Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 2, Issue 2, Monday 4 July, 11 Highlights Epidemiological week no. 2 (24-3 June, 11) 91 districts and 3 agencies provided surveillance data to the DEWS this week from 3,519 fixed health facilities and 5 mobile medical outreach centres. A total of 1,79,1 consultations were reported through DEWS of which 1% were acute respiratory infections (ARI), 12% skin disease, 1% acute diarrhoea, and % were suspected Malaria. A total of 127 alerts with 13 outbreaks were reported in week-2, 11: Altogether 45 alerts were for Measles; 41 for, 12 for Pertussis, 5 for, 4 for Acute diarrhoea, 3 each for Bloody diarrhoea and Tetanus, 2 each were for Meningitis, Neonatal Tetanus, Chicken Pox, DHF, and Scabies, while one each for Acute Jaundice syndrome, ARI, Diphtheria, and Mumps. National Polio Eradication Initiative reported Four confirmed polio cases this week. One each from and Orakzai Agencies in ; one from Thatta district in Sindh, while one from Pishin district in Balochistan. Total 5 (57=type1, and 1=type3) confirmed polio cases have been reported in 11 from 24 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 ()/ 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) Epi week Disease Wk-19 Wk- Wk-21 Wk-22 Wk-23 Wk-24 Wk-25 Wk-2 Other Acute Diarrhoea (Not Watery) 94,472 (1%) 12,955 (11%) 1,7 (1%) 12,5 (1%) 1,753 (1%) 12,217 (1%) 13,97 (1%) 17,9 (1%) Total consultation 94,711 97,35 1,,71 995,731 1,9,254 1,2,9 1,19,724 1,79,1 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 12 districts had outbreaks of, 9 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 Table 1: Leading causes of seeking health care in flood affected districts, 29 July 1 to 3 June 11, compiled from weekly reports Diseases Total Skin Diseases 3,21,95 (11%) Acute Respiratory Infection,153,91 (24%) Acute Diarrhoea 3,1,94 (9%) Bloody Diarrhoea 294,547 (1%) Suspected Malaria 2,,21 (%) Unexplained Fever 1,331,45 (4%) Total Consultations 34,339,935 Focus on: Islamabad, June 11 Epidemiological Bulletin: DEWS, Pakistan, Week no. 2 (24-3 June, 11) Figure 2: Weekly number of reporting health facilities (Wk 33/1 to Wk 2/11) Outbreaks of identified in sectors G/1 and G7/2 last week and F/1 and Barakhau this week; Alerts at Zia mosque Village and Saidpur Village. WHO/ NIH investigated alerts and confirmed cases of V. c. Ogawa, and CDA Health Directorate leading response with awareness messages in media and mosques. Cholera Task Force established to coordinate Health and Water inputs with CDA Health, CDA Water, Water Testing Lab for CDA, NIH Public Health Division, WHO, UNICEF, UN Habitat, and PLAN Pakistan. City Hospitals responding: PIMS 139 cases and Polyclinic 41 cases admitted. WHO conducted initial hygiene promotion sessions and WHO and UNICEF supplied 1, aqua tabs,, soap,, PUR Sachets. 25 volunteers from PLAN Pakistan and 4 LHWs in ICT trained to provide follow up visits and health and hygiene education. UN Habitat and UNICEF developed messages for mosques, churches and general public used in campaigns and given to CDA for printing. EDO H in ICT seeking partners for organizing safe water for Barakhau. WHO/ NIH investigation in process for Saidpur Village and Zia mosque Village cases while initial health and hygiene sessions and water treatment at household level have been initiated Mobile Fixed Wk 33 Wk 34 Wk 35 Wk 3 Wk 37 Wk 3 Wk 39 Wk 4 Wk 41 Wk 42 Wk 43 Wk 44 Wk 45 Wk 4 Wk 47 Wk 4 Wk 49 Wk 5 Wk 51 Wk 52 Wk 1 11 Wk 2 Wk 3 Wk 4 Wk 5 Wk Wk 7 Wk Wk 9 Wk 1 Wk 11 Wk 12 Wk 13 Wk 14 Wk 15 Wk 1 Wk 17 Wk 1 Wk 19 Wk Wk 21 Wk 22 Wk 23 Wk 24 Wk 25 Wk 2 5 Distribution of Wild Polio Virus cases Pakistan 1 and 11 Year 1: The total number of polio cases reported in 1 is 144 including 1 type 1 cases and 24 type 3 from 4 infected districts/towns/agencies. Year 11: The total number of polio cases confirmed by the laboratory is 5 (57=type 1, and 1=type3) till date from 24 districts. Province Cases 1 Cases 11 P1 P3 P1 P3 Punjab Sindh FATA Balochistan 17 - AJK Gilgit Baltistan Islamabad Total 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 : , 2 Fax : , wr@pak.emro.who.int.

