Weekly Epidemiological - · PDF filepected Malaria cases have also shown seasonal increase...

Weekly Epidemiological Bulletin

This weekly Epidemiological Bulletin is published jointly by the 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. 44 (28 October to 3 November, 2011)

• 81 districts and 2 agencies provided surveillance data to the DEWS this week from 2,645 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC.

• A total of 865,624 consultations were reported through DEWS of which 212,701 (25%) were acute respiratory infections (ARI); 77,027 (9%) were Skin disease; 64,535 (7%) were acute diarrhoea; and 68,921 (8%) were suspected Malaria.

• A total of 126 alerts with 15 outbreaks were reported in week‐44, 2011: Altogether 29 alerts were for Dengue Fever, 27 for AWD, 24 for Measles, 13 for Neonatal tetanus and Tetanus, 9 for Leishmaniasis, 8 for Pertussis, 4 for Bloody diarrhoea, 2 for Malaria, while 10 for other non‐communicable diseases.

• National Polio Eradication Initiative reported 9 new polio cases, 1 from Sindh, 4 each from Balochistan and FATA. As of 5th November, 2011, Pakistan has reported a total of 145 polio cases (143 type‐1 and 2 type‐3) from 44 districts/towns/tribal agen‐cies/areas. Please see map on page 6.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 44, Thursday 11 November, 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: Weekly trend of leading priority diseases in Pakistan, 29 July 2010 to 27 October 2011 (Epi week 31, 2010 to week 44, 2011)

Disease Wk-37 Wk-38 Wk-39 Wk-40 Wk-41 Wk-42 Wk-43 Wk-44

Acute diarrhoea 109,523 (12%) 110,835 (11%) 105,295 (11%) 97,007 (10%) 93,085 (9%) 74,150 (8%) 62,465 (8%) 64,535 (7%)

Total consultation 931,318 1,005,251 995,450 1,014,266 1,033,276 897,025 807,137 865,624

Suspected malaria 64,766 (7%) 78,109 (8%) 83,684 (8%) 82,802 (8%) 86,326 (8%) 68,426 (8%) 58,543 (7%) 68,921 (8%)

Acute respiratory infection 175,906 (19%) 193,771 (19%) 205,597 (21%) 209,436 (21%) 223,902 (22%) 213,142 (24%) 193,267 (24%) 212,701 (25%)

Bloody diarrhoea 7,920 (0.85%) 8,676 (0.86%) 9,393 (0.94%) 8,075 (0.80%) 8,107 (0.78%) 6,082 (0.68%) 5,441 (.67%) 5,202 (0.60%)

Skin diseases 107,435 (12%) 107,243 (11%) 105,912 (11%) 95,842 (9%) 94,167 (9%) 81,134 (9%) 69,304 (9%) 77,027 (9%)

Since July 29, 2010, approximately 51,215,386 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on around 1,000,000 consultations per week, there is a drop in timely reporting due to challenges in accessibility caused by floods, security and infrastructure. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 8 weeks (37 to 44, 2011) acute diarrhoea cases have been decreased (From 12% to 7%), while at the same time cases of ARI have been increased (From 19% to 25%). Sus‐pected Malaria cases have also shown seasonal increase from week 35 especially from districts in Sindh and Balochistan.

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AD BD ARI S. Malaria

Epidemiological Bulletin: DEWS, Pakistan, Week no. 44 (27 October to 3 November, 2011)

This weekly Epidemiological Bulletin is published jointly by the 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, 02

Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

2‐Nov BD AJK Muzaffara‐bad

Village Buttle, U.C Kahori, Tehsil Patika. 1 2 1 3 Alert for 7 cases of Bloody Diarrhea reported from BHU Patika. Stool sample collected for lab confirmation.

DHO Muzaffarabad informed. Active surveillance done and no other cases found, health education given.

6‐Nov Diphtheria ICT Islamabad Chunggi, Pind Paracha (PIMS Hosp) 0 1 0 0

Probable diphtheria case, 6 years old, not vaccinated except polio, hospitalized on 6 Nov, tracheotomy, ADS 80,000 IU, expired on 7 Nov 11 pm, respiratory distress, 2 siblings and 7 cousins in household also un‐vaccinated, started on prophylactic erythromycin, vaccination scheduled.

