Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Highlights Epidemiological week no. (17-3 June 1) Volume 3, Issue 7, Wednesday 7 June 1 Figure1: 86 districts reported to DEWS in week, 1. : 173 alerts investigated, responding to 7 outbreaks involving 418 measles cases. CCHF: In 1, total of 1 confirmed cases have been reported throughout the country. Most of the cases (1) directly reported from Balochistan, 4 each KPK and Sindh and 1 from Punjab. outbreaks identified in districts of Sindh and responded few confirmed cases in localities. Acute diarrhoea: Trend of acute diarrhoea is stable in all provinces. Districts in Sindh and Khyber Pakhtunkhwa are investigating alerts for acute watery diarrhoea/suspected cholera. No new polio case was reported; As of June 1, Pakistan has reported a total of polio cases (19 type1, type3 and 1 mixture type1 and 3) from 13 districts/tribal agencies. 86 districts have reported in week, 1, Please see map.,6 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week 81,7 patients consultations were reported in week compared to 833,414 consultations reported on week 4, 1. Figure: Weekly trend of Acute diarrhoea in Pakistan Week1, 11 to week, 1. Priority diseases under surveillance in DEWS Pneumonia Acute Watery Diarrhoea Bloody diarrhoea Other Acute Diarrhoea Suspected Enteric/Typhoid Fever Suspected Suspected Meningitis Suspected Dengue fever Suspected Viral Hemorrhagic Fever Suspected Suspected Diphtheria Suspected Suspected Acute Viral Hepatitis Neonatal Tetanus Acute Flaccid Paralysis Scabies Cutaneous Others 11 1 Cumulative number of selected health events reported in 1 (1 Jan 3 June 1) Disease # of Cases Acute diarrhoea 1,69,43 8% Bloody diarrhoea 8,391.48% ARI 3,3,196 % S. 7,999 % Skin Diseases 736,469 4% Unexplained fever 81,7 3% Total (All consultations) 16,71,988 Major health events reported during the (17 3 June 1) Disease # of Cases Acute diarrhoea 7,793 9% Bloody diarrhoea 4,17.1% ARI 118,7 % S. 4, 6% Skin Diseases 36,77 % Unexplained fever 9,687 4% Total (All consultations) 81,7 The graph (Figure1) shows the comparison of weekly trend of Acute diarrhoea as proportional morbidity (percentage of cases out of total consultations) reported to DEWS each week in year 11 and 1. The overall weekly trend of acute diarrhoea remained stable during the last 4 week, however in KP the weekly proportional morbidity of AD shows an upward trend in all the provinces. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 1

2 Weekly Bulletin: DEWS, Pakistan, Week no. (17 to 3 June 1) Current week's (/1) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 1Jun Balochistan Killa Saifullah Muslim Bagh town area, Tehsil Muslim Bagh suspected cases of were reported. Patients were investigated and found lesions on face, nose, arms and legs. No travel history have seen in these patient. Treatment as per WHO protocol was given. 19Jun Balochistan Pishin Village Kolak, UC Oramzai 6 6 suspected cases of were reported. Patients have history of disease since one year but no improvement after treatment. Treatment has provided to the patients. 19Jun 19Jun 18Jun Jun Balochistan Awaran Balochistan Chagai Balochistan Jaffarabad Balochistan Jhal Magsi Mungli, UC Parwar, Tehsil Mashkai BHU Padag, Killi Mohammad Jhan Amuri, UC Padag Goth Mohammd Amin Kanadrani Village Khichi, UC Barija cases of malaria were reported and tested for confirmation.11 found positive (SPR=%) of P.F= (FR=%), P. V=, Mix=4. Anti malarial treatment provided. Information shared with DHO and requested for bed nets and fogging in the locality. 3 cases of suspected malaria were reported. 3 slides were tested where 19 verified positive (SPR=63%) of pf=8 (FR=4%),pv=11. RDTs and antimalarial medicines were provided. Bed nets not available in the district. 17 cases for suspected malaria were reported. 1 slides were tested using RDTs and all verified positive (SPR %). Antimalarial drug provided for treatment. Bed nets and insecticides not available in the district. Suspected cases of malaria were reported from village. 1 slides tested out of which 14 were found positive (SPR=67%) of pf=7 (FR=48%), pv=4, Mix=3. Information shared with DHMT and requested to take necessary action. ACTs supplied for proper treatment of the patients. 18Jun Balochistan Lasbela DHQ Hospital, Tehsil Uthal cases of were reported. slides tested where 13 were positive (SPR=%) pf=7 (FR=4%), pv=6. Patients were treated with antimalarial drugs. Information shared with DHO for necessary action. 