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 30, Monday 1 August, 2011

Highlights Priority diseases

under surveillance Epidemiological week no. 30 (22 - 28 July, 2011) in DEWS

Acute Flaccid Paralysis (AFP) • 88 districts and 3 agencies provided surveillance data to the DEWS this week Acute Jaundice Syndrome (AJS) from 3,092 health facilities. Acute Respiratory Infections (Upper and Lower) (ARI) • A total of 1,010,892 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI), 12% skin disease, 10% acute diar- Acute Watery Diarrhoea (AWD)/ Suspected Cholera rhoea, and 6% suspected Malaria. Acute Bloody Diarrhoea (BD)

• A total of 131 alerts with 20 outbreaks were reported in week-30, 2011: Alto- Other Acute Diarrhoeas (AD)

gether 50 alerts were for AWD; 38 for Measles; Eight for Neonatal tetanus Suspected Viral Hemorrhagic and Tetanus; Seven for Pertussis; Four for Leishmaniasis; Three for Malaria; Fever (VHF)

Two for Acute jaundice syndrome; One for Bloody diarrhoea, and 18 were Suspected Malaria (Mal)

for other suspected diseases. Suspected Measles (MS)

Suspected Meningitis (MG) • National Polio Eradication Initiative reported no new confirmed polio case this week. Total 60 (59=type1, and 1=type3) confirmed polio cases have been Others reported in 2011 from 25 districts.

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

2009 2010 2011

12 Percentage 8

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

Epi‐week

Disease Wk-23 Wk-24 Wk-25 Wk-26 Wk-27 Wk-28 Wk-29 Wk-30 Other Acute Diarrhoea (Not Watery) 100,753 (10%) 102,217 (10%) 103,978 (10%) 107,924 (10%) 100,320 (10%) 104,413 (10%) 107,861 (10%) 103,341 (10%) Total consultation 1,009,254 1,028,090 1,019,724 1,087,368 994,345 1,025,647 1,034,504 1,010,892

Since July 29, 2010, approximately 38,413,010 patient consultations have been reported to the DEWS from the five provinces and three agencies and state of AJK. In this week 30, 2011 (22 to 28 July, 2011) reports were received from 3,092 health centers and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases, acute respiratory infections 172,676 (17%), skin diseases 123,139 (12%) and suspected malaria 57,544 (6%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 2009, 2010 and 2011 up until now.

