Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 3, Issue 17, Wednesday 2 May 212 Highlights Epidemiological week no. 17 (22 to 28 April 212) Priority diseases under surveillance in DEWS In week 17, 212, total 87 districts including 2 agencies provided surveillance data to the DEWS on weekly basis from around 1,98 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC. A total of 78,79 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI); 9% were acute diarrhoea; % were suspected malaria; while 4% were Skin disease. A total of 246 alerts reported while outbreaks were identified in week 17, 212: Altogether 13 alerts for Measles; for Leishmaniasis; 18 each for AWD and Typhoid; 17 for Acute diarrhoea; 11 for NNT and tetanus; 9 for Pertussis; 8 for Bloody diarrhoea; 3 each for acute jaundice syndrome and Scabies; 2 for DF; while 1 each for Malaria and ARI. In this week no new polio cases was reported. As of 3 April 212, the total number of polio cases confirmed by the laboratory is from districts/towns/tribal agencies and areas. Acute (Upper) Respiratory Infection Pneumonia Suspected Diphtheria Suspected Pertussis Acute Watery Diarrhoea Bloody diarrhoea Other Acute Diarrhoea Suspected Enteric/Typhoid Fever Suspected Malaria Suspected Meningitis Suspected Dengue fever Suspected Viral Hemorrhagic Fever Pyrexia of Unknown Origin Suspected Measles Suspected Acute Viral Hepatitis Chronic Viral Hepatitis Neonatal Tetanus Acute Flaccid Paralysis Scabies Cutaneous Leishmaniasis Others Figure1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week1, 211 to week17, wk 21 wk 23 wk wk 27 wk wk 41 wk 43 wk wk 47 wk Table 1: Most common communicable diseases syndromes reported weekly Disease Wk- Wk-11 Wk-12 Wk-13 Wk-14 Wk- Wk-16 Wk-17 Acute respiratory infection,186 (23%) 162,3 (23%) 1,261 (21%),8 (2%) 128,63 (2%) 132,836 (19%) 131,146 (18%) 126,299 (17%) Skin diseases 3,99 (4%) 31,713 (4%) 28,719 (4%) 31,638 (4%) 28,123 (4%) 28,2 (4%) 28,441 (4%) 3,647 (4%) Acute diarrhoea 38,427 (6%) 4,9 (6%) 41, (6%) 1,227 (7%) 2,33 (8%) 6,39 (9%) 63,332 (9%) 68,364 (9%) Bloody diarrhoea 2,874 (.42%) 3,61 (.1%) 2,89 (.42%) 3,48 (.%) 2,977 (.46%) 3,328 (.47%) 3,63 (.%) 3,421 (.%) Suspected malaria 29,99 (4%) 3,94 (4%) 29,21 (4%) 32,888 (4%) 28,298 (4%) 3,846 (4%) 31,73 (4%) 34,721 (%) Total consultation 688, , ,47 772,42 647,69 711,3 718,289 78,79 The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as proportional morbidity (percentage of cases out of total consultations) reported to DEWS on weekly basis. The above table provides the total consultations for the last 8 weeks proportional morbidity of the leading five disease syndrome. Proportional morbidity of ARI is highest in Pakhtunkhwa, Sindh and Balochistan, while acute diarrhoea is highest in Pakhtunkhwa, FATA, Sindh and Balochistan (please see the graphs for every province in page 7 and 8). For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 1

2 Previous week's (16/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 18Apr Leishmaniasis Balochistan Killa Saifullah Village & UC Urgas Apr Malaria Balochistan Jhal Magsi Village & UC Barija Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) 26 cases of Leishmaniasis were reported. Patients were investigated and found lesion on face, nose, arm and leg. All the patients have no travel history. Treatment as per WHO protocol was given. All information shared with DHO. 24 cases of suspected malaria were reported from BHU. 21 were tested on RDTs out of which 14 verified positive (slide positivity 67%). Distribution shows FP, Vivax and 4 Mixed (Falciparum ratio 64%). All the cases are from one location village barija. Anti Malarial medicine were supplied to BHU to facilitate patient management. Information shared with DHO and requested for further prevention. 