Epidemiological Week No. 22 (24 -30 May 08) June 17/ Vol. 132/ DEWS 2008-22

Abbaspur: Cleaning and chlorination of water tank. Pictured credit: Dr. Fawad Khan

Reporting Units ...... 2 Total number of consultations...... 2 DEWS Data, Epidemiological Week No. 22, 2008 ...... 3 DEWS Data, (Epidemiological Weeks No.18 – 22, 2008):...... 4 Acute Diarrhoea and suspected Cholera: ...... 5 Acute Respiratory Tract Infections: ...... 7 Upper and Lower Respiratory Tract Infection:...... 8 Other Conditions under Surveillance: ...... 8 Outbreak Alert and Response...... 8 Number of reported cases and deaths per District, AJK ...... 10 Number of reported cases and deaths per District, NWFP ... 11

ƒ This week 73,565 consultations were ƒ Districts Battagram and Neelum reported from 288 reporting units reported higher proportion of consultations for Acute Diarrhoea ƒ ARI remains the leading cause of compared to other districts

consultation this week and the weekly ƒ Five alerts were received and trend is on decline investigated ( 2 AFP, 5 Bloody

Diarrhoea, 1 Suspected Measles, and ƒ Acute Diarrhoea reported in 10% of all 1 Suspected Malaria) consultations an increase by 1% as compared to last week. ƒ None of the alerts was found to be an outbreak

The Weekly Morbidity and Mortality Report (WMMR) is published by the Ministry of Health of Pakistan (MOH) and the World Health Organization (WHO). The WMMR is built on surveillance data that health service providers and NGOs transmit on a weekly basis from health facilities and hospitals in those areas affected by the earthquake that struck Pakistan on 8 October 2005.

The WMMR objectives are to monitor the trend of health conditions over a period of time and provide vital information to all health partners. The WMMR is only a snapshot of the health conditions in those facilities where events are registered and data collected and does not necessarily reflect the situation from other health facilities.

The WMMR is a publication that has been developed for emergencies and previously used in other areas such as the Darfur Crisis.

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

The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, National Park Road, Chak Shahzad, Islamabad, Pakistan. For More Information, please contact: Dr. Rayana Bouhaka, Manager Operations, WHO/EHA/Pakistan; [email protected] or Dr. Birjees Mazher Kazi, Chief, Public Health Laboratories Division, NIH MOH; [email protected] or WHO Webpage: http://www.whopak.org/disaster WMMR Weekly Morbidity and Mortality Report Pakistan 17 June 2008 / Vol. 132/ DEWS 2008-22

Reporting Units

During week 22, 2008, total 288 (86%) weekly reports were received from the DEWS reporting sites on the due time. Compared to last week the DEWS reporting have decreased by 2% this week (88% and 86% respectively). The total number of reporting sites in the Earthquake affected districts remains 335 as of week 22, 2008. Table 1, summarizes reporting by each earthquake affected district for the last 4 weeks.

Table1. Heath Facilities by district, reported from Earthquake Affected Areas, Pakistan, 3 -30 May 2008. Reporting Health Facilities Area Population 3-9 May 08 10-16 May 08 17-23 May 08 24-30 May 08 Week-19 Week-20 Week-21 Week-22 Bagh 452,532 35 35 36 36 Battagram 592,256 37 36 38 32 Mansehra 1,154,804 64 59 65 65 Muzaffarabad 770,000 70 70 76 73 Neelum 184,000 18 17 18 19 Poonch 633,712 63 64 61 63 Total 3,727,668 287(86%) 281(84%) 294(88%) 288(86%)

Total number of consultations

During week 22, Total 73,565 patient consultations were reported, a decrease by 7% compared to last week. Similar to the prior weeks, the district of Muzaffarabad reports the highest proportion (33%) and Neelum reports the lowest proportion (5%) of the total consultation reported from all the Earthquake affected districts. Neelum is the smallest district with the least number of DEWS reporting sites among all the districts in the earthquake area. Figure 1 depicts the pattern of weekly reporting units participating in the DEWS and the total number of weekly consultations reported from week 1, 2007 to week 22, 2008