6‐Nov Diphtheria ICT Islamabad G‐Sokh, Bharakaho 1 0 0 0 Probable diphtheria case, 20 months old female, not vaccinated except polio drops, hospitalized on 6 Nov, ADS 80,000 IU, tracheostomy on 7 Nov, acute renal failure, myocarditis, expired 8 Nov, 6 siblings un‐vaccinated, family moved from Bajaour 6 years ago, erythromycin provided for all household members, field

28‐Oct AWD Sindh Badin Village Jeo Lund, Taluka Tando Bago 1 5 0 3 Alert for case of AWD hospitalized for dehydration, reinforced case management, active surveillance done

and located 8 other cases of AD in the field, health education provided to the affected families, Aqua tabs

2‐Nov AWD Sindh Badin Village Sohrab Khaskhali, UC Saeed Pur, Taluka Talhar 1 4 0 1

Alert for hospitalized case of AWD who was also having Malaria positive, 5 other AD cases on active surveil‐lance, health education imparted to families, Aqua tabs, Zinc tabs, Bed NETS and ORS distributed, MO, BHU and DHMT informed, 1 Stool and 2 water sample collected.

2‐Nov AWD Sindh Tharparkar Village Kharo Bajeer, UC Malanhore Veena, Taluka Mithi

1 0 1 5 Alert for 7 AWD cases hospitalized with dehydration, community water supply is the source of water, health education imparted regarding Boiling of water and hand washing with soap, Aqua tabs, Hygiene kits and ORS distributed, EDO‐H informed, 1 stool and 2 water sample taken.

31‐Oct AWD Sindh Thatta Village Adam Bhambharo, UC Sonda 2 1 3 2

Alert for AWD hospitalized with severe dehydration, (Keenjhar) canal was the source of water, health education imparted to neighbors, Community and Household members, Aqua tabs, Zinc tabs, ORS, Jerry cans and Filters distributed, EDO‐H informed and 2 water sample taken.

29‐Oct BD Sindh Tando Allah Yar

Village Aijaz Ali shah, Fazil stop, UC Began Jarwar 1 3 1 1 Alert for BD case admitted in hospital with dehydration. Active surveillance in field located 5 other cases,

health education imparted to affected families regarding proper hand washing and Health and Hygiene;

2‐Nov BD Sindh Umer Kot Village Nimro Khoso, UC Padhrio Farm, Taluka Samaro 2 3 0 1 Alert for 2 cases BD admitted in hospital, active surveillance done, health education imparted, Aqua tabs,

water filters, Hygiene kits, Jerry cans and ORS distributed, MS‐THQ, EDO‐H informed and 2 water sample

1‐Nov H1N1 KPK Haripur Haripur city 0 0 0 1

Alert for confirmed case H1N1 reported from Haripur city. Case initially suspected to be Dengue fever with platelets dropping from 280,000 to 156,000. She was referred to private hospital in Islamabad on 27‐10‐11 where her throat swab was positive for H1N1. EDO Health was informed. Joint team of WHO and DoH conducted active surveillance, no more cases were found. The affected family was educated on respiratory etiquette and preventive measure. LHW was educated on case definition and was instructed by DoH to monitor community and in specific the close contacts for suspected sign and symptoms. IEC material was also distributed.

29‐Oct AD Punjab Rajanpur Moza Miran Pur, UC Miran Pur, Tehsil Rojhan 53 19 28 19

Analysis of weekly data from BHU Miranpur for week 43 showed very unusual rise in Acute Diarrhea cases to 119, crossing the alert threshold of 45, most of these cases (81) were of children under 5 years of age. On review of the OPD data at the BHU, more than 65% (79) of the cases were from Moza Miranpur. Field investigation found 9 more cases of AD in 20 randomly selected households. Hand pumps are the sole source of drinking water for the community. HE Session was conducted for the community by SO DEWS and

3‐Nov Malaria Sindh Dadu Village Sim UC Tor, Taluka Johi 4 11 5 6

26 Cases of suspected Malaria investigated, total 14+v (54% SPR) confirmed by RDT in which 9PV+ve, 4PF+v, 1Mix+v, (36% FR); cases treated, health education imparted to the community, coordinated action planned by DOH, PPHI, MERLIN and CARE intl,

29‐Oct Malaria Sindh Larkana Village Kanga UC Kanga talka Larkana 4 13 2 6

Responding to alert for malaria, tested 25 fever cases with RDT. Results showed 18 positive (72%); 6 were P. falciparum or mixed infections (24%) and 12 were P. Vivax (48%). Cases treated with appropriate meds and vector control response coordinated.

