Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 3, Issue 6, Wednesday 4 July 1 Highlights Figure1: 88 districts reported to DEWS in week 6, 1. Epidemiological week no. 6 (4-3 June 1) : 146 alerts investigated this week, responding to 3 outbreaks involving 38 measles cases, 8 deaths. : 1 alerts investigated this week and 6 outbreaks identified in districts of Sindh with 41 cases and 1 death; 1 outbreak in Thatta with confirmed V. c. Ogawa, 1 in Badin with V. c. Inaba, while 4 outbreaks are pending for labs result. No new CCHF case reported this week; 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. No new polio case was reported; As of July 1, Pakistan has reported a total of polio cases (19 type1, type3 and 1 mixture type1 and 3) from 13 districts/tribal agencies. 88 districts have reported to DEWS in week 6, 1, Please see map.,7 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week 83,476 patients consultations were reported in week 6 compared to 838,79 consultations reported on week, 1. Total 9 alerts were investigated, while response provided to 39 outbreaks. Figure: Weekly trend of Acute diarrhoea in Pakistan Week1, 11 to week6, 1. Priority diseases under surveillance in DEWS Pneumonia Acute Watery Diarrhoea Bloody diarrhoea Other Acute Diarrhoea Suspected Enteric/Typhoid Fever Suspected Malaria 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 Cumulative number of selected health events reported in Epiweek 1 6 (1 Jan 3 June 1) Disease # of Cases Acute diarrhoea 1,346,646 8% Bloody diarrhoea 84,34.% ARI 3,443,184 % S. Malaria 8,66 % Skin Diseases 77,3 4% Unexplained fever 61,683 3% Total (All consultations) 17,84,383 Major health events reported during the Epiweek 6 (4 3 June 1) Disease # of Cases Acute diarrhoea 74,941 9% Bloody diarrhoea 3,871.% 1 ARI 118,18 14% S. Malaria 46,3 6% Skin Diseases 37,74 % Epiweek Unexplained fever 3,6 4% Total (All consultations) 83,476 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. Trend of acute diarrhoea is stable in all provinces. Districts in Sindh and Khyber Pakhtunkhwa are investigating alerts for acute watery diarrhoea/suspected cholera. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 1

2 Weekly Bulletin: DEWS, Pakistan, Week no. 6 (4 to 3 June 1) Current week's (6/1) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Jun Jun 6Jun Balochistan Killa Saifullah Balochistan Lasbela Balochistan Kech Kili Nali, UC Nasai, Tehsil Muslim Bagh Allu Goth, UC Lakhra, Tehsil Lakhra Pullabad UC Gomazi, Tump suspected cases of measles were reported. Vit A drops were given to the cases. Health education imparted. None of the suspected case were found vaccinated against measles. DHO informed and requested for intensified outreach vaccination activity in the locality. An alert of suspected measles was reported. During active search more suspected cases were found. Vit A drops were given to the cases. All cases were found unvaccinated against measles. 1 children were assessed for routine immunization where BCG with scar 7(7%), M1 6(6%) and M %. Information shared with DHO for outreach vaccination activity in the locality. blood samples were collected for lab confirmation. suspected cases of measles were reported. On active surveillance 4 more suspected cases were found. Vit A drops provided. 6 children were assessed for routine immunization out of which 7 were found unvaccinated against any antigen. Vaccination was done on the spot. Information was shared with DHO. 6Jun Balochistan Mastung Killi Sadeeq Abad, UC Ghulam Prinz 1 4 An alert of suspected measles was reported. On active search 9 more suspected cases were found. All the cases were refusals for routine vaccination. Health education session conducted about the importance of immunization with the community. Outreach vaccination activity planned. 7Jun 7Jun 7Jun Balochistan Kech Balochistan Killa Saifullah Balochistan Ziarat Kohad UC Balicha, Tump Nomadic population at Kan mehterzai, Tehsil Muslim Bagh Shereen, UC Chutair, Tehsil Sinjavi suspected cases of measles were reported. On active surveillance more suspected cases were found. Vit A drops provided. Health education imparted. Immunization status of the community was not satisfactory. Matter was discussed with DDHO and DSM PPHI. Outreach vaccination activity planned. 8 suspected cases of measles were reported. Cases were found unvaccinated against measles. Vit A drops were given to the cases. Health education imparted. Immunization status of the community was not satisfactory. Informed DHO and requested for the intensified outreach activity in the locality. An alert of suspected measles was reported. On field investigation,8 more suspected cases were found. All the cases were found unvaccinated against measles. Vitamin A drops were given to the cases. Health education imparted. 