District Battagram Reported Highest Reported from 294 Reporting Units Proportion of Consultations for Acute Diarrhoea

Home , Battagram, Battagram District, Mansehra District, Muzaffarabad District

Epidemiological Week No. 21 (17 -23 May 08) June 9/ Vol. 131/ DEWS 2008-21

Bagh: Unprotected water sources- A common reason for contamination and Reporting Units ...... 2 water borne diseases during rainy season. Total number of consultations...... 2 Pictured credit: Dr. Majid Bhatti DEWS Data, Epidemiological Week No. 21, 2008 ...... 3 DEWS Data, (Epidemiological Weeks No.18 – 21, 2008):...... 4 Acute Diarrhoea and suspected Cholera: ...... 5 Acute Respiratory Tract Infections: ...... 7 Upper and Lower Respiratory Tract Infection:...... 8 Other Conditions under Surveillance: ...... 8 Outbreak Alert and Response...... 8 Number of reported cases and deaths per District, AJK ...... 10 Number of reported cases and deaths per District, NWFP ... 11

This week 79,038 consultations were District Battagram reported highest reported from 294 reporting units proportion of consultations for Acute Diarrhoea

ARI remains the leading cause of Eight alerts were received and consultation this week and the weekly investigated ( 1 AFP, 3 Bloody trend is on decline Diarrhoea, 1 Suspected Measles, 1

Suspected Cholera 1 AD, and 1 Acute Diarrhoea reported in 9% of all Suspected Malaria) consultations an increase by 1% as compared to last week. None of the alerts was found to be an outbreak

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 produced with the financial support of AAI Australia, Americares, CIDA, Denmark, DFID, ECHO, Ireland, Italy, Japan, Korea, Monaco, Norway, SIDA, Slovak Republic, Switzerland, Turkey, USAID

The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, National Park Road, Chak Shahzad, Islamabad, Pakistan. For More Information, please contact: Dr. Rayana Bouhaka, Manager Operations, 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 June 2008 / Vol. 131/ DEWS 2008-21

Reporting Units

During week 21, 2008, total 294 (88%) weekly reports were received from the DEWS reporting sites on the due time. Compared to last week the DEWS reporting have increased by 4% this week (84% and 88% respectively). The total number of reporting sites in the Earthquake affected districts remains 335 as of week 21, 2008. Table 1, summarizes reporting by each earthquake affected district for the last 4 weeks.

Table1. Heath Facilities by district, reported from Earthquake Affected Areas, Pakistan, 26 April - 23 May 2008. Reporting Health Facilities Area Population 26Apr-2May 08 3-9 May 08 10-16 May 08 17-23 May 08 Week-18 Week-19 Week-20 Week-21 Bagh 452,532 33 35 35 36 Battagram 592,256 37 37 36 38 Mansehra 1,154,804 61 64 59 65 Muzaffarabad 770,000 66 70 70 76 Neelum 184,000 15 18 17 18 Poonch 633,712 66 63 64 61 Total 3,727,668 278(83%) 287(86%) 281(84%) 294(88%)

Total number of consultations

During week 21, Total 79,038 patient consultations were reported, an increase by 6% compared to last week. Similar to the prior weeks, the district of Muzaffarabad reports the highest proportion (32%) and Neelum reports the lowest proportion (5%) of the total consultation reported from all the Earthquake affected districts. Neelum is the smallest district with the least number of DEWS reporting sites among all the districts in the earthquake area. Figure 1 depicts the pattern of weekly reporting units participating in the DEWS and the total number of weekly consultations reported from week 1, 2007 to week 21, 2008.

