Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 3, Issue 3, Wednesday 13 June 1 Highlights Epidemiological week no. 3 (3-9 June 1) Figure1: 87 districts reported to DEWS in week 3, 1. : 168 alerts investigated, responding to 31 outbreaks involving 41 measles cases. CCHF: two new cases reported in week 3; In 1, total of 7 cases have been reported throughout the country. Acute diarrhoea: Trend of acute diarrhoea in on the rise in all provinces. Districts in Sindh and are investigating alerts for acute watery diarrhoea/ suspected cholera. Five new polio cases were reported; As of 11 June 1, Pakistan has reported a total of polio cases (19 type1, type3 & 1 mixture type1 & 3) from 13 districts/tribal agencies. 87 districts have reported in week 3, 1, Please see map.,1 health centres have reported to the Disease Early Warning System (DEWS) in week 3, 1 73,614 patients consultations were reported over the week 3 compared to 79,763 consultations reported on week, 1. Figure: Weekly trend of Acute diarrhoea in Pakistan Week1, 11 to week3, 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 Pertussis Suspected Acute Viral Hepatitis Neonatal Tetanus Acute Flaccid Paralysis Scabies Cutaneous Others Cumulative number of selected health events reported in 1 3 (1 Jan 9 June 1) Disease # of Cases Acute diarrhoea 1,11,4 7% Bloody diarrhoea 71,716.48% ARI 3,71,81 % S. 664,6 4% Skin Diseases 66,87 4% Unexplained fever 19,78 3% Total (All consultations) 1,37,413 Major health events reported during the 3 (3 9 June 1) Disease # of Cases Acute diarrhoea 69,34 9% Bloody diarrhoea 3,.44% 1 ARI 11,78 1% S. 38,93 % Skin Diseases 3,783 4% Unexplained fever 7,439 4% Total (All consultations) 73,614 The graph (Figure1) shows the weekly trend of Acute diarrhoea as proportional morbidity (percentage of cases out of total consultations) reported to DEWS on weekly basis. Proportional morbidity of acute diarrhoea is high in, FATA, Sindh and Balochistan; Please see graphs on page 4 and. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 1

2 Weekly Bulletin: DEWS, Pakistan, Week no. 3 (3 to 9 June 1) Current week's (3/1) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 1 suspected case was reported from a Private Clinic. During active surveillance 4 more suspected cases were found. Vit A drops provided. Health education imparted. Epi team vaccinated 1 Sarmastani Kurd 3Jun Balochistan Khuzdar 4 1 Abad, UC Lizo children of <13 years pf age against measles. DHO was informed about the situation. 3Jun 3Jun Balochistan Khuzdar 3Jun Punjab Bhakkar Village Raijj, UC Zeedi Charsadda Battagram 3 1 Mohallah Masoomabad; Mohallah Farooqabad, Bhakkar Jun Balochistan Awaran DHQ Hospital 4Jun 4Jun 4Jun 4Jun 4Jun Balochistan Awaran Balochistan Awaran Balochistan Awaran Balochistan Jhal Magsi Balochistan Lasbela Jibri, UC Nokjo, Tehsil Mashkai Killi Mungli, UC Parwar Waja Bagh, UC camp Jhaoo,Tehsil Jhal Jhaoo BHU Sabz Ali Umrani, (Sabz Aki umrani) Civil Hospital, Tehsil Bela Jun Balochistan Gwadar DHQ Hospital Jun Sindh Tando Allah Yar 4Jun Sindh Mirpur Khas 4Jun Sindh Shikarpur 4Jun Jun Jun Jun Jun Sindh Tando Muhammad Khan Balochistan Jhal Magsi Balochistan Kech D. I. Khan Mardan Jun Punjab Layyah Jun Punjab Multan Village Vanheil Thebo, taluka Jhando Mari Village Mehboob Farm, UC Jhulri, taluka Mirpurkhas Village Manik Lashari, near Khabri, UC Taib Village Suleman Soomro, UC Moula Katiar, taluka Bulri Shah Karim BHU Gajan,Killi Gajan, UC Patri Mohallah Mullibasti, UC Absar Haleem (Islamia) Colony, City Village Jauro Dheri, UC Gumbat, Tehsil Mardan Khu Wasti Wala,UC Bait Wasava Shumali, Tehsil Layyah Pulbararan, MDA chowk suspected case was reported from DHQ. On active search 6 more suspected cases were found. Vit A drops were given to all the cases. 1 Blood sample sent to NIH for lab confirmation. DHO informed. An alert of suspected was reported. On active surveillance 8 more of suspected measles cases were found. 9 children were assessed for routine immunization and all of them found unvaccinated against measles. Intensified outreach vaccinated activity conducted. Blood samples taken and sent to NIH for lab testing. Vit. A given to the cases. Health education imparted. 