3‐Nov Pertussis Sindh Matiari Village Sahar Mangwano, UC Shah Alam, Taluka Matiari 7 5 5 4 Alert for Pertussis; Active surveillance identified 21 probable cases, Health education imparted, EDO‐H

informed and 2 Throat sample collected.

3‐Nov Pertussis Sindh Matiari Village Suleman Mangwano, Taluka Matiari 8 9 7 13 During active surveillance found 34 cases of probable Pertussis, Health education imparted, EDO‐H in‐

formed and 1 Throat sample taken.

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

28‐Oct AWD Battagram Village Shingalo Bala, UC Gijjbori 0 1 0 0

29‐Oct Measles Swat Village Beha UC Janu, Tehsil Kha‐wazkhela 0 0 2 0

29‐Oct Measles Swat Village Gishar UC Shalpin, Tehsil Khawazkhela 0 0 0 2

30‐Oct DHF Mansehra Baffa Mansehra 0 0 0 1

30‐Oct DHF Mansehra Mohallah Panjmieral Shinkiari 0 1 0 0

30‐Oct AWD Torghar Village Nabar, Balkot 0 1 0 0

31‐Oct Measles Shangla village Peecha, UC Alooch 1 0 0 0

31‐Oct Measles Upper Dir Lower Dir (Village Bekarai) 1 0 0 0

1‐Nov H1N1 Haripur Haripur city 0 0 0 1

1‐Nov AD Kohat Village Suleman Talab, BHU Suleman Talab 0 0 0 1

1‐Nov Measles Lower Dir Malakand (Chakdara, L‐Dir) 1 0 0 0

1‐Nov Measles Malakand Batkhela 2 0 0 0

1‐Nov Measles Malakand zulamkot 1 0 2 0

1‐Nov Measles Shangla Villlage Mach Kandai 0 1 0 0

1‐Nov Measles Swat Village Shin Gath UC Shin, Tehsil Khawazkhela 0 0 1 1

2‐Nov Measles Charsadda Busakhel 1 0 0 0

2‐Nov Measles Charsadda Faqir Kallay 0 0 1 0

2‐Nov CCHF Swabi BMC Swabi, SWABI 0 2 0 0

2‐Nov DHF Swabi BMC Swabi, UTLA 0 1 0 0

3‐Nov DHF D. I. Khan Kulachi 0 1 0 0

3‐Nov DHF Haripur Haripur city 0 0 0 1

3‐Nov Measles Swat Village Mehak UC Devlai, Tehsil Kabal 1 0 0 0

3‐Nov Measles Swat Village Melaga Landi Shah, UC Kotlai, Tehsil Kabal 1 0 0 0

4‐Nov DHF Haripur Afghan Refugee camp 20 0 1 0 0

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

28‐Oct Measles Lasbela Hub city 6 0 0 0

29‐Oct Leishmaniasis Jhal Magsi Pachl UC Khari DHQ Hospital 1 0 0 0

31‐Oct Measles Khuzdar Mojahid Abad Koshk UC Gazgi Tehsil Khuzdar 1 0 0 0

31‐Oct Leishmaniasis Lasbela Hospital colony, zero point Uthal 0 3 0 0

31‐Oct Leishmaniasis Pishin killi piralizai, Tehsil Killa Abdullah 0 1 0 0

31‐Oct NNT Sibi DHQ Sibi 1 0 0 0

1‐Nov Typhoid Chagai killi Baz Mohammad‐UC Dalbandin town 0 1 1 2

2‐Nov Leishmaniasis Jhal Magsi Saidali Goth UC Panjuk DHQ Hospital 1 0 0 0

2‐Nov Measles Pishin killi machan (Haji bosan), u/c machan 0 0 1 0

2‐Nov Leishmaniasis Sibi Village Glusher Qadeem, UC Luni 0 1 0 0

3‐Nov Rabies Chagai Killi Kharasi Talab U/C Taftan 3 11 0 1

3‐Nov Measles Lasbela Punjabi mohalla UC Allahabad Tehsil HUB 4 0 1 0

