Weekly Epidemiological · Distribution of Wild Polio Virus cases Pakistan 2010 and 2011 Year 2010:...

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. 26 (24 - 30 June, 2011)

• 91 districts and 3 agencies provided surveillance data to the DEWS this week from 3,519 fixed health facilities and 5 mobile medical outreach centres.

• A total of 1,079,681 consultations were reported through DEWS of which 18% were acute respiratory infections (ARI), 12% skin disease, 10% acute diarrhoea, and 6% were suspected Malaria.

• A total of 127 alerts with 13 outbreaks were reported in week-26, 2011: Altogether 45 alerts were for Measles; 41 for AWD, 12 for Pertussis, 5 for Leishmaniasis, 4 for Acute diarrhoea, 3 each for Bloody diarrhoea and Tetanus, 2 each were for Meningitis, Neonatal Tetanus, Chicken Pox, DHF, and Sca-bies, while one each for Acute Jaundice syndrome, ARI, Diphtheria, and Mumps.

• National Polio Eradication Initiative reported Four confirmed polio cases this week. One each from Khyber and Orakzai Agencies in Khyber Pakhtunkhwa; one from Thatta district in Sindh, while one from Pishin district in Balochistan. Total 58 (57=type1, and 1=type3) confirmed polio cases have been reported in 2011 from 24 districts.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 26, Monday 4 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-19 Wk-20 Wk-21 Wk-22 Wk-23 Wk-24 Wk-25 Wk-26

Other Acute Diarrhoea (Not Watery) 94,472 (10%) 102,955 (11%) 106,720 (10%) 102,005 (10%) 100,753 (10%) 102,217 (10%) 103,978 (10%) 107,209 (10%)

Total consultation 904,711 976,358 1,020,071 995,731 1,009,254 1,028,090 1,019,724 1,079,681

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 12 districts had outbreaks of AWD, 9 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. 26 (24 - 30 June, 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 58 (57=type‐1, and 1=type3) till date from 24 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 17 - AJK - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 57 1

Focus on: AWD Islamabad, 6 June 2011

Outbreaks of AWD identified in sectors G6/1 and G7/2 last week and F6/1 and Barakhau this week; Alerts at Zia mosque Village and Saidpur Village. WHO/ NIH investigated alerts and confirmed cases of V. c. Ogawa, and CDA Health Directorate leading response with awareness messages in media and mosques. Cholera Task Force established to coordinate Health and Water inputs with CDA Health, CDA Water, Wa‐ter Testing Lab for CDA, NIH Public Health Division, WHO, UNICEF, UN‐Habitat, and PLAN‐Pakistan. City Hospitals responding: PIMS 139 cases and Polyclinic 41 cases admitted. WHO conducted initial hygiene promotion sessions and WHO and UNICEF supplied 100,000 aqua‐tabs, 20,000 soap, 20,000 PUR‐Sachets. 25 volunteers from PLAN‐ Pakistan and 40 LHWs in ICT trained to pro‐vide follow up visits and health and hygiene education. UN‐Habitat and UNICEF developed messages for mosques, churches and general public used in campaigns and given to CDA for printing. EDO‐H in ICT seeking partners for organizing safe water for Barakhau. WHO/ NIH investigation in process for Saidpur Village and Zia mosque Village cases while initial health and hygiene sessions and water treat‐ment at household level have been initiated.

Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 26/2011) Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 30 June 2011, compiled from weekly reports

Diseases Total

Skin Diseases 3,621,695 (11%) Acute Respiratory Infection 8,153,891 (24%) Acute Diarrhoea 3,186,946 (9%) Bloody Diarrhoea 294,547 (1%) Suspected Malaria 2,006,821 (6%) Unexplained Fever 1,331,458 (4%) Total Consultations 34,339,935

