Weekly Field Epidemiology Report

Federal Disease Surveillance and Response Unit Field Epidemiology & Disease Surveillance Division National Institute of Health (NIH) Islamabad WEEKLY FIELD EPIDEMIOLOGY REPORT

Volume 3—Issue 32 Aug 01-07, 2021 Date: Aug 11, 2021

Provincial Technical Officers and fellows of FELTP assigned at the Disease Surveillance, Response Units

(DSRU’s) are working with provincial, and district health authorities on event based disease surveillance and outbreak response. DSRUs are sharing the disease surveillance data, outbreak reports and activities of FELTP fellows to the Federal Disease Surveillance and Response Unit (FDSRU) at the Field Epidemiology and Disease Surveillance Division (FEDSD) National Institute of Health (NIH) Islamabad on weekly basis. COVID-19 Surveillance

PDSRUs in Provinces are working with the February 2020. Daily flights data from international provincial department of health on COVID-19 airports in Pakistan is being shared by the Central surveillance, response and contact tracing since Health establishment (CHE) Islamabad with February, 2020 in Pakistan. FELTP fellows Alumni FDSRU teams who conduct daily calls on given are actively involved in COVID-19 Surveillance contact numbers of the travelers to ask about their throughout Pakistan. Data is being shared with health status, advise them for immediate contact at FDSRU on daily basis and a SitRep is being issued the nearest designated hospital in case of COVID- by FEDSD National Institute of Health Islamabad 19 symptoms. Total 147,481 travelers have been FDSRU has developed a mechanism for tracking of traced and contacted by Aug 07, 2021. travelers from other countries to Pakistan since 02 Table-1: Weekly Surveillance data COVID-19 by Aug 07, 2021 Province/ Suspected cases Lab Update Hospital Update Region reported

Cumulative Tests performed Tested positive cases Currently Discharged/Recovered Expired (Cumulative) (Cumulative) admitted

AJK 250,490 250,490 26,874 71 22,061 645 Baluchistan 263,643 369,171 31,138 27 29,351 331 GB 155,813 158,020 8,703 71 7,656 152 Islamabad 1,786,570 1,786,570 90,503 323 84886 814 KP 2,070,633 2,423,936 147,973 1,032 137,575 4,540 Punjab 6,247,153 6,317,318 363,644 1647 335079 11194 Sindh 5,142,901 5,142,901 398,745 1560 345031 6189 Total 15,917,203 16,448,406 1,067,580 4,731 961,639 23,865

PDSRU SINDH Total 400,293 confirmed COVID-19 cases were (n=6,878) and District Ghotki (n=6,019). Age group reported from Sindh until Aug 07,2021. 348,461 ≥70 has the highest attack rate (2366/100,000) cases have recovered while 6,249 cases expired due followed by 50-59 years age group (2064/100,000), to COVID-19. Most of these cases were reported 60-69 years age group (1847/100,000) & 30-39 years from District Karachi (n=259,130) followed by age group (1643/100,000 population). District Hyderabad (n=23,732), District Sukkur

Volume 03-- Issue 32 Aug 01-07, 2021 Date: Aug 11, 2021

Figure-1: Sindh - District-wise distribution of COVID-19 cases (Cumulative up to week 32)

Figure-2: Sindh – Age group-wise Attack Rates /100,000 population (Aug 07, 2021)

2500 2366 2064 2000 1847 1643 1560 1500 1157

1000 Attack rate/100,000 Attack

500 289 18 0 <1-9 y 10-19 y 20-29 y 30-39 y 40-49 y 50-59 y 60-69 y 70+ Age Groups

PDSRU Punjab PDSRU Punjab has reported total 6,266,745 Lahore has the highest number of confirmed cases suspected cases of COVID-19 and out of these (n=1,87,375) followed by District Rawalpindi 364,6805were lab confirmed COVID-19 cases up to (n=29,928), District Faisalabad (n=22,229), District Aug 07, 2021. 335,079 cases have recovered and Multan (n=18,540) and District Gujranwala 11,199 cases expired due to COVID-19. District (n=8,603) respectively.

Volume03 -- Issue 32 Aug 01-07, 2021 Date: Aug 11, 2021

Figure-3: Geographical Distribution of COVID-19 Cases in Punjab Province (Up to week 32)

PDSRU - Baluchistan province

The department of Health Baluchistan has reported (n=2,267), District Khuzdar (n=1,170) and District 30,278 positive cases of COVID-19 and 331 deaths Lasbela (n=787). Age group 30-44 has the highest until Aug 07, 2021. 28,930 cases have recovered. number of COVID-19 cases (n=9,457) followed by District Quetta has the highest number of confirmed age group 15-29 (n=8,766) & age group 45-59 cases (n=19,913) followed by District Kech (n=5,068).

