Weekly Epidemiological - WHOtabs, ORS and Zinc tabs provided, 1 Stool sample collected and found...

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. 41 (7 to 13 October, 2011)

• 80 districts and 2 agencies provided surveillance data to the DEWS this week from 2,537 health facilities.

• A total of 973,066 consultations were reported through DEWS of which 206,950 (22%) were acute respiratory infections (ARI), 91,550 (11%) were Skin disease, 86,882 (10%) were acute diarrhoea, and 83,649 (6%) were suspected Malaria.

• A total of 188 alerts with 15 outbreaks were reported in week-41, 2011: Altogether 89 for DHF; 27 for AWD; 27 for Measles;17 for Neonatal Tetanus and Tetanus; 11 for Leishma-niasis; 8 for Malaria; 2 each for Diphtheria, Meningitis and Pertussis; while 1 each for Acute jaundice syndrome, Bloody diarrhoea and Typhoid.

• National Polio Eradication Initiative reported eight new polio cases including seven type-1 cases from Balochistan (two each from Quetta & Pishin and one from Loralai) and FATA (one each from Khyber and South Waziristan agencies) and one type-3 polio case from FATA (Khyber agency). One polio case (from Nowshera district in Khyber Pakhtunkhwa province) has been reversed by the laboratory based on the results of the genomic sequenc-ing. As of 17th October, Pakistan has reported a total of 118 polio cases (116 type-1 & 2 type-3) from 37 districts/towns/tribal agencies/areas.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 41, Monday 17 October, 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 13 October 2011 (Epi week 31, 2010 to week 41, 2011)

Disease Wk-34 Wk-35 Wk-36 Wk-37 Wk-38 Wk-39 Wk-40 Wk-41

Acute diarrhoea 94,494 (11%) 40,403 (10%) 96,128 (11%) 109,523 (12%) 110,835 (11%) 105,295 (11%) 96,749 (10%) 86,882 (9%)

Total consultation 880,166 389,729 864,693 931,318 1,005,251 995,450 1,012,744 973,066

Suspected malaria 60,222 (7%) 22,729 (6%) 58,753 (7%) 64,766 (7%) 78,109 (8%) 83,684 (8%) 82,541 (8%) 83,649 (9%)

Since July 29, 2010, approximately 48,583,865 patient consultations have been reported to the DEWS from all provinces and three agencies and state of AJK. From last 5 weeks (37 to 41, 2011) acute diarrhoea cases have been decreasing by 3%, while at the same time cases of sea‐sonal suspected malaria have been increasing by 3%. Majority of the malaria cases were reported from districts in Sindh and Balochistan. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS.

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Percentage

AD BD ARI S. Malaria

Epidemiological Bulletin: DEWS, Pakistan, Week no. 41 (7 to 13 October, 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

12‐Oct Leishmani‐

asis Balochis‐tan

Jhal Magsi

Kotra UC Khari CD Kotra Tehsil Gandawah

1 5 0 0 6 cases were reported. Cases were checked and investigated. Health hygiene Sensitization was conducted. Treatment was given and DHO was informed.

11‐Oct Malaria Balochis‐tan

Chagai DHQ Dalbandin town 0 0 0 0 20 Malaria cases were observed. Slide test was taken and all found positive PF=8 and PV=12 while no for mix (SPR= 100% while FR = 40%). Case management reinforced. RDTs were further distributed and DHO was requested for Bed nets.

7‐Oct Malaria Balochis‐tan

Jhal Magsi

Barija UC Barija BHU Barija Tehsil Jhal Magsi

11 22 7 13 one malaria alert was reported. Investigation was carried out. 53 samples were tested 25 came positive (11 fal,10 viva and 4 mixed). RDTs were provided and issue was also discussed with DHO for further preventive measures

13‐Oct Pertussis GB Diamir DHQ Hospital, village Jaleel, Chilas

4 1 7 1

DHQ hospital Chilas received two patients of suspected Pertussis. On field investigation found 11 more cases. Some cases had months of history and some had history of weeks. Vaccination status assessed and found all children unimmunized. Erythromycin advised to all the cases and contacts. Health education given about patient care and importance of vaccination. Direct all the unimmunized children to nearby health facility for vaccination.EDO health informed about the patients.EDO health deployed a vaccination team to the locality for vaccination. Throat swab taken and sent to NIH.

7‐Oct AWD KPK Kohat Afghan Refugee camp, Ghulam Banda

0 0 1 0

Detailed Investigations done, Case was reported by MDM‐F from DTC running in DHQ hospital, EHA‐Team went to the residence of the patient and carried out detailed investigations, 1 sample was collected and sent to NIH for confirmation and was found positive for V.c. Ogawa. Health and Hygiene session conducted with the family and neighboring households, ORS Sachets pro‐vided to the affected family, EDO‐H informed and alerted.

