Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 2, Issue 46, Monday 21 November, 2 Highlights Epidemiological week no. 46 ( to 17 November, 2) 8 districts and 2 agencies provided surveillance data to the DEWS this week from 2,636 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC. A total of 816,8 consultations were reported through DEWS of which 23,121 (%) were acute respiratory infections (); 72,768 (9%) were Skin disease; 61,792 (8%) were acute diarrhoea; and 7,97 (7%) were suspected malaria. A total of 124 alerts with 1 outbreaks were reported in week 46, 2: Altogether 28 alerts for AWD, 23 for Measles; 22 for Neonatal tetanus and tetanus; 18 for Leishmaniasis; 7 for Pertussis; 6 each for Malaria and ; 4 each for DHF and Acute diarrhoea; 2 for AJS; while 1 each for CCHF, Diphtheria, Typhoid and unexplained fever. In this week nine new polio cases were confirmed by the laboratory, four from FATA (three from North Waziristan agency and one from Khyber agency); two each from Balochistan (Mastung and Barkhan districts) and Punjab (Vehari and districts); and one from Khyber Pakhtunkhwa (Lakki Marwat district). As of 21st November 2, Pakistan has reported a total of 14 polio cases (12 type 1 & 2 type 3) from 48 districts/towns/tribal agencies and areas. Priority diseases under surveillance in DEWS Acute Flaccid Paralysis (AFP) Acute Jaundice Syndrome (AJS) Acute Respiratory Infections (Upper and Lower) () 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: Weekly trend of leading priority diseases in Pakistan, 29 July 21 to 27 October 2 (Epi week 31, 21 to week 46, 2) wk 31 wk 33 wk wk 37 wk 39 wk 41 wk 43 wk 4 wk 47 wk 49 wk 1 wk Disease Wk-39 Wk-4 Wk-41 Wk-42 Wk-43 Wk-44 Wk-4 Wk-46 Acute respiratory infection,97 (21%) 29,436 (21%) 223,92 (22%) 213,432 (24%) 193,863 (24%) 217,676 (%),386 (%) 23,121 (%) Skin diseases 1,912 (%) 9,842 (9%) 94,167 (9%) 81,161 (9%) 69,393 (9%) 77,842 (9%) 33,869 (8%) 72,768 (9%) Acute diarrhoea 1,29 (%) 97,7 (1%) 93,8 (9%) 74,189 (8%) 62,628 (8%) 6,71 (8%) 32,4 (8%) 61,792 (8%) Bloody diarrhoea 9,393 (.94%) 8,7 (.8%) 8,17 (.78%) 6,89 (.68%),461 (.68%),289 (.6%) 2,71 (.68%),76 (.7%) Suspected malaria 83,684 (8%) 82,82 (8%) 86,326 (8%) 68,441 (8%) 8,613 (7%) 69,48 (8%) 33,8869 (8%) 72,768 (9%) Total consultation 99,4 1,14,266 1,33, ,98 88,94 879,8 47, ,8 Since July 29, 21, approximately 2,46,12 patient consultations have been reported to the DEWS from all provinces, FATA and AJ&K. While we still receive reports on around 1,, consultations per week, there is a drop in timely reporting due to EID holidays, challenges in accessibility caused by security situation in some areas. The above graph shows the weekly trend of four major diseases as percentage of cases out of total consultations reported to DEWS. From last 8 weeks (39 to 46, 2) acute diarrhoea cases have been decreased (From % to 8%), while at the same time cases of have been increased (From 21% to %). A slight fluctuation in the suspected malaria cases have been seen recently after consistent seasonal increase from week especially from districts in Sindh and Balochistan. This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , 1

