Weekly Epidemiological - WHO

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. 39 (23 - 29 September, 2011)

• 81 districts and 3 agencies provided surveillance data to the DEWS this week from 2,609 health facilities.

• A total of 983,250 consultations were reported through DEWS of which 21% were acute respiratory infections (ARI), 11% Skin disease, 11% acute diarrhoea, and 8% suspected Malaria.

• A total of 287 alerts with 19 outbreaks were reported in week-39, 2011: Altogether 168 for DHF; 54 were for AWD; 19 for Leishmaniasis; 17 for Neonatal Tetanus and Tetanus; 15 for Measles; 4 for Malaria; 2 each for Diphtheria, Pertussis, Typhoid and Chicken pox; while 1 each for CCHF and Mumps.

• National Polio Eradication Initiative reported 9 new type-1 confirmed polio cases this week: One each from Killa Abdullah, Pishin, Quetta and Loralai (districts in Balochistan) Karachi and Badin (districts in Sindh), Upper Dir (Khyber Pakhtunkhwa), North Waziris-tan (FATA) and Lodhran (Punjab). As of 29 September, 2011, Pakistan has reported a to-tal of 100 polio cases (99 type-1 cases & 1 type-3 case) from 37 districts/towns/tribal agen-cies/areas.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 39, Monday 03 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: Three years trend of Acute diarrhoea in Pakistan (2009, 2010, and 2011 up till week 39)

Disease Wk-32 Wk-33 Wk-34 Wk-35 Wk-36 Wk-37 Wk-38 Wk-39

Acute Diarrhoea 106,918 (10%) 101,174 (10%) 94,494 (11%) 40,403 (10%) 96,128 (11%) 109,476 (12%) 110,466 (11%) 104,320 (11%)

Total consultation 1,040,292 988,119 880,166 389,729 864,693 930,999 1,001,763 983,250

Since July 29, 2010, approximately 46,582,048 patient consultations have been reported to the DEWS from all provinces and three agencies and state of AJK. In this week 39, 2011 (23 to 29 September, 2011) reports were received from 2,609 health facilities and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases 104,320 (11%), acute respiratory infections 202,956 (21%), Skin diseases 105,505 (11%) and suspected malaria 83,294 (8%). 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

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. 39 (23 to 29 September, 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 <5M >5M <5F >5F Action Taken

28‐Sep Measles Balochistan Mastung Killi rahim Abad, ghancha Dhori

1 0 3 1

One case of suspected Measles was admitted with post measles complication (Pneumonia) at BMCH. The case is getting treatment and has received Vit. A. Sample was taken and sent to NIH. On field investigation 4 other cases were found. Non of the child was vaccinated (nomadic fami‐lies). Vit. A given to all the children and blood samples collected. Clinically it is an outbreak. DHO Mastung was informed and requested for vaccination in the area.

28‐Sep Typhoid Balochistan Chagai BHU chatter U/C Padag

0 2 1 4 7 cases of typhoid fever were reported. Investigation was done. Aqua tabs were distributed in the affected family. Health education session conducted in community to use boiled water.

29‐Sep Typhoid Balochistan Lasbela Halima Hospital UCPathira HUB

1 19 1 26 47 suspected cases of typhoid fever were reported. Among them 29 cases were positive after Typhi dot test. Field investigation and preventive activities are going on.

28‐Sep DHF Balochistan Quetta Fatima Jinnah Chest Hospital, Quetta

0 1 0 0

one case of Dengue Fever was reported from isolation ward of Fatima Jinnah Chest Hospital Quetta. Case was attended. Patient had 5 days fever history. the patient was studying from Lahore and habitant of Zhob, later on brought to Quetta. On Lab investigation; dengue fever was confirmed. patient is getting improved. (first case in Quetta)

29‐Sep Pertussis Gilgit‐Baltistan

Diamer FAP Loshi 10 1 5 0

FAP Loshi reported five patients of suspected Pertussis. On field investigation 11 more cases found. None of the child was vaccinated in the area. Syp. Erythromycin provided to cases and close contacts. Health education session conducted in the local school about the importance of vaccination and about isolation of the patients. Knowledge shared with the dispenser of health facility about the vaccination schedule and management of cases.DHO health informed about the issue. DHO health deployed the vaccination team to the locality for vaccination of unimmunized children.

26‐Sep AWD Khyber Pakhtunk‐hwa

Lower Dir Village sorai, UC Kambat, Tehsil Samar Bagh

0 2 0 12

An outbreak having 14 cases of AWD (8 were severely dehydrated) was reported, cases were Investigated, Stool sample collected for lab confirmation, ORS, Hygiene kits & Aqua tabs were provided to the affected family members and surrounding community, Health & Hygiene promo‐tion Session conducted with family members. On active Surveillance 33 more cases of diarrhoea were found in the surrounding areas. EDO H Informed , RRT assigned in the affected areas for 5 days with daily reporting. HRDS was also involved in response.

29‐Sep DHF Punjab D. G. Khan Basti Peehar uc More Jhangii tehsil Taunsa

0 4 0 0

6 suspected cases of DHF were reported from the same location of DG Khan. The details are shared with the EDOH DG Khan. dengue awareness sessions were conducted . fogging of the area is done by a CDC team from the health department. Isolation and treatment of the patient started. Further investigation underway.

29‐Sep DHF Punjab Khanewal NHM (Khanewal) 0 17 0 1

18 Patients with DF reported at Nishter Hospital Multan from different locations of Khanewal district and mostly from the rural areas. The patients have history of either travel or stay at Lahore in recent past or an established epidemiological link with Dengue patient. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department informed at district Khanewal and provincial level. Follow up is on going.