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. 30 (22 - 28 July, 2011) Previous week's Outbreaks: Date Disease Province District Area M F Action Taken Balochis‐ Village Kud Sayan‐UC AWD outbreak comprising of 35 cases. 2 stool sample collected and found positive for V.c. Ogawa, 4 water sample were also 16‐Jul AWD Lasbela 7 9 4 15 tan Kathore, Tehsil Bela collected for quality test. AWD outbreak reported in media. Cases investigated with collaboration with DHO and health authorities staff, house to Balochis‐ Kehn, Barani Bhaint, UC 17‐Jul AWD Khuzdar 6 24 2 21 house survey revealed cases with typical sign and symptoms. Two stool and two water samples were collected and sent to tan Ornach, Tehsil Nall NIH. Health education session conducted, water filters, aqua tabs, hygiene kits were distribute in the community. Union Council Tasp Balochis‐ During NID, AWD alert was reported, area visited, 12 patients found. Early response team meeting was conducted with DHO 21‐Jul AWD Panjgor Sarekalat, Mohalla 5 4 1 2 tan and health authorities. DTC established in BHU Tasp Bazar. Medicine, Health education sessions provided. Johan Dun 4 suspected AD cases with moderate dehydration were reported and 23 more found during active surveillance in village Barkot, Haripur. The patients presented with moderate dehydration. Initial epidemiological investigation suggested contami‐ nated water was the source. Stool sample was taken sent to NIH and found positive for V.c. Ogawa. Environmental assess‐ 15‐Jul AWD KPK Haripur Village Bagra, UC Bagra 6 8 2 13 ment was carried out water samples were taken and found contaminated. 6 cases with moderate dehydration were admit‐ ted in different health facilities. Aqua tabs, ORS and soap were distributed. Door to door by LHW during the polio campaign. Health and Hygiene session conducted for the affected community. Water tank was cleaned with the help of local commu‐ nity. EDO Health was informed. AWD alert was reported from DHQ hospital Mardan. The case was investigated and sample taken and found positive for V.c. Mohalla Sharif Abad, Ogawa. EDO Health, DSM of PPHI, MS of DHQ and EPI Coordinator informed. On active surveillance in the area one more 16‐Jul AWD KPK Mardan 0 0 0 0 Takht Bai patient recovered from diarrhea was found. Water samples taken and being tested. Health Education conducted with households and community. IEC material, soap and aqua tabs were distributed. Hasan Garha UC Mera Two AWD cases were reported form Akora Khattak, Nowshera. 1/2 samples collected was found positive for V.c. Ogawa. 15‐Jul AWD KPK Nowshera Akora Khattak Now‐ 0 1 0 1 Hygiene sessions were conducted, Filters and IEC material distributed. No more cases were found during field surveillance. shera Alert for BD was reported by BHU Muslimabad. 6 cases were reported from a poultry farm in the village. On active case finding 15 more diarrhoea cases were found having abdominal cramps and some with bloody diarrhoea. All these cases are Village Muslimabad, UC resident employees of same poultry farm. Stool sample was taken and sent to NIH. Environmental assessment was carried 16‐Jul BD KPK Haripur 0 21 0 0 Muslimabad out and water samples were taken from 2 sources and 1 found contaminated. Management of the poultry farm were advised to use the safe water source. Health and hygiene session was conducted for the staff. Aqua tabs, soap and ORS were distributed. Follow up visit was made on 20th July. No new cases were reported. EDO health was informed. One AWD case reported from Nishter hospital, sample taken and found positive for V.c. Ogawa, the area was visited jointly by the SO,EHE and DEWS FP. House to house survey conducted no other cases found in the locality. Area was assessed for Mohalla Koharay Wala, 21‐Jul AWD Punjab Multan 0 1 0 0 the WASH. Health education session conducted, health hygiene kits (Aqua tabs, Jerry cans, Multi purpose soap, Antiseptic Ghazia Abad Chowk soap, Buckets and water filter) distributed. LHWs mobilized to conduct HE sessions on hygiene in the other areas of the whole UC. shared the line list with EDO(H). Chah Mithoo Wala, Near by Four AWD cases from four different locations were reported, 4/4 samples found positive for V.c. Ogawa. In the locality/area Sardar Koorey Khan School; 10 households on each side were interviewed but no more similar case or suspect was found. Health education to family 15‐Jul Khoo M. Hussain Wala, Near members in households visited. Distribution of soap, Aqua Tabs, jerry cans, buckets, water filters and IEC among them. by Taleri Nehar, UC Taleri; AWD Punjab Muzaffargarh Basti Babrey, Moza Chah 0 0 1 3 Nearest BHU Doaba was visited and MO was given briefing on the situation, control measures and importance of awareness among general masses about safe drinking water, food and personal hygiene, it was also suggested to advise LHWs, CDC 19‐Jul Godhar, UC Van Patafi; Dera Murad Wala, Chah Pir Wala, supervisor & School Health & Nutrition Supervisor to impart above said information among community while conducting UC Bhutta Pur their HE sessions in the catchment area. EM & EH assessment was also done at BHU. Village Ali junejo,Deh Alert for 4 cases of AWD. Reinforced case management, active surveillance done, Health education, ORS, Aqua tabs and Zinc 18‐Jul AWD Sindh TM Khan jaith,UC Dhando,Taluka 1 0 2 1 Tando ghulam haider tabs Provided, DMT & EDO‐H informed, 1 stool sample collected and found positive for V.c. Ogawa, 2 Water samples taken. Tando Allah Village Azizullah memon Alert for 24 cases suspected Pertussis. Reinforced case management, active surveillance done, Health education, Erythromy‐ 21‐Jul Pertussis Sindh 6 3 12 3 Yar farm cin provided for cases, 3 throat swab samples taken. Current week's Outbreaks: Date Disease Province District Area M F Action Taken Village Muri, Town An alert for AWDin two villages of Muzaffarabad was responded in a medical camp where 130 cases from one village and 50 Committee Ghari cases from another village were treated. There was one death was reported from RHC Ghari Dupatta, one sample (was 24‐Jul AD AJK Muzaffarabad 24 34 64 58 Dupatta; Village Khutti, found positive for V.c. Ogawa. Community awareness session conducted, IEC material distributed. DHO was informed about Muzaffarabad situation.