2 Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 ( to 17 November, 2) Current week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Nov AWD KPK Lower Dir 16 Nov Pertussis KPK Lower Dir 1 Nov AJS Sindh Badin Sindh 17 Nov AWD Sindh Thatta 16 Nov Malaria Sindh Ghotki Nov Malaria Sindh Thatta 16 Nov Malaria Sindh Thatta 14 Nov Pertussis Sindh Tharparkar 16 Nov Pertussis Sindh Tharparkar Village Gular, UC & Tehsil Samar Bagh Village Sharmakhan Shontala, UC & Tehsil Samar Bagh Village Mian Pota, UC Talhar, Taluka Talhar Baloch Mohalla, Old Wolcut Factory, UC # 6, Taluka Mirpurkhas Village Allo Tara, UC Sonda, Taluka Thatta. Village Muhammad Shar UC Bairoota Taluka Daharki Village Pir Dino Khaskheli, UC Jhirk, Taluka Thatta Village Sheikh Muhammad Ismail, UC Jhirk, Taluka Thatta Village Bhoongrai Khosa, UC Mitho Dabhro, Taluka Diplo Village Baando Kapri, UC Warawah, Taluka Nagarparkar Current week's Alerts: Province Sindh Date Disease District Area <M >M <F >F 17 Nov AD Naushahro Feroze Baladi Mohalla, UC and taluka Kandiyaro Nov AJS Badin Village Mian Pota, UC Talhar, Taluka Talhar 2 1 Nov AJS Benazirabad Police Line Dispensory, UC Nov AWD Badin Village Haji Channesar Jat, Dadar ko Farm, UC Rahuki Nov AWD Hyderabad Gayoosala, Usmanabad near Bilala Masjid, UC 16, Taluka Hyderabad 3 12 Nov AWD Rajar Colony, UC #, Taluka Mirpurkhas 1 2 Village Junejo Colony, near Bus Trrminal Mirpurkhas, UC Turk Ali Mari 1 Opposite Bhittai hospital, Baloch Colony, UC # Taluka Mirpurkhas 1 1 Village Faiz Muhammad Laghari, near Jamrau Mori, UC Doulat Pur 1 Village Haji Mubarak Khaskheli, Kapri Mohalla, UC Mir Ghulam Hussain Talpur 1 Baloch Mohalla, Old Wolcut Factory, UC # 6, Taluka Mirpurkhas Nov AWD Qambar Shahdadkot Village Norang UC Jean abro Nov AWD Sanghar Village Khairo Kaloi, Taluka Shahdadpur 2 1 Nov AWD Tando Allah Ashfaq Tawn, UC Pak Singhar, Taluka Tando Yar Allahyar 1 Nov AWD Tando Allah Yar Madina Colony Taluka Tando Allahyar 1 Nov AWD Tando Allah Village Sultan Abad, UC Sheikh Musa, Taluka Yar Tando Allahyar 1 12 Nov AWD Tando Allah Village Maqbool memon (Hingorja Mohalla), Yar UC Missan 4 Nov AWD Tharparkar Village Bachal Shah Colony UC Mithi 1 Nov AWD Tharparkar Village Sukhpur, UC Nagarparkar, Taluka Nagarparkar 12 Nov AWD Tharparkar Village Kuwara, UC Pithapur, taluka Nagarparkar 13 Nov AWD Tharparkar IDP Tent city Naukot, UC Mahrano, Taluka Mithi 2 1 Nov AWD Tharparkar Village Edani, Peer Mohalla, UC Dhaheli, Taluka Chachro. 1 1 Nov AWD Tharparkar Village Jarelo, Rind Mohalla, UC Tar Ahmed, Taluka Chachro Nov AWD Thatta Sonda Citu UC Sonda 1 Thatta Village Allah Buksh Tara, UC Sonda 1 Thatta Village Moosa Merbahar, UC Sonda Thatta Village Saleh Muhammad Sheikh, Taluka Shah Bundar Nov AWD Thatta Village Allo Tara, UC Sonda, Taluka Thatta Nov AWD Umer Kot Khoso Paro, near Ali Nawaz Khaskheli house, UC 2, Taluka Umerkot Nov AWD Umer Kot Village Waryam Rajar, Bheel Paro, UC Atta Muhammad Pali 1 2 A Case of suspected AWD was reported, on active surveillance more cases were found in same area with severe dehydration, all the patients were referred to DHQ Hospital for IV therapy, Stool samples collected for lab confirmation but both found negative for Cholera, Water Samples taken for any fecal contamination, ORS, Hygiene kits & Aqua tabs distributed, Health & Hygiene promotion Session conducted with family members. During active surveillance 2 cases of suspected Pertussis were found having typical Cough with vomiting, more cases were found in the same area but most of them were unimmunized for routine vaccination. some were already recovered, Erythromycin was provided to all close contacts, Nasophyrangeal swab were taken from 2 cases for confirmation. Outreach Immunization activity was carried out by EPI team in the area. EDO was Informed. 