29‐Sep DHF Punjab Multan Nishter Hospital Multan‐ Multan City

0 26 0 6

32 Patients with DF reported at Nishter Hospital Multan from different locations of Tehsil Multan and mostly from the city areas. Patients have history of either travel or stay at Lahore in recent past or an established epidemiological link with Dengue patient. 6 cases are indigenous to Mul‐tan and no travel history. Necessary measures at hospital ensured. All the locations were visited by WHO team and DoH staff. Active case finding of the area done in the respective localities. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Follow up is on going.

29‐Sep DHF Punjab Muzaffar‐garh

NHM (Muzaffargarh)

0 17 0 1

18 Patients with DF reported at Nishter Hospital Multan from different locations of Muzaffargarh district and mostly from the rural areas. All of them have history of either travel or stay at Lahore in recent past . Respective health authorities were informed. IRS and fumigation was conducted in the areas. HE to the family and community members done. Health department and SO in‐formed at district Muzaffargarh and provincial level. Follow up is on going.

29‐Sep DHF Punjab Vehari NHM (Vehari) 0 11 0 1

12 Patients with DF reported at Nishter Hospital Multan from different locations of Vehari district and mostly from the rural areas. The patients have history of either travel or stay at Lahore in recent past. Respective health authorities were informed. IRS and fumigation was conducted in the areas. HE to the family and community members done. Health department informed at district Vehari and provincial level. Follow up is on going.

24‐Sep AWD Sindh Jamshoro Village Khuda Buksh, UC Taung , Thano Bola khan

2 2 3 4 11 cases of diarrhoea reported. Reinforced case management, Active Surveillance done, Health education, Aqua tabs, Zinc tabs, Hygiene kits, ORS and Jerry cans distributed, EDO‐H informed, 2 Stool sample and 3 water sample collected for laboratory test..

27‐Sep AWD Sindh Khairpur Private center Pir Jo Goth, taluka Kingri

0 3 2 1 6 AWD cases admitted in DHQ hospital with sever dehydration, WHO SO DEWS provide assis‐tance and 1 stool sample collected. Case management reinforced, field investigation is in pro‐gress.

23‐Sep AWD Sindh Naushahro Feroze

Ward # 1, Tha‐roshah City‐2

3 1 2 0 6 suspected cases of AWD admitted in hospital with complaint of severe dehydration, hospital investigation completed, field investigation in progress.

27‐Sep AWD Sindh Naushahro Feroze

Village Pahlwan Khoso, UC New Jatoi, Moro

2 3 1 0 6 AWD cases admitted in DHQ N Feroze with sever dehydration, WHO SO DEWS provide assis‐tance and 1 stool sample collected. Further investigation and response activities in progress.

24‐Sep AWD Sindh Tharparkar Village Jetrar, UC Tar Ahmed, Taluka Chachro

1 6 3 7 Responding to AWD alert. Active surveillance done in the village 17 cases with 6 deaths were reported. Case management reinforced, Health education session conducted in the community. Aqua tabs and ORS distributed, EDO‐H informed. Situation is now under control.

28‐Sep Leishmani‐

asis Sindh Jacobabad

Manohar hospital Seetlani

1 2 1 0 Responding to an alert, 7 more cases found on active search, patient given bed net health hy‐giene session done reported to EDOH. WHO provided treatment (supplied medicines) for all the patients.

24‐Sep Malaria Sindh Larkana Village kothi talka larkana

10 3 4 2

BHU Kothi in its weekly Malaria report shared that 13 out of 16 cases were positive (10 Vivax and 3 PF) (SPR= 81%. On field investigation BHU record verified and 3 more cases were found. All the cases were reported from three adjacent villages. Vector control response is planned for the villages.

28‐Sep Malaria Sindh Sukkur BHU Hussain Kalwar, taluka Pano Akil

1 6 3 0 Investigation done and record verified of facility, response is planned for village, information shared to EDOH, MCP and issued falciparum treatment to the affected cases through EDOH Sukkur.