8‐Oct AWD KPK Kohistan Village Kuz Sherial, UC Shariyal, Tehsil Palas

0 0 0 1

Alert for AWD, patient was admitted in DTC, RHC Pattan. Active surveillance was done in Village Kuz Sheriayl, no more cases were found. EDO‐H was informed. Health and hygiene education provided to the households and to the community. 1 stool sample was taken and sent to NIH for lab confirmation. The result was reported positive for V.c Ogawa.

12‐Oct AWD KPK Kohistan Village Sazeen, UC Sazeen, Tehsil Dassu

0 2 2 5

DPO Kohistan was informed about “a Cholera Epidemic” in village Sazeen by SHO Police Station Sazeen. The DPO informed SO DEWS about it. According to the MT of RHC Shatiyal, he has treated five cases from one house of Sazeen village in the last one week. Active surveillance was done in Village Sazeen (Kot and Dogga). Four more cases were found. Health & hygiene educa‐tion provided to the household and to the community. EDO‐H was informed about the cases. Aqua Tabs distributed. Sample was taken and sent to NIH for culture and sensitivity and lab confirmation of Cholera. Patients were rehydrated and were stable.

12‐Oct Malaria KPK Bajaur Agency

Village Talay, Tehsil Salarzai

5 8 7 11 31 patients of suspected Malaria tested with RDT‐kit were positive for PF, MCP with partners like Merlin & ACD is mobilized and a Mass Screening day is carried out in the village for free testing and treatment of positive cases.

8‐Oct AWD Punjab Bhakkar Basti Chaina Wali, UC Katchi Shahani

0 1 0 0 1 Suspected case was reported, resident of Chaina Wala. On active surveillance no more case was found, Health and hygiene session given, ORS use was explained, rectal swab in carryblair sent to NIH which was found positive for V.c. Ogawa, follow up planned.

13‐Oct Leishmani‐

asis Punjab Mianwali

Jallalpoor, kalookhel, Kot chandna UC

0 5 1 3

Alert for Leishmaniasis, patients registered and line list is maintained, Training of health care provider for Leishmaniasis treatment and prevention done by IRC, Patient were screened by DDOH for IM and IL injections, Duty of dispenser in Jallapoor BHU to collect injections from EDO(H) office, Malaria Program requested for fogging and IRs of the area.

11‐Oct AWD Sindh Jam‐shoro

Malik Shah Nawaz Land, UC. A,B Shoro, Taluka Kotri

1 1 0 1

3 Suspected cases found with no severe dehydration in field investigation, Reinforced case man‐agement, the source of water is open well, provide IEC material to LHW regarding health and Hygiene, Health education was imparted and sensitized regarding Proper hand washing, Aqua tabs, ORS and Zinc tabs provided, 1 Stool sample collected and found positive for V.c. Ogawa, 2 water sample also collected.

10‐Oct AWD Sindh TM Khan Naseerabad, UC‐3 0 0 0 1

Suspected case was found in hospital, active surveillance done, Hand pump was the source of water, health education imparted, Aqua tabs and Hygiene kits provided, 1 case reported. Stool sample collected and transported to NIH for confirmation which was reported positive for V.c. Ogawa.

11‐Oct AWD Sindh Umer Kot

Village Ghamori, Palli Mohalla, UC Sabho, Taluka Umerkot

4 5 6 4

19 Suspected cases found with no severe dehydration in field investigation, Reinforced case management, provide Aqua tabs, Water filters, Hygiene kits, Jerry cans and ORS to LHW regard‐ing health and Hygiene, Health education imparted and sensitized regarding Proper hand wash‐ing, Aqua tabs, ORS and Zinc tabs provided, 1 Stool and 2 water samples collected.

10‐Oct Malaria Sindh Badin Village Nabi Buksh Kambo, UC Malan, Taluka Matli

1 3 3 2 9 suspected cases of malaria out of which 8 were confirmed by RDT (SPR = 89%), bed nets distrib‐uted, Anti Malaria therapy done, Health education imparted, Malaria supervisor, MS DHMT were informed and requested for spray and fumigation.

7‐Oct Malaria Sindh Khairpur Village Arab Machhi, UC Kumb, taluka Kot Diji

50 25 50 25

Malaria outbreak reported, field investigation completed, a total of 142 slides were taken, out of which 24 positive falciparum and 38 Vivax declared (SPR = 44% while FR = 39%). Medical camp established by EDOH and SDPP teams, more 500 OPD screened, LHW involved for health & hy‐giene session, IEC were distributed in the affected community. Urgent need of bed nets.