3 Previous week's Outbreaks: Epidemiological Bulletin: DEWS, Pakistan, Week no. 2 (24-3 June, 11) Date Disease Province District Area <M >M <F >F Action Taken Village Hattiyan Cluster of cases with AJS from one location, samples taken and sent to AIMS hospital. 1/2 found Jun AJS AJK Muzaffarabad 2 Dupatta positive for Hepatitis E. Active surveillance done and no other cases found. 22 Jun AJS AJK Neelum 23 Jun Malaria Balochistan Jaffarabad Village Khawaja Sai, Sharda BHU Monder Kot, Tehsil Gandakha Jun ICT Islamabad FGSH (G /1, G 7/2) Jun 23 Jun 23 Jun 22 Jun Jun Abbottabad Battagram Battagram RHC Havellian, Abbottabad Huthal Deeshan, kot gala, UC Peshoora Vill. Khawargai, UC Battagram Haripur Khalabut Sector 3 1 Mansehra Jun Punjab Multan 1 Jun Punjab Muzaffargarh Jun Sindh Karachi 22 Jun Sindh Larkana 17 Jun Sindh Matiari 1 Jun Sindh Village Shah Khel Garhi Chowk Sheh Abbas Near Al Mustufa Plaza, Khaji Wala House Chor wala Mouza UC Baseera M.Ali Society, Gulshan e iqbal Village Abbas Kalhoro, tehsil Bakrani Village Lakho Rahoo,UC Khando,Taluka Hala Nagori Plot,Khalil masjid Cluster of 5 cases with AJS reported from RHC Sharda, samples collected and sent to DHQ Neelum, DHO concerned informed. Alert of suspected malaria comprising of 11 cases was reported. The DHO was informed and requested for distribution of bed nets to the said location. 45 samples were checked through RDTs and 23 verified positive (P.F, 5/ P.V, 5/ mixed, 13), SPR= 51.1%, while Falciparum Rate= 7.2%. alert in Islamabad with one death, 4/7 stool sample found positive for V. Cholera, active surveillance for other cases, water samples collected, Aqua tabs and hygiene kits were distributed, Health education session given to the families and in the community. CDA Directorate Health arranged isolation ward for suspected cholera patients, Director of Water Management for CDA to address the situation, Radio Pakistan to air health and hygiene awareness messages, Director of AuQaf called to Khatibs (imam of mosques) to add information about prevention and treatment of diarrhea in Friday sermon. CDA Health directorate requested UNICEF support in chlorination. Alert reported from RHC Havellian, Abbottabad, the patient belongs to village Kallig. UC Kholian Bala, Haripur. On further investigation and active surveillance, it was found that there was also a Acute diarrhoea death and almost 7% of population is suffering from acute diarrhoea. Detailed environmental assessment of the area carried out to identify the source of contamination. / water samples found contaminated. Aqua tabs and ORS distributed among the affected population along with health and hygiene education. Stool sample was taken and sent to NH. EDO health was informed. Comprehensive health and hygiene campaign launched in the area. Temporary dispensary established for the affected population. Alternate source of clean water supplied to the community through TMA tankers along with cleaning of the source and decontamination of storage tanks. A suspected case was reported from DHQH. On investigation and active surveillance in area no more cases were found. Sample was taken and found positive for V.c. Ogawa. EDOH, MS DHQ were informed about the case. Health and hygiene education provided to the household. Area was visited with sanitary inspectors of DoH and Water source was identified and water sample was taken for contamination. Health and hygiene sessions