Weekly Epidemiological Bulletin Disease Early Warning System and Response in Pakistan

Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan

Volume 2, Issue 25, Monday 27 June, 2011

Highlights Priority diseases under surveillance Epidemiological week no. 25 (17 - 23 June, 2011) in DEWS

• 90 districts and 3 agencies provided surveillance data to the DEWS this week from 3,341 fixed health Acute Flaccid Paralysis (AFP)

facilities and 5 mobile medical outreach centres. Acute Jaundice Syndrome (AJS)

• A total of 1,012,742 consultations were reported through DEWS of which 18% were acute respiratory Acute Respiratory Infections infections (ARI), 11% skin disease, 10% acute diarrhoea, and 6% were suspected Malaria. (Upper and Lower) (ARI)

Acute Watery Diarrhoea (AWD)/ • Currently 76 DEWS surveillance officers are responding to alerts in 104 districts and agencies all over Suspected Cholera the country. Acute Bloody Diarrhoea (BD)

• A total of 147 alerts with 11 outbreaks were reported in week-25, 2011: Altogether 73 alerts were for Other Acute Diarrhoeas (AD) Measles; 29 for AWD, 9 for Leishmaniasis, 8 for Acute diarrhoea, 7 for Pertussis, 4 for Acute Jaundice Syndrome, 3 each were for Meningitis and Neonatal Tetanus, 2 each for Chicken Pox, Mumps, Sca- Suspected Viral Hemorrhagic bies and Tetanus, while 1 each for DHF, Hemorrhagic Fever and Malaria. Fever (VHF)

Suspected Malaria (Mal) • National Polio Eradication Initiative reported three confirmed polio cases this week. One each from Suspected Measles (MS) Killa Abdullah, and Khuzdar districts in Balochistan; and one from Jamshoro district in Sindh. Total 54 confirmed polio cases have been reported in 2011 from 24 districts. Suspected Meningitis (MG)

Others

Figure‐1: Three years trend of Acute diarrhoea in Pakistan, (2009, 2010 and 2011)

2009 2010 2011

12 Percentage

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Epi‐week

Disease Wk-18 Wk-19 Wk-20 Wk-21 Wk-22 Wk-23 Wk-24 Wk-25

Other Acute Diarrhoea (Not Watery) 85,473 (10%) 94,472 (10%) 102,955 (11%) 106,720 (10%) 102,005 (10%) 100,753 (10%) 101,336 (10%) 103,438 (10%)

Total consultation 864,932 904,711 976,358 1,020,071 995,731 1,009,254 1,013,505 1,012,742

Figure‐1 above represents trend of "proportional morbidity." This is the number of new consultations for acute diarrhea divided by the total number of consultations. The very dramatic peak starting about week 31, 2010, demonstrates the increase in acute diarrhoea cases from the flood‐affected areas starting in KP the first week of August 2010.

The “proportional morbidity” of diarrhoea in 2011 so far follows the seasonal trend of 2009 and early 2010. However the cholera cases and outbreaks are above the usual number and started earlier than usual this year. Last week 10 districts had outbreaks of AWD, 8 more were confirmed this week.

Diseases Total 4000 Mobile Fixed 6 5

3500 7 7

Skin Diseases 3,494,190 (11%) 3 8 6 7 7 7 6 8 13 6

3000 6 6 8 8 Acute Respiratory Infection 7,955,651 (24%) 8 8 8 11 2500 11 8 11 8 11

2000 8 12

411 Acute Diarrhoea 3,078,316 (9%) 400 375 331 11 215 361 3354 3341 1500 192 26 3259 3250 3215 3196 153 3120 26 3058 3022 3021 2982 128 2935 2909 2785 105 2745 46 81 2547 2466 58 2450 2404 2349

1000 2322 2262 2255 2251 Bloody Diarrhoea 285,916 (1%) 2199 2022 2021 1797 1680

500 1463 1289 1215 1167 1158 1143 999 1130 1113 1111 967 949 1073 1067 879 Suspected Malaria 1,942,552 (6%) 854 0 2 3 4 5 6 7 8 9

Unexplained Fever 1,291,756 (4%) 11 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 14 15 16 17 18 19 20 21 22 23 24 25 10 11 12 13

‐ Wk Wk Wk Wk Wk Wk Wk Wk 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 Wk Wk Wk Total Consultations 33,238,687 Wk

Focus on: Basic Messages about Cholera Treatment and Prevention Through collaboration of the Ministry of Health district and provincial levels, National Institute of Health and the Disease Early Warning System (DEWS) teams and Environmental Health Engineers supported by WHO and WASH teams supported by UNICEF cholera has been detected and controlled in all four major provinces during last two weeks. With prompt, effective treatment, Cholera mortality is less than 1%. Cholera is spread via the fecal‐oral route, most commonly by drinking water or eating food which is contaminated by sewage.