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

28‐Sep AWD Quetta Kili sabzal, Kharot abad 0 0 0 1

28‐Sep AWD Quetta Killi Brahimzai, Brewery Road 0 0 1 0

28‐Sep CCHF Quetta Fatima Jinnah Chest Hospital 0 4 0 1

23‐Sep Chicken Pox Jhal Magsi Jhal Magsi near petrol pump 0 1 2 1

26‐Sep Chicken Pox Panjgur Union Council ,Washbood 0 9 0 2

24‐Sep DHF Jaffarabad Abro Muhallah, Murad Colony 0 1 0 0

29‐Sep DHF Jaffarabad Nasrullhah Colony, Usta Mohammad Road 0 1 0 0

24‐Sep DHF Loralai Nishtar Hospital Multan 0 1 0 0

28‐Sep DHF Quetta Fatima Jinnah Chest Hospital 0 1 0 0

27‐Sep Leishmaniasis Bolan Village mashkaf, tehsil Dhadar 0 1 0 0

24‐Sep Leishmaniasis Jhal Magsi goth mangiani, UC patri, BHU Gajan 1 0 0 0

26‐Sep Leishmaniasis Jhal Magsi Goth Shahal Abd Khanpur 1 0 0 0

26‐Sep Leishmaniasis Jhal Magsi Qazi Mohalla, UC Gandawah 1 0 0 0

27‐Sep Leishmaniasis Khuzdar Chapootaro UC Zeedi tehsil Khuzdar 0 1 0 0

27‐Sep Leishmaniasis Khuzdar Sunni UC Khand Tehsil Khuzdar 0 1 0 0

28‐Sep Leishmaniasis Khuzdar Jaffar Abad UC Baleena Kattan 0 1 0 0

28‐Sep Leishmaniasis Lasbela Askani MohlaUC AllahAbad,HUB 0 1 0 0

28‐Sep Measles Mastung Killi rahim Abad, ghancha Dhori 1 0 3 1

29‐Sep Leishmaniasis Lasbela Rest house Mohalla UC,Tehsil Bela 0 0 0 1

28‐Sep Leishmaniasis Panjgur Union council Chitkan 0 1 0 0

30‐Sep Leishmaniasis Quetta Hazara town, Brewery road 0 1 0 2

30‐Sep Leishmaniasis Quetta New Pashtoon Abad 1 1 0 1

23‐Sep Leishmaniasis Sibi Azad khan street, UC#1 Luni road 0 0 1 0

23‐Sep Leishmaniasis Sibi Village Talli, UC Talli 0 0 0 1

28‐Sep Leishmaniasis Sibi Muhalla Allabad, UC#4 0 1 0 0

30‐Sep Leishmaniasis Ziarat Aghbargh 0 0 0 1

28‐Sep Measles Panjgur Union Council Tasp 0 0 2 0

26‐Sep NNT Bolan Village Bagh, Tehsil Bagh 0 0 1 0

28‐Sep Tetanus Khuzdar Sardari Shehr UC Zeedi Tehsil Khuzdar 0 0 0 1

28‐Sep Typhoid Chagai BHU chatter U/C Padag 0 2 1 4

29‐Sep Typhoid Lasbela Halima Hospital UCPathira HUB 1 19 1 26

Current week's Alerts: Province Sindh (Cont’d) Date Disease District Area <5M >5M <5F >5F 29‐Sep DHF Benazirabad Village Anwar Magsi, near Magsi stop 0 1 0 0

