Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 2, Issue 1, Monday 18 April, 211 Highlights Epidemiological week no. 1 (8-14 April 211) 84 districts in provinces and State of Azad Jammu and Kashmir (AJK) provided surveillance data to the DEWS. This system is gradually expanding to provide information about communicable disease threats in all parts of Pakistan. 2,964 fixed health facilities and 6 mobile medical outreach centres provided surveillance data for this week. A total of 921,86 consultations were reported through DEWS of which 2% were acute respiratory infections (ARI), 11% skin disease, 9% acute diarrhoea, and 6% were suspected Malaria. A total of 7 alerts were reported in week-1, 211: Altogether 37 alerts were for ; 11 were for Pertussis, each were for Acute Watery Diarrhoea, and Tetanus, 4 were for Malaria, 2 each were for Bloody diarrhoea, and Dengue Hemorrhagic Fever, while 1 each for ARI, Chickenpox, Leishmaniasis, and Meningitis. There were 2 polio cases confirmed this week: one from Agency (FATA), and another from Orangi (Karachi) 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) s (AD) Suspected Viral Hemorrhagic Fever (VHF) Suspected Malaria (Mal) Suspected (MS) Suspected Meningitis (MG) Others Figure-1: Weekly trend of leading priority diseases in Pakistan, 29 July 21 to 7 April 211 (Epi week 31, 21 to week 14, 211) wk 31 wk 33 wk 3 wk 37 wk 39 wk 41 wk 43 wk 4 wk 47 wk 49 wk 1 wk 1 3 Table-1: Priority diseases reported during the week 7 to week 1, 211 Diseases Wk-8 Wk-9 Wk-1 Wk-11 Wk-12 Wk-13 Wk-14 Wk-1 Skin Disease 68, (9%) 61,67 (8%) 79,747 (9%) 82,332 (9%) 7,43 (9%) 78,277 (9%) 74,6 (9%) 83,342 (9%) ARI (URI and LRI) 2,489 (3%) 217,49 (3%) 249,133 (29%) 262,71 (28%) 223,829 (27%) 22,26 (26%) 212,6 (2%) 223,47 (24%) 3,27 (6%) 46,412 (6%) 7,134 (7%) 6,283 (7%) 67,46 (8%) 74,382 (9%) 73,81 (9%) 86,83 (9%) Bloody Diarrhoea 4,81 (1%) 4,862 (1%),494 (1%),99 (1%),89 (1%) 6,94 (1%),42 (1%) 7,8 (1%) Suspected Malaria 46,66 (6%) 4,37 (6%) 2,266 (6%) 6,24 (6%) 2,712 (6%),411 (6%) 3,111 (6%) 4,812 (6%) Total consultation 821, ,987 8,4 92,176 82, , , ,86 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 (8-14 April 211) Table-2: Leading causes of seeking health care in the flood affected districts, 29 Fig-2: Weekly number of reporting health units (Week to week 1-211) July 21 to 14 April Mobile Fixed Focus on: AWD Contingency Plan Wk 33 Wk 34 Wk 3 Wk 36 Wk 37 Wk 38 Wk 39 Wk 4 Wk 41 Wk 42 Wk 43 Wk 44 Wk 4 Wk 46 Wk 47 Wk 48 Wk 49 Wk Wk 1 Wk 2 Wk 1 11 Wk 2 Wk 3 Wk 4 Wk Wk 6 Wk 7 Wk 8 Wk 9 Wk 1 Wk 11 Wk 12 Wk 13 Wk 14 Wk 1 Diseases Total Skin Diseases 2,8,813 (11%) Acute Respiratory Infection,92,66 (2%) (Not Watery) 2,98,46 (9%) Bloody Diarrhoea 23,173 (1%) Suspected Malaria 1,361,778 (6%) Unexplained Fever 938,898 (4%) Total Consultations 23,76,41 Last year, in view of the emergency flood situation, WHO in collaboration with partners established about 7 Diarrhea Treatment Centers (DTCs) as a preemptive measure in the flood affected districts. WHO provided drugs and non drug items to run these centers and also trained the staff of these treatment centers. Through these DTCs, more than 6, patients