Weekly Epidemiological - WHO...Epidemiological Bulletin: DEWS, Pakistan, Week no. 32 (5 to 11 August, 2011) This weekly Epidemiological Bulletin is published jointly by the National

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. 32 (5 - 11 August, 2011) • 86 districts and 3 agencies provided surveillance data to the DEWS this week from

3,099 health facilities.

• A total of 1,031,289 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI), 13% skin disease, 10% acute diarrhoea, and 6% suspected Malaria.

• A total of 141 alerts with 36 outbreaks were reported in week-32, 2011: Altogether 63 alerts were for AWD; 17 for Measles; 10 for Neonatal tetanus and Tetanus; 10 for AD; nine for Pertussis; eight for Meningitis; seven for Leishmaniasis; six for bloody diarrhoea; three each were for AJS and DHF; two for malaria, while one each chicken pox, mumps and scabies.

• National Polio Eradication Initiative reported six new confirmed polio cases this week: three from Killa Abdullah, one from Dera Bugti districts in Balochistan, while one each from Mohmand and South Waziristan agencies in FATA. Total 69 (68=type1, and 1=type3) confirmed polio cases have been reported in 2011 from 28 districts.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 32, Tuesday 16 August, 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-25 Wk-26 Wk-26 Wk-28 Wk-29 Wk-30 Wk-31 Wk-32

Acute Diarrhoea 103,978 (10%) 107,924 (10%) 100,320 (10%) 104,413 (10%) 107,861 (10%) 103,098 (10%) 109,255 (10%) 105,674 (10%)

Total consultation 1,019,724 1,087,368 994,345 1,025,647 1,037,391 1,019,120 1,078,912 1,031,289

Since July 29, 2010, approximately 40,534,326 patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week 32, 2011 (5 to 11 August, 2011) reports were received from 3,099 health centers and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases 105,674 (10%), acute respiratory infec‐tions 178,407 (17%), skin diseases 135,539 (13%) and suspected malaria 58,947 (6%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 2009, 2010 and 2011 up until now.

0

4

8

12

16

20

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Percentage

Epi‐week

2009 2010 2011

Epidemiological Bulletin: DEWS, Pakistan, Week no. 32 (5 to 11 August, 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, E-mail: [email protected]. 02

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

11‐Aug AWD AJK Bagh Vill rangoli hans choki UC rangla the dhirkot

1 4 2 8 Alert for death from AWD reported from village Hans Choki, Dhirkot. During field investigation 16 more diarrhoea cases were found sample from two suspected cases taken and sent to NIH.

10‐Aug AWD AJK Hattian Village Khalana, UC Chokothi, Hattian Bala

7 57 9 39 AWD cases reported from RHC ‐ Chokothi, District Hattiyan Bala. Sample collected and sent to NIH. Water sample was also taken for quality testing. During active surveillance community awareness session conducted, IEC material distributed and DHO was informed.

10‐Aug AWD AJK Poonch village Khori Channa UC Ali Sojal The rawalakot

2 5 2 7

Increase in no of AD was reported from FAP Khori Channa . During field investigation 15 more cases were found and one death reported due to diarrhoea, sample from one suspected case was taken and sent to NIH. Medicines and IV fluids were provided at RHC. Aqua tabs and ORS was distributed in the community through LHWs. Water sampling was done, heath hygiene sessions were conducted. RHC staff was requested for daily AD case reporting.

8‐Aug AWD Balochis‐tan

Mastung Killi Bezani, Tehsil Karde‐gap

5 10 3 17 AWD alert was reported, and 35 cases including one death. 1/2 Stool sample found positive for V.c. Ogawa, water samples were also collected for quality testing. DDK, Aqua Tab., Water filters and hygiene kits were distributed. Health education was also given.

10‐Aug Malaria Balochis‐tan

Jaffarabad BHU Ghot Allah Yar Khoso

7 14 11 17 49 malaria cases were reported. 13 samples were tested and 7 found positive (P. Falciparum 3, P. Vivax 2 & mixed 2) and treated. (SPR = 53.8%, while FR = 38.4%). Further response planned with EDO‐H.

10‐Aug Leishmaniasis

FATA Bajaur Agency

UC Kotkai, Tehsil Salarzai 0 4 0 3 Seven cases of Leishmaniasis identified. Health education given. Medical treatment planned.

