Weekly Epidemiological - World Health OrganizationEpidemiological Bulletin: DEWS, Pakistan, Week no....

Weekly Epidemiological Bulletin

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].

Epidemiological week no. 28 (8 - 14 July, 2011) • 89 districts and 3 agencies provided surveillance data to the DEWS this week from 3,227

fixed health facilities and two mobile medical outreach centres.

• A total of 1,016,615 consultations were reported through DEWS of which 18% were acute respiratory infections (ARI), 12% skin disease, 10% acute diarrhoea, and suspected Ma-laria remains at 6%.

• Critical situation of diarrhea in KP, surpassing the proportional morbidity recorded in the 2010 post-Flood period. 12 out of 21 reporting districts in KP have more than 16% diar-rhea cases out of total consultations at public health facilities.

• A total of 116 alerts with 12 outbreaks were reported in week-28, 2011: Altogether 37 alerts were for AWD; 32 for Measles; 11 for Neonatal Tetanus and Tetanus, Six each were for Acute diarrhoea and Pertussis, five for Leishmaniasis, four for Meningitis, three each were for Bloody diarrhoea and Chicken pox, two each were for DHF, Scabies and Ty-phoid, while one each for Malaria, Mumps and Unexplained Fever.

• National Polio Eradication Initiative reported no newly confirmed polio case this week. Total 59 (58=type1, and 1=type3) confirmed polio cases have been reported in 2011 from 25 districts.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 28, Monday 18 July, 2011

Priority diseases under surveillance

in DEWS

Acute Flaccid Paralysis (AFP)

Acute Jaundice Syndrome (AJS)

Acute Respiratory Infections (Upper and Lower) (ARI)

Acute Watery Diarrhoea (AWD)/ Suspected Cholera

Acute Bloody Diarrhoea (BD)

Other Acute Diarrhoeas (AD)

Suspected Viral Hemorrhagic Fever (VHF)

Suspected Malaria (Mal)

Suspected Measles (MS)

Suspected Meningitis (MG)

Others

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

Disease Wk-21 Wk-22 Wk-23 Wk-24 Wk-25 Wk-26 Wk-27 Wk-28

Other Acute Diarrhoea (Not Watery) 106,720 (10%) 102,005 (10%) 100,753 (10%) 102,217 (10%) 103,978 (10%) 107,924 (10%) 99,777 (10%) 104,531 (10%)

Total consultation 1,020,071 995,731 1,009,254 1,028,090 1,019,724 1,087,368 991,853 1,016,615

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 nine districts had outbreaks of AWD, nine more were confirmed this week.

0

4

8

12

16

20

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

Percentage

Epi‐week

2009 2010 2011

Epidemiological Bulletin: DEWS, Pakistan, Week no. 28 (8 - 14 July, 2011)

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

Current week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken

8‐Jul AWD AJK Sudhnoti Village Bhatiyan UC Patan sher khan The Mang

0 0 0 1 1 case of AWD reported from RHC Mang and managed there stool sample collected and found positive for V.c. Ogawa. Field investigation was carried out with DOH team no other active case of AWD was found.

14‐Jul Malaria Balochis‐tan

Jaffarabad CD Baloo Pur, Tehsil Sohbat Pur

7 19 4 16 Alert for 46 cases of Malaria were reported, 12/18 samples found positive for Malaria (P. Falciparium 5, P.Vivax 4, Mixed 3). SPR 67% while Falciparum rate also 67%. Appropriate treatment initiated, DHO informed who requested for distribution of bednets in the affected location.

12‐Jul AWD ICT Islamabad Merabadia, F11/1 1 0 0 0 A case of AWD reported from a private hospital. On field investigation a V.c. positive case was found in the locality of Mera‐badia i.e opposite to F11‐1 sector. Patient recovered. No other case was found during active search. Water disinfection at household level, ORS and hygiene messages shared.

13‐Jul AWD Punjab Bhakkar UC Pir Ashab 0 0 0 1 1 AWD case was reported from UC Pir Ashab, Tehsil and District Bhakkar, on active surveillance no more cases were found. Stool sample collected and found positive for V.c . water sample were tested and found contaminated. Health and hygiene session given, ORS use was explained, life straws, jerry cans, aqua tabs and soaps were distributed in the community.