16Apr Measles Balochistan Gwadar Village Nayabad, UC GwadarN cases of Measles were reported from DHQ Hospital. All the patients were timely responded and presented with typical signs and symptoms. Vit A drops provided and health education imparted. children were assessed for vaccination, 6 Children found totally unvaccinated whereas 4 had received only one dose of Measles. DHMT was informed and requested to send outreach team for vaccination. 19Apr Pertussis Killi Samazai, UC Gawal Balochistan Killa Saifullah Ismailzai Pertussis cases were reported. On investigation; 13 more cases were identified with same signs and symptoms. Patient was given health education. Erythrocin and Cough syrup was given. Community awarenesss session was conducted. All patients found totally unvaccinated. Information shared with DHO and EPI representative and requested to send outreach team for vaccination. 19Apr Measles FATA Agency Mashoom baba Tatara, UC Kambila, Tehsil Mulagori 7 6 One case and a death due to measles were reported from BHU Kambila. On active surveillance 13 cases including 2 deaths of suspected measles were identified in whom 6 seriously ill children were referred to the KTH Peshawar. The Agency Surgeon, FSMO and PPHI were informed.an investigation team including PPHI monitoring officer was formed for the affected area.another death was occurred on the day the investigation team arrived there.vitamin A given to the measles cases.mass measles vaccination of 13 children were done.health education imparted.blood samples of two suspected cases taken and sent to NIH Islamabad.Report shared with DOH and PPHI. 2Apr Measles Pakhtunkhwa Buner charnee near kalpani tehsil gagra cases of suspected measles were reported from BHU. On active surveillance, 4 more suspected measles cases were found. All 6 cases found totally unvaccinated. 12 children were assesed in house cluster, % found vaccinated against pentavalent and measles 1 vaccine. 2 blood samples were taken. Information shared with EPI coordinator and outreach vaccination campaign will be planned in the locality. 17Apr Measles Pakhtunkhwa Haripur Afghan Refugee camp Alert of suspected measles case was generated by BHU. Suspected case was given Vit A drops. Blood sample was taken and sent to NIH. Active surveillance was conducted in the area. 16 more cases were identified who had measles in past 1 month. During active surveillance and record analysis, 1132 children were assessed for vaccination status. 338 children were missing measles 1 vaccine and 173 children were missing measles 2 vaccine. Children were referred to nearest health facility for completion of vaccination. Health education session on prevention and spread was conducted for the affected families. CHWs were involved in active case finding. EDO Health and Save the children were informed about the outbreak. 18Apr Measles Pakhtunkhwa Haripur Afghan Refugee camp Alert of suspected measles case was generated from Afghan Refugee camp 2. Suspected case was given Vit A. Blood sample was taken and sent to NIH. Active surveillance was conducted in the area. 28 more cases were identified who had developed measles in past 1 month. On active surveillance and record analysis, 698 children were assessed for vaccination status.83 children were missing measles 1 vaccine and children missing measles 2 vaccine. CHWs were involved in active case finding. EPI coordinator and save the children were informed about the outbreak. Missing children were referred to nearest health facility for completion of vaccination. Health education on prevention and spread was conducted for the affected families. 