have been treated and the mortality rate was less than.1 %, which is a remarkable achievement. However, these centers were mainly run by NGOs, and the role of Health Department was very minimal so the investment was not sustainable. Keeping in view the lessons learnt during this program, preparedness activities for the anticipated rise in the incidence of the AWD this summer are being taken an initiative upon, with due collaboration with the provincial and the district authorities. The following generic strategies are proposed with regard to DTCs in the flood affected districts at the onset of summer this year: 1. The DTCs would be established on basis of threat of AWD outbreak rather than on preemptive basis, while drugs and non drug items for the treatment of diarrhea outbreaks would be stockpiled in flood affected districts either at EDO(H) office or DHQ Hospital as a preparedness measure. 2. For every district, a team of doctors, staff nurses and 3 sanitary workers, nominated by the respective EDO Health of the subsequent district, may be trained in AWD response. They would constitute a Mobile AWD Response Team that would be available to rush to any reported AWD outbreak site within their respective district to establish a 24 hour treatment center and provide in service training to local staff to take over for the duration of the outbreak. 3. EDO Health would establish ORT Corners in the facilities that have high utilization rates and are imparting 24/7 services (RHCs and THQs). WHO would only provide drug items (zinc and ORS) for these corners. 4. DEWS provincial Hospital Coordinator and DEWS Surveillance Officers in respective districts will conduct supportive supervision and also provide technical assistance to the health care providers if required. Figure-3: Acute Respiratory Infection trends, Disaster affected districts, Pakistan 29, 21 and 211 Since July 29, 21, a total of,92,66 Acute Respiratory Infection (both Upper and Lower) patient consultations have been reported to DEWS from the districts participating in DEWS in provinces and the state of AJK In the graph at right, DEWS weekly reports received for ARI in 211 are compared to the reports of 21 and 29 from disaster affected districts. This week, DEWS received 223,47 reports of Acute Respiratory Infection, 24% of total consultations, 1% higher proportional morbidity reported by DEWS in week 1/21, but the same proportional morbidity reported in week 1/ Epi week Figure-4: Acute Diarrhea trends, Disaster affected districts, Pakistan 29, 21 and 211 Since July 29, 21, a total of 2,98,46 acute diarrhea patient consultations have been reported to DEWS from the districts participating in DEWS in provinces and the state of AJK. In the graph at right, DEWS weekly reports received in 211 are compared to the reports of 21 and 29 from disaster affected districts. This week, DEWS received 86,83 reports of acute diarrhea, 9% of total consultations. 1% lower proportional morbidity than reported by DEWS in week 1/21, but the same proportional morbidity reported in week 1/ Epi week Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 2 Fax : , wr@pak.emro.who.int.

