Proportion of Consultations for Acute

Epidemiological Week No. 35 (23 - 29 Aug 08) Sept 25/ Vol. 145/ DEWS 2008-35

Rawalakot: Water supply tanks are eroded with grass and weeds in spring. Need a mechanism for cleaning. Reporting Units ...... 2 Picture credit: Dr. Nadeem Gondal Total number of consultations...... 2 DEWS Data, Epidemiological Week No. 35, 2008 ...... 3 DEWS Data, (Epidemiological Weeks No.32 – 35, 2008):...... 4 Acute Diarrhoea and suspected Cholera: ...... 5 Acute Respiratory Tract Infections: ...... 7 Upper and Lower Respiratory Tract Infection:...... 7 Other Conditions under Surveillance: ...... 8 Outbreak Alert and Response...... 8 Number of reported cases and deaths per District, AJK ...... 9 Number of reported cases and deaths per District, NWFP ... 10

In week 35, total 67,419 consultations Proportion of consultations for acute reported from 254 reporting units diarrhoea showing a gradual declining trend in all earthquake affected ARI remains the leading cause of districts

consultation this week accounting for Three alerts were received and 19% of total consultations investigated accordingly

Acute Diarrhoea was reported in 10% There were no outbreak reported from of all consultations, a decrease by 1% any earthquake affected district. compared to the previous 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 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 25 September 2008 / Vol. 145/ DEWS 2008-35

Reporting Units

During week 35, 2008, total 254 (76%) weekly reports were received on due time out of the total 335 DEWS reporting sites in the earthquake districts. Compared to last week, the DEWS reporting have decreased by 3%. The reporting from district Bagh, Muzaffarabad and Neelum has dropped in this week. Table 1, summarizes the reporting by each earthquake affected district for the last 4 weeks.

Table1. Heath Facilities by district, reported from Earthquake Affected Areas, Pakistan, 2 – 29 Aug 2008. Reporting Health Facilities Area Population 2-8 Aug 08 9-15 Aug 08 16-22 Aug 08 23-29 Aug 08 Week-32 Week-33 Week-34 Week-35 Bagh 452,532 29 26 27 20 Battagram 592,256 39 33 35 36 Mansehra 1,154,804 65 68 67 70 Muzaffarabad 770,000 66 62 71 65 Neelum 184,000 15 12 13 8 Poonch 633,712 60 51 53 55 Total 3,727,668 274(82%) 252(75%) 266(79%) 254(76%)

Total number of consultations

During week 35, total 67,419 patient consultations were reported, a decrease by 7% compared to last week. District Mansehra reports the highest proportion (34%) and district Neelum reports lowest proportion (2%) 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 affected area. There is an overall decline in consultations starting from week 49, 2007 onwards compared to the previous weekly pattern. This declining trend could be a result of people going to private clinics for health care which are now functional in the earthquake affected areas. 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 35, 2008.

Figure1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, Week 1, 2007 – week 35 2008. # of Units Weekly Pattern of reporting consultations # of Cns. 350 120000 Reporting Unit Consultations

300 100000

250 80000 200 60000 15 0 40000 10 0

50 20000

0 0 W03 W05 W07 W09 W11 W13 W15 W17 W19 W21 W23 W25 W27 W29 W31 W33 W35 W37 W39 W41 W43 W45 W47 W49 W51 W03 W05 W07 W09 W11 W13 W15 W17 W19 W21 W23 W25 W27 W29 W31 W33 W35 Ep i- w e e k W01/07 W01/08

2 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145/ DEWS 2008-35

DEWS Data, Epidemiological Week No. 35, 2008

During the Epidemiological week 35 (23 to 29 August, 2008), a total of 67,419 consultations were reported through DEWS. The distribution of consultations by age groups indicate that 19% are children less than 5 years of age, 21% 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 35, 53% were female patients. The proportion for Upper Respiratory Tract Infection was 16%, Acute Diarrhoea 10%, Unexplained Fever 9%, Lower Respiratory Tract Infection 4% and Scabies 5% in all age groups and both sexes. Out of the total 67,419 reported consultations in all ages and both sexes, 56% (37,643) 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, 23-29 August 2008, Earthquake Affected Areas, Pakistan

