Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume, Issue, Monday 1 July, 11 Highlights Epidemiological week no. ( - 1 July, 11) 9 districts and 3 agencies provided surveillance data to the DEWS this week from 3,7 fixed health facilities and two mobile medical outreach centres. A total of 1,1,1 consultations were reported through DEWS of which 1% were acute respiratory infections (ARI), 1% skin disease, 1% acute diarrhoea, and suspected Malaria remains at %. Critical situation of diarrhea in KP, surpassing the proportional morbidity recorded in the 1 post-flood period. 1 out of 1 reporting districts in KP have more than 1% diarrhea cases out of total consultations at public health facilities. A total of 11 alerts with 1 outbreaks were reported in week-, 11: Altogether 37 alerts were for AWD; 3 for Measles; 11 for Neonatal Tetanus and Tetanus, Six each were for Acute diarrhoea and Pertussis, five for Leishmaniasis, four for Meningitis, three each were for Bloody diarrhoea and Chicken pox, two each were for DHF, Scabies and Typhoid, while one each for Malaria, Mumps and Unexplained Fever. National Polio Eradication Initiative reported no newly confirmed polio case this week. Total 9 (=type1, and 1=type3) confirmed polio cases have been reported in 11 from districts. 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, (9, 1 and 11) Disease Wk-1 Wk- Wk-3 Wk- Wk- Wk- Wk-7 Wk- Other Acute Diarrhoea (Not Watery) 1,7 (1%) 1, (1%) 1,73 (1%) 1,17 (1%) 13,97 (1%) 17,9 (1%) 99,777 (1%) 1,31 (1%) Total consultation 1,,71 99,731 1,9, 1,,9 1,19,7 1,7,3 991,3 1,1,1 Figure 1 above represents trend of "proportional morbidity." This is the number of new consultations for acute diarrhea divided by the total number of consultations. The very dramatic peak starting about week 31, 1, demonstrates the increase in acute diarrhoea cases from the flood affected areas starting in KP the first week of August 1. The proportional morbidity of diarrhoea in 11 so far follows the seasonal trend of 9 and early 1. However the cholera cases and outbreaks are above the usual number and started earlier than usual this year. Last week nine districts had outbreaks of AWD, nine more were confirmed this week. This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int. 1

2 Epidemiological Bulletin: DEWS, Pakistan, Week no. ( - 1 July, 11) Previous week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 7 Jul BHU Mohammad Ameen patients of suspected malaria were reported, 3 of the 3 tests found positive (P. Falciparum 1, P.Vivax 7, mixed Balochistan Malaria Jaffarabad Kandrani, Tehsil Sohbat ); Slide Positivity Rate = %, while Falciparum rate = 7%, treatment provided. DHO was informed and requested to Pur distribute bed nets to the affected community. Jul suspected cases for malaria were reported. All the cases were tested and 3 verified positive and treated (SPR = Balochistawan Killi Qadir Abad UC sara Malaria Kharan 1%). The area was surveyed along with DHMT and fogging spray was conducted. Antimalarial medicine were also available in BHU Sarawan while DHO EDO was informed and requsted to provide bed nets. Jul AWD KPK Abbottabad Village Khan, UC Sarpana AWD outbreak reported from village Khann, Abbottabad. About cases with three deaths reported in three days, DTC established, and Rapid Response Team activated immediately. Two sample were collected and found positive for V.c. Ogawa. Six out of eight water samples were also found contaminated. Probable Pertussis cases were reported from BHU Duli Banda which is covering some part of UC Sudal. Detailed history 7 Jul Pertussis KPK Kohat UC Sudal taken, blood and Nasopharyngeal swabs were collected and transported to NIH. Erythromycin delivered to contacts, Maintained line list. Brief hygiene session conducted with the community, family of cases advised for isolation and strict hygiene measures to be taken. EDO H, PPHI and EPI department informed and alerted. Jul AWD KPK Mansehra Three AWD cases with dehydration identified in emergency ward of DHQ, samples were found positive for V.c. Ogawa. Village Shah Khel Garhi; EDOH, MS DHQ and