Treatment

• Any person with diarrhea should drink more fluids, such as water, juice, and soup. The best drink is a balanced solution of sugar and salts called ORS (oral rehydration salts) which is provided at public health facilities or can be purchased in the market and mixed with safe water to provide quick fluid replacement. Zinc supplement is also recommended. • If diarrhea is continuous or vomiting prevents drinking fluids, the patient should go urgently to a hospital or clinic to re‐ ceive intravenous fluids. Patients who are promptly treated respond rapidly and recover.

Prevention

• Always be sure you are drinking water is safe ‐ filtered, chlorinated, or bottled. Avoid ice in restaurants and drinks and ice cream sold in the market because they may not be made with safe water. • “Boil it, cook it, peel it or leave it” is good advice about raw fruits and vegetables in countries endemic for cholera. Cook food well, eat it hot, keep it covered, and peel fruits and vegetables. • Wash hands after using the toilet and before eating, or use an antiseptic hand gel.

Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases reported in 2010 is 144 including 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/agencies.

Year 2011: The total number of new type‐1 polio cases confirmed by the laboratory is 54 till date from 24 districts.

Cases 2010 Cases 2011 Province P1 P3 P1 P3

Punjab 6 1 - -

Sindh 26 1 13 -

Khyber Pakhtunkhwa 19 5 6 -

FATA 63 11 18 -

Balochistan 6 6 16 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 54 -

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. 25 (17 - 23 June, 2011) Previous week's Outbreaks: Date Disease Province District Area M F Action Taken 14 AWD cases were reported. Field investigation was conducted and all the cases were visited. Severely dehy‐ Ali Mohammad Goth, 14‐June AWD Balochistan Lasbela 2 3 0 9 drated patients were referred to JGQ Hospital Hub. 2 samples were collected and found positive for V.c. Ogawa. Veerahub, UC Dureji Health Education was given as well as safe drinking water methodology was also stressed. Number of AD cases Three AWD cases who belong to village Nara reported from Ayub Teaching Hospital. Laboratory test of 3 Samples Village Nagri Payan, declared positive for V.c. Ogawa. District response team activated. Active surveillance conducted in the area. 13‐June AWD KPK Abbottabad 0 2 0 1 Havelian Necessary logistics provided, Aqua tabs, IEC material, soaps provided, Health and hygiene sessions provided through LHWs in the area. WHO and UNICEF collaborated in WASH response. AWD alert, one stool sample was collected and found positive for V.c. Ogawa. In the locality/area 10 households were interviewed but no more similar case or suspect was found. Health education to family members in house‐ St No. 6 Mohallah holds visited. Distribution of soaps, Aqua Tabs, jerry cans, water filters & IEC among them. Nearest HF was visited Islampura School wala 13‐June AWD Punjab Sargodha 0 0 1 0 & SMO was given briefing on the situation, control measures & importance of awareness among general masses Chowk Sargodha UC about safe drinking water, food & personal hygiene & it was also suggested to advise LHWs, CDC supervisor & 148 School Health & Nutrition Supervisor to impart above said information among community while conducting their HE sessions in the catchment area. EM & EH assessment was also done at HF. A death due to AWD was reported, upon field investigation 54 more AWD cases found with severe dehydration, rapid response team mobilized to affected village, field clinic established, Joint health & hygiene session conducted Village Jumoo Khan 10‐June AWD Sindh Naushahro Feroze 1 26 4 23 in collaboration with EDO‐H and NGO teams. Distributed Aqua tabs, ORS and IEC material. 1/2 stool samples found Mari , UC‐Dageja positive for V.c. Ogawa, 8 water samples also collected to test bacteriological contamination. Number of AD cases declined, no AWD case this week. Nagarparkar Town, UC 39 samples were collected and 25 found positive for P. Vivax (SPR = 64%). THQ to inform EDO‐H. Treatment and 13‐June Malaria Sindh Tharparkar 0 12 0 13 Nagarparkar control measures provided by Global Fund resources to the district. Village Arbab Ali Three cases of AWD reported, upon field investigation patients found with severe dehydration. 1 stool sample 13‐June AWD Sindh Khairpur Katoher, UC Shadi 3 0 0 0 collected and tested positive for V.c. Ogawa. Proper case management reinforced. health and hygiene session Shaheed conducted in the affected community. Number of AD cases declined, no AWD case this week. Village Mian Khakhrani, 1 case of AWD reported, field investigation conducted. 1 stool sample collected for lab confirmation and found 13‐June AWD Sindh Larkana 1 0 0 0 UC Bakrani positive for V.c. Ogawa. Health and hygiene session conducted. No other case found. One death due to AWD reported, upon field investigation 42 more AWD cases found with severe dehydration, Village Qabool Lashari, rapid response team moved to the at affected village, field clinic established, health & hygiene session conducted 13‐June AWD Sindh Naushahro Feroze 6 24 4 18 UC‐Dageja in the village. Distributed Aqua tabs, ORS and IEC material. 1 stool sample collected but found negative for Cholera, 8 water samples also tested for contamination. Number of AD cases declined, no other case this week. AWD Alert, Active Surveillance done, samples collected and 1/ 4 stool samples reported positive for V.c Ogawa. Village Salman Mu‐ 13‐June AWD Sindh Thatta 0 3 2 4 Reinforced Case Management, ORS Distributed, Health Education conducted, Report shared with EDO‐H 4/4 water naro,UC Mureed Khoso samples found contaminated. Life Starw filters, Aqua Tabs, Jerry csns, and Hygiene kits were provided to the AWD alert, Active Surveillance Done. 1 stool sample collected for lab confirmation and reported positive for V.c. Village Gul Muhammad Ogawa. Reinforced Case Management, Hygiene Kit, ORS, Aqua Tabs and Zinc Tabs Distributed. Health Education 14‐June AWD Sindh Dadu 0 2 0 3 Chandio,Belo Patan sessions conducted, EDO‐H informed about the case, 2 water Samples tested. Number of AD cases declined, no AWD case this week. Village Ghazi Khan AWD alert, Active Surveillance Done. Stool samples collected for lab confirmation. 