Figure1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, Week 1, 2007 – week 22 2008. # of units Weekly pattern of reporting consultations # of Cns. 350 120000 Reporting Unit Consultations 300 100000 250 80000 200 60000 150 40000 100

50 20000

0 0 W01/07 W05 W09 W13 W17 W21 W25 W29 W33 W37 W41 W45 W49 W01/08 W05 W09 W13 W17 W21

Epi-week

2 WMMR Weekly Morbidity and Mortality Report Pakistan 17 June 2008 / Vol. 132/ DEWS 2008-22

DEWS Data, Epidemiological Week No. 22, 2008

During the Epidemiological week 22 (24 – 30 May, 2008), total 73,565 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, 39%, the majority, are adults 15-45 years of age, and 21% are adults above 45 years age. Of the total consultations reported for week 22, 52% were from female patients. The proportion for Upper Respiratory Tract Infection was 18%, Unexplained Fever 9%, Acute Diarrhoea 10%, Lower Respiratory Tract Infection 5% and Scabies 5% in all age groups and both sexes. Out of the total 73,565 reported consultation, in all ages and both sexes, 52% (38,533) 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, 24 to 30 May 2008, Earthquake Affected Areas, Pakistan

Distribution of consultations by age Distribution of consultations by Disease 40 AD 39% 10% LRTI 35 URTI 5% 30 18% MAL 25 <1% 20 21% 21% 19% 15 UF

consultations 10 9% Percentage of all 5 SCB 0 5% OTH <5 5-14 15-44 ≥45 53% Age-group

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

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

Figure 3.Distribution of reported consultations by disease/health event and age groups, 24 to 30 April 2008, Earthquake Affected Areas, Pakistan Distribution of consultations (Male) Distribution of consultations (Female) AD AD LRTI URTI 11% LRTI 9% URTI 5% 19% 5% MAL MAL 17% <1% <1%

UF UF 9% 9% SCB SCB 5% 5% OTH OTH 50% 55%

3 WMMR Weekly Morbidity and Mortality Report Pakistan 17 June 2008 / Vol. 132/ DEWS 2008-22

Disease Distribution by Age:

Acute Upper Respiratory Tract Infections (URTI) is the highest reported disease in all age groups during week 22. In children less than five years of age Upper Respiratory Tract Infection was reported in 25% of the consultations, followed by Acute Diarrhoea (AD) 18%, Unexplained Fever 9%, Lower Respiratory Tract Infection (LRTI) 6%, Scabies 4% and other health problems 36%. In children 5 to 15 years of age Upper Respiratory Tract Infection was reported in 21% of the consultations followed by Acute Diarrhoea 11%, Unexplained Fever (UF) 10%, Scabies 6%, Lower Respiratory Tract Infection 6% and other health problems 46%. In both the adult age groups (15-45 years and above 45 years) the proportion of the other health problems (60%) is higher than reported for children, followed by URTI 16% and 14% in the respective age groups. The proportion of the remaining reported communicable diseases in adults is lower than reported in children but with slight differences between the two adult age groups. Figure 4 presents the comparisons of the reported consultation by age groups.

Figure4. Proportion of primary causes for all reported cases by age groups, 24 – 30 May 2008, Earthquake Affected Areas, Pakistan,

SCB AD SCB AD MAL 4% 18% MAL LRTI 4% 7% <1% <1% 4% LRTI 6% URTI SCB AD MAL OTH SCB AD MAL 16% 5% 6% M<1%LRTI 36% 6% 11% <1% LRTI 5% 6% UF URTI URTI OTH 9% URTI 14% 25% 60% UF 21% 9% OTH UF OTH 60% < 5yrs (n=14,337) 46% ≥15 - ≤44yrs (n=28,802) 9% UF 10% 5 - <15yrs (n=15,260) ≥ 45yrs (n=15,166)

