Weekly Epidemiological - WHO · 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

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. 27 (1 - 7 July, 2011)

• 87 districts and 3 agencies provided surveillance data to the DEWS this week from 3,158 fixed health facilities and one mobile medical outreach centres.

• A total of 977,368 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI), 11% skin disease, 10% acute diarrhoea, and suspected Ma-laria remains at 6%.

• A total of 118 alerts with 14 outbreaks were reported in week-27, 2011: Altogether 41

alerts were for AWD; 36 for Measles; 11 for Neonatal Tetanus and Tetanus, nine for Per-tussis; four for Acute Diarrhoea; 3 for Leishmaniasis; Two each were for Chicken Pox, Malaria, Meningitis and Mumps; while one each for AJS, Bloody diarrhoea, CCHF, DHF, Scabies and Typhoid.

• National Polio Eradication Initiative reported one confirmed polio case this week from

district Quetta in Balochistan. 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 27, Monday 11 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-20 Wk-21 Wk-22 Wk-23 Wk-24 Wk-25 Wk-26 Wk-27

Other Acute Diarrhoea (Not Watery) 102,955 (11%) 106,720 (10%) 102,005 (10%) 100,753 (10%) 102,217 (10%) 103,978 (10%) 107,924 (10%) 97,531 (10%)

Total consultation 976,358 1,020,071 995,731 1,009,254 1,028,090 1,019,724 1,087,368 977,368

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, eight 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. 27 (1 - 7 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

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: New Strategy for Diarrhoea Rapid Response Teams (DRT) Efforts are ongoing this week to control outbreaks in Abbottabad, KPK; in Multan district, Punjab; in Bara Kahu, ICT. When cases of AWD have been identified in any district significantly above the usual number of admissions, the new strategy for Diarrhoea Rapid Response Teams (DRT) has been triggered to provide 24/7 emergency care at a nearby health facility. The DRT include 5 doctors, 5 nurses and 3 cleaners from each district trained by WHO surveillance teams, to move into the area of the outbreak to establish immediate care for the cholera cases. WHO supports the training of the DRT and provides top‐up displacement payment during their overtime or “out of station” work. The dis‐placement component costs significantly less than running Diarrhea Treatment Centers such as were set up as an emergency measure im‐mediately with the flood of 2010, but they are expected to be just as effective.

The strategy, however, depends on the early detection and response to cholera cases by the DEWS team. We have expanded the DEWS team by 30 Surveillance Officers this year, to a total of 76, who are effectively covering about 96 of the most vulnerable districts and agen‐cies. In the coming weeks, we anticipate more Alerts for acute watery diarrhea (AWD) and more outbreaks of cholera threatening lives in many districts, extending from now until October, 2011. Without DEWS, districts will return to the chaos of late detection and “catch‐up” response, and overwhelming extended outbreaks may occur in some districts potentially causing a higher death toll.

In May and June 2011, 257 alerts and 97 outbreaks confirmed due to an epidemic strain of cholera, Vibrio cholera Ogawa. During this time 4506 cases of AWD have been reported, associated with the confirmed outbreaks, and 35 deaths, CFR



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

24‐Jun AWD KPK Mardan Mistri abad, Canal Road 0 1 0 0

An AWD case reported from DHQH, Mardan. On investigation and active surveillance in area no more cases found. Sample taken and found positive for V.c. Ogawa. EDOH, MS DHQ, DSM PPHI and Coordinator Public Health were informed about the case. Health and hygiene education provided to the household and to the community. Water source was identified and water sample was taken for microbial contamination testing.

29‐Jun Leishma‐niasis

KPK Shangla Kuzbat Kot 1 7 2 12

Alert for Leishmaniasis was reported from CD SHANG, a response team with WHO,PRCS/ GRC, CordAid and DOH visited the affected village Auzbat Kot , 22 suspected cases of Cutaneous Leishmaniasis were clinically identified. Intra‐lesional injections were given to all of them and follow‐up advised ,bed nets distributed , health & hygiene session conducted . Plan for residual spray was made . A 3 day medical camp was established in the village.