23‐Sep DHF Sukkur Hassan Chowk, Old Sukkur 0 1 0 0

23‐Sep DHF Sukkur Mian dad Khoso, site area 0 0 0 1

28‐Sep DHF Sukkur Garam Godi 0 1 0 0

26‐Sep DHF TA Yar Pathan Colony City Tando Allahyar 1 0 0 0

26‐Sep DHF TA Yar Village Porho 0 0 0 0

28‐Sep DHF TA Yar Village Jam Khan Laghari, UC Dad Janwan 0 1 1 3

29‐Sep DHF TA Yar Village Vanghi Otho, Taluka Chambar 0 0 0 0

26‐Sep DHF Tharparkar Village Tagoosar, UC Tagoosar 0 1 0 0

26‐Sep DHF Thatta Memon Mohalla chouhar Jamali 0 0 0 1

27‐Sep DHF Thatta Village Bilawal Dal taluka thatta 0 1 0 0

26‐Sep DHF Umer Kot Village Tagoosar 0 1 0 0

28‐Sep Leish. Jacobabad Manohar hospital Seetlani 1 2 1 0

24‐Sep Malaria Larkana Village kothi talka larkana 10 3 4 2

28‐Sep Malaria Sukkur BHU Hussain Kalwar, taluka Pano Akil 1 6 3 0

28‐Sep Malaria Thatta Memon Mohalla Darro City 0 1 2 3

28‐Sep Malaria Thatta Village Haji Chutto Jalalani Jhoke Shareef 1 1 1 2

29‐Sep Measles Ghotki Village Mohammad Ali Bozdar, UC Jarwar 2 3 1 0

26‐Sep Measles Hyderabad Nabibux village 1 0 0 0

26‐Sep Measles Hyderabad Village Nabi Buksh Panhwar 0 1 0 0

23‐Sep Measles Umer Kot H.No.B‐66,WAPDA office road 1 0 0 0

26‐Sep NNT Karachi Umar Farooq Colony, Dislwa Town 1 0 0 0

28‐Sep NNT Karachi C Area, Qayumabad near Jamia Masjid 1 0 0 0

28‐Sep NNT Karachi Sector 32 C, Zia Colony, Korangi No, 1 1 0 0 0

28‐Sep NNT Karachi UC Kalakot Goth, Bajora 0 0 1 0

23‐Sep NNT N Feroze Village Lalu, UC Darya Khan Mari 0 0 1 0

26‐Sep NNT Qambar Village Gabi dero talka 1 0 0 0

28‐Sep NNT Qambar Village Shahbeg Chandio Talka Mirokhan 0 0 1 0

23‐Sep NNT Benazirabad Village Dorai Maher 0 0 1 0

29‐Sep NNT Shikarpur Village Dhani Bux Marfani 1 0 1 0

24‐Sep Mumps Larkana Village jhangara UC Kothi Talka Larkana 1 8 2 5

23‐Sep NNT Ghotki Village: Gaimro 0 0 1 0

23‐Sep NNT Ghotki Village: Kalu Khan Sangi UC Bandh 0 0 1 0

23‐Sep NNT Ghotki Village: Mazari Kolachi UC Adilpur 0 0 1 0

27‐Sep NNT Ghotki Village: Sikandar Pitafi UC Keejhar 0 0 1 0

26‐Sep NNT Karachi Katchi Abadi, Madina colony, Sohrab goth 0 0 1 0

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

28‐Sep AWD Badin village M.moosa Jamal, UC khadharo 1 2 0 0

27‐Sep AWD Dadu Village Jam Babar UC Sawro Taulka Johi 0 0 0 0

23‐Sep AWD Jamshoro Bahatti Colony, UC Nazo line Taluka Kotri 0 0 0 1

24‐Sep AWD Jamshoro Village Khuda Buksh, UC Taung 2 2 3 4

26‐Sep AWD Karachi Q Area, Korangi 2, Korangi Town 0 2 0 2

27‐Sep AWD Karachi Quarter No. 3, Manora cantt, Kemari Town 0 1 1 0

27‐Sep AWD Kashmore Near Jamia Masjid, Kashmore 0 0 1 0

27‐Sep AWD Khairpur Private center Pir Jo Goth, taluka Kingri 0 3 2 1

24‐Sep AWD Larkana Village Haji Mashori Talka Dokri 0 2 0 1

29‐Sep AWD Larkana Siraj Gadhi Muhalla Dokri city 0 1 0 1

27‐Sep AWD Matiari New SaeedAbad City, Mochi para 0 0 0 1

27‐Sep AWD Matiari Village Hote sujal, Taluka New saeedabad 0 1 0 0

27‐Sep AWD Matiari Village Ilyas Abrejo, Taluka New Saeedabad 0 1 0 0

27‐Sep AWD Mirpur Khas H.No.17/1,Malik Baboo Thabba Mohalla, 0 0 0 1

27‐Sep AWD Mirpur Khas Village Gulsher Gorchani 0 1 0 0

27‐Sep AWD Mirpur Khas Village Mubarik Noohani,UC.Kangoro 0 0 0 1

27‐Sep AWD Mirpur Khas Villlage Tulsi Paro 0 0 0 1

29‐Sep AWD Mirpur Khas Village Allah Rakhio Gorchani 0 1 0 0

29‐Sep AWD Mirpur Khas Village Mubarik Khaskheli,UC.Mir Imam bux 0 1 0 0

23‐Sep AWD N Feroze Ward # 1, Tharoshah City‐2 3 1 2 0

24‐Sep AWD N Feroze Village Moosa Khan Rajper UC Koor Hassan 0 1 0 0

25‐Sep AWD N Feroze DHQ Naushahero Feroze 0 0 0 1

25‐Sep AWD N Feroze Rajput Mohalla 0 1 0 0

27‐Sep AWD N Feroze Village Pahlwan Khoso, UC New Jatoi, Moro 2 3 1 0

28‐Sep AWD N Feroze Village Jalbani Tehsil Bhiria 0 0 0 1

26‐Sep AWD Qambar Village Norgahi UC Jean abro 1 0 1 1

29‐Sep AWD Sanghar THQ Tando Adam 4 0 0 0

23‐Sep AWD Shikarpur Khan chandabad colony 1 0 1 0

28‐Sep AWD TA Yar IDP Camp higher secondry school camp 0 0 2 3