17Apr Measles Punjab D. G. Khan Mitha khoo uc Gadai 1 1 Seven suspected cases of measles were detected and responded, vitamin A drops given, one blood specimen collected and sent to NIH, on field investigation found 43% children fully vaccinated. Health education session conducted. Provided IEC material. Outreach vaccination activity planned with the help of DOH. 18Apr AWD Sindh Dadu 18Apr AWD Sindh Matiari 2Apr AWD Sindh Thatta 18Apr CCHF Sindh Karachi Village Guhram Khan Gopang, near Pir Najeeb ullah Village Essani Khoso, near Oil field, Palijani station, taluka Matiari Village Ghulam Muhammad Khati, UC Karochan, taluka Kharochan NIBD (National Institute of Blood Disease), GulshaneIqbal Town An alert of AWD was reported from hospital with severe dehydration, during active surveillance 7 more cases were found, Water supply suspected as the source of disease, Aqua tabs, Zinc tabs and ORS distributed, health and Hygiene session was conducted, EDOH, THO, DSC and FPNational program was informed, 1 Stool and 2 water samples were collected for lab testing. 6 cases of AWD were admitted in THQ, active search for more cases was done, Hand Pump was the source of water, Aqua tabs, Zinc tabs supplied, IEC material and ORS distributed, health sessions conducted, EDOH informed, 3 Stool and 4 water samples collected for lab testing. Suspected cases of AWD was reported from community, active surveillance done along with PPHI & Merlin NGO and found five more cases of AWD in the village, open Dug well was the suspected source of water, Aqua tabs, Zinc tabs, ORS and IEC Material distributed, health education imparted, EDOH informed and 2 Water samples collected for quality testing. 1 confirmed case of CCHF was reported from NIBD, EDO representative accompanied during investigation, case belongs to quetta, initially case was suspected for Malaria and anti Malarial treatment given.later on CCHF diagnosed by lab test. Platelets count reduced to,, patient attendent were sensitized regarding proper Hygiene, brief about the mode of transmission, advised to use insect repellents and information shared with SO DEWS Quetta. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 2

3 Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) Current week's (17/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken An alert of suspected measles case was reported from Sheikh Zaid Hosp Rawalakot. Upon field investigation 8 more suspected cases were found, blood samples collected from suspected 24Apr Measles AJK Poonch cases and sent to NIH.Vaccination status of 21 children from 11 household were vill Naka Kharick UC Town assessed and all of them found vaccinated against Measles 1 vaccine. All the cases were Tehsil Rawalakot studying at same school. School was visited and no more case was found. Vit. A was given to active cases. DOH was informed and mop up vaccination has been planned in the UC. Health education session conducted in the community. 27Apr AWD Balochistan Lasbela Sidique Goth,Parya Goth UC Kehwari,Tehsil Lakhra Village and UC Shna 26Apr Leishmaniasis Balochistan Killa Saifullah Khuwara 26Apr Measles Apr Leishmaniasis 26Apr Pertussis Balochistan Jaffarabad Pakhtunkhwa Pakhtunkhwa Mardan 26Apr Measles Punjab Rajanpur 23Apr AWD Sindh Dadu 26Apr AWD Sindh Dadu 24Apr AWD Sindh Apr Measles Sindh Dadu Village Nushki jadeed, Tehsil Gandakha Village Pir Ali, Kandao Baba & Jan Abad, UC Qasim Swabi Private Clinic, TandKohi Tando Muhammad Khan 24Apr Measles Sindh Ghotki 26Apr Measles Sindh Ghotki 23Apr Measles Sindh Hyderabad 24Apr Measles Sindh Karachi 27Apr Measles Sindh Kashmore Moza Islampur, UC Bukhara, Tehsil Jampur Village Meenhoon Khan Bhand taluka Dadu Village Dar