949

1073

1143

1111

1130

1158

1167

1113

1067

999

879

854

967 1289

1215

1463

1797

1680

2022

2021

2262

2349

2255

2199

2251

2322

2450

2466

2404

2547

2785

2745

2909

2935

2982

3120

3021

3022

3058

3196

3250

3215

3259

3354

3375

3519

361 375 411

331

400

215

192

153

128

105

81

58 46

26

2611

812

8 1111 11

11

88 88 8 86

6 6 13 8 6 6 7 7 7

87 7 36 55

0

500

1000

1500

2000

2500

3000

3500

4000

Wk 33

Wk 34

Wk 35

Wk 36

Wk 37

Wk 38

Wk 39

Wk 40

Wk 41

Wk 42

Wk 43

Wk 44

Wk 45

Wk 46

Wk 47

Wk 48

Wk 49

Wk 50

Wk 51

Wk 52

Wk 1‐11

Wk 2

Wk 3

Wk 4

Wk 5

Wk 6

Wk 7

Wk 8

Wk 9

Wk 10

Wk 11

Wk 12

Wk 13

Wk 14

Wk 15

Wk 16

Wk 17

Wk 18

Wk 19

Wk 20

Wk 21

Wk 22

Wk 23

Wk 24

Wk 25

Wk 26

Mobile Fixed



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

20‐Jun AJS AJK Muzaffarabad Village Hattiyan Dupatta

0 2 0 0 Cluster of 6 cases with AJS from one location, samples taken and sent to AIMS hospital. 1/2 found positive for Hepatitis E. Active surveillance done and no other cases found.

22‐Jun AJS AJK Neelum Village Khawaja Sai, Sharda

0 1 0 0 Cluster of 5 cases with AJS reported from RHC Sharda, samples collected and sent to DHQ Neelum, DHO concerned informed.

23‐Jun Malaria Balochistan Jaffarabad BHU Monder Kot, Tehsil Gandakha

15 55 12 34 Alert of suspected malaria comprising of 116 cases was reported. The DHO was informed and requested for distribution of bed nets to the said location. 45 samples were checked through RDTs and 23 verified positive (P.F, 5/ P.V, 5/ mixed, 13), SPR= 51.1%, while Falciparum Rate= 78.2%.

23‐Jun AWD ICT Islamabad FGSH (G 6/1, G 7/2) 0 2 0 2

AWD alert in Islamabad with one death, 4/7 stool sample found positive for V. Cholera, active surveillance for other cases, water samples collected, Aqua tabs and hygiene kits were distributed, Health education session given to the families and in the community. CDA Directorate Health arranged isolation ward for suspected cholera patients, Director of Water Management for CDA to address the situation, Radio Pakistan to air health and hygiene awareness messages, Director of AuQaf called to Khatibs (imam of mosques) to add information about prevention and treatment of diarrhea in Friday sermon. CDA Health directorate requested UNICEF support in chlorination.

23‐Jun AWD Khyber Pakhtunk‐hwa

Abbottabad RHC Havellian, Abbottabad

0 1 0 0

AWD Alert reported from RHC Havellian, Abbottabad, the patient belongs to village Kallig. UC Kholian Bala, Haripur. On further investigation and active surveillance, it was found that there was also a Acute diarrhoea death and almost 70% of population is suffering from acute diarrhoea. Detailed environmental assessment of the area carried out to identify the source of contamina‐tion. 6 /6 water samples found contaminated. Aqua tabs and ORS distributed among the affected population along with health and hygiene education. Stool sample was taken and sent to NH. EDO health was informed. Comprehensive health and hygiene campaign launched in the area. Tempo‐rary dispensary established for the affected population. Alternate source of clean water supplied to the community through TMA tankers along with cleaning of the source and decontamination of storage tanks.


Battagram Huthal Deeshan, kot gala, UC Peshoora

0 1 0 0

A suspected case was reported from DHQH. On investigation and active surveillance in area no more cases were found. Sample was taken and found positive for V.c. Ogawa. EDOH, MS DHQ were informed about the case. Health and hygiene education provided to the household. Area was visited with sanitary inspectors of DoH and Water source was identified and water sample was taken for contamination. Health and hygiene sessions conducted with the community and some aqua tabs were distributed. Detailed environmental assessment is underway in area.