24‐Jun Leishma‐niasis

Punjab Mianwali Tolla Mangalli,UC Chapri,Tahsil Issa Kheel

1 2 0 5 Eight suspected Leishmaniasis cases were found during active surveillance. Line listing ensured and treatment started. Area was searched for breeding sites of the vectors. Area notables were involved in proper disposal of solid wastes.

24‐Jun AWD Sindh Dadu Village Talbani Panhwar,Near BHU Phakka,UC Yaar Muham‐mad Kalhoro

1 1 1 0 Three AWD cases reported. Reinforced case management, active surveillance, Aqua tabs, Zinc tabs and ORS provided, Health education, EDO‐H informed. 1 Stool sample collected and found positive for V.c. Ogawa. Two water samples also collected. No other cases found.

24‐Jun AWD Sindh Jamshoro Brufat Mohalla, UC Nagoline, Taluka Kotri

0 1 0 0 One AWD case reported. Reinforced case management, active surveillance, Zinc tabs, Chlorine tabs and IEC Mate‐rial Provided, Health education, EDO‐H informed. 1 stool sample was collected and found positive for V.c. Ogawa. Two water samples also collected and found microbiological contamination. No other cases found.

24‐Jun AWD Sindh Karachi Hussaini Gali,Sindhi Mo‐halla,BaBa Island,UC 4 Kemari Town

0 1 0 0 One AWD case reported. Reinforced case management, active surveillance, Aqua tab distributed, Health education Provided, Health staff briefed about AWD rapid response, THO informed. one stool sample collected and found positive for V.c. Ogawa. No other cases found.

27‐Jun AWD Sindh Khairpur UC Deparja, tehsil Thari Mirwah

0 1 0 2 Three AWD cases reported at community, health and hygiene session conducted. 1/3 stool sample collected, and found positive for V.c. Ogawa. No other cases found.

27‐Jun AWD Sindh Qambar Shahdad‐kot

Larkana (Near Ber Road, UC 2, Tehsil Qambar)

0 0 0 1 One AWD case reported, health and hygiene session conducted, 1 stool sample collected and found positive for V.c. Ogawa. 2 water samples were also collected and found microbiological contamination at household level. No other cases found.

28‐Jun Pertussis Sindh Tando Allah Yar Village Kamal Khan aglam 3 6 3 8 20 probable Pertussis cases reported from one village, Reinforced case management, active surveillance, Health education, Erythromycin provided to case and contacts, 2 throat swab sample collected and sent to NIH for testing. EDO‐H and EPI taken on board to insure immunization coverage in the area.

28‐Jun AWD ICT ICT Bara Kahu ‐ ‐ ‐ ‐

Two AWD cases reported from Polyclinic, samples were taken and found positive for V.c. Ogawa. During field investigation water samples taken from water storage tanks and found contaminated, 40 LHWs were briefed on messages on of safe drinking water and sanitation to pass to community. Aqua Tabs and health education provided in the community. Health department ICT did chlorination of water storage tank and wells in the community.

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

7‐Jul Malaria Balochis‐tan

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.

4‐Jul Malaria Balochis‐tan

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.

6‐Jul Leishmani‐

asis FATA Bajaur Agency

Village Maina of Tehsil Mamoond

3 6 2 13 Alert for Leishmaniasis identified and line listed. Inj Glucantime arranged for treatment of cases. Health education done.

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. More information awaited.

3‐Jul AWD KPK Battagram Vill Haveeloo, UC Jambaira, Tehsil Allai

0 0 0 1

AWD case severely dehydrated, receiving IV reported from DHQH. Sample found positive for V.c. Ogawa. Active surveil‐lance done in the area, no other case found. Health and hygiene session conducted in the area. Aqua tabs were distrib‐uted in the community. Use of boiling water was emphasized as well as hand washing with soap and personal hygiene. EDOH and MS DHQH informed about the situation. Environmental assessment underway in the area.