54 suspected malaria cases were reported. 22 samples were taken and 13 verified positive (P. Falciparum 7, P.Vivax 4, mixed Balochis‐ BHU Noor Mohammad 28‐Jul Malaria Jaffarabad 0 0 0 0 2); SPR=59%, while FR=69%. The patients were treated and DHO is informed and requsted for distribution of bednets to the tan Jamali location. Balochis‐ Positive malaria cases were reported where 10 were positive for P.Vivax and 11 for P. Falciparum. Anti malarial medicines 25‐Jul Malaria Kharan Killi Patkin Kharan 3 7 3 8 tan from the HF were used to treat patients. DHO was informed. Balochis‐ 44 cases for suspected malaria were reported. 16 samples were taken and 9 came positive (P. Falciparum 5, Vivax 3, Mixed 28‐Jul Malaria Nasirabad CD. Wahid Bukhsh 0 0 0 0 tan 1) (SPR=56%; FR=67%) patients treated. DHO is informed and requested to for distribution of Bed nets. 4 probable Pertussis cases were reported from BHU Kohad, with typical signs and symptoms. Upon field investigation 11 Balochis‐ Kohad, UC Bahlicha , case with typical signs and symptoms of whooping cough were found. patients were on Tx with antibiotics (Erythromycin ) 4 27‐Jul Pertussis Kech 3 3 3 6 tan Turbat sample collected and sent to NIH. information shared with DHO. Planned vaccination for the unimmunized children. health education was given. AWD alerts reported by DHQ with severe dehydration. The patient is a resident of village Shurak. The patient lives close to the area where an outbreak of cholera was confirmed in the previous week. Sample was collected and found positive for V.c. 23‐Jul AWD KPK Haripur Village Shurak, UC Bagra 0 0 0 1 Ogawa. Health and Hygiene session was conducted for the affected community. Water tank was already cleaned. Aqua tabs, ORS and soap were distributed. EDO Health was informed about the suspected case.

35 cases of AD with mild to moderate dehydration and few cases proceeding to severe dehydration found were referred to LMH hospital, One death reported in the same area, 3 Rectal Swabs collected. Families are IDPs from Orakzai Agency, Village Kamal Khel, UC Provided ORS, Aqua tabs and hygiene kits, water samples from all households collected for microbial investigations, there 30‐Jul AD KPK Kohat 7 5 8 15 Dhoda are nine household of these IDPs in that area and almost all affected, each household on average has 25 people including children, MDM‐F requested for establishing mobile health clinic, EDO‐H informed and alerted, No LHW in the area for health and hygiene messages, detailed health and hygiene sessions done with all families.

Village Qumeera, UC Alert with seven AWD cases from one village was investigated, 2 Samples taken and send to NIH and both found positive for 22‐Jul AWD KPK Lower Dir Khagram, Tehsil Warri, 0 0 3 4 V.c. Ogawa, EDO‐H was informed about the situation. Health and hygiene promotion session conducted with family mem‐ Upper Dir. bers, Antiseptic soap and aqua tabs were distributed. Alert for 7 cases of AD from one house, EH engineer assessed the area and took samples of water. Active surveillance was Near RHC Chowki 28‐Jul AD KPK Mansehra 3 3 2 2 carried out and one stool sample taken and sent to NIH, no history of travel, samples are in process, detailed investigations shaukat Abad underway. One AWD case reported from DHQ, on active surveillance 9 more diarrhoea cases were found, Three were admitted in Vill. Lohar, UC Mohib different hospitals in Mardan and were rehydrated. Health and hygiene session conducted, IEC material, soap, aqua tabs 25‐Jul AWD KPK Mardan 1 4 3 1 Banda distributed, sample from was found positive for V.c. Ogawa. Cases coordinated with EDOH, MS DHQH, DSM PPHI and Coordinator NP. Follow up and environmental investigations planned in the area. One AWD case was investigated in KTH Peshawar. Sample sent to NIH which was found positive for V.c. Ogawa. Health Kandey Mansoor Khel, 22‐Jul AWD KPK Peshawar 0 1 0 0 Education imparted to the parents of the patient. Use of ORS stressed. The concerned PHO has planned a response in the Palosai Tarlarzai area in consultation with EDO Health.