7 cases of suspected acute viral hepatitis investigated, health education imparted, one pregnant women suspected case was give TT vaccine, informed MS RHC and DHMT and 3 blood sample taken and sent to NIH 1 suspected case was found in hospital, on active surveillance more cases with diarrhoea were found in the community. Contaminated water of hand pump was the possible source, health education imparted, Aqua tabs, Zinc tabs and ORS distributed, EDO H, DSM PPHI informed. 3 Patient were admitted in Hospital, during active surveillance 13 more cases found, Canal was the source of drinking water, health education imparted, Aqua tabs, Zinc tabs, ORS, Jerry cans and water filter distributed, EDO H informed and 2 water sample taken. Suspected Malaria Death reported by health technician at EDOH office Mirpur Mathelo. Field investigation done and WHO response, DEWS team performed MP tests on RDTs and found 3 positive cases (P. Falciparum 17, P. Vivax 3, Mixed 1) in the village. ACT & bed nets provided, Health education session conducted in the community, moreover informed EDOH for fumigation and resudal spray. 19 cases of malaria (7 P. Falciparum and 2 Mix) found confirmed by RDT, health education imparted to family members and other neighbor, Anti Malaria medicines and Bed Nets provided and EDO H informed. cases of malaria (8 P. Falciparum and 3 Mix) found confirmed by RDT, health education imparted to family members and other neighbor, Anti Malaria medicines and Bed Nets provided and EDO H informed. 1 Suspected case investigated, Throat Swab collected, sensitized regarding proper vaccination and Personal Hygiene, informed EDO H, DSM PPHI, MS DHQ regarding the cases and Throat swab taken. 9 case of Pertussis were investigated, History of Patient was taken, Health education imparted regarding Vaccination and Proper health and Hygiene, Anti Biotic and Antipyratic tabs given, inform EDO H, DSM PPHI, MS THO. Cont d: Province Sindh Date Disease District Area <M >M <F >F 14 Nov Diphtheria Dadu Najab shah Mohalla, UC and Taluka Johi 1 16 Nov Malaria Ghotki Village Muhammad Shar UC Bairoota Taluka Daharki Nov Malaria Thatta Jhirck City, Mallah Mohalla, UC Jhirk Taluka Thatta Nov Malaria Thatta Village Pir Dino Khaskheli, UC Jhirk, Taluka Thatta Nov Malaria Thatta Village Sheikh Muhammad Ismail, UC Jhirk, Taluka Thatta Nov Measles Jacobabad Channa Mohalla, UC Jaffarabad 1 1 Nov Measles Jamshoro Ameer complex UC Nagoline Taluka Kotri 1 1 Nov Measles Jamshoro Near SDA office, Khuda Ki Basti # 3 UC Sonowaller 1 17 Nov Measles Jamshoro Village Shah Paro, near G. High school, UC Nagoline 1 14 Nov Measles Karachi Siddique Akbar Mohalla, near Al Khidmat hospital, sector E, SITE Nov Measles Shikarpur Qazi Mohalla, Shikarpur City 1 12 Nov NNT Badin Village Potho, Ali Mirshah, UC Kario Ganwer, Taluka Golarchi 17 Nov NNT Dadu Village Hiro Laghari, UC Pat Gul Muhammad, Taluka Johi 16 Nov NNT Ghotki Village Waryam Chachar UC Mithri Taluka Garh 1 1 Nov NNT Karachi Neonatal ICU, NICH/Sec 48 B, Korangi # 2, Korangi Tawn 1 17 Nov NNT Karachi Kachi Abadi, Bhains colony Bin Qasim Town 14 Nov NNT Khairpur Village Gazi buledi UC Kalar Talka Kamber 1 14 Nov NNT Khairpur