Figure1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, Week 1, 2007 – week 21 2008. # of units Weekly pattern of reporting consultations # of Cns. 350 120000 Reporting Unit Consultations 300 100000 250 80000 200 60000 150 40000 100

50 20000

0 0 W01/07 W06 W11 W16 W21 W26 W31 W36 W41 W46 W51 W04 W09 W14 W19 Epi-week

2 WMMR Weekly Morbidity and Mortality Report Pakistan 9 June 2008 / Vol. 131/ DEWS 2008-21

DEWS Data, Epidemiological Week No. 21, 2008

During the Epidemiological week 21 (17 – 23 May, 2008), total 79,038 consultations were reported through DEWS. The distribution of consultations by age groups indicate that 19% are children less than 5 years of age, 20% are children 5-14 years of age, 41%, the majority, are adults 15-45 years of age, and 20% are adults above 45 years age. Of the total consultations reported for week 21, 53% were from female patients. The proportion for Upper Respiratory Tract Infection was 17%, Unexplained Fever 9%, Acute Diarrhea 9%, Lower Respiratory Tract Infection 5% and Scabies 5% in all age groups and both sexes. Out of the total 79,038 reported consultation, in all ages and both sexes, 54% (43,072) accounted for health problems other than the diseases reported above. See (Figure 2).

Figure 2.Distribution of reported consultations by disease/health event and age groups, 17 to 23 May 2008, Earthquake Affected Areas, Pakistan

Distribution of consultations by age Distribution of consultations by reported 45 AD diseases LRTI 40 URTI 9% 41% 5% 35 17% MA L 30 <1% 25 UF 20 9% 20%

consultations 20% 15 19% Percentage ofall 10 SCB 5% 5 OTH 0 54% <5 5-14 15-44 ≥45 Age-group

*OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance

Comparison of consultation by sex shows that in female patients, health events other than the five common communicable diseases are reported higher than males (57% and 52% respectively). In males the proportion for Acute Diarrhoea and UARI is higher than for females. The proportion of consultations for LRI and UF is same both in males and females (Figure 3)

Figure 3.Distribution of reported consultations by disease/health event and age groups, 17 to 23 April 2008, Earthquake Affected Areas, Pakistan Distribution of consultations (Female) Distribution of consultations (Male) AD AD 8% LRTI URTI 10% LRTI 5% MA L URTI 5% 16% 19% MA L <1% <1% UF 9% UF 9% SCB 5% SCB 5% OTH 52% OTH 57%

3 WMMR Weekly Morbidity and Mortality Report Pakistan 9 June 2008 / Vol. 131/ DEWS 2008-21

Disease Distribution by Age:

Acute Upper Respiratory Tract Infections (URTI) is the highest reported disease in all age groups during week 21. In children less than five years of age Upper Respiratory Tract Infection was reported in 25% of the consultations, followed by Acute Diarrhoea (AD) 17%, Unexplained Fever 10%, Lower Respiratory Tract Infection (LRTI) 6%, Scabies 4% and other health problems 37%. In children 5 to 15 years of age Upper Respiratory Tract Infection was reported in 20% of the consultations followed by Unexplained Fever (UF) 10%, Acute Diarrhoea 10%, Scabies 6%, Lower Respiratory Tract Infection 6% and other health problems 47%. In both the adult age groups (15-45 years and above 45 years) the proportion of the other health problems is higher than reported for children (64% and 60% respectively), followed by URTI 14% in both adult age groups. The proportion of the remaining reported communicable diseases in adults is lower than reported in children but with slight differences between the two adult age groups. Figure 4 presents the comparisons of the reported consultation by age groups.

Figure4. Proportion of primary causes for all reported cases by age groups, 17 – 23 May 2008, Earthquake Affected Areas, Pakistan,

SCB AD SCB AD MAL 4% 17% MAL LRTI 4% 6% <1% <1% 4% LRTI 6% URTI SCB AD MAL OTH SCB AD MAL 14% 5% 6% M<1%LRTI 37% 6% 10% <1% LRTI 5% 6% UF URTI URTI OTH 8% URTI 14% 25% 64% UF 20% 10% OTH UF OTH 60% < 5yrs (n=14,996) 47% ≥15 - ≤44yrs (n=32,204) 10% UF 10% 5 - <15yrs (n=15,880) ≥ 45yrs (n=15,958)

*OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance

DEWS Data, (Epidemiological Weeks No.18 – 21, 2008):

During the period 26 April to 23 May, 2008 (Epidemiological weeks 18 to 21, 2008 both inclusive), total 294,509 consultations were reported in the Earthquake affected areas. The proportion of the five common diseases under surveillance was, 46% (134,570) of the total consultations reported during this period. This proportion remains almost consistent for the last four weeks. During this period 18% (53,811) of consultations were due to Upper Respiratory Tract Infection (URTI), 9% (26,040) Unexplained Fever (UF), 8% (23,610) Acute Diarrhoea (AD), 5% (14,182) Lower Respiratory Tract Infection (LRTI), and 5% (13,944) due to Scabies (SCB). Acute Jaundice Syndrome was reported in 79 consultations and Bloody Diarrhoea was reported in 1292 consultation during this period.