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. 30 (22 - 28 July, 2011) Current week's Outbreaks: Continued Date Disease Province District Area M F Action Taken Two AWD cases were investigated, Treatment given, Health education sessions conducted to the family as well as in the RHC Yar Hussain, 22‐Jul AWD KPK Swabi 1 1 0 0 community. Active surveillance done, no other case found. 1/2 samples collected found positive for V.c. Ogawa. EDO and MS Mohallah Yar Hussain of BMC informed. District Response team was properly trained on Cholera management, and PPHI staff were also trained. AWD alert reported from DHQ Timergara. Two cases were investigated & samples was sent to NIH for confirmation. Health 22‐Jul AWD KPK Upper Dir Khagram, Warrai 0 0 3 4 Education session conducted and aqua tabs were provided. One case of AWD investigated, session on health education and hand washing given, sample of one case taken and sent to Chah Seer wala, Chak 3 NIH which was found positive for V.c. Ogawa. Medicines prescribed.LHW trained and requested to give health session to the 25‐Jul AWD Punjab D. G. Khan 0 0 0 1 UC Kot Chutta females in the families of patients and around .Doctors and staff of the nearby RHC requested to support the families and keep. Surveillance of the area done. Line listing of the cases done. Patients treated and required medicines arranged. One case of AWD investigated along with active surveillance of the area. ERT had visited the area & suspect's stool swab sample was collected & sent to NIH. In the locality/area 20 households were interviewed but no more similar case or suspect Chah Mittho Wala, UC was found. Health education to family members in households visited. Distribution of soaps, Aqua Tabs, jerry cans, buckets, 23‐Jul AWD Punjab Muzaffargarh 0 0 0 1 City‐2 water filters & IEC among them. Nearest BHU visited & MO were given briefing on the situation, control measures & impor‐ tance of awareness among general masses about safe drinking water, food & personal hygiene & it was also suggested along with continuous strict surveillance. One case of AWD investigated along with active surveillance of the area. Samples were collected & sent to NIH which was found positive for V.c. Ogawa. In the locality/area 20 households were interviewed but no more similar case or suspect was Mohalla Khurshid Abad, found. Health education to family members in households visited. Distribution of soap, Aqua Tabs, jerry cans, buckets, water 27‐Jul AWD Punjab Muzaffargarh Nearby Excise Office, UC 0 1 0 0 filters & IEC among them. Nearest BHU visited & MO was given briefing on the situation, control measures & importance of Lutkeran awareness among general masses about safe drinking water, food & personal hygiene & it was also suggested along with continuous strict surveillance. Mumtaz colony, Babul Reinforced case management, active surveillance found no further cases, Health education, ORS, Aqua tabs and Zinc tabs 27‐Jul AWD Sindh Hyderabad 0 1 0 0 islam Masjid Provided, DMT & EDO‐H informed, 1 stool sample collected and found positive for V.c. Ogawa, 1 Water sample also taken. Reinforced case management, active surveillance found no further cases, Health education, ORS, Aqua tabs and Zinc tabs 23‐Jul AWD Sindh Jamshoro Taluka Sehwan 0 5 0 0 provided, DMT & EDO‐H informed, 2 stool samples were collected and both found positive for V.c. Ogawa, 3 Water samples also taken. Usmanabad, Saddar Reinforced case management, active surveillance found no further cases, Health education, ORS, Aqua tabs and Zinc tabs 28‐Jul AWD Sindh Karachi 1 0 0 5 town Provided, DMT & EDO‐H informed, 1 stool & 2 Water sample taken. Naushahro Three AWD cases were investigated with 24 hours. 2/3 samples collected and sent to NIH were found positive for V.c. 26‐Jul AWD Sindh BHU Moro‐UC Deparja 2 1 0 0 Feroze Ogawa. Health education, ORS, Aqua tabs and Zinc tabs provided. Table‐1: 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 85 439 183 50 13 698 281 Acute Jaundice Syndrome 5 2 29 12 2 ‐ 36 14 Bloody Diarrhoea 10 1 48 9 1 ‐ 59 10 Measles 48 6 1167 80 38 ‐ 1253 86 Pertussis 1 ‐ 171 17 7 1 179 18 NNT + Tetanus 5 ‐ 107 ‐ 8 ‐ 120 ‐ Malaria 12 7 48 32 3 3 63 42 Leishmaniasis 1 ‐ 67 17 4 ‐ 72 17 Others 156 43 379 38 18 3 553 84 Total 447 144 2455 388 131 20 3033 552 Province Khyber Pakhtunkhwa: Figure-2: Three years trend of Acute diarrhoea, province KPK • This week 21 districts reported to DEWS from 712 health facilities with a total of 179,097 patients con- 25 2009 2010 2011 sultations. 20 • AD cases reported were showing a consistent upward 15 trend and accounted for 15% - 17% of the total con-

sultations in last 4 weeks. 10 Percentage

• 45 alerts were reported in this week, 21 were for 5 Measles, 18 for AWD, two each were for acute diar- 0 rhoea and Leishmaniasis, while one each for Pertus- 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 sis and DHF. Epi‐Week Province Sindh: Figure-3: Three years trend of Acute diarrhoea, province Sindh • This week 21 districts reported to DEWS from 951 health centers with a total of 433,583 patient consul- 25 tations during the reporting period of week 30, 2011. 2009 2010 2011 20

• In Sindh, AD cases reported were 38,038 (9%), same 15 proportional morbidity as compared with last week. 10 Percentage

• 28 alerts were reported from Sindh in this week: 14 5 were for AWD, five for neonatal tetanus and tetanus, four for Measles, three for Pertussis, while one each 0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 for chicken pox and mumps. Epi‐Week