Battagram Vill. Khawargai, UC Battagram

1 0 0 1

One suspected case was reported from DHQH. On investigation an adult female patient was found with severe dehydration. History revealed that two of her children had severe diarrhea few days back and they received treatment, but after few days She along with her 3yo son developed se‐vere diarrhea. Both admitted in DHQH and receiving treatment with I/V fluids. Sample was taken and found positive for V.c. Ogawa. During active surveillance no more cases were found. EDOH, MS DHQ were informed about the case. Health and hygiene education provided to the household. Area was visited with sanitary inspectors of DoH and Water source was identified and water sample was taken for contamination testing.


Haripur Khalabut Sector 3 0 1 0 0 One case of AWD reported On investigation and active surveillance in area no more case was found. Sample was taken and found positive for V.c. Ogawa. EDOH, was informed about the case. Health & hygiene education provided to the household and to the community.


Mansehra Village Shah Khel Garhi

0 1 0 0

An AWD case was reported from DHQH. On investigation and active surveillance in area no more case was found. Sample was taken and found positive for V.c. Ogawa. EDOH, MS DHQ and Coordi‐nator Public Health were informed about the case. Health & hygiene education provided to the household and to the community. Water source was identified which was hand pumps and springs. Epidemiological & Environmental investigations are underway.

20‐Jun AWD Punjab Multan

Chowk Sheh Abbas Near Al Mustufa Plaza, Khaji Wala House

1 1 0 0

Two brothers suffering from AWD reported from Nishter Hospital. Surveillance Officer visited the cases in the ward and assessed the situation over there. 1/2 Stool Samples taken found positive for V.c. Ogawa. Field investigations were carried out by SO, EHE and DoH team. No more cases was found through active Surveillance. Water Samples were taken and HE sessions were con‐ducted in the community and affected family. Aqua tabs, Jerry cans and Life straw were distrib‐uted

18‐Jun AWD Punjab Muzaffargarh Chor wala Mouza‐UC Baseera

1 0 1 0

Two AWD alerts from two different locations, Two samples collected and found positive for V.c. Ogawa. On active surveillance no more cases found. Health education to family members in households visited. Distribution of soap, Aqua Tabs, jerry cans, water filters & IEC among them. Nearest RHC Baseera was visited & SMO was given briefing on the situation, control measures & importance of awareness among general masses about safe drinking water, food & personal hygiene & it was also suggested to requested LHWs, CDC supervisor & School Health & Nutrition Supervisor to impart above said information among community while conducting their HE sessions in the catchment area. EM & EH assessment was also done at RHC.

20‐Jun AWD Sindh Karachi M.Ali Society, Gul‐shan‐e‐iqbal

0 0 1 0 Reinforced case management, active surveillance done, Aqua tabs Provided, Health education, Health Staff Trained for Rapid Response, EDO‐H informed & 1 stool Sample collected and found positive for V.c. Ogawa.

22‐Jun AWD Sindh Larkana Village Abbas Kal‐horo, tehsil Bakrani

0 0 1 0 Suspected AWD case reported, date of onset was 21‐06‐2011, field investigation completed, health & hygiene session conducted, IEC material, Aqua tabs and hygiene kits were distributed, 1 stool sample collected and found positive for Cholera, 3 water samples also collected.

17‐Jun AWD Sindh Matiari Village Lakho Ra‐hoo,UC Khando,Taluka Hala

2 1 2 0 Reinforced case management, active surveillance, ORS & Zinc Tabs Provided, Health education, EDO‐H informed & 1 stool sample collected and found positive for V.c. Ogawa, two water samples also collected.

18‐Jun AWD Sindh Tando Allah Yar

Nagori Plot,Khalil masjid

1 3 0 0 Reinforced case management, active surveillance done, ORS & Zinc Tabs Provided, Health educa‐tion, EDO‐H informed & 1 stool sample collected and found positive for V.c. Ogawa, two water samples also collected

17‐Jun AWD Sindh Thatta

Village Bachal Khaskheli,UC Googani,Taluka Shah Bunder

0 1 0 1 Reinforced case management, active surveillance, ORS, Aqua tabs & Zinc Tabs Provided, Health education, EDO‐H informed. One stool sample collected and found positive for V.c. Ogawa, two water samples also collected.