9‐Aug Pertus‐sis

Gilgit‐Baltistan

Diamir Juglote Tangir 12 3 7 7

Civil hospital Juglote Tangir reported three patients of suspected Pertussis. On field investigation found 26 more cases. Immunization status was assessed and found no child vaccinated. Samples taken from the infected children. Outbreak declared and stakeholders of health informed about the situation.DSM PPHI directed his staff to provide medicines for cases and contacts and EDO health directed his vaccination team to the locality to search and make a micro plan for vaccina‐tion of unvaccinated children.

13‐Aug AWD ICT Islamabad FG Polyclinic (dalla Chir‐rah)

0 2 1 3

Alert for AWD, 6 family members were admitted in three days, during active surveillance, 3 more cases were found, sample collected and health education session done, Aqua tab, ORS were distributed, water sample from spring and bore collected for quality testing. Arranged for chemical disinfection of bore hole and spring by health department.

8‐Aug AWD KPK Abbottabad Village Hadora, UC Dalola 0 7 1 11 Alert for AWD. Active surveillance done 19 cases of AD identified. 1 stool sample taken and found positive for V.c. Ogawa. Water samples taken for quality testing. Response team mobilized emer‐gency medicines delivered. DTC established. ORS, Aqua tabs and health education given.

9‐Aug AWD KPK Battagram Vill. Banjo baba, UC Gajjbori

2 3 1 3

3 cases of suspected AWD were reported from DHQH. On active surveillance 6 more suspected cases were found. Sample was taken and found positive for V.c. Ogawa. Water samples were taken for assessment of contamination. Aqua tabs, soap, IEC material along with health and hy‐giene promotion given to the community. EDOH, MS DHQH and program manager health Save the Children were informed.

9‐Aug AWD KPK Buner Vill Chinglai Jaffar Khel, Tehsil Thothalai

0 4 0 1

Alert reported of death due to AWD. Area was visited and death of a 4 year old child was con‐firmed due to diarrhea and vomiting. Active surveillance was carried out in the area and five more diarrhoea cases were found. Sample was taken from one patient and found positive for V.c. Ogawa. Health and hygiene session was conducted with the community. Aqua tabs, Soap and IEC material was provided. Water source was identified and samples were taken for quality testing. EDOH office informed.

10‐Aug AWD KPK Haripur Village Najafpur, UC Najafpur

3 11 4 24

AWD outbreak was reported by RHC Khanpur as 8 patients from village Najafpur presented with AWD. The cases started around 7th August. On active case finding 35 more cases were identified from one location. Water samples were tested which came back positive for contamination. The source of water was stream. Stool sample was taken and sent to NIH which was found positive for V.c. Ogawa. Aqua tabs, ORS and soap were distributed house to house by LHW. Health and Hy‐giene session was conducted for the affected community. EDO Health was informed.

5‐Aug AD KPK Kohistan Village Zaid Khar, UC Kameela, Tehsil Dassu

1 16 1 17

Alert for increased AD cases from village Zaid khar, on investigation 35 AD cases were found. EDO‐H was informed about the cases. One stool sample taken and sent to NIH but found negative for V. cholera. AD outbreak was declared by EDO (H) Kohistan. A Field DTC was established with the Help of Malteser International and DoH. WHO provided medicines, Malteser provided its Project Man‐ger and two Doctors, DoH provided medicines and a Medical Technician. Health & hygiene educa‐tion provided to the households and to the community. Hygiene kits and Aqua tabs distributed in the area.

5‐Aug to 10‐Aug

AWD KPK Lower Dir

Village Bar Kalay, UC & Tehsil Khall; Village Serao Kandao, UC Toor Mang, Tehsil Khall; A/R Taimar Camp, Timargara; Mo‐halla Behren, Village Shirkhanai, UC Ha‐yaserae, Tehsil Balmbat

1 9 0 15

Four alerts for AWD from different locations in Lower Dir. 25 cases were investigated. 4 samples collected and all found positive for V.c. Ogawa. Water samples also collected for quality testing. EDO‐H informed, during active surveillance ORS and hygiene kits provided, Aqua Tabs distributed, health and hygiene promotion session conducted with family members.

9‐Aug AWD KPK Upper Dir

Village Almast, Osherey Darra; Village Dood Banno, Nasir Abad, Osherey Darra

0 0 0 3

Two alerts for AWD from different locations in Upper Dir were reported from DHQ Timergrah, Lower Dir. Cases Investigated, stool samples collected and found positive for V.c. Ogawa, ORS & Hygiene kits provided, Aqua tabs given, Health & Hygiene promotion Session conducted with family members. Field investigation ongoing.