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 Sajawal Shareef 0 1 0 0 A suspected case of AWD with dehydration found at DHQ, sample was taken and found positive for V.c. Ogawa. During active surveillance no more cases found. Environmental investigation ongoing.

2&4‐Jul

AWD KPK Mardan

Mohallah Mullayan, Vill. Parhoti; Mohallah Muham‐mad 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 alert, the case was reported from BHU Hamidpur Konora, the area of the case was visited jointly with the SO,EHE and DEWS FP. Stool sample taken and sent to NIH which found positive for V.c. Ogawa. House to house survey con‐ducted 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 called to THE Reported health facility and were trained on DEWS Alerts definitions and HE. LHWs mobilized to conduct HE sessions on hygiene in the other Ares 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.

7‐Jul Pertussis Sindh Sanghar Village haji faizullah laghari, Deh bakhoro, UC Mian

3 0 2 12 12 suspected cases were found, active surveillance ongoing, erythromycin provided to cases and contacts, collected 2 specimen and sent to NIH. EDO‐H consulted about improving immunization outreach.

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.



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

3‐Jul AWD Battagram Vill Haveeloo, UC Jambaira, Tehsil Allai 0 0 0 1

6‐Jul Measles Battagram Vill. Sukheli Banda, UC Gajjbori 1 0 0 0

6‐Jul Measles Buner Vill Khel Daggar, Tehsil Daggar 0 0 0 1

5‐Jul AWD Charsadda Vill. Garhi Shahbaz Khan, Prang 0 1 0 0

5‐Jul AWD Charsadda Vill. Khatako Kanday, UC Utmanzai 0 0 0 1

4‐Jul Pertussis Charsadda Vill. Garhi Shahbaz MC 2, Prang 1 0 0 0

4‐Jul Pertussis Charsadda Vill. Mamakhel, MC 3 1 0 0 0

2‐Jul AWD Hangu Hangu 0 0 0 1

4‐Jul AWD Hangu Karbogha 1 0 0 0

3‐Jul AWD Haripur Muhallah Saeed Abad Haripur City, UC Haripur

0 0 0 1

5‐Jul AWD Haripur Afghan Refugee Camp UC Khalabut 0 0 0 1

7‐Jul AWD Haripur Sardar Colony UC Ali Khan 0 1 0 0

1‐Jul Measles Haripur Pakhral chawk Khalabut sector 2 UC Khalabut

0 0 1 0

6‐Jul AWD Kohat Mian Garhi, UC Nasrat Khel 1 0 0 0

7‐Jul Pertussis Kohat UC Sudal 5 2 6 8

5‐Jul NNT Lower Dir Village Lar dok, UC Doog Darra , Sherin‐gal

1 0 0 0

4‐Jul AWD Mansehra Village Sajawal Shareef 0 1 0 0

2‐Jul AWD Mardan Mohallah Mullayan, Vill. Parhoti 0 0 1 0

4‐Jul AWD Mardan Mohallah Muhammad abad, Haji korona, Baghdada

0 1 0 0


asis Shangla Kuz Bat kot UC Shang 0 4 0 4

4‐Jul Measles Shangla Mian Kele UC Pirabad 1 0 0 0

6‐Jul Measles Shangla Pirabad 0 0 1 0

5‐Jul Measles Swabi CH Topi 1 0 0 0

5‐Jul Pertussis Swabi CH Topi 0 0 1 0

4‐Jul Measles Swat Village Nowkhera, UC Darmai, Tehsil Matta

0 0 1 0

6‐Jul Measles Swat Village Gishara Parona Chinar, UC Jambel, Tehsil Babuzai

1 0 0 0

6‐Jul Measles Swat Village Gogdara Mohallah Guli Khel, UC Tando Dag, Tehsil Babuzai