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

7‐Oct AWD Dadu Village Bhai Khan Lashari, UC Syal 1 3 0 1

10‐Oct AWD Dadu Village Sim, UC Torr, Taluka Johi 0 0 0 0

12‐Oct AWD Dadu Najam Colony City Dadu 0 0 0 1

11‐Oct AWD Hyderabad Chistiya Masjid, Block D, Latifabad #2 0 0 0 1

11‐Oct AWD Hyderabad Tanga Stand, Diyaldas Compound Phuleli, UC‐3

0 1 0 0

11‐Oct AWD Jamshoro Malik Shah Nawaz Land, UC. A,B Shoro, Taluka Kotri

1 1 0 1

8‐Oct AWD N Feroze UC‐Ghanghra, Village Mohamed bux Mangrio Taluka kandiaro

0 0 1 1

7‐Oct AWD Sanghar Village Niaz Khan Boldani, UC Jatia, Taluka Shahdadpur

1 2 0 0

8‐Oct AWD Shikarpur Near Public School, Rustam road 2 0 0 1

10‐Oct AWD TM Khan Naseerabad, UC‐3 0 0 0 1

12‐Oct AWD TM Khan Village Sahib Khan Laghari, UC Tando Allahyar turk

1 0 0 0

9‐Oct AWD Tharparkar Village Mondro, UC Nagarparkar 1 0 0 0

10‐Oct AWD Tharparkar Chandio Paro Mondro Thar 1 0 0 0

8‐Oct AWD Thatta Sujawal City 0 2 0 0

8‐Oct AWD Umer Kot FAP Tent Village, near Village Araro Burguri, UC Araro Burguri, Taluka Samaro.

0 0 0 0

11‐Oct AWD Umer Kot Village Ghamori, Palli Mohalla, UC Sabho, Taluka Umerkot

4 5 6 4

8‐Oct DHF Ghotki Peer Qasim Mohalla 0 0 0 1

7‐Oct DHF Jacobabad DHQ Jacobabad 0 1 0 0

12‐Oct DHF Karachi Chakiwara, Lee Market, Saddar Town 0 1 0 0

12‐Oct DHF Karachi Gazar Abad, Street 52, Mehrunesa Manzil, Sadar Town

0 1 0 0

13‐Oct DHF Karachi Garden West, Near Mohammadi Masjid, Sadar Town.