9‐Aug AWD KPK Malakand Khado Pul 0 1 0 0 An iNGO (MSF) reported a case of AWD. Sample taken and sent to NIH for confirmation which was found positive for V.c. Ogawa. Further response planned with INGO.

9‐Aug AWD KPK Mardan G.T Road, Shergarh 0 1 0 0 An iNGO (MSF) in Malakand reported a case of AWD belonging to Mardan. The suspected AWD case was investigated. Samples taken & sent to NIH for confirmation which was found positive for V.c. Ogawa. Field investigation planned.

5‐Aug AWD KPK Swabi

DHQ Swabi, Mohallah Balar Khel, UC Marghuz; RHC Yar Hussain, Mohal‐lah New Mira Khel; RHC Yar Hussain, Mohallah Zyam

1 2 0 1

Three alerts for AWD from different locations in Swabi. During investigation treatment given, health education sessions conducted to the family as well as in the community. Active surveillance found no other cases. Two samples were collected and found positive for V.c. Ogawa. EDO and MS of BMC informed. Hygiene sessions planned for community.



Province Khyber Pakhtunkhwa: • This week 20 districts reported to DEWS from 720

health facilities with a total of 161,569 patients con-sultations.

• AD cases reported were showing a consistent upward trend and accounted for 16% of the total consulta-tions in last 4 weeks.

• 44 alerts were reported in this week, 34 were for

AWD, four for measles, two for DHF, while one each for AD, BD, Leishmaniasis and Pertussis.

Figure-2: Three years trend of Acute diarrhoea, province KPK

Province Sindh:

• This week 19 districts reported to DEWS from 830 health centers with a total of 435,087 patient consul-tations during the reporting period of week 32, 2011.

• In Sindh, AD cases reported were 39,894 (9%), same proportional morbidity as compared with last week.

• 30 alerts were reported from Sindh in this week: 13 were for AWD, four each were for Measles, Neonatal tetanus and Pertussis, two each for Tetanus and Men-ingitis, while one for Dengue hemorrhagic fever .

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

Table‐1: Total number of alerts and outbreaks reported and investigated with appropriate response Disease

Post Flood 2010 2011 (up till wk 31) Total A O A O A O A O

Acute Watery Diarrhoea 209 85 551 243 63 29 823 357

Bloody Diarrhoea 10 1 52 9 6 ‐ 68 10 Measles 48 6 1233 80 17 ‐ 1298 86 Pertussis 1 ‐ 183 19 9 2 193 21

Malaria 12 7 54 37 2 2 68 46 Leishmaniasis 1 ‐ 77 18 7 2 85 20 Others 156 43 412 39 24 1 592 83 Total 447 144 2722 457 141 36 3310 637

Current Week

Acute Jaundice Syndrome 5 2 33 12 3 ‐ 41 14

NNT + Tetanus 5 ‐ 127 ‐ 10 ‐ 142 ‐

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Current week's Outbreaks: (Cont’d) Date Disease Province District Area M F Action Taken

9‐Aug AWD KPK Swat

Village Jurra, UC Pir Kaley, Tehsil Matta; Village Bazkhela, UC Dureshkhela,Tehsil Matta

0 1 1 0 Alert for AWD sampled and second case of AWD found on field investigated from village Jura. One sample found positive for V.c. Ogawa, while second patient was referred to THQ Matta. Water samples were collected from spring and tank sources for quality testing.

5‐Aug AWD KPK Upper Dir Payeen Rokhan, Urban Dir; Dogdara, Menadog, Bair

0 0 0 2 Two alerts of AWD from different locations were investigated, samples were sent to NIH both were found positive for V.c. Ogawa. Health Education session conducted and 4000 aqua tabs were provided. EHE chlorinated the water source. EDO‐H informed.

9‐Aug Malaria Punjab DG. Khan UC Samina 3 3 3 3 15 cases of suspected malaria were tested and 12 found positive (8 falciparum and 4 Vivax; SPR = 80%, while FR = 66.6%) patients treated. Further investigation planned.

9‐Aug Meningi‐

tis Punjab DG. Khan

Basti Hairo Sharqi Taunsa

0 0 0 1 Alert for meningitis, sample was collected and sent to NIH which was found positive for Meningococcal Meningitis. Health education to the family and prophylactic antibiotic to the contacts. During field investigation no other cases found.

11‐Aug AWD Sindh Qambar Shahdadkot

Qubo Saeed Khan UC, Tehsil Shahdadkot

7 2 5 2 PU&AMI team reported that one child died due to suspected cholera and 15 other children have vomiting and severe diarrhea, field investigation is in process by SO DEWS Larkana/Qambar.