conducted with the community and some aqua tabs were distributed. Detailed environmental assessment is underway in area. One suspected case was reported from DHQH. On investigation an adult female patient was found with severe dehydration. History revealed that two of her children had severe diarrhea few days back and they received treatment, but after few days She along with her 3yo son developed severe diarrhea. Both admitted in DHQH and receiving treatment with I/V fluids. Sample was taken and found positive for V.c. Ogawa. During active surveillance no more cases were found. EDOH, MS DHQ were informed about the case. Health and hygiene education provided to the household. Area was visited with sanitary inspectors of DoH and Water source was identified and water sample was taken for contamination testing. One case of reported On investigation and active surveillance in area no more case was found. Sample was taken and found positive for V.c. Ogawa. EDOH, was informed about the case. Health & hygiene education provided to the household and to the community. An case was reported from DHQH. On investigation and active surveillance in area no more case was found. Sample was taken and found positive for V.c. Ogawa. EDOH, MS DHQ and Coordinator Public Health were informed about the case. Health & hygiene education provided to the household and to the community. Water source was identified which was hand pumps and springs. Epidemiological & Environmental investigations are underway. Two brothers suffering from reported from Nishter Hospital. Surveillance Officer visited the cases in the ward and assessed the situation over there. 1/2 Stool Samples taken found positive for V.c. Ogawa. Field investigations were carried out by SO, EHE and DoH team. No more cases was found through active Surveillance. Water Samples were taken and HE sessions were conducted in the community and affected family. Aqua tabs, Jerry cans and Life straw were distributed Two alerts from two different locations, Two samples collected and found positive for V.c. Ogawa. On active surveillance no more cases found. Health education to family members in households visited. Distribution of soap, Aqua Tabs, jerry cans, water filters & IEC among them. Nearest RHC Baseera was visited & SMO was given briefing on the situation, control measures & importance of awareness among general masses about safe drinking water, food & personal hygiene & it was also suggested to requested LHWs, CDC supervisor & School Health & Nutrition Supervisor to impart above said information among community while conducting their HE sessions in the catchment area. EM & EH assessment was also done at RHC. Reinforced case management, active surveillance done, Aqua tabs Provided, Health education, Health Staff Trained for Rapid Response, EDO H informed & 1 stool Sample collected and found positive for V.c. Ogawa. Suspected case reported, date of onset was 21 11, field investigation completed, health & hygiene session conducted, IEC material, Aqua tabs and hygiene kits were distributed, 1 stool sample collected and found positive for Cholera, 3 water samples also collected. Reinforced case management, active surveillance, ORS & Zinc Tabs Provided, Health education, EDO H informed & 1 stool sample collected and found positive for V.c. Ogawa, two water samples also collected. Reinforced case management, active surveillance done, ORS & Zinc Tabs Provided, Health education, EDO H informed & 1 stool sample collected and found positive for V.c. Ogawa, two water samples also collected Village Bachal Reinforced case management, active surveillance, ORS, Aqua tabs & Zinc Tabs Provided, Health Khaskheli,UC 17 Jun Sindh Thatta 1 1 education, EDO H informed. One stool sample collected and found positive for V.c. Ogawa, two Googani,Taluka water samples also collected. Shah Bunder 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