1 0 0 0

6‐Jul Measles Swat Village Pand Miangano Cham, UC Pand, Tehsil Babuzai

1 0 0 0

7‐Jul Measles Swat Village Kaduna,UC Marghuzar,Tehsil Babuzai

0 0 0 1

7‐Jul Measles Swat Village Tando Dag Jalala, UC Tando Dag, Tehsil Babuzai

1 0 0 0

7‐Jul Measles Tank Aarban 1 0 0 0

7‐Jul Measles Tank Mohalla Shahjehan 0 0 0 1

5‐Jul AWD Abbottabad Village Khann, UC Sarpana ‐ ‐ ‐ 2

Current week's Alerts: Province Sindh Date Disease District Area 5M 5F

4‐Jul AWD Badin THQ Hospital Golarchi,Taluka Golarchi 0 0 0 0

2‐Jul AWD Dadu Shahbaz colony, Monder nako City 2 0 4 3

5‐Jul Measles Ghotki Village Bhandki UC I Ghotki 1 0 0 0

7‐Jul Measles Ghotki UC Khuwara, Village Mohammad Hashim Behan, Ghotki

1 0 0 0

7‐Jul Measles Ghotki Village Hashim Behan 0 3 0 0

5‐Jul NNT Ghotki Village Kamal fakeer Mahar UC Bereri 1 0 0 0

6‐Jul AWD Hyderabad Village Wali Muhammad Rind,UC sehri 2 1 1 0

1‐Jul Tetanus Jacobabad UC Saeedo Kot Village Mohammad Zaman Sarki, Tehsil Thul

0 0 1 0

5‐Jul AWD Jamshoro UC Channai Taluka sehwan 0 1 0 0

6‐Jul Measles Jamshoro UC Sanwalter,Taluka kotri 0 0 1 0

7‐Jul Measles Kashmore BHU MK Mazari 1 0 0 0

3‐Jul AWD Khairpur UC Kandri, Tehsil Faiz Gunj 1 0 0 0

4‐Jul NNT Khairpur Khairpur 1 0 0 0

2‐Jul Tetanus Khairpur UC Mehar Ali, Village Phul Wahan, Tehsil Piryalo

1 0 0 0

2‐Jul AWD Larkana Village wada phull UC Phull Taluka 2 1 0 5

2‐Jul Tetanus Larkana Bhutta muhalla UC Naudero talka Rato‐dero

0 0 0 1

6‐Jul AWD Matiari Village Mansoorah,Taluka new saeeda‐bad

0 0 4 1

7‐Jul Measles Mirpur khas Village Ismail kumbhar, Nohri paro, UC Ismail kumbhar

1 1 3 0

5‐Jul AWD Naushahro Feroze

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

2 0 1 0

5‐Jul AWD Naushahro Feroze

Village Paroo Tetri Mari, UC‐Bhanbhri, Taluka N‐Feroze

4 3 3 2

3‐Jul Tetanus Qambar Shahdadkot

Gopang muhalla near THQ Hospital UC 2 Kamber

0 0 0 1

2‐Jul NNT S. Benazirabad Village Raees ahmed khan kaloi, UC That,Taluka kazi ahmed