9‐Aug AWD Sindh Tando Allah Yar

Village Sarange Hakra, UC Sheikh Mussa

0 1 0 0 Alert for AWD, reinforced case management, active surveillance found no other cases, health education, ORS, Aqua tabs and Zinc tabs provided, DMT & EDO‐H informed, 1 stool sample was collected and found positive for V.c. Ogawa, 2 Water sample also taken for quality testing.

6‐Aug Pertussis Sindh Jamshoro Shoro village, UC Son‐wallar 3, Taluka Kotri

2 2 1 3 Eight cases of suspected Pertussis reported. Two throat swab samples collected, health education provided, Erythromy‐cin tabs provided to cases and contacts. EDO‐H informed for ongoing outbreak.

Epidemiological Bulletin: DEWS, Pakistan, Week no. 32 (5 to 11 August, 2011) Province Punjab: • 12 districts reported data to DEWS from Punjab

province, 873 health facilities reported a total of 287,699 patient consultations during this reporting period

• AD cases reported were 20,311, and stabilized at 7% from last four weeks.

• 26 alerts were reported in this week from Punjab; Six for AD, five each were for AWD and BD, three for Meningitis, two each for neonatal tetanus, tetanus and measles, while one for malaria.

Figure-4: Trend of acute diarrhoea, province Punjab (3 August 2010 to 11 August 2011)


State of Azad Jammu and Kashmir:

• In this week, weekly report received from 97 health centers from 10 districts, with a total of 35,821 patient consultations.

• ARI cases reported were 3,916 (11%), while Acute diarrhoea re-ported 3,581 (10%) cases.

• Eight alerts were received and responded this week, five were for AWD, while three for measles.

• This week 54 health centers in 3 agencies reported from FATA, with a total of 8,769 patient consultations.

• ARI cases reported were 1,419 (16%), while Acute diarrhoea re-ported 1,458 cases (17%)

• Four alerts, two for AWD, while one each for measles and Leishmaniasis received and responded this week.

Gilgit Baltistan:

• In this week, 66 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 32,011 patient consultations.

• ARI cases reported were 3,423 (11%), while Acute Diarrhoea 6,160 (19%).

• Five alerts received and responded this week, Two each were for AJS and Meningitis, while one for Per-tussis.

Figure-6: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 11 Aug 2011)

FATA:

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Province Balochistan:

• In this week, 18 districts reported to DEWS from Balochistan province. 459 health centers reported a total of 70,333 patient consultations.

• AD reported in 8,6247 (12%) of the total consulta-tions, 1% lower proportional morbidity as compared with last week.

• 22 alerts were reported in this week from Balochis-tan, five were for Leishmaniasis, three each for AD, measles and Pertussis, two for AWD, while one each for AJS, Chicken pox, malaria. Meningitis, mumps and Scabies.

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

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Current week's Alerts: Province Balochistan Date Disease District Area 5M 5F 9‐Aug AD Dera Bugti Rahim Yar Khan‐Sheikh Zayad Hospital(Sui) 0 1 0 0