4 Epidemiological Bulletin: DEWS, Pakistan, Week no. 2 (24-3 June, 11) Current week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 2 Jun ICT Islamabad FGSH (Bara Kahu) Jun KPK Haripur 25 Jun KPK Haripur Village Chach Mera, UC Kholian Bala Afghan Refugee Camp, Khalabut Township, UC Khalabut Jun KPK Mardan Mistri abad, Canal Road 1 Three cases reported from Bara Kahu, Islamabad, 2/3 stool samples found positive for V.c. Ogawa. Water samples also collected, aqua tab, hygiene kits distributed, HE session done for the families and nearby community. Social mobilization through LHWs on safe drinking water and sanitation. LHWs will be involved to distribute Aqua tab and HE messages. No more cases found during field surveillance. Three patients reported from RHC Havellian, Haripur. All the three patients belongs to one family. They had a recent travel history to Village Kallig for a funeral. One stool sample was taken and sent to NIH and found positive for V.c. Ogawa. On active case finding, no other cases found. LHWs of the area were also involved in the active surveillance. An cases reported from a private hospital. The patient belongs to Afghan Refugee camp, Khalabut township. The patient was brought in a state of shock. Stool sample was taken and sent to NIH, and found positive for V.c. Ogawa. Environmental assessment of the area and surrounding was carried out. Joint team with Save the children has been established for comprehensive treatment and control response as these refugee camps are handled by Save the children. An case reported from DHQH, Mardan. On investigation and active surveillance in area no more cases found. Sample taken and found positive for V.c. Ogawa. EDOH, MS DHQ, DSM PPHI and Coordinator Public Health were informed about the case. Health and hygiene education provided to the household and to the community. Water source was identified and water sample was taken for microbial contamination testing. A possible outbreak of was reported from CD SHANG on 2th June, a response team in coordination with 29 Jun WHO,PRCS/ GRC, CordAid and DOH visited the affected village Auzbat Kot, 22 suspected cases of Cutaneous KPK Shangla Kuzbat Kot were clinically identified. Intra lesional injections were given to all of them and follow up advised,bed nets distributed, health & hygiene session conducted. EDOH, WHO country Office & WHO hub office were informed and request for analysis and residual spray was made. A 3 day medical camp was established (3th June, 1st and 2nd July) in the village. 