1 0 0 0

5‐Jul NNT S. Benazirabad Village jamal Keerio chotiari,Taluka Khipro

1 0 0 0

7‐Jul NNT S. Benazirabad Village Dargar pir Zakiri, UC Pir zakiri,Taluka Sakrand

1 0 0 0

7‐Jul Pertussis Sanghar Village haji faizullah laghari, Deh bakhoro, UC Mian

3 0 2 12

6‐Jul AWD Shikarpur Sadar City 0 1 2 1

7‐Jul Measles Shikarpur Shikarpur 0 1 0 0

7‐Jul AWD Sukkur GH Bagirji, Bashirabad muhalla Bagirji 0 0 0 1

4‐Jul Measles Sukkur Jogi muhalla near Asif Colony Bachal shah Miyani talluka

0 0 1 0

5‐Jul AWD Tando Muham‐mad Khan

Village Taj Muhammad solangi, UC Qubool pur

0 1 1 2

7‐Jul AWD Tando Muham‐mad Khan

Village Mushtarqa colony 1 2 2 0

5‐Jul Measles Tharparkar Sodhra paro,Chachiro town,Taluka Chachiro

0 3 2 1

2‐Jul AWD Thatta Village ali muhad jat, UC Kothi, Taluka jati 2 6 1 3

4‐Jul AWD Thatta Village arif samoo, Kharochan City 2 4 0 3

1‐Jul AWD Umer kot Haji badal nohri, UC &Taluka Pithoro 6 3 1 2



Current week's Alerts: Province Balochistan Date Disease District Area 5M 5F

6‐Jul Measles Chagai Killi Toheed Abad Chaghi village 0 2 0 0

7‐Jul Typhoid Chagai Ameen Abad Chaghi village 0 1 2 1


asis Jaffarabad

Collony Cattle form, Tehsil Usta Mohammad

0 0 0 1

7‐Jul Malaria Jaffarabad BHU Mohammad Ameen Kandrani, Tehsil 11 11 20 12

6‐Jul Pertussis Jaffarabad Shaheed Murad colony, ward No. 3 Tehsil Jhat Pat

2 1 0 1

4‐Jul Mumps Kech Bund‐e kalat Absar UC Absar 0 1 0 3

4‐Jul Malaria Kharan Killi Qadir Abad UC sarawan 0 0 0 0

7‐Jul Meningitis Killa Saiful‐lah

DHQ Loralai(Awal phatak Killa Saifullah) 1 0 0 0

1‐Jul Measles Lasbela Bela City 0 0 0 1

5‐Jul Measles Nasirabad Ghot Mir Mohammad, UC Quba Sher Khan 0 2 3 0

5‐Jul Pertussis Nasirabad Ghot Jamal Khan Bugti, UC Quba sher khan, berron area

0 3 2 0

4‐Jul CCHF Panjgur UC Gramkan, Mohallah Abdul Malik 0 0 0 1

5‐Jul Chicken pox Ziarat Ghoshi 1 1 1 0

4‐Jul Mumps Ziarat Kawas 1 0 0 0

4‐Jul Pertussis Ziarat Zindra 1 0 0 0

6‐Jul Pertussis Ziarat Ziarat 1 0 1 0

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

4‐Jul Measles Bagh Village Dhar Samniyan UC Dharay 1 0 0 0

2‐Jul AWD Kotli DHQ Kotli (Aghar colony, kakni) 5 15 5 11

4‐Jul AWD Muzaffara‐bad

Mohalla Rarror, Village Ambore 0 0 0 1

4‐Jul AWD Muzaffara‐bad

Mohallah Muniri, Village Ambore 0 1 0 0

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


asis Bajaur Agency

Village Maina of Tehsil Mamoond 3 6 2 13

1‐Jul Measles Ghizer Village Thaus Paeen UC Thaus Tehsil Yasin 0 1 0 0

1‐Jul Measles Ghizer Village Umal Sat UC Hundur Teehsil Yasin 0 0 0 1

5‐Jul AWD Islamabad CH PIMS (New Shakrial, Near Zia Masjid) 0 0 0 1

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

2‐Jul AWD Bhakkar Mohallah Sheikhan, Dolat Wala Hamza Abad, UC Chak No. 60‐61/ML

0 1 0 0

7‐Jul Measles Bhakkar Jhammat Niwani, UC Sial, tehsil Bhakkar 0 0 1 0

2‐Jul Scabies Bhakkar BHU Peer Ashab, UC Peer Ashab, Tehsil Bhakkar

0 13 0 15

1‐Jul AD Layyah BHU pharpur UC pharpur 18 10 22 12

2‐Jul BD Layyah Basti Jhoak Jaskani UC Karoor thal jandi 0 1 2 0

6‐Jul DHF Mianwali Mayo Hospital Lahore (UC Tarag,Tehsil EsaKhel)