Coordinator Public Health were informed about the cases. Health & hygiene education provided to Sadiqabad, Chitti Dheri; 3 the households and to the community. Water source identified which was hand pumps and springs. Epidemiological & Village Sajawal Shareef Environmental investigations are underway. & Jul Current week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Jul AWD AJK Sudhnoti Village Bhatiyan UC Patan sher khan The Mang 1 13 Jul AWD Punjab Bhakkar UC Pir Ashab 1 Jul AWD Punjab Muzaffargarh 13 Jul AWD Punjab Muzaffargarh Basti Yaroo Wala, UC Baseera Basti Chah Tayyab Wala, Moza Bhakhar Noon, UC Budh case of AWD reported from RHC Mang and managed there stool sample collected and found positive for V.c. Ogawa. Field investigation was carried out with DOH team no other active case of AWD was found. 1 Jul Malaria Balochistan Sohbat Pur Alert for cases of Malaria were reported, 1/1 samples found positive for Malaria (P. Falciparium, P.Vivax, Mixed 3). CD Baloo Pur, Tehsil Jaffarabad SPR 7% while Falciparum rate also 7%. Appropriate treatment initiated, DHO informed who requested for distribution of bednets in the affected location. A case of AWD reported from a private hospital. On field investigation a V.c. positive case was found in the locality of Merabadia 1 Jul AWD ICT Islamabad Merabadia, F11/1 1 i.e opposite to F11 1 sector. Patient recovered. No other case was found during active search. Water disinfection at household level, ORS and hygiene messages shared. 1 Jul AWD Khyber One AWD case was reported by private clinic, case investigated jointly with DoH. Sample collected and sent to NIH and Jhazo Maidan, UC Pakhtunkhwa and preventive measures reinforced in the area. Hangu 1 found positive for V.c. Ogawa. No other suspected cases found on active surveillance. Environmental assessment in progress Ganjiano Kale Suspected outbreak of AWD was reported from BHU Kundi from village Baji Sar. Patients presented to BHU with severe 1 Jul AWD dehydration and informed the incharge of BHU about other cases in their locality with same sign and symptoms. Investigations showed the cases started on 1th of July after having a lunch at a wedding (food borne). Samples sent to NIH were Khyber Village Baji Sar, Pakhtunkhwa Kundi, Tehsil Ghazi Haripur Union Council 3 1 found negative for V. Cholera. Total of cases were found on active case finding. cases were severely dehydrated and out of them were admitted in different health facilities of Ghazi for treatment. Aqua tabs, ORS and soaps were distributed and Health and Hygiene session was conducted for the affected community. EDO Health was informed of the outbreak 11 Jul AWD KPK Mardan Jul AWD Punjab Multan Jul AWD Sindh Larkana Jul AWD Sindh Naushahro Feroze Jul AWD Sindh Thatta Khyber AWD Pakhtunkhwa Mardan Mohallah Mullayan, Vill. Parhoti; Mohallah Muhammad abad, Haji korona, Baghdada Medina Town Old Shujabad Road Basti Fatool Pur, Labar Morh Village wada phull UC Phull Taluka Village Allah Jurio Rajper, UC Ghair Gaju, Taluka Bhiria Village ali muhad jat, UC Kothi, Taluka jati Mohallah Pirano Korona, UC Manga, Charsadda Road Jul AWD Punjab Rawalpindi Ora Sharif, Murree Alerts for AWD from two different locations. Detailed history taken, Complete examination done, sample collected and sent to NIH, both found positive for V.c. Ogawa. Health and Hygiene session conducted, EDO H, DSM PPHI, MS DHQH and Coordinator National programme Alerted and informed. AWD case reported from BHU Hamidpur Konora, the area of the case was visited jointly with the SO,EHE and DEWS FP. Stool sample found positive for V.c. Ogawa. House to house survey conducted no other cases found in the locality. Area was assessed for the WASH. Health education session conducted, health hygiene kits (Aqua tabs, Jerry cans, Multi purpose soap, Antiseptic soap, Buckets and water filter) distributed. LHWs of the UC were trained on DEWS Alerts definitions and HE. LHWs mobilized to conduct HE sessions on hygiene in the other Areas of the whole UC. shared the line list with EDO(H). Alert for eight cases AWD from one village. Health hygiene sessions done, aqua tabs, ORS, life straw, IEC, jerry cans distributed, / stool samples found positive for V.c. Ogawa, water samples also collected, reports shared with EDO H. No further cases on follow up. 3 suspected AWD cases reported, one stool sample taken and found positive for V.c. Ogawa, 3 drinking water samples taken for analysis, Hypothesis is poor practice of food handling resulted in AWD outbreak. 