• AD cases reported were 20,157, and stabilized at 7% 15

from last four weeks. Percentage 10

• 17 alerts were reported in this week from Punjab; 10 5 for AWD, four were for Acute diarrhoea, while one each for measles, neonatal tetanus and mumps. 0 1 4 7 101316192225283134374043464952 Epi‐week

Province Balochistan: Figure-5: Three years trend of Acute diarrhoea, province Balochistan • In this week, 16 districts reported to DEWS from Balochistan province. 341 health centers reported a 25 total of 53,014 patient consultations. • AD reported in 7,546 (14%) of the total consulta- 20 tions, same proportional morbidity as compared with 15 last week.

• 25 alerts were reported in this week from Balochis- Percentage tan, five were for chicken pox, four for measles, three each for malaria and Pertussis, two each were for 5 2009 2010 2011 acute jaundice syndrome and Leishmaniasis, while 0

one each for acute diarrhoea, acute watery diarrhoea, 1 4 7 101316192225283134374043464952 mumps, typhoid, neonatal tetanus and tetanus. Epi‐week

Gilgit Baltistan:

Figure-6: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 28 July 2011) • In this week, 65 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 45 AD BD ARI S. Malaria 26,362 patient consultations. 40 35 30 • ARI cases reported were 2,739 (10%), while Acute 25 Diarrhoea 4,078 (15%). 20 Percentage 15 • Eight alerts received and responded this week, five 10 for Measles, two for AWD and one for bloody diar- 5 0 rhoea. 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

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

State of Azad Jammu and Kashmir: FATA:

• In this week, weekly report received from 87 health centers from 10 • This week 48 health centers in 3 agencies reported from FATA, districts, with a total of 29,121 patient consultations. with a total of 9,826 patient consultations. • ARI cases reported were 2,738 (9%), while Acute diarrhoea reported • ARI cases reported were 1,697 (17%), while Acute diarrhoea re- 2,569 (9%) cases. ported 1,146 cases (12%) • Seven alerts were received and responded this week, four were for • One AWD alert was received and responded this week. AWD and 3 for measles.

45 45 AD BD ARI S. Malaria AD BD ARI S. Malaria 40 40 35 35 30 30 25 25 20 20 Percentage

15 Percentage 15 10 10 5 5 0 0 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

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 wk wk wk wk wk wk wk

25‐Jul Chicken Pox Kech Gokdan UC Gokdan, Turbat 1 3 1 2

# 44 Killa Abdul‐ 5 22 26‐Jul Chicken Pox UC bughra 0 1 0 0 1 11 lah 0 Killa Abdul‐ UC memoodabad 2, muhalla ameer Muham‐ 26‐Jul Chicken Pox 0 1 1 1 lah mad Wk‐27 Wk‐28 Wk‐29 Wk‐30 Killa Abdul‐ 27‐Jul Chicken Pox UC murda karez, Killi Malik khan 0 0 0 1 Epi‐week AWD Measles Pertussis Leishmaniasis lah 23‐Jul Chicken Pox Sibi Village marghzani 1 0 1 0 Leishmani‐ 26‐Jul Khuzdar Bazgeer UC Khand Tehsil Khuzdar 0 0 0 1 Number of alerts dete cte d by week, Sindh (Week 27 to 30, 2011) asis 25 Leishmani‐ 23‐Jul Pishin UC yaro, Killi Khatk‐e‐zai 0 1 0 0 20 asis 17 16 28‐Jul Malaria Jaffarabad BHU Noor Mohammad Jamali 0 0 0 0 14 15 13

25‐Jul Malaria Kharan Killi Patkin Kharan 3 7 3 8 ale rts 10 9 8 of 10 28‐Jul Malaria Nasirabad CD. Wahid Bukhsh 0 0 0 0 # 4 23‐Jul Measles Chagai Killi Haji Hamal Khan Brabcha 0 0 0 1 5 33 1 2 1 Killa Abdul‐ 28‐Jul Measles Tehsil Gulistan, UC deobandi 0 0 0 0 lah 0 25‐Jul Measles Lasbela Murad Gujar Goth Uc Pathra 1 0 0 0 Wk‐27 Wk‐28 Wk‐29 Wk‐30 28‐Jul Measles Loralai Bakhma Muhallah Town 1 0 0 0 Epi‐week AWD Measles L eishmaniasis Malaria Pertussis 27‐Jul Mumps Khuzdar Sath Marlla UC Zereena Kattan 0 1 0 1 22‐Jul NNT Jaffarabad Ghot Hamid khan Qambrani, UC Sibi Jadid 0 0 0 0 27‐Jul Pertussis Kech Kohad, UC Bahlicha , Turbat 3 3 3 6 Number of alerts dete cte d by week, Punjab (week 27 to 30 , 20 11) 25 25‐Jul Pertussis Kharan Killi Patkin Kharan 1 1 1 0 AWD Measles Pertussis 27‐Jul Pertussis Sibi Village safi 0 2 0 0 20 28‐Jul Tetanus Khuzdar Killi Saleh Mohammad UC Wadh 0 0 1 0 13