0 0 0 1

13‐Oct DHF Karachi Momin Abad, Street 4/F, Orangi Town 0 1 0 0

13‐Oct DHF Karachi Street 2/C, Landi Town, N‐Karachi 0 1 0 0

9‐Oct DHF Kashmore Village Khahi, taluka Kashmore 0 1 0 0

8‐Oct DHF Khairpur GIMS taluka Gambat 0 2 0 0

10‐Oct DHF Khairpur Village Mohal, Garhi Yaseen 0 0 0 1

8‐Oct DHF N Feroze GIMS taluka Gambat 0 1 0 0

9‐Oct DHF N Feroze UC‐DK Maree, DK, Mari city 0 0 0 1

8‐Oct DHF Benazirabad Taj Colony UC. 6, Taluka Nawabshah 0 1 0 0

8‐Oct DHF Benazirabad Village Ghulam Jeelani, 68 Mori, Taluka Daur 0 1 0 0

11‐Oct DHF Benazirabad Pir Zakiri, UC Pir Zakiri, Taluka Sakrand 0 1 0 0

10‐Oct DHF Shikarpur DHQ Shikarpur 1 0 0 0

8‐Oct DHF Sukkur GMC Hospital 0 1 0 0

10‐Oct DHF Sukkur GMC Sukkur 0 3 1 0

10‐Oct Malaria Badin Village Nabi Buksh Kambo, UC Malan, Taluka Matli

1 3 3 2

10‐Oct Malaria Badin Village Qadar Bux colony, UC Matli 2 2 1 2

12‐Oct Malaria Badin Village Mir Muhammad Shaikh, UC Khorwah, Taluka Golarchi

3 2 2 2

7‐Oct Malaria Khairpur Village Arab Machhi, UC Kumb, taluka Kot Diji 50 25 50 25

8‐Oct Malaria Tharparkar Village Keetar, UC Kheensar, Taluka Chachro 0 0 0 0

7‐Oct Measles Ghotki village Arab Kalwar UC Bereri 0 1 0 0

8‐Oct Measles Shikarpur Wazirabad, taluka Lakhi 0 0 1 0

8‐Oct Measles Tharparkar Village Chachi, UC Chachro, Taluka Chachro 1 0 0 3

11‐Oct NNT Badin Village Rahuki, Taluka Golarchi 1 0 0 0

9‐Oct NNT Ghotki Village Mino Bozdar, UC Jarwar, taluka Mirpur Mathelo

1 0 0 0

12‐Oct NNT Ghotki Village Mevo Bozdar, UC Jarwar 1 0 0 0

10‐Oct NNT Karachi Neonatal ICU, NICH, Jamshed Tawn 1 0 0 0

13‐Oct NNT Karachi Neonatal ICU, NICH 0 0 1 0

8‐Oct NNT Benazirabad Village Maqsoodo Rind, Taluka Shahdadpur. 1 0 0 0

8‐Oct Tetanus Qambar Shahdadkot

Village Achar Magsi, UC Hazarwah, taluka Qubo Saeed Khan

0 1 0 0


Village Chajjra, taluka Qambar 0 0 0 1


Village Qaim Khan Lanjwani, taluka Sijawal 1 0 0 0

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

13‐Oct AJS Layyah TDA colony 1 0 0 2

8‐Oct AWD Bhakkar Basti Chaina Wali, UC Katchi Shahani 0 1 0 0

12‐Oct AWD Bhakkar Nazir Town, UC Bhakkar Urban II 0 1 0 0

10‐Oct AWD DG Khan Chah Lahoree wala Moza Samina Gharbee uc Samina

0 0 0 1

12‐Oct AWD RY Khan Jamal Din Wali 0 0 0 2

12‐Oct AWD RY Khan UC Kot Karam Khan 0 0 0 1

7‐Oct DHF Bhakkar DHQ Hospital Bhakkar, Nalka Chadranwala 0 1 0 0

10‐Oct DHF Bhakkar DHQ Hospital Bhakkar‐Chak # 24/TDA Daryakhan Bhakkar

0 0 0 1

10‐Oct DHF Bhakkar DHQ Hospital Bhakkar‐Chak # 33/TDA Bhakkar.

0 0 1 0

11‐Oct DHF Bhakkar DHQ Hospital Bhakkar, Basti Qurashianwala Karoor Chak # 24/TDA