1 suspected AWD cases were found, 1/ samples collected found positive for V.c. Ogawa, Reinforced case management, active surveillance done and no further case found, health education, aqua tabs, zinc tabs, ORS & IEC material provided, EDO H,DSM PPHI and MS DHQ informed, water samples were collected. False alert Media reported increase in diarrhoea cases and five deaths, investigation by EDO H Rawalpindi, THQ Murree, and MS hospital DHQ found no deaths due to diarrhoea and no increase in cases. One death is yo due to heart disease and one death is 7yo due to vomiting. One case of AWD reported. Sample collected and found positive for V.c. Ogawa, active surveillace conducted and 3 diarrhoea cases found in the area. EDO H, DSM PPHI, MS DHQH and Coordinator National programme informed and alerted. Health and Hygiene session conducted. LHWs asked continue house to house survey for diarrhea patients and to provide health and hygeine education and distribute aqua tabs in the community. District Rapid Response team moblized to strengthen RHC Manga and staff alerted and trained on diarrhea case management. 1 AWD case was reported from UC Pir Ashab, Tehsil and District Bhakkar, on active surveillance no more cases were found. Stool sample collected and found positive for V.c. water sample were tested and found contaminated. Health and hygiene session given, ORS use was explained, life straws, jerry cans, aqua tabs and soaps were distributed in the community. cases and one death due to AWD reported from Basti Yaroo Wala. DEWS team visited the affected village found 13 diarrhoea cases. The team visited the nearest health facilities, BHU Ali Wala and RHC Baseera and briefed the doctors para medical staff on the situation and implementation of control measures, to rais awareness in the community about safe drinking water, food and personal hygiene. The facilities were assessed for availability of medicine and supplies. HE sessions were conducted by LHS, LHWs, Sanitation Staff, DSC, EH Eng. 1 Stool sample was collected and found positive for V.c. Ogawa, Water samples collected for quality testing (results awaiated). Solid wast scattered all over in the area collected and burned. Soaps, Aqua Tabs, buckets, jerry cans, water filters, ORS and IEC material distributed. 1 AWD Stool swab sample was collected and sent to NIH which was found positive for V.C Ogawa. In the locality/area 1 households on each side were interviewed but no more similar case or suspect was found except two cases od AD. Health education to family members in households visited. Distribution of soaps, Aqua Tabs, jerry cans, buckets, water filters & IEC among them. Nearest The MO at the nearest health facility was briefed briefed on the situation, control measures. The importance of safe drinking water, food and personal hygiene and LHWs, CDC supervisor and School Health and Nutrition Supervisor would impart HE sessions in the catchment area discussed. EM & EH assessment was also done at BHU. 13 Jul AWD Sindh Matiari UC Zeir Pir Village, Deper Lakha, Near mansoorah 1 1 Seven cases of AWD were recorded. Reinforce case management,active survelliance done, Health education, Aqua tabs, ORS, IEC Material,family filters, Jerrycans and Zinc Tabs provided, 1 stool sample collected and found positive for V.c. Ogawa, Water samples also collected for quality testing (results awaited), EDO H and DOH Informed. 13 Jul AWD Sindh Village Rab Rakhio Qambar Shahdadkot Lakho, Tehsil Qambar 1 1 AWD case reported, stool samples found positive for V.c. Ogawa, 3 drinking water samples also collected for quality testing. The alert responded along with rapid response team of EDOH. This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int.