3 Table-3: Alerts reported in week 1 of 211 Date of Disease Province District Location alert 11 Apr 11 ARI Balochistan Ziarat 11 Apr 11 BD Balochistan Ziarat 11 Apr 11 Chicken Pox Balochistan Khuzdar RHC Kawas, Kawas RHC Kawas, Kawas Irrigation Colony Khuzdar Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (8-14 April 211) Male Female < > < > Action taken / Notes Most of the cases were followed up and belong to scattered sites. Mild cases were found and no active case with Pneumonia or other severe symptoms was found. EDO health office, CMO was informed. On field investigation no active BD cases were found. It was a misdiagnosis. Staff of the health facility were trained on case definitions. 3 suspected cases were reported. On investigation it was presented with typical sign and symptoms of chickenpox. Symptomatic treatment were given. Health education were also given to the affected family. 14 Apr 11 Malaria Balochistan Jaffarabad BHU Abdul Aziz Khoso samples were collected and 9 found positive for Malaria (4 P.Falciparum, P.Vivax). EDO H is informed and requested for provision of antimalarial drugs and RDTs 14 Apr 11 Malaria Balochistan Jaffarabad CD. Naseer Khan Khoso samples were collected and 2 found positive for Malaria (9 P.Falciparum, 7 P.Vivax, 4 mixed). EDO H is informed and requested for provision of antimalarial drugs and RDTs 14 Apr 11 Malaria Balochistan Jhal Magsi BHU Gajan Apr 11 Malaria Balochistan Jhal Magsi DHQ Gandawah Apr 11 Balochistan Bolan Village Mal Soriyani RDT Kits distributed. 22 samples were tested and 13 found positive for Malaria (1 P.Falciparum, 2 P.Vivax & 1 mixed). Requested EDO Health to provide anti malarial medicines RDT Kits distributed. 2 samples were tested and 39 found positive for Malaria (21 P.Falciparum, 7 P.Vivax & 11 mixed). Requested EDO Health to provide anti malarial medicines 1 suspected case was reported but upon field investigation no cases found in the suroundings. 14 Apr 11 Balochistan Chagai Killi Qasim Abad Dalbandin 3 Vitamin A, symptomatic treatment is given and advised for isolation. Parents of the affected children refused for blood samples. EDO Health is informed 13 Apr 11 Balochistan Lasbela Akram colony UC Beroot 1 Suspected measles case investigated. Vitamin A was given. Blood Sample Collected and sent to NIH, Information given to EDO (H). Treatement given by pediatration 14 Apr 11 Balochistan Panjgur Mohalla Washap Union Council Sordo 1 During the investigation 1 suspected case was found. Patient was isolated. Health education was given. Field investigation continued. 11 Apr 11 Pertussis Balochistan Bolan Village Mal Soriyani suspected cases found on field visit. Gave erythromicin to cases and contacts, field investigation found many unimmunized children, informed the EDO health. 1 Apr 11 Tetanus Balochistan Bolan Village Sunny 1 14 Apr 11 ICT Islamabad CH PIMS (Ghuri town Khanna) 11 Apr 11 Tetanus ICT Islamabad CH PIMS 1 13 year old male case identified in DHQ hospital Sibi. TIGs were not available so localy purchased ATS were given. Inquiry revealed that boy had previous bruising on his right knee and no medical treatment was given and during harvesting he developed fever and stiffness of muscles, immunization history unclear, case survived up until present. Health facility reported 4 suspected cases. On active surveillance one case was found,vit. A was given. A suspected case was reported from the health facility and upon field investigation a 1 year old patient with history of neck stiffness and inability to stand was found. Patient recovered. Health education was given. 12 Apr 11 BD Haripur Afghan Refugee Camp 3 UC Khalabut Alert of BD was investigated from CD KTS3 and BHU STC 4. 