1/2 stool sample found positive 15‐June AWD Sindh S. Benazirabad Hoat,UC Khair‐ 0 0 0 3 for Cholera. Case management reinforced. ORS, Aqua Tabs and Zinc Tabs Distributed. Health Education conducted shah,Taluka Nawabshah in the affected population. EDO‐H informed. water Sample collected for quality testing. Number of AD cases AWD alert, Active Surveillance conducted. 1 stool sample collected laboratory test and found positive for V.c. Village Haji Mir Hassan 15‐June AWD Sindh Tando Allah Yar 0 0 0 1 Ogawa. Case Management reinforced, ORS, Aqua Tabs and Zinc Tabs Distributed, Health Education sessions Thoro,UC A conducted, EDO‐H Informed. No other case found. Current week's Outbreaks: Date Disease Province District Area M F Action Taken AWD alert reported from RHC Havellian, Abbottabad, the patient belongs to village Kallig, UC Kholian Bala, Hari‐ pur. On further investigation and active surveillance, it was found that there was also a Acute diarrhoea death and almost 70% of population is suffering from acute diarrhoea. Detailed environmental assessment of the area carried out to identify the source of contamination. 6 out of 6 water samples found contaminated. Aqua tabs and RHC Havellian, Abbotta‐ 18‐June AWD KPK Abbottabad 0 0 0 0 ORS distributed among the affected population along with Health and hygiene education. Stool sample was taken bad and sent to NIH. EDO health was informed of the suspected cases. Comprehensive health and hygiene campaign launched in the area. Temporary dispensary established for the affected population. Alternate source of clean water supplied to the community through TMA tankers along with cleaning of the source and decontamination of storage tanks. Cluster of 6 cases with AJS from one location, samples taken and sent to AIMS hospital. 1/2 found positive for 20‐June AJS AJK Muzaffarabad Village Hattiyan Dupatta 0 2 0 0 Hepatitis E. During active surveillance no other cases found. Alert of suspected malaria comprising of 116 cases was reported. The DHO was informed and requested for BHU Monder Kot, Tehsil 23‐June Malaria Balochistan Jaffarabad 15 55 12 34 distribution of bed nets to the said location. 45 samples were tested, 23 verified positive (P.F, 5/ P.V, 5/ mixed, Gandakha 13) , SPR= 51.1%, while Falciparum Rate= 78.2%. AWD alert in Islamabad with one death, 4/7 stool sample found positive for V. Cholera, active surveillance for other cases, water samples collected, Aqua tabs and hygiene kits were distributed, Health education session given to the families and in the community. CDA Directorate Health arranged isolation ward for suspected cholera 23‐June AWD ICT Islamabad FGSH (G 6/1, G 7/2) 0 2 0 2 patients, Director of Water Management for CDA to address the situation, Radio Pakistan to air health and hy‐ giene awareness messages, Director of AuQaf called to Khatibs (imam of mosques) to add information about prevention and treatment of diarrhea in Friday sermon. CDA Health directorate requested UNICEF support in chlorination. Village Lakho Rahoo,UC AWD Alert, reinforced case management, active surveillance, ORS & Zinc Tabs Provided, Health education, EDO‐H 17-Jun AWD Sindh Matiari 2 1 2 0 Khando,Taluka Hala informed & 1 stool sample collected and found positive for V.c. Ogawa, two water samples also collected. Village Bachal Khask- AWD alert, reinforced case management, active surveillance, ORS, Aqua tabs & Zinc Tabs Provided, Health 17-Jun AWD Sindh Thatta heli,UC Googani,Taluka 0 1 0 1 education, EDO‐H informed. One stool sample collected and found positive for V.c. Ogawa, two water samples Shah Bunder also collected for bacteriological contamination. Two AWD alerts from two different locations, Two samples collected and found positive for V.c. Ogawa. On active surveillance no more cases found. Health education to family members in households visited. Distribution of soap, Aqua Tabs, jerry cans, water filters & IEC among them. Nearest RHC Baseera was visited & SMO was given briefing Mouza Bandhi; Chorwala, 18-Jun AWD Muzaffargarh 1 0 1 0 Punjab UC Baseera on the situation, control measures & importance of awareness among general masses about safe drinking water, food & personal hygiene & it was also suggested to requested LHWs, CDC supervisor & School Health & Nutrition Supervisor to impart above said information among community while conducting their HE sessions in the catch‐ ment area. EM & EH assessment was also done at RHC. AWD alert, reinforced case management, ORS and Zinc Tabs Provided, Health education given, EDO‐H informed. 1 18-Jun AWD Sindh Tando Allah Yar Nagori Plot,Khalil masjid 1 3 0 0 stool sample collected and found positive for V.c. Ogawa, two water samples also collected for bacteriological contamination testing. M.Ali Society, Gulshan-e- AWD alert, reinforced case management, active surveillance done and no other case found, Aqua tabs Provided, 20-Jun AWD Sindh Karachi 0 0 1 0 iqbal Health education, EDO‐H informed. 1 stool Sample collected and found positive for V.c. Ogawa. Two AWD patients from same family reported from Nishter Hospital. 1/2 stool sample found positive for V.c. Chowk Sheh Abbas Near Ogawa. Field investigations were carried out with EHE and DoH team. On active surveillance no more cases 20-Jun AWD Punjab Multan Al Mustufa Plaza, Khaji 1 1 0 0 Wala House found . Water samples were taken and HE sessions were conducted in the community and affected family. Aqua tabs, Jerry cans and Life straw filters were provided.