3 Table 1: Leading causes of seeking health care in flood affected districts, 9 July 1 to 1 July 11, compiled from weekly reports Diseases Total Skin Diseases 3,3,17 (11%) Acute Respiratory Infection,1,71 (3%) Acute Diarrhoea 3,391,99 (9%) Bloody Diarrhoea 31,9 (1%) Suspected Malaria,1, (%) Unexplained Fever 1,,1 (%) Total Consultations 3,3,9 Focus on: critical diarrhea situation in KP Epidemiological Bulletin: DEWS, Pakistan, Week no. ( - 1 July, 11) Figure : Weekly number of reporting health facilities (Wk 33/1 to Wk /11) Mobile Fixed Wk 33 Wk 3 Wk 37 Wk 39 Wk 1 Wk 3 Wk Wk 7 Wk 9 Wk 1 Wk 1 11 Wk 3 Wk Wk 7 Wk 9 Wk 11 Wk 13 Wk 1 Wk 17 Wk 19 Wk 1 Wk 3 Wk Wk 7 Diarrhea outbreaks were controlled last week with action by WHO (DEWS and Environmental Health), local counterparts (DTC Rapid Response Teams), and other partners (UNICEF and INGOs) in Abbottabad and Mansehra, KP; and Bhakkar, Punjab. This week efforts are ongoing to control diarrhea outbreaks in Mardan, KP, and Khuzdar, Balochistan. Figure 3 on page shows critical situation of diarrhea in KP, surpassing the proportional morbidity recorded in the 1 post Flood period. Graph at the right, is comparison chart showing that 1 out of 1 reporting districts in KP have more than 1% diarrhea cases out of total consultations at public health facilities. Post Flood peak was at 1% so there is clearly a worse diarrhea situation this year in KP. Damaged infrastructure due to last year s Flood and spreading of organism through the river and IDP movements are factors likely responsible for the increase in diarrhea Acute Diarrhoea proportional morbidity (%) by district, Khyber Pakhtunkhwa Week, Mansehra District is one example. In week 7, there was a % rise in AD cases reported from DHQ Hospital mainly from three different villages where five positive cases of V.c. Ogawa were identified. The Cholera Task Force at district level was activated under chair of DCO, soap, aquatabs and jerry cans were distributed, and health education sessions conducted by the involvement of LHWs and CWS (IP of UNHCR). The DTC Rapid Response Team was activated in week 7 to treat cases /7 in the DHQ Hospital and maintain an ORT corner. Situation was controlled in those villages but the number of diarrhea cases continues to rise at the DHQ and investigation of new AWD cases is underway. Distribution of Wild Polio Virus cases Pakistan 1 and 11 Year 1: The total number of polio cases reported in 1 is 1 including 1 type 1 cases and type 3 from infected districts/towns/agencies. Year 11: The total number of polio cases confirmed by the laboratory is 9 (=type 1, and 1=type3) till date from districts. Province Cases 1 Cases 11 P1 P3 P1 P3 Punjab Sindh Khyber Pakhtunkhwa 19 - FATA Balochistan 1 - AJK Gilgit Baltistan Islamabad Total 1 1 This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 3 Fax : , wr@pak.emro.who.int.