7 suspected cases of measles were reported. On active surveillance 3 more suspected cases were found. Total 96 children were assessed for routine immunization and vaccinated (BCG+ ). Blood sample was collected and sent to NIH for lab testing.vit A drops provided to the cases.health education imparted about importance of vaccination. General hygiene and isolation measures were demonstrated to the community. EDO(H) informed. 1 suspected cases of were reported. 6 slides were tested and 49 found positive (SPR=8%) pf=, pv=, Mix=; (FR=%). Anti malarial medicines were given to patients. Information was shared with DHO. suspected cases of were reported and tested. slides were positive for pf, pv 8, Mix 1; (SPR=91%, while FR=6%). Antimalarial drugs were provided. DHO was informed. 34 suspected cases of reported and tested, were found positive for pf 8, pv 1; (SPR=9%, while P. Falciparum=4%). Anti malarial meds were given. All the information shared with DHO. 7 suspected cases were reported and tested, 4 verified positive of pf, pv 1 and Mix 37 (SPR=77%, while FR=7%. Anti malarial meds were provided for treatment. Information shared with DHO. 1 suspected cases were reported. 1 slides were tesed and 1 found positive for pf=1; (SPR=71% and FR=1%). Anti l medicines and RDTs were supplied. Information shared with DHO and district malaria program representative. 7 suspect cases of were reported. 61 slides were tested of which 31 found positive for pf 1, pv 1 (SPR=1%, while FR=3%). Antimalarial meds were provided to the hospital. DHO was informed. 9 suspected measles cases were reported from DHQ. Most of the cases are from one location. During active surveillance no more cases were found in the locality. 6 cases of /suspected cholera were reported, during active surveillance more cases were found, Aqua tabs, Zinc tabs and ORS distributed, EDOH informed, 1 Stool and 4 water samples collected and sen to NIH for lab testing. An alert of suspected measles was reported from community, during active surveillance total cases were found. Vitamin(A) dose were given to all cases. Vaccination status were assessed for 6 children out of which 1= 4 (76%), =1 (16%), health education imparted,edoh informed and Blood samples collected for lab confirmation. An alert of suspected was notified. During field investigation 4 more suspected cases were found, vitamin (A) dose given to the cases, immunization status of 16 children were assessed out of which 11 children (68%) were found vaccinated against BCG and rest ofthe children were unvaccinated against all antigens. Information shared with DHMT and Blood samples were collected for lab testing. Deaths due to complication were reported from community, on active surveillance 7 more suspected measles cases were found, Vitamin(A) drops provided to the cases, health education imparted, 1 children were assessed for routine immunization where =1 4(4%) and none of the child were vaccinated against. EDOH informed and 6 Blood samples were collected for lab testing. 4 suspected cases were reported. 1 slides were tested, 9 found positive for pf 7, Mix ; (SPR=9% and FR= 1%). Antimalarial medicines and RDTs were supplied. Information was shared with DHO and district malaria program representative. suspected measles cases were reported. During active surveillance 1 children checked for routine immunization out of which 9 were found totally unvaccinated (43%), Vitamin A drops was given to all the cases. Information shared with DHO. deaths due to measles were reported. During active surveillance three more cases of suspected found. Vit A drops were given to the cases. 3 children below the age of 13 years were assessed for routine immunization and found unvaccinated. DSV EPI vaccinated the children against measles. DHO informed about the situation. An alert for suspected was reported. On field investigation more suspected cases were found. Vitamin A drops were given to the cases. 1 children were checked for routine immunization and found unvaccinated against measles; EPI team vaccinated 8 children with measles vaccine. Health education sessions conducted, EDOH, EPI Coordinator and LHS were informed. An alert of suspecetd was reported. On active search 7 more suspected cases were found. Vitamin A drops were given to suspected cases and contacts. 