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

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

During the period 26 April to 30 May, 2008 (Epidemiological weeks 18 to 22, 2008 both inclusive), total 300,485 consultations were reported in the Earthquake affected areas. The proportion of the five common diseases under surveillance was, 45% (135,280) of the total consultations reported during this period. This proportion remains almost consistent for the last four weeks. During this period 18% (53,912) of consultations were due to Upper Respiratory Tract Infection (URTI), 9% (26,651) Unexplained Fever (UF), 9% (25,948) Acute Diarrhoea (AD), 5% (14,605) Lower Respiratory Tract Infection (LRTI), and 5% (14,164) due to Scabies (SCB). Acute Jaundice Syndrome was reported in 76 consultations and Bloody Diarrhoea was reported in 1328 consultation during this period.

A total of 63 deaths were reported during this period. Most (92%) of the total reported deaths were due to health events other than the diseases under weekly surveillance. Four deaths were due to Acute Diarrhoea reported in last four weeks, one from Mansehra and three deaths from Poonch District with a total AD case fatality of 0.015%. One death was reported due to Lower Respiratory Tract Infection during the last four week period and the total case fatality for LRTI stands at 0.007%. No deaths were reported from any other disease under weekly surveillance during this four week period.

4 WMMR Weekly Morbidity and Mortality Report Pakistan 17 June 2008 / Vol. 132/ DEWS 2008-22

Table 2. Weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, Week 19 - 22, 2008. Week WEEK 19 WEEK 20 WEEK 21 WEEK 22 TOTAL CFR% Event C D C D C D C D C D AD 5357 1 6232 1 7132 1 7227 1 25948 4 0.015 AFP 1 0 2 0 2 0 2 0 7 0 0.000 AJS 15 0 21 0 21 0 19 0 76 0 0.000 BD 297 0 366 0 352 0 313 0 1328 0 0.000 LRTI 3484 0 3817 0 3708 1 3596 0 14605 1 0.007 MAL 343 0 364 0 420 0 354 0 1481 0 0.000 MG 3 0 0 0 0 0 0 0 3 0 0.000 MS 0 0 3 0 0 0 0 0 3 0 0.000 OTH 40959 13 39743 18 43072 16 38533 11 162307 58 0.036 SCB 3474 0 3517 0 3744 0 3429 0 14164 0 0.000 UF 5851 0 7053 0 6989 0 6758 0 26651 0 0.000 URTI 13367 0 13613 0 13598 0 13334 0 53912 0 0.000 Total Cons. 73151 14 74731 19 79038 18 73565 12 300485 63 RU 287 281 294 288

Acute Diarrhoea and suspected Cholera: During week 22, 2008, Acute Diarrhoea was reported in 7,227 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 18% of the total consultations with a 1% increase compared to week 21. In children 5 to 14 years of age, 11% of the consultations were for AD with an increase of 1% compared to week 21. In the adult age groups, 15-45 years and above 45 years of age, AD consultations were reported as 7% and 6% respectively, out of the total consultations. From week 16 onwards, the proportion of Acute Diarrhoea weekly consultations are increasing gradually. In week 22 the proportion has reached at 10% compared to 6% in week 16. Comparison of the weekly trend of AD from week 1 to 22, depicts a similar pattern for the last three years (Fig 6). There were no cases of suspected cholera reported from any district; however, there was one death due to acute diarrhoea reported from district Poonch.

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

Percentage of all 4 2 0 1 3 5 7 9 111315171921232527293133353739414345474951 Epi-week 2005 2006 2007 2008

5 WMMR Weekly Morbidity and Mortality Report Pakistan 17 June 2008 / Vol. 132/ DEWS 2008-22

In general there is an increasing trend of Acute Diarrhoea in all districts depicted for the last few weeks. When compared the trends of Acute Diarrhoea by district from Week 1 to 22, 2008, Battagram and Neelum report the highest proportion of AD throughout the period and presents a fluctuating pattern of cases. However, there is neither the indication of case clustering nor does the situation look like an epidemic reported from any part of the districts. It should be noted that Neelum has had reported a drop in the proportion of cases in week 21 but now has risen again.. (Fig 6). As the disease pattern indicates the seasonal increase in the Diarrhoeal diseases the health cluster partners in the districts have already started measures and activities on prevention and control of diarrhoea diseases and are vigilantly monitoring the AD situation in their respective districts.