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

28‐Jun AWD ICT Islamabad FGSH (Bara Kahu) 0 2 0 1

Three AWD cases reported from Bara Kahu, Islamabad, 2/3 stool samples found positive for V.c. Ogawa. Water samples also collected, aqua tab, hygiene kits distributed, HE session done for the families and nearby community. Social mobiliza‐tion through LHWs on safe drinking water and sanitation. LHWs will be involved to distribute Aqua tab and HE messages. No more cases found during field surveillance.

24‐Jun AWD KPK Haripur Village Chach Mera, UC Kholian Bala

0 3 0 0 Three AWD patients reported from RHC Havellian, Haripur. All the three patients belongs to one family. They had a recent travel history to Village Kallig for a funeral. One stool sample was taken and sent to NIH and found positive for V.c. Ogawa. On active case finding, no other cases found. LHWs of the area were also involved in the active surveillance.

25‐Jun AWD KPK Haripur Afghan Refugee Camp, Khalabut Township, UC Khalabut

0 1 0 0

An AWD cases reported from a private hospital. The patient belongs to Afghan Refugee camp, Khalabut township. The patient was brought in a state of shock. Stool sample was taken and sent to NIH, and found positive for V.c. Ogawa. Environmental assessment of the area and surrounding was carried out. Joint team with Save the children has been established for comprehensive treatment and control response as these refugee camps are handled by Save the children.

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 Leishmani‐

asis KPK Shangla Kuzbat Kot 1 7 2 12

A possible outbreak of Leishmaniasis was reported from CD SHANG on 28th June , a response team in coordination 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 . EDOH , WHO country Office & WHO hub office were informed and request for analysis and residual spray was made . A 3 day medical camp was established (30th June , 1st and 2nd July) in the village.


asis 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.

25‐Jun AWD Punjab Multan Kho Dor‐Hatta Janazagha Qadir Pur Rawan

0 0 0 1

One AWD case was reported from RHC Qadir Pur. Stool sample taken and found positive for V.c. Ogawa. Field investigation was carried out by SO, EHE and DoH team. No more cases was found during active surveillance. Water Samples were taken and HE sessions were conducted in the community and affected family. Aqua tabs, Jerry cans and Life straw filters were distributed

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.

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 Material Provided, Health education, EDO‐H informed. 1 stool sample was collected and found positive for V.c. Ogawa. Two water samples also collected.

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

0 1 0 0 One AWD case reported. Reinforced case management, active surveillance, Aqua tab distributed, Health education Pro‐vided, Health staff briefed about AWD rapid response, THO informed. one stool sample collected and found positive for V.c. Ogawa.

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

0 1 0 2 Three AWD cases reported, case responded at community, health and hygiene session conducted. 1/3 stool sample collected, and found positive for V.c. Ogawa.

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.

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 educa‐tion, essential medicine (Erythromycin and Priton syp) Provided, 2 throat swab sample collected and sent to NIH for testing.