23-Jun AWD Battagram Vill. Khawargai, UC Battagram 1 0 0 1 Bahwal Victoria Hospital Mohalla 21-Jun Measles Bahawalpur Vehaarri Wala, Chowk Sikandar, UC- 1 0 0 0 13 17-Jun AJS Buner Vill. Bairo, UC Pandair, 1 0 1 0 23-Jun Measles Bahawalpur BVH, Multiple Locations, Lodhran 3 1 0 0 25-Jun Measles Buner Vill Warae Kilay, UC Norezai Gagra 0 0 2 0 Moza Kalwal, UC Maibal, Tehsil 22-Jun AD Bhakkar 0 15 1 5 20-Jun Measles Charsadda Majoon Kilay, Mera Turangzai 1 0 1 0 Kalurkot

22-Jun Measles Charsadda Yakh Kohi 1 0 1 0 18-Jun Measles D. G. Khan Dhorewala Jhok utra 0 0 1 0

Village Chajhian, Union Council Moza Haji Kaman UC Jhakar Imam 18-Jun AD Haripur 0 0 0 0 20-Jun Measles D. G. Khan 0 0 1 0 Ghumawan Shah Village Kallig, Union Council Kholian 18-Jun AWD Haripur 0 0 0 0 Basti Tub UC Mangrotha Tehsil Bala 23-Jun Measles D. G. Khan 0 0 0 1 Taunsa Haemor- New Padhina, Khalabut Township, 22-Jun rhagic Haripur 0 0 0 1 UC Khalabut 23-Jun Pertussis D. G. Khan Basti Chitarwata UC Tuman Qaisrani 1 0 0 0 fever

Ward#5,Near Eidghah,Mohalla 17-Jun Measles Haripur Village Barkot, Union Council Barkot 0 0 0 1 21-Jun AWD Jhang 2 0 0 1 Ghulab Wala

Muhallah Akbarabad, Union Council 17-Jun Measles Haripur 0 1 0 0 Barkot, 17-Jun Measles Jhang Chak No444,Gojjra Road 0 0 0 2