8 cases were reported from the two health facilities. Active Surveillance in the area conducted and assessment carried out for the source of infection. Water samples tested for contaminations, stool samples could not be taken as the patients had already taken antibiotics. Health education session conducted in the area. IEC material and aqua tabs distributed in the affected houses. No new cases found. EDO Health office informed. 13 Apr 11 Leishmaniasis Kohistan Ayub Teaching Hospital (Vill Sarphoo, Kameela) confirmed cases reported from Ayub Teaching hospital belonging to Kohistan district. Coordination done with the EDO and Health partners. Coordinated activities are under way to trace the cases and search other cases in the area. 9 Apr 11 Haripur DHQ Haripur (Village Mirpur UC Mirpur) Alert was received from DHQ Haripur. Active surveillance in the area revealed 4 new cases. Vaccine status of the area revealed that village was missed in the last measles campaign. Children given VitA. Sample taken and sent to NIH. Mass measles campaign carried out for all children under 1 years. EDO and EPI coordinator informed. 13 Apr 11 Mardan Mohallah Neharabad UC Mayar Vit.A given,health education sessions conducted,edo H and EPI coordinator Informed, No other cases found. Patient isolated. Plan developed for strengthening of routine EPI. 13 Apr 11 Nowshera Vill Bahram kallay 9 Apr 11 BMC, Malki Abad, Speena Khauray 9 Apr 11 BMC, UC Topi, Bara Hemlet Apr 11 Private clininc, UC Gandaf 11 Apr 11 Private clininc, UC Topi, Gadoon Malik abad 4 13 Apr 11 Private clininc, UC Topi, Gadoon Malik abad 1 2 Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int. 3

4 Table-4: Alerts reported in week 1 of 211. (Cont d) Date of alert Disease Province District Location 12 Apr 11 Pertussis 13 Apr 11 AWD Punjab Bhawalpur BMC, Mohallah Palosai, Kangu Der Basti Dubba Dera Bhakha < Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (8-14 April 211) Male > Female < > 1 Action taken / Notes Health education sessions conducted,edo H and EPI coordinator Informed, Active Surveillance done. Pt isolated, health education and preventive session delievered in the relevant UC. Water and stool sample taken for lab test. Conducted health and hygine sessions in the community; Life Straws, aquatabs, Jerry cans and soaps were distributed. Assessment of essential medicines at the facility was also done. 14 Apr 11 DHF Punjab Bhakkar Multan (Ward No.19, Street Ali Asghar) 1 Isolation was ensured, health education sessions with the family and HF staff conducted, Sample was collected 11 Apr 11 Punjab Rajanpur Basti Hadiani UC Darkhast Jamal Khan shumali 1 1 Doses of vitamin A given, collected blood specimen, throat swab and sent to NIH, EDO(H) informed. 13 Apr 11 Punjab Sargodha Block No. 28, St. No. 2 UC 14 Doses of vitamin A given to < children, collected blood specimen, throat swab and sent to NIH,, EDO(H) informed. 11 Apr 11 Punjab Sargodha Imtiazabad UC164 1 Doses of vitamin A given to < children, collected blood specimen and sent to NIH, EDO(H) informed. 12 Apr 11 Meningitis Punjab Layyah Mohala darbar sharif,urban 2 karoor 1 CSF sample taken and sent to IPH, health eduction session was conducted for the community 9 Apr 11 Pertussis Punjab Sargodha THQ Sahiwal 1 Suspected alert was investigated and throat swab were taken and sent to NIH. Lab and field investigation continued. 9 Apr 11 AWD Sindh Dadu Lashari Medical Center UC 1 1 Alert was reported from health facility. 1 stool samples collected but found negative for cholera. Health education was provided. Chlorine tabs and ORS were distributed. 