0 1 0 0

11‐Oct DHF Bhakkar DHQ Hospital Bhakkar, Chak # 67/TDA Sarai Muhajir Bhakkar

0 1 0 0

11‐Oct DHF Bhakkar DHQ Hospital Bhakkar, Mandi Town Bhakkar 0 1 0 0

11‐Oct DHF Bhakkar DHQ Hospital Bhakkar, Moza Dargolla 0 1 0 0

13‐Oct DHF DG Khan Nishter Hospital Multan‐ DG Khan 0 3 0 0

13‐Oct DHF DG Khan Village Sokar uc sokar Tehsil Taunsa 0 1 0 0

13‐Oct DHF Jhang Nishter Hospital Multan‐ Jhang 0 2 0 0

13‐Oct DHF Khanewal Nishter Hospital Multan‐ Khanewal 0 8 0 0

13‐Oct DHF Lahore Nishter Hospital Multan‐ Lahore 0 0 0 2

7‐Oct DHF Layyah Basti ehsan pur u/c pharpur 0 1 0 0

9‐Oct DHF Layyah 150 TDA layyah 0 1 0 0

9‐Oct DHF Layyah Chak no 217 TDA Fatehpur 0 1 0 0

10‐Oct DHF Layyah Basti shahnawaz 0 1 0 0

11‐Oct DHF Layyah Peer jagi more u/c ladhana 0 1 0 0

12‐Oct DHF Layyah Chak no 134 Tda 0 1 0 0

13‐Oct DHF Layyah Mohallah eidgah urban 2 city 0 1 0 0

7‐Oct DHF Mianwali Mohallah Hashim Shah 0 1 0 0

7‐Oct DHF Mianwali Mohallah Phatoon Khela wala, Shadia 0 1 0 0

8‐Oct DHF Mianwali Paka Ganjera,Wam Bucharan 0 1 0 0

12‐Oct DHF Mianwali Ban Hafiz,chakrala 0 1 0 0

13‐Oct DHF Multan Nishter Hospital Multan‐Multan City 0 10 0 3

12‐Oct DHF Muzaffargarh Mohallah Khurshid Abad, UC Lutkeran 0 1 0 0

13‐Oct DHF Muzaffargarh Basti Chavind Wali, Moza & UC Qasba Gujrat, Kotaddu

0 1 0 0

13‐Oct DHF Muzaffargarh Nishter Hospital Multan‐ Muzaffargarh 0 7 0 1

13‐Oct DHF Pakpattan Nishter Hospital Multan‐ Pakpattan 0 2 0 0

7‐Oct DHF RY Khan Azeem Town, Sadiqabad 0 1 0 0

7‐Oct DHF RY Khan Chak no.35/A Liaquatpur 0 1 0 0

7‐Oct DHF RY Khan Mohala Imam Bargha Sadiqabad 0 1 0 0

7‐Oct DHF RY Khan Zafar Colony, St. No.01 0 0 0 1

8‐Oct DHF RY Khan Jamal Din Wali Road Chongi No.8 Latif Abad 0 1 0 0

8‐Oct DHF RY Khan Khai Khair Shah Khanpur 0 1 0 0

8‐Oct DHF RY Khan Mian Mad Darbari St.No.21 0 1 0 0

9‐Oct DHF RY Khan Basti Ghulam Sarwar Marazi, Mouza Kacha Chowhan

0 1 0 0

9‐Oct DHF RY Khan Street NO.7 Azizabad, near Rehmat Science High School

0 1 0 0

9‐Oct DHF RY Khan Street. NO.10 Jinnah Park City 0 1 0 0

10‐Oct DHF RY Khan Chak No.159/P Tehsil Sadiqabad 0 0 0 1

10‐Oct DHF RY Khan Chak NO.79/A Ferroza Tehsil Liaqatpur 0 1 0 0

10‐Oct DHF RY Khan House No.94/A Mouhalla Islam Pura, Sher Ghar Road Mailsi

0 0 0 1

10‐Oct DHF RY Khan Vilage Haji Ali Murad Kazani Tehsil Mathal 0 1 0 0

11‐Oct DHF RY Khan Chak Abbass 0 1 0 0

11‐Oct DHF RY Khan Chak No.188/P Tehsil Sadiqabad 0 1 0 0

11‐Oct DHF RY Khan Mujahid Colony Street # 04 Tehsil Sadiqabad 0 1 0 0

11‐Oct DHF RY Khan Treen Colony, House No.27 0 1 0 0

12‐Oct DHF RY Khan Mohallah Hussain Abad , St, No.1 Tehsil Sadiqabad

0 1 0 0

12‐Oct DHF RY Khan Rao Town, Tehsil Sadiqabad 0 1 0 0

12‐Oct DHF RY Khan Shafi Town, Shahbaz Pur Raod 0 0 0 1

12‐Oct DHF RY Khan Tareen Colony, Sui Gas 0 1 0 0

13‐Oct DHF RY Khan Nursing Hostel, Sheikh Zayed Hospital 0 0 0 1

13‐Oct DHF Sahiwal Nishter Hospital Multan‐Sahiwal 0 2 0 0

13‐Oct DHF Vehari Nishter Hospital Multan‐Vehari 0 11 0 1

13‐Oct Leishma‐niasis

Mianwali Jallalpoor, kalookhel, Kot chandna UC 0 5 1 3

11‐Oct NNT Muzaffargarh Basti Bhatian, UC Noohan Wali 1 0 0 0

11‐Oct NNT Muzaffargarh Basti Shah Wala, Moza Robella, UC Alurid, Kotaddu

1 0 0 0

13‐Oct NNT Rajanpur Basti Deero Dildar, Moza Sargaani, UC Urban Rojhan

1 0 0 0

13‐Oct NNT Rajanpur Basti Math Wah, Chak Dilbar, UC Rojhan 1 0 0 0

13‐Oct Tetanus Rajanpur Basti Jam Iqbal, Moza Patni, UC Muhammad Pur

0 1 0 0

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

12‐Oct Leishmaniasis Jhal Magsi Kotra UC Khari CD Kotra Tehsil Gandawah 1 5 0 0

13‐Oct Leishmaniasis Jhal Magsi Pach UC Khari DHQ Hospital Gandawah Tehsil Gandawah

0 1 0 0

9‐Oct Leishmaniasis Kech Sahahitump UC Koshkalat 0 1 0 0

11‐Oct Leishmaniasis Khuzdar Tehsil Khuzdar 0 2 1 0

7‐Oct Leishmaniasis Quetta Hazara town, Brewery road 0 1 0 0

13‐Oct Leishmaniasis Quetta Hazara Town 0 1 0 3

13‐Oct Leishmaniasis Quetta Pashtoon abad 1 0 1 1

12‐Oct Leishmaniasis Sibi Allahabad UC#3 0 1 0 0

13‐Oct Leishmaniasis Sibi Bolan Market UC#2 0 1 0 0

12‐Oct Leishmaniasis Ziarat Chutair 0 1 0 0

11‐Oct Malaria Chagai DHQ Dalbandin town 0 0 0 0

7‐Oct Malaria Jhal Magsi Barija UC Barija BHU Barija Tehsil Jhal Magsi 11 22 7 13

11‐Oct Measles Khuzdar Koshk UC Gazgi Tehsil Khuzdar 0 0 1 0

13‐Oct Measles Lasbela Jam Colony UC Pathra, HUB 2 0 0 0

10‐Oct Measles Panjgur Union Council ,Chitkan Brohi Mohallah Gareeb Abad District Panjgur

0 2 0 0

10‐Oct Measles Panjgur Union Council Essai Mohalla Sandhay ser, District Panjgur

0 0 0 1

13‐Oct Measles Quetta Gulistan road, SBBH, Quetta 1 0 0 0

12‐Oct Meningitis Loralai Reported from Children ward DHQ Hospital Loralai. Address:‐ Killi Duki, Tehsil Duki District Loralai.