Mangneja, taluka K.N Shah Village Ali Muhammad, UC & taluka Bulri Shah Karim Village Allah Wasayo Janweri, UC Mangwani, taluka Mehar Soomra Muhalla, Rahmoo wali, UC 3 Village Chhato Lund, UC Yaro Lund Latifabad Unit #12, near Kamal Autos, taluka Latifabad Musani 2 Muhalla, Village Rehri Goth, UC2, Bin Qasim town Mushtaq Bijrani, UC Karam Pur, taluka Tangwani An alert of suspected AWD was reported from CD. Investigation team reached the area and on active search 12 more suspected cases were found. Health and hygeine session conducted in the locality. Aqua tabs and ORS were distributed. 2 stool samples and 3 water samples were collected for lab testing. 16 suspected cases of Cutaneous Leishmaniasis were reported. Patients were investigated and lesions were found on face, nose, arm and leg. No travel history. Outbreak was declared and treatment as per WHO protocol was started. Information shared with DHMT. The alert of suspected measles is in continuation of Measles outbreak from Noshki Jadeed. During followup visit 13 more suspected cases of measles were found. VitA drops were given to cases. Two blood samples were collected. 43 children were assessed for routine immunization, only (48%) 21 children were partially vaccinated against BCG whereas none of the child found vaccinated against measles. Health education imparted and EDOH was informed. An Outbreak of Cutaneous Leishmaniasis with 11 cases were reported from 3 adjacent villages of UC Qasim. In response Active surveillance was conducted and more cases were identified in the areas, line list maintained. onjob training of health staff was conducted for Intralesional adminstration of Inj Glucantine. Health & Hygiene sessions conducted, RBM focal person was informed and requested for residual spray in the areas. EDO Health and focal person was informed. Suspected case of Pertussis was reported from BMC Swabi. Case was investigated and responded in the presence of Health department personelle. On active search, 4 more cases were found in the same locality. Erythromycin given to all cases and contacts, outreach vaccination campaign initiated in the locality, Health education imparted. EDO H and EPI coordinator Informed. An alert of suspected measles was reported by MO THQ. On active surveillance, more cases of suspected measles were found. Blood samples were drawn from 2 cases and sent to NIH for lab confirmation. Vit A doses were given to the cases. 46 children were assessed for routine immunization out of which 67% (31) of the children were partially vaccinated and rest of the children were totally unvaccinated. HE session conducted for the community about importance of Immunization against VPDs. Findings were discussed with DHO Rajanpur and it was decided that mopup measles vaccination campaign will be carried out in the area after finishing of Polio NIDs. Suspected cases of AWD was admitted in hospital with severe Dehydration, community members refrain for further investigation at home, Hand pump was the source of water, Aqua tabs, Zinc tabs supplied and ORS distributed in hospital, health education imparted, EDOH, THO, DSC, FPEPI informed and 2 water samples collected for lab testing. An alert of suspected AWD was investigated in hospital, during active surveillance more suspected cases were found, water supply was the source of water, Aqua tabs, Zinc tabs and ORS distributed, health education imparted, EDOH, THO, DSC and FP National program was informed and 2 water samples collected for quality testing. Suspecetd case of AWD was admitted in DTC center,on active search more suspected cases of AWD found in the village, Water supply was the source of water, Aqua tabs, Zinc tabs and ORS distributed, health