Distribution of consultations by age Distribution of consultations by disease 45 AD URTI 10% 40 LRTI 41% 16% 35 4% 30 25 UF 9% 20 21% 20% Percentage 15 19% 10 SCB 5% 5 OTH 0 <5 5-14 15-44 ≥45 56% 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 common communicable diseases are reported higher than males (56% and 54% respectively). In males, the proportion for Acute Diarrhoea and URTI were higher than females. (Figure 3)

Figure 3.Distribution of reported consultations by disease/health event and age groups, 23-29 Aug 2008, Earthquake Affected Areas, Pakistan Distribution of consultations (Male) Distribution of consultations (Female) AD AD URTI 9% URTI 11% LRTI LRTI 15% 17% 4% 4% UF UF 9% 9% SCB SCB 5% 5% OTH OTH 54% 58%

3 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145/ DEWS 2008-35

Disease Distribution by Age:

Acute Upper Respiratory Tract Infections (URTI) is the highest reported disease in all age groups. In children less than five years of age Upper Respiratory Tract Infection comprised of 24% of the total consultations, followed by Acute Diarrhoea (AD) 16% of the consultations, Unexplained Fever 10%, Lower Respiratory Tract Infection (LRTI) 5%, Scabies 5% and other health problems 40%. In children 5 to 15 years of age Upper Respiratory Tract Infection was reported in 19% of the consultations followed by Acute Diarrhoea 12%, Unexplained Fever (UF) 9%, Scabies 6%, Lower Respiratory Tract Infection 4% and other health problems 48%. In both adult age groups, 15-45 years and above 45 years, the proportion of the other health problems is higher than reported for children. The proportion of the remaining reported communicable diseases in both adult groups is lower than reported in children. Figure 4 presents the comparisons of the reported consultation by age groups.

Figure4. Proportion of primary causes for all reported cases by age groups, 23-29 Aug 2008, Earthquake Affected Areas, Pakistan. SCB SCB AD AD MAL 5% 4% 7% 16% <1% LRTI 3% SCB AD MAL MAL URTI 6% 8% OTH SCB AD <1% <1% 12% LRTI 40% 6% 12% MAL LRTI 3% <1% UF 5% 7% URTI LRTI OTH 14% 4% UF URTI 66% 24% 10% URTI OTH 19% UF 58% < 5yrs (n=12,699) OTH ≥15 - ≤44yrs (n=27,454) 10% 48% UF 9% 5 - <15yrs (n=13,965) ≥ 45yrs (n=13,343)

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

DEWS Data, (Epidemiological Weeks No.32 – 35, 2008):

During the period 2 to 29 August, 2008 (Epidemiological weeks 32 to 35, 2008 both inclusive), total 280,115 consultations were reported in the Earthquake affected areas. The proportion of the five common diseases under surveillance was, 44% (122,431) of the total consultations reported during this period. This proportion remains almost consistent for the last four weeks. During this period 15% (41,258) of consultations were due to Upper Respiratory Tract Infection (URTI), 11% (31,094) Acute Diarrhoea (AD), 8% (23,578) Unexplained Fever (UF), 4% (10,749) Lower Respiratory Tract Infection (LRTI), and 5% (13,229) due to Scabies (SCB). Acute Jaundice Syndrome was reported in 49 consultations and Bloody Diarrhoea was reported in 1,084 consultations during this period.

Total 93 deaths were reported during the last four weeks period. Most (81%) of the total reported deaths were due to health events other than the diseases under weekly surveillance. Five deaths reported due to Lower respiratory tract infection and the total case fatality for LRTI over the past four weeks is 0.047%. Out of the total deaths in the last four week period, twelve deaths were reported to be due to acute diarrhoea resulting in a case fatality for AD of 0.039%. No other deaths were reported from any of the other diseases under weekly surveillance during this four week period.