4 Current week's Alerts: Province Sindh Date Disease District Area Epidemiological Bulletin: DEWS, Pakistan, Week no. ( - 1 July, 11) Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <M >M <F >F <M >M <F >F 1 Jul AWD Jamshoro UC Sari,Taluka Thano bula khan 1 Jul AWD Kashmore BHU Din Muhammad Kosh 1 1 Jul AWD S. Benazirabad Police line UC 3,Taluka Nawabshah 3 13 Jul AWD Karachi Manzoor colony, Jamshed town 1 13 Jul AWD Karachi Near Bilal Masjid,Shaikh Mohalla,Mawach goth,uc 1 13 Jul AWD Khairpur Uberi near Bus stop Shah Ladhani 1 13 Jul AWD Larkana 13 Jul AWD Matiari 13 Jul AWD Matiari 13 Jul AWD Mirpurkhas 13 Jul AWD Qambar Shahdadkot UC Pathan, Village Paryal Jatoi, Tehsil Bakrani UC Zeir Pir Village, Deper Lakha, Near mansoorah Village DoDo Rajani,near khando,uc Hala Machi colony,girhore sharif,uc Girhore sharif Village Rab Rakhio Lakho, Tehsil Qambar 1 13 Jul AWD Thatta Village Majano Detho, UC Mehar Shah 1 1 Jul AWD Shikarpur THQ Lakhi Jul AWD Khairpur 1 Jul 1 Jul 1 Jul AWD Chicken Pox Chicken Pox Naushahro Feroze Shikarpur Naushahro Feroze Village Abad near Kalhori, UC Shadi Shaheed 1 Village Taagri UC Masur g wah 1 1 Village Haji Ahmed, near Soomar Goth, Tehsil Lakhi RHC Kamal Dero 1 Jul DHF Karachi Karachi City 1 Jul 9 Jul Measles Measles Tando Muhammad khan Village haji khan chandio,deh Nuhani, UC Dhando Tando Allah Yar 3 1 Village sono Khan, Taluka Jhando mari 1 11 Jul Measles Ghotki Village Pir Mubarak Shah UC Adilpur 1 1 Jul Measles Sukkur Miani Road Sukkur 1 1 Jul Measles Tando Allah Yar Piyaro Lund City, Taluka Jhando mari 1 13 Jul Measles Sukkur Village Tando Booro. Tehsil Rohri 1 13 Jul Measles Ghotki Village Bahawal Khan Jiskani UC Bhaitoor Taluka Khan Garh 1 1 Jul Measles Thatta Village Muhammad Mallah, UC Bello 1 1 Jul Meningitis Jacobabad Gul Hospital 3 9 Jul NNT Sukkur 11 Jul NNT Qambar Shahdadkot 1 Jul NNT Sukkur Cross notified case of village Garo Daro UC Mubarak Pur Talkuka Pano Akil 1 Village Sher Ali Mugheri, Tehsil Miro Khan 1 UC mubarakpur, Village Bai Khan near Gharo daro, Tehsil Panoakil 1 1 Jul NNT Jacobabad Gul Hospital 1 1 Jul Tetanus Ghotki UC Lohi, Village Hamal Laghari near Sardar Garh 1 1 Jul Tetanus Jacobabad Gul Hospital 1 1 Jul Tetanus Shikarpur Near Shahi Bagh Road 1 Jul AWD Swabi BMC Swabi, UC Mankai, Mohallah Threr Jul AWD Swabi RHC Yar Hussain, UC Yaqoobi, Mohallah Shahab khel 1 1 Jul AWD Hangu Jhazo Maidan, UC Ganjiano Kale 1 11 Jul AWD Mardan Mohallah Pirano Korona, UC Manga, Charsadda Road 1 11 Jul AWD Peshawar Judge Bangla, Miskeen Abad, Nothia Jadeed 1 1 Jul AWD Kohat UC Duli banda Jul AWD Hangu UC M.Khawaja 1 1 Jul AWD Haripur Village Baji Sar, Union Council Kundi, Tehsil Ghazi Jul DHF Haripur Village Sarai Naimat Khan, UC Sarai Naimat Khan 1 Jul Leishmaniasis Shangla Village Batkot UC Shang 1 