education imparted, EDOH informed, 1 Stool sample and 2 water samples were collected for testing. An alert of suspected case of Measles was investigated in hospital, on active surveillance, 8 more cases of suspected measles were found. vaccination status were assessed for 9 children, 3% of the children were vaccinated against measles 1 vaccine and 16% for measles 2 vaccine. Vitamin(A) dose was given to all cases, health education imparted, children were referred to THQ for completion of vaccination, EDOH, THO, EPIFP informed and 1 Blood sample collected for lab testing. 2 suspected cases of measles were admitted in MCH centre.during active search more cases of measles were found from the locality, blood samples collected and sent to NIH, Vitamin (A) was given to all cases, health education imparted regarding isolation and prevention of Measles, information share with EDOH & DSV and request for vaccination in the village. An alert of suspected measles were reported by Polio team. Investigation was carried out by DEWS and Polio team. On active search 7 cases of suspected measles were found. Vitamin (A) was given to all cases, health education imparted, information shared with EDOH & DSV for vaccination in the village and Blood samples collected and send to NIH for lab confirmation. An alert of measles was reported from DGH, during active search 4 more cases were found, vaccination status were assessed for children and only 3 (3%) children were found vaccinated for measles 1 vaccine, Vitamin (A) drops given to all cases, health education imparted, DHO, DSC and DO informed and Blood sample were collected for lab confirmation. Suspected case of Measles was informed by DTHO Bin Qasim town and NPOWHO, during active surveillance 7 more suspected cases were found, vitamin(a) dose was given to all cases, vaccination status were assessed for 9 children and none of the children found vaccinated against measles vaccine. Health education imparetd, THMT and THO informed and request for immunization in the area and 1 Blood sample collected for lab confirmation. An alert of measles was reported by PEO during POLIO monitoring. On active surveillance, 6 suspected cases of measles were found. 2 children were assessed for routine immunization and none of the child found vaccinated against measles 1 & 2 vaccine where as 21% children were partially immunized with BCG vaccine. Vitamin (A) was given to all cases, health education imparted, community members sensitized regarding importance of vaccination. Information shared with DHMT & DSC and blood samples collected for lab confirmation. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 3

4 Cont d Current week's (17/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 24Apr Measles Sindh Naushahro feroze Ward # 13, Old Station, near Jiskani Masjid, Moro 8 3 Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) An alert of suspected measles case was reported from a private clinic, on active search 11 more suspected cases of measles were found, Vitamin(A) were given to all cases, health education imparted, children were assessed for routine immunization status, 33% () of the children were found vaccinated against measles 1 vaccine where as none of the child vaccinated for measles 2. DHMT and EDOH informed and 6 Blood samples collecetd for lab testing. 