24 Jun Punjab Mianwali 25 Jun Punjab Multan 24 Jun Sindh Dadu 24 Jun Sindh Jamshoro 24 Jun Sindh Karachi Sindh Khairpur Sindh 2 Jun Pertussis Sindh Qambar Shahdadkot Tando Allah Tolla Mangalli,UC Chapri,Tahsil Issa Kheel Kho Dor Hatta Janazagha Qadir Pur Rawan Village Talbani Panhwar,Near BHU Phakka,UC Yaar Muhammad Kalhoro Brufat Mohalla, UC Nagoline, Taluka Kotri Hussaini Gali,Sindhi Mohalla,BaBa Island,UC 4 Kemari Town UC Deparja, tehsil Thari Mirwah Larkana (Near Ber Road, UC 2, Tehsil Qambar) Current week's Alerts: Province Punjab Village Kamal Khan aglam 3 3 Date Disease District Area <5M >5M <5F >5F 29 Jun AD Bhakkar Mullan Wali City,Tehsil Bhakkar Jun Measles Bhakkar Mohallah Eid Gah, Behal, UC Behal, Tehsil Bhakkar 1 2 Jun Measles D. G. Khan X Block Model Town, UC 1 NNT D. G. Khan Basti Khoo Tootewala Pir Adil 1 3 Jun Pertussis D. G. Khan near MCH centre, street Dr Sher, Taunsa city 1 3 Jun Pertussis D. G. Khan Nizam abad urban UC Taunsa city 1 24 Jun Khushab UC Padrar 2 BD Layyah Basti Kutai WalaKaroor Jun BD Layyah Peer Jagi More, THQ Kot sultan Jun 25 Jun Meningitis Layyah Mohalla Eidgah Urban 1 Meningitis Layyah Ward Number Karoor city 1 2 Jun Mianwali 24 Jun Takht Rachora village,uc Tabiser,Tahsil Issa Khel Eight suspected cases were found during active surveillance. Line listing ensured and treatment started. Area was searched for breeding sites of the vectors. Area notables were involved in proper disposal of solid wastes. One case was reported from RHC Qadir Pur. Stool sample taken and found positive for V.c. Ogawa. Field investigation was carried out by SO, EHE and DoH team. No more cases was found during active surveillance. Water Samples were taken and HE sessions were conducted in the community and affected family. Aqua tabs, Jerry cans and Life straw filters were distributed Three cases reported. Reinforced case management, active surveillance, Aqua tabs, Zinc tabs and ORS provided, Health education, EDO H informed. 1 Stool sample collected and found positive for V.c. Ogawa. Two water samples also collected. One case reported. Reinforced case management, active surveillance, Zinc tabs, Chlorine tabs and IEC Material Provided, Health education, EDO H informed. 1 stool sample was collected and found positive for V.c. Ogawa. Two water samples also collected. One case reported. Reinforced case management, active surveillance, Aqua tab distributed, Health education Provided, Health staff briefed about rapid response, THO informed. one stool sample collected and found positive for V.c. Ogawa. Three cases reported, case responded at community, health and hygiene session conducted. 1/3 stool sample collected, and found positive for V.c. Ogawa. One case reported, health and hygiene session conducted, 1 stool sample collected and found positive for V.c. Ogawa. 2 water samples were also collected. probable Pertussis cases reported from one village, Reinforced case management, active surveillance, Health education, essential medicine (Erythromycin and Priton syp) Provided, 2 throat swab sample collected and sent to NIH for testing. 4 4 Mianwali Tolla Mangalli,UC Chapri,Tahsil Issa Kheel Jun Multan Kho Dor Hatta Janazagha Qadir Pur Rawan 1 3 Jun Multan Madina Town near adda Qadir Pur Rawan 1 2 Jun Muzaffargarh Basti Chak Wala, UC Baseera 3 3 Jun Muzaffargarh Basti Beri Wala, UC Baseera Jun Measles Muzaffargarh UC Karamdad Qureshi, DHQ Hospital Jun Rahim Khan Chak 72, Byepass, Street #, Mohallah Kumharah 1 3 Jun ARI Sargodha BHU 121 NB Tehsil Sillanwali Jun Measles Sargodha Abdullah Hayat Colony St. No. 1 Sargodha UC Current week's Alerts: Province Balochistan Date Disease District Area <5M >5M <5F >5F 3 Jun Measles Bolan BHU Ab e gum 3 29 Jun Measles Chagai Killi gorgage girdi jungle Refugee camp 1 29 Jun Pertussis Chagai Kili Haji majeed khan Dawood abad UC