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

29‐Jun AD Bhakkar Mullan Wali City,Tehsil Bhakkar 2 5 0 6

29‐Jun Measles Bhakkar Mohallah Eid Gah, Behal, UC Behal, Tehsil Bhakkar

0 0 0 1

28‐Jun Measles D. G. Khan X Block Model Town, UC 6 0 0 0 1

27‐Jun NNT D. G. Khan Basti Khoo Tootewala Pir Adil 1 0 0 0

30‐Jun Pertussis D. G. Khan near MCH centre, street Dr Sher, Taunsa city

0 1 0 0

30‐Jun Pertussis D. G. Khan Nizam abad urban UC Taunsa city 1 0 0 0

24‐Jun Leishma‐niasis

Khushab UC Padrar 0 0 0 2

27‐Jun BD Layyah Basti Kutai WalaKaroor 1 1 0 1

28‐Jun BD Layyah Peer Jagi More, THQ Kot sultan 1 1 1 0

24‐Jun Meningi‐

tis Layyah Mohalla Eidgah Urban 0 1 0 0

25‐Jun Meningi‐

tis Layyah Ward Number 6 Karoor city 0 1 0 0

28‐Jun AWD Mianwali Takht Rachora village,UC Tabiser,Tahsil Issa Khel

0 4 0 4

24‐Jun Leishma‐niasis

Mianwali Tolla Mangalli,UC Chapri,Tahsil Issa Kheel 1 2 0 5

25‐Jun AWD Multan Kho Dor‐Hatta Janazagha Qadir Pur Rawan

0 0 0 1

30‐Jun AWD Multan Madina Town near adda Qadir Pur Rawan

0 0 0 1

28‐Jun AWD Muzaffargarh Basti Chak Wala, UC Baseera 0 0 0 3

30‐Jun AWD Muzaffargarh Basti Beri Wala, UC Baseera 0 0 1 1

24‐Jun Measles Muzaffargarh UC Karamdad Qureshi, DHQ Hospital 1 0 1 0

28‐Jun AWD Rahim Yar Khan

Chak 72, Byepass, Street # 6, Mohallah Kumharah

0 0 0 1

30‐Jun ARI Sargodha BHU 121 NB Tehsil Sillanwali 9 15 9 7

30‐Jun Measles Sargodha Abdullah Hayat Colony St. No. 1 Sar‐godha UC 143

0 0 0 1

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

30‐Jun Measles Bolan BHU Ab‐e‐gum 3 0 0 0

29‐Jun Measles Chagai Killi gorgage girdi jungle Refugee camp 0 1 0 0

29‐Jun Pertussis Chagai Kili Haji majeed khan Dawood abad‐UC sadder Dalbandin

0 1 0 1

28‐Jun Pertussis Gwadar BHU Sorbandar 0 0 1 0

30‐Jun AJS Jhal Magsi DHQ Hospital Gandawah 1 0 0 0

24‐Jun Scabies Jhal Magsi BHU Hathyari 12 7 9 4

24‐Jun Scabies Jhal Magsi RHC Jhal Magsi 24 41 27 22

29‐Jun Pertussis Kalat Goam UC Kalat sadar, tehsil Kalat 1 1 1 1

25‐Jun Chicken Pox Kech RHC Nasirabad, Village Sehrabad 0 2 1 1

29‐Jun Measles Kech Syed Akram Muhalla, UC Absar 0 0 1 1

25‐Jun AWD Khuzdar Killi Ahmed Jan‐UC Gresha 0 2 0 0

25‐Jun Measles Khuzdar Abbi Noghe UC Tootak tehsil Khuzdar 1 0 1 0

24‐Jun Pertussis Khuzdar Koshk UC Gazgi tehsil Khuzdar 1 0 1 0

30‐Jun Measles Lasbela Near Police station HUB 1 0 0 0

30‐Jun Measles Nasirabad Ghot Haji Imdad Khoso 1 2 0 0

26‐Jun Mumps Panjgur Washbood Mir Berkatullah mohalla UC Washbood

1 0 0 0

29‐Jun AD Ziarat BHU Gogai 0 0 0 0

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

28‐Jun Measles Bagh Chirooti Happy Land School‐Pak Gali 0 2 0 3

29‐Jun AWD Hattian Village Andrasari, P.O Salmia, Tehsil Chikkar

0 1 0 0

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

29‐Jun Measles Bajaur Agency

Village Jar Tehsil Khar 1 0 1 1

27‐Jun Measles Gilgit Astore Colony Nagaral Gilgit 1 0 0 0