11‐Aug AD Jhal Magsi DHQ Hospital 13 42 7 14

11‐Aug AD Ziarat Aghbargh 2 6 1 7

9‐Aug AJS Kech RHC Nasirabad 0 1 2 0

8‐Aug AWD Mastung Killi Bezani, Tehsil Kardegap 5 10 3 17

9‐Aug AWD Sibi Muhalla Allahabad Sibi 0 0 0 1

9‐Aug Chicken pox Ziarat Kochkai 0 0 1 0

11‐Aug Leishmaniasis Awaran Village Shikari, Camp Jahoo 0 0 1 0

11‐Aug Leishmaniasis Quetta New Pashtoon Abad 0 0 0 2

10‐Aug Malaria Jaffarabad BHU Ghot Allah Yar Khoso 7 14 11 17

9‐Aug Measles Awaran Peer Dan, Camp Jahoo 0 0 1 0

9‐Aug Measles Lasbela Meeran Khan Goth 0 0 1 0

7‐Aug Measles Nasirabad Ghot Jamal Khan Bugti, UC Quba sher khan 1 0 1 0

9‐Aug Meningitis Sibi Kut‐Mundai Sibi 0 0 1 0

9‐Aug Mumps Ziarat Cheena 1 0 0 0

8‐Aug Pertussis Chagai Killi Malik dinar Dramin UC Balanosh 0 1 0 2

8‐Aug Pertussis Jaffarabad DHQ Hospital, Dera Allah Yar 1 0 1 0

9‐Aug Pertussis Lasbela Cheezalabad, UC Baroot 0 0 1 0

7‐Aug Scabies Chagai Killi Ismaili langer UC Chilghazi 0 2 0 3

11‐Aug Leishmaniasis Jhal Magsi Villege patir BHU Gajan 0 0 0 1

10‐Aug Leishmaniasis Lasbela Bandica UC Winder 0 0 0 1

10‐Aug Leishmaniasis Quetta Hazara town, Berwary road 1 0 0 2

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

8‐Aug AWD Bagh Vill Makhyala UC Makhyala Tehsil Dhirkot 2 3 1 4

11‐Aug AWD Bagh Vill rangoli hans choki UC rangla the dhirkot 1 4 2 8

10‐Aug AWD Hattian Village Khalana, UC Chokothi, Hattian Bala 7 57 9 39

8‐Aug AWD Poonch village Ali Sojal UC Ali Sojal The rawalakot 0 1 0 0

10‐Aug AWD Poonch village Khori Channa UC Ali Sojal The rawalakot

2 5 2 7

11‐Aug Measles Bagh VillRai Na Khater UC Saliyan bagh 0 0 0 1

6‐Aug Measles Poonch Vill Aar gali UC Pachoot Poonch 1 0 0 0

9‐Aug Measles Poonch vill Chapra Ban UC Hurnamera Poonch 0 0 0 1

8‐Aug AWD Mohmand Agency

Baro Khail 0 1 0 0

8‐Aug AWD Mohmand Agency

Miangan Ghalanai 0 0 0 3

10‐Aug Leishmani‐

asis Bajaur Agency

UC Kotkai, Tehsil Salarzai 0 4 0 3

5‐Aug Measles Bajaur Agency

Village Tarkho, Tehsil Mamoond 1 0 1 0

11‐Aug AJS Diamir Bazar area MC Chilas 1 1 1 0

11‐Aug AJS Gilgit Village Jiglot sai Tehsil & District Gilgit 0 1 0 0

9‐Aug Meningitis Ghizer Village Tero UC Gulakhmuli Tehsil Gupis 0 1 0 0

12‐Aug Meningitis Skardu Village kundos khaplu ghanche 0 0 0 1

9‐Aug Pertussis Diamir Juglote Tangir 12 3 7 7

10‐Aug AWD Islamabad FG Polyclinic (G6/2) 0 0 0 2

13‐Aug AWD Islamabad FG Polyclinic (dalla Chirrah) 0 2 1 3

12

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AWD Leishmaniasis Measles Pertussis

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1 2 23 2

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AWD Leishmaniasis Malaria Measles Pertussis

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AWD Malaria Measles Pertussis

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Number of alerts detected by week, Punjab (Wk 29 ‐32, 2011

AWD Malaria Measles Pertussis

AWD, 63

Measles, 17

AD, 10 NNT+Tetanus, 10

Pertussis, 9

Meningitis, 8

Leishmaniasis, 7

BD, 6AJS, 3

DHF, 3

S. Malaria, 2

Scabies, 1

Chicken pox, 1

Mumps, 1

Distribution of alerts by disease, Wk 32 (4 ‐11 Aug, 2011) (n=141)



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

9‐Aug AD Kohat Vill. Togh Bala 4 8 6 9

8‐Aug AWD Abbotta‐bad

Village Hadora, UC Dalola 0 7 1 11

11‐Aug AWD Abbotta‐bad

Village Mera Hasnal, UC Seer 0 3 0 1

9‐Aug AWD Battagram Vill. Banjo baba, UC Gajjbori 2 3 1 3

10‐Aug AWD Battagram Vill. Shingli bala, UC Peshoora 0 0 0 1

10‐Aug AWD Battagram Vill.Bishkot Sayrai, UC Thakot 0 1 0 4

10‐Aug AWD Battagram Vill.Kocha, UC Pashto, Tehsil Allai 0 0 0 1

9‐Aug AWD Buner Vill Chinglai Jaffar Khel, Tehsil Thothalai 0 4 0 1

9‐Aug AWD Haripur Afghan Refugee Camp15, UC Panian 1 2 3 2

10‐Aug AWD Haripur Village Najafpur, UC Najafpur 3 11 4 24

9‐Aug AWD Kohat Village Bahadar Kot, UC Urban VI 0 1 0 0

5‐Aug AWD Kohistan Village Zaid Khar, UC Kameela, Tehsil Dassu 1 16 1 17

5‐Aug AWD Lower Dir Village Bar Kalay, UC & Tehsil Khall 0 1 0 3

9‐Aug AWD Lower Dir Village Almast, Osherey Darra 0 0 0 1

9‐Aug AWD Lower Dir Village Serao Kandao, UC Toor Mang, Tehsil Khall.