ale rts 15

24‐Jul Typhoid Chagai Killi Qasim Khan Dalbandin town 0 2 0 2 of 10 9 # 10 Current week's Alerts: AJK; FATA; GB and ICT 6 7 4 5 5 Date Disease District Area <5M >5M <5F >5F 1 1 26‐Jul AWD Bagh Village Sabokot Ranga, UC Rangla 0 1 0 0 0 24‐Jul AWD Muzaffara‐ Village Muri, Town Committee Ghari 15 23 49 43 Wk‐27 Wk‐28 Wk‐29 Wk‐30 Muzaffara‐ Village Khutti, Town Committee Ghari Epi‐week 25‐Jul AWD 9 11 15 15 bad Dupatta, Muzaffarabad 27‐Jul AWD Sudhnoti village Haveli Sabokot Rangla UC Rangla 0 1 0 0 Number of ale rts dete cte d by week, Balochistan (Week 27 to 30 , 20 11) 27‐Jul Measles Bagh village Capriyan UC Maloot Dist Bagh 0 1 0 0 25 Near National Bank Pakistan by pass raod AWD Measles L eishmaniasis Malaria Pertussis 28‐Jul Measles Bagh 0 0 2 0 Bagh 20

28‐Jul Measles Poonch Village Banni UC Singola Tehsil Rawalakot 0 0 0 1 15 Bajaur alerts 28‐Jul AWD Qazi Dherai, Jar, Tehsil Khar 0 0 0 1

Agency of 10 7

# 6 22‐Jul AWD Ghizer Village Gulmoti UC singal Tehsil Punial 0 1 0 0 4 5 4 5 3 2 3322332 3 23‐Jul AWD Ghizer Village Ishkoman UC Imit Tehsil Ishkoman 0 1 0 0 1 1 1 22‐Jul BD Gilgit Village Sakwar Tehsil Gilgit 0 1 0 0 0 Hunza Village Mianchar UC Minapin Pisan Tehsil 25‐Jul Measles 0 1 0 0 Wk‐27 Wk‐28 Wk‐29 Wk‐30 Nagar Nagar 2 Epi‐week 23‐Jul Measles Skardu Sikandar Abad Oro Kumra 1 0 0 0 24‐Jul Measles Skardu Haiderabad Gangopi 0 0 0 1 24‐Jul Measles Skardu Sar Khor Rgayul Shegari Khurd 0 1 0 0 Number of alerts dete cte d by week, AJK (Week 27 to 30, 201 1) 25‐Jul Measles Skardu Degree college colony jafari mohala 0 1 0 0 25 AWD Measles 20

Dsitribution of alerts by diseases, week 30 (22 ‐ 28 July, 2011) n=131 ale rts

of 10

# NNT + Tetanus, 8 3334 3 5 1 AD, 7 0

Pertussis, 7 Wk‐27 Wk‐28 Wk‐29 Wk‐30 Measles, 38 Epi‐week

Chicken pox, 6

Number of ale rts dete cte d by week, Gilgit Baltistan (Week 27 to 30, 2011) 25 AWD Measles Malaria 20 Leishmaniasis, 4

Malaria, 3 alerts 15

Mumps, 3 # 10 4 5 AJS, 2 5 2 1 1 2 BD, 1 0 DHF, 1 Wk‐27 Wk‐28 Wk‐29 Wk‐30 AWD, 50 Typhoid, 1 Epi‐week

27‐Jul Mumps Thatta Sapa Mori Taluka Jharak 0 6 0 2 26‐Jul DHF Haripur Khalabut Township Sector 3, UC Khalabut 0 1 0 0

28‐Jul NNT Ghotki Bago Wah, Hussain Beli road, UC III 1 0 0 0 28‐Jul Leishmaniasis Lower Dir Village Jalley, UC Munjai 0 0 6 7