8 Apr 11 AWD Sindh Jacobabad Near Madarsa Ghulam Rasool UC Thul 1 A 32 years old male was suspected as a case of Acute Diarrhoea. Sample was collected and sent to NIH. 12 Apr 11 AWD Sindh Mirpur Khas DHQ Hospital 1 3 1/1 sample found positive for Cholera, DTC and ORT corners establishment in progress, IEC, health education, health staff briefed on case definition and report cases timely 14 Apr 11 AWD Sindh Naushahro Feroze Village Sawan Chandio, Deh Abji UCAbran AWD cases found at DHQ, 3 were dehydrated, all were from same family, 2 stool samples were taken and shipped to NIH, WHO medicine kit (DDK) supplied to DHQ through EDO H, Health hygiene kit and Aquq tabs distributed. 14 Apr 11 DHF Sindh Naushahro Feroze Khairpur (Ghareebabad ward 16, Mehrabpur) 1 suspected case, admitted today with positive anti dengue IGM, negative MP test, platelets 24, from Agha Khan lab, now case is referred to Sukkur hospital. Cross notified by DEWS Khairpur. 12 Apr 11 Sindh Badin Village Alhan shah UC Gharo Health education imparted, request for mop up vaccination in village, EDOH informed, vitamin A dose given, active surveillance on going 12 Apr 11 Sindh Badin Village Mitho Khan Gopang UC Peeru Lashari 1 1 Health education imparted, request for mop up vaccination in village, EDOH informed, vitamin A dose given, active surveillance 11 Apr 11 Sindh Ghotki Village Sodho Khan Shahani 1 suspected case, gave vitamin A, collected specimen and sent to NIH, upon field investigation no more cases found. 9 Apr 11 Sindh Jacobabad Mirza Wah, near village sharbat Pahore suspected case, gave vitamin A, upon field investigation no more cases found and outreach vaccination scheduled for community. 11 Apr 11 Sindh Jacobabad RHC Colony Mirpur Buriro 1 1 suspected case, gave vitamin A, family refused to give specimen, upon field investigation no more cases. 11 Apr 11 Sindh Jamshoro Village Gari Wari UC Sehwan I 1 Gave vitamin A dose, case isolation, health education session 8 Apr 11 Sindh Karachi Street 1, Macchi market, Bangali para 1 Complicated case of measles, admitted to NICH. Sample collected, Vitamin A dose given. Health education imparted. Informed and ensure THO 1 Apr 11 Sindh Kashmore Village Jalal din Khoso UC Gulanpur 1 suspected case, gave vitamin A, upon field investigation no more cases found 9 Apr 11 Sindh Khairpur Chondko Taluka Nara 1 1 suspected case, gave vitamin A, collected specimen and sent to NIH, upon field investigation no more cases found 11 Apr 11 Sindh Mirpur Khas Village Talib Dal, Kachelo Farm UC Imam Bux 1 2 Active surveillance, samples collected, vitamin A dose, health education, EDOH informed 13 Apr 11 Sindh Nawabshah Dr. Ali Gohar ja Hari UC Amerji Health education imparted, request for mop up vaccination in village, EDOH informed, vitamin A dose given, active surveillance 13 Apr 11 Sindh Nawabshah Rehmanabad UC Bandhi Health education imparted, EDOH informed, vitamin A dose given, active surveillance Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int. 4

5 Table-4: Alerts reported in week 1 of 211. (Cont d) Date of alert Disease Province District Location < Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (8-14 April 211) Male > Female < > Action taken / Notes 8 Apr 11 Sindh Sanghar Village Mir Hassan Marri Taluka Sanghar Active surveillance, samples collected, gave vitamin A dose to cases, health education, EDOH informed 14 Apr 11 Sindh Shikarpur Qazi Muhalla, Garhi Yasin 1 suspected case, gave vitamin A, collected specimen and sent to NIH, upon field investigation no more cases found 12 Apr 11 Sindh Sukkur Malohi Village, Deh Soni 1 suspected case, gave vitamin A, collected specimen and sent to NIH, patient is admitted at Muhammadi Medical Center Sukkur 9 Apr 11 Sindh Sukkur Village Aandho Khan Bagirji 1 suspected case, child was investigated, no rash and no fever, baby was sick but not matching to case definition. 