13 Jul Leishmaniasis Lower Dir Village Jalley, UC Munjai Jul Measles Swat Village Koz Sangar, UC Jambel, Tehsil Babuzai 1 Jul Measles Swat Village Manglor, UC Manglor, Tehsil Babuzai 1 11 Jul Measles Mansehra Mangal dora L.Nawab 1 13 Jul Measles Swat Village Chail, UC Chail, Tehsil Behrain Jul Measles Mansehra Gia Mera Road College Doraha 1 1 Jul Measles Mansehra Muslim Town Channar Road Lari Ada 1 1 Jul Measles Mansehra Near Madni Masjid Lari Ada 1 1 Jul Measles Swabi CH Topi, Right Bank 1 1 Jul Measles Swabi Private Clinic, Gandaf Jul Measles Haripur Khalabut Township Sector, UC Khalabut 1 1 Jul Meningitis Swabi BMC Swabi 1 1 Jul Pertussis Kohat UC Duli banda Jul Pertussis Swabi BMC Swabi, UC Mankai, Mohallah Threr Jul Pertussis Charsadda Vill. Hameed Mian Dherai, UC Umerzai Jul Pertussis Charsadda Vill. Zarinabad, UC Nisatta Jul UXF Haripur Khalabut Township, UC Khalabut Current week's Alerts: Province Punjab Date Disease District Area <M >M <F >F 9 Jul AD Layyah BHU Jhakar UC jhakar pacca Jul AD Bhakkar UC Chak no 1/ML 3 1 Jul AD Bhakkar Basti Gaman, UC Malana Daggar, Tehsil Kalur Kot Jul AD Rahim Yar Khan Basti Ch M Sadiq, Tehsil Sadiqabad Jul AD Rahim Yar Khan Kotla Pathan, Tehsil Khanpur Jul AD Rahim Yar Khan UC Gehna Lar tehsil Khanpur Jul AWD Bhakkar Chak no 7, Rakh Dulle Wala, UC Jhammat shumali 1 13 Jul AWD Bhakkar UC Pir Ashab 1 Jul AWD Muzaffargarh Basti Yaroo Wala, UC Baseera Jul AWD Muzaffargarh Basti Rogh, UC Baseera Jul AWD Khanewal Nishtar Hospital Multan (1 L, 19 Chak Tehsil Mian Chanu) 1 13 Jul AWD Muzaffargarh Basti Chah Tayyab Wala, Moza Bhakhar Noon, UC Budh 1 13 Jul AWD Muzaffargarh Basti Mithi Khooi, Noor Kubra, UC Baseera 1 1 Jul AWD Muzaffargarh Chah Mithoo Wala, Near by Sardar Koorey Khan School 1 1 Jul AWD Muzaffargarh Khoo M. Hussain Wala, Near by Taleri Nehar, UC Taleri 1 1 Jul AWD Muzaffargarh Mohallah Panwar Shumali, UC Mehmood Kot 1 13 Jul BD Layyah Chak no3 Jamal chapri 1 13 Jul BD Rahim Yar Khan Unran tehsil Liaqatpur Jul BD Mianwali Mohallah Dhirkana Walla, UC Dub Baloochan,Piplan Jul Measles D. G. Khan Moza Thata Gabolan UC Mutafaraq Chahan 1 13 Jul Measles Layyah Mohala wahka wala u/c urban 1 13 Jul Measles D. G. Khan Daat Qureshi UC Aaliwala 1 13 Jul Measles D. G. Khan Mohalla Ghalloowala UC Urban Taunsa 1 13 Jul Meningitis Multan Khan Pur Bagha Sher, Post Office Khan Pur Shumali 1 9 Jul Meningitis Layyah Chak no 137 UC 137 TDA 1 1 Jul NNT Bhakkar Village Bhalmana, UC Mulana Gaggar 1 11 Jul Scabies Bahawalpur Basti Shukar, Moza Karam Din, UC Head Rajkan Jul Scabies Bahawalpur Basti dada potra, basti sahwan, UC 1, RHC Lal Sohanra Jul Tetanus Multan 9 Chak Kot Adu Muzaffar Garh 1 1 Jul Tetanus Khanewal CH Multan (Salar Wahain Basti Iqbal Nagar) 1 This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int.