3‐Nov Leishmaniasis Quetta Hazara Town, Quetta 1 3 0 1

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

29‐Oct DHF Bagh DHQ hosp bagh UC town 0 1 0 0

31‐Oct NNT Bajaur Agency Village Janat Shah Tehsil Khar 1 0 0 0

31‐Oct NNT Bajaur Agency village Sabar shah of tehsil Salarzai 1 0 0 0

31‐Oct Pertussis Diamir DHQ Hospital Chilas 1 0 0 0

2‐Nov Measles Astore BHU Parishing 1 0 1 0

2‐Nov BD Muzaffarabad Village Buttle, U.C Kahori 1 2 1 3

2‐Nov Pertussis Skardu Village sadpara, UC Shagari khurd 1 0 0 0

3‐Nov Pertussis Poonch 2 AK brigade Rawalakot Poonch 0 0 0 1

6‐Nov Diphtheria ICT Chunggi, Pind Paracha (PIMS Hosp) 0 1 0 0

6‐Nov Diphtheria ICT G‐Sokh, Bharakaho 1 0 0 0


This weekly Epidemiological Bulletin is published jointly by the 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, 03

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

28‐Oct AWD Badin Village Jeo Lund, Taluka Tando Bago 1 5 0 3

29‐Oct NNT Dadu Village Imam Buksh Khaskheli, Taluka Dadu 1 0 0 0

29‐Oct Malaria Larkana Village Kanga UC Kanga talka Larkana 4 13 2 6

29‐Oct BD T Allah Yar Village Aijaz Ali shah, Fazil stop 1 3 1 1

29‐Oct NNT Thatta Pathan Colony, UC Kala Kot, Taluka Thatta 1 0 0 0

29‐Oct AWD Thatta Village Muhammad Khan Khaskheli, UC Kalri 1 1 0 1

29‐Oct AWD Thatta Village Payaro Jakhro, UC Thatta 0 2 0 0

30‐Oct DHF Ghotki SZ Hospital RY Khan (Ghotki & Kashmoor) 0 2 0 0

31‐Oct AWD Dadu Sheikh Mohalla City Dadu 0 2 0 0

31‐Oct NNT Larkana Village Ezat ji wandh, taluka Ratodero 1 0 0 0

31‐Oct AWD TM Khan Peoples colony, UC‐2 1 0 0 0

31‐Oct AWD TM Khan Talpur Colony, UC‐1 1 1 1 0

31‐Oct AWD Thatta Village Adam Bhambharo, UC Sonda 2 1 3 2

31‐Oct AWD Thatta Village Khameeso Khaskheli, UC Ali Bahar 1 1 0 0

1‐Nov Measles Jamshoro Ghosia Colony, Nagoline Taluka Kotri 1 0 0 0

1‐Nov Measles Karachi Bhawani Chali, SITE Town 2 0 0 0

1‐Nov NNT Karachi Neonatal ICU, NICH 2 0 0 0

1‐Nov Measles N Feroze Memon Mohalla Halani 1 0 0 0

1‐Nov Measles S. Benazira‐bad Village Bakshal Baladi, Kazi Ahmed 1 0 0 0

1‐Nov NNT Sanghar IDP camp Tori Mori, Taluka Sanghar 0 0 0 0

1‐Nov AWD Thatta Village Syed Ali shah, UC Kalri 1 1 0 0

2‐Nov AWD Badin Village Sohrab Khaskhali, Taluka Talhar 1 4 0 1

2‐Nov AWD Hyderabad Gulshan‐e‐Fareed, Noorani Basti, 0 1 0 0

2‐Nov AWD Hyderabad Hussaini Chawk, Paretabad 0 0 0 1

2‐Nov Pertussis Jamshoro Khaskheli Mohalla, Taluka Kotri 1 0 1 0

2‐Nov DHF Karachi Street #4, Sector# 4A, Nazimabad 0 0 0 1

2‐Nov BD Benazirabad Mehran Colony, UC#. 2, Sakrand 0 1 0 4

2‐Nov AWD Sanghar Village Mehrab Shahi, UC Soomer Faqir 1 0 0 0

2‐Nov AWD Tharparkar Village Kharo Bajeer, UC Malanhore Veena, Taluka Mithi 1 0 1 5