Village Muhammad Murad Rind UC Nizamani 1 Nov NNT Khairpur Village Haji Maheral Alamani UC Kot mir Muhammad Taluka Kingri 16 Nov NNT Khairpur Village Haji Khair Muhammad Bhambhro UC Sikanderabad Taluka Nara 16 Nov NNT Khairpur Village Mohabat khan UC Chondiko Taluka Nara 17 Nov NNT Khairpur Village Khuda Bux Brohi, UC Hingoja, taluka Sobho Dero 16 Nov NNT Larkana Village Gull Mohammed Tunio Taluka Bakrani 14 Nov NNT Qambar Village Gazi buledi UC Kaler talka Shahdadkot Kamber 1 17 Nov NNT Sanghar Daper Colony, UC 2, Taluka Sanghar This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , 2 14 Nov 16 Nov Pertussis Tharparkar Village Bhoongrai Khosa, UC Mitho Dabhro, Taluka Diplo Pertussis Tharparkar Village Baando Kapri, UC Warawah, Taluka Nagarparkar

3 Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 ( to 17 November, 2) Current week's Alerts: Province Balochistan Current week's Alerts: Province Punjab Date Disease District Area <M >M <F >F Date Disease District Area <M >M <F >F Nov Leishmaniasis Khuzdar UC Zereena Kattan & UC d 3 12 Nov Leishmaniasis Khuzdar Rabat, UC Goani Grehsa; Lope; Kanak, UC Gazgi 3 12 Nov NNT Quetta Bolan Medical Complex Hospital 1 12 Nov Tetanus Quetta Bolan Medical Complex Hospital 14 Nov Pertussis Khuzdar Nawa, UC Baleena Kattan, Tehsil Khuzdar 1 Nov Typhoid Chagai Killi georgage, Girdi jungle Refugee camp Nov Pertussis Kharan Wapda road, UC Northern town Nov Leishmaniasis Kalat Chashma, UC Lakhorian, Tehsil Surab 16 Nov NNT Nasirabad DHQ Dera Murad Jamali 16 Nov Leishmaniasis Bolan Mohalla Ghulam Bolak, Dhadar 1 16 Nov CCHF Quetta Fatima Jinnah Chest Hospital 2 16 Nov Leishmaniasibad Jaffara Cattle farm colony, Tehsil Jhat Pat 1 17 Nov Pertussis Kech Khuda Yousuf Mahallah, UC Absar 1 17 Nov Measles Quetta Bolan Medical Complex Hospital Kech Akram Ward, UC Absar 1 Lasbela Mangya UC Sheh Tehsil Lakhra Nov Leishmaniasiwan UC Khudabadan East, Mohallah Sara Panjgur 1 Panjgur UC Washbood, Mohallah Faqeer Abad pishin Grid colony, UC bazar e khona 1 Quetta Hazara town, Brewery road Quetta Pashtoon Abad 1 Sibi Mohala Allabad, UC 3 & Ghareebabad 2 17 Nov Pertussis Ziarat Kawas sharki 2 1 Ziarat Pasara, Cheena 1 Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <M >M <F >F Nov AWD Lower Dir Village Gular, UC & Tehsil Samar Bagh Nov Measles Swabi BMC Swabi, Kadi and Baja 2 Nov Measles Swat Village & UC Kabal, Tehsil Kabal 1 Nov Measles Swat Village Mehak UC Kala Kale, Tehsil Kabal 1 12 Nov Measles Lower Dir Village Sabar Shah & Serai, UC Tazagram, Tehsil Adenzai Nov Measles Lower Dir Village Shirkhanai, UC Hayaserai, Tehsil Balmbat Nov Measles Charsadda Azizkhel 1 14 Nov Measles Swat Village Chinar Baba Khwazakhela 1 14 Nov Measles Swat Village Dherai, Mohallah Alfalah, UC Kanju, Tehsil Kabal 1 Nov Measles Charsadda Dab Kallay 1 Nov Measles Charsadda Munda camp 1 Nov Measles Swabi Private Clinic, Narangi Nov Measles Swat Village & UC Shahderai,mohallah thana, Tehsil Kabal 16 Nov Measles Haripur Tarbella Cant, tehsil Ghazi 16 Nov Measles Lower Dir Village Shontala, UC & Tehsil Samar Bagh Nov Measles Swabi BHU Fazal Abad, Tel Banda 1 16 Nov Pertussis Lower Dir Village Sharmakhan Shontala, UC & Tehsil Samar Bagh Nov DHF Bhakkar Nov Leishmaniasis D. G. Nov NNT Rajanpur Current week's Alerts: AJK; FATA; GB and ICT Date Disease District Area <M >M <F >F 1 Nov NNT Bajaur Agency 17 Nov NNT Bajaur Agency 17 Nov Measles