sadder Dalbandin Jun Pertussis Gwadar BHU Sorbandar 1 3 Jun AJS Jhal Magsi DHQ Hospital Gandawah 1 24 Jun Scabies Jhal Magsi BHU Hathyari Jun Scabies Jhal Magsi RHC Jhal Magsi Jun Pertussis Kalat Goam UC Kalat sadar, tehsil Kalat Jun Chicken Pox Kech RHC Nasirabad, Village Sehrabad Jun Measles Kech Syed Akram Muhalla, UC Absar Jun Khuzdar Killi Ahmed Jan UC Gresha 2 25 Jun Measles Khuzdar Abbi Noghe UC Tootak tehsil Khuzdar Jun Pertussis Khuzdar Koshk UC Gazgi tehsil Khuzdar Jun Measles Lasbela Near Police station HUB 1 3 Jun Measles Nasirabad Ghot Haji Imdad Khoso Jun Mumps Panjgur Washbood Mir Berkatullah mohalla UC Washbood 1 29 Jun AD Ziarat BHU Gogai Current week's Alerts: AJK; FATA; GB and ICT Date Disease District Area <5M >5M <5F >5F 2 Jun Measles Bagh Chirooti Happy Land School Pak Gali Jun Hattian Village Andrasari, P.O Salmia, Tehsil Chikkar 1 2 Jul Kotli DHQ Kotli (Aghar colony, kakni) Jun Measles Bajaur Agency Village Jar Tehsil Khar Measles Gilgit Astore Colony Nagaral Gilgit 1 Measles Gilgit Village Sakwar Gilgit 1 29 Jun Measles Gilgit Mohallah Shakpura village Jalalabad Gilgit 1 29 Jun Measles Gilgit Village Danyore Gilgit 1 29 Jun Measles Gilgit Village Nomal Gilgit 1 2 Jun Islamabad FGSH (Bara Kahu) 2 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. 4

5 Epidemiological Bulletin: DEWS, Pakistan, Week no. 2 (24-3 June, 11) Current week's Alerts: Province Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F Date Disease District Area <5M >5M <5F >5F 24 Jun Abbottabad Kiala, UC Gariphulgran, Havallian 1 2 Jun Measles Abbottabad Lower Malikpura 1 2 Jun Measles Abbottabad Kalumera, UC Jhangra, Tehsil Havallian 1 3 Jun Buner Vill Doga, UC Amnawar Tehsil Gagra 1 3 Jun Buner Vill Mani pur, dewana baba, tehsil Gagra 1 Badin THQ Hospital Tando bago,taluka tando bago 29 Jun Badin Village sahib dino khaskheli,uc saeed pur,taluka Talhar 1 24 Jun Dadu Village Arab panhwar,uc Pipri Jun Dadu Village Talbani Panhwar,Near BHU Phakka,UC Yaar Muhammad Kalhoro Jun Measles Buner Vill Warae Kilay, UC Norezai Gagra 2 29 Jun Measles Buner Vill Afsar abad, Saidu Sharif 1 3 Jun Measles Buner Village jangai near Koriya tehsil Mandan 1 Measles Charsadda Village Bagh, UC Jamal Abad 1 29 Jun Hangu Thall AR Camp Jun Measles Hangu Naryab 1 24 Jun Haripur Village Chach Mera, UC Kholian Bala 3 25 Jun Haripur 2 Jun Haripur 25 Jun Measles Haripur Afghan Refugee Camp, Khalabut Township, UC Khalabut Village Dairee Sundarpur, UC Sikandarpur Muhallah Dari, Sectoc 3 Khalabut Township, UC Khalabut Jun Measles Haripur Muhallah Anora, Sectoc 3 Khalabut Township, UC Khalabut 1 29 Jun Measles Haripur Village Khalo, UC Ghazi, Tehsil Ghazi Jun Measles Haripur Ghazi city, near Janazagah, UC Ghazi, Tehsil Ghazi Jun Measles Haripur Muhallah feroz, UC Tarbella, Haripur 1 AD kohat UC Bazid khel Jun AD Kohat UC Khadder Khel Jun BD Kohat UC Ziarat Sheikh Allah Dad Jun Mansehra Shaikh Abad Camp 1 3 Jun Mansehra Sadiqabad, Chitti Dheri 1 24 Jun Mardan Mistri abad, Canal Road 1 2 Jun Nowshera Mohallah Zarin Abad Kheweshgi 1 3 Jun Nowshera Union Council Behram Kalay 1 2 Shangla Vill Kuzkele, UC Sarkool Jun Shangla Kuzbat Kot Jun Measles Shangla Kuz said Abad Kele, UC Chakesar 1 2 Jun Measles Shangla Village amlok Banai,Tehsil Alpurai 1 Swabi DHQ Mardan(Pardah Kalei, Kalu Khan) 1 3 Jun Swabi BMC Swabi, Shah Mansoor 1 24 Jun DHF Ghotki Village Waloo Mahar UC Mithri 2 3 Jun DHF Ghotki Village Gulan laghari