A total of 66 deaths were reported during this period. Most (91%) of the total reported deaths were due to health events other than the diseases under weekly surveillance. Four deaths were due to Acute Diarrhoea reported in last four weeks, one from Mansehra and three deaths from Poonch District with a total AD case fatality of 0.017%. Two deaths were reported due to Lower Respiratory Tract Infection during the last four week period and the total case fatality for LRTI stands at 0.014%. No deaths were reported from any other disease under weekly surveillance during this four week period.

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Table 2. Weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, Week 18 - 21, 2008. Week WEEK 18 WEEK 19 WEEK 20 WEEK 21 TOTAL CFR% Event C D C D C D C D C D AD 4889 1 5357 1 6232 1 7132 1 23610 4 0.017 AFP 0 0 1 0 2 0 2 0 5 0 0.000 AJS 22 0 15 0 21 0 21 0 79 0 0.000 BD 277 0 297 0 366 0 352 0 1292 0 0.000 LRTI 3173 1 3484 0 3817 0 3708 1 14182 2 0.014 MAL 474 0 343 0 364 0 420 0 1601 0 0.000 MG 0 0 3 0 0 0 0 0 3 0 0.000 MS 0 0 0 0 3 0 0 0 3 0 0.000 OTH 36165 13 40959 13 39743 18 43072 16 159939 60 0.038 SCB 3209 0 3474 0 3517 0 3744 0 13944 0 0.000 UF 6147 0 5851 0 7053 0 6989 0 26040 0 0.000 URTI 13233 0 13367 0 13613 0 13598 0 53811 0 0.000 Total Cons. 67589 15 73151 14 74731 19 79038 18 294509 66 RU 278 287 281 294

Acute Diarrhoea and suspected Cholera: During week 21, 2008, Acute Diarrhoea was reported in 7,132 patients accounting for 9% of the total consultation in all age groups. In children less than 5 years of age Acute Diarrhoea was reported in 17% of the total consultations with a 2% increase compared to week 20. In children 5 to 14 years of age, 10% of the consultations were for AD with an increase of 1% compared to week 20. In the adult age groups, 15-45 years and above 45 years of age, AD consultations were reported as 6% for both age groups out of the total consultations. From week 16 onwards, the proportion of Acute Diarrhoea weekly consultations are increasing gradually. In week 21 the proportion has reached at 9% compared to 6% in week 16. Comparison of the weekly trend of AD from week 1 to 21, depicts a similar pattern for the last three years (Fig 6). There were no cases of suspected cholera reported from any district; however, there was one death due to acute diarrhoea reported from district Poonch.

Figure 5: Trend in Acute diarrhoea as a percent of all consultations, comparison by years, Earthquake Affected Areas, Pakistan, Weekly comparison of acute diarrhoea (Year 05, 06, 07 and 08) 18 16 14 12 10 8 6

consultations 4 Percentage of all 2 0 1 4 7 101316192225283134374043464952 Epi-week 2005 2006 2007 2008

5 WMMR Weekly Morbidity and Mortality Report Pakistan 9 June 2008 / Vol. 131/ DEWS 2008-21 In general the trend of Acute Diarrhoea in all districts is showing an increasing trend for the last few weeks. When compared the trends of Acute Diarrhoea by district from Week 1 to 21, 2008, Battagram reports the highest proportion of AD throughout the period and presents a fluctuating pattern of cases. However, there is neither the indication of case clustering nor does the situation look like an epidemic reported from any part of the district. It should be noted that Neelum has had the highest rate of AD within the last three weeks and now it reports a slight drop in the proportion of AD cases. (Fig 7). As the disease pattern indicates the seasonal increase in the Diarrhoeal diseases the health cluster partners in the districts have already started measures and activities on prevention and control of diarrhoea diseases and are vigilantly monitoring the AD situation in their respective districts.