26Apr Measles Sindh Qambar Shahdadkot Kot Ghulam Shah, UC Rawanti, taluka Kambar An alert of suspected measles case was reported from BHU, during active surveillance more cases of suspected measles were found, Vitamin (A) provided and Health Education imparted, blood samples were taken for lab confirmation. Immunization status was assessed for 6 children and only 2 (less than half) found vaccinated against measles 1 vaccine whereas none of the children received measles 2 vaccine. DHMT and EDOH was informed for implementation of routine immunization in the locality 26Apr Measles Sindh Tando Village Suleman Soomro, Muhammad UC Mula Katiar, taluka Khan Tando Muhammad Khan An alert of suspected Measles case was reported from the community, during active surveillance 8 more suspected cases were found, 9 children were assessed for routine immunization and only 1 child were found vaccinated gainst measles 1 vaccine and none for measles 2 vaccine. Vitamin(A) given to all cases, health education imparted, EDOH informed and 1 Blood sample collected for lab confirmation. 23Apr Measles Sindh Thatta 23Apr Measles Sindh Thatta Village Allah Dad Solangi, UC Googani, taluka Shah Bunder Village Chatto Jamali, UC Chouhar Jamali, taluka Shah Bunder Suspected case of Measles was notified from THQ Sujawal, active surveilliance was done in the village and found 9 more cases of post Measles, Cluster of houses were taken where 23 children were assessed, routine coverage found below 7%, health education imparted, Vitamain (A) was given, blood sample collected and infromation share with DHO, THO & TSV. Suspected case of Measles & one death was notified from community. On active surveillance more cases of Measles were found, Cluster of houses were taken where 18 children were assessed, routine coverage was below %, health education imparted, Vitamain (A) was given to the cases. Infromed DHO, THO & TSV. 24Apr Pertussis Sindh Ghotki Gahi Mangrio, UC Mithri An alert of suspected pertussis case was notified from a private clinic, during active surveillance, 9 more cases were foundin the locality. House to House cluster taken to assess the routine immunization status and none of the child found vaccinated, 14 days complete dose of erythromycin was provided to all patients and close contacts. informed EDOH & DSV for vaccination and conducted health promotion in the area. 24Apr Pertussis Sindh Khairpur 23Apr Pertussis Sindh Tharparkar 24Apr Pertussis Sindh Thatta Village Bahar Larik UC Noorpur Taluka Kingri Village Seenhara, UC Tardos, taluka Chachro Village Haji Usman Lodo, UC Gul Muhammad Baran, taluka Jati An alert of suspected Pertussis cases were reported from community, on active search 13 suspected cases were found,13 children were assessed for routine immunization and none of the child found vaccinated. Health promotion activity conducted in the locality, information provided to Incharge BHU, DHMT and request for mopup the area. Suspected case of Pertussis was informed by AWARE NGO team. On active search 6 more cases of Pertussis were found, No health facility located in the village, immunization status of children under years of age were assessed and all children found totally unvaccinated, health education imparted regarding importance of immunization. Erythromycin tabs and syrups, Cough syrups supplied. Health education material distributed, EDOH was informed and Nasal Swabs were collected for lab confirmation. Suspected cases of pertussis were reported by Dr. Soomar Khoso, On active surveillance, 4 more cases were found, vaccination status were checked for 9 children and only 9% children found partially vaccinated with penta 1. Health education imparted, Erythromycin was given to cases and informed DHO,THO, TSV and Throat samples were collected for testing. Distribution of Wild Polio Virus cases Pakistan 211 and 212 As of 3 April 212, the total number of polio cases confirmed by the laboratory is from districts/towns/tribal agencies and areas. Province Cases 211 Cases 212 P1 P3 P1 P3 P1+P3 Punjab 9 1 Sindh 33 2 Pakhtunkhwa 23 4 FATA Balochistan 73 2 AJ&K GilgitBaltistan 1 Islamabad Total For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 4

