Weekly-Epidemiological Bulletin-33-04042011.Pub

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 2, Issue 13, Monday 04 April, 2011

Highlights Priority diseases under surveillance Epidemiological week no. 13 (25 - 31 March 2011) in DEWS

Acute Flaccid Paralysis (AFP) • 74 districts in 5 provinces and State of Azad Jammu and Kashmir (AJK) provided surveillance data to the DEWS. This system is gradually expanding to provide information about Acute Jaundice Syndrome (AJS)

communicable disease threats in all parts of Pakistan as the country goes through the re- Acute Respiratory Infections covery process. (Upper and Lower) (ARI)

• 2,835 fixed health facilities and 12 mobile medical outreach centres provided surveillance Acute Watery Diarrhoea (AWD)/ data for this week. Suspected Cholera

• A total of 845,183 consultations were reported through DEWS of which 25% were acute Acute Bloody Diarrhoea (BD) respiratory infections (ARI), 11% skin disease, 9% acute diarrhoea, and 6% were suspected Other Acute Diarrhoeas (AD) Malaria. Suspected Viral Hemorrhagic • A total of 61 alerts were reported in week-13, 2011: Altogether 31 alerts were for Measles; Fever (VHF) 7 were for Pertussis, 6 were for chickenpox, 4 each were for Meningitis, and Malaria, 3 Suspected Malaria (Mal) were for Tetanus; 2 for Leishmaniasis, while 1 each for Acute Jaundice Syndrome, Diph- theria, Influenza, and Mumps. Suspected Measles (MS)

• There were 2 polio cases confirmed this week: 1 from FATA (FR Lakki) , and 1 from Suspected Meningitis (MG) Sindh (Badin) Others

Figure-1: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 31 March 2011 (Epi week 31, 2010 to week 13, 2011)

25 Percentage

0 1 2 3 4 5 6 7 8 9

10 11 12 13 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 AD BD ARI S. Malaria

Table-1: Priority diseases reported during the week 5 to week 12, 2011

Diseases Wk-6 Wk-7 Wk-8 Wk-9 Wk-10 Wk-11 Wk-12 Wk-13

Skin Disease 75,030 (9%) 56,464 (9%) 68,055 (9%) 61,675 (8%) 79,747 (9%) 82,310 (9%) 75,043 (9%) 77,157 (9%)

ARI (URI and LRI) 267,612 (31%) 201,493 (31%) 250,489 (30%) 217,495 (30%) 249,133 (29%) 261,405 (28%) 223,829 (27%) 218,272 (26)

Other Acute Diarrhoea (Not Watery) 50,346 (6%) 39,728 (6%) 53,257 (6%) 46,412 (6%) 57,134 (7%) 65,107 (7%) 67,046 (8%) 71,945 (9%)

Bloody Diarrhoea 5,069 (1%) 4,437 (1%) 4,851 (1%) 4,862 (1%) 5,494 (1%) 5,990 (1%) 5,589 (1%) 6,439 (1%)

Suspected Malaria 50,431 (6%) 35,061 (5%) 46,665 (6%) 40,357 (6%) 52,266 (6%) 56,251 (6%) 52,712 (6%) 55,132 (7%)

Total consultation 860,286 653,895 821,436 721,987 850,554 923,109 825,367 845,183

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: [email protected]. 01 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Table-2: Leading causes of seeking health care in the flood affected districts, 29 Fig-2: Weekly number of reporting health units (Week 33-2010 to week 13-2011) July 2010 to 31 March 2011

3000 6 13 Diseases Total Mobile Fixed 6 6 8 2500 8 8 Skin Diseases 2,426,823 (11%) 11 11 8 8 11 8 8 2000 11 Acute Respiratory Infection 5,508,467 (25%) 8 1500 12 (Not 411 26 11 Other Acute Diarrhoea 400 1,936,188 (9%) 2834