19Jun Jun 17Jun Jun Jun 1Jun Balochistan Kech Balochistan Kech Balochistan Khuzdar Balochistan Khuzdar Balochistan Killa Saifullah Balochistan Panjgur Balochistan Pishin Balochistan Pishin Jamadar Ayoob ward, UC Absar Suthkalbazaar, UC Koshkalat Baleena Rodeni, UC and Tehsil Surab Sat Marlla, UC Zereena Kattan, Tehsil Khuzdar Killi Alozai, UC Akhterzai, Tehsil Killa Saifullah Mohalla Shapatan, UC Chitkan Killi samkhail, UC Saranan Village killi Baranzai, UC Gulistan Jun Balochistan Ziarat Mana, UC Zindra Jun Balochistan Ziarat Pasara, UC Sinjawi Jun Balochistan Nushki Jun FATA Bajaur Agency Killi Zangi Abad, UC Ahmed Waal Village SeraiHaji lawang, Tehsil Khar suspected cases of measles were reported. During field investigation 4 more suspected cases were found. 3 children were assessed for routine immunization out of which 3 (13%) were not vaccinated against any antigen. Health education session conducted regarding importance of routine immunization. Information shared with DHO. suspected cases of measles were reported through community. During field investigation 3 more suspected cases were found.vit A drops were given to the cases and health education imparted in the community regarding routine immunization. 8 children were assessed for routine immunization out of which were found totally unvaccinated against measles. Information shared with DHO. An alert of suspected measles was reported. On field investigation 1 more suspected cases were found. Vit A drops were given to the cases. Cases were assessed for the routine immunization but none of child found vaccinated against measles. Information shared with DHMT and requested for intensified outreach activity in the locality. Health education imparted regarding the routine immunization. blood samples were taken for confirmation. Alert reported through LHW. investigation was done. Patients were presented with typical signs & symptoms and had no immunization history. Vit A provided to all suspects. One blood sample was collected and sent to NIH. community was told about routine immunization importance and requested take their children to nearby EPI centre for routine immunization. Information shared with DHO and EPI team. 9 children less then years were checked, confirmed through EPI card while others partially immunized. one dose coverage was 37.% while second dose was zero. 6 suspected cases of measles were reported. Vit A drops provided. None of the case were found vaccinated against measles. Immunization status of the community was not satisfactory because outreach activity has not been done due to compromised security in the area. DHO was informed about the situation. An alert of measles were reported. During field investigation, 4 more suspected cases were found. Vit A drops were given to the cases. Health education imparted. children were assessed for routine immunization out of which 4 (8%) were found vaccinated against measles. 4 suspected cases and 1 death due to measles were reported. All the cases were found unvaccinated. Vit A drops provided and health education imparted. 3 children were checked for routine immunization and all of them were found unvaccinated against measles. Vaccination done on spot by the support of EPI team. An outbreak of measles was reported from HF. Vit A drops were provided and health education was imparted in the community. During house to house survey, 73 children were assessed for routine immunization and none of them were found vaccinated against measles. Vaccinated these children on spot by the support of EPI team. An alert of suspected measles were reported. On active search 4 more suspected cases were found. None of the case were found vaccinated against measles. Vit A drops provided to all cases. Blood sample was collected and sent to NIH for lab confirmation. Health education imparted. 9 children were assessed for routine immunization where children found completely vaccinated while rest of them were partially vaccinated. 3 children were found vaccinated with 1 (37%). An alert of suspected measles was reported. On active search 6 more suspected cases were found. Cases were found unvaccinated. Vitamin A drops were given to the cases. Health education imparted. Matter was discussed with DHMT and EPI inchrage. 