Figure 6: Trend in Acute diarrhoea as a percent of all consultations, comparison by districts weeks 1-22, 2008, Earthquake Affected Areas, Pakistan Weekly trend of Acute Diarrhoea by district 14 Percentage of all 12 consultations 10 8

6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Epi-week BAGH BATTAGRAM MANSEHRA MUZAFFARABAD NEELUM POONCH

Bloody Diarrhoea: During week 22 of 2008, total 313 cases of Bloody Diarrhoea were reported from all the districts, which is slightly lower than the total BD consultation reported during the previous week. The overall proportion of reported Bloody Diarrhoea is very small for all the weekly consultations with a little weekly fluctuation. When compared the weekly trend of the BD by districts, District Muzaffarabad, Neelum and Battagram report slightly higher proportion compared to other three districts with a weekly fluctuating pattern of the disease. The WHO team along with DoH and Health Partners have conducted a thorough assessment of the BD situation in the districts and preventive measures have been initiated. The probable reason for the relatively higher proportion in these three districts 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 1.80 1.60 1.40 1.20 1.00 0.80

consultations 0.60 Percentage of all 0.40 0.20 0.00 12345678910111213141516171819202122 Epi-week BAGH BATTA GRA M MA NSEHRA MUZAFFARABAD NEELUM POONCH

6 WMMR Weekly Morbidity and Mortality Report Pakistan 17 June 2008 / Vol. 132/ DEWS 2008-22

Acute Respiratory Tract Infections:

During week 22, 2008, total 16,930 consultations for ARI (both Upper and Lower Respiratory Tract Infection) were reported. ARI accounts for 23% of the total consultations reported for the week (URTI 18% and LRTI 5%) and are still the leading cause of consultations for all age groups, among all the diseases under surveillance. For the current week in children less than 5 years of age URTI was reported in 25% and LRTI in 6% of consultations. In 5 to 14 year age groups URTI was reported in 21% and LRTI in 6% of consultations. In 15 to 45 year age group URTI was reported for 16% and LRTI for 4% of consultations. In the age group above 45 years URTI was reported for 14% and LRTI for 5% of consultations. Proportion of ARI in male patients was reported higher compared to females. The weekly trend of ARI for the same weeks (from week 1 to 22) from the last three years displays a similar trend to that of 2008. The overall ARI trend, from weeks 10 to 18 remain consistent with a little weekly fluctuation in the earthquake affected districts. However, the proportion of ARI from weeks 12 to 22 in 2008 remains slightly higher than the same period in 2006 and 2007 (Fig 8). During week 22, 2008 there were 3596 consultations for Lower Respiratory Tract Infection and no deaths were reported.

Figure 8: Comparison of ARI weekly trends of year 2005, 2006, 2007 and 2008, Earthquake affected districts Pakistan Weekly ARI trend, comparison by year 05, 06, 07 and 08 40 35 30 25 20 15

consultations 10 Percentage of all 5 0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Epi-week 2005 2006 2007 2008

Malaria: In week 22, 2008, there were 354 suspected cases of malaria reported. District Poonch is reporting the highest number of suspected malaria case compared to the other districts. In comparison to last week, the proportion of suspected malaria cases has increase in the districts of Poonch, and Bagh and there has been a decrease in cases in the district of Muzaffarabad (Fig 9). There were no associated deaths due to suspected malaria reported from any district. Compared to the same weeks from the last two years, the percentage of malaria in 2008 is lower.