Muhallah Sayeedan, Kalabut Town- 20-Jun Measles Haripur 0 0 0 1 Leishma- ship 21-Jun Khushab UC Padrar Noshera 0 0 0 2 niasis Village Dharam Pan, Union Council 21-Jun Measles Haripur 1 0 0 0 Sarai Naimat Chah navail wala tibi kalan nashaib u/ 20-Jun Measles Layyah 1 0 0 0 c samtia Village Pallasi Mera, Union Council 21-Jun Measles Haripur 1 1 2 1 Sarai Naimat Meningi- 22-Jun Layyah Basti multani u/c wara sehra 0 1 0 0 tis 18-Jun AD Kohat UC Surgul, District Kohat 0 0 0 2 Meningi- Shahnawaz Walla,UC Kacha Gu- 23-Jun Mianwali 1 0 0 0 21-Jun AD Kohat UC Sherkot, District Kohat 2 4 1 3 tis jrat,Piplan

Meningi- 23-Jun Mianwali Village Gharbi,UC Dillaywalli 1 0 0 0 22-Jun AD Kohat UC Usterzai Bala 1 2 3 1 tis

21-Jun Measles Lower Dir Village Darorha, Nehak Darra, Warri 1 0 0 0 20-Jun AD Multan Nishter Hospital Multan 0 0 0 0

17-Jun Measles Malakand DHQ Batkhela, UC Batkhela 1 0 1 0 Chowk Sheh Abbas Near Al Mustufa 20-Jun AWD Multan 1 1 0 0 Plaza, Khaji Wala House 17-Jun Measles Malakand Village Gumbat 1 0 1 0 Writers Colony, Chnar Peer Chock 20-Jun AWD Multan 0 1 0 0 Street No 10 20-Jun AWD Mansehra Village Shah Khel Garhi 0 1 0 0

18-Jun AWD Muzaffargarh Mouza Bandhi-UC Baseera 0 0 1 0 21-Jun AWD Mardan Gali no 6, Canal Road 0 0 0 1

24-Jun AWD Mardan Mistri abad, Canal Road 0 1 0 0 18-Jun AWD Muzaffargarh Chor wala Mouza-UC Baseera 1 0 0 0

20-Jun AWD Nowshera Mohallah Sheikhan, Shaidu Khel 0 3 0 0 22-Jun Measles Muzaffargarh UC Bait Qaim Wala 0 1 0 0

19-Jun Pertussis Shangla village Bara martoba, UC Bar Puran 0 0 0 1 22-Jun Measles Muzaffargarh UC Shadi Khan Munda 0 1 0 0 21-Jun Measles Swabi DHQ Swabi, Ismail Abad 1 0 0 0

DHQ Swabi, Hemlet, Right Bank, 23-Jun Measles Muzaffargarh UC DD Panah 0 1 0 0 22-Jun Measles Swabi 0 2 1 1 Topi

DHQ Swabi, UC Topi, Mohallah 23-Jun AD Sargodha BHU 110 SB 1 4 2 5 22-Jun Measles Swabi 2 0 2 1 Kande Musa khel

19-Jun Measles Swat Village Sardan Shawar, Tehsil Matta 0 1 0 0 23-Jun AD Sargodha BHU 113 SB Tehsil Sargodha 1 2 2 2

20-Jun Measles Swat Village Nall, Tehsil Khwazakhela 0 0 1 0 18-Jun Measles Sargodha Bakkhar Bar Tehsil Shah Pur, UC 60 1 0 0 0

Village Rahat Kot near BHU Rahat 21-Jun Measles Swat 3 0 1 1 Kot Al Waqar Colony Bhalwal Tehsil 22-Jun Measles Sargodha 0 0 1 0 Bhalwal 18-Jun Measles Tank Deri Abakhel and Manjhi 1 0 1 0 22-Jun Measles Sargodha Chak Nazam East Tehsil Bhalwal 0 2 1 1 19-Jun Measles Tank Mulazai 0 1 0 0 Ward No. 3 Circular Road Opposite 22-Jun Measles Sargodha 1 0 0 0 21-Jun Measles Tank Pir Tangi and Saraghra 1 0 1 1 Lal Haveli Tehsil Shah Pur

22-Jun Measles Tank Toran 1 0 0 0 23-Jun Measles Sargodha Kot Khush Hal Tehsil Pindi Bhattian 1 0 0 0

22-Jun Measles Ghotki Marwari muhallah UC Umar Daho 0 0 1 0 23-Jun Malaria Jaffarabad BHU Monder Kot, Tehsil Gandakha 15 55 12 34