331 26 2786 375 2740 Watery) 361 215 2546 2399 2401 192 46 2377 2295

1000 2247 2196 2192 153 2186 2159

128 1960 105 1856 Bloody Diarrhoea 190,508 (1%) 81 58 1627 1391 1342

500 1259 1139 881 826 788 758 745 715 702

655 Suspected Malaria 1,253,573 (6%) 597 575 509 502 0 439 9 8 7 6 5 4 3 2 Unexplained Fever 876,087 (4%)

11 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 13 12 11 10 ‐

1 Wk Wk Wk Wk Wk Wk Wk Wk

Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Total Consultations 21,791,709

Focus on: Polio

Here we are sharing a serious concern from the polio eradication program, Epi-week # Province / Agency District / Area Cases during the last three weeks a total of 11 new cases of type‐1 polio cases FATA Khyber 1 (See table on the right) were confirmed by the laboratory. They include 4 Sindh Badin 1 cases from FATA (Khyber, Kurram, Lakki Marwat and FR Lakki) 3 cases Wk‐11 Sindh TM Khan 1 from Sindh (Badin, TM Khan), 2 from Khyber Pakhtunkhwa (Peshawar, Khyber Pakhtunkhwa Peshawar 1 Nowshera), and 2 from Balochistan (Pishin, and Killa Abdulla). Khyber Pakhtunkhwa Nowshera 1 st As of 31 March, Pakistan has reported a total of 26 polio cases (all type‐1) FATA Kurram 1 from 13 districts/tribal areas/agencies. FATA Lakki Marwat 1 Wk‐12 Balochistan Pishin 1 Clustering of type‐1 polio cases in south Sind is of serious concern and war‐ Balochistan Killa Abdulla 1 rant aggressive response with appropriate oral polio vaccine. Four type‐1 FATA FR Lakki 1 polio cases have been reported in the past eight weeks from neighboring Wk‐13 areas of three districts. Sindh Badin 1

Technical Advisory Group for Polio Eradication in Pakistan and Afghanistan met this week on 24 and 25 March to review the current situation in both countries, evaluate impact of eradication activities and advise further guidance on strategies and activities employed for polio eradi‐ cation as appropriate. This was followed by the inter‐country coordination meeting for polio eradication in Pakistan and Afghanistan on 26th March to further consolidate cross border collaboration for polio eradication.

Figure-3: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 2009, 2010 and 2011

40 Since July 29, 2010, a total of 5,508,467 Acute Respiratory Infection (both Upper and Lower) patient consultations have been reported to DEWS from 35 the districts participating in DEWS in 5 provinces and state of AJK. 30

25 In the graph at right, DEWS weekly reports received for ARI in 2011 are com‐ 20

pared to the reports of 2010 and 2009 from disaster‐affected districts. Percentage 15 2009 10 This week, DEWS received 218,272 reports of Acute Respiratory Infection, 26% 2010 2011 of total consultations, 1% lower proportional morbidity reported by DEWS in 5 week‐13/2010, but as same in week‐13/2009. 0 1 4 7 101316192225283134374043464952 Epi week

Figure-4: Acute Diarrhea trends, Disaster affected districts, Pakistan 2009, 2010 and 2011

20 2009 18 Since July 29, 2010, a total of 1,936,188 acute diarrhea patient consultations 2010 16 have been reported to DEWS from the districts participating in DEWS in 5 2011 provinces and state of AJK. 14 12 In the graph at right, DEWS weekly reports received in 2011 are compared to 10 the reports of 2010 and 2009 from disaster‐affected districts. 8 Percentage 6 This week, DEWS received 71,945 reports of acute diarrhea, 9% of total con‐ 4 sultations. This is same proportional morbidity than reported by DEWS in 2 week‐13/2010, but 1% higher then week‐13/2009. 0 1 4 7 101316192225283134374043464952 Epi‐week

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Table-3: Alerts reported in week 13 of 2011