27‐Sep AWD TM Khan Village Janan Soomro, UC Janan Taluka Bhulri 0 0 0 1

23‐Sep AWD Tharparkar Village Bangeret, UC Mirwah, 0 2 0 0

24‐Sep AWD Tharparkar Village Jetrar, UC Tar Ahmed, Taluka Chachro 1 6 3 7

24‐Sep AWD Tharparkar Village Khario Fazal, UC Kheenser 0 0 0 1

26‐Sep AWD Thatta Mallah Mohalla Chuhar Jamali 0 2 0 0

26‐Sep AWD Thatta Village Haji Waro Khaskhali 0 2 0 0

26‐Sep AWD Thatta Village Jungo Jalbani Shah Bunder 1 1 1 1

28‐Sep AWD Thatta Village Bhalo Parahyar UC DKS Mirpur Bathoro 1 1 1 2

28‐Sep AWD Umer Kot IDPs camp,near Ratnore Road,UC.Gharbabad 0 0 0 1

28‐Sep AWD Umer Kot IDPs camp,near Walhar 0 0 0 3

28‐Sep AWD Umer Kot Nohri Mohalla,Hyderfarm,UC.Khejrari 0 0 0 1

28‐Sep AWD Umer Kot Village Kumbar Paro,Ward‐311,UC.Gharibabad 0 0 0 1

28‐Sep AWD Umer Kot Village Wania Paro 0 0 0 2

27‐Sep DHF Badin Village haji G.Hussain Lail, Uc Pangrio 0 1 0 0

23‐Sep DHF Ghotki Village Ali Mahar UC Mithri 0 1 0 0

27‐Sep DHF Ghotki Village Jhanpur UC Ali Bag 1 0 1 0

27‐Sep DHF Ghotki Village New Wahi 0 0 0 1

27‐Sep DHF Ghotki Village Rafique Ahmed Pitafi Masoo Wah 1 0 0 0

27‐Sep DHF Ghotki Village Yakhtiar Pitafi UC Keejhar 0 0 1 0

29‐Sep DHF Ghotki Rahim Yar Khan (Ubaro Distt. Ghotki) 0 1 0 0

24‐Sep DHF Hyderabad Paramedics LUH colony 0 0 4 0

24‐Sep DHF Hyderabad Peramedic Colony, LUMHS 0 1 0 0

26‐Sep DHF Hyderabad Civil Hospital 0 6 0 1

26‐Sep DHF Hyderabad civil Hospital, LUMHS 0 0 7 0

28‐Sep DHF Hyderabad civil Hospital, LUMHS 0 0 9 0

29‐Sep DHF Hyderabad CIVIL HOSPITAL LUH Isra universty 0 0 4 0

23‐Sep DHF Khairpur Village Moosani, taluka Khairpur 0 1 0 0

25‐Sep DHF Khairpur Near Mehar Shah, taluka Kingri 0 1 0 0

27‐Sep DHF Khairpur Village Arab Machhi, UC Kumb, taluka Kot Diji 0 0 0 1

29‐Sep DHF Khairpur Village Qabool Khan Gopang 0 1 0 0

29‐Sep DHF Khairpur Village Qadam Maitlo, UC Ahmedpur 0 1 0 0

29‐Sep DHF Khairpur Village Rahooja, UC Manghanwari 0 1 0 0

29‐Sep DHF Khairpur Village Uberhi, UC Baberloi, taluka Khairpur 0 1 0 0

29‐Sep DHF Larkana Village sher Khan Jatoi talka bakrani 0 1 0 0

26‐Sep DHF N Feroze Ward # 13, Latif Colony, Moro 0 1 0 0

28‐Sep DHF N Feroze Bhiria city, DHQ N Feroze 0 1 0 0

28‐Sep DHF N Feroze Village Saleemabad, Kandiyaro City 0 1 0 0

29‐Sep DHF N Feroze Mithiani City, UC Mithiani 0 1 0 0

29‐Sep DHF N Feroze Village Bago Dero, UC Abad 0 1 0 0

29‐Sep DHF Qambar village peer Ali shah UC Abad talka warah 0 1 0 0

27‐Sep DHF Benazirabad Kamala Colony, UC‐6, Taluka Nawabshah 0 1 0 0

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

24‐Sep AWD Bhakkar Chak Number 205 TDA, UC 60‐61 ML 0 1 0 0

24‐Sep AWD Bhakkar Chak Number 208 TDA, UC 60‐61 ML 0 0 0 1

28‐Sep AWD MZG Basti Beriwala, UC Baseera 0 1 0 0

23‐Sep DHF Bhakkar DHQ Hospital Bhakkar, Bhakkar City 0 0 0 1

24‐Sep DHF Bhakkar DHQ Hospital Bhakkar 0 1 0 0

24‐Sep DHF Bhakkar DHQ Hospital Bhakkar, Cheena 0 1 0 0


24‐Sep DHF Bhakkar DHQ Hospital Bhakkar, Gadola 0 0 0 1

25‐Sep DHF Bhakkar DHQ Hospital Bhakkar, Bhakkar City 0 2 0 0


27‐Sep DHF Bhakkar DHQ Hospital Bhakkar, Kalur Kot 0 2 0 0


28‐Sep DHF Bhakkar DHQ Hospital Bhakkar, DHQ Colony 0 1 0 0


29‐Sep DHF Bhakkar NHM (Bakhar) 0 1 0 0

26‐Sep DHF D. G. Khan Basti Malangwali Moza Hoti Thana Djal 0 1 0 0

29‐Sep DHF D. G. Khan Basti Peehar uc More Jhangii tehsil Taunsa 0 4 0 0

29‐Sep DHF D. G. Khan NHM (DG Khan) 0 2 0 0

29‐Sep DHF Jhang NHM (Jhang) 0 2 0 1

29‐Sep DHF Khanewal NHM (Khanewal) 0 17 0 1

29‐Sep DHF Lahore NHM (Lahore) 0 1 0 0

24‐Sep DHF Layyah MOHALLAH EIDGAH WARD NO 4 0 0 0 1

24‐Sep DHF Layyah WARD NO 1 MULTAN ROAD CHOWK AZAM 0 1 0 0

25‐Sep DHF Layyah BASTI BAGHWALA PHARPUR NASHEEB 0 1 0 0

25‐Sep DHF Layyah MOHALAH AHMAD ALI OULAKH URBAN 2 0 1 0 0

26‐Sep DHF Layyah WARD NO 2 URBAN 2 KAROOR 0 1 0 0

28‐Sep DHF Layyah CHAK NO 171 U/C 172 0 1 0 0