Figure 9: Weekly trends in Suspected Malaria as percentage of all consultations, comparison by district, Earthquake Affected Areas, Pakistan, weeks 1-22, 2008 Weekly trend of Malaria by district 1.80 1.60 1.40 1.20 1.00 0.80 0.60 consultations

Percentage of all 0.40 0.20 0.00 12345678910111213141516171819202122 Epi-week BAGH BATTAGRAM MA NSEHRA MUZAFFARABAD POONCH

7 WMMR Weekly Morbidity and Mortality Report Pakistan 17 June 2008 / Vol. 132/ DEWS 2008-22

Upper and Lower Respiratory Tract Infection:

During week 22, 2008, there were 5% (3,596) of consultations for Acute Lower Respiratory Tract Infections and 18% (13,334) of cases of Upper Respiratory tract Infections reported through the DEWS system. There is an overall declining trend in Upper and Lower Respiratory Tract Infection from week 16, 2008 onwards. The proportion of consultation for ARII remained almost consistent from week 10 to 15. From week 16 onwards proportion of consultations for ARI has further declined (Figure 10).

Figure 10: Weekly Proportion of URTI and LRTI as percentage of all consultations, (week 1 – 22, 2008) Earthquake Affected Areas, Pakistan Weekly proportion of ARI, (week 1-22, 2008) 30 LRTI URTI 25

20

15

10 consultations Percentage of all 5

0 12345678910111213141516171819202122 Epi-week

Other Conditions under Surveillance:

During this week, 38,533 (52%) consultations out of the total 73,565 consultation, in all ages and both sexes were for health problems other than reportable disease under weekly surveillance. There were 19 cases of Acute Jaundice Syndrome and two cases of suspected AFP reported one from Mansehra and one from Rawalakot district. There were no cases of suspected Measles, Meningitis, suspected Hemorrhagic Fever, and Neonatal Tetanus reported from any district for week 22, 2008.

Outbreak Alert and Response1

During week 22, 2008, in total 5 alerts were identified/ reported and were responded accordingly. None of these alerts was found as an outbreak.

Mansehra:

District Mansehra reported 3 alerts during week 22 and were responded 1. DHQ Hospital Mansehra reported two cases of AFP. WHO Polio team investigated the cases and stool samples were taken and sent for laboratory investigation to NIH. Stool sample results are pending a. The first case was a 16 month old male child from Dab Mansehra with complaints of fever and weakness in both legs since the 22nd of May. The child was fully vaccinated b. The second case was a five year old male child from Kayan Jabori with fever and weakness in both legs since the 24th of May.. Vaccination status of the child was unknown.

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 17 June 2008 / Vol. 132/ DEWS 2008-22 2. Five cases of Bloody Diarrhoea were reported from BHU Pano Dheri. WHO team investigated the cases and found as sporadic and there was no clustering. 3. RHC Shinkiari reported one suspected case of Measles in a five year old female with symptoms of fever and rashes on the face and body. Blood samples were taken by WHO team and sent to NIH for confirmation. All children in the household were vaccinated for measles and the case refrained from attending school. EPI technician of the area was directed to perform a mop up vaccination of missed children.

Bagh

BHU Sohawa Sharif reported an increase in number of suspected malaria cases in week 22. Upon investigation the reported cases were from different areas and had visited BHU on different days indicating no clustering. The cases were diagnosed based on clinical features and no thick and thin smears were conducted.

9 WMMR Weekly Morbidity and Mortality Report Pakistan 17 June 2008 / Vol. 132/ DEWS 2008-22

Number of reported cases and deaths per District, AJK

Table 3. Number of reported cases and deaths, Bagh District*, Earthquake Affected Areas, Pakistan, 3 -30 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D C D 19 495 0 0 0 8 0 0 0 161 0 1503 0 55 0 0 0 0 0 0 0 227 0 139 0 1 0 7021 2 20 489 0 0 0 18 0 0 0 165 0 1392 0 56 0 0 0 0 0 0 0 282 0 131 0 4 0 6932 1 21 644 0 0 0 14 0 0 0 127 0 1611 0 55 0 0 0 0 0 0 0 268 0 249 0 4 0 6034 1 22 657 0 0 0 18 0 0 0 115 0 1405 0 76 0 0 0 0 0 0 0 253 0 242 0 1 0 5747 0 Total 2285 0 0 0 58 0 0 0 568 0 5911 0 242 0 0 0 0 0 0 0 1030 0 761 0 10 0 25734 4