Figure 6: Trend in Acute diarrhoea as a percent of all consultations, comparison by districts weeks 1-21, 2008, Earthquake Affected Areas, Pakistan Weekly trend of acute diarrhoea by district 14

consultations 4 Percentage of all 2

0 23456789101112131415161718192021 Ep i- w e e k BAGH BATTAGRAM MA NSEHRA MUZAFFARABAD NEELUM POONCH

Bloody Diarrhoea: During week 21 of 2008, a total of 352 cases of Bloody Diarrhoea were reported from all the districts, which is slightly lower than the total BD consultation reported during the previous week. The overall proportion of reported Bloody Diarrhoea is very small for all the weekly consultations with a little weekly fluctuation.

When comparing the weekly trend of the BD by district, District Muzaffarabad, Neelum and Battagramm reporting slightly higher proportion compared to other three districts with a weekly fluctuating pattern of the disease. The WHO team along with DoH and Health Partners have conducted a thorough assessment of the BD situation in the districts and preventive measures have been initiated. The reason for this relatively higher proportion in three districts is due to consumption of contaminated water poor hygienic practices (Figure 7).

Figure 7: Trend in weekly Bloody diarrhoea as a percent of all consultations, comparison by district, Earthquake Affected Areas, Pakistan, Weekly trend of Bloody diarrhoea by district 2.00 1.80 1.60 1.40 1.20 1.00 0.80

consultations 0.60 Percentage of all 0.40 0.20 0.00 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Epi-week BAGH BATTAGRAM MA NSEHRA MUZAFFARABAD NEELUM POONCH

6 WMMR Weekly Morbidity and Mortality Report Pakistan 9 June 2008 / Vol. 131/ DEWS 2008-21 Acute Respiratory Tract Infections:

During week 21, 2008, total 17,306 consultations for ARI (both Upper and Lower Respiratory Tract Infection) were reported. ARI accounts for 22% of the total consultations reported for the week (URTI 17% and LRTI 5%) and are still the leading cause of consultations for all age groups, among all the diseases under surveillance. For the current week in children less than 5 years of age URTI was reported in 25% and LRTI in 6% of consultations. In 5 to 14 year age groups URTI was reported in 20% and LRTI in 6% of consultations. In 15 to 45 year age group URTI was reported for 14% and LRTI for 3% of consultations. In the age group above 45 years URTI was reported for 14% and LRTI for 5% of consultations. Proportion of ARI in male patients was reported higher compared to females. The weekly trend of ARI for the same weeks (from week 1 to 21) from the last three years displays a similar trend to that of 2008. The overall ARI trend, from weeks 10 to 18 remain consistent with a little weekly fluctuation in the earthquake affected districts. However, the proportion of ARI from weeks 12 to 21 in 2008 remains slightly higher than the same period in 2006 and 2007. During week 21, 2008 there were 3708 consultations for Lower Respiratory Tract Infection and one death was reported from Muzaffarabad district.

Figure 8: Comparison of ARI weekly trends (week 1 to 20) years 2006, 2007 and 2008, Earthquake affected districts Pakistan Weekly comparison of ARI trend (Year 05, 06, 07 and 08) 40 35 30

25 20 15

consultations 10 Percentage of all 5 0 1 4 7 101316192225283134374043464952 Ep i- w e e k 2005 2006 2007 2008

Malaria: In week 21, 2008, there were 420 suspected cases of malaria reported. District Poonch is reporting the highest number of suspected malaria case compared to the other districts. In comparison to last week, the proportion of suspected malaria cases has increase in the districts of Battagram, Mansehra and Muzaffarabad (figure 10). There were no associated deaths due to suspected malaria reported from any district. Compared to the same weeks from the last two years, the percentage of malaria in 2008 is lower.