8‐Jul AWD Punjab Muzaffargarh Basti Yaroo Wala, UC Baseera

1 6 0 6

4 cases and one death due to AWD reported from Basti Yaroo Wala. DEWS team visited the affected village found 13 diar‐rhoea cases. The team visited the nearest health facilities, BHU Ali Wala and RHC Baseera and briefed the doctors para medical staff on the situation and implementation of control measures, to rais awareness in the community about safe drinking water, food and personal hygiene. The facilities were assessed for availability of medicine and supplies. HE sessions were conducted by LHS, LHWs, Sanitation Staff, DSC, EH Eng. 1 Stool sample was collected and found positive for V.c. Ogawa, 5 Water samples collected for quality testing (results awaiated). Solid wast scattered all over in the area collected and burned. Soaps, Aqua Tabs, buckets, jerry cans, water filters, ORS and IEC material distributed.

13‐Jul AWD Punjab Muzaffargarh Basti Chah Tayyab Wala, Moza Bhak‐har Noon, UC Budh

0 0 0 1

1 AWD Stool swab sample was collected and sent to NIH which was found positive for V.C Ogawa. In the locality/area 10 households on each side were interviewed but no more similar case or suspect was found except two cases od AD. Health education to family members in households visited. Distribution of soaps, Aqua Tabs, jerry cans, buckets, water filters & IEC among them. Nearest The MO at the nearest health facility was briefed briefed on the situation, control measures. The importance of safe drinking water, food and personal hygiene and LHWs, CDC supervisor and School Health and Nutrition Supervisor would impart HE sessions in the catchment area discussed. EM & EH assessment was also done at BHU.

13‐Jul AWD Sindh Matiari UC Zeir Pir Village, Deper Lakha, Near mansoorah

0 5 1 1 Seven cases of AWD were recorded. Reinforce case management,active survelliance done, Health education, Aqua tabs, ORS, IEC Material,family filters, Jerrycans and Zinc Tabs provided, 1 stool sample collected and found positive for V.c. Ogawa, 5 Water samples also collected for quality testing (results awaited), EDO‐H and DOH Informed.

13‐Jul AWD Sindh Qambar Shahdad‐kot

Village Rab Rakhio Lakho, Tehsil Qambar

0 0 0 1 1 AWD case reported, stool samples found positive for V.c. Ogawa, 3 drinking water samples also collected for quality testing. The alert responded along with rapid response team of EDOH.

10‐Jul AWD Khyber Pakhtunk‐hwa

Hangu Jhazo Maidan, UC Ganjiano Kale

0 1 0 0 One AWD case was reported by private clinic, case investigated jointly with DoH. Sample collected and sent to NIH and found positive for V.c. Ogawa. No other suspected cases found on active surveillance. Environmental assessment in progress and preventive measures reinforced in the area.


Haripur Village Baji Sar, Union Council Kundi, Tehsil Ghazi

3 15 4 24

Suspected outbreak of AWD was reported from BHU Kundi from village Baji Sar. Patients presented to BHU with severe dehydration and informed the incharge of BHU about other cases in their locality with same sign and symptoms. Investiga‐tions showed the cases started on 10th of July after having a lunch at a wedding (food borne). Samples sent to NIH were found negative for V. Cholera. Total of 46 cases were found on active case finding . 8 cases were severely dehydrated and 4 out of them were admitted in different health facilities of Ghazi for treatment. Aqua tabs, ORS and soaps were distributed and Health and Hygiene session was conducted for the affected community. EDO Health was informed of the outbreak


Mardan Mohallah Pirano Korona, UC Manga, Charsadda Road

102 79 108 118

One case of AWD reported. Sample collected and found positive for V.c. Ogawa, active surveillace conducted and 423 diarrhoea cases found in the area. EDO‐H, DSM PPHI, MS DHQH and Coordinator National programme informed and alerted. Health and Hygiene session conducted. LHWs asked continue house to house survey for diarrhea patients and to provide health and hygeine education and distribute aqua tabs in the community. District Rapid Response team moblized to strengthen RHC Manga and staff alerted and trained on diarrhea case management.

Previous week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken


Jaffarabad BHU Mohammad Ameen Kandrani, Tehsil Sohbat Pur

11 11 20 12 54 patients of suspected malaria were reported, 23 of the 34 tests found positive (P. Falciparum 10, P.Vivax 7, mixed 6); Slide Positivity Rate = 68%, while Falciparum rate = 70%, treatment provided. DHO was informed and requested to distribute bed nets to the affected community.


Kharan Killi Qadir Abad UC sara‐wan

0 0 0 0 45 suspected cases for malaria were reported. All the cases were tested and 23 verified positive and treated (SPR = 51%). The area was surveyed along with DHMT and fogging spray was conducted. Antimalarial medicine were also available in BHU Sarawan while DHO EDO was informed and requsted to provide bed nets.