8 children were assessed for routine immunization out of which were partially immunized. On outreach activity 134 children were vaccinated. Follow up planned. 8Jun Balochistan Lasbela Allah abad town, Tehsil HUB 6 suspected cases of Cutaneous were reported. Cases were on Injection Glucantime. During active search, 4 more suspected cases were found. Information shared with DHO. 8Jun Balochistan Pishin Killi Huramzai, UC Huramzai 3 suspected cases of were reported. Erythromycin tabs and syrups provided to the cases and contacts. Health education imparted. DHO informed. 8Jun Balochistan Pishin Moula Muhammad Khan yaro, UC Yaro 3 suspected cases of measles were reported. Vit A drops provided. Health education imparted. Cases were found unvaccinated against measles. Vaccination done on the spot. 9Jun Malaria Balochistan Jhal Magsi (RHC Jhalmagsi), UC Jhal Magsi, Tehsil Jhal magsi suspected cases of Malaria were reported. 6 cases were tested and 3 found positive (SPR= 7%) for PF=11, PV=14 & mixed=7(fr=6%). ACTs were provided. All cases belongs to same locality. Information shared with DHMT and requested to take further necessary action. 9Jun Balochistan Pishin Killa Haji Khan, UC Jaji Khan 1 An outbreak of suspected measles was reported. During field investigation, total of 8 suspected cases of measles were found. All the cases were found unvaccinated against measles. Vit A drops provided. Health education imparted. DHO informed about the outbreak and requested for intensified outreach activity in the locality. 6Jun Jun BD FATA Khyber Pakhtunkhwa Khyber Agency Mansehra Village Miwa khan,barra Dara,UC Kambila Village Dheryal, UC Sum Ellahi Mang An outbreak and death due to suspected measles were reported. On field investigation, total of 9 cases were found including a death. Vitamin A drops were given to the suspected cases. blood samples collected and sent to NIH for lab confirmation. Health education imparted. 17 children vaccinated for measles on outreach activity. Report shared with the Agency Surgeon, PPHI and FSMO. An alert of Bloody Diarrhea was reported. On field investigation,9 more cases were found. 1 stool sample was taken and sent to NIH for lab confirmation. Health education imparted, Soap and Chlorine tablets Distributed, All cases were using the same source of water, EHE requested to visit the area for chlorination of tank (source) 7Jun Khyber Pakhtunkhwa Haripur Village Amgah, UC Kotehra 3 1 suspected of measles were reported. Vitamin A drops provided to the cases. Health education imparted. Outreach vaccination is scheduled subject to availability of vaccine. Jun Punjab D. G. Khan Basti walia uc Kot Haibat 4 1 An alert of suspected measles was reported. During active search, 4 more suspected cases were found. Vit A drops were given to the cases. 1 blood sample collected and sent to NIH for lab confirmation. 11 children were assessed for routine immunization coverage and none of the child found vaccinated against any antigen. 16 children were covered in the outreach vaccination activity. Community was provided awareness through health education session for highlighting the importance of vaccination of their children against all the EPI diseases. Jun Sindh Qambar Shahdadkot Jun Sindh Sukkur 6Jun Sindh Dadu Massan Muhalla, UC, taluka Shahdadkot Sasti basti, UC Tamachani, taluka new Sukkur Village Buthi, UC Dhani Buksh Bughio deaths and suspected cases of measles were reported. Vitamin (A) drops provided, health education imparted, cluster for vaccination wasn't taken due to female families were at home. Information shared with THO and request for intensified outreach vaccination activity in the area. suspected cases of were reported. During field investigation 3 more suspected cases were found, 4 blood samples collected and sent to NIH for lab confirmation. Vitamin A drops were given to the cases. Health education imparted. 8 children were assessed for routine immunization where none of the child were found vaccinated against measles. Information shared with DHMT. An alert of measles was reported. During field investigation, 1 more suspected cases were found including 1 death. Vitamin (A) drops provided. Health education imparted. 1 children were assessed for routine immunization where BCG= 1(8%), Penta1=1(64%),Penta=9(8%), Penta3=7(48%), 1=8 (6%), =7(49%). THO informed and Blood samples collected for lab testing. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