Village Sharbat Khan Tart UC Ran- Ghot Khair Pur, U/C Sameji, tehsil 24-Jun Measles Ghotki 2 0 5 1 21-Jun Measles Jaffarabad 1 0 0 0 watti Usta Mohammad Hussainabad, U/C Usta Mohammad 23-Jun Measles Jaffarabad 1 0 0 0 22-Jun NNT Ghotki Muhallah Anwarabad UC I Ghotki 1 0 0 0 2, Tehsil Usta Mohammad

Gulshan-e-Elahi,Noorani 24-Jun Scabies Jhal Magsi BHU Hathyari 12 7 9 4 20-Jun Measles Hyderabad 2 0 0 0 basti,Paretabad Village Muhammad Hussain-UC 24-Jun Scabies Jhal Magsi RHC Jhal Magsi 24 41 27 22 20-Jun AWD Jacobabad 0 0 0 1 Rindwatti Vill Haji Javed Lashari-Near Madina 20-Jun AJS Kech Balochi bazaar Absar, Tehsil Turbat 0 1 0 2 20-Jun AWD Jacobabad 0 0 0 1 Mill UC Kot Jangu, Village Abdul Khaliq 21-Jun Pertussis Kech BHU Kohl UC Bahlicha, Tehsil Tump 0 0 1 0 21-Jun Measles Jacobabad 1 0 0 0 Khoso Leishmani- 17-Jun Khuzdar Shai Bagh UC Lizo tehsil Khuzdar 0 1 0 0 20-Jun AWD Jamshoro Behar Colony,Taluka Kotri 0 1 0 0 asis Leishmani- 22-Jun Khuzdar Hayat Abad UC Gazgi tehsil Khuzdar 0 1 0 0 asis 20-Jun AWD Karachi M.Ali Society, Gulshan-e-iqbal 0 0 1 0 Leishmani- 23-Jun Khuzdar Sarrap UC Norgam tehsil Zehri 0 1 0 0 asis 20-Jun Measles Karachi Bhittai Colony Korangi Town 1 0 2 0 21-Jun Measles Khuzdar Sath Marlla UC Zereena Kattan 1 0 0 0 St # 2,Block E,Saifi lane Baghdadi,UC 20-Jun Measles Karachi 1 0 0 0 -5,Lyari town 17-Jun Pertussis Khuzdar Akiro UC Lizo tehsil Khuzdar 0 0 1 0 Gali # 11, Khokhrapar 3 1/2, UC 4 21-Jun Measles Karachi 0 0 0 1 Sath Marlla UC Zereena Kattan Malir Town 17-Jun Pertussis Khuzdar 0 1 0 0 Tehsil Khuzdar 20-Jun NNT Karachi Neonatal ICU,NICH 0 0 1 0 Killi Mohammad Waris UC Took 21-Jun Pertussis Khuzdar 0 0 1 1 Tehsil Wadh Village Haji Muhammad Sher, GD 22-Jun AWD Khairpur 0 0 1 0 Leishmani- Daud Sher 17-Jun Lasbela Bela City 1 0 0 0 asis 23-Jun Measles Khairpur Village Babar Kandhro, tehsil Kingri 1 0 0 0 21-Jun Measles Nasirabad Ghot Molvi Din Mohammad Jhakrani 0 0 0 0

23-Jun NNT Khairpur UC Deparja, tehsil Thari Mirwah 0 0 1 0 Agriculture colony, town area of 22-Jun Measles Nasirabad 0 1 0 0 D.M.J Leishmani- 22-Jun AWD Larkana Village Abbas Kalhoro, tehsil Bakrani 0 0 1 0 17-Jun Panjgur UC Chitkan Mohallah Shapatan 0 1 0 0 asis Village Lakho Rahoo,UC Leishmani- 17-Jun AWD Matiari 2 1 2 0 17-Jun Panjgur UC Khudabadan West 0 1 0 0 Khando,Taluka Hala asis UC Khudabadan, East Mohalla 21-Jun AWD Mirpur Khas Aftab Karhai Hotel 0 1 0 0 21-Jun Measles Panjgur 2 0 0 0 sarawan Qambar 19-Jun Measles Village Rahuja, tehsil Qambar 0 1 0 0 23-Jun Measles Quetta Gopher Abad, Saryab Road 1 3 2 0 Shahdadkot S. Benazira- Chicken 17-Jun Measles Asghar Colony,UC Sakrand 2 1 0 0 0 23-Jun Sibi Village rahozai, Talli 0 0 1 0 bad Pox Village Noor Muhammad Khask- Warchoom, Mana, Baba kharwari, 23-Jun Measles Sanghar 0 3 0 1 23-Jun AWD Ziarat 3 1 0 3 heli,UC Kannar Ziarat town