27‐Jun Measles Gilgit Village Sakwar Gilgit 0 0 1 0

29‐Jun Measles Gilgit Mohallah Shakpura village Jalalabad Gilgit

0 0 1 0

29‐Jun Measles Gilgit Village Danyore Gilgit 0 0 1 0

29‐Jun Measles Gilgit Village Nomal Gilgit 1 0 0 0

28‐Jun AWD Islamabad FGSH (Bara Kahu) 0 2 0 1



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

24‐Jun AWD Abbottabad Kiala, UC Gariphulgran, Havallian 0 0 1 0

26‐Jun Measles Abbottabad Lower Malikpura 0 0 1 0

28‐Jun Measles Abbottabad Kalumera, UC Jhangra, Tehsil Havallian 1 0 0 0

30‐Jun AWD Buner Vill Doga, UC Amnawar Tehsil Gagra 0 0 0 1

30‐Jun AWD Buner Vill Mani pur, dewana baba, tehsil Gagra 1 0 0 0

25‐Jun Measles Buner Vill Warae Kilay, UC Norezai Gagra 0 0 2 0

29‐Jun Measles Buner Vill Afsar abad, Saidu Sharif 1 0 0 0

30‐Jun Measles Buner Village jangai near Koriya tehsil Mandan 0 1 0 0

27‐Jun Measles Charsadda Village Bagh, UC Jamal Abad 1 0 0 0


asis Hangu Thall AR Camp 1 0 0 1

26‐Jun Measles Hangu Naryab 0 0 1 0

24‐Jun AWD Haripur Village Chach Mera, UC Kholian Bala 0 3 0 0

25‐Jun AWD Haripur Afghan Refugee Camp, Khalabut Town‐ship, UC Khalabut

0 1 0 0

28‐Jun AWD Haripur Village Dairee Sundarpur, UC Sikandar‐pur

0 0 1 0

25‐Jun Measles Haripur Muhallah Dari, Sectoc 3 Khalabut Town‐ship, UC Khalabut

2 0 0 0

25‐Jun Measles Haripur Muhallah Anora, Sectoc 3 Khalabut Township, UC Khalabut

0 1 0 0

29‐Jun Measles Haripur Village Khalo, UC Ghazi, Tehsil Ghazi 0 1 1 0

29‐Jun Measles Haripur Ghazi city, near Janazagah, UC Ghazi, Tehsil Ghazi

0 0 1 1

29‐Jun Measles Haripur Muhallah feroz, UC Tarbella, Haripur 0 0 0 1

27‐Jun AD kohat UC Bazid khel 2 4 5 7

28‐Jun AD Kohat UC Khadder Khel 1 3 8 5

28‐Jun BD Kohat UC Ziarat Sheikh Allah Dad 1 0 4 3

25‐Jun AWD Mansehra Shaikh Abad Camp 0 0 0 1

28‐Jun Measles Shangla Village amlok Banai,Tehsil Alpurai 1 0 0 0

27‐Jun AWD Swabi DHQ Mardan(Pardah Kalei, Kalu Khan) 0 1 0 0

30‐Jun AWD Swabi BMC Swabi, Shah Mansoor 0 0 0 1

28‐Jun Measles Swabi BHU Zaida, Near Bilal Mosque 1 0 1 1

30‐Jun Pertussis Swabi CH Topi 1 0 0 0

24‐Jun Measles Swat Village Balogram, Tehsil Khwazakhela 0 0 1 0

24‐Jun Measles Swat Village Spal Bandai, Marghuzar, tehsil Babuzai

0 0 1 0

25‐Jun Measles Swat Village Kaduna, Marghuzar, tehsil Babuzai

1 0 0 0

27‐Jun Measles Swat Village Pararai 1 0 1 0

28‐Jun Measles Swat Village Jrandu Dherai, Tehsil Kanju 0 1 1 0

27‐Jun Measles Tank Pathan Kot 2 0 0 0

29‐Jun Measles Tank Ranwal and Abbakhel 2 0 0 0

30‐Jun AWD Mansehra Sadiqabad, Chitti Dheri 0 1 0 0

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

28‐Jun AWD Nowshera Mohallah Zarin Abad Kheweshgi 1 0 0 0

30‐Jun AWD Nowshera Union Council Behram Kalay 0 1 0 2


asis Shangla Vill Kuzkele, UC Sarkool 1 3 1 1


asis Shangla Kuzbat Kot 1 7 2 12

24‐Jun Measles Shangla Kuz said Abad Kele, UC Chakesar 0 0 1 0

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