0 7 0 10

10‐Aug AWD Lower Dir A/R Taimar Camp, Timargara 0 1 0 0

10‐Aug AWD Lower Dir Mohalla Behren, Village Shirkhanai, UC Hayaserae, Tehsil Balmbat

1 0 0 2

10‐Aug AWD Lower Dir Village Dood Banno, Nasir Abad, Osherey Darra

0 0 0 2

8‐Aug AWD Mardan Mohallah Akhoon zadgan, UC Mayar 0 1 0 0

8‐Aug AWD Mardan Mohallah Maseti Colony, opp. MMC 1 0 0 0

8‐Aug AWD Mardan Mohallah Saudagar, UC Mohib Banda 0 1 0 0

11‐Aug AWD Nowshera Safi Abad, Near Jalozai IDP's Camp, C/O CAMP NGO Health Post

0 0 2 1

5‐Aug AWD Swabi DHQ Swabi, Mohallah Balar Khel, UC Marghuz 0 1 0 1

6‐Aug AWD Swabi RHC Yar Hussain, Mohallah New Mira Khel 1 0 0 0

8‐Aug AWD Swabi RHC Yar Hussain, Mohallah Zyam 0 1 0 0

10‐Aug AWD Swabi BMC, Mohallah Ibrahim Khel, UC Kunda 0 1 0 0

9‐Aug AWD Swat Masoom Shaheed Colony, UC & Tehsil Matta 0 1 0 0

9‐Aug AWD Swat Village Jurra, UC Pir Kaley, Tehsil Matta 0 1 0 0

10‐Aug AWD Swat Village Bazkhela, UC Dureshkhela,Tehsil Matta 0 0 1 0

11‐Aug AWD Swat Village Baalegram, UC Kokarai, Tehsil Babuzai 0 1 0 0

9‐Aug BD Haripur Afghan Refugee Camp 16, UC Panian 2 1 1 3

5‐Aug DHF Haripur Khalabut Township, UC Khalabut 0 0 0 1

5‐Aug DHF Peshawar Kuz Bahar Adda, Dehgaan,Khugiani, Nin‐garhar, Afghanistan

0 1 0 3

11‐Aug Leishmaniasis Shangla Kuzbat Kot 0 2 0 3

8‐Aug Measles Charsadda Vill Khasta, UC Shulgara 0 0 1 0

11‐Aug Measles Charsadda Vill. Daulat Pura 0 0 1 0

6‐Aug Measles Mansehra Battal 1 0 0 0

6‐Aug Measles Swat Village Khwazakhela,UC Khwazakhela and Tehsil Khwazakhela.

0 0 0 1

9‐Aug Pertussis Charsadda Vill Muslimabad, Station Koroona 0 0 1 0

Current week's Alerts: Province Sindh Date Disease District Area 5M 5F 9‐Aug AWD Dadu Street near Workshop, Ghareebabad colony 0 1 0 0