2‐Nov AWD Thatta Village Karo Mistri, UC Makli 2 1 1 0 0

2‐Nov AWD Thatta Village Muhammad Urs Ghandro 0 1 0 0

2‐Nov AWD Umer Kot Khalid Colony, Bhudo Khaskheli 0 1 0 1

2‐Nov AWD Umer Kot Village Kunri Memon, Shedi Paro 1 1 1 0

2‐Nov AWD Umer Kot Village Morejhango Mahhal Paro, 0 0 0 1

2‐Nov BD Umer Kot Village Nimro Khoso, UC Padhrio Farm 2 3 0 1

3‐Nov Malaria Dadu Village Sim UC Tor, Taluka Johi 4 11 5 6

3‐Nov Leishmani‐asis Jacobabad UC Dastgeer Colony 2 1 2 0

3‐Nov NNT Khairpur THQ Kot Diji 1 0 0 0

3‐Nov NNT Khairpur Village Kotlo UC deh Sohu 0 0 1 0

3‐Nov AWD Matiari Village Sadiq Khoso, UC Khyber 1 0 1 0

3‐Nov Pertussis Matiari Village Sahar Mangwano, UC Shah Alam 7 5 5 4

3‐Nov Pertussis Matiari Village Suleman Mangwano 8 9 7 13

3‐Nov AWD Mirpur khas Village Zaman Shar, UC Ismail Kambar, 2 0 1 2

3‐Nov Measles Qambar Ghousal Mohalla Kambar city 1 0 0 0

3‐Nov Measles Qambar Village Hama, taluka Warrah 0 0 1 1

3‐Nov NNT Qambar Village Raes Jeeo Khan Janwari, UC dost Ali 1 0 0 0

3‐Nov AWD T Allah Yar Village Pir Kathi, Taluka Tando Allahyar 0 1 0 0

3‐Nov AWD Tharparkar Village Mondro, UC Nagarparkar 0 0 1 0

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

29‐Oct NNT Bhakkar Basti Qazi Abad‐Sheikh Rao Pul, UC Gadola 1 0 0 0

29‐Oct DHF Jhang Nishter Hospital Multan, Jhang 0 1 0 0

29‐Oct DHF Mianwali Jal Janubi, Piplan 0 1 0 0

29‐Oct DHF Muzaffargarh Nishter Hospital Multan, Muzaffargarh 0 5 0 0

29‐Oct DHF Pakpattan Nishter Hospital Multan, Pakpattan 0 9 0 2

29‐Oct AD Rajanpur Moza Miran Pur, UC Miran Pur 53 19 28 19

29‐Oct UXF Rajanpur Moza Wang, UC Wang, Tehsil Rajanpur 6 9 1 6

30‐Oct DHF D. G. Khan Nishter Hospital Multan, DG Khan 0 1 0 0

30‐Oct DHF Sahiwal Nishter Hospital Multan, Sahiwal 0 3 0 0

31‐Oct DHF Bahawalnagar Nishter Hospital Multan, Bahawalnagar 0 1 0 0

31‐Oct AWD Bhakkar Moza Khitchi Kalan‐UC Katchi Shahani 0 1 0 0

31‐Oct DHF Mianwali Swance 0 1 0 0

31‐Oct AWD Muzaffargarh Basti Hinjra, Nearby Mehmood Textile Mills, UC Taleri 0 1 2 2