4 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145/ DEWS 2008-35

Table 2: Weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, Week 32 - 35, 2008. Week WEEK 32 WEEK 33 WEEK 34 WEEK 35 TOTAL CFR% Event C D C D C D C D C D AD 8960 1 7335 5 7911 5 6888 1 31094 12 0.039 SC 0 0 1 0 0 0 0 0 1 0 0.000 AFP 2 0 1 0 0 0 2 0 5 0 0.000 AJS 17 0 6 0 11 0 15 0 49 0 0.000 BD 332 0 241 0 293 0 218 0 1084 0 0.000 LRTI 3198 2 2647 0 2515 1 2389 2 10749 5 0.047 MAL 447 0 219 0 369 0 345 0 1380 0 0.000 MG 0 0 1 1 0 0 0 0 1 1 0.000 MS 0 0 0 0 2 0 1 0 3 0 0.000 OTH 42837 14 35368 14 41836 21 37643 26 157684 75 0.048 SCB 3510 0 3038 0 3403 0 3278 0 13229 0 0.000 UF 6151 0 5508 0 5950 0 5969 0 23578 0 0.000 URTI 11006 0 9062 0 10519 0 10671 0 41258 0 0.000 Total Cons. 76460 17 63427 20 72809 27 67419 29 280115 93 RU 274 252 266 254

Acute Diarrhoea and suspected Cholera:

During week 35, 2008, Acute Diarrhoea (AD) was reported in 6,888 patients accounting for 10% of the total consultation in all age groups. In children less than 5 years of age Acute Diarrhoea was reported in 16% of the total consultations in the age group. In children 5 to 14 years of age, 12% of the consultations were for AD. In the adult age groups, 15-45 years and above 45 years of age, AD consultations were reported as 7% and 8% respectively, out of the total consultations in the respective age groups. The Acute Diarrhoea weekly consultations started increasing gradually from week 16 onwards, and reached at its peak on week 28. The proportion of consultations for AD, showing a gradually declining trend from week 29 onwards presenting the usual seasonal pattern of the disease. However, this year the overall weekly pattern of AD has been slightly lower than the previous two years, in the earthquake affected districts; but generally, the weekly trend of AD from week 1 to 35 depicts a similar pattern for the last three years (Fig 6).

Figure 5: Trend in Acute diarrhoea as a percent of all consultations, weekly comparison by year, Earthquake Affected Areas, Pakistan,

18 Weekly comparison of acute diarrhoea (Year 05, 06, 07 and 08) 16 14 12 10 8 6 consultations

Percentage ofall 4 2 0 1 4 7 101316192225283134374043464952 Ep i- w e e k 2005 2006 2007 2008

5 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145/ DEWS 2008-35 In general the proportion of Diarrhoea started declining in all the districts for the last few weeks. When comparing the trends of Acute Diarrhoea by district from Week 1 to 35, 2008, Battagram, Poonch and Neelum report the highest proportion of AD throughout the period and present a fluctuating pattern of cases. District Neelum is reporting the highest percentage of consultations for Acute Diarrhoea but the proportion has dropped in week 35 compared to the previous week. But there is neither the indication of clustering of cases nor does the situation look like an epidemic reported from any part of the district. All of the earthquake affected districts are showing a drop in the AD consultation in week 35, except Mansehra, 2008 (Fig 6). The health cluster partners in the Earthquake affected districts are continuously conducted activities on prevention and control of diarrhoeal diseases by taking appropriate measures and vigilantly monitored the Acute Diarrhoea situation in their respective districts.

Figure 6: Trend in Acute diarrhoea as a percent of all consultations, comparison by districts weeks 1-35, 2008, Earthquake Affected Areas, Pakistan Weekly trend of acute diarrhoea by district 20 18 16 14 12 10 8 consultations Percentage of 6 4 2 0 1 4 7 10 13 16 19 22 25 28 31 34 Ep i- w e e k BAGH BATTAGRAM M ANSEHRA M UZAFFARABAD NEEL UM POONCH

Bloody Diarrhoea:

During week 35 of 2008, a total of 218 cases of Bloody Diarrhoea were reported from all the districts, which is comparatively lower than the total BD consultations 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 compared the weekly trend of the BD by districts, Neelum report higher proportion compared to other districts during the last few weeks. Although there is no clustering of cases in any one area but the sporadic cases are being reported continuously. The probable explanation for the relatively higher proportion in the district is the consumption of contaminated water and 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

1.50

1.00 consultations Percentage of 0.50

0.00 1 4 7 101316192225283134 Ep i- w e e k BAGH BATTAGRAM MANSEHRA M UZAFFARABAD NEEL UM POONCH

6 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145/ DEWS 2008-35 Acute Respiratory Tract Infections:

During week 35, 2008, a total of 13,060 consultations for ARI (both Upper and Lower Respiratory Tract Infection) were reported. ARI account for 19% of the total consultations reported for the week (URTI 16% and LRTI 3%) and is 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 24% and LRTI in 5% of the consultations. In the 5 to 14 year age group URTI was reported in 19% and LRTI in 4% of the consultations. In the 15 to 45 year age group, URTI was reported for 12% and LRTI for 3% of the consultations. In the age group above 45 years URTI was reported for 14% and LRTI for 3% of the consultations. Overall, the proportion of ARI in male patients was reported to be higher compared to females. The weekly trend of ARI for the same weeks (from week 1 to 35) from the last two years display a similar trend to that of 2008. The overall ARI trend, from weeks 10 to 15 remain consistent with a little weekly fluctuation in the earthquake affected districts. The proportion of ARI from week 16 to 26 in 2008 remains slightly higher than the same period in 2006 and 2007, however, from weeks 27 onwards the trend has been declining and now is at the same level as the previous years (Fig 8). During week 35, 2008 there were 2,389 consultations for Lower Respiratory Tract Infection.

Figure 8: Comparison of ARI weekly trends of year 2005, 2006, 2007 and 2008, Earthquake affected districts Pakistan Weekly trend of ARI, comparison by year (05, 06, 07 and 08) 40 35 30 25 20 15 consultations Percentage of 10 5 0 1 4 7 101316192225283134374043464952 Epi-week 2005 2006 2007 2008

Upper and Lower Respiratory Tract Infection:

During week 35, 2008, 3% (2,389) of the consultations were for Acute Lower Respiratory Tract Infections and 14% (10,671) of cases were for Upper Respiratory tract Infections reported in all age groups through the DEWS system. The proportion of consultations for ARI has started showing the upward trend from week 35. (Figure10).

Figure 10: Weekly Proportion of URTI and LRTI as percentage of all consultations, (week 1 – 35, 2008) Earthquake Affected Areas, Pakistan Weekly proportion of ARI (Week 1-31, 2008) 30 LRTI URTI 25

10 consultations Percentage of 5

0 1 4 7 101316192225283134 Ep i- w e e k

Suspected Malaria:

7 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145/ DEWS 2008-35

In week 35, 2008, there were 345 suspected cases of malaria reported. District Poonch reports highest number of suspected malaria cases compared to the other districts. In comparison to last few weeks, the proportion of suspected malaria cases has slightly increased in the districts except Muzaffarabad and Mansehra. Districts Muzaffarabad and Mansehra reported less cases of suspected Malaria compared to previous week. There were no associated deaths due to malaria reported from any district.

Figure 9: Weekly trends in Suspected Malaria as percentage of all consultations, comparison by district, Earthquake Affected Areas, Pakistan, weeks 1-35, 2008 Weekly trend of Malaria by district 2.5

1.5

1 consultations Percentage of 0.5

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 Ep i- w e e k BAGH BATTAGRAM M ANSEHRA MUZAFFARABAD POONCH

Other Conditions under Surveillance:

During this week, 37,643 (56%) consultations out of the total 67,419 consultations, in all ages and both sexes were for health problems other than the reportable diseases under weekly surveillance. There were 15 cases of suspected Acute Jaundice Syndrome reported from all the earthquake affected districts. No cases of suspected Hemorrhagic Fever or Neonatal Tetanus reported from any district for week 35, 2008.

Outbreak Alert and Response1

During week 35, 2008, Three (3) alerts were identified/ reported from Battagram and were responded.

Battagram:

Acute Diarrhea: An alert was received from Civil Dispensary Gijbori reporting total number of ten cases in the whole week. This was more than the usual routine. On investigation these were all sporadic cases and had healed by now.

Bloody Diarrhea An alert of Bloody Diarrhea was reported from Paimal Sharif, Basic Health Unit; on investigation these were also sporadic cases. No clustering was identified there too.

Measles: A case of measles was reported from the Basic Health Unit in Allai. The female child of 7 years age was in recovery phase when we reached there and no other cases were found as per the records of the BHU.