19-Jun AWD Shikarpur Village Siddique Mari 0 1 0 0 20-Jun Mumps Ziarat Cheena, Killi Raghai, Mana 2 0 1 0

21-Jun AWD Shikarpur Near Shahi Bagh Road 2 3 0 2 21-Jun Pertussis Ziarat Sakhobai, Ziarat town 2 0 1 0

Chicken 20-Jun Shikarpur Village Sher Mohammad Brohi 1 0 0 0 Current week's Alerts: AJK; FATA; GB and ICT Pox Date Disease District Area <5M >5M <5F >5F 23-Jun Measles Shikarpur Village Sher Mohammad Brohi 1 0 0 0 22-Jun Measles bagh village Saliyan Maldiyalan UC 1 0 0 0 Gharibabad, near A Section Police 23-Jun Measles Sukkur 1 0 0 0 23-Jun Measles bagh village Chichri UC Mallot 1 0 0 0 Station Leishma- Hattiyan 23-Jun THQ Hattiyan Bala-Village Sarai 1 0 0 0 20-Jun Tetanus Sukkur Pano Akil 0 0 0 1 niasis Bala 20-Jun AJS Muzaf- Village Hattiyan Dupatta 0 2 0 0 20-Jun Tetanus Sukkur UC and Tehsil Saleh pat 1 0 0 0 22-Jun AJS Neelum Village Khawaja Sai, Sharda 0 1 0 0 Tando Allah 18-Jun AWD Nagori Plot,Khalil masjid 1 3 0 0 Bajaur Village Maina of Tehsil Ma- Yar 22-Jun Measles 1 0 0 0 Agency moond Tando Mu- Village Muhammad khan talpur,UC Bajaur Village Shah naray of Tehsil 20-Jun AWD hammad 0 5 0 1 22-Jun Mumps 2 1 0 0 Shaikh Burkhyo Agency Salarzai Khan Khyber Haji Khan Mir Killi, Sheri Khel, 21-Jun Measles 0 1 1 2 Tando Mu- Agency Ghani Khel, Landikotal 20-Jun AWD hammad Village Shaikh Burkhio 0 1 0 0 Khan 17-Jun Measles Astore Civil Hospital Eidgha Astore 1 0 3 0 Village Bapuhar UC Bhakuo,Taluka 18-Jun Measles Tharparkar 0 1 2 1 20-Jun Measles Ghizer Gahkuch Paeen Mohallah Go- 0 0 0 1 Mithi 23-Jun Measles Ghizer Village Barkulti Par Tehsil Yasin 0 1 0 0 Village Bachal Khaskheli,UC 17-Jun AWD Thatta 0 1 0 1 Village Hundur center Tehsil Googani,Taluka Shah Bunder 23-Jun Measles Ghizer 0 0 0 2 Village Pandhi Mallah,UC Bu- Yaseen 19-Jun Measles Thatta 11 7 8 6 hara,Taluka Mirpur Sakro 18-Jun Measles Gilgit Baseen Khari 1 0 0 0 Village Haji Mian khan Rajar,UC 21-Jun Measles Gilgit Jiglote Goro 0 0 1 0 20-Jun Measles Umer Kot 0 0 1 0 sabho 21-Jun Measles Gilgit Nomal Majini Mohallah 0 0 1 0 Village Kharoro Charan,UC Kharoro Islama- 22-Jun Measles Umer Kot 1 0 0 0 23-Jun AWD FGSH (G 6/1, G 7/2) 0 2 0 2 Syed bad Islama- 22-Jun Measles Umer Kot Village New chor, UC Chor 0 0 3 0 22-Jun Measles CH PIMS (Kachiabadi G12) 1 0 0 0 bad 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. 25 (17 - 23 June, 2011) Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Post Flood 2010 2011 Current Week Total Disease A O A O A O A O Acute Watery Diarrhoea 209 85 237 81 29 9 475 175 Acute Jaundice Syndrome 5 2 22 10 4 1 31 13 Bloody Diarrhoea 10 1 38 8 ‐ ‐ 48 9 Measles 50 7 912 65 73 ‐ 1035 72 Pertussis 2 ‐ 129 13 7 ‐ 138 13 NNT + Tetanus 6 ‐ 67 ‐ 5 ‐ 78 ‐ Malaria 12 7 37 25 1 1 50 33 Leishmaniasis 1 ‐ 40 14 9 ‐ 50 14 Others 156 43 297 36 19 1 472 80 Total 451 145 1779 252 147 12 2377 409 Province Khyber Pakhtunkhwa: Figure-3: Three years trend of Acute diarrhoea, province KPK This week 20 districts reported to DEWS from 779 health • 20 facilities with a total of 189,067 patients consultations.