5‐Jul AWD KPK Abbottabad Village Khan, UC Sarpana 0 0 0 2 AWD outbreak reported from village Khann, Abbottabad. About 588 cases with three deaths reported in three days, DTC established, and Rapid Response Team activated immediately. Two sample were collected and found positive for V.c. Ogawa. Six out of eight water samples were also found contaminated.

7‐Jul Pertussis KPK Kohat UC Sudal 5 2 6 8

Probable Pertussis cases were reported from BHU Duli Banda which is covering some part of UC Sudal. Detailed history taken, blood and Nasopharyngeal swabs were collected and transported to NIH. Erythromycin delivered to contacts, Maintained line‐list. Brief hygiene session conducted with the community, family of cases advised for isolation and strict hygiene measures to be taken. EDO‐H, PPHI and EPI department informed and alerted.

4‐Jul AWD KPK Mansehra Village Shah Khel Garhi; Sadiqabad, Chitti Dheri; Village Sajawal Shareef

0 3 0 0

Three AWD cases with dehydration identified in emergency ward of DHQ, samples were found positive for V.c. Ogawa. EDOH, MS DHQ and Coordinator Public Health were informed about the cases. Health & hygiene education provided to the households and to the community. Water source identified which was hand pumps and springs. Epidemiological & Environmental investigations are underway.

2&4‐Jul

AWD KPK Mardan

Mohallah Mullayan, Vill. Parhoti; Mohallah Mu‐hammad abad, Haji korona, Baghdada

0 0 1 0 Alerts for AWD from two different locations. Detailed history taken, Complete examination done, sample collected and sent to NIH, both found positive for V.c. Ogawa. Health and Hygiene session conducted, EDO‐H, DSM PPHI, MS DHQH and Coordinator National programme Alerted and informed.

4‐Jul AWD Punjab Multan Medina Town Old Shuja‐bad Road Basti Fatool Pur, Labar Morh

0 0 0 1

AWD case reported from BHU Hamidpur Konora, the area of the case was visited jointly with the SO,EHE and DEWS FP. Stool sample found positive for V.c. Ogawa. House to house survey conducted no other cases found in the locality. Area was assessed for the WASH. Health education session conducted, health hygiene kits (Aqua tabs, Jerry cans, Multi purpose soap, Antiseptic soap, Buckets and water filter) distributed. LHWs of the UC were trained on DEWS Alerts definitions and HE. LHWs mobilized to conduct HE sessions on hygiene in the other Areas of the whole UC. shared the line list with EDO(H).

2‐Jul AWD Sindh Larkana Village wada phull UC Phull Taluka

2 1 0 5 Alert for eight cases AWD from one village. Health hygiene sessions done, aqua tabs , ORS, life straw, IEC, jerry cans distributed, 2/2 stool samples found positive for V.c. Ogawa, water samples also collected, reports shared with EDO‐H. No further cases on follow‐up.

5‐Jul AWD Sindh Naushahro Feroze

Village Allah Jurio Rajper, UC‐Ghair Gaju, Taluka Bhiria

2 0 1 0 3 suspected AWD cases reported, one stool sample taken and found positive for V.c. Ogawa, 3 drinking water samples taken for analysis, Hypothesis is poor practice of food handling resulted in AWD outbreak.

2‐Jul AWD Sindh Thatta Village ali muhad jat, UC Kothi, Taluka jati

2 6 1 3 12 suspected AWD cases were found, 1/2 samples collected found positive for V.c. Ogawa, Reinforced case manage‐ment, active surveillance done and no further case found, health education, aqua tabs, zinc tabs, ORS & IEC material provided, EDO‐H,DSM‐PPHI and MS DHQ informed,4 water samples were collected.

8‐Jul AWD Punjab Rawalpindi Ora Sharif, Murree ‐ ‐ ‐ ‐ False alert– Media reported increase in diarrhoea cases and five deaths, investigation by EDO‐H Rawalpindi, THQ Murree, and MS hospital DHQ found no deaths due to diarrhoea and no increase in cases. One death is 54yo due to heart disease and one death is 7yo due to vomiting.



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 59 (58=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 18 - AJK - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 58 1

Focus on: critical diarrhea situation in KP

Diarrhea outbreaks were controlled last week with action by WHO (DEWS and Environmental Health), local counterparts (DTC Rapid Response Teams), and other partners (UNICEF and INGOs) in Abbottabad and Man‐sehra, KP; and Bhakkar, Punjab. This week efforts are ongoing to control diarrhea outbreaks in Mardan, KP, and Khuzdar, Balochistan.