5 Number of alerts by province, week 17, 212 Province Sindh 23Apr AWD Dadu Village Butra Gopang, taluka Dadu Apr AWD Dadu Village Doodani Jamali, taluka Johi 1 23Apr AWD Dadu Village Kaloo Khan Lund, taluka Dadu 1 23Apr AWD Dadu Village Meenhoon Khan Bhand 6 26Apr AWD Dadu Village Dar Mangneja, taluka K.N Shah Apr AWD Hyderabad Kacha Qila, taluka Hyderabad Apr AWD Hyderabad Khawaja colony, Kachi Abadi 1 Apr AWD Hyderabad Rustum Malang Goth, Wadhu Wah 1 27Apr AWD Jamshoro Village Kamal Rashdani, UC Lakhat 1 1 Apr AWD Sanghar Village Dutro Shareef, UC Landhi 1 Apr AWD T Allah Yar Village Ahmed Khan Lashari 1 Apr AWD T Allah Yar Village Deputy Abdul Haq 1 24Apr AWD TM Khan Village Ali Muhammad Apr AWD TM Khan Talpur colony 2 26Apr AWD TM Khan Village Kamal Rashdani Apr AWD Tharparkar Village Amin ji Dhani, UC Rajoro 2 24Apr Measles Badin Shahbaz colony, UC and taluka Badin Apr Measles Badin Koat Foram, Kumbhar Muhalla Apr Measles Badin Chak #41, UC Ahmed Rajo 3 1 Apr Measles Dadu Village Allah Wasayo Janweri Apr Measles Dadu Village Rahim Ali Khoso Apr Measles Ghotki Soomra Muhalla, Rahmoo wali Apr Measles Ghotki Village Abdullah Lakhan 1 1 Apr Measles Ghotki Village Chibhar Kosh, UC Wasti Jeewan Apr Measles Ghotki Benazir colony, UC Apr Measles Ghotki Memon Muhalla, Ghota market Apr Measles Ghotki Randhawa house, near Anaj Mandi 1 26Apr Measles Ghotki Village Chhato Lund, UC Yaro Lund Apr Measles Hyderabad Latifabad # taluka Latifabad Apr Measles Hyderabad Latifabad Unit #12, near Kamal Autos Apr Measles Hyderabad Behind Civil hospital, taluka Hyderabad 1 26Apr Measles Hyderabad Allah Dad Chand Goth, Ooder cinema 1 26Apr Measles Hyderabad Mir Muhalla, near Jamia Masjid 1 27Apr Measles Hyderabad Mullah Ismail Goth, Islamin colony Apr Measles Karachi Behind Abdullah Shah Ghazi Mazar 1 24Apr Measles Karachi Malokhair Muhalla, Village Rehri Goth Apr Measles Karachi Musani 2 Muhalla, Village Rehri Goth 1 1 Apr Measles Karachi Street #1, Eidgah cho 27Apr Measles Karachi Street #, Delhi colony Apr Measles Kashmore Mushtaq Bijrani, UC Karam Pur Apr Measles Khairpur Mallah Muhallah, UC Ahmedpur 1 26Apr Measles Khairpur Sheikh Mohalla, Rahooja Goth Apr Measles Khairpur Village Haji Hatim Ali Shambani 1 23Apr Measles Larkana Village Sanhro Machi 1 24Apr Measles Larkana Channa Muhalla, Akil road 1 26Apr Measles Larkana Near Brohi hotel, Khaliq colony 1 26Apr Measles Larkana Village Alam Khan Gopang Apr Measles Larkana Meat Street, Nazar Muhalla 1 27Apr Measles Larkana Near Khosa Imam Bargah Apr Measles Larkana Village Ghulam Hussain Mugheri 2 24Apr Measles Mirpur Khas Village Khakoo Khan Maher Apr Measles N feroze Sochi Paro, near Edhi center Apr Measles N feroze Village khair Muhammad Dasti Apr Measles N feroze Ward # 13, Old Station Apr Measles Q Shahdadkot Ali Sahabo, UC Wagan, taluka Warah Apr Measles Q Shahdadkot Kot Ghulam Shah, UC Rawanti Apr Measles Q Shahdadkot Sangha, UC Jean Abro 1 26Apr Measles Sanghar Doctors colony, Civil hospital Apr Measles Shikarpur Village Daro, UC Amrote Sharif 1 23Apr Measles Shikarpur Village Maroo Kakepota 1 24Apr Measles Shikarpur Village Qambar Wahan 3 Apr Measles Shikarpur Village M. Hayat Junejo Apr Measles Shikarpur Village Daud ji Wandh Apr Measles Sukkur GMC Teaching hospital and Kumbhar 1 28Apr Measles Sukkur Dadu Canal, UC Arain 1 Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) Cont d Province Sindh 26Apr Measles TM Khan Village Suleman Soomro Apr Measles Thatta Village Ali Morai, UC Bujora 1 23Apr Measles Thatta Village Allah Dad Solangi Apr Measles Thatta Village Chatto Jamali 4 3 Apr Measles Thatta Village Sof