16 • AD is showing a consistent upward trend and accounted for 14% - 15% of the total consultations in last 4 weeks. 12 Percentage

8 • 35 alerts were reported in this week, 21 were for Measles, 7 for AWD, 4 for acute diarrhoea, while 1 each for Acute 4 Jaundice Syndrome, Hemorrhagic Fever and Pertussis. 2009 2010 2011 0 1 4 7 101316192225283134374043464952 Epi‐Week

Province Punjab:

Figure-4: Trend of acute diarrhoea, province Punjab (3 August 2010 to 23 June 2011) • 12 districts reported data to DEWS from Punjab province,

931 health facilities reported a total of 268,045 patient con- 16 sultations during this reporting period 2010 2011 14 AD cases reported were 20,536, and stabilize at 8% from last • 12 3 weeks. 10 • 30 alerts were reported in this week from Punjab; 15 8 were for Measles, 6 for AWD, 4 for Acute diarrhoea, 3 for 6 Meningitis, while 1 each for Leishmaniasis and Pertussis. Percentage • Increased number of confirmed malaria cases from 9 dis- 4 tricts. 117 from Muzaffargarh, 50 from DG Khan, 31 were 2 from Sargodha, 11 each were from Bhakkar, Layyah and 0

Rajanpur, 7 were from Mianwali, 4 from Khushab, while 2 1 4 7 101316192225283134374043464952 were from Bahawalpur. Epi‐week

Province Sindh:

Figure-5: Three years trend of Acute diarrhoea, province Sindh • This week 22 districts reported to DEWS from 1,004 20 health centers with a total of 423,960 patient consultations during the reporting period of week 25, 2011. 16 • In Sindh, AD cases reported were 40,416 (10%), 1% 12 higher proportional morbidity as compared with last

week. Percentage 8 • 39 alerts were reported from Sindh in this week: 18 4 were for Measles, 14 for AWD, 3 for Neonatal Teta- 2009 2010 2011

nus, 2 for Tetanus, while 1 each for Chicken Pox and 0

DHF. 1 4 7 101316192225283134374043464952

Epi‐Week

Epi‐week Gilgit Baltistan:

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 23 June 2011) • In this week, 51 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 50 45 21,964 patient consultations. 40 35 • ARI cases reported were 2,419 (11%), while Acute 30 Diarrhoea 2,395 (11%). 25 Percentage 20 15 10 • Seven Measles alerts were received and responded 5 this week. 0 wk 13 wk 14 wk 15 wk 16 wk 17 wk 18 wk 19 wk 20 wk 21 wk 22 wk 23 wk 24 wk 25 AD BD ARI S. Malaria

FATA:

Figure-8: Trend of priority communicable diseases, FATA (4 February to 23 June 2011) • This week 47 health centers in 3 agencies reported from FATA, with a total of 9,020 patient consulta- 50 tions. 40 30

• ARI cases reported were 1,657 (18%), while Acute Percentage diarrhoea reported 1,095 cases (12%) 10 0 6 7 8 9

• Three alerts, two were for Measles and one for 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

wk wk wk wk Mumps was received and responded this week. wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk AD BD ARI S. Malaria State of Azad Jammu and Kashmir: Figure-9: Trend of priority communicable diseases, AJK (25 March to 23 June 2011)

• In this week, weekly report received from 80 health 50 45 centers in 10 districts, with a total of 30,623 patient 40 consultations. 35 30 25 • ARI cases reported were 3,672 (12%), while Acute 20 diarrhoea reported 1,489 (5%) cases. Percentage 15 10 5 • Five alerts reported and responded in this week; 2 0

each were for Measles and Acute Jaundice Syndrome, wk 13 wk 14 wk 15 wk 16 wk 17 wk 18 wk 19 wk 20 wk 21 wk 22 wk 23 wk 24 wk 25 While one for Leishmaniasis. AD BD ARI S. Malaria

Islamabad Capital Territory: Figure-10: Trend of priority communicable diseases, Islamabad (1 January to 23 June 2011) • This week 3 health facilities are reporting through 60 DEWS with a total of 2,710 patient consultations. 50 40 • ARI cases reported were 319 (12%), while Acute Diar- 30 rhoea 274 (10%). Fluctuation in rates was due to diffi- Percentage culties in collecting reports as the system is being es- 20 tablished. 10 0 9 8 7 6 5 4 3 2 1

25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10

wk wk wk wk wk wk wk wk • Two alerts, one AWD (outbreak) and one for Measles wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk

received and responded this week. AD BD ARI S. Malaria