Male Female Date of alert Province District Location Disease Action taken / Notes > <5 <5 >5 5 5 suspected cases reported, 2 samples taken and sent to NIH for lab 26-Mar-11 Balochistan Chagai Girdi Jungle Measles 1 4 0 0 confirmation. Health awareness sessions conducted in the community. Informed EDO‐H and EPI Field investigation conducted, six patients of Chickenpox found. Health Chicken 29-Mar-11 Jaffarabad Tent City 4 0 0 2 Balochistan Pox education was given on prevention of the disease and advised the pa‐ tients to visit nearest HF for further treatment. Alerts from 2 different locations reported 90 cases (65 and 25 respec‐ BHU Gandakha and tively). 43 samples (29 and 14) tested and 25 found positive (16 and 9). 31-Mar-11 Balochistan Jaffarabad BHU Mohd Ibrahim Malaria 0 0 0 0 Gajani EDO‐H informed and requested to provide ant malarial drugs and RDTs at the reporting health facilities. Two alerts from 2 different locations reported 43 cases (9 and 14 respec‐ BHU Barija and BHU tively). 23 samples (9 and 14) tested and 16 found positive (7 and 9). RDT 25-Mar-11 Balochistan Jhal Magsi Malaria 0 0 0 0 Dhor-Ri Kits provided. EDO‐H informed and requested to provide bed nets and enforce other preventive activities in the community. Upon field investigation no cases of acute Jaundice Syndrome were found 31-Mar-11 Balochistan Naseerabad Pat Feeder IDPs Camp AJS 0 2 0 6 (false alert). Health education on prevention of AJS, importance of vac‐ cines was given in the community. EDO‐H was also informed. Vitamin A was given, Specimen collected and sent to NIH. Informed EDO 29-Mar-11 Balochistan Sibi Village Khajjak Measles 1 0 0 0 Health, EPI and UNICEF. The case was reported from village Kotla for a close contact of an old Khyber PIMS (Village Kotla-UC confirmed H1N1 case. Case was referred to PIMS flu clinic for treatment 30-Mar-11 Haripur H1N1 0 0 0 0 Pakhtunkhwa Muslimabad) and investigation. 1 sample was collected and sent to NIH for lab investi‐ gations. Initially 2 suspected case reported from DHQ hospital Haripur, both from Village Gudwalian. Nine more cases were found on active surveillance in Khyber Village Ghumawan-UC the area, 5 blood samples and 4 throat swabs were taken and sent to 31-Mar-11 Haripur Measles 2 2 2 5 Pakhtunkhwa Bandi Sher Khan NIH. Active cases were given Vit. A. Vaccine status was also assessed in the surrounding areas. mostly the cases were either less than 9 months or above 5 years age thus not vaccinated in the recent measles campaign. Suspected case was given Vit A. 1 sample collected and sent to NIH for Khyber confirmation EDO‐H and EPI Coordinator informed, cases isolated, plan 30-Mar-11 Mardan Batay Korona-Jhanday Measles 0 3 1 0 Pakhtunkhwa made for strengthening routine vaccinations, EPI Technician informed and advised to vaccinate other children in locality. Vit.A given, 2 samples collected and sent to NIH. Health education ses‐ Khyber BKMC (UC Marghuz, 31-Mar-11 Swabi Measles 2 0 0 0 sions conducted, EDO H and EPI coordinator Informed, Active Surveil‐ Pakhtunkhwa Mohallah Gaar Munaraa) lance done. Khyber BKMC (UC Shahman- Health education sessions conducted, EDO H and EPI coordinator In‐ 29-Mar-11 Swabi Mumps 0 1 0 0 Pakhtunkhwa soor) formed, Active Surveillance done. 1 sample collected and sent to NIH. Khyber Leishma Symptomatic treatment was advised, bed nets were provided, health 30-Mar-11 Tank Bangal Khan Korona 0 1 0 0 Pakhtunkhwa niasis education sessions were conducted and EDO health was informed. Mohallah Sialanwal- Gave two doses of vitamin A, collected blood specimen, throat swab and 30-Mar-11 Punjab Bhakkar Measles 0 0 0 1 darya khan sent to NIH, EDO(H) informed. THQ Kaloor kot (UC Meningi- CSF sample taken and send to IPH, health education was given, No other 30-Mar-11 Punjab Bhakkar 1 0 0 0 Maibal Shareef) tis case was found during active surveillance in the area. Vitamin A given to all children. 1 sample collected and sent to NIH. Health 30-Mar-11 Punjab D. G. Khan UC Tibi Qaisranee Measles 1 0 0 0 Education given as well as community mobilization was done. Leishma 1 Patient were screened by DDOH for IM and IL injections, Line listing was 30-Mar-11 Punjab Mianwali BHU Tolla Bangi Khel 5 1 7 niasis 1 made, EDO‐H ensured to provide antimony injections. Rahim Yar Gave two doses of vitamin A, collected blood specimen and sent to NIH, 29-Mar-11 Punjab Sirhaj Hospital Khanpur Measles 1 0 1 0 Khan EDO(H) informed. Two doses of vitamin A given to cases; collected blood specimen and Basti Lshikari hadyani- 28-Mar-11 Rajanpur Measles 0 0 1 0 Punjab UC darkhast Jamal sent to NIH, field investigation found many unimmunized children and , EDO‐H informed. Village M. Ramzan Two alerts from different locations received and respond accordingly. Notkani-UC khairpur and Gave Vitamin A, isolation of cases, 2 samples collected and sent to NIH, 26-Mar-11 Sindh Badin Measles 1 1 2 0 Fazal Abad coloney Malti advocated for vaccination in town, health education and active case 1 finding. One suspected case found during visit to MCH center. Upon field visit no Muhallah Tando Biland- Chicken 25-Mar-11 Ghotki 0 0 0 1 Sindh UC III; Pox other case found in the area. Health education was to the patients atten‐ dant. Suspected case of Measles reported from three different health facilities/ MCH Center-Dhondho Locations. On field investigation 13 more suspected cases were found Muhallah UC Ghotki; one death was reported and at least 5 cases refused to participate in the 30-Mar-11 Sindh Ghotki Mahar Bazar-UC II Measles 3 1 2 2 Ghotki and village Nabi investigation. Gave Vit. A to all suspected cases. Six Blood specimen BuxGabol-UC Jarwar collected and sent to NIH. Informed EDOH and suggested to improve vaccination in the given locations. Village Dari UC Adil Pur; Village Waheed Bux Malik- UC Ruk; village Four alerts for Suspected case of Pertussis reported. Upon field investiga‐ Lind Bazar-Taluka Khan Pertus- tion 1 of the alerts found false. Twelve suspected cases found from three 25-Mar-11 Sindh Ghotki 1 4 1 6 Garh; Dhondho Muhallah sis location. Symptomatic treatment was given, informed EDO‐H and DHMT UC Ghotki; Soomra for health promotion and control measures in the area Muhallah Anwarabad-UC I Ghotki This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Table-4: Alerts reported in week 13 of 2011. (Cont’d) Male Female Date of alert Province District Location Disease Action taken / Notes <5 >5 <5 >5 Suspected case of Tetnus was reported from MCH centre by Soomra Muhallah, Anwara- pediatrician. Upon hospital investigation fever with fits and 28-Mar-11 Sindh Ghotki Tetanus 0 0 1 0 bad-UC I Ghotki lock jaw was observed. TIG was given but patient expired on 30‐3‐2011. Patient and attendants were educated on disease prevention Chicken 28-Mar-11 Hyderabad Village jani Mungio 2 3 0 0 Sindh Pox and isolation of patients, cases encouraged to take rest, drink sufficient water and practice frequent hand washing. Two alerts with 1 suspected case from each site, gave vitamin Village Muhammad Bachal A, collected specimen and sent to NIH, upon field investiga‐ 28-Mar-11 Sindh Jacobabad and Mohalla Jano Bello- Measles 2 0 0 0 UC Mouchi Basti tion four more cases found and outreach vaccination sched‐ uled for community. Gave Vitamin A to suspected cases; cases isolation; 2 samples Ghaffar Mohalla UC-5, 28-Mar-11 Sindh Karachi Machar Colony Measles 3 1 1 1 collected and sent to NIH; advocated for vaccination in town; health education 3 suspected case, reported from community, upon field inves‐ Village Bago Dero, taluka Chicken 31-Mar-11 Khairpur 3 0 0 0 Sindh Kotdiji Pox tigation 10 more cases found. Health education on prevention and hygiene