14 Apr 11 Sindh Tando Allah Yar Koochra Paro UC 1, Taluka Tando Allah yar Vitamin A dose, Case isolation, health education, 2nd dose (LHW), active case finding, reinforced case management, hygiene kits distributed 13 Apr 11 Sindh Tando Allah Yar UC Began Jawan, Fazil Stop Taluka Chamber Vitamin A dose, case isolation health education, 1 sample collected and sent to NIH, mop up vaccination, active case finding 8 Apr 11 Sindh Tharparkar Village Godhiarr UC M.Bhatti, Taluka Mithi Health education, active surveillance, sample collected, EDOH informed 12 Apr 11 Sindh Thatta Village Muhammad Urs Khaskhali UC Bachal Gugo Health education imparted, request for mop up vaccination in village, EDOH informed, vitamin A dose given, active surveillance 1 Apr 11 Sindh Umerkot Village Bhadho Kapri UC Chajro Active surveillance, samples collected, gave vitamin A dose, health education, EDOH informed 9 Apr 11 Pertussis Sindh Ghotki Village Faqir Mian Bag, Katach Area 1 1 suspected case, collected specimen and sent to NIH, gave erythromycin to case and contacts, upon field investigation found many unimmunized children and outreach vaccination scheduled for community. 12 Apr 11 Pertussis Sindh Sukkur MMC (Islam Colony, Qureshi Goth) suspected case, gave erythromycin to case and contacts, upon field investigation many unimmunized children found and outreach vaccination scheduled for community. 14 Apr 11 Pertussis Sindh Sukkur Village Muhammad Ibraheem Indhar, Pano Akil 1 1 suspected case, collected specimen and sent to NIH, gave erythromycin to case and contacts, upon field investigation found many unimmunized children and outreach vaccination scheduled for community. 13 Apr 11 Pertussis Sindh Tando Allah Yar Akram colony UC 3 1 Case isolation, health education, active case finding, reinforced case management, Erythromycin treatment 13 Apr 11 Pertussis Sindh Tando Allah Yar CH Tando Allah Yar 1 Case isolation, health education, active case finding, reinforced case management, erythromycin / priton treatment 8 Apr 11 Pertussis Sindh Tando Allah Yar UC Began Jawan, Fazil Stop Taluka Chamber 4 Case isolation, health education, active case finding, reinforced case management, treatment with erythromycin, sample collected and lab investigations are under process. 14 Apr 11 Pertussis Sindh Tando Allah Yar UC Began Jawan, Fazil Stop Taluka Chamber Case isolation, health education, active case finding, 1 sample collected and sent to NIH, reinforced case management, erythromycin / priton treatment 14 Apr 11 Pertussis Sindh Tando Allah Yar Village Shobholchan Mastoi UC Mirabad 1 Case isolation, health education, active case finding, reinforced case management, erythromycin / piriton treatment 11 Apr 11 Tetanus Sindh Ghotki Village Nibaho Khan Chachar, Adilpur 1 Suspected case of Tetanus was admited in MCH Centre notified by pediatrician. Hospital investigation completed. TIG was given to the patient. 14 Apr 11 Tetanus Sindh Larkana Village Illahi Bux Chandio Taluka Ratodero 1 Patient is admitted in CMC Larkana, TIG was provided by WHO 14 Apr 11 Tetanus Sindh Qambar Shahdadkot CMC Larkana (Village Meenha Tajo) Patient is admitted in CMC Larkana, TIG was provided by WHO Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int.

6 Province This week 2 districts reported to DEWS from KP province, 691 health facilities reported 177,92 patients consultations to DEWS. ARI is the leading disease in KP province. ARI cases reported 4,67 (31%), a decreasing by 1% in proportional morbidity as compared with last week. 11 alerts were reported in this week from, 8 were for, while 1 each for Leishmaniasis, Pertussis, and Bloody diarrhoea. Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (8-14 April 211) Figure-: Trend of priority communicable diseases, province KP (31-July 21 to 14 April 211) wk 41 wk 43 wk 4 wk 47 wk 49 wk 1 3 Diseases Wk-12 Wk-13 Wk-14 Wk-1 Skin Diseases 7,478 (4%) 7,73 (4%) 7,871 (%) 7,32 (4%) ARI (URI and LRI),817 (33%) 3,81 (31%),49 (32%) 4,67 (31%) 13,77 (8%) 14,978 (9%) 16, (1%) 18,878 (11%) Bloody Diarrhea 1,221 (1%) 1,48 (1%) 1,296 (1%) 1,618 (1%) Suspected Malaria 1,99 (1%) 2,37 (1%) 2,363 (1%) 2,73 (2%) Total consultations 168, , ,79 177,92 Province Punjab 12 districts reported data to DEWS from Punjab province, 82 health centers reported a total of 229,6 patient consultations during this reporting period ARI cases reported were 3, (23%), a decline by 2% in proportional morbidity as compared with last week. 7 alerts were reported in this week from Punjab; 3 were for, while 1 each for AWD, DHF, Pertussis, and Meningitis. This week a total of 6,2 malaria samples were tested of which 174 were positive (slide positivity rate 2.7%, while falciparum rate was 61.4%). Figure-6: Trend of priority communicable diseases, province Punjab (3 August 21 to 14 April 211) wk 41 wk 43 wk 4 wk 47 wk 49 wk 1 3 Diseases Wk-12 Wk-13 Wk-14 Wk-1 Skin Diseases 16,62 (9%) 17,39 (8%) 17,42 (8%) 18,941 (8%) ARI (URI and LRI) 49,76 (26%) 2,369 (26%) 1,278 (2%) 3, (23%) 1,2 (8%) 16,73 (8%) 1,738 (8%) 18,417 (8%) Unexplained Fever 6,176 (3%) 7, (3%) 7,67 (3%) 6,826 (3%) Suspected Malaria 6,684 (3%) 7,71 (4%) 7,47 (4%) 6,198 (3%) Total consultations 193,93 23,992 23,26 229,6 Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int. 6

7 Province Sindh This week 22 districts reported to DEWS from Sindh province, and 1,33 health centers reported a total of 43,124 patient consultations during the reporting period of week 1, 211. Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (8-14 April 211) Figure-7: Trend of priority communicable diseases, province Sindh (6 August 21 to 14 April 211) 4 4 In Sindh, ARI cases reported were 96,328 (22%), 1% lower proportional morbidity as compared with last week alerts were reported from Sindh in this week: 21 were for, 8 were for Pertussis, 4 were for Acute Watery Diarrhoea, 3 were for Tetanus, while 1 was for Dengue Hemorrhagic Fever wk 41 wk 43 wk 4 wk 47 wk 49 wk 1 3 Diseases Wk-12 Wk-13 Wk-14 Wk-1 Skin Diseases 46,3 (12%) 48,28 (11%) 4,117 (12%) 1,79 (12%) ARI (URI and LRI) 1,746 (2%) 11,94 (24%) 88,77 (23%) 96,328 (22%) 31,947 (8%) 3,34 (8%) 33,621 (9%) 38,284 (9%) Bloody Diarrhea 2,64 (1%) 2,92 (1%) 2,277 (1%) 3,1 (1%) Suspected Malaria 36,933 (9%) 37,42 (9%) 34,43 (9%) 37,246 (9%) Total consultations 397, ,18 382,927 43,124 Province Balochistan In this week, 17 districts reported to DEWS from Balochistan province. 37 fixed and mobile medical outreach centers reported a total of 61,11 patient consultations. ARI reported in 13,167 (22%) of the total consultations which is same proportional morbidity as compared with last week. 13 alerts were reported in this week from Balochistan, 4 each were for, and Malaria, while 1 each was for ARI, Bloody Diarrhoea, Chickenpox, Pertussis, and Tetanus. Malaria cases were reported from some of the districts in Balochistan. In week 1 a total of 866 malaria samples were tested of which 37 were positive and slide positivity rate was 3.%, while falciparum rate was 7.6%. Diseases Wk-12 Wk-13 Wk-14 Wk-1 Skin Diseases 4,317 (7%) 4,429 (7%) 3,897 (6%) 4,132 (7%) ARI (URI and LRI) 1,927 (26%) 14,818 (24%) 13,873 (22%) 13,167 (22%) Figure-8: Trend of priority communicable diseases, province Balochistan (6 August 21 to 14 April 211) wk 41 wk 43 wk 4 wk 47 wk 49 wk 1 3,94 (1%) 6,741 (11%) 6,729 (11%) 7,414 (12%) Bloody Diarrhea 1,66 (3%) 2,147 (3%) 1,77 (3%) 2,248 (4%) Suspected Malaria 7,124 (12%) 7,979 (13%) 8,667 (14%) 8,498 (14%) Total consultations 61,97 62,24 62,18 61,11 Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 7 Fax : , wr@pak.emro.who.int.