0 0 0 1

4‐Jul AWD Multan Medina Town Old Shujabad Road Basti Fatool Pur, Labar Morh

0 0 0 1

7‐Jul AWD Multan Farooq Pura Pourani Chain Marhi 0 0 0 1

7‐Jul AWD Multan Shah Shams Colony Near Shah Shams Darbar

0 1 0 0

2‐Jul Chicken Pox

Multan Basti Arbi Near Qadimi Jama Masjid 0 2 0 2

2‐Jul Measles Multan Chak No.1 Faiz Junobi, Near Ada Lar 0 1 0 0

2‐Jul Tetanus Multan Nishter Hospital, Moza punal Nashaib Post office Juman Shah

0 1 0 0

3‐Jul AWD Muzaffargarh Basti Chandia, Urban jatoi 2 0 0 1

5‐Jul AWD Muzaffargarh Basti Kalarwala, UC Baseera 1 0 0 1

2‐Jul Measles Muzaffargarh Basti Nirali Wala, UC City‐2 0 0 0 1

6‐Jul Measles Muzaffargarh Basti Piplan Wala, UC Basera 1 0 1 0

6‐Jul Measles Muzaffargarh Basti wada Khoo, UC Baseera 1 1 0 0

6‐Jul Measles Muzaffargarh Mohalla Aim Wala, City UC‐1 1 0 0 0

6‐Jul AD Rahim Yar Khan Chak # 148‐P, Tehsil Sadiqabad 6 5 8 6

7‐Jul AD Rahim Yar Khan Chak # 158‐P, UC 160‐P, Tehsil Sadiqabad 7 5 2 3

7‐Jul AJS Rahim Yar Khan UC Jamaldin wali, The Sadiqabad 0 4 0 2

7‐Jul Measles D. G. Khan Basti Hadwar Shumali Taunsa 1 0 0 0

7‐Jul Meningitis D. G. Khan Moza Chitbani uc Sokar, Tehsil Taunsa 0 0 0 1

1‐Jul AD Layyah BHU 157 TDA UC 164 TDA 9 7 14 8

AWD, 41

Measles, 36

Pertussis, 9

NNT, 6

Tetanus, 5AD, 4

Leishmaniasis, 3

Malaria, 2

Meningitis, 2

Mumps, 2

Chicken Pox, 2

AJS, 1

BD, 1

CCHF, 1

DHF, 1

Scabies, 1

Typhoid, 1

Distribution of alerts by diseases, week 27, 1 ‐ 7 July, 2011 (n= 118)

1618

69

29

14

1916

1

5

1

0

5

10

15

20

25

30

35

Wk 24 Wk 25 Wk 26 Wk 27

# of alerts

Epi‐week

Number of alerts detected by week, province Sindh (Week 24 to 27, 2011)

MS AWD Pertussis Leishmaniasis

2421 22

14

9 1013 13

1 1 14

13

1

0

5

10

15

20

25

30

Wk 24 Wk 25 Wk 26 Wk 27

# of alerts

Epi‐week

Number of alerts detected by week, province Khyber Pakhtunkhwa (Week 24 to 27, 20111)


1815

4

75

67

6

12

1 12

0

5

10

15

20

Wk 24 Wk 25 Wk 26 Wk 27

# of alerts

Epi‐week

Number of alerts detected by week, province Punjab (Week 24 to 27, 2011)


7 76

32

1 1

5 54 4

1

7

1

0

2

4

6

8

10

Wk 24 Wk 25 Wk 26 Wk 27

# of alerts

Epi‐week

Number of alerts detected by week, province Balochistan (Week 24 to 27, 2011)




Province Khyber Pakhtunkhwa:

• This week 21 districts reported to DEWS from 682 health facilities with a total of 165,546 patients consultations.