UC Bandh 1 24 Jun Measles Ghotki Village Sharbat Khan Tart UC Ranwatti Jun NNT Ghotki UC Qadirpur, Village Raeed Mohammad Lakhan 1 Pertussis Ghotki Village Mehar Chachar, near Katcho Bindi Jacobabad Mugheri Shop, Chana Mohalla 1 24 Jun Jamshoro Brufat Mohalla, UC Nagoline, Taluka Kotri 1 29 Jun Jamshoro 24 Jun Karachi 29 Jun UC Thano arab khan,taluka Thano bula khan Hussaini Gali,Sindhi Mohalla,BaBa Island,UC 4 Kemari Town 1 1 Diphtheria Karachi KTH (Mohallah Mauripur, Karachi Gharbi) 1 29 Jun Measles Karachi Near Muhammadi Masjid,Machar colony,uc Jun Measles Kashmore Village Jeend Mazari 2 2 Jun Tetanus Kashmore Village Gahno Khan Khoso, near Tangwani 1 Khairpur UC Deparja, tehsil Thari Mirwah 1 2 Measles Khairpur Bugti Nomadic community 1 3 Jun Tetanus Khairpur Tehsil Kingri 1 2 Jun Tetanus Larkana Village Kandero Mugheri 1 3 Jun Naushahro Feroze Pertussis Naushahro Feroze Qambar Shahdadkot 24 Jun S. Benazirabad Chicken Pox UC Molhan, Tehsil Bhiria, Village Misri Solangi Village Wadero Abdul Kareem Bhurt, near Bhority, Tehsil Kandiyaro Larkana (Near Ber Road, UC 2, Tehsil Qambar) Village Laal Muhammad Maher,UC Mirza bagh,taluka kazi ahmed Shikarpur Village Thanhrio 1 Pertussis Shikarpur Village Haji Sadoro Jafri, Zarkhail Road, near Choi Shakh 5 1 Measles Sukkur New Pind, Gopang Mohalla, near Polic Station Tanki 1 3 Jun Pertussis Sukkur Royal Road, Old Sukkur 1 Akram colony city 3 2 Jun Measles Swabi BHU Zaida, Near Bilal Mosque Jun Pertussis Swabi CH Topi 1 24 Jun Measles Swat Village Balogram, Tehsil Khwazakhela 1 24 Jun Measles Swat Village Spal Bandai, Marghuzar, tehsil Babuzai 1 2 Jun Nagori plot, city 1 Near khalil masjid,uc Village sabir qaim khani,uc shaikh musa khan Jun Measles Swat Village Kaduna, Marghuzar, tehsil Babuzai 1 29 Jun UC.1, Sanjar chang,taluka Chamber 2 Measles Swat Village Pararai Jun Measles Swat Village Jrandu Dherai, Tehsil Kanju 1 1 Measles Tank Pathan Kot 2 2 Jun 2 Jun Measles Pertussis Village Sono khan mari,taluka jhando mari 1 Village Kamal Khan aglam Jun Measles Tank Ranwal and Abbakhel 2 24 Jun Tharparkar Village Godhiar,UC Mithrio bhatti,mithi 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

6 Epidemiological Bulletin: DEWS, Pakistan, Week no. 2 (24-3 June, 11) Table 2: 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 Others Total Province : This week districts reported to DEWS from 75 health facilities with a total of 179,429 patients consultations. Figure-3: Three years trend of Acute diarrhoea, province KPK AD is showing a consistent upward trend and accounted for 14% - 15% of the total consultations in last 4 weeks. 42 alerts were reported in this week, 22 were for Measles, 13 for, 3 for, 2 for Acute diarrhoea, while 1 each for Bloody diarrhoea and Pertussis Epi Week Province Punjab: 12 districts reported data to DEWS from Punjab province, 91 health facilities reported a total of 275,9 patient consultations during this reporting period AD cases reported were,93, and stabilize at % from last 4 weeks. 21 alerts were reported in this week from Punjab; were for, 4 for Measles, 2 each for Bloody diarrhoea,, Meningitis and Pertussis, while 1 each for acute diarrhoea, ARI and Neonatal Tetanus. Increased number of confirmed malaria cases from 9 districts. 