6 children < years were assessed for routine immunization out of which 4 were found totally unvaccinated. Follow up planned. An alert of suspected was reported. During field investigation 7 suspected cases were found. Erythromycin tabs and syrups provided to the cases and contacts. Health education imparted. Informed DHO 4 suspected cases of measles were reported. On active search more suspected cases were found. Blood samples were collected and sent to NIH for lab confirmation. Vit A drops provided and health education imparted. 39 children were assessed for routine immunization out of which 3 (8%)were found unvaccinated against measles,17 (43%) for BCG & Penta1 to 3 whereas rest of the children were found totally unvaccinated. children were vaccinated against measles. Agency Surgeon and epidemic response team were informed about the situation and necessary actions were taken. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

3 Cont d current week's (/1) Outbreaks: Date Disease Province District Area 1Jun FATA Mohmand Agency <M >M <F >F Action Taken Daro bazaranmbar 1 3 Weekly Bulletin: DEWS, Pakistan, Week no. (17 to 3 June 1) An outbreak of 6 suspected cases of measles was found on active surveillance. Vit A drops provided and health education imparted. During field investigation, 9 children were assessed for routine immunization out of which 81 (8%) were found unvaccinated against measles. Agency Surgeon & EPI Coordinator informed, 84 children were vaccinated against after the intensified outreach vaccination activity in the area. Jun Khyber Pakhtunkhwa Khyber Pakhtunkhwa Abbottabad Murkalan, Nelay p, Mangalar Mardan Village Qasim, UC Toru, Tehsil Mardan suspected cases of measles from the same family were found on active surveillance visit to hospital. Vit A drops provided. During field investigation children were assessed for routine immunization out of which 3 were found totally unvaccinated. Vaccination was done on the spot by the support of EPI. An alert of suspected measles was reported. On active search 4 more suspected cases were found. Vitamin A drops were given to the cases.17 children were assessed for routine immunization but none of the patient were found vaccinated against measles. Health education session conducted, EDOH Focal person & EPI Coordinator were informed. Khyber Pakhtunkhwa Shangla Mol Sar UC Butyal deaths due to suspected measles were reported. During active surveillance 4 more suspected cases were found. Vitamin A drops provided. The whole of the village has been left unvaccinated for the past 9yrs; reason being life threats from the local community to EPI technician. DEWSTeam along with DOH gathered the elders and managed to vaccinate 6 children for 1. Blood samples were taken from children and sent to NIH for further analysis. Follow up planned. Jun Khyber Pakhtunkhwa Sindh Sindh Swabi 1Jun Sindh Sukkur Private Clinic, Bacha Saib Banda, Dand Village Haji Sher Tando Muhammad, taluka Allahyar Chambar Dadu Peerzada Muhalla, Farash goth, UC Arain Hashim Wakeel Muhalla, taluka K.N Shah An alert of suspected measles was reported. During field investigation 9 more suspected cases were found in the same locality. EPI Cards were not available with the cases and parents were not able to recall about the vaccination. Vit.A drops provided, health education imparted, EDO H and EPI coordinator Informed. Intensified outreach vaccination activity planned. An alert of was reported. On active search 6 more cases were found, Hand pump was the source of water. Aqua tabs, Zinc tabs and ORS were distributed, health education imparted, EDOH informed, 1 Stool and water samples collected for lab confirmation. 3 cases were reported from Muhalla Peerzada, Farash Goth, active search for more case was carried out, Aqua tabs, Jerry cans, Life straw filters and IEC Material distributed, health education imparted, DHMT informed, 1 stool sample found positive for Cholera, 3 water sample also collected result awaited. An alert of suspected measles was reported. During active surveillance more suspected cases were found, Vitamin (A) drops were provided, health education imparted. 7 children were assessed for routine immunization where 4(64%) were found vaccinated for measles1 and 3 (7%) for measles. THO and EDOH informed. Blood samples collected for lab testing. Jun Sindh Dadu GulshaneMunir colony, city Dadu 1 1 case was reported with severe dehydration, vomiting and Fever, during field investigation 1 more case was found, Aqua tabs, Zinc tabs and ORS distributed, health education imparted, EDOH, THO and DSC informed, 1 Stool sample was collected and found positive for Cholera, water sample also collected result awaited. 