Village Abdul Raheem 2 suspected cases one each admitted in GIMS hospital Gam‐ Dahar-UC Agraa Tal and Meningi- bat and DHQ city Hospital with fever, motions, fits, uncon‐ 28-Mar-11 Sindh Khairpur 1 0 1 0 Ranwal Goth taluka Khair- tis sciousness from two different locations. Patient getting treat‐ pur ment. DHQ (Village Yakoob Arain Patient was admitted in DHQ city hospital Khairpur, TIG was 28-Mar-11 Sindh Khairpur Tetanus 0 1 0 0 -UC Sui Gas Tal) provided by WHO but patient died due to complications. Village Wada Bosan, Diphthe- 1 suspected case admitted in CMC hospital Larkana. Investiga‐ 28-Mar-11 Sindh Larkana 0 1 0 0 taluka Ratodero ria tion in progress CMC Larkana (UC Bero Patients are admitted in CMC Larkana, TIG was provided by 30-Mar-11 Sindh Larkana Tetanus 0 0 1 0 Chandio, UC Naudero) WHO. Two alerts were reported from two different sites, upon field Naushahro Village Ahmedani Laghari, Chicken 26-Mar-11 2 0 0 0 Sindh Feroze UC Fatoo Balal, Moro Pox investigation many other cases found, health education planned in community. Naushahro 1 suspected case, gave vitamin A, collected specimen and sent 28-Mar-11 Sindh Village Phull Measles 1 0 0 0 Feroze to NIH, outreach vaccination scheduled for community. Naushahro Village Ahmed Laghari UC 10 suspected cases, reported from the village by SAHKAR 31-Mar-11 Sindh Pertussis 0 0 0 0 Feroze Fatoo Bilal, Moro DOST NGO, field investigation is in progress. Goth Gulab Khan Bhang- Vitamin A, isolation, advocated for vaccination in town, health 29-Mar-11 Sindh Nawabshah Measles 0 0 1 0 war education and active case finding Health education, all cases improving, EDOH informed, case 29-Mar-11 Sindh Nawabshah Taj Colony-UC 6 Pertussis 3 2 3 0 treatment reinforced Vitamin A, isolation, 3 samples collected and sent to NIH, Village Ali Nawaz Bhambro 29-Mar-11 Sindh Sanghar -Mohalla Lakho Sher Measles 1 1 1 2 advocated for vaccination in town, health education and active case finding.