27‐Jun AWD Badin THQ Hospital Tando bago,Taluka tando bago

0 0 0 0

29‐Jun AWD Badin Village sahib dino khaskheli,UC saeed pur,Taluka Talhar

0 1 0 0

24‐Jun AWD Dadu Village Arab panhwar,UC Pipri 0 1 0 1

24‐Jun AWD Dadu Village Talbani Panhwar,Near BHU Phakka,UC Yaar Muhammad Kalhoro

1 1 1 0

24‐Jun DHF Ghotki Village Waloo Mahar UC Mithri 0 0 0 2

30‐Jun DHF Ghotki Village Gulan laghari UC Bandh 1 0 0 0

24‐Jun Measles Ghotki Village Sharbat Khan Tart UC Ranwatti 2 0 5 1

30‐Jun NNT Ghotki UC Qadirpur, Village Raeed Mohammad Lakhan

1 0 0 0

27‐Jun Pertussis Ghotki Village Mehar Chachar, near Katcho Bindi 4 3 3 0

27‐Jun AWD Jacobabad Mugheri Shop, Chana Mohalla 0 0 1 0

24‐Jun AWD Jamshoro Brufat Mohalla, UC Nagoline, Taluka Kotri 0 1 0 0

29‐Jun AWD Jamshoro UC Thano arab khan,Taluka Thano bula khan

0 1 0 0

24‐Jun AWD Karachi Hussaini Gali,Sindhi Mohalla,BaBa Is‐land,UC 4 Kemari Town

0 1 0 0

29‐Jun Diphthe‐

ria Karachi KTH (Mohallah Mauripur, Karachi Gharbi) 0 0 0 1

29‐Jun Measles Karachi Near Muhammadi Masjid,Machar col‐ony,UC‐5

1 0 0 0

25‐Jun Measles Kashmore Village Jeend Mazari 0 0 0 2

28‐Jun Tetanus Kashmore Village Gahno Khan Khoso, near Tang‐wani

0 1 0 0

27‐Jun AWD Khairpur UC Deparja, tehsil Thari Mirwah 0 1 0 2

27‐Jun Measles Khairpur Bugti Nomadic community 1 0 0 0

30‐Jun Tetanus Khairpur Tehsil Kingri 0 0 1 0

28‐Jun Tetanus Larkana Village Kandero Mugheri 0 1 0 0

30‐Jun AWD Naushahro Feroze

UC Molhan, Tehsil Bhiria, Village Misri Solangi

1 0 3 0

27‐Jun Pertussis Naushahro Feroze

Village Wadero Abdul Kareem Bhurt, near Bhority, Tehsil Kandiyaro

1 0 0 0

27‐Jun AWD Qambar Shahdadkot

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

0 0 0 1

24‐Jun AWD S. Benazirabad Village Laal Muhammad Maher,UC Mirza bagh,Taluka kazi ahmed

0 0 0 1

27‐Jun Chicken Pox

Shikarpur Village Thanhrio 0 0 0 1

27‐Jun Pertussis Shikarpur Village Haji Sadoro Jafri, Zarkhail Road, near Choi Shakh

5 0 1 0

27‐Jun Measles Sukkur New Pind, Gopang Mohalla, near Polic Station Tanki

1 0 0 0

30‐Jun Pertussis Sukkur Royal Road, Old Sukkur 1 0 0 0

27‐Jun AWD Tando Allah Yar

Akram colony city 0 0 0 3


Nagori plot, Tando Allah Yar city 0 1 0 0


Near khalil masjid,UC 3 0 1 0 1


Village sabir qaim khani,UC shaikh musa khan

1 0 2 0


UC.1, Sanjar chang,Taluka Chamber 0 2 0 0

28‐Jun Measles Tando Allah Yar

Village Sono khan mari,taluka jhando mari

1 0 0 0

28‐Jun Pertussis Tando Allah Yar

Village Kamal Khan aglam 3 6 3 8

24‐Jun AWD Tharparkar Village Godhiar,UC Mithrio bhatti,Mithi 3 3 2 5



Province Khyber Pakhtunkhwa:

• This week 20 districts reported to DEWS from 756 health facilities with a total of 179,429 patients consultations.

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

• 42 alerts were reported in this week, 22 were for Measles, 13

for AWD, 3 for Leishmaniasis, 2 for Acute diarrhoea, while 1 each for Bloody diarrhoea and Pertussis.