3 children were assessed for routine immunization out of which 6 (74%) children were vaccinated against BCG and rest of the children found totally unvaccinated. During intensified outreach activity, 93 children were vaccinated against measles under 1 years of age. 3 blood sample were taken and sent to NIH for lab confirmation. Health education imparted. EDO(H) and DSC was informed. An alert of suspected measles was reported. During active surveillance 7 more suspected cases were found. 4 blood samples were taken and sent to NIH for lab confirmation. Vit A drops were given to the cases. Intensified outreach activity conducted in the locality, 1 children < yrs of age were vaccinated for routine immunization. Health and hygiene sessions conducted about the importance of routine vaccination. Information shared with EDO(H), DOH(HQ), DOH, DDOH and DSC. Follow up planned. Jun Sindh Karachi Chakra Goth Korangi town 3 An alert of suspected measles was received from Tertiary Care Hospital, index case was partially vaccinated, during field investigation 7 more suspected cases were found, Vitamin(A) dose were given to all cases, health education imparted, immunization status of children were assessed out of which 1= 1 (74%), = 1 (8%), DHMT informed and 1 Blood sample sent to NIH. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

3 Cont d current week's (3/1) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 6Jun Balochistan Pishin 6Jun FATA 6Jun 6Jun Sindh 6Jun Pertussis Sindh 6Jun Pertussis Sindh 6Jun Pertussis Sindh Agency Swabi Ghotki Shaheed Benazir Abad 7Jun Balochistan Pishin 7Jun FATA 7Jun FATA 7Jun 7Jun Punjab 7Jun Sindh 8Jun Balochistan Sibi 8Jun Typhoid 8Jun Sindh 8Jun Sindh 8Jun sindh 8Jun Pertussis Sindh 9Jun Sindh Muhammadin colony, UC Yaro Village Manz choki,uc Pirokhel,Tehsil Landikotal Private clinic, Seray Charbagh Village Pinyio Labano UC Bandh Village Nizamudin Dahri, UC Sun sawri Village Daim Khaskheli, taluka Jhando Tando Allah Yar Mari Village Haji Bachal Tando UC Mirabad, taluka Allah Yar Jhando Mari Bajaur Agency Agency Haripur Muzaffargarh Khairpur Haripur Khairpur Khairpur Shaheed Benazir Abad Tharparkar Shikarpur Village killi Malikayar, UC malikayar village Koohi sha & Badezaghan Shekhano, Tehsil Utmankhel Village Pasid Khel,UC Torkham,Tehsil Landikotal Raja Bagh, UC Tofkian, BHU Tofkian Gali # 1, Safdar Colony, UC City3 Mohalla Zameer Lanj wa, Village Darri, UC Mohabat wah Village Safi, UC Khurruk Village Kariplian, UC Kariplian Village Daim Khan Gopang, near Village Younus Ujjan, UC Mohabat wah Village Qabool Khan Gopang, UC Moabat wah, taluka Kot Diji. Village Maroof kaliyar, UC Heaberi Village Kerio Dolat, UC Peelu, taluka Nagarparkar Muhalla Ameen shah chishti, near Mukhtiarkar office, UC4 Weekly Bulletin: DEWS, Pakistan, Week no. 3 (3 to 9 June 1) suspected case of was reported. During active surveillance 6 more suspected cases were found. Vit A drops provided to all cases and Health education imparted in the locality. 8 suspected cases of measles cases were reported. Vitamin A drops were given to the cases. blood samples 1 were sent to NIH for lab confirmation. 4 children were vaccinated against measles. Health education imparted. Report shared with Agency Surgeon and FSMO. An alert of suspected was reported from a private clinic. During field investigation 7 more suspected cases were found. Vit.A drops were given to the cases, health education sessions conducted, EDO H and EPI coordinator informed. An alert of suspected measles case was reported. On active search 4 more suspected cases were found. 3 1 blood samples were collected and sent to NIH for lab confirmation. 