31‐Oct DHF Rahim Yar Khan Basti Haji Guhlam Sarwar Mouza Kachha 0 3 0 0

31‐Oct Pertussis Rajanpur Basti Sheikhan, Moza Chak Karia 0 0 1 0

1‐Nov Tetanus Bhakkar Chak No 64 TDA, UC 60‐61 ML 0 1 0 0

1‐Nov DHF Bhakkar DHQ Hospital Bhakkar 0 1 0 0

1‐Nov DHF Muzaffargarh Basti Ghori Wali, UC Budh, Kotaddu 0 1 0 0

1‐Nov DHF Rahim Yar Khan Haji Muhammad Colony & Labor Colony 0 3 0 0

1‐Nov ARI Rajanpur Moza Kotla Dewan, UC Kotla Dewan 74 49 68 32

1‐Nov Scabies Rajanpur Moza Kotla Dewan, UC Kotla Dewan 45 27 16 22

1‐Nov DHF Vehari Nishter Hospital Multan, Vehari 0 3 0 1

2‐Nov DHF D. G. Khan Chah Naj wala UC Nawan shumali 0 1 0 0

2‐Nov Leishmani‐asis D. G. Khan DHQ Hospital DG Khan; Faridi Chowk

Qaziwala 0 1 0 1

2‐Nov DHF Kasur Nishter Hospital Multan, Kasoor 0 1 0 0

2‐Nov Leishmani‐asis Mianwali Jalal poor,kotchandna,issa kheel 1 3 1 5

2‐Nov DHF Rahim Yar Khan

Chak No 77/NP Kot Samaba, Taranda Saway Khan 0 1 0 1

2‐Nov Mumps Rahim Yar Khan Mohallah Laran, Kot Samaba 0 1 0 2

2‐Nov DHF Rahim Yar Khan Nishter Hospital Multan, Rahim Yar Khan 0 1 0 0

3‐Nov DHF Khanewal Nishter Hospital Multan, Khanewal 0 31 0 9

3‐Nov DHF Multan Nishter Hospital Multan, Multan 0 7 0 3

3‐Nov DHF Muzaffargarh Khoo Mian Afzal, UC Binda Ishaq, Jatoi 0 1 0 0

3‐Nov Pertussis Rajanpur Mohallah Kamagran, UC Rajanpur Gharbi, Tehsil Rajanpur 0 0 1 0


This weekly Epidemiological Bulletin is published jointly by the 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]. 04

Province Khyber Pakhtunkhwa: • This week 649 health facilities from 18 districts reported to

DEWS with a total of 140,356 patients consultations.

• The proportional morbidity of AD is showing gradual decline during the last 6 weeks after a consistent higher proportion (16%) from week 35, 2011.

• 24 alerts were reported in this week, 13 were for Measles; 6 for DHF; 2 for AWD; while 1 each for Acute diarrhoea, CCHF and H1N1.

• 1 outbreak for H1N1 was received and responded.

Figure-3: Trend of priority communicable diseases, province KPK

Province Sindh:

• This week 890 health centers from 22 districts reported to DEWS with a total of 379,741 patient consultations.

• In Sindh, AD cases reported were 31,405 (8%), same propor-tional morbidity as compared with last week.

• 48 alerts were reported from Sindh in this week: 23 were for AWD; 8 for Neonatal tetanus; 6 for Measles; 3 each for Bloody diarrhoea and Pertussis; 2 each for DHF and Malaria; while 1 for Leishmaniasis.

• 10 outbreaks 4 for AWD and 2 each for Bloody diarrhoea, Malaria and Pertussis were received and responded.

Figure-4: Trend of priority communicable diseases, province Sindh

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

Post Flood 2010 2011 (up till wk 43) Current Week (44) Total A O A O A O A O

Acute Watery Diarrhoea 209 85 1220 527 27 4 1456 616 Acute Jaundice Syndrome 5 2 42 14 ‐ ‐ 47 16 Bloody Diarrhoea 10 1 86 16 4 3 100 20 Dengue Fever 81 32 733 111 29 ‐ 843 143 Measles 48 6 1460 88 24 ‐ 1532 94 Pertussis 1 ‐ 235 59 8 2 244 61 NNT + Tetanus 5 ‐ 279 ‐ 13 ‐ 297 0 Malaria 12 7 99 65 2 2 113 74 Leishmaniasis 1 ‐ 195 27 9 ‐ 205 27 Others 75 11 497 56 10 2 582 69 Total 447 144 4846 963 126 13 5419 1120

Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 3 November 2011, compiled from weekly reports

Diseases Number of Consultations

Acute Respiratory Infection 11,429,695 (22%)

Skin Diseases 5,490,946 (11%) Acute Diarrhoea 4,868,620 (10%) Bloody Diarrhoea 431,245 (1%) Suspected Malaria 3,165,876 (6%) Unexplained Fever 1,965,702 (4%) Total Consultations 51,215,386

Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 44/2011)

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Epidemiological Bulletin: DEWS, Pakistan, Week no. 44 (27 October to 3 November, 2011) Province Punjab: • This week 483 health facilities from 8 districts reported data to

DEWS from Punjab province with a total of 218,951 patient consultations.

• AD cases reported were 11,577 and showing proportional morbidity lower by 1% as compared with last week .

• 33 alerts were reported in this week from Punjab; 20 were for DHF; 2 for Neonatal tetanus and tetanus; 2 each for AWD, Leishmaniasis and Pertussis; while 1 each for AD, ARI, Mumps, Scabies and Unexplained fever.

• 10 outbreaks 4 for AWD; 2 each for BD, Malaria and Pertussis were received and responded this week.