135 from Muzaffargarh, 4 from DG Khan, 32 were from Bhakkar, 2 from Rajanpur, 17 from Khushab, 11 each were from Layyah and Mianwali, 1 were from Sargodha, while 4 from Bahawalpur. Province Sindh: This week 23 districts reported to DEWS from 1,21 health centers with a total of 497,137 patient consultations during the reporting period of week 2, 11. In Sindh, AD cases reported were 44,92 (9%), 1% lower proportional morbidity as compared with last week. 37 alerts were reported from Sindh in this week: 1 were for, for Measles, 5 for Pertussis, 3 for Tetanus, 2 for DHF, while 1 each for Chicken pox, Diphtheria and Neonatal Tetanus. Figure-4: Trend of acute diarrhoea, province Punjab (3 August 1 to 3 June 11) Figure-5: Three years trend of Acute diarrhoea, province Sindh 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. Epi week Epi Week

7 Province Balochistan: Epidemiological Bulletin: DEWS, Pakistan, Week no. 2 (24-3 June, 11) In this week, 1 districts reported to DEWS from Balochistan province. 44 fixed and 5 mobile medical outreach centers reported a total of 5,51 patient consultations. AD reported in,91 (14%) of the total consultations, 1% higher proportional morbidity as compared with last week. 17 alerts were reported in this week from Balochistan, were for Measles, 4 for Pertussis, 2 for Scabies, while 1 each for Acute diarrhoea, AJS,, Chicken Pox and Mumps. Figure-: Three years trend of Acute diarrhoea, province Balochistan Gilgit Baltistan: In this week, 5 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 1,2 patient consultations. ARI cases reported were 2,3 (13%), while Acute Diarrhoea 2,157 (12%). Five Measles alerts were received and responded this week. FATA: This week 49 health centers in 3 agencies reported from FATA, with a total of 11,149 patient consultations. ARI cases reported were 1,5 (15%), while Acute diarrhoea reported 1,7 cases (1%) Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 3 June 11) Figure-: Trend of priority communicable diseases, FATA (4 February to 3 June 11) AD BD ARI S. Malaria wk 13 wk 14 wk 15 wk 1 wk 17 wk 1 wk 19 wk wk 21 wk 22 wk 23 wk 24 wk 25 wk 2 AD BD ARI S. Malaria One alert for Measles was received and responded this week. wk wk 7 wk wk 9 wk 1 wk 11 wk 12 wk 13 wk 14 wk 15 wk 1 wk 17 wk 1 wk 19 wk wk 21 wk 22 wk 23 wk 24 wk 25 wk 2 State of Azad Jammu and Kashmir: In this week, weekly report received from health centers in 1 districts, with a total of 2,342 patient consultations. ARI cases reported were 3,23 (13%), while Acute diarrhoea reported 1,953 (7%) cases. Figure-9: Trend of priority communicable diseases, AJK (25 March to 3 June 11) AD BD ARI S. Malaria Three alerts reported and responded in this week; 2 were for and One for Measles. 1 wk 13 wk 14 wk 15 wk 1 wk 17 wk 1 wk 19 wk wk 21 wk 22 wk 23 wk 24 wk 25 wk 2 Islamabad Capital Territory: This week 4 health facilities are reporting through DEWS with a total of 4,14 patient consultations. ARI cases reported were 9 (24%), while Acute Diarrhoea 19 (%). Fluctuation in rates was due to difficulties in collecting reports as the system is being established. Figure-1: Trend of priority communicable diseases, Islamabad (1 January to 3 June 11) AD BD ARI S. Malaria One alert for (outbreak) received and responded this week. wk 1 wk 2 wk 3 wk 4 wk 5 wk wk 7 wk wk 9 wk 1 wk 11 wk 12 wk 13 wk 14 wk 15 wk 1 wk 17 wk 1 wk 19 wk wk 21 wk 22 wk 23 wk 24 wk 25 wk 2 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 2, 11 Epidemiological Bulletin: DEWS, Pakistan, Week no. 2 (24-3 June, 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.