9‐Aug AWD Dadu Village Dari sallar, Near Phulji station 0 1 0 1

11‐Aug AWD Hyderabad Bhains colony, Madina Tawn, new Sabzi 1 0 2 1

5‐Aug AWD Karachi Akbari Muhalla near Akbari Masjid, Pathan 0 1 1 0

10‐Aug AWD Kashmore Village Taj Mohammad, UC Tangwani 4 1 0 0

11‐Aug AWD Larkana Village Barani 1 0 0 0

11‐Aug AWD Larkana Village Wakro, Tehsil Dokri 1 0 0 0

8‐Aug AWD Qambar Shahdadkot

Village Bhambho Khan Chandio, Miro Khan 0 2 0 0

11‐Aug AWD Qambar Qubo Saeed Khan UC, Tehsil Shahdadkot 7 2 5 2

11‐Aug AWD Tando Muham‐Village Bachal khan Lagwani, UC Lakhat 0 1 0 2

10‐Aug AWD Thatta RHC Chouhar Jamali taluka Shah Bunder 1 0 0 0

5‐Aug DHF Naushahro Feroze

Village Lundo Mori, UC Saeedpur, Tehsil Mehrabpur

1 2 0 1

9‐Aug Measles Ghotki Channa Muhallah near Babri Masjad Umar 1 0 0 0

8‐Aug Measles Karachi St # 68. Urdu Bazar Shershah, Kemari Town 0 0 0 1

9‐Aug Measles S. Benazirabad Sher Muhammad Colony, UC Kazi ahmed 0 0 1 0

6‐Aug Measles Tharparkar Village Mathrio junejo, UC Satidera, Taluka Nagarparkar

1 0 0 0

8‐Aug Meningi‐

tis Ghotki Village Bhishti Lashkar Khan UC Hussain Beli 1 0 0 0

11‐Aug Meningi‐

tis Jacobabad Gul Hospital 3 0 0 0

8‐Aug NNT Ghotki Village Saindad Indhar, UC Bago Daho 1 0 0 0

11‐Aug NNT Ghotki Village Sabar Bozdar, UC Gari Chakar 1 0 0 0

9‐Aug NNT Karachi Neonatal ICU, NICH 1 0 0 0

9‐Aug NNT Khairpur Village Mehar Ali Bugti, UC Chondiko, Tehsil Nara

1 0 0 0

6‐Aug Pertussis Jamshoro Shoro village, UC Sonwallar 3, Taluka Kotri 2 2 1 3

6‐Aug Pertussis S. Benazirabad Village Ferry Khan Jamali, UC Bandhi taluka daur

1 0 0 0

6‐Aug Pertussis S. Benazirabad Village Sobho Jamali, UC Ameerji taluka daur 1 0 2 0

6‐Aug Pertussis Tharparkar Village Mathrio junejo, UC Satidera, Taluka Nagarparkar

0 2 0 1

9‐Aug Tetanus Shikarpur Shikarpur 0 1 0 0

11‐Aug Tetanus Sukkur Village Ali Wahan, Tehsil Rohri 0 1 0 0

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

6‐Aug AD Layyah BHU Shahpur tehsil karoor 13 11 16 10

8‐Aug AD RY Khan Sh Zayed Hospital 0 0 0 2

9‐Aug AD RY Khan 55 NP, Tehsil Rahim Yar Khan 13 9 12 17

9‐Aug AD RY Khan Tibbi Gul Mohd, Tehsil RYKhan 17 26 19 24

10‐Aug AD RY Khan UC Allahabad, Tehsil Liaqatpur 8 12 11 10

11‐Aug AD RY Khan UC Sehja tehsil Khanpur 6 4 9 11

11‐Aug AWD D. G. Khan Basti Saadkani Moza Gadai Sharqi uc Khakhi 1 0 0 0

9‐Aug AWD Multan Bohar gate, qadeerabad 0 0 0 1

8‐Aug AWD Muzaffargarh Basti Ghulam Ali, Chowk Ghulam ali Wala, UC Gul Wala

0 0 0 1

11‐Aug AWD Muzaffargarh Basti Luphey Wala, Moza Deenpur, UC Jaggatpur

0 1 0 0

11‐Aug AWD Muzaffargarh Basti Peerwala, Liaqatabad, UC Gerey Wahin 0 1 0 0

11‐Aug BD Bhakkar Mohallah Eid Gah Behal, UC Behal 0 2 0 1

8‐Aug BD Layyah Moaza sehar U/c Sahoo wala 1 0 2 0

11‐Aug BD Mianwali Mohallah Imam Kot , UC Dub Baloochan, Piplan

1 1 1 1

11‐Aug BD Mianwali Near Railway track,village Thathi, UC Thathi 1 0 1 1

10‐Aug BD RY Khan Khanbela, Tehsil Liaqatpur 2 3 1 2

9‐Aug Malaria D. G. Khan UC Samina 3 3 3 3

10‐Aug Measles Khanewal Multan (Sehwan Yar Shah Wala, Tehsil Main Channu)

0 1 0 0

6‐Aug Measles Muzaffargarh AES Lalpir coloney, UC Budh, Kotaddu 0 1 0 0

9‐Aug Meningitis D. G. Khan Basti Hairo Sharqi Taunsa 0 0 0 1

10‐Aug Meningitis Multan st # 14 Zakria town 1 0 0 0

10‐Aug Meningitis Rajanpur Multan (Basti Hajur,Post office Dajal, Tehsil Jampur)

0 1 0 0

5‐Aug NNT D. G. Khan BMP Post Basti Manka Sobhannee uc Fazla Katch

0 0 1 0

9‐Aug NNT Layyah ward no 6 Fateh pur urban tehsil karoor 0 0 1 0

8‐Aug Tetanus RY Khan Basti Kandeer Choki, Bangi 62, Manthar, Tehsil RYKhan

0 1 0 0

8‐Aug Tetanus Rajanpur Rahim Yar Khan (Soun Miani Tehsil Rojhan, Rajanpur)

1 0 0 0



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: The total number of polio cases confirmed by the laboratory is 69 (68=type‐1, and 1=type3) till date from 28 districts.