Village Alaf, shashaid city two alerts for suspected Measles, gave vitamin A, collected 25-Mar-11 Sindh Shikarpur and village Mad Khoso Measles 0 0 2 0 specimen and sent to NIH, outreach vaccination scheduled for taluka Lakhi community. 1 suspected case, gave vitamin A, collected specimen and sent 24-Mar-11 Sindh Sukkur Village Kandri, taluka Rohri Measles 1 0 0 0 to NIH, outreach vaccination scheduled for community. Mahar Village Garhi, taluka Meningi- Patient admitted at GMC hospital Sukkur. Investigation in 31-Mar-11 Sindh Sukkur 0 0 0 1 Pano Akil tis progress Three alerts from different locations (9 suspected cases in village Jogi Vero and Veeni total). Gave Vitamin A dose, 3 blood sample collected (one ji Veri in UC Dahli and 26-Mar-11 Sindh Tharparkar village Sameja Paro UC Measles 2 3 3 1 from each site) and sent to NIH, health education, advocacy Gadhro, Taluka Chachro with district health authority to undertake vaccination in the affected areas Alerts from three different locations. Patient and attendants Chicken were given health education on disease prevention and isola‐ 26-Mar-11 Sindh Thatta Pir Jo Goth 1 5 4 7 Pox tion of the patient. Cases encouraged to take rest, drink suffi‐ cient water and practice frequent hand washing.