19Jun Sindh Dadu Bhittai Muhalla, city and taluka Mehar 3 1 An alert of suspected measles was reported, On active search more suspected cases were found. Vitamin (A) drops were given to the cases, health education imparted. Routine immunization status were assessed for 6 children where 4(63%) found vaccinated with measles1 and 3(6%) with measles. 3 Blood samples were collected for lab confirmation. THO and EDOH informed. Outreach vaccination activity planned. 1Jun Sindh Dadu Village Alam Khan Jatoi, UC Muradabad, taluka Dadu 3 An alert of suspected measles was reported. During field investigation 4 more suspected cases were found. Vitamin (A) drops provided, health education imparted. Routine immunization status were assessed for 7 children where measles1= 3(47%) and = (9%).EDOH, THO and DSC informed and request outreach vaccination activity in the area. Blood samples collected for lab confirmation. Jun Sindh Dadu Village Dato khan Rodhani, UC Chinni, taluka Johi suspected cases of were detected on active surveillance visit. Vitamin (A) drops provided, health education imparted. Vaccination status were assessed for 11 children where 1= 4(33%), = (1%). EDOH, THO and DSC informed. Blood samples collected for lab testing. 1Jun Sindh Kashmore Village Huzoor Bux kosh, UC Gheehal pur An alert of suspected measles was notified. During field investigation 4 more suspected cases were found, vitamin (A) drops provided, health education imparted. Vaccination status of 1 children were assessed where 3(4%) children had BCG scar and rest of the children were found totally unvaccinated, information shared with DHMT. 4 Blood samples collected for lab confirmation. 19Jun Sindh Khairpur Village Dau, UC Therhi, taluka Khairpur 1 7 An alert of suspected was cross notified from Sukkur. During field investigation 18 more suspected cases were found, vitamin (A) drops provided, blood samples collected for lab confirmation,18 children were assessed for their routine immunization where none of the child was found vaccinated against measles, information shared with DHMT. Outreach vaccination activity planned. 1Jun Sindh Khairpur Village Ghulam Muhammad Khushk, UC Nizamani An alert of suspected measles was notified. During field investigation total suspected cases including 1 death due to measles complications were found. Vitamin (A) drops provided to the cases, blood samples collected and sent to NIH for lab confirmation. children were assessed for routine immunization where none of the child found vaccinated against measles. Information shared with DHMT and outreach vaccination activity planned. Jun Sindh Qambar Fateh Mohammad ShahdadSuprkot Taulka, UC Dostli, Kambar An alert of suspected measles was reported. During field investigation 4 more suspected cases were found, Vitamin (A) drops provided, health education imparted. Vaccination status of children were assessed where BCG=3(3%), Penta1=3(3%), Penta=(%), Penta3=1(%), 1=1(%), =(%), DHMT informed and request for outreach vaccination activity in the area. 3 Blood samples were collected for lab confirmation. Jun Sindh Shikarpur Village sher dil khakhrani, UC waryaso 6 3 An alert of suspected was cross notified from Larkana. During field investigation total 9 suspected cases were found, 6 blood samples were collected for lab confirmation, Vitamin (A) drops were given to the cases, health education imparted about the importance of routine immunization. children were assessed for routine immunization where BCG=6(4%) and no history for other antigens. Information shared with DHMT. Jun Sindh Thatta Village Ali Muhammad Mirbahar, UC Kalri 1 1 An alert of suspected measles was notified. During field investigation 6 more suspected post measles cases were found. Cluster of 3 houses were taken where 1 children were assessed for routine immunization but none of the child were found vaccinated. Health education imparted, Vitamin (A) drops provided, 4 blood samples collected for lab confirmation. Informed DHO, THO & TSV. Outreach vaccination activity planned. Jun Sindh Naushah Village Latif Arain, ro feroze UC DK Mari 6 3 An alert of suspected was reported. During field investigation total 9 suspected cases were found. Health education imparted. Erythromycin tabs and syrups provided to the cases and contacts, 1 children were assessed for routine immunization where BCG= 9(7%), penta1=7(8%), penta=6(%),penta3=(41%), 1=3(%),=(%). Information shared with DHMT. Jun Sindh Sukkur Village Roshanabad, UC patini, taluka Rohri An alert of suspected was reported. During field investigation more suspected cases were found. 