1 0 0 0

12‐Oct NNT Chagai killi toughie, Chagai village 1 0 0 0

7‐Oct NNT Nasirabad DHQ, Dera Murad Jamali 0 0 1 0

10‐Oct Typhoid Chagai Girdi jungle, refugee camp, killi gorgage 4 0 2 0



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

7‐Oct AWD Kohat Afghan Refugee camp, Ghulam Banda 0 0 1 0

8‐Oct AWD Kohistan Kohistan 0 0 0 1

8‐Oct AWD Kohistan Village Kuz Sherial, UC Shariyal, Tehsil Palas 0 0 0 1

12‐Oct AWD Kohistan Village Sazeen, UC Sazeen, Tehsil Dassu 0 2 2 5

7‐Oct AWD Shangla Village Basi kelay 0 1 0 1

12‐Oct AWD Shangla Village Pagorai/UC Mian Kele 0 0 0 1

11‐Oct DHF Battagram Jaba Chanar, UC Ajmera 0 1 0 0

11‐Oct DHF Battagram Maidan Matta, UC Ajmaira, Tehsil Batagram 0 1 0 0

11‐Oct DHF D. I. Khan Band Kurai, Tehsil Paharpur 0 0 1 0

7‐Oct DHF Haripur Village Bagra, UC bagra 0 1 0 0

8‐Oct DHF Haripur Naseem Town Haripur city 0 1 0 0

10‐Oct DHF Haripur Afghan Refugee camp 15 0 1 0 0

11‐Oct DHF Haripur Village Khaido, UC Syria 0 3 1 0

12‐Oct DHF Haripur Village Sikandarpur UC Sikandarpur 0 1 0 0

13‐Oct DHF Haripur Village Bagra, UC Bagra 0 1 0 0

10‐Oct DHF Mansehra Bajna 0 1 0 0

10‐Oct DHF Mansehra Dhodial 0 1 0 0

10‐Oct DHF Mansehra Hassa Balakot 0 1 0 0

10‐Oct DHF Mansehra Kary Nawaz abad UC Sachan 0 1 0 0

10‐Oct DHF Mansehra Mohallah Balyani Balakot 0 1 0 0

10‐Oct DHF Mansehra Shamdara Oghi 0 1 0 0

7‐Oct DHF Nowshera Near: PTCL Exchange, Risalpur 0 0 1 0

13‐Oct DHF Shangla Village Derai Belkanai, Tehsil Alpurai 0 1 0 0

12‐Oct Diphtheria Buner UC sorray tehsil chagharzai 0 0 1 0

7‐Oct Diphtheria Nowshera Mohalla Gilda Khel Village Speen Kanay Cherat District Nowshera 03072689877

0 0 1 0

12‐Oct Malaria Bajaur Agency Village Talay, Tehsil Salarzai 5 8 7 11

12‐Oct Measles Battagram Village Kund, UC Jambaira, Tehsil Allai 0 1 0 0

11‐Oct Measles Buner village arra near jowar pir baba road 0 1 0 0

13‐Oct Measles Buner village zyarat kalay dewana baba tehsil gagra

0 0 0 1

11‐Oct Measles Charsadda Landay Bazar Prang 1 0 0 0

12‐Oct Measles Charsadda Ashraf Mian Kallay 0 0 0 1

12‐Oct Measles Charsadda Fatmakhel 0 0 1 0

12‐Oct Measles D. I. Khan Gali Bagh Wali, Opposite Laghari, Masood Colony

1 0 0 0

7‐Oct Measles Mardan Mohallah Mohib Banda Near Jalil House Tehsil & District Mardan.

0 1 0 0

9‐Oct Measles Mardan Mohallah Spin Kary near Ghalader Mardan 0 1 0 0

10‐Oct Measles Mardan Mohallah Khuday Noor Kali Shankar Kat Lang Road Mardan Tehsil & District Mardan.