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

• 33 alerts were reported in this week, 14 were for Measles, 13

for AWD, 4 for Pertussis, while 1 each for Leishmaniasis and Neonatal tetanus.

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

Province Punjab: • 12 districts reported data to DEWS from Punjab province,

881 health facilities reported a total of 256,605 patient con-sultations during this reporting period

• AD cases reported were 17,971, and stabilize between 7% to 8% from last four weeks.

• 24 alerts were reported in this week from Punjab; 7 for Measles, 6 were for AWD, 4 for Acute diarrhoea, while one each for AJS, Bloody diarrhoea, chicken pox, DHF, Menin-gitis, Scabies, and Tetanus.

• A total of 402 confirmed malaria cases reported from 9 districts in Punjab this week. 216 from Muzaffargarh, 70 from Bhakkar, 54 from DG Khan, 18 from Sargodha, 15 from Layyah, 12 from Rajanpur, 11 from Mianwali, while three each were from Khushab and Bahawalpur.

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 85 312 116 41 8 562 209

Bloody Diarrhoea 10 1 41 8 1 ‐ 52 9 Measles 50 7 1054 78 36 ‐ 1140 85 Pertussis 2 ‐ 148 14 9 2 159 16

Malaria 12 7 38 26 2 2 52 35 Leishmaniasis 1 ‐ 54 16 3 1 58 17 Others 156 43 329 36 14 ‐ 499 79 Total 451 145 2082 306 118 13 2650 464

Current Week

Acute Jaundice Syndrome 5 2 28 12 1 ‐ 34 14

NNT + Tetanus 6 ‐ 78 ‐ 11 ‐ 95 ‐

Province Sindh:

• This week 21 districts reported to DEWS from 977 health centers with a total of 422,108 patient consul-tations during the reporting period of week 27, 2011.

• In Sindh, AD cases reported were 39,019 (9%), same proportional morbidity as compared with last week.

• 35 alerts were reported from Sindh in this week: 16 were for AWD, 9 for Measles, 9 for Neonatal Tetanus and Tetanus, while one for Pertussis.

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

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Epidemiological Bulletin: DEWS, Pakistan, Week no. 27 (1 - 7 July, 2011) Province Balochistan:

• In this week, 18 districts reported to DEWS from Balochistan province. 435 fixed and one mobile medi-cal outreach centers reported a total of 70,785 patient consultations.

• AD reported in 9,401 (13%) of the total consulta-tions, 1% lower proportional morbidity as compared with last week.

• 16 alerts were reported in this week from Balochis-tan, 4 for Pertussis, 3 for Measles, 2 each for Malaria and Mumps, while one each for CCHF, Chicken pox, Leishmaniasis, Meningitis and Typhoid.

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


State of Azad Jammu and Kashmir:

• In this week, weekly report received from 93 health centers from 10 districts, with a total of 33,486 pa-tient consultations.

• ARI cases reported were 4,668 (14%), while Acute diarrhoea reported 2,595 (8%) cases.

• Six alerts reported and responded in this week; 5 were for AWD and one for Measles.

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

FATA:

• This week 51 health centers in 3 agencies reported from FATA, with a total of 10,715 patient consulta-tions.

• ARI cases reported were 1,719 (16%), while Acute diarrhoea reported 1,232 cases (11%)

• One alert for Leishmaniasis was received and re-sponded this week.

Gilgit Baltistan:

• In this week, 39 health centers from 5 districts in Gilgit Baltistan sent weekly report with a total of 18,123 patient consultations.

• ARI cases reported were 2,314 (12%), while Acute Diarrhoea 1,999 (11%).

• Two 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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Alerts and outbreaks, week 27, 2011

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