Village Ghulam Hussain Measles alert from 5 different location investigated and 29 Nohani; Sujawal ward No suspected cases identified; gave Vitamin A and advised for 1, Chawan muhallah;Dino 1 25-Mar-11 Thatta Measles 9 6 3 Sindh Jat-UC Gul Muhammad 1 cases Isolation. 5 samples collected and sent to NIH. EDO‐H Baran; village Pinyo Sand; informed and recommended vaccination in the affected vil‐ and Sulman Meerbahar lages and health education Health education in the community, EDOH requested to send 30-Mar-11 Sindh Thatta Village Essa Khan Sand Pertussis 1 0 0 0 vaccinator, pateint and contacts prescribed Erythromycin.

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Province Khyber Pakhtunkhwa Figure-5: Trend of priority communicable diseases, province KP (31-July 2010 to 31 March 2011) • This week 16 districts reported to DEWS

from KP province, 593 health facilities 50 reported 147,531 patients consultations to 45 DEWS. 40 35 • ARI is the leading disease in KP province. 30 ARI cases reported 46,826 (32%), 1% 25 lower proportional morbidity as com- Percentage 20 15 pared with last week. 10

5 • 6 alerts were reported in this bulletin 0 1 3 5 7 9

31 33 35 37 39 41 43 45 47 49 51 from Khyber Pakhtunkhwa, 3 were for 11 13

wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk Measles, while 1 each for Mumps, Influ- wk wk enza, and Leishmaniasis. AD BD ARI S. Malaria

Diseases Wk-10 Wk-11 Wk-12 Wk-13

Skin Diseases 7,117 (5%) 7,836 (4%) 7,478 (4%) 6,615 (4%)

ARI (URI and LRI) 53,437 (37%) 61,398 (34%) 55,817 (33%) 46,826 (32%)

Other Acute Diarrhoea 10,060 (7%) 13,664 (8%) 13,577 (8%) 12,541 (9%) (Not Watery)

Bloody Diarrhea 1,024 (1%) 1,313 (1%) 1,221 (1%) 1,253 (1%)

Suspected Malaria 1,773 (1%) 2,219 (1%) 1,959 (1%) 2,028 (1%)

Total consultations 144,754 181,133 168,794 147,531 Province Punjab Figure-6: Trend of priority communicable diseases, province Punjab (3 August 2010 to 31 March 2011) • 12 districts reported data to DEWS from Punjab province, 749 health centers reported a total of 50 203,992 patient consultations during this report- 45 ing period 40 • ARI cases reported were 52,369 (26%), same 35 proportional morbidity as compared with last 30 week. 25 20 • 6 alerts were reported in this bulletin from Percentage 15 Punjab; 4were for measles, while 1 each for Men- 10 ingitis, and Leishmaniasis. 5 • This week a total of 7,892 malaria samples were 0 1 3 5 7 9

tested of which 128 were positive (slide positivity 11 13 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 rate 1.6%, while falciparum rate was 34.3%). wk AD BD ARI S. Malaria

Diseases Wk-10 Wk-11 Wk-112 Wk-13

Skin Diseases 16,821 (9%) 17,224 (8%) 16,625 (9%) 17,309 (8%)

ARI (URI and LRI) 55,193 (28%) 56,139 (27%) 49,706 (26%) 52,369 (26%)

Other Acute Diarrhoea 12,243 (6%) 12,418 (6%) 15,200 (8%) 16,753 (8%) (Not Watery)

Unexplained Fever 5,074 (3%) 5,882 (3%) 6,176 (3%) 7,050 (3%)