1 0 0 0

11‐Oct Measles Swabi BMC swabi, Charbagh 1 0 0 0

12‐Oct Measles Swabi BHU Checknoda, Mohallah zamindar cham 2 0 1 1

11‐Oct Measles Swat Village and UC Chuprial near RHC Chuprial, Tehsil Matta

0 0 1 0

11‐Oct Measles Swat Village Sambat, UC Baidara Koz Cham, Tehsil Matta

1 0 0 0

12‐Oct Measles Swat Village Kokarai Janam Khel mashogai china, UC Kokarai, Tehsil Babuzai

0 0 1 0

12‐Oct Measles Swat Village Udigram Mohallah Jalal Abad, UC Udigram, Tehsil Babuzai

1 0 0 0

13‐Oct Measles Swat Village Devlai fazal abad, UC Devlai, Tehsil Kabal

1 0 0 0

13‐Oct Measles Swat Village Melaga Mohallah Barsarona,UC Kotlai, Tehsil Kabal

1 0 0 0

13‐Oct NNT Bajaur Agency AHQ Hospital(kaga, Lashora, Shahnaray, Arkanai)

3 0 1 0

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

11‐Oct BD skardu Satellitetown 1 0 0 0

11‐Oct Meningitis Ghanche Mohalla Gongma Bara UC Bara 0 0 0 1

10‐Oct DHF Gilgit DHQ Hospital Gilgit 0 1 0 0

8‐Oct Measles Diamir DHQ Hospital Chilas 1 0 0 0

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

13‐Oct Pertussis skardu Ranga UC, shagri khurd 0 1 0 0

On the Friday the 14th of October 2011, Premiere Urgence and Aide Medicale Internationale (PU‐AMI) celebrated Global Hand Washing Day in collaboration with the World Health Organization (WHO) with a grand festival at Warah Boys High School, district Kamber Shahdadkot, Sindh.

The manifestation with almost 2000 students started with a warm welcome from the principal and a traditional Sindh welcome dance. After explaining the importance of this day and hand washing by Ghulam Muhiuddin‐ WASH engineer, Dr Liaquat – S.O from WHO and Adnan Wahab, medical coordinator assistant and Noortje Van Langen, HHP program manager from PU‐AMI, all the students joined in a Hand Washing Rally through the city of Warah to spread the key messages all over the community.

In the afternoon the festivities continued with a hand washing dem‐onstration for all the students, which was followed with great en‐thusiasm. At a hygiene workshop, the students could bring their knowledge into practice in small groups. To encourage the student to adopt the right hand washing practices, soaps and IEC materials were distributed. Apart from activities, the day became extra excit‐ing with a big hand washing quiz.

Global Hand washing day, Activity summary from district Kamber Shahdadkot, Sindh


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]. 05

Province Khyber Pakhtunkhwa: • This week 618 health facilities from 17 districts reported to

DEWS with a total of 132,761 patients consultations.

• The proportional morbidity of AD showing gradual decline during the last 4 weeks after a consistent higher proportion (16%) for almost 10 weeks.

• 45 alerts were reported in this week, 18 were for Measles; 17 for DHF, 6 for AWD, 2 for Diphtheria, while 1 each for Neonatal Tetanus and Malaria.

• 4 outbreaks 3 for AWD and 1 for Malaria were identified and responded.

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

Province Sindh:

• This week 782 health centers from 22 districts reported to DEWS with a total of 440,075 patient consultations.

• In Sindh, AD cases reported were 44,783 (10%), propor-tional morbidity lower by 1% as compared with last week.

• 51 alerts were reported from Sindh in this week: 18 were for DHF; 16 for AWD; 9 for Neonatal tetanus and Tetanus; 5 for Malaria and 3 for Measles.

• 5 outbreaks 3 for AWD and 2 for Malaria were identified 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 40) Current Week (41) Total

A O A O A O A O Acute Watery Diarrhoea 209 85 1126 496 27 8 1362 589 Acute Jaundice Syndrome 5 2 40 14 1 ‐ 46 16 Bloody Diarrhoea 10 1 82 14 1 ‐ 93 15 Dengue Fever 81 32 558 110 89 8 728 150 Measles 48 6 1388 87 27 ‐ 1463 93 Pertussis 1 ‐ 222 25 2 1 225 26 NNT + Tetanus 5 ‐ 231 ‐ 17 ‐ 253 ‐ Malaria 12 7 79 54 8 5 99 66 Leishmaniasis 1 ‐ 163 24 11 2 175 26 Others 75 11 476 53 5 1 556 65

Total 447 144 4365 877 188 25 5000 1046

Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 13 October 2011, compiled from weekly reports

Diseases Total

Acute Respiratory Infection 10,793,228 (22%)

Skin Diseases 5,260,835 (11%)

Acute Diarrhoea 4,661,009 (10%)

Bloody Diarrhoea 413,564 (1%)

Suspected Malaria 2,967,048 (6%)

Unexplained Fever 1,859,743 (4%)

Total Consultations 48,583,865

Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 41/2011)

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Epidemiological Bulletin: DEWS, Pakistan, Week no. 41 (7 to 13 October, 2011) Province Punjab: • This week 479 health facilities from 8 districts reported data

to DEWS from Punjab province with a total of 258,624 patient consultations.