Focus on: Basic messages about cholera treatment and prevention

Through collaboration of the Ministry of Health at district and provincial levels, NIH and the Disease Early Warning System (DEWS) teams supported by WHO, cholera has been detected and controlled in all provinces of the country. DEWS teams respond to calls from health providers reporting cases of suspected cholera: “severe dehydration or death due to acute diarrhea in a person over age five years old.” Severe cholera is characterized by a sudden onset of profuse, watery diarrhea along with nausea and vomiting. Cholera diarrhea can look like cloudy rice water. Chol‐era can cause death from dehydration (the loss of water and salts from the body) within hours if not treated. With prompt, effective treatment, mortality is less than 1%, but without treatment 50% of the most severe cases die within a few hours.

Treatment Any person with diarrhea should drink more fluids, such as water, juice, and soup. The best drink is a balanced so‐lution of sugar and salts called ORS (oral rehydration salts) which is provided at public health facilities or can be purchased in the market and mixed with safe water to provide quick fluid replacement. Zinc supplement is also rec‐ommended. If diarrhea is continuous or vomiting prevents drinking fluids, the patient should go urgently to a hospi‐tal or clinic to receive intravenous fluids. Patients who are promptly treated respond rapidly and recover.

Prevention Cholera is spread via the fecal‐oral route, most commonly by drinking water or eating food which is contaminated by sewage. Always be sure you are drinking water which has been tested for quality – filtered, chlorinated, or bot‐tled. Avoid ice in restaurants and drinks and ice cream sold in the market because they may not be made with safe water. “Boil it, cook it, peel it or leave it” is good advice about raw fruits and vegetables in countries endemic for cholera. Cook food well, eat it hot, keep it covered, and peel fruits and vegetables. Wash hands after using the toi‐let and before eating, or use an antiseptic hand gel.

Figure‐7: Weekly number of reporting health facilities (Wk 33/2010 to Wk 32/2011) Table‐2: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 11 August 2011, compiled from weekly reports

Diseases Total Skin Diseases 4,373,347 (11%) Acute Respiratory Infection 9,237,583 (23%) Acute Diarrhoea 3,818,282 (9%) Bloody Diarrhoea 347,034 (1%) Suspected Malaria 2,369,213 (6%) Unexplained Fever 1,545,346 (4%) Total Consultations 40,534,326

Province Cases 2010 Cases 2011 P1 P3 P1 P3

Punjab 6 1 - -

Sindh 26 1 14 -

Khyber Pakhtunkhwa 19 5 6 -

FATA 63 11 21 1

Balochistan 6 6 26 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 68 1

949

1073

1143

1111

1130

1158

1167

1113

1067

999

879

854

967

1289

121

5146

317

9716

80202

2202

122

6223

49

225

521

99

2251

2322

2450

246

624

0425

4727

85274

529

09293

529

8231

2030

21

3022

3058

3196

325

032

15325

933

5433

75

3363

3234

325

9325

1309

2328

830

99361

375 411

331

400

215

192

153

128

105

81 58 46 26

2611

8 128 1111 11 11 8 8 88 8 8 66 6 13 8 6 6 7 7 7 87 7 36 6 6 2 2

0

500

1000

1500

2000

2500

3000

3500

4000

Wk 33

Wk 35

Wk 37

Wk 39

Wk 41

Wk 43

Wk 45

Wk 47

Wk 49

Wk 51

Wk 1‐11

Wk 3

Wk 5

Wk 7

Wk 9

Wk 11

Wk 13

Wk 15

Wk 17

Wk 19

Wk 21

Wk 23

Wk 25

Wk 27

Wk 29

Wk 31

Mobile Fixed



Alerts and outbreaks, week 32, 2011

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Weekly Epidemiological - WHO...Epidemiological Bulletin: DEWS, Pakistan, Week no. 32 (5 to 11 August, 2011) This weekly Epidemiological Bulletin is published jointly by the National