Mohmand Agency DHQ Bhakkar Mohallah Jhakkar Alamabad Chak 217/TDA Mohala Duleani Tiba near CH Sakhi Sarwar Faisal Colony, Choti Road, UC Basti Rindan village rashakai, tehsil Nawagai village gabaray, tehsil Mamoond Nov NNT Rajanpur THQ Jampur, Basti Mushtaq Khosa, UC Basti Foja Nov DHF Mianwali Nai Abadi Kotchandna, Isa Kheel 1 14 Nov Leishmaniasis 14 Nov Leishmaniasis Basti Ahmed abad, Malik pur, UC Jaja Abasian, tehsil pur 1 UC bela, Tehsil Liaqatpur 1 1 Kasai This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , 3 12 Nov 14 Nov Nov RHC Zahir Pir, Tehsil pur Nov AD Mianwali BHU PaiKheel Nov 1 Nov 1 Nov Malaria BHU Allah Jiwaya Lar, Tehsil Liaqatpur 1 Nov DHF Vehari BHU 87/A, Tehsil Liaqatpur BHU Haroonabad, Tehsil Liaqatpur RHC Sinanawan Moza Dharam Pura, Inshallah Nursery, Gali No. 2, Tehsil Mailsi 1 1 Khushab Village Payel, Khushab Nov NNT D. G. Gohra, UC Tuman Qaisrani 1 17 Nov 17 Nov AD Basti New Qadir Pur & Thatha Sharif, UC Qadirpur Chajra BHU /NP, Roshan Bhait, Tehsil Sadiqabad Nov UXF Mianwali BHU Chak 6 ml, piplan Nov AD 16 Nov Leishmaniasis 14 Nov Malaria 14 Nov DHF Pakpattan Basti Darkhan Wala, BHU Usman Koria, UC Kharak BHU Usman Koria Chak No. 79/EB, Darya Ding, Tehsil Arif BHU Bhong, Tehsil Sadiqabad

4 Table 1: Leading causes of seeking health care in flood affected districts, 29 July 21 to 1 November 2, compiled from weekly reports Diseases Number of Consultations Acute respiratory infection,74,63 (22%) Skin diseases,98,14 (%) Acute diarrhoea 4,964,18 (9%) Bloody diarrhoea 439,816 (1%) Suspected malaria 3,4,132 (6%) Unexplained fever 1,18,36 (4%) Total consultations 2,46,12 Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 ( to 17 November, 2) Table 2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease Post Flood 21 2 (up till ) Current Week (46) Total A O A O A O A O Acute watery diarrhoea Acute jaundice syndrome Bloody diarrhoea Dengue fever Measles Pertussis NNT + tetanus Malaria Leishmaniasis Others Total Province Khyber Pakhtunkhwa: This week 67 health facilities from 16 districts reported to DEWS with a total of 138,6 patients consultations. The proportional morbidity of AD dropped by 1% as compared with last week. 17 alerts were reported in this week, 1 were for Measles; while 1 each for AWD and Pertussis. 2 outbreaks, 1 each for AWD and Pertussis both were from Lower Dir were received and responded this week. Province Sindh: This week 882 health facilities from 23 districts reported a total of 36,82 patient consultations. In Sindh, AD cases reported were 28,686 (8%), 1% lower proportional morbidity as compared with last week. 7 alerts were reported from Sindh in this week: 27 were for AWD; 14 for Neonatal tetanus; 6 for Measles, 4 for Malaria, 2 each for Pertussis and AJS, while 1 each for AD and Diphtheria. 9 outbreaks, 3 for Malaria, while 2 each for AWD and Pertussis, while 1 for AJS were received and responded this week. Figure 2: Weekly number of reporting health facilities (Wk 33/21 to Wk 46/2) Number of HFs Mobile Figure-3: Trend of priority communicable diseases, province KPK Figure-4: Trend of priority communicable diseases, province Sindh Wk 33 Wk Wk 37 Wk 39 Wk 41 Wk 43 Wk 4 Wk 47 Wk 49 Wk 1 Wk 1 Wk 3 Wk Wk 7 Wk 9 Wk Wk 13 Wk 1 Wk 17 Wk 19 Wk 21 Wk 23 Wk Wk 27 Wk 29 Wk 31 Wk 33 Wk Wk 37 Wk 39 Wk 41 Wk 43 Wk Fixed Epi week wk wk This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , 4