29‐Sep DHF Layyah BHAIT GUJJI U/C WARA SEHRA 0 0 0 1

29‐Sep DHF Lodhran NHM (Lodhran) 0 4 0 1

26‐Sep DHF Mianwali Chak20DB,Piplan 0 1 0 0

26‐Sep DHF Mianwali Moh Ibraheem Abaad 0 1 0 0

27‐Sep DHF Mianwali hussain abad Daudkheel 0 1 0 0

28‐Sep DHF Mianwali Afghan Refugee camp Kotchandna IssaKhel 0 1 0 0

28‐Sep DHF Mianwali Mohallah Allou walla,Pacca Gujran 0 1 0 0

29‐Sep DHF Multan Nishter Hospital Multan‐ Multan City 0 26 0 6

23‐Sep DHF MZG Thermal Power Plsnt 0 0 0 1

26‐Sep DHF MZG Izafi basti, UC Sinanwan, Tehsil Kotaddu 0 1 0 0

26‐Sep DHF MZG Nearby Jhang Mor, Mohallah Qayyum Nagar 0 1 0 0

29‐Sep DHF MZG NHM (Muzaffargarh) 0 17 0 1

29‐Sep DHF Pakpattan NHM (Pakpattan) 0 1 0 0

23‐Sep DHF R Yar Khan Airport Road City RYK 0 1 0 0

23‐Sep DHF R Yar Khan Block X Scheme No. 3 Gulshan‐e‐Iqbal 0 1 0 0

23‐Sep DHF R Yar Khan Ranger H/Q City 0 1 0 0

23‐Sep DHF R Yar Khan Y Block Gulshan‐e‐Iqbal 0 1 0 0

23‐Sep DHF R Yar Khan Zahid House Iqbal Nagar Street No.4 City RYK 0 1 0 0

24‐Sep DHF R Yar Khan Airpot Chowk Rashiadabad City RYK 0 1 0 0

24‐Sep DHF R Yar Khan Basti Bapran, Mouza Dari Azeem Khan 0 1 0 0

24‐Sep DHF R Yar Khan Karim Public School Iqbal Nagar City RYK 0 1 0 0

24‐Sep DHF R Yar Khan Old Sadiqabad City City Sadiqabad 0 1 0 0

25‐Sep DHF R Yar Khan Basti Bulaqiwali Sheikh Wahin 0 1 0 0

25‐Sep DHF R Yar Khan Chak 138/P Tehsil Rahimyarkhan 0 1 0 0

26‐Sep DHF R Yar Khan Block Y Gulshan Iqbal 0 1 0 0

26‐Sep DHF R Yar Khan Eisa Khail State, Kot Samaba 0 0 0 1

26‐Sep DHF R Yar Khan Mazhar Farid Colony 0 1 0 0

26‐Sep DHF R Yar Khan Mouza Murtazabad 0 1 0 0

26‐Sep DHF R Yar Khan Mujhahid Colony 0 1 0 0

26‐Sep DHF R Yar Khan Rehman Colony 0 1 0 1

27‐Sep DHF R Yar Khan Chak No.216/p Sadiqabad 0 1 0 0

27‐Sep DHF R Yar Khan Basti Dogran Mouza Kacha Bhotta Sadiqabad 0 1 0 0

27‐Sep DHF R Yar Khan Basti Thanidar Near Coca Cola Factory 0 1 0 0

27‐Sep DHF R Yar Khan Chak NO.100/NP P/o Kotla Pathan 0 1 0 0

27‐Sep DHF R Yar Khan Parana Karkhana Feroza Tehsil Liaquatpur 0 1 0 0

28‐Sep DHF R Yar Khan Basti Juyia Mouza kalka Khanpur 0 1 0 0

28‐Sep DHF R Yar Khan Chak No.101/P Sarbhuri 0 1 0 0

28‐Sep DHF R Yar Khan Mohalla Taliya 0 1 0 0

29‐Sep DHF R Yar Khan Basti Siyal Gehmal Peer Sehja 0 1 0 0

29‐Sep DHF R Yar Khan Chak NO.171/P Tehsil Sadiqabad 0 1 0 0

29‐Sep DHF R Yar Khan Ghari Ikhriar Khan Khanpur 0 1 0 0

29‐Sep DHF R Yar Khan Gulshan Iqbal Scheme #3 0 1 0 0

28‐Sep DHF Rajanpur Amir Muaaviya Colony, Amir Muaaviya road 0 1 0 0

28‐Sep DHF Rajanpur WAPDA Colony, Lundi‐Patafi road 0 0 0 1

29‐Sep DHF Rajanpur NHM (Rajan Pur) 0 1 0 1

27‐Sep Leishmaniasis D. G. Khan Village Yaroor Khosa UC Yaroo 0 1 0 0

23‐Sep Measles Muzaffar‐garh

Basti Ghallo Wala, UC Kharak 0 0 0 1

24‐Sep NNT Rajanpur Basti Habibullah 1 0 0 0



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

30‐Sep AWD Kohat Mohallah Charbagh, Doran Shah Quarters 0 0 0 1

24‐Sep AWD Lower Dir Village Jazai Payeen, UC Kambat 0 0 0 2

26‐Sep AWD Lower Dir Village sorai, UC Kambat 0 2 0 12

23‐Sep AWD Shangla Village Motha Khan Kelay 0 1 0 0

28‐Sep AWD Shangla Miankele Pagorai, UC Pirabad 0 0 0 1

28‐Sep AWD Shangla Village Lal Khanay, UC Alpurai 0 1 0 0

23‐Sep DHF Abbottabad Bandi Dhondan, Qalandarabad 0 1 0 0

23‐Sep DHF Abbottabad Mohalla Jogan, Nawansher 0 1 0 0

27‐Sep DHF Abbottabad Thanda Choha, Nawansher 0 1 0 0

24‐Sep DHF Haripur Village Khanpur, UC Khanpur 0 2 0 0

26‐Sep DHF Haripur Village Bandi Bareela 0 0 0 1

27‐Sep DHF Haripur Moochi Bazar Haripur city 0 1 0 0

28‐Sep DHF Haripur Kalu Mirpur 0 1 0 0

29‐Sep DHF Haripur Village Najafpur, Muhallah Haraly 0 1 0 0

26‐Sep DHF Mansehra College doraha UC Labarkot 0 1 0 0

26‐Sep DHF Mansehra Village chitta Battta UC Sandesar 0 1 0 0

26‐Sep DHF Mansehra Village Ghazikot 0 0 0 1

26‐Sep DHF Mansehra Village Shahkot Oghi 0 1 0 0

26‐Sep DHF Mansehra Village Takia Shelia 0 1 0 0