Figure-4: Geographical Distribution of COVID-19 Cases in Baluchistan Province (Cumulative up to Week 32)

Volume03 -- Issue 32 Aug 01-07, 2021 Date: Aug 11, 2021

Figure-5: Baluchistan –Age group wise distribution of COVID-19 positive cases (up to Aug 07,2021)

10000 9457 8766 9000 8000 7000 6000 5068 5000 4075 4000

No. of Cases of No. 2912 3000 2000 1000 0 1-14y 15-29 30-44 45-59 60+ Age Groups

PDSRU- Gilgit-Baltistan (GB)

PDSRU GB has reported total 156,586 suspected negative for COVID-19. 7,482 cases have recovered cases of COVID-19 and out of these 10,948 were lab from COVID-19 while 153 cases expired. During confirmed COVID-19 up to Aug 07,2021 and 867 current week highest number of COVID-19 cases cases were detected during last week, while no lab were detected in District Skardu (n=223) followed by results are awaited. 135,691 suspects were declared District Gilgit (n=195) and District Ghizer (n=156).

Table -2 Detail of number of samples, confirmed Covid-19 cases & Deaths in GB up to Aug 07,2021

District Number of Negative Positive Awaited Recovered Expired Samples Suspects Discarded

Astore 16730 14974 53 00 481 05 08 Diamer 19983 17707 57 00 380 05 01 Ghanche 9408 8946 21 00 197 06 96 Ghizer 13823 12611 156 00 579 08 02 Gilgit 37174 32638 195 00 3269 69 84 Hunza 19384 11834 116 00 795 03 17 Kharmang 6159 5929 09 00 164 00 26 Nagar 7085 6487 21 00 230 04 02 Shigar 5965 5606 16 00 208 04 28 Skardu 20875 18959 223 00 1179 49 82 Grand Total 156586 135691 867 00 7482 153 346

Figure-6: GB-District-Wise distribution of confirmed COVID-19 cases, Aug 01-07,2021

500 450 400 350 300 250 223 195 200 156 No. of Cases of No. 150 116 100 53 57 50 21 9 21 16 0 Astore Diamer Ghanche Ghizer Gilgit Hunza Kharmang Nagar Shigar Skardu Districts

Volume03 -- Issue 32 Aug 01-07, 2021 Date: Aug 11, 2021

PDSRU-AJK cases have recovered from COVID-19 and 646 cases PDSRU AJK has reported total 252,343 suspected expired due to COVID-19. District Muzaffarabad cases of COVID-19 and out of these 27,228 were lab has the highest number of cases (n=6,853) followed confirmed COVID-19 up to Aug 07, 2021 while no by District Mirpur (n=4,633), District Poonch lab-results of suspected cases are awaited. 22,323 (n=3,910) and District Kotli (n=3,172).

Table -3: Distribution of suspected and confirmed Covid-19 cases in AJK up to Aug 07,2021

Total Suspected Cases Lab Tests Conducted Lab Confirmed Cases Active Cases Recovered Total Deaths

252,343 252,157 27,228 4319 22,323 646 Figure-7: AJK-District-Wise distribution of confirmed COVID-19 cases up to Aug 07,2021

7200 6853 6600 6000 5400 4633 4800 4200 3910 3600 3172 3000 2400 1988 1834 1779 No. of Cases of No. 1800 1165 1200 463 600 292 0 Muzaffarabad Mirpur Poonch Kotli Bhimber Bagh Pallandri Hattian Bala Neelum Havaili Districts

PDSRU-KPK District Mardan (n=9,415), District Swat (n=8,638) PDSRU KPK has reported total 2,070,633 suspected and District Nowshera (n=6,174). Age group 60-69 cases of COVID-19 and out of these 1,48,619 were years has the highest attack rate/100,000 (AR=1046) lab confirmed COVID-19 up to Aug 07, 2021 while followed by 40-49 years age group (AR=961) and 4,556 patients expired. District Peshawar has the 50-59 years age group (AR=816). highest number of cases (n=54,799) followed by

Figure-8: Geographical Distribution of COVID-19 Cases in KPK Province (Cumulative up to Week 32)

Volume 03-- Issue 32 Aug 01-07, 2021 Date: Aug 11, 2021

Figure-9: KPK –Attack rates /100,000 population in different age groups (up to Aug 07, 2021) 1200 1046 961 1000 816 800 698 647 584 600 491

400 Attack rate/100,000 Attack 200 102 31 0 0 – 9 10 – 19 20 – 29 30 – 39 40 – 49 50 – 59 60 – 69 70 – 79 >80 Age Groups

Communicable Disease Surveillance

Measles Surveillance: Diphtheria/Pertussis Surveillance: In 2020, total 1986 confirmed Measles cases During 2018 total 464 and during 2019 total 614- reported from all PDSRUs/RDSRUs. In week 32, suspected cases of Diphtheria were reported. In week 110 cases of measles were reported from KPK & 32, no case of was reported from any province or Baluchistan. region. Dengue Surveillance: CCHF Surveillance: In 2018, total 3204 Dengue cases reported from In 2018, total 63 CCHF (suspected and confirmed) Sindh. In 2019 total 24,610 cases reported which cases were reported from DSRUs and 75 cases have includes 48 new case reported from Baluchistan. In been reported in 2019. During week 32, 03 new cases week 32, 147 cases were reported from Baluchistan were reported from Baluchistan. & Sindh.