1 children were assessed for routine immunization out of which four were found vaccinated against BCG and rest of the children were totally unvaccinated. Information shared with DHMT for intensified outreach vaccination activity in the locality. An alert of suspected Pertussis was notified from a Private Clinic. During field investigation 1 more suspected 16 cases were found, Erythromycin tabs provided to the cases and contacts, 1 children were assessed for routine immunization where 4 (7%)have BCG scar and 4 (7%) were found vaccinated against penta1, rest of the children found totally unvaccinated. Information shared with DHMT. An alert of suspected Pertussis was reported from community. On active search total 7 suspected cases were found, health education imparted, Erythromycin Syp provided to the cases, vaccination status were assessed for 7 children where BCG 4 (6%) and Penta 3 (%). EDOH informed and Nasal Swabs were collected for lab confirmation. An alert of suspected Pertussis were reported from community. During active search total 1 suspected 3 cases were found, health education imparted, Erythromycin Syp distributed to the cases. Vaccination status were assessed for 1 children where BCG= 6(6%) and Penta= 4(4%) were found. EDOH informed about the situation and 4 Nasal Swabs were collected for lab confirmation. 13 suspected cases were reported from the village Malikayar. On field investigation 113 children 1 7 were assessed for routine immunization and none of the child found vaccinated against any antigen. Outbreak investigation and EPI coverage was discussed with DHO and EPI representative. Intensified outreach vaccination activity was planned. 3 suspected cases of measles were reported. During active surveillance 4 more cases were found. Blood samples taken from patients and sent to NIH for lab testing. Health and hygeine sessions conducted. Vitamin A drops were given to all cases and contacts. Routine immunization status were assessed for 8 children under years of age out of which 6 were found vaccinated for routine and 1. Agency Surgeon & DSV was informed about the situation. teams sent to the area for coverage. Suspected measles cases were reported by EPI Technician. The affected area was visited. 11 suspected cases were identified on active search. Vitamin A drops were given to cases. blood samples sent to NIH for lab confirmation. 68 children were assessed for routine immunization and all of them found totally unvaccinated. Health education imparted. Report shared with Agency Surgeon and FSMO. 6 suspected measles cases were reported. During field investigation 18 children were assessed for routine immunization and all of them found unvaccinated against measles. Vitamin A drops were given to the cases. Information shared with PEO polio and EPI coordinator about the vaccination status. Intensified outreach vaccination activity scheduled. An alert of suspected was reported. On active search more suspected cases were found. Vit A drops were given to all cases. Blood samples were collected and sent to NIH for lab testing. Health education imparted. Intensified outreach vaccination activity planned. An alert of suspected was reported. During field investigation 8 more suspected cases were found 7 and all were unvaccinated. Vitamin (A) drops provided to all cases, health education imparted, Information was shared with DHMT and request for intensified outreach activity. Blood samples were collected and sent to NIH for lab confirmation. 1 suspected case of measles was reported. On active search more suspected cases were found. Vit A drops 1 3 provided to all cases. 1 children less then years were assessed for routine immunization and 16 were found unvaccinated against measles (64%). Health education imparted and parents were advised to visit EPI center for vaccination. 6 suspected cases of Enteric Fever were reported. Blood samples were tested and IgM came back positive for S.Typhi, field investigation found possible source as contaminated water supply. 