27‐Jul NNT Khairpur Village Mehrab Butto 1 0 0 0 28‐Jul Leishmaniasis Shangla Kuzbat Kot 0 3 0 2 Otaque Ali Murad Rajar,Near Saheban‐jo‐ 27‐Jul Measles Charsadda Vill. Abbass Kalay 1 0 0 0 26‐Jul NNT Umer Kot 0 0 0 0 kot, UC Atta Muhammad Palli 27‐Jul Measles Charsadda Vill. Ibrahimzai, Mohallah Miangan 1 0 0 0 22‐Jul Pertussis Kashmore Village Khan Mazari 1 0 0 0 22‐Jul Measles Haripur Muhallah Khattak Abadi, Ghazi, UC Ghazi 2 0 0 0 25‐Jul Pertussis Matiari Village Haji Nazir Memon 4 0 1 0 22‐Jul Measles Haripur Near Ghazi High School, Ghazi city, UC Ghazi 0 1 0 0 Village Choopni samejo, UC Malenhore 25‐Jul Pertussis Tharparkar 0 0 0 3 veena, Mithi 22‐Jul Measles Haripur Village Moin Banda, UC Ghazi 1 0 0 0 25‐Jul Tetanus Karachi Khada Market, Lyari Town 0 1 0 0 23‐Jul Measles Mansehra Daana NJear Police Lines Jaloo 0 1 0 0 23‐Jul Measles Shangla Village Qut Bigas, UC Pirabad 1 0 0 0 28‐Jul Tetanus Larkana Village Chutto Khan 0 0 1 0 26‐Jul Measles Swabi BMC Swabi, Punjpir 1 0 0 0 Current week's Alerts: Province Punjab Village Aligrama, Mohallah Ghatoo Jumat, UC Date Disease District Area <5M >5M <5F >5F 23‐Jul Measles Swat 0 1 0 0 Kabal 25‐Jul AD Bhakkar Sial City, UC Sial, Tehsil Bhakkar 7 5 2 0 Village Saidu Sharif, Mohallah Nasir Khail, UC 23‐Jul Measles Swat 0 0 0 1 26‐Jul AD Bhakkar Moza Bisal, UC litten, Tehsil Mankera 1 8 1 2 Saidu Sharif

22‐Jul AD Layyah BHU Marhan wali UC Samtia Tehsil karoor 13 9 14 10 24‐Jul Measles Swat Village Baba Jee, UC Barikot 0 0 1 0 Rahim Yar UC Ameengarh, BHU Khairpur Khadali, Tehsil 25‐Jul AD 14 21 8 36 Village Balogram Mohallah Ranjo Gat, UC Khan Rahim Yar Khan 24‐Jul Measles Swat 0 1 0 0 Qambar Junubi Eid Gah, UC bhakkar Urban II, Tehsil 28‐Jul AWD Bhakkar 0 1 0 0 Bhakkar Village Saidu Sharif near Police station, UC 24‐Jul Measles Swat 1 0 0 0 25‐Jul AWD D. G. Khan Chah Seer wala, Chak 3 UC Kot Chutta 0 0 0 1 Saidu Sharif Basti Anwal Wali Bhatta Laj Pal Hamid Pur 26‐Jul Measles Swat Village Kota, Mohallah Saidan, UC Barikot 1 0 0 0 24‐Jul AWD Multan 0 1 0 0 Kanora Village Shin, Mohallah Momin Abad, UC Shin, 26‐Jul Measles Swat 1 0 0 0 24‐Jul AWD Multan Sikandar Town Industrial State 0 1 0 0 Tehsil Khwazakhela Wal Wat Morh Basti Tikhay Sial Chah 24‐Jul AWD Multan 0 1 0 0 Village Islampur Mohallah Kar, UC Islampur, Hansalay Wala 27‐Jul Measles Swat 0 0 1 0 Tehsil Babuzai 26‐Jul AWD Murree Polyclinic Hospital Islamabad 0 1 0 1 Village Shagai , UC Saidu Sharif , Tehsil Ba‐ 27‐Jul Measles Swat 0 0 1 0 Basti Janey Wala, Khoo Bashkan Wala, UC buzai 22‐Jul AWD Muzaffargarh 2 0 0 0 Noohan Wali Village Kanju Mohallah Niamat Abad, UC 28‐Jul Measles Swat 0 1 0 0 22‐Jul AWD Muzaffargarh Gali # 4, Tibba Karim Abad, UC Lutkeran 0 0 0 1 Kanju, Tehsil Kabal