Figure-5: Trend of priority communicable diseases, province Punjab


State of Azad Jammu and Kashmir:

• In this week, reports were received from 122 health facilities from 10 districts with a total of 29,843 patient consultations.

• ARI cases reported were 5,531 (19%), while Acute diarrhoea reported 1,181 (4%) cases.

• 3 alerts one each for DHF, Bloody diarrhoea and Pertussis was re-ceived and responded this week.

• This week 42 health facilities in 2 agencies reported from FATA, with a total of 7,507 patient consultations.

• ARI cases reported were 2,007 (27%), while Acute diarrhoea was reported 580 cases (8%)

• Two alerts for Neonatal tetanus were received and responded this week.

Province Gilgit Baltistan:

• In this week, 78 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 21,048 pa-tient consultations.

• ARI cases reported were 5,249(25%), while Acute Diar-rhoea were 1,709 (8%).

• 3 alerts 2 for Pertussis and 1 for Measles was received and responded this week.

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan

FATA:

Province Balochistan:

• In this week, 16 districts reported to DEWS from Ba-lochistan province. 381 health centers reported a total of 68,178 patient consultations.

• AD reported in 6,479 (10%) of the total consultations, same proportional morbidity as compared with the last week.

• 13 alerts were reported in this week from Balochistan, 6 for Leishmaniasis; 4 for Measles; while 1 each for Neo-natal tetanus, Rabies and Typhoid.

• No outbreak for any disease was reported this week.

Figure-6: Trend of priority communicable diseases, province Balochistan

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Focus on: Situation in Sindh (week 44, 2011)

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: As of 5 November, 2011, the total number of polio cases con‐firmed by the laboratory is 145 (143=type‐1, and 2=type3) from 44 districts.

Province Cases 2010 Cases 2011 P1 P3 P1 P3

Punjab 6 1 2 - Sindh 26 1 29 - Khyber Pakhtunkhwa 19 5 12 - FATA 63 11 40 2 Balochistan 6 6 59 - AJK - - - - Gilgit‐Baltistan - - 1 - Islamabad - - - - Total 120 24 143 2

• There were no heavy rains were forecasted by Met Department this week and no heavy rains were observed except small showers at scattered places.

• Some BHUs and GDs are still under water in districts Badin, Mirpurkhas, Umarkot, Sanghar and Tando Allahyar. But all the DHQs are functioning including DHQ Sanghar which was heavily submerged in rain water. While 9 DTCs are working properly and reporting on daily basis, the number of diarrhea cases in each plan (A, B and C) is decreasing day by day.

• This week a total of 48 alerts and outbreaks were reported from 19 districts of Sindh, while 4 districts did not report any alert. Thatta is the district which reported a large number of alerts (8), while Jacobabad, Mirpurkhas and Naushehro Feroz reported 1 alert for each. AWD alerts were on the top and contributing 50% (24) of alerts, followed by NNT 9 cases, Measles 6, Pertussis and BD 3 for each, Ma‐laria 2 alerts. One case of Leishmaniasis was reported from Jacobabad. The number of VPD alerts (Measles and Pertussis) is increasing in every week, as season changes and in view of low routine immunization in Sindh. While 61 confirmed dengue cases with 2 deaths were also reported.

• Sindh malaria control program has collected a total of 29,563 slides plus RDTs out of which 2808 were found positive for malaria. Plas‐modium Vivax was on the top with 1491 positive number of cases, followed by falciparum 787 cases and mixed 530 cases (FR = 47%). No death due to malaria was reported from any corner of Sindh. Highest FR was found in district Thatta 63%, followed by Badin 43% and Jacobabad 41%.

Pakistan Dengue Situation, 5th November 2011 Since the beginning of the year and as of 5th November 2011 ; 519,466 cases of suspected dengue fever cases and 22,343 Lab confirmed cases were reported from Provincial Dengue Focal Points from across the country with 337 deaths (CFR = 1.51%).

Over 90% of cases were reported in Punjab province. Following data of lab confirmed cases is received from the provincial health depart‐ment.

Provinces 2011

Suspected Confirmed Deaths

Punjab 516583 20565 314

Sindh 1295 916 15

Islamabad 968 620 2

Khyber Pakhtunkhwa 502 210 6

AJK 99 21 0

FATA 7 6 0

Balochistan 6 3 0

Gilgit Baltistan 6 2 0

Total 519466 22343 337



Alerts and outbreaks, week 44, 2011

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