Figure 3 on page 6 shows critical situation of diarrhea in KP, surpassing the proportional morbidity recorded in the 2010 post‐Flood period. Graph at the right, is comparison chart showing that 12 out of 21 report‐ing districts in KP have more than 16% diarrhea cases out of total consul‐tations at public health facilities. Post‐Flood peak was at 15% so there is clearly a worse diarrhea situation this year in KP. Damaged infrastructure due to last year’s Flood and spreading of organism through the river and IDP movements are factors likely responsible for the increase in diarrhea. Mansehra District is one example. In week 27, there was a 6% rise in AD cases reported from DHQ Hospital mainly from three different villages where five positive cases of V.c. Ogawa were identified. The Cholera Task Force at district level was activated under chair of DCO, soap, aquatabs and jerry cans were distributed, and health education sessions conducted by the involvement of LHWs and CWS (IP of UNHCR). The DTC Rapid Re‐sponse Team was activated in week 27 to treat cases 24/7 in the DHQ Hospital and maintain an ORT corner. Situation was controlled in those villages but the number of diarrhea cases continues to rise at the DHQ and investigation of new AWD cases is underway.

Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 28/2011) Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 14 July 2011, compiled from weekly reports

Diseases Total

Skin Diseases 3,853,176 (11%) Acute Respiratory Infection 8,510,715 (23%) Acute Diarrhoea 3,391,969 (9%) Bloody Diarrhoea 312,290 (1%) Suspected Malaria 2,126,056 (6%) Unexplained Fever 1,400,601 (4%) Total Consultations 36,356,090

949

107

3114

3111

111

3011

5811

67

1113

106

799

9879

854

967

1289

1215

1463 1797

168

020

22

2021

226

223

49

2255

2199

225

123

22

245

0246

624

04

254

727

85

274

529

09

2935

298

231

2030

21

3022

305

831

9632

5032

15

3259

335

4337

533

6332

31

3228

361

375 411

331

400

215

192

153

128

105

81 58 4626 26 11

8 128 11 11 1

1 11 8 8 8 8 8 8 66 6 138 6 6 7 7 7 8

7 7 36 6 6 2 2

0

500

1000

1500

2000

2500

3000

3500

4000

Wk 33

Wk 35

Wk 37

Wk 39

Wk 41

Wk 43

Wk 45

Wk 47

Wk 49

Wk 51

Wk 1‐11

Wk 3

Wk 5

Wk 7

Wk 9

Wk 11

Wk 13

Wk 15

Wk 17

Wk 19

Wk 21

Wk 23

Wk 25

Wk 27

Mobile Fixed

29

23 22 21 21 21 20 19 18 17 17 1614 14 13 13 12 11 11 10 10

0

5

10

15

20

25

30

35

Percentage

Acute Diarrhoea proportional morbidity (%) by district, Khyber Pakhtunkhwa‐Week 28, 2011



Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F

8‐Jul AWD Swabi BMC Swabi, UC Mankai, Mohallah Threr 0 1 0 1

10‐Jul AWD Swabi RHC Yar Hussain, UC Yaqoobi, Mohallah Shahab khel

0 1 0 0

10‐Jul AWD Hangu Jhazo Maidan, UC Ganjiano Kale 0 1 0 0

11‐Jul AWD Mardan Mohallah Pirano Korona, UC Manga, Charsadda Road

0 1 0 0

11‐Jul AWD Peshawar Judge Bangla, Miskeen Abad, Nothia Jadeed

0 1 0 0

12‐Jul AWD Kohat UC Duli banda 1 3 2 5

13‐Jul AWD Hangu UC M.Khawaja 1 0 0 0

15‐Jul AWD Haripur Village Baji Sar, Union Council Kundi, Tehsil Ghazi

3 15 4 24

12‐Jul DHF Haripur Village Sarai Naimat Khan, UC Sarai Naimat Khan

0 1 0 0

8‐Jul Leishmani‐

asis Shangla Village Batkot UC Shang 1 0 0 5

13‐Jul Leishmani‐

asis Lower Dir Village Jalley, UC Munjai 0 0 2 2

8‐Jul Measles Swat Village Koz Sangar, UC Jambel, Tehsil Babuzai

0 0 0 1

8‐Jul Measles Swat Village Manglor, UC Manglor, Tehsil Babuzai

0 0 1 0

11‐Jul Measles Mansehra Mangal dora L.Nawab 1 0 0 0

13‐Jul Measles Swat Village Chail, UC Chail, Tehsil Behrain 1 1 0 0

14‐Jul Measles Mansehra Gia Mera Road College Doraha 1 0 0 0

14‐Jul Measles Mansehra Muslim Town Channar Road Lari Ada 1 0 0 0

14‐Jul Measles Mansehra Near Madni Masjid Lari Ada 1 0 0 0

14‐Jul Measles Swabi CH Topi, Right Bank 1 0 0 0

14‐Jul Measles Swabi Private Clinic, Gandaf 1 0 1 0

14‐Jul Measles Haripur Khalabut Township Sector 4, UC Khala‐but

0 0 1 0

12‐Jul Meningitis Swabi BMC Swabi 0 1 0 0

12‐Jul Pertussis Kohat UC Duli banda 0 0 1 1

13‐Jul Pertussis Swabi BMC Swabi, UC Mankai, Mohallah Threr 1 0 1 0

13‐Jul Pertussis Charsadda Vill. Hameed Mian Dherai, UC Umerzai 0 1 1 2

13‐Jul Pertussis Charsadda Vill. Zarinabad, UC Nisatta 1 0 1 1

11‐Jul UXF Haripur Khalabut Township, UC Khalabut 9 18 13 21

Current week's Alerts: Province Sindh

Date Disease District Area <5M >5M <5F >5F

12‐Jul AWD Jamshoro UC Sari,Taluka Thano bula khan 2 5 2 4

12‐Jul AWD Kashmore BHU Din Muhammad Kosh 0 1 0 0

12‐Jul AWD S. Benazirabad Police line UC‐3,Taluka Nawabshah 0 0 0 3

13‐Jul AWD Karachi Manzoor colony, Jamshed town 0 1 0 0

13‐Jul AWD Karachi Near Bilal Masjid,Shaikh Mo‐halla,Mawach goth,UC‐8

0 1 0 0

13‐Jul AWD Khairpur Uberi near Bus stop Shah Ladhani 0 0 0 1

13‐Jul AWD Larkana UC Pathan, Village Paryal Jatoi, Tehsil Bakrani

0 1 0 0

13‐Jul AWD Matiari UC Zeir Pir Village, Deper Lakha, Near mansoorah

0 5 1 1

13‐Jul AWD Matiari Village DoDo Rajani,near khando,UC Hala 2

4 4 1 1

13‐Jul AWD Mirpurkhas Machi colony,Girhore sharif,UC Girhore sharif

1 0 0 1

13‐Jul AWD Qambar Shahdadkot

Village Rab Rakhio Lakho, Tehsil Qambar 0 0 0 1

13‐Jul AWD Thatta Village Majano Detho, UC Mehar Shah 4 0 4 1

14‐Jul AWD Shikarpur THQ Lakhi 0 1 1 1

14‐Jul AWD Khairpur Village Abad near Kalhori, UC Shadi Shaheed

0 0 0 1

14‐Jul AWD Naushahro Feroze

Village Taagri‐UC Masur g wah 0 1 0 1

12‐Jul Chicken Pox

Shikarpur Village Haji Ahmed, near Soomar Goth, Tehsil Lakhi

0 2 0 0

14‐Jul Chicken Pox

Naushahro Feroze

RHC Kamal Dero 2 0 0 0

12‐Jul DHF Karachi Karachi City 0 0 0 1

8‐Jul Measles Tando Muham‐mad khan

Village haji khan chandio,Deh Nuhani, UC Dhando

3 0 1 2

9‐Jul Measles Tando Allah Yar

Village sono Khan, Taluka Jhando mari 2 1 2 0

11‐Jul Measles Ghotki Village Pir Mubarak Shah UC Adilpur 2 0 0 1

12‐Jul Measles Sukkur Miani Road Sukkur 1 0 0 0

12‐Jul Measles Tando Allah Yar

Piyaro Lund City, Taluka Jhando mari 1 0 0 0

13‐Jul Measles Sukkur Village Tando Booro. Tehsil Rohri 1 0 0 0

13‐Jul Measles Ghotki Village Bahawal Khan Jiskani UC Bhaitoor Taluka Khan Garh

1 0 0 0

14‐Jul Measles Thatta Village Muhammad Mallah, UC Bello 2 1 0 0

14‐Jul Meningi‐

tis Jacobabad Gul Hospital 3 0 0 0

9‐Jul NNT Sukkur Cross notified case of village Garo Daro UC Mubarak Pur Talkuka Pano Akil

0 0 1 0

11‐Jul NNT Qambar Shahdadkot

Village Sher Ali Mugheri, Tehsil Miro Khan 1 0 0 0

12‐Jul NNT Sukkur UC mubarakpur, Village Bai Khan near Gharo daro, Tehsil Panoakil