23‐Jul AWD Muzaffargarh Chah Mittho Wala, UC City‐2 0 0 0 1 28‐Jul Measles Swat Village Shakardara Miangano Cham, UC Matta 0 0 1 0 Mohalla Khurshid Abad, Nearby Excise Office, 27‐Jul AWD Muzaffargarh 0 1 0 0 Village Tahir Abad,UC Band Mingora, Tehsil UC Lutkeran 28‐Jul Measles Swat 0 1 0 0 Babuzai 28‐Jul Measles DG Khan More kot qaisrani distri uc Nari Tehsil Taunsa 0 0 0 1 Rahim Yar 26‐Jul Measles Tank Waraspoon kiri maghzai 0 0 1 0 27‐Jul Mumps UC 125 P tehsil Rahim Yar Khan 3 0 1 1 Khan 26‐Jul NNT Layyah Mauza ladhana UC Ladhana tehsil Layyah 0 0 1 0 26‐Jul Pertussis Swabi BHU Zaida, Mohallh Barghandi Dudher 0 0 0 1

4000 Diseases Total Mobile Fixed 6 6 6 7 2 3500 2 7 3 8 6 7 7 7 6 8 13 6 Skin Diseases 4,098,958 (11%) 3000 6 6 8 8 8 11 8 11 2500 8 8 11 8 Acute Respiratory Infection 8,866,598 (23%) 11

2000 8 12 411 400 375 331 11 215 361 192 26 153 3375 3363 Acute Diarrhoea 3,603,596 (9%) 1500 3354 3259 3259 26 3250 3251 3234 3215 128

3196 3120 3092 3058 3021 3022 105 2982 2935 2909 46 2785 2745 81 58 2547 2466 2450 2404

1000 2349 2322 2262 2255 2251 2199 2022 2021

Bloody Diarrhoea 330,047 (1%) 1797 1680

500 1463 1289 1215 1167 1158 1143 999 1130 1113 1111 967 949 1073 1067 879 854 Suspected Malaria 2,244,250 (6%) 0 9 7 5 3

11 11 13 15 17 19 21 23 25 27 29 33 35 37 39 41 43 45 47 49 51 ‐

1 Wk Wk Wk Wk Unexplained Fever 1,469,679 (4%) Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Total Consultations 38,413,010 Wk

Focus on: Partners for health and hygiene awareness in Khyber Pakhtunkhwa In the context of some outbreaks of Acute Diarrhoea in some districts of Khyber Pakhtunkhwa, WHO has called different partners for a con‐ sultation meeting on 2 August 2011 with the main goal to strengthen the Hygiene Promotion activities and dissemination of messages among the affected communities and to jointly ensure a coordinated response to control outbreaks and to reduce morbidity and mortality. Participants were from: MOH; UNICEF; MSF; Merlin; PRC; IOM Hum Com; Medecins du Monde, Abbasi Foundation.

Action points from the meeting:

Every organization should share on daily basis interventions implemented.

WHO: i) Circulate the matrix with main interventions for each district and related leading organization for following up and monitoring of activities; ii) provide supplies to IOM IOs; iii) share with partners daily report and updated figures/data; iv) explore the involvement of other organizations through health cluster mechanism (Health). UNICEF as the leading agency on WASH will: i) ensure the involvement of the LHWs in the affected districts; ii) facilitate a meeting at provin‐ cial level with LHWs Program, most probably on Thursday 4 August 2011; iii) provide ORS to PRC; iv) share with partners IEC materials; v) update on WASH every two weeks. MERLIN: share with partners IEC materials. MSF: explore possibilities to collaborate in the affected districts for this joint response to AWD. PRC: i) Mobilize network of volunteers for targeting communities in the district of Mansehra; ii) Collaborate with WHO will in Kohistan; iii) involve other partners in the PHAST Training starting on 13 August in Kohistan and Shangla (other community‐based workers such as IOM IOs will be involved in this training including LHWs); iv) share the list of PRC Focal Persons at district level. IOM: i) provide details of radio channels utilized for this campaign; ii) explore possibilities of spreading education messages on AWD through newspapers; iii) mobilize religious leaders through the human network by focusing on the most affected districts MOH: recommend to partners to involve PPHI.

While the MOH recognized these joint efforts from the partners, it was also pointed out the importance to explore long‐term solutions. Interventions last year in flood‐affected districts have prevented AWD outbreaks in the same districts this year.

The meeting was a good exercise for sharing responsibilities and expertise in such a critical situation and partners were active in finding solu‐ tions and exploring possibilities of expanding activities by mobilizing human resources in the affected districts.

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 polio cases confirmed by the laboratory is 60 (59=type ‐1, and 1=type3) till date from 25 districts.

Province Cases 2010 Cases 2011 P1 P3 P1 P3 Punjab 6 1 - -

Sindh 26 1 14 -

Khyber Pakhtunkhwa 19 5 6 - FATA 63 11 19 1 Balochistan 6 6 19 - AJK - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 59 1 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. 30 (22 - 28 July, 2011) Alerts and outbreaks, week 30, 2011