Table 4. Number of reported cases and deaths, Poonch District*, Earthquake Affected Areas, Pakistan, 3 -30 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D C D 19 828 1 0 0 15 0 0 0 806 0 1811 0 124 0 0 0 0 0 0 0 474 0 1303 0 0 0 4322 4 20 880 1 0 0 22 0 0 0 829 0 1879 0 154 0 0 0 0 0 0 0 405 0 1214 0 0 0 4514 0 21 921 0 0 0 12 0 1 0 792 0 1943 0 141 0 0 0 0 0 0 0 470 0 1065 0 0 0 4956 2 22 931 0 0 0 13 0 0 0 871 0 1807 0 140 0 0 0 0 0 0 0 421 0 1235 0 0 0 4430 5 Total 3560 2 0 0 62 0 1 0 3298 0 7440 0 559 0 0 0 0 0 0 0 1770 0 4817 0 0 0 18222 11

Table 5. Number of reported cases and deaths, Muzaffarabad District*, Earthquake Affected Areas, Pakistan, 3 -30 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D C D 19 1778 0 0 0 132 0 0 0 1666 0 4629 0 111 0 0 0 0 0 0 0 1165 0 2357 0 1 0 8280 0 20 2201 0 0 0 156 0 0 0 2149 0 5236 0 112 0 0 0 0 0 0 0 1377 0 3750 0 7 0 9752 12 21 2368 0 0 0 125 0 0 0 1942 1 5085 0 129 0 0 0 0 0 0 0 1289 0 3565 0 0 0 10677 6 22 2513 0 0 0 98 0 0 0 1637 0 4902 0 40 0 0 0 0 0 0 0 1327 0 3402 0 2 0 10689 0 Total 8860 0 0 0 511 0 0 0 7394 1 19852 0 392 0 0 0 0 0 0 0 5158 0 13074 0 10 0 39398 18

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Number of reported cases and deaths per District, NWFP

Table 6. Number of reported cases and deaths, Battagram District*, Earthquake Affected Areas, Pakistan, 3 -30 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D C D 19 898 0 0 0 76 0 0 0 131 0 1944 0 47 0 0 0 0 0 0 0 512 0 797 0 4 0 6074 0 20 1079 0 0 0 82 0 0 0 155 0 1720 0 29 0 0 0 0 0 0 0 542 0 816 0 1 0 5641 0 21 1233 0 0 0 110 0 0 0 130 0 1638 0 83 0 0 0 0 0 0 0 479 0 878 0 9 0 5579 1 22 1217 0 0 0 116 0 0 0 160 0 2115 0 81 0 0 0 0 0 0 0 487 0 646 0 11 0 4999 0 Total 4427 0 0 0 384 0 0 0 576 0 7417 0 240 0 0 0 0 0 0 0 2020 0 3137 0 25 0 22293 1

Table 7. Number of reported cases and deaths, Mansehra District*, Earthquake Affected Areas, Pakistan, 3 -30 May 2008.

AD SC BD AFP LRTI URTI MAL MS MG AHF SCB UF AJS OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D C D 19 1033 0 0 0 31 0 1 0 257 0 2579 0 2 0 0 0 3 0 0 0 905 0 1192 0 6 0 13688 7 20 1287 0 0 0 60 0 2 0 262 0 2871 0 5 0 3 0 0 0 0 0 790 0 1118 0 7 0 11605 0 21 1526 1 0 0 52 0 1 0 256 0 2509 0 11 0 0 0 0 0 0 0 962 0 1201 0 8 0 13867 6 22 1398 1 0 0 35 0 2 0 369 0 2204 0 6 0 0 0 0 0 0 0 762 0 1206 0 4 0 10762 6 Total 5244 2 0 0 178 0 6 0 1144 0 10163 0 24 0 3 0 3 0 0 0 3419 0 4717 0 25 0 49922 19

11