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 25 September 2008 / Vol. 145/ DEWS 2008-35

Number of reported cases and deaths per District, AJK

Table 3. Number of reported cases and deaths, Bagh District*, Earthquake Affected Areas, Pakistan, 2 – 29 Aug 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 32 1051 0 0 0 32 0 0 0 140 0 867 0 34 0 0 0 0 0 0 0 275 0 231 0 1 0 5418 0 33 957 2 0 0 28 0 0 0 141 0 774 0 29 0 0 0 0 0 0 0 299 0 199 0 0 0 4832 2 34 847 0 0 0 38 0 0 0 126 0 834 0 49 0 2 0 0 0 0 0 250 0 170 0 1 0 5162 8 35 523 1 0 0 3 0 0 0 110 1 768 0 49 0 0 0 0 0 0 0 182 0 132 0 1 0 2993 4 Total 3378 3 0 0 101 0 0 0 517 1 3243 0 161 0 2 0 0 0 0 0 1006 0 732 0 3 0 18405 14

Table 4. Number of reported cases and deaths, Poonch District*, Earthquake Affected Areas, Pakistan, 2 – 29 Aug 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 32 1437 1 0 0 27 0 0 0 701 1 1576 0 146 0 0 0 0 0 0 0 495 0 1024 0 2 0 5039 3 33 1160 0 0 0 23 0 0 0 628 0 1197 0 71 0 0 0 0 0 0 0 330 0 835 0 0 0 3823 4 34 1187 0 0 0 29 0 0 0 651 0 1482 0 125 0 0 0 0 0 0 0 367 0 815 0 0 0 4176 0 35 1054 0 0 0 17 0 0 0 610 0 1488 0 124 0 0 0 0 0 0 0 430 0 912 0 3 0 4136 2 Total 4838 1 0 0 96 0 0 0 2590 1 5743 0 466 0 0 0 0 0 0 0 1622 0 3586 0 5 0 17174 9

Table 5. Number of reported cases and deaths, Muzaffarabad District*, Earthquake Affected Areas, Pakistan, 2 – 29 Aug 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 32 3031 0 0 0 164 0 0 0 1705 0 3988 0 178 0 0 0 0 0 0 0 1263 0 2889 0 0 0 10939 4 33 2729 0 0 0 120 0 0 0 1351 0 3581 0 109 0 0 0 0 0 0 0 1163 0 2900 0 0 0 8610 14 34 2906 0 0 0 114 0 0 0 1262 0 3774 0 135 0 0 0 0 0 0 0 1281 0 2890 0 0 0 10436 10 35 2404 0 0 0 108 0 0 0 1224 0 3860 0 106 0 0 0 0 0 0 0 1250 0 2646 0 0 0 9274 13 Total 11070 0 0 0 506 0 0 0 5542 0 15203 0 528 0 0 0 0 0 0 0 4957 0 11325 0 0 0 39259 41

9 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145 DEWS 2008 -35

Number of reported cases and deaths per District, NWFP

Table 6. Number of reported cases and deaths, Battagram District*, Earthquake Affected Areas, Pakistan, 2 – 29 Aug 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 32 1256 0 0 0 58 0 0 0 94 0 1518 0 85 0 0 0 0 0 0 0 389 0 831 0 6 0 5822 0 33 669 0 0 0 12 0 0 0 46 0 948 0 9 0 0 0 0 0 0 0 226 0 463 0 1 0 3095 0 34 996 0 0 0 59 0 0 0 97 0 1405 0 56 0 0 0 0 0 0 0 301 0 542 0 7 0 5233 0 35 1024 0 0 0 66 0 0 0 63 0 1589 0 63 0 1 0 0 0 0 0 311 0 848 0 10 0 5517 0 Total 3945 0 0 0 195 0 0 0 300 0 5460 0 213 0 1 0 0 0 0 0 1227 0 2684 0 24 0 19667 0

Table 7. Number of reported cases and deaths, Mansehra District*, Earthquake Affected Areas, Pakistan, 2 – 29 Aug 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 32 1770 0 0 0 27 0 2 0 321 1 2639 0 4 0 0 0 0 0 0 0 943 0 1146 0 7 0 14085 7 33 1479 5 0 0 34 0 1 0 198 0 2261 0 1 0 0 0 1 1 0 0 917 0 1081 0 5 0 13894 4 34 1645 0 0 0 25 0 0 0 225 1 2690 0 4 0 0 0 0 0 0 0 1084 0 1507 0 3 0 15938 15 35 1766 0 0 0 18 0 2 0 286 2 2851 0 3 0 0 0 0 0 0 0 1075 0 1424 0 1 0 15241 7 Total 6660 5 0 0 104 0 5 0 1030 4 10441 0 12 0 0 0 1 1 0 0 4019 0 5158 0 16 0 59158 33