3 Weekly Bulletin: DEWS, Pakistan, Week no. 6 (4 to 3 June 1) Cont d current week's (6/1) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 6Jun Sindh 6Jun Sindh 6Jun Sindh 7Jun Sindh 7Jun Sindh 7Jun Sindh 7Jun Sindh 7Jun Sindh Dadu Karachi Shikarpur Dadu Khairpur Khairpur Village Mureed Dero, UC Drigh Bala, taluka Johi Al Shifa football ground, Patel Para, Lasbella Chowk Village Ladho khan Banglani, UC Jano Village Manjhi Laiyo, UC Drigh Bala, taluka Johi Settlement, near Mangi Mari, UC Sagyoon Village Ghulam Hussain Channa, UC Sagyoon Haji Mohammad Qambar Khan Lashari, UC Shahdadkot Kalar, taluka Qambar An alert of suspected measles was reported. On active search 4 more suspected cases were found, Vitamin (A) drops provided to the cases, health education imparted regarding routine immunization. 1 children were assessed for routine immunization where BCG=3(3%), Penta1=3(3%), Penta=(%), Penta3=1 (1%), 1=(%) and =(%). DHMT informed and 3 Blood samples collected for lab confirmation. Shikarpur 8Jun Sindh Ghotki 8Jun Sindh 8Jun Sindh 8Jun Sindh Khairpur Matiari Shaheed Benazir Abad 9Jun Sindh Dadu 9Jun Sindh Dadu 9Jun Sindh 9Jun Sindh 9Jun Sindh Ghotki Larkana Jun Sindh Badin 18Jun Sindh Thatta Village lorae, near Maal puri Bypass Village Banho Khushk UC Jarwar Village Fauji Ahmed Ali laghari, UC Chondiko Village Wali Muhammad Akhund, UC Sekhat Village Mir khan laghari Alamdar road, main Guhram Gopang city Ghareebabad Muhalla, near Girls degree college Ghulam abad near Degree college UC I Mirpur Mathelo Village yar ali chandio Qambar Wanji Khoso, UC ShahdadLakhakot taluka Naseerabad Village Moosa Malah, UC Abdullah shah Village Muhammad Khan Jatoi, taluka Mirpur Bathoro An alert of suspected was reported. During field investigation total 1 suspected cases were found. Erythromycin tabs and syrups were given to the case and contacts, health education imparted. 1 children were assessed for routine immunization where BCG=(4%), Penta1=4(36%), Penta=3(7%), Penta3= (1%), 1=3(3%), =(18%). Information shared with EDOH, THO, EPIFP. 1 throat Swab collected for lab testing. An alert of suspected measles was reported. During active surveillance 4 more suspected cases were found. Vitamin (A) dose were given to all cases, health education imparted, 1 children were assessed for routine immunization where BCG=19(9%), Penta1=16(76%), Penta=1(71%), Penta3=1(71%), 1=13(6%), =(4%), DHMT informed about the case and 1 Blood sample collected for lab testing. suspected cases of were reported. On active search 4 more suspected cases were found, Vitamin (A) drops were given to the cases, health education imparted, 16 children were assessed for routine immunization where none of the child were found vaccinated against measles, DHMT informed. 4 Blood samples collected for lab confirmation. An alert of suspected measles was reported. During active surveillance total 13 suspected cases were found, vitamin (A) drops provided, health education imparted. 13 children were assessed for routine immunization where BCG=(4%), Penta1=3(6%), Penta=(16%), Penta3=1(13%), 1=(%), =1(14%). THO informed and request for outreach vaccination activity in the locality. Blood samples collected for lab confirmation. An alert of suspected measles was reported. On active search, more suspected cases were found, blood samples collected for lab confirmation, Vitamin (A) dose were given to the cases. None of the case were found vaccinated against measles. Information shared with DHMT and request for outreach vaccination activity in the locality. An alert of suspected was reported. On active search, total of suspected cases were found. 1 children were assessed for routine immunization where (%) were found vaccinated against BCG. Information shared with DHMT and 1 Nasopharyngeal Swab collected for lab confirmation. An alert of was reported. During field investigation more cases were found, water supply was the source of contamination of water, health education imparted, Aqua tabs, Zinc tabs, ORS and IEC material distributed. Information shared with DHMT, 1 Rectal swab and 4 water samples collected for lab testing. A death was reported due to /suspected cholera. During field investigation, 6 more cases were found. Health education imparted. Aqua Tab & Hygiene Kits distributed. Hand pump was the source of drinking water. 4 water samples were tested and all found unfit for drinking purpose. Information shared with DHO Ghotki. An alert of suspected was reported. On field investigation, more suspected cases were found. 