8 Islamabad Capital Territory This week Islamabad is reporting from four health facilities with a total of 3,688 patient consultations. ARI cases reported were 1,12 (3%), while Acute Diarrhoea 47 (12%). Fluctuation in rates is due to difficulties in collecting reports as the system is being established. Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (8-14 April 211) Figure-9: Trend of priority communicable diseases, Islamabad (1 January to 14 April 211) alerts one each was for, and Tetanus received this week from Islamabad. wk 2 wk 4 wk wk 6 wk Diseases Wk-12 Wk-13 Wk-14 Wk-1 Skin Diseases 2 (1%) 7 (1%) 21 (2%) 26 (1%) ARI (URI and LRI) 1,288 (1%) 12 (17%) 42 (32%) 1,12 (3%) (Not Watery) 2 (8%) 2 (9%) 139 (1%) 47 (12%) Bloody Diarrhea 4 (2%) (1%) 4 Suspected Malaria (1%) Total consultations 2, 88 1,398 3,688 FATA This week FATA is reporting from 12 health centers, with a total of,27 patient consultations. Figure-9: Trend of priority communicable diseases, FATA (4 February to 14 April 211) ARI cases reported were 1,7 (18%), while Acute diarrhoea reported 1,4 cases (26%) No alert was received this week wk 6 wk Diseases Wk-12 Wk-13 Wk-14 Wk-1 Skin Diseases 68 (%) 117 (8%) 136 (7%) 23 (%) ARI (URI and LRI) 34 (2%) 34 (24%) 17 (28%) 1,7 (18%) (Not Watery) 182 (13%) 216 (1%) 283 (1%) 1,4 (26%) Bloody Diarrhea Suspected Malaria (1%) 71 (1%) Total consultations 1,374 1,41 1,868,27 Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 8 Fax : , wr@pak.emro.who.int.

9 Gilgit Baltistan Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (8-14 April 211) In this week, weekly report from 3 districts in Gilgit Baltistan sent weekly report from 24 health centers with a total of 6,442 patient consultations. ARI cases reported were 2,328 (36%), while Acute Diarrhoea 442 (7%). The DEWS network has been recently introduced in Gilgit Baltistan and is being established. No alert was received this week. Diseases Wk-13 Wk-14 Wk-1 Skin Diseases 49 (1%) ARI (URI and LRI) 1,647 (3%) 262 (7%) 1,617 (41%) 442 (7%) 2,328 (36%) 247 (%) 232 (6%) 74 (12%) Bloody Diarrhea 63 (1%) Suspected Malaria 2 Total consultations 4, (1%) 2 (1%) 3, (2%) 4 6,442 State of Azad Jammu and Kashmir In this week, weekly report from 7 districts in AJK received to DEWS system from twenty nine (29) health centers with a total of 7,381 patient consultations. ARI cases reported were 1,39 (17%), while Acute diarrhoea reported 37 (4%) cases No alert was received this week. Diseases Wk-13 Wk-14 Wk-1 Skin Diseases 13 (2%) ARI (URI and LRI) 216 (4%) 41 (8%) Bloody Diarrhea - Suspected Malaria - Total consultations (4%) 1,143 (2%) 289 (6%) , 37 (4%) 1,39 (17%) 438 (6%) ,381 Distribution of Wild Polio Virus cases Pakistan 21 and 211 Year 21: The total number of polio cases reported in 21 is 144 including 12 type- 1 cases and 24 type-3 from 4 infected districts/towns/ agencies. Year 211: The total number of new type-1 polio cases confirmed by the laboratory is 28 to date from 13 districts. Two polio cases confirmed this week: one from (FATA), and another from Orangi (Karachi). Cases 21 Cases 211 Province P1 P3 P1 P3 Punjab Sindh FATA Balochistan AJK Gilgit Baltistan Islamabad Total Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , 9 Fax : , wr@pak.emro.who.int.

10 Confirmed Alerts (1st Dec 21 to 14 April 211) Epidemiological Bulletin: DEWS, Pakistan, Week no. 1 (8-14 April 211) Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , wr@pak.emro.who.int. 1