0 0 1 0

14‐Jul NNT Jacobabad Gul Hospital 0 0 1 0

10‐Jul Tetanus Ghotki UC Lohi, Village Hamal Laghari near Sardar Garh

0 0 1 0

14‐Jul Tetanus Jacobabad Gul Hospital 0 1 0 0

14‐Jul Tetanus Shikarpur Near Shahi Bagh Road 0 0 1 0

Current week's Alerts: Province Punjab Date Disease District Area <5M >5M <5F >5F

9‐Jul AD Layyah BHU Jhakar UC jhakar pacca 14 11 17 11

11‐Jul AD Bhakkar UC Chak no 60‐61/ML 2 5 6 3

12‐Jul AD Bhakkar Basti Gaman, UC Malana Daggar, Tehsil Kalur Kot

2 15 3 10

14‐Jul AD Rahim Yar Khan Basti Ch M Sadiq, Tehsil Sadiqabad 9 17 13 10

15‐Jul AD Rahim Yar Khan Kotla Pathan, Tehsil Khanpur 13 18 11 17

15‐Jul AD Rahim Yar Khan UC Gehna Lar tehsil Khanpur 6 11 9 14

13‐Jul AWD Bhakkar Chak no 7, Rakh Dulle Wala, UC Jhammat shumali

1 0 0 0

13‐Jul AWD Bhakkar UC Pir Ashab 0 0 0 1

8‐Jul AWD Muzaffargarh Basti Yaroo Wala, UC Baseera 0 2 1 1

9‐Jul AWD Muzaffargarh Basti Rogh, UC Baseera 1 0 0 1

13‐Jul AWD Khanewal Nishtar Hospital Multan (15‐L, 129 Chak Tehsil Mian Chanu)

0 0 0 1

13‐Jul AWD Muzaffargarh Basti Chah Tayyab Wala, Moza Bhakhar Noon, UC Budh

0 0 0 1

13‐Jul AWD Muzaffargarh Basti Mithi Khooi, Noor Kubra, UC Baseera 0 0 1 0

15‐Jul AWD Muzaffargarh Chah Mithoo Wala, Near by Sardar Koorey Khan School

0 0 0 1

15‐Jul AWD Muzaffargarh Khoo M. Hussain Wala, Near by Taleri Nehar, UC Taleri

0 0 0 1

15‐Jul AWD Muzaffargarh Mohallah Panwar Shumali, UC Mehmood Kot

0 1 0 0

13‐Jul BD Layyah Chak no325 Jamal chapri 1 0 2 0

13‐Jul BD Rahim Yar Khan Unran tehsil Liaqatpur 1 0 2 1

14‐Jul BD Mianwali Mohallah Dhirkana Walla, UC Dub Ba‐loochan,Piplan

0 1 1 1

11‐Jul Measles D. G. Khan Moza Thata Gabolan UC Mutafaraq Chahan

1 0 0 0

13‐Jul Measles Layyah Mohala wahka wala u/c urban 2 1 0 0 0

13‐Jul Measles D. G. Khan Daat Qureshi UC Aaliwala 1 0 0 0

13‐Jul Measles D. G. Khan Mohalla Ghalloowala UC Urban Taunsa 0 1 0 0

13‐Jul Meningitis Multan Khan Pur Bagha Sher, Post Office Khan Pur Shumali

1 0 0 0

9‐Jul Meningitis Layyah Chak no 137 UC 137 TDA 0 1 0 0

12‐Jul NNT Bhakkar Village Bhalmana, UC Mulana Gaggar 0 0 1 0

11‐Jul Scabies Bahawalpur Basti Shukar, Moza Karam Din, UC Head Rajkan

26 136 23 131

12‐Jul Scabies Bahawalpur Basti dada potra, basti sahwan, UC‐21, RHC Lal Sohanra

39 58 53 60

13‐Jul Tetanus Multan 29 Chak Kot Adu Muzaffar Garh 1 0 0 0

14‐Jul Tetanus Khanewal CH Multan (Salar Wahain Basti Iqbal Nagar)