1 Nasopharyngeal swab collected for lab confirmation. Erythromycin tabs and syrups were distributed. 1 children were assessed for routine immunization where none of the child found vaccinated against measles. Information shared with DHMT and request for outreach vaccination activity in the area. An alert of suspected was reported. During field investigation total suspected cases were found, health education imparted, Erythromycin tabs and syrups provided to the cases and contacts. 6 children were assessed for routine immunization where BCG=3(%), Penta =(4%). EDOH informed and Nasopharyngeal swabs collected for lab testing. An alert of suspected was notified. On active search, more suspected cases were found. Cluster for routine immunization was taken from 1 houses where 14 children were assessed, BCG scar=8(66%), Penta1= 7(8%), Penta3=6(4%), 1=4(8%) and =(%).Information shared with DHMT. cases were notified. During field investigation 6 more cases were found. Water supply was the source of water, Aqua tabs, Zinc tabs and ORS distributed in the community, health education imparted. EDOH, THO, DSC and FPNational program informed. Stool and water samples collected for lab confirmation. An alert of was reported. During field investigation 4 more cases were found, Water supply was the source of water, Aqua tabs, Zinc tabs and ORS distributed, health education imparted. EDOH, THO, DSC and FPNational program informed. 1 Stool and water samples collected for lab testing. An alert of suspected measles was reported. During active search more suspected cases were found. Vitamin A drops provided. blood samples collected and sent to NIH for lab testing. Health education imparted to the community regarding the importance of routine immunization, 13 children were assessed for routine immunization where 1 child was found with BCG scar and rest of the children were totally unvaccinated. Information shared with DHMT and requested for vaccination in the area. An alert of suspected measles was notified. On active search 11 more suspected cases were found, Vitamin (A) drops were given to the cases, health education imparted. 1 children were assessed for routine immunization where BCG (%) and rest of the children were found totally unvaccinated. DHO informed about the situation and 6 Blood samples collected for lab confirmation. An alert of suspected case was reported. On active search 4 more suspected cases were found, Vitamin (A) drops provided to the cases, health education imparted. 1 children were assessed for routine immunization where BCG=3(3%), Penta1=3(3%), Penta=(%), Penta3=1(1%), 1=(%) and =(%). DHMT informed and Blood samples collected for lab confirmation. An alert of was reported. During field investigation 3 more cases were found, Hand pump was the source of water, Aqua tabs, Zinc tabs, ORS and Dettol soaps distributed, health education imparted, DHMT and MS informed, 1 Stool sample tested which resulted positive for Vibrio Cholera Inaba. An alert of was reported. On active search 1 more case was found, Hand Pump was the source of water, Aqua tabs, Zinc tabs and ORS distributed, health education imparted. 1 Stool sample collected which resulted positive for Vibrio CholeraOgawa. Information shared with EDOH for further necessary action. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 3

4 Weekly Bulletin: DEWS, Pakistan, Week no. 6 (4 to 3 June 1) Figure3: Number of alerts received and responded, week 6, 1 Figure4: Number of consultations by age and gender, week 6, CCHF DF Malaria # of cases 1 1 < 1 yr 14 yr 14 yr 1 yr + yr Male Female Province Khyber Pakhtunkhwa: 444 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS with a total of 133,91 patients consultations reported in week 6, 1. Total 3 alerts were received while 3 outbreaks were identified and appropriate measures were taken. Altogether 9 alerts for ; while 1 each for BD,, and Typhoid. Acute diarrhoea shows a slightly upward trend in KP. Figure-: Trend of acute diarrhoea diseases, province KPK Figure-6: Number of alerts received and responded week 3-6, 1, province KPK CCHF DF Province Sindh: 74 health facilities from 3 districts in province Sindh were reported to DEWS with a total of 379,36 patients consultations in week 6, 1. Total 9 alerts received while 1 outbreaks were identified and appropriate measure were taken. Altogether 6 alerts for ; 9 for ; 7 for Typhoid; 6 for ; 4 for NNT; for Scabies; while 1 each for Diphtheria and. The AD shows a steady trend in Sindh. Figure-7: Trend of trend of acute diarrhoea, province Sindh 11 1 