3 Nasopharyngeal swabs were collected for lab confirmation, Erythromycin tabs and syrups provided to the cases and contacts. Health education imparted. children were assessed for routine immunization where 1 (8%)children were found vaccinated against BCG, while no information provided by parents regarding Pentavalent vaccine. Information shared with DHMT. Jun Sindh Tharparkar Village Burkhio, UC Mithrio Charan, taluka Chachro 1 1 An alert of suspected was reported. During field investigation total 7 suspected cases were found, Erythromycin tabs and Syps were given to the cases and contacts, health education imparted, vaccination status were assessed but none of the child were found vaccinated, EDOH informed. Nasopharyngeal swabs were collected for lab confirmation. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 3

4 Weekly Bulletin: DEWS, Pakistan, Week no. (17 to 3 June 1) Figure3: Number of alerts received and responded, week, 1 Figure4: Number of consultations by age and gender, week, Wk Wk3 Wk4 Wk Province Khyber Pakhtunkhwa: CCHF DF # of cases 46 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS with a total of 13,9 patients consultations reported in week, 1. Total 7 alerts were received while 4 outbreaks were identified and appropriate measures were taken. Altogether alerts for ; 14 each for ; while 1 each for, AFP, and Typhoid. Acute diarrhoea shows a slightly upward trend in KP. < 1 yr 14 yr 14 yr yr + yr Male Female Figure-: Trend of acute diarrhoea diseases, province KPK Figure-6: Number of alerts received and responded week -, 1, province KPK Province Sindh: health facilities from 3 districts in province Sindh were reported to DEWS with a total of 37,8 patients consultations in week, 1. Total 93 alerts received while 14 outbreaks were identified and appropriate measure were taken. Altogether 6 alerts for ; 16 for ; 6 for Typhoid; 4 for ; 3 for NNt; for AFp; while 1 each for AJS and Scabies. The AD shows a steady trend in Sindh. 4 3 Wk Wk3 Wk4 Wk CCHF DF Figure-7: Trend of trend of acute diarrhoea, province Sindh Figure-8: Number of alerts received and responded week -, 1, province Sindh Province Punjab: 4 health facilities from 8 districts in province Punjab reported to DEWS with a total of 194,46 patients consultations in week, 1. Total 4 alerts were received and appropriate measures were taken. Altogether 3 alerts for ; 9 for Acute diarrhoea; for Typhoid; 4 for ; while 1 each for AFP, AJS, ARI, Bloody diarrhoea, and Scabies. A slightly decline noted in the proportion of AD consultation in Punjab during the last few week. Wk Wk3 Wk4 Wk Figure-9: Trend of acute diarrhoea, province Punjab Figure-: Number of alerts received and responded week -, 1, province Punjab Wk Wk3 Wk4 Wk DF For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 4

5 Province Balochistan: Weekly Bulletin: DEWS, Pakistan, Week no. (17 to 3 June 1) 49 health facilities from 3 districts in province Balochistan reported to DEWS with a total of 78,19 patients consultations in week, 1. Total 49 alerts reported while 19 outbreaks were identified and appropriate measures were taken in week, 1. Altogether 6 alerts for ; 7 each for and ; each for CCHF and Typhoid; while 1 each for Acute diarrhoea, AFP,, and Scabies.. Figure-11: Trend of acute diarrhoea, province Balochistan Figure-1: Number of alerts received and responded week -, 1, province Ba Province Gilgit Baltistan: health facilities from 4 districts in Gilgit Baltistan reported to DEWS with a total of 13,8 patients consultations in week, 1. No alerts were reported in week, 1. AD showing upward trend. 4 3 Wk Wk3 Wk4 Wk CCHF Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week -, 1, Gilgit Baltistan 3 3 FATA: health facilities from 3 agencies in FATA reported to DEWS with a total of,66 patients consultations in week, 1. Total alerts for were reported in week, 1 and appropriated measures were taken. # of laerts 4 3 Wk Wk3 Wk4 Wk Figure-: Trend of acute diarrhoea, FATA Figure-16: Number of alerts received and responded week -, 1, FATA State of Azad Jammu and Kashmir: 78 health facilities from 6 districts in AJ&K reported to DEWS with a total of 18,4 patients consultations in week, 1. No alerts reported in week, 1. Wk Wk3 Wk4 Wk Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 4 -, 1, AJ&K Wk Wk3 Wk4 Wk For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