1 case referred to DHQ 4 haripur with complications (pain right illiac fossa and tender abdomen). Water samples from source, homes were taken and assessed for contamination. Health and hygiene sessions were conducted. Water supply operators were requested to ensure chlorinated water supply. Information shared with DHO. An alert of suspected was reported from community, on active search total suspected cases were 1 found. Vitamin (A) provided, 1 children were assessed for routine immunization out of which (%) children were vaccinated against BCG and rest of the children found totally unvaccinated. Information shared with DHMT and request for outreach activity in the area. 1 Blood sample collected for lab testing. An alert of suspected case was reported. During field investigation total suspected cases were 1 found, vitamin (A) drops were given to all cases.1 children were assessed for routine immunization where 3 (3%)children found with BCG Scar and rest of the children found totally unvaccinated. Information shared with DHMT. 3 Blood samples collected for lab confirmation An alert of suspected measles case was notified. During field investigation 8 more suspected cases were found. Vitamin (A) drops were given to the cases, health education imparted. 14 children were assessed for routine immunization out of which 4 (8%)were found vaccinated against 1 and none of the child was vaccinated against measles. DHMT informed and 3 Blood samples were collected for lab testing. 3 suspected cases of pertussis were reported, on field investigation more suspected cases were found. Erythromycin tabs and Syr were distributed to all cases and contacts, immunization status were assessed for 8 children where none of the child found vaccinated, health education imparted, EDOH informed and Nasal Swab were taken for lab confirmation. An alert of suspected case was notified. On active search 4 more suspected cases were found, vitamin (A) dose were given to all cases, 14 children were assesed for routine immunization where (14%) children had BCG scar and rest of the children found totally unvaccinated. DHMT informed and Blood samples 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. 3 (3 to 9 June 1) Figure3: Number of alerts received and responded, week 3, 1 Figure4: Number of consultations by age and gender, week 3, CCHF DF Pertussis Number of cases 1 1 Wk Wk1 Wk Wk3 < 1 yr 14 yr 14 yr 1 yr + yr Male Female Province : 468 health facilities from 17 districts of reported to DEWS with a total of 1,74 patients consultations reported in week 3, 1. Total 7 alerts were received while 6 outbreaks were identified and appropriate measures were taken. Altogether 9 alerts for ; 4 each for ; each for Bloody diarrhoea and Typhoid; while 1 each for Acute diarrhoea,, CCHF, DF and NNT. Figure-: Trend of acute diarrhoea diseases, province KPK Figure-6: Number of alerts received and responded week - 3, 1, province KPK Province Sindh: health facilities from 3 districts in province Sindh were reported to DEWS with a total of 99,891 patients consultations in week 3, 1. Total 6 alerts received while 1 outbreaks were identified and appropriate measure were taken. Altogether 37 alerts for ; 7 for ; for Pertussis; 4 for Typhoid; while 1 each for Bloody diarrhoea, and Food poisoning Wk Wk1 Wk Wk3 CCHF DF Figure-7: Trend of trend of acute diarrhoea, province Sindh Figure-8: Number of alerts received and responded week - 3, 1, province Sindh DF Province Punjab: 41 health facilities from 8 districts in province Punjab reported to DEWS with a total of 17,99 patients consultations in week 3, 1. Total 48 alerts were received while outbreaks were identified and appropriate measures were taken. Altogether 8 alerts for ; each for Scabies and Typhoid; each for Acute diarrhoea, ARI, Bloody diarrhoea and Dengue fever, while 1 each for and. 6 4 Wk Wk1 Wk Wk3 Pertussis Figure-9: Trend of acute diarrhoea, province Punjab Figure-1: Number of alerts received and responded week - 3, 1, province Punjab DF # od alerts 1 1 Wk Wk1 Wk Wk3 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. 3 (3 to 9 June 1) 476 health facilities from districts in province Balochistan reported to DEWS with a total of 67,94 patients consultations in week 3, 1. Total 44 alerts reported while 14 outbreaks were identified and appropriate measures were taken in week 3, 1. Altogether 18 alerts for ; 13 for ; 7 for ; while 1 each for Acute diarrhoea, CCHF, Scabies, Typhoid, Chickenpox and Mumps. Figure-11: Trend of acute diarrhoea, province Balochistan Figure-1: Number of alerts received and responded week - 3, 1, province Ba CCHF Province Gilgit Baltistan: 36 health facilities from 4 districts in Gilgit Baltistan reported to DEWS with a total of 16,97 patients consultations in week 3, 1. No alerts or outbreak for any