5 Current week's Alerts: Province Balochistan Date Disease District Area <M >M <F >F 1 Jul Chicken Pox Ghot Abdul Sattar, UC Dirgi, Tehsil Sohbat Jaffarabad Pur 1 1 Jul Leishmaniasis Jhal Magsi BHU Khichi 1 Jul Leishmaniasis Lasbela Madina Colony Hub 1 11 Jul Leishmaniasis Lasbela Near RCD road Uthal 1 1 Jul Malaria Jaffarabad CD Baloo Pur, Tehsil Sohbat Pur Epidemiological Bulletin: DEWS, Pakistan, Week no. ( - 1 July, 11) Number of alerts detected by week, province Sindh (Week to, 11) 19 Wk Wk Wk 7 Wk Jul Measles Jaffarabad Mir Allah Koheli Bugti, Nazd Faqeer Abdul Rasheed, in front of Haji Sarkaar, tehsil Sohbat Pur, from Security compromised areas of Jaffarabad Jul Measles Khuzdar Soneji UC Gazgi tehsil Khuzdar 1 Jul Measles Quetta Killi Gul Mohammad, Air Port road 1 9 Jul Measles Lasbela Zar khan Goth UC pathra 1 1 Jul Measles Quetta Block, Satellite town Number of alerts detected by week, province Khyber Pakhtunkhwa, (Week to, 11) Jul Measles Quetta New Railway Housing Society, Brewery road 1 Wk Wk Wk 7 Wk Jul Mumps Lasbela Raees Goth UC Gabapat,Kemari Town Karachi(cross case) Jul Pertussis Khuzdar Bajori UC Baghbana tehsil Khuzdar Jul Pertussis Nasirabad Ghot Mohammad Ramzan, Tehsil DMJ 1 1 Jul Tetanus Khuzdar Londo, Rann Bhit UC Baghbana tehsil Khuzdar 1 9 Jul Typhoid Chagai Dawood Abad UC Chi ghazi Number of alerts detected by week, province Punjab (Week to, 11) Jul Typhoid Chagai Killi Station Taftan 1 1 Wk Wk Wk 7 Wk Current week's Alerts: AJK; FATA; GB and ICT Date Disease District Area <M >M <F >F Jul AWD Sudhnoti Village Bhatiyan UC Patan sher khan The Mang 1 Jul AWD Sudhnoti Village Narori UC Mang The Mang 1 Number of alerts detected by week, province Balochistan (Week to, 11) 1 Jul AWD Sudhnoti Vill Billan Nar UC Baral Tehsil Pallandri 1 1 Jul AWD Islamabad AlShifa Hospital (Merabadia) 1 9 Jul Measles Gilgit Village Bagrote UC Bagrote Tehsil Gilgit Jul Measles Gilgit Amphary Thopchar Gilgit town area 1 1 Jul Measles Gilgit Village Nomal UC Nomal Tehsil 7 district Gilgit 1 Wk Wk Wk 7 Wk 11 Jul Measles skardu Abbas abad oro UC kumra Tehsil Skardu 1 Number of alerts detected by week, AJK (Week to 9, 11) Distribution of alerts by diseases, week ( 1 July), 11 (n=11) NNT + Tetanus, 11 AD, Pertussis, Leish, Meningitis, Measles, 3 BD, 3 C. Pox, Wk Wk Wk 7 Wk Number of alerts detected by week, province Gilgit Baltistan (Week to, 11) DHF, AWD, 37 Scabies, Typhoid, Malaria, 1 Mumps, 1 Unexplained Fever, Wk Wk Wk 7 Wk Measles This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int.

