 1 0 148 0 4281 1 0 0 0 0 21 0 0 0 0 0 1527 0 747 0 15583 0 43 525 0 23 0 1 0 30 0 1298 1 0 0 0 0 13 0 1 0 0 0 500 0 357 0 3797 1 44 1417 0 64 0 0 0 88 0 5044 1 0 0 0 0 13 0 0 0 0 0 1097 1 611 15868 1 Total 4867 0 303 0 3 0 345 0 15506 6 0 0 1 1 80 0 1 0 0 0 4568 1 2585 0 51175 5 *Data from Balakot Tehsil were merged with the data from Mansehra district.