0 1 0 0



Current week's Alerts: Province Balochistan

Date Disease District Area <5M >5M <5F >5F

14‐Jul Chicken Pox Jaffarabad Ghot Abdul Sattar, UC Dirgi, Tehsil Sohbat Pur

2 1 0 0

14‐Jul Leishmaniasis Jhal Magsi BHU Khichi 0 0 0 1

8‐Jul Leishmaniasis Lasbela Madina Colony Hub 0 0 0 1

11‐Jul Leishmaniasis Lasbela Near RCD road Uthal 0 0 0 1

14‐Jul Malaria Jaffarabad CD Baloo Pur, Tehsil Sohbat Pur 7 19 4 16

13‐Jul Measles Jaffarabad

Mir Allah Koheli Bugti, Nazd Faqeer Abdul Rasheed, in front of Haji Sarkaar, tehsil Sohbat Pur, from Security compromised areas of Jaffarabad

1 0 1 1

13‐Jul Measles Khuzdar Soneji UC Gazgi tehsil Khuzdar 1 0 2 0

8‐Jul Measles Quetta Killi Gul Mohammad, Air Port road 0 0 0 1

9‐Jul Measles Lasbela Zar khan Goth UC pathra 0 0 1 0

12‐Jul Measles Quetta Block ‐ 4, Satellite town 2 1 1 1

12‐Jul Measles Quetta New Railway Housing Society, Brewery road

0 0 1 0

8‐Jul Mumps Lasbela Raees Goth UC Gabapat,Kemari Town Karachi(cross case)

1 1 1 0

12‐Jul Pertussis Khuzdar Bajori UC Baghbana tehsil Khuzdar 1 1 1 0

14‐Jul Pertussis Nasirabad Ghot Mohammad Ramzan, Tehsil DMJ 2 0 1 0

12‐Jul Tetanus Khuzdar Londo, Rann Bhit UC Baghbana tehsil Khuzdar

0 1 0 0

9‐Jul Typhoid Chagai Dawood Abad UC Chi ghazi 0 2 0 1

11‐Jul Typhoid Chagai Killi Station Taftan 0 1 2 1

Current week's Alerts: AJK; FATA; GB and ICT Date Disease District Area <5M >5M <5F >5F

8‐Jul AWD Sudhnoti Village Bhatiyan UC Patan sher khan The Mang

0 0 0 1

8‐Jul AWD Sudhnoti Village Narori UC Mang The Mang 0 1 0 0

12‐Jul AWD Sudhnoti Vill Billan Nar UC Baral Tehsil Pallandri 0 1 0 0

12‐Jul AWD Islamabad AlShifa Hospital (Merabadia) 1 0 0 0

9‐Jul Measles Gilgit Village Bagrote UC Bagrote Tehsil Gilgit 0 0 1 0

11‐Jul Measles Gilgit Amphary Thopchar Gilgit town area 1 0 0 0

14‐Jul Measles Gilgit Village Nomal UC Nomal Tehsil 7 district Gilgit

0 0 1 0

11‐Jul Measles skardu Abbas abad oro UC kumra Tehsil Skardu 0 0 1 0

AWD, 37

Measles, 32

NNT + Tetanus, 11 AD, 6

Pertussis, 6

Leish, 5

Meningitis, 4

BD, 3

C. Pox, 3

DHF, 2

Scabies, 2

Typhoid, 2

Malaria, 1

Mumps, 1

Unexplained Fever, 1

Distribution of alerts by diseases, week 28 (8 ‐ 14 July), 2011 (n=116)

14

1917

15

18

6

9 8

5

1

0

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Wk 25 Wk 26 Wk 27 Wk 28

# of alerts

Epi‐week

Number of alerts detected by week, province Sindh (Week 25 to 28, 2011)

AWD MS Pertussis Leish

10

13

18

8

21 22

14

10

1 1

4 431 2

0

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10

15

20

25

Wk 25 Wk 26 Wk 27 Wk 28

# of alerts

Epi‐week

Number of alerts detected by week, province Khyber Pakhtunkhwa, (Week25 to 28, 2011)


6 7 6

10

15

4

7

4

1 21 2

0

5

10

15

20

25

Wk 25 Wk 26 Wk 27 Wk 28

# of alerts

Epi‐week

Number of alerts detected by week, province Punjab (Week 25 to 28, 2011)


1 1

7 6

3

65 4 42

7

13

0

5

10

15

20

25

Wk 25 Wk 26 Wk 27 Wk 28

# of alerts

Epi‐week

Number of alerts detected by week, province Balochistan (Week 25 to 28, 2011)


13 32 1 11

0

5

10

15

20

25

Wk 25 Wk 26 Wk 27 Wk 28

# of alerts

Epi‐week

Number of alerts detected by week, AJK (Week 25 to 29, 2011)


75

24

0

5

10

15

20

25

Wk 25 Wk 26 Wk 27 Wk 28

# of alerts

Epi‐week

Number of alerts detected by week, province Gilgit Baltistan (Week 25 to 28, 2011)

Measles



Province Khyber Pakhtunkhwa:

• This week 21 districts reported to DEWS from 729 health facilities with a total of 184,301 patients consultations.