Figure 9: Weekly trends in Suspected Malaria as percentage of all consultations, comparison by district, Earthquake Affected Areas, Pakistan, weeks 1-21, 2008 Weekly trend of Malaria by district 1.80 1.60 1.40 1.20 1.00 0.80 0.60 consultations

Percentage of all 0.40 0.20 0.00 1 2 3 4 5 6 7 8 9 101112131415161718192021 Ep i- w e e k BAGH BATTAGRAM MA NSEHRA MUZAFFARABAD POONCH

7 WMMR Weekly Morbidity and Mortality Report Pakistan 9 June 2008 / Vol. 131/ DEWS 2008-21

Upper and Lower Respiratory Tract Infection:

During week 21, 2008, there were 5% (3,708) of consultations for Acute Lower Respiratory Tract Infections and 17% (13,598) of cases of Upper Respiratory tract Infections reported through the DEWS system. There is an overall declining trend in Upper and Lower Respiratory Tract Infection from week 16, 2008 onwards. The proportion of consultation for ARII remained almost consistent from week 10 to 15. From week 16 onwards proportion of consultations for ARI has further declined (Figure 10).

Figure 10: Weekly Proportion of URTI and LRTI as percentage of all consultations, (week 1 – 21, 2008) Earthquake Affected Areas, Pakistan Weekly proportion of ARI (Upper and Lower) week 1-20, 2008 30 LRTI URTI 25

10 consultations Percentage of all 5

0 123456789101112131415161718192021 Ep i- w e e k

Other Conditions under Surveillance:

During this week, 43,072 (54%) consultations out of the total 79,038 consultation, in all ages and both sexes were for health problems other than reportable disease under weekly surveillance. There were two cases of suspected AFP reported one from Mansehra and one from Rawalakot district. There were no cases of suspected Measles, Meningitis, suspected Hemorrhagic Fever, and Neonatal Tetanus reported from any district for week 21, 2008.

Outbreak Alert and Response1

During week 21, 2008, in total eight alerts were identified/ reported and were responded accordingly. None of these alerts was found as an outbreak.

Mansehra:

District Mansehra reported 4 alerts during week 21 and were responded 1. DHQ Hospital Mansehra reported AFP in a 27 month old female child from Lari Adda Mansehra with fever and weakness in both legs. Stool samples were taken and sent for laboratory investigation to NIH. Results awaited 2. Three alerts for increased number of Bloody Diarrhoea reported from three different reporting site from RHC Shinkiari, BHU Kathai and Shugli Bandi and BHU Paras.. On investigation it was founds that the cases in BHU Pars were sporadic and no clustering. The increased number reported from rest of the two sites was due to problem with the diagnosis (following case definition)

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) 8 WMMR Weekly Morbidity and Mortality Report Pakistan 9 June 2008 / Vol. 131/ DEWS 2008-21 Muzaffarabad:

Two alerts reported from district Muzaffarabad, both the alerts were investigated and found false: 1. One alert was detected for 6 cases of Suspected Cholera from a Field Health Clinic in Garhi Dupatta. On investigation it was a false reporting (typing error) 2. Another alert for 4 Suspected Measles cases were reported from BHU Panjgran. On investigation it was a false reporting (typing error)

Battagramm:

1. An alert for increase in the number of Acute Diarrhoea from few DEWS reporting sites were identified. The alerts were investigated and no clustering of cases detected 2. Another alert for increase in cases of Malaria from Thakot was identified and investigated. The situation was not like an outbreak. Through EDO-H Malaria control programme is involved preventive activities.

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Number of reported cases and deaths per District, AJK

Table 3. Number of reported cases and deaths, Bagh District*, Earthquake Affected Areas, Pakistan, 26 April -23 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS 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 C D 18 439 0 0 0 22 0 0 0 166 0 1437 0 58 0 0 0 0 0 0 0 272 0 104 0 2 0 6738 7 19 495 0 0 0 8 0 0 0 161 0 1503 0 55 0 0 0 0 0 0 0 227 0 139 0 1 0 7021 2 20 489 0 0 0 18 0 0 0 165 0 1392 0 56 0 0 0 0 0 0 0 282 0 131 0 4 0 6932 1 21 644 0 0 0 14 0 0 0 127 0 1611 0 55 0 0 0 0 0 0 0 268 0 249 0 4 0 6034 1 Total 2067 0 0 0 62 0 0 0 619 0 5943 0 224 0 0 0 0 0 0 0 1049 0 623 0 11 0 26725 11