Jakharo taluka Thatta Apr Measles Thatta Water Pump Colony, UC Gharo Apr Measles Thatta Shah Ibrahim, Ward # Apr Measles Umer Kot Akhay Ji Dhani, UC Gharibabad 2 23Apr NNT Badin Village Dhano Kohli, CHAK #7 1 23Apr NNT Q Shahdadkot Bero Khoso, UC Dostli 1 24Apr NNT Q Shahdadkot Badi Hakara, Behram 1 27Apr NNT Q Shahdadkot Gopang Mohalla Baghoder 1 27Apr NNT Q Shahdadkot Village Magasi, near Shaikh Wah 1 28Apr NNT Sukkur Village Sajjan Bharo, Alaf Kacho 1 24Apr Pertussis Ghotki Gahi Mangrio, UC Mithri Apr Pertussis Ghotki Village Chhato Lund, UC Yaro Lund Apr Pertussis Khairpur Village Bahar Larik UC Noorpur Apr Pertussis Q Shahdadkot Jan Muhammad Banghar Apr Pertussis Tharparkar Village Seenhara, UC Tardos Apr Pertussis Tharparkar Village Chaudhary colony 1 24Apr Pertussis Thatta Village Haji Usman Lodo Apr Scabies Ghotki Village Aliabad, UC Yaro Lund Apr Scabies Sukkur Jamia Arabia Madarsah 6 26Apr Typhoid Sukkur Bvillage Behram Jatoi 1 1 Province Balochistan Apr AJS Chagai Killi Kunar Kani, UC Chilgazi Apr AWD Lasbela Sidique Goth,Parya Goth 3 23Apr AWD Sibi BHU Sultan Kot Apr Leishmaniasis Jhal Magsi Village Gajan, UC Patri Apr Leishmaniasis Kalat Village Jeeva, Tehsil Surab 1 26Apr Leishmaniasis Killa Saifullah Village and UC Shna Khuwara Apr Leishmaniasis Lasbela Village Lakhra, Tehsil Uthal. 2 1 Apr Leishmaniasis Panjgur Mohalla Taar Office, UC Chitkan 1 27Apr Leishmaniasis Panjgur Mohalla Ball UC Washbood 1 Apr Leishmaniasis Ziarat Village Chawatra, UC Ziarat 1 26Apr Measles Jaffarabad Village Nushki jadeed, Tehsil Gandakha Apr Measles Kech Village Sulband, UC Nodiz 2 27Apr Measles Kech Village Kasak, UC Shahrak Apr Measles Sibi RHC Lehri 1 24Apr NNT Chagai Killi Qasim Khan, UC Town Dalbandin 1 26Apr Pertussis Killa Saifullah Village and UC Shna Khuwara 1 22Apr Typhoid Chagai Faisal Colony, UC sadder Dalbandin Apr Typhoid Kharan BHU Lijjay, UC Sarawan 2 2 Province Gilgit Baltistan 23Apr Measles Skardu Village Hargeesa clifton road Skardu 1 FATA Date Disease Agency Area <M >M <F >F 27Apr Leishmaniasis Village Ghakhi and Shagai Tana Apr Measles Bajaur village Alijan, Tehsil Khar 1 24Apr Measles Bajaur village Maina, Tehsil Mamoond 1 24Apr Measles Bajaur village sheikh kalay, Tehsil Khar 1 Apr Measles Mohmand Shah jee korona 2 26Apr Measles Mohmand Mare Kale 1 23Apr NNT Bajaur village Kotkai, Tehsil Salarzai 1 Apr NNT Bajaur village Ambar, Tehsil Ambar, Mohmand 1 Apr NNT Bajaur village garigal of Tehsil Mamoond 1 Apr NNT Bajaur village sheikh kalay, Tehsil Khar 1 Azad Jammu and Kashmir Apr Leishmaniasis Bagh RHC Seasar UC/Tehsil dhirkot 1 3 Apr Leishmaniasis Bagh vill khana mori Bagh UC Town Tehsil Bagh 1 27Apr Leishmaniasis Poonch Sheikh Zaid hosp Rawalakot Apr Measles Bagh vill Dhara Saliayan UC Saliyan Tehsil bagh 1 26Apr Measles Bagh vill nakar Saliyan Maldiyalan UC saliyan Tehsil Bagh 1 24Apr Measles Poonch vill Naka Kharick UC Town Tehsil Raw3alakot For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int.

6 Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) Province Pakhtunkhwa Province Punjab Apr AD Kohat Village Suleman Talab 23Apr Leishmaniasis Lakki Marwat Mohallah Boghanan 1 Apr Leishmaniasis Mardan Village Pir Ali, Kandao Baba & Janabad Apr Leishmaniasis Nowshera Ghazi Abad, Dak Ismail Khel Apr Leishmaniasis Nowshera Halki Banda, Dak Ismail Khel 1 23Apr Leishmaniasis Nowshera Shah Kot, Dak Ismail Khel Apr Leishmaniasis Nowshera Farangi Talab, Dak Ismail Khel 1 27Apr Leishmaniasis Nowshera Hospital Korona, Dak Ismail Khel 1 27Apr Leishmaniasis Nowshera Kotki Kalay, Dak Ismail khel Apr Leishmaniasis Nowshera Phase 6, Sector A, Block 3, Tent Apr Leishmaniasis Nowshera Phase 6, Sector D, Block 2, Tent Apr Leishmaniasis Nowshera Shah Kot