5 Province Punjab: This week 484 health facilities from 8 districts reported data to DEWS from Punjab province with a total of 19,8 patient consultations. AD cases reported were,974 (6%) and showing 1% higher proportional morbidity as compared with last week. 23 alerts were reported in this week from Punjab; 6 were for ; 4 each for DHF and Leishmaniasis; 3 each for AD and NNT; 2 for Malaria; while 1 for unexplained fever. No outbreak for any disease was received this week. Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 ( to 17 November, 2) Figure-: Trend of priority communicable diseases, province Punjab wk Province Balochistan: In this week, 18 districts reported to DEWS from Balochistan province. 49 health centers reported a total of 71,81 patient consultations. AD reported in 6,761 (9%) of the total consultations, 2% lower proportional morbidity as compared with the last week. 24 alerts were reported in this week from Balochistan, 14 for Leishmaniasis; 4 for Pertussis; 3 for Neonatal tetanus and tetanus; while 1 each for CCHF, Measles and Typhoid. Figure-6: Trend of priority communicable diseases, province Balochistan wk Province Gilgit Baltistan: Figure-7: Trend of priority communicable diseases, Gilgit Baltistan In this week, 47 health centers from districts in Gilgit Baltistan sent weekly report with a total of 16,668 patient consultations. cases reported were 2,76 (17%), while Acute diarrhoea were 1,297 (8%). No alert or outbreak was received in this week from any area of Gilgit Baltistan wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 State of Azad Jammu and Kashmir: FATA: In this week, reports were received from 8 health facilities from 1 districts with a total of 26, patient consultations. cases reported were,313 (2%), while Acute diarrhoea reported 969 (4%) cases. No alerts or outbreak was received this week from any area of AJ&K. This week 39 health facilities in 2 agencies reported from FATA, with a total of 6,88 patient consultations. cases reported were 1,69 (%), while Acute diarrhoea was reported 12 cases (7%) 3 alerts, 2 for Neonatal tetanus and 1 for Measles were received and responded this week wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 1 wk 6 wk wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ,

6 Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 ( to 17 November, 2) Distribution of Wild Polio Virus cases Pakistan 21 and 2 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 2: As of 18 November, 2, the total number of polio cases confirmed by the laboratory is 14 (12=type 1, and 2=type3) from 48 districts. Province Cases 21 Cases 2 P1 P3 P1 P3 Punjab Sindh Khyber Pakhtunkhwa FATA Balochistan AJ&K Gilgit Baltistan Islamabad Total Pakistan Dengue Situation, th November 2 Since the beginning of the year and as of Week 46 th 2; 4,663 cases of suspected dengue fever cases and 23,19 Lab confirmed cases were reported across the country with 6 deaths (CFR = 1.%). Over 9% of cases were reported in Punjab province. Provinces 2 Suspected Confirmed Deaths Punjab Sindh Islamabad Khyber Pakhtunkhwa AJK FATA 7 6 Balochistan 6 3 Gilgit Baltistan 6 2 Total This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , 6

7 Epidemiological Bulletin: DEWS, Pakistan, Week no. 46 ( to 17 November, 2) Alerts and outbreaks, week 46, 2 This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : , 7