Table 4. Number of reported cases and deaths, Poonch District*, Earthquake Affected Areas, Pakistan, 26 April -23 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS 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 C D 18 948 0 0 0 10 0 0 0 820 0 2317 0 139 0 0 0 0 0 0 0 469 0 1337 0 5 0 4684 3 19 828 1 0 0 15 0 0 0 806 0 1811 0 124 0 0 0 0 0 0 0 474 0 1303 0 0 0 4322 4 20 880 1 0 0 22 0 0 0 829 0 1879 0 154 0 0 0 0 0 0 0 405 0 1214 0 0 0 4514 0 21 921 0 0 0 12 0 1 0 792 0 1943 0 141 0 0 0 0 0 0 0 470 0 1065 0 0 0 4956 2 Total 3577 2 0 0 59 0 1 0 3247 0 7950 0 558 0 0 0 0 0 0 0 1818 0 4919 0 5 0 18476 9

Table 5. Number of reported cases and deaths, Muzaffarabad District*, Earthquake Affected Areas, Pakistan, 26 April -23 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS 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 C D 18 1478 0 0 0 139 0 0 0 1468 1 4534 0 143 0 0 0 0 0 0 0 933 0 2605 0 5 0 7655 1 19 1778 0 0 0 132 0 0 0 1666 0 4629 0 111 0 0 0 0 0 0 0 1165 0 2357 0 1 0 8280 0 20 2201 0 0 0 156 0 0 0 2149 0 5236 0 112 0 0 0 0 0 0 0 1377 0 3750 0 7 0 9752 12 21 2368 0 0 0 125 0 0 0 1942 1 5085 0 129 0 0 0 0 0 0 0 1289 0 3565 0 0 0 10677 6 Total 7825 0 0 0 552 0 0 0 7225 2 19484 0 495 0 0 0 0 0 0 0 4764 0 12277 0 13 0 36364 19

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Number of reported cases and deaths per District, NWFP

Table 6. Number of reported cases and deaths, Battagram District*, Earthquake Affected Areas, Pakistan, 26 April -23 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS 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 C D 18 839 0 0 0 73 0 0 0 151 0 1817 0 134 0 0 0 0 0 0 0 475 0 863 0 8 0 4952 0 19 898 0 0 0 76 0 0 0 131 0 1944 0 47 0 0 0 0 0 0 0 512 0 797 0 4 0 6074 0 20 1079 0 0 0 82 0 0 0 155 0 1720 0 29 0 0 0 0 0 0 0 542 0 816 0 1 0 5641 0 21 1233 0 0 0 110 0 0 0 130 0 1638 0 83 0 0 0 0 0 0 0 479 0 878 0 9 0 5579 1 Total 4049 0 0 0 341 0 0 0 567 0 7119 0 293 0 0 0 0 0 0 0 2008 0 3354 0 22 0 22246 1

Table 7. Number of reported cases and deaths, Mansehra District*, Earthquake Affected Areas, Pakistan, 26 April -23 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS 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 C D 18 934 1 0 0 19 0 0 0 293 0 2529 0 0 0 0 0 0 0 0 0 926 0 1202 0 0 0 10905 2 19 1033 0 0 0 31 0 1 0 257 0 2579 0 2 0 0 0 3 0 0 0 905 0 1192 0 6 0 13688 7 20 1287 0 0 0 60 0 2 0 262 0 2871 0 5 0 3 0 0 0 0 0 790 0 1118 0 7 0 11605 0 21 1526 1 0 0 52 0 1 0 256 0 2509 0 11 0 0 0 0 0 0 0 962 0 1201 0 8 0 13867 6 Total 4780 2 0 0 162 0 4 0 1068 0 10488 0 18 0 3 0 3 0 0 0 3583 0 4713 0 21 0 50065 15