Suspected Malaria 4,754 (2%) 5,413 (3%) 6,684 (3%) 7,571 (4%)

Total consultations 195,512 206,444 193,903 203,992

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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]. 05 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Province Sindh Figure-7: Trend of priority communicable diseases, province Sindh (6 August 2010 to 31 March 2011) • This week 23 districts reported to DEWS from

Sindh province, and 1,082 health centers re- 50

ported a total of 424,185 patient consultations 45 during the reporting period of week 13, 2011. 40

• In Sindh, ARI cases reported were 101,954 30

(24%), 1% lower proportional morbidity as 25 compared with last week. 20 Percentage 15

• 40 alerts were reported from Sindh in this 10

week: 22 were for Measles, 7 were for Pertussis, 5 5 were for Chickenpox, 3 were for Tetanus, 2 0 were for Meningitis, and 1 for Diphtheria. 1 3 5 7 9

31 33 35 37 39 41 43 45 47 49 51 11 13

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

AD BD ARI S. Malaria

Diseases Wk-10 Wk-11 Wk-12 Wk-13

Skin Diseases 52,630 (12%) 53,708 (11%) 46,530 (12%) 48,208 (11%)

ARI (URI and LRI) 123,923 (27%) 127,894 (27%) 100,746 (25%) 101,954 (24%)

Other Acute Diarrhoea 29,757 (7%) 33,711 (7%) 31,947 (8%) 35,354 (8%) (Not Watery)

Bloody Diarrhea 3,079 (1%) 3,035 (1%) 2,640 (1%) 2,952 (1%)

Suspected Malaria 39,779 (9%) 42,099 (9%) 36,933 (9%) 37,542 (9%)

Total consultations 455,919 475,096 397,149 424,185

Province Balochistan Figure-8: Trend of priority communicable diseases, province Balochistan (6 August 2010 to 31 March 2011) • In this week, 16 districts reported to DEWS from Balochistan province. 378 fixed and 12 mobile medi- 50 cal outreach centers reported a total of 62,254 patient 45 consultations. 40 • ARI reported in 14,818 (24%) of the total consulta- 35 tions which is 2% lower proportional morbidity as 30 compared with last week. 25 20 • 8 alerts were reported in this week from Balochistan, Percentage 15 4 were for Malaria, 2 were for Measles, while 1 each was for acute Jaundice Syndrome, and Chickenpox. 10 5 • Malaria cases were reported from some of the districts 0 in Balochistan. In week 13 a total of 878 malaria 1 3 5 7 9

31 33 35 37 39 41 43 45 47 49 51 11 13

wk samples were tested of which 300 were positive and wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk slide positivity rate was 34%, while falciparum rate wk wk was 68%. AD BD ARI S. Malaria

Diseases Wk-10 Wk-11 Wk-12 Wk-13

Skin Diseases 3,062 (6%) 3,410 (6%) 4,317 (7%) 4,429 (7%)

ARI (URI and LRI) 14,634 (30%) 15,189 (27%) 15,927 (26%) 14,818 (24%)

Other Acute Diarrhoea 4,606 (9%) 5,053 (9%) 5,940 (10%) 6,741 (11%) (Not Watery)

Bloody Diarrhea 1,386 (3%) 1,607 (3%) 1,665 (3%) 2,147 (3%)

Suspected Malaria 5,950 (12%) 6,512 (11%) 7,124 (12%) 7,979 (13%)

Total consultations 49,521 57,068 61,597 62,254

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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]. 06 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Islamabad Capital Territory Figure-9: Trend of priority communicable diseases, Islamabad (1 January to 31 March 2011)

• This week Islamabad is reporting from two 70 health facilities with a total of 588 patient consultations. 60 50

• ARI cases reported were 102 (17%), while 40 Acute Diarrhoea (Not Watery) 52 (9%). Fluc- Percentage 30 tuation in rates is due to difficulties in collect- ing reports as the system is being established. 20 10