27‐Sep DHF Mansehra Chitta Batta UC sandesar 0 1 0 0

27‐Sep DHF Mansehra KATH Staff Colony Mansehra 0 1 0 0

27‐Sep DHF Mansehra Main Bazar Baffa 0 0 0 1

27‐Sep DHF Mansehra Shanay Payen Darband 0 1 0 0

27‐Sep DHF Mansehra Village Labar kot 0 1 0 0

27‐Sep DHF Mansehra Village rahar UC Behali 0 1 0 0

28‐Sep DHF Abbottabad Gariphul Gran, Havallian 0 1 0 0

28‐Sep DHF Abbottabad Sialkot, Thandiani 0 1 0 0

29‐Sep DHF Abbottabad Birangali 0 1 0 1

29‐Sep DHF Abbottabad Sultanur, Havallian 0 0 0 1

27‐Sep DHF Buner village batay dara near pir baba tehsil dagar 0 1 1 0

27‐Sep DHF Buner village matwani tehsil gagra 0 1 0 0

27‐Sep DHF D. I. Khan P.O. Shor kot, Village Hassam 0 1 0 0

24‐Sep DHF Abbottabad Begakot, Kothiala 0 1 0 0

24‐Sep DHF Abbottabad Kunj Kadeem 0 1 0 0

25‐Sep DHF Abbottabad Karimpura 0 0 0 1

26‐Sep DHF Abbottabad Bandi Mansoor 0 1 0 0

26‐Sep DHF Abbottabad Nathiagali 0 1 0 0

27‐Sep DHF Abbottabad Akhreela 0 0 0 1

27‐Sep DHF Abbottabad Gulshan Iqbal Road, Near Sathi Masjid 0 1 0 0

27‐Sep DHF Abbottabad Kuthwal 0 1 0 0

27‐Sep DHF Mansehra Zafar ground Mansehra City 0 0 0 1

28‐Sep DHF Mansehra Dabgran Near Sheikhabad Camp 0 0 0 1

28‐Sep DHF Mansehra Kalgan UC Labarkot 0 1 0 0

28‐Sep DHF Mansehra Mohallah Mufti abad Mansehra City 0 0 0 1

28‐Sep DHF Mansehra Narah Balakot 0 1 0 0

28‐Sep DHF Mansehra Trangri Payen 0 1 0 0

26‐Sep DHF Nowshera Bela Korona, Pirpai 0 1 0 0

26‐Sep DHF Peshawar Street No: 10, Sector: J‐2, Phase:02 0 1 0 0

27‐Sep DHF Swabi BMC Swabi, Nursing Hostel 0 0 0 1

27‐Sep DHF Swabi CH TOPI, Mohallah Alizai Betakara 0 1 0 0

29‐Sep DHF Swabi BMC Swabi, Gandaf 0 1 0 0

29‐Sep DHF Swat Village Landey Kas, UC Malekanan 0 1 0 0

29‐Sep DHF Swat Village Rang Mohallah Mingora 0 1 0 0

29‐Sep DHF Swat Village& UC Kanju, Tehsil Kabal 0 1 0 0

26‐Sep DHF Tank D.I.Khan (Sakna Mohammad Akbar 0 1 0 0

26‐Sep DHF Torghar Basi Khail, Mangrai, Kamasir 0 2 0 0

28‐Sep Leish. Nowshera Miangul Kalay, Zando Banda 0 1 0 0

23‐Sep Measles Balakot Kholian Joshal Hungrai Balakot 1 0 0 0

28‐Sep Measles Buner village arra near jowar pir baba road 1 1 0 0

27‐Sep Measles Charsadda Shah jee Baba Kallay 1 0 0 0

28‐Sep Measles Charsadda Pir Mohammad Kallay 1 0 0 0

29‐Sep Measles Lower Dir Balambat Colony, Near Police line 1 0 0 0

29‐Sep Measles Nowshera Jabba Daudzai, Mohallah Ilyas Ustad 1 0 0 0

28‐Sep Measles Swat Village & UC Chuprial, Tehsil Matta 2 0 0 0

28‐Sep Measles Swat Village & UC Matta College Chowk 1 0 0 0

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

26‐Sep DHF Bhimber CMH Muzaffarabad 0 1 0 0

28‐Sep DHF MZD Central Plate, Muzaffarabad City 0 0 0 1

28‐Sep DHF MZD Shoukat Lines, Muzaffarabad City 0 1 0 0

29‐Sep Diphtheria Khyber Agency Peshawar 0 0 0 1

24‐Sep Diphtheria N Waziristan Agency LRH Peshawar 0 1 0 0

27‐Sep Pertussis Diamer DHQ Hospital Chilas 0 0 1 0

29‐Sep Pertussis Diamer FAP Loshi 10 1 5 0

27‐Sep AWD Islamabad CH PIMS (St 19, I‐10‐1) 0 0 1 0



Province Khyber Pakhtunkhwa: • This week 724 health facilities from 20 districts re-

ported to DEWS with a total of 180,243 patients con-sultations.

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

• 65 alerts were reported in this week, 50 were for DHF, 8 for Measles, 6 for AWD, while one for Leishmaniasis.

• 1 AWD outbreak identified and responded.

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

Province Sindh:

• This week 776 health centers from 21 districts re-ported to DEWS with a total of 459,037 patient con-sultations.

• In Sindh, AD cases reported were 52,945 (12%), same proportional morbidity as compared with last week.

• 106 alerts were reported from Sindh in this week: 42 were for AWD; 40 for DHF; 14 for Neonatal tetanus; 4 each for Measles and Malaria, while 1 each for Leishmaniasis and Mumps.

• 8 outbreaks identified and responded.