• AD cases reported were 16,389 and showing proportional morbidity lower by 1% as compared with last week .

• 65 alerts were reported in this week from Punjab; 53 were for DHF; 5 for AWD; 5 for Neonatal tetanus and Tetanus while 1 each for Leishmaniasis and Acute jaundice syn-drome.

• 2 outbreaks 1 each for AWD and Leishmaniasis were re-ceived and responded.

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


State of Azad Jammu and Kashmir:

• In this week, reports were received from 117 health facilities from 10 districts with a total of 29,351 patient consultations.

• ARI cases reported were 4,795 (16%), while Acute diarrhoea re-ported 1,212 (4%) cases.

• No alert was received this week from any area of AJK.

• This week 42 health facilities in 2 agencies reported from FATA, with a total of 7,772 patient consultations.

• ARI cases reported were 1,706 (22%), while Acute diarrhoea was reported 541 cases (7%)

• No alert was received this week from any area of FATA.

Province Gilgit Baltistan:

• In this week, 78 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 25,973 patient consultations.

• ARI cases reported were 5,583 (21%), while Acute Diarrhoea were 2,817 (11%).

• 6 alerts received and responded this week, 2 were for Pertussis, while 1 each for Bloody diarrhoea, Menin-gitis, DHF and Measles.

• 1 outbreak for Pertussis was received and responded.

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

FATA:

Province Balochistan:

• In this week, 16 districts reported to DEWS from Balochis-tan province. 421 health centers reported a total of 78,510 patient consultations.

• AD reported in 8,053 (10%) of the total consultations, 1% lower proportional morbidity as compared with the last week.

• 21 alerts were reported in this week from Balochistan, 10 were for Leishmaniasis; 5 for Measles; 2 each for Malaria and Neonatal tetanus; while 1 each for Meningitis and Ty-phoid.

• 3 outbreaks 2 for Malaria and 1 for Leishmaniasis was iden-tified and responded.

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

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Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases reported in 2010 is 144 includ‐ing 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/agencies. Year 2011: As of 17 October, 2011, the total number of polio cases con‐firmed by the laboratory is 118 (116=type‐1, and 2=type3) from 37 districts.

Focus on: Health situation in province Sindh, Week 41/2011

Regarding the health situation in Sindh, we would like to provide an update to the partners:

• Rain water is evacuated from DHQ Mirpurkhas and it became functional.

• DHQ Sanghar is still under water and nonfunctional; in its place a field hospital established by Muslim Aid is functioning.

• DTCs have started functioning at 08 sites, namely DHQ Thatta, THQ Golarchi District Badin, DHQ Tando Mu‐hammad Khan, THQ Sakrand District Shaheed Benazirabad, DHQ Tando Allahyar, THQ Shahdadpur District Sanghar, THQ Kunri District Umarkot, THQ Nagar Parker District Tharparker. DTC at Civil Hospital Mirpurk‐has will be functional within two to three days; the delay was due to water inside the hospital now it is de‐watered.

• There were total 51 Alerts and outbreaks from Sindh from 19 districts. There was an outbreak of AWD in Umarkot District in which 19 cases and one death reported. After inter‐

ventions the condition is under control. No more cases and deaths are reported. There was outbreak of Malaria in village Arab Solangi District Khairpur from where 71 were confirmed out

of 142 suspected cases and falciparum ratio was 46.

• The Dengue was on the top and contributing 34% of all alerts, followed by AWD 28%, malaria 12%, NNT 6%.

• Falciparum ratio is high in Thatta 63%, followed by Badin 45%, Jacobabad 44%, Hyderabad 33%, and Lar‐kana is 30%. The slide positivity rate is high in Matiari i.e. 85%, followed by Tharparker 33%, Umarkot 23%, Larkana and Mirpurkhas 16% each. Slide positivity ratio for whole Sindh is 12 and FR is 23.

• Till 15th October a total of 668 dengue positive cases were reported from Sindh, out of which 530 belong to Karachi and 138 to rest of Sindh. Total of 10 deaths occurred, 9 from Karachi and one from Ghotki.

• Global Hand Washing day October 15th, 2011 was celebrated in Hyderabad, Shaheed Benazirabad, Tando

Allahyar, Badin, Tando Muhammad Khan, and Jamshoro from southern Sindh, and in Shikarpur, Ghotki and Larkana in northern Sindh.

Province Cases 2010 Cases 2011 P1 P3 P1 P3

Punjab 6 1 2 -

Sindh 26 1 20 -

Khyber Pakhtunkhwa 19 5 11 -

FATA 63 11 30 2

Balochistan 6 6 52 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 116 2



Alerts and outbreaks, week 41, 2011

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