• AD is showing a consistent upward trend and accounted for 15% - 17% of the total consultations in last 4 weeks.

• 27 alerts were reported in this week, 10 were for Measles, 8

for AWD, 4 for Pertussis, 2 for Leishmaniasis, while 1 each for DHF, Meningitis and Unexplained Fever.

Figure-3: Three years trend of Acute diarrhoea, province KPK

Province Punjab:

• 12 districts reported data to DEWS from Punjab province, 879 health facilities reported a total of 260,751 patient con-sultations during this reporting period

• AD cases reported were 18,657, and stabilize between 7% to 8% from last four weeks.

• 30 alerts were reported in this week from Punjab; 10 for AWD, 6 for Acute diarrhoea, 4 for Measles, 3 for Bloody diarrhoea, three for Neonatal Tetanus and tetanus, while two each for Meningitis, Scabies.

Figure-4: Trend of acute diarrhoea, province Punjab (3 August 2010 to 30 June 2011)

Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response

Disease Post Flood 2010 2011 Total A O A O A O A O

Acute Watery Diarrhoea 209 85 359 132 37 10 605 227

Bloody Diarrhoea 10 1 42 8 3 ‐ 55 9 Measles 50 7 1092 79 32 ‐ 1174 86 Pertussis 2 ‐ 158 16 6 ‐ 166 16

Malaria 12 7 40 28 1 1 53 36 Leishmaniasis 1 ‐ 57 17 5 ‐ 63 17 Others 156 43 343 36 21 ‐ 520 79 Total 451 145 2210 328 116 11 2777 484

Current Week

Acute Jaundice Syndrome 5 2 29 12 ‐ ‐ 34 14

NNT + Tetanus 6 ‐ 90 ‐ 11 ‐ 107 0

Province Sindh:

• This week 22 districts reported to DEWS from 1,012 health centers with a total of 445,575 patient consul-tations during the reporting period of week 28, 2011.

• In Sindh, AD cases reported were 40,139 (9%), same proportional morbidity as compared with last week.

• 34 alerts were reported from Sindh in this week: 15 were for AWD, 8 for Measles, 7 for Neonatal Tetanus and Tetanus, Two for Chicken pox, while one each for DHF and Meningitis.

Figure-5: Three years trend of Acute diarrhoea, province Sindh

0

4

8

12

16

20

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

Percentage

Epi‐Week

2009 2010 2011

0

2

4

6

8

10

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14

16

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

Percentage

Epi‐week

2010 2011

0

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8

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20

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

Percentage

Epi‐Week

2009 2010 2011

Epidemiological Bulletin: DEWS, Pakistan, Week no. 28 (8 - 14 July, 2011) Province Balochistan:

• In this week, 17 districts reported to DEWS from Balochistan province. 409 fixed and one mobile medi-cal outreach centers reported a total of 64,098 patient consultations.

• AD reported in 8,145 (13%) of the total consulta-tions, same proportional morbidity as compared with last week.

• 17 alerts were reported in this week from Balochis-tan, 6 were for Measles, 3 for Leishmaniasis, 2 each were for Pertussis and Typhoid, while one each for Chicken pox, Malaria, Mumps and Tetanus.

Figure-6: Three years trend of Acute diarrhoea, province Balochistan


State of Azad Jammu and Kashmir:

• In this week, weekly report received from 91 health centers from 10 districts, with a total of 30,216 pa-tient consultations.

• ARI cases reported were 3,400 (11%), while Acute diarrhoea reported 2,843 (9%) cases.

• Three AWD alerts reported and responded in this week.

Figure-9: Trend of priority communicable diseases, AJK (25 March to 30 June 2011)

FATA:

• This week 48 health centers in 3 agencies reported from FATA, with a total of 9,425 patient consulta-tions.

• ARI cases reported were 1,554 (16%), while Acute diarrhoea reported 1,018 cases (11%)

• No alerts were received this week from any area in Fata.

Gilgit Baltistan:

• In this week, 60 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 22,249 patient consultations.

• ARI cases reported were 2,546 (11%), while Acute Diarrhoea 3,086 (14%).

• Four Measles alerts were received and responded this week.

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 7 July 2011)

Figure-8: Trend of priority communicable diseases, FATA (4 February to 7 July 2011)

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AD BD ARI S. Malaria

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Alerts and outbreaks, week 28, 2011

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