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

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

916 health facilities reported a total of 275,890 patient con-sultations during this reporting period

• AD cases reported were 20,983, and stabilize at 8% from last 4 weeks.

• 21 alerts were reported in this week from Punjab; 6 were for AWD, 4 for Measles, 2 each for Bloody diarrhoea, Leishmaniasis, Meningitis and Pertussis, while 1 each for acute diarrhoea, ARI and Neonatal Tetanus.

• Increased number of confirmed malaria cases from 9 dis-tricts. 135 from Muzaffargarh, 48 from DG Khan, 32 were from Bhakkar, 28 from Rajanpur, 17 from Khushab, 11 each were from Layyah and Mianwali, 10 were from Sar-godha, while 4 from 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 85 269 97 41 10 519 192

Bloody Diarrhoea 10 1 38 8 3 ‐ 51 9 Measles 50 7 1009 65 45 ‐ 1104 72 Pertussis 2 ‐ 136 13 12 1 150 14

Malaria 12 7 38 26 ‐ ‐ 50 33 Leishmaniasis 1 ‐ 49 14 5 2 55 16 Others 156 43 313 36 15 ‐ 484 79 Total 451 145 1951 271 127 13 2529 429

Current Week

Acute Jaundice Syndrome 5 2 27 12 1 ‐ 33 14

NNT + Tetanus 6 ‐ 72 ‐ 5 ‐ 83 ‐

Province Sindh:

• This week 23 districts reported to DEWS from 1,210 health centers with a total of 497,137 patient consul-tations during the reporting period of week 26, 2011.

• In Sindh, AD cases reported were 44,962 (9%), 1% lower proportional morbidity as compared with last week.

• 37 alerts were reported from Sindh in this week: 18 were for AWD, 6 for Measles, 5 for Pertussis, 3 for Tetanus, 2 for DHF, while 1 each for Chicken pox, Diphtheria and Neonatal Tetanus.

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

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Epidemiological Bulletin: DEWS, Pakistan, Week no. 26 (24 - 30 June, 2011) Province Balochistan:

• In this week, 18 districts reported to DEWS from Balochis-tan province. 448 fixed and 5 mobile medical outreach cen-ters reported a total of 65,518 patient consultations.

• AD reported in 8,891 (14%) of the total consultations, 1% higher proportional morbidity as compared with last week.

• 17 alerts were reported in this week from Balochistan, 6 were for Measles, 4 for Pertussis, 2 for Scabies, while 1 each for Acute diarrhoea, AJS, AWD, Chicken Pox and Mumps.

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


State of Azad Jammu and Kashmir:

• In this week, weekly report received from 86 health centers in 10 districts, with a total of 28,342 patient consultations.

• ARI cases reported were 3,623 (13%), while Acute diarrhoea reported 1,953 (7%) cases.

• Three alerts reported and responded in this week; 2 were for AWD and One for Measles.

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

Islamabad Capital Territory: Figure-10: Trend of priority communicable diseases, Islamabad (1 January to 30 June 2011)

• This week 4 health facilities are reporting through DEWS with a total of 4,014 patient consultations.

• ARI cases reported were 966 (24%), while Acute Diar-rhoea 819 (20%). Fluctuation in rates was due to diffi-culties in collecting reports as the system is being es-tablished.

• One alert for AWD (outbreak) received and re-sponded this week.

FATA:

• This week 49 health centers in 3 agencies reported from FATA, with a total of 11,149 patient consulta-tions.

• ARI cases reported were 1,665 (15%), while Acute diarrhoea reported 1,087 cases (10%)

• One alert for Measles was received and responded this week.

Gilgit Baltistan:

• In this week, 50 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 18,202 patient consultations.

• ARI cases reported were 2,320 (13%), while Acute Diarrhoea 2,157 (12%).

• Five Measles alerts were received and responded this week.

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 30 June 2011)

Figure-8: Trend of priority communicable diseases, FATA (4 February to 30 June 2011)

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Alerts and outbreaks, week 26, 2011

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