Figure-4: Three years trend of Acute diarrhoea, province Sindh

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

Post Flood 2010 2011 (up till wk 38) Current Week (39) Total

A O A O A O A O

Acute Watery Diarrhoea 209 85 1022 466 54 6 1285 557

Acute Jaundice Syndrome 5 2 39 14 ‐ ‐ 44 16

Bloody Diarrhoea 10 1 80 14 ‐ ‐ 90 15

Dengue Fever 81 32 270 98 168 6 519 136

Measles 48 6 1352 83 15 1 1415 90

Pertussis 1 ‐ 217 23 2 1 220 24

NNT + Tetanus 5 ‐ 200 ‐ 17 ‐ 222 ‐

Malaria 12 7 72 50 4 2 88 59

Leishmaniasis 1 ‐ 129 22 19 1 149 23

Others 75 11 463 49 8 2 546 62

Total 447 144 3844 819 287 19 4578 982

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

Diseases Total

Skin Diseases 5,072,985 (11%)

Acute Respiratory Infection 10,374,133 (22%)

Acute Diarrhoea 4,475,987 (10%)

Bloody Diarrhoea 398,040 (1%)

Suspected Malaria 2,800,439 (6%)

Unexplained Fever 1,783,643 (4%) Total Consultations 46,582,048

Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 39/2011)

0

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7 7 36 6 6 2 2

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Mobile Fixed

Epidemiological Bulletin: DEWS, Pakistan, Week no. 39 (23 to 29 September, 2011) Province Punjab: • This week 395 health facilities from 6 districts re-

ported data to DEWS from Punjab province with a total of 173,983 patient consultations.

• AD cases reported were 15,754 and showing 1% higher proportional morbidity as compared with last week .

• 77 alerts were reported in this week from Punjab; 71 were for DHF; 3 for AWD; while 1 each for Leishmaniasis, Measles and Neonatal tetanus.

• 5 outbreaks identified and controlled

Figure-5: Trend of acute diarrhoea, province Punjab (3 August 2010 to 29 September 2011)


State of Azad Jammu and Kashmir:

• In this week, reports received from 120 health facilities from 10 districts with a total of 41,504 patient consultations.

• ARI cases reported were 6,933 (16%), while Acute diarrhoea re-ported 2,346 (6%) cases.

• 3 alerts for DHF were received and responded this week.

• This week 55 health facilities in 3 agencies reported from FATA, with a total of 13,260 patient consultations.

• ARI cases reported were 1,1810 (20%), while Acute diarrhoea re-ported 1,054 cases (8%)

• 2 alerts for Diphtheria received and responded this week.

Gilgit Baltistan:

• In this week, 78 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 27,983 patient consultations.

• ARI cases reported were 5,106 (18%), while Acute Diarrhoea 4,027 (14%).

• 2 alerts received and responded this week, both were for Pertussis.

• 1 Pertussis outbreak identified and responded.

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 29 September 2011)

FATA:

Province Balochistan:

• In this week, 17 districts reported to DEWS from Balochistan province. 461 health centers reported a total of 87,330 patient consultations.

• AD reported in 8,685 (10%) of the total consulta-tions, 2% decline in the proportional morbidity as compared with last week.

• 31 alerts were reported in this week from Balochis-tan, 16 were for Leishmaniasis; 4 for DHF; 2 ech were for AWD, Measles Neonatal tetanus and Teta-nus, Typhoid and Chicken pox; while 1 for CCHF.

• 4 outbreaks identified and controlled.

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

0

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2010 2011

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Epi‐week 2009 2010 2011

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AD BD ARI S. Malaria

05

1015202530354045

wk 13

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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: The total number of polio cases confirmed by the laboratory is 100 (99=type‐1, and 1=type3) till date from 37 districts.

Focus on: AWD in Sindh

Since the floods, DEWS teams have been vigilantly monitoring the disease pattern and rigorously following all the alerts and outbreaks in the flood affected districts of Sindh. Acute Watery Diarrhoea (AWD) has been one of the special concerns in the flood affected population. From August 12 to September 29, 2011, a total of 223 alerts of AWD have been responded. Fifty eight (58) out‐breaks have identified and controlled. 172 stool sample collected and transported for Laboratory investigation, V. C confirmed in 37 samples; 786 Acute Watery Diarrhoea cases and 58 deaths due to diarrhea (in all groups) have been reported in the flood affected population. Diarrheal diseases especially Cholera is still a big threat in the flood affected areas. The DEWS teams in collaboration with the DoH and health cluster partners, monitoring the diar‐rheal diseases in the affected districts. Some key facts about Cholera: • Cholera is an extremely virulent disease. It affects both children and adults and can kill within hours. • The short incubation period of two hours to five days, enhances the potentially explosive pattern of outbreaks. • Cholera is caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. About 75%

of people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 7–14 days after infection and are shed back into the environment, potentially infecting other people.

• Cholera transmission is closely linked to inadequate environmental management where basic infrastructure is not available. As a consequence of a disaster water and sanitation systems disrupt, populations displaced to inadequate and overcrowded camps where minimum requirements of clean water and sanitation are not met, increases the risk of cholera transmission (should the bacteria be present or introduced) and frequent out‐breaks encountered. Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases in the affected population.

• Cholera is an easily treatable disease. Up to 80% of people can be treated successfully through prompt admini‐stration of oral rehydration salts (ORS). Very severely dehydrated patients require administration of intrave‐nous fluids.

• In order to ensure timely access to treatment, cholera treatment centers (CTCs) should be set up among the affected populations.

Province Cases 2010 Cases 2011 P1 P3 P1 P3

Punjab 6 1 2 -

Sindh 26 1 19 -

Khyber Pakhtunkhwa 19 5 9 -

FATA 63 11 26 1

Balochistan 6 6 42 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 99 1



Alerts and outbreaks, week 39, 2011

Documents

Weekly Epidemiological - WHO