disease was reported in week 3, 1. Wk Wk1 Wk Wk3 Pertussis Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week - 3, 1, Gilgit Baltistan FATA: health facilities from 3 agencies in FATA reported to DEWS with a total of 14,11 patients consultations in week 3, 1. Total 13 alerts reported in week 3, 1. Altogether 9 for ; 3 for NNT; while 1 for were reported and appropriated measures were taken Wk Wk1 Wk Wk3 Pertussis Figure-1: Trend of acute diarrhoea, FATA Figure-16: Number of alerts received and responded week - 3, 1, FATA State of Azad Jammu and Kashmir: 16 health facilities from 9 districts in AJ&K reported to DEWS with a total of 3,737 patients consultations in week 3, 1. Total 17 alerts reported in week 3, 1. Altogether 1 alerts were for ; while for were reported and appropriate measures were taken. Wk Wk1 Wk Wk3 Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 19 -, 1, AJ&K Wk Wk1 Wk Wk3 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

6 Weekly Bulletin: DEWS, Pakistan, Week no. 3 (3 to 9 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 3, 1 five new type1 polio cases were reported, 3 from Federally Administered Tribal Areas (one from South Waziristan, two from Agency) and one each from Punjab (Rajanpur) and Sindh (Larkana) provinces. As of 11 June 1, Pakistan has reported a total of polio cases (19 type1, type3 & 1 mixture type1 & 3) from 13 districts/tribal agencies. Province 11 1 (up till week ) Current week 3, 1 Total for 1 (week 13, 1) A O A O A O A O Acute watery diarrhoea Acute jaundice syndrome Bloody diarrhoea Dengue fever Pertussis NNT + tetanus Others Total Cases 11 Cases 1 P1 P3 P1 P3 P1+P3 Punjab 9 Sindh 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 7% mortality 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 1 8 Cases Positive Deaths 6 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. Number of cases In 1, total of suspected cases have been reported throughout the country with 1 confirmed to date and deaths. Out of 1 cases with linked history of Balochistan, 13 cases have been reported from Quetta. Chart at right illustrates current situation of CCHF cases in 1. CFR is 33%. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int

7 Weekly Bulletin: DEWS, Pakistan, Week no. 3 (3 to 9 June 1) Action taken by WHODEWS team: 1. WHODEWS team is working in close coordination with health department in order to control CCHF outbreaks.. Monitoring the cases and their contacts on regular basis. Monitoring the Health staff on regular basis. 3. Monitoring contacts of the cases including family members and health staff for two weeks after exposure 4. Conducting regular meetings with DG Health and CCHF Focal Person DG Health office to update them regarding the situation and it is possible outcomes.. District health department has planned doortodoor distribution of flyers in Quetta to raise awareness of the hazards of exposure to ticks and fresh blood on butchering. 6. Conducting meetings with DG Livestock along with CCHF Focal person and update him regarding the situation and requested for intervention from his department. 7. Continuous awareness sessions are being conducted, to prevent tick bite/contact and use of PPE or proper clothing with gloves, masks and long boots, among high risk groups. : As of 9 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 and table illustrates about the alerts and outbreaks in week 3 up to 9 June. Table1 1 (Week 1 3) Table 3, 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 1 13 ICT 1 38 AJ&K 1 1 Balochistan FATA Gilgit Baltistan ICT 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 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 to the right show the weekly number of confirmed Dengue cases reported by surveillance focal points in the Departments of Health in Sindh and Punjab in 1. Total number of confirmed dengue cases to date in 1 is 6 in Sindh and 64 in Punjab. Month of peak incidence in 1 was November while peak incidence in 11 was in September and October. # f cases Punjab Sindh Epi week For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 7

8 Alerts and outbreaks, week 3, 1 Weekly Bulletin: DEWS, Pakistan, Week no. 3 (3 to 9 June 1) 8