Figure-8: Number of alerts received and responded week 3-6, 1, province Sindh Malaria Province Punjab: 399 health facilities from 9 districts in province Punjab reported to DEWS with a total of 188,188 patients consultations in week 6, 1. Total 48 alerts were received and appropriate measures were taken. Altogether 3 alerts for ; each for Acute diarrhoea, AJS, ARI and Scabies; while 1 each for, BD, DF and Tetanus. A steady trend noted in the proportion of AD consultation in Punjab during the last few week. Figure-9: Trend of acute diarrhoea, province Punjab Figure-1: Number of alerts received and responded week 3-6, 1, province Punjab DF Malaria 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. 6 (4 to 3 June 1) 471 health facilities from 1 districts in province Balochistan reported to DEWS with a total of 74,77 patients consultations in week 6, 1. Total 6 alerts reported while 1 outbreaks were identified and appropriate measures were taken in week 6, 1. Altogether 1 alerts for ; 4 for ; each for Malaria, and chicken pox; while 1 for. An upward trend noted in AD. Figure-11: Trend of acute diarrhoea, province Balochistan Figure-1: Number of alerts received and responded week 3-6, 1, Balochistan 1 1 Province Gilgit Baltistan: health facilities from 4 districts in Gilgit Baltistan reported to DEWS with a total of 1, patients consultations in week 6, 1. alerts for measles were reported in week 6, 1. AD showing a slightly upward trend CCHF Malaria Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week 3-6, 1, Gilgit Baltistan FATA: health facilities from 3 agencies in FATA reported to DEWS with a total of 16,13 patients consultations in week 6, 1. 1 alert for was reported in week 6, 1 and appropriated measures were taken Figure-1: Trend of acute diarrhoea, FATA Figure-16: Number of alerts received and responded week 3-6, 1, FATA State of Azad Jammu and Kashmir: 1 health facilities from 9 districts in AJ&K reported to DEWS with a total of 7,84 patients consultations in week 6, 1. 6 alerts for reported in week 6, 1 and appropriate measures were taken. Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 3-6, 1, AJ&K For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

6 Weekly Bulletin: DEWS, Pakistan, Week no. 6 (4 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 6, 1 no new type1 polio case was reported (up till week ) Current week 6, 1 Total for 1 (week 16, 1) A O A O A O A O Acute watery diarrhoea Acute jaundice syndrome Bloody diarrhoea Dengue fever NNT + tetanus Malaria Others Total As of July 1, Pakistan has reported a total of polio cases (19 type 1, 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 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 1 Number of CCHF cases (week 1 to 6, 1), Pakistan situation of CCHF cases in 1. 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). # of cases Any contact of a CCHF patient should monitor his/her temperature for 14 days and see a doctor if fever develops. The anti viral medicine Ribavirin has been effective in saving lives of patients who report early to the health facility Epiweek For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 6

7 Weekly Bulletin: DEWS, Pakistan, Week no. 6 (4 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 summarizes the situation of measles in 1 up to 3 June; and table illustrates the alerts and outbreaks in week 6 (43 June, 1). Table1 1 (Week 1 6) Table Epi week 6, 1 Province # of Alerts # of Outbreaks # of Cases # of Deaths AJ&K Balochistan FATA Gilgit Baltistan 1 16 ICT Province # of Alerts # of Outbreaks # of Cases # of Deaths AJ&K 6 7 Balochistan FATA Gilgit Baltistan ICT 1 3 Khyber Pakhtunkhwa Khyber Pakhtunkhwa Punjab Sindh Total Punjab Sindh 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: Weekly trend of positive Dengue cases, week 1 to 6, 1 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 68 in Sindh and 7 in Punjab. Month of peak incidence in 1 was November while peak incidence in 11 was in September and October. # of cases Punjab Sindh Malaria: The chart at right shows the malaria slide positivity rate and Falciparum rate reported in week 6, 1. Total number of malaria cases tested in week 6, 1 is 13, out of which 381 were found positive; 88 for P. Vivax; 98 for P. Falciparum; while 36 for Mixed (SPR = 19.%; F. R =.3%) Malaria slide positivity and Falciparum rate, week 6, Balochistan Sindh KP FATA Punjab AJK GB 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 6, 1 Weekly Bulletin: DEWS, Pakistan, Week no. 6 (4 to 3 June 1) For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 8