• No alert was received this week. 0

wk 1wk 2wk 3wk 4wk 5wk 6wk 7wk 8wk 9wk 10 wk 11 wk 12 wk 13 AD BD ARI S. Malaria

Diseases Wk-10 Wk-11 Wk-12 Wk-13

Skin Diseases 41 (1%) 35 (2%) 25 (1%) 7 (1%)

ARI (URI and LRI) 1,582 (47%) 404 (25%) 1,288 (51%) 102 (17%)

Other Acute Diarrhoea (Not 292 (9%) 108 (6%) 200 (8%) 52 (9%) Watery)

Bloody Diarrhea 2 16 (1%) 40 (2%) 5 (1%)

Suspected Malaria 10 3 12 -

Total consultations 3,371 1,765 2,550 588 FATA Figure-9: Trend of priority communicable diseases, FATA (4 February to 31 March 2011) • This week FATA is reporting from one health 40 center in IDP camp in Mohmand Agency, with a 35 total of 1,374 patient consultations. 30

25 • ARI cases reported were 345 (25%), while Acute 20 diarrhoea reported 182 cases (13%)

Percentage 15 • No alert was received this week. 10 5 0

wk 6wk 7wk 8wk 9wk 10 wk 11 wk 12 wk 13

AD BD ARI S. Malaria

Diseases Wk-10 Wk-11 Wk-12 Wk-13

Skin Diseases 76 (5%) 97 (6%) 68 (5%) 117 (8%)

ARI (URI and LRI) 364 (25%) 381 (24%) 345 (25%) 340 (24%)

Other Acute Diarrhoea (Not 176 (12%) 153 (10%) 182 (13%) 216 (15%) Watery)

Bloody Diarrhea 1 - 1 1

Suspected Malaria - 5 - 10

Total consultations 1,477 1,603 1,374 1,415

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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]. 07 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Gilgit Baltistan • In this week, first weekly report from 3 districts in Gilgit Baltistan sent weekly report from twenty three health centers with a total of 4,686 patient consultations.

• ARI cases reported were 1,288 (51%), while Acute Diarrhoea (Not Watery) 200 (8%). Fluc- tuation in rates is due to difficulties in collect- ing reports as the system is being established.

• No alert was received this week.

Diseases Wk-12

Skin Diseases 459 (10%)

ARI (URI and LRI) 1,647 (35%)

Other Acute Diarrhoea (Not Watery) 247 (5%)

Bloody Diarrhea 63 (1%)

Suspected Malaria 2

Total consultations 4,686 State of Azad Jammu and Kashmir • In this week, first weekly report from 2 districts in AJK received to DEWS system from twenty three health centers with a total of 532 patient consultations.

• ARI cases reported were 216 (40%), while Acute diarrhoea reported 41 (13%) cases

• No alert was received this week.

Diseases Wk-12

Skin Diseases 13 (2%)

ARI (URI and LRI) 216 (40%)

Other Acute Diarrhoea (Not Watery) 41 (8%)

Bloody Diarrhea -

Suspected Malaria -

Total consultations 532

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Cases 2010 Cases 2011 Year 2010: The total num- Province ber of polio cases reported in P1 P3 P1 P3 2010 is 144 including 120 type- Punjab 6 1 - - 1 cases and 24 type-3 from 40 infected districts/towns/ Sindh 26 1 6 - agencies.

Khyber Pakhtunkhwa 19 5 3 - Year 2011: The total number of new type-1 polio cases FATA 63 11 13 - confirmed by the laboratory is 26 to date. Balochistan 6 6 4 -

2 polio cases confirmed this AJK - - - - week: 1 from FATA (FR Lakki) , and 1 from Sindh Gilgit‐Baltistan - - - - (Badin). Islamabad - - - -

Total 120 24 26 -

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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]. 07 Epidemiological Bulletin: DEWS, Pakistan, Week no. 13 (25 - 31 March 2011) Confirmed Alerts (1st Dec 2010 to 1st April 2011)