6 Epidemiological Bulletin: DEWS, Pakistan, Week no. ( - 1 July, 11) Table : Total number of alerts and outbreaks reported and investigated with appropriate response Disease Post Flood 1 11 Current Week Total A O A O A O A O Acute Watery Diarrhoea Acute Jaundice Syndrome Bloody Diarrhoea Measles Pertussis NNT + Tetanus Malaria Leishmaniasis Others Total Province Khyber Pakhtunkhwa: This week 1 districts reported to DEWS from 79 health facilities with a total of 1,31 patients consultations. AD is showing a consistent upward trend and accounted for 1% - 17% of the total consultations in last weeks. 7 alerts were reported in this week, 1 were for Measles, for AWD, for Pertussis, for Leishmaniasis, while 1 each for DHF, Meningitis and Unexplained Fever. Figure-3: Three years trend of Acute diarrhoea, province KPK Epi Week Province Punjab: Figure-: Trend of acute diarrhoea, province Punjab (3 August 1 to 3 June 11) 1 districts reported data to DEWS from Punjab province, 79 health facilities reported a total of,71 patient consultations during this reporting period AD cases reported were 1,7, and stabilize between 7% to % from last four weeks. 1 3 alerts were reported in this week from Punjab; 1 for AWD, for Acute diarrhoea, for Measles, 3 for Bloody diarrhoea, three for Neonatal Tetanus and tetanus, while two each for Meningitis, Scabies Province Sindh: This week districts reported to DEWS from 1,1 health centers with a total of,7 patient consultations during the reporting period of week, 11. Figure-: Three years trend of Acute diarrhoea, province Sindh 1 In Sindh, AD cases reported were,139 (9%), same proportional morbidity as compared with last week. 3 alerts were reported from Sindh in this week: 1 were for AWD, for Measles, 7 for Neonatal Tetanus and Tetanus, Two for Chicken pox, while one each for DHF and Meningitis Epi Week This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int.

7 Province Balochistan: In this week, 17 districts reported to DEWS from Balochistan province. 9 fixed and one mobile medical outreach centers reported a total of,9 patient consultations. Epidemiological Bulletin: DEWS, Pakistan, Week no. ( - 1 July, 11) Figure-: Three years trend of Acute diarrhoea, province Balochistan 3 AD reported in,1 (13%) of the total consultations, same proportional morbidity as compared with last week alerts were reported in this week from Balochistan, were for Measles, 3 for Leishmaniasis, each were for Pertussis and Typhoid, while one each for Chicken pox, Malaria, Mumps and Tetanus Gilgit Baltistan: Figure-7: Trend of priority communicable diseases, Gilgit Baltistan ( March to 7 July 11) In this week, health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of,9 patient consultations. AD BD ARI S. Malaria ARI cases reported were, (11%), while Acute Diarrhoea 3, (1%). Four Measles alerts were received and responded this week wk 13 wk 1 wk 1 wk 1 wk 17 wk 1 wk 19 wk wk 1 wk wk 3 wk wk wk wk 7 wk FATA: Figure-: Trend of priority communicable diseases, FATA ( February to 7 July 11) This week health centers in 3 agencies reported from FATA, with a total of 9, patient consultations. 3 AD BD ARI S. Malaria ARI cases reported were 1, (1%), while Acute diarrhoea reported 1,1 cases (11%) 3 No alerts were received this week from any area in Fata. 1 1 wk wk 7 wk wk 9 wk 1 wk 11 wk 1 wk 13 wk 1 wk 1 wk 1 wk 17 wk 1 wk 19 wk wk 1 wk wk 3 wk wk wk wk 7 wk State of Azad Jammu and Kashmir: In this week, weekly report received from 91 health centers from 1 districts, with a total of 3,1 patient consultations. ARI cases reported were 3, (11%), while Acute diarrhoea reported,3 (9%) cases. Three AWD alerts reported and responded in this week. Figure-9: Trend of priority communicable diseases, AJK ( March to 3 June 11) 3 1 AD BD ARI S. Malaria wk 13 wk 1 wk 1 wk 1 wk 17 wk 1 wk 19 wk wk 1 wk wk 3 wk wk wk wk 7 wk This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 7 Fax : , wr@pak.emro.who.int.

8 Alerts and outbreaks, week, 11 Epidemiological Bulletin: DEWS, Pakistan, Week no. ( - 1 July, 11) This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int.