6 Weekly Bulletin: DEWS, Pakistan, Week no. (17 to 3 June 1) Table1: Total number of alerts and outbreaks reported and investigated with appropriate response Disease Distribution of Wild Polio Virus cases Pakistan 11 and 1 In week 4, 1 no new type1 polio case was reported (up till week 4) Current week, 1 Total for 1 (week 1, 1) A O A O A O A O Acute watery diarrhoea Acute jaundice syndrome Bloody diarrhoea Dengue fever NNT + tetanus Others Total As of th June 1, Pakistan has reported a total of polio cases (19 type1, type3 & 1 mixture type1 & 3) from 13 districts/tribal agencies. Province Cases 11 Cases 1 P1 P3 P1 P3 P1+P3 Punjab 9 Sindh 33 3 Khyber Pakhtunkhwa 3 4 FATA Balochistan 73 AJ&K GilgitBaltistan 1 Islamabad Total Follow up of CCHF, and Dengue CCHF: CCHF is a serious viral hemorrhagic fever with up to % case fatality rate, caused by an RNA virus of family Bunyaviridae, genus Nairovirus, carried by Hyalomma species of ticks. Human beings become infected by tick bites or crushing the ticks, which are usually found on sheep, cattle, goats or camels, and their slaughtered skins. They may also be exposed to the virus in blood or tissues of a viremic animal during its slaughter and butchering; or by contact with infected blood or secretions of acute human cases in home or hospital setting. In Pakistan, the first known CCHF outbreak occurred during January 1976 at Rawalpindi General Hospital (RGH) among a surgical team. After above scenario, outbreaks were reported mostly from Balochistan province during 1978, 1987, 1994, 199 and 1999 involving 4 to 9 cases per year. In 1, total of 8 suspected cases have been reported throughout the country with 1 confirmed to date and 6 deaths; (CFR is 3%). 17 cases have been reported from Balochistan; 4 each from KP and Sindh and 3 from Punjab. Chart at right illustrates current situation of CCHF cases in 1. Numbers Number of CCHF cases (week 1 to, 1), Pakistan Cases Positive Deaths Approximately all the cases have contact history with animal trading/handling, tick bite, contact with patient, tannery worker, butcher/animals slaughtering, a traditional practice of wearing fresh animal skin (posti) to treatment ailment. These animals and their skins have continuous movement!intra Pakistan and between neighboring countries (Afghanistan and Iran). For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 6

7 Weekly Bulletin: DEWS, Pakistan, Week no. (17 to 3 June 1) : As of 3 June 1, more measles cases and deaths have been reported in Pakistan than in 1 months last year. Table 1 updates the situation of measles in 1 up to 3 June; and table illustrates about the alerts and outbreaks in week (17 3 June, 1). Table1 1 (Week 1 ) Table Epi week, 1 Province # of Alerts # of Outbreaks # of Cases # of Deaths Province # of Alerts # of Outbreaks # of Cases # of Deaths AJ&K Balochistan FATA Gilgit Baltistan 14 ICT 38 AJ&K Balochistan FATA Gilgit Baltistan ICT Khyber Pakhtunkhwa Khyber Pakhtunkhwa 4 96 Punjab Sindh Total Punjab Sindh 6 9 Total As it is shown in the above table that majority of the measles cases have been reported from Sindh and Khyber Pakhtunkhwa provinces. Both of these provinces have announced the EPI facilities will be providing measles vaccine twice a week for all children under age. Dengue: The chart at right show the weekly number of confirmed Dengue cases reported by surveillance focal points from the Departments of Health in Sindh and Punjab in 1. Total number of confirmed dengue cases to date in 1 is 67 in Sindh and 7 in Punjab. Month of peak incidence in was November while peak incidence in 11 was in September and October. # of cases Weekly trend of positive dengue cases, week 1 to, 1 Punjab Sindh Epi week : 6 slide positivity rate, Week, 1 The chart at right shows the malaria slide positivity rate and Falciparum rate reported in week, 1. Total number of malaria cases tested in week, 1 is 1899, out of which 43 were found positive. 4 3 Balochistan Sindh KP FATA Punjab GB AJK ICT SPR F. R For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 7

8 Alerts and outbreaks, week, 1 Weekly Bulletin: DEWS, Pakistan, Week no. (17 to 3 June 1) For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 8