Table-4: Weekly and Cumulative Diseases Updates Aug 07, 2021

Disease Total Cases in 2020 Aug 01-07, 2021 Total Cases in 2021 1 CCHF 19 3 17 2 Varicella 235 0 0 3 Dengue 4024 147 2558 4 Chikungunya 0 0 0 5 Measles 1986 110 3911 6 Diphtheria/Pertussis 140 0 35 Suspected / confirmed 7 9 0 0 Seasonal Influenza 8 NNT 150 1 27

Table 5: Dengue cases reported in 2017, 2018, month-wise distribution in 2019 & current week (All provinces and regions) Month KPK Sindh AJK ICT TDs - KP Baluch Punjab Total

Jan–Dec 2017 18,857 2,884 6 120 406 86 579 22,938

Jan-Dec 2018 332 2088 1 0 175 69 539 3204

Jan-Dec 2019 5214 2937 506 2847 1484 2841 8826 24547 Jan-Dec 2020 3 2722 2 184 0 493 38 3,442 Total 24406 10631 515 3151 2065 3489 9982 54131 07/08/2021 0 83 0 0 0 64 0 147

Total (2021) 0 1316 0 0 24 1218 0 2558

Volume03 -- Issue 32 Aug 01-07, 2021 Date: Aug 11, 2021

Extensive drug Resistant (XDR) Typhoid Fever Surveillance in Sindh Province In Karachi total 15,172 cases of extensive drug reported in the age group 0-4 years. The overall resistance typhoid fever were reported from January attack rate was 76/100,000. The age group 0-4 years 01, 2017 to Aug 07, 2021. During current week total was the most affected (attack rate 233/100,000) 72 cases of XDR typhoid fever were reported from followed by age group 5-9 years (attack rate different hospitals in Karachi. The XDR Typhoid 161/100,000). Females have higher attack rate cases were reported mostly among the children and 84/100,000 as compared to Males. maximum number of XDR cases 6355 (42%) were

Table-6: Number of XDR Typhoid fever cases Karachi from January 1, 2017 to Aug 07, 2021

Year Year XDR Cases

Jan to December 2017 175

Jan to December 2018 3712

Jan to December 2019 7088

Jan to December 2020 2510 Till Aug 07, 2021 2021 1687 Total 15,172 Figure 10: Week-wise number of XDR Typhoid fever cases in Karachi, from January 1, 2017 to Aug 07, 2021 300

250

200

150

No.of cases No.of 100

0 Week 1 Week 4 Week 7 Week 3 Week 6 Week 9 Week Week 10 Week 13 Week 16 Week 19 Week 22 Week 25 Week 28 Week 31 Week 34 Week 37 Week 40 Week 43 Week 46 Week 49 Week 52 Week 12 Week 15 Week 18 Week 21 Week 24 Week 27 Week 30 Week 33 Week 36 Week 39 Week 42 Week 45 Week 48 Week 51 Week 02 Week 05 Week 08 Week 11 Week 14 Week 17 Week 20 Week 23 Week 26 Week 29 Week 32 Week 35 Week 38 Week 41 Week 44 Week 47 Week 50 Week 01 Week 04 Week 07 Week 10 Week 13 Week 16 Week 19 Week 22 Week 25 Week 28 Week 31 Week Epi Weeks

XDR Typhoid Surveillance Data Sindh-Province (Excluding Karachi) Total 7731 Salmonella Typhoid cases reported from affected age group was 0 to 4 years (n=1505) with November 2016 to Aug 07, 2021 from different attack rate 51.0/10000 population followed by 5-9 districts of Sindh province (excluding Karachi). years of age group (n= 1135) with attack rate Among these cases 5905 were Extensive Drug 38.7/10000 population. Over all attack rate is Resistant cases. Out of these cases n=4101 (69.5%) 18.8/10000 population (n=4101). were reported from District Hyderabad. The most

Table 7: Extensive drug Resistant (XDR) Typhoid Fever Surveillance Hyderabad and other districts

Year Hyderabad Other District Total 2016 12 0 12 2017 485 4 489 2018 891 207 1098 2019 1645 998 2643 2020 708 415 1123 January 01 – July 31, 2021 350 171 526 Current week Aug 01-07, 2021 10 4 14

Total 4101 1799 5905

Volume 03-- Issue 32 Aug 01-07, 2021 Date: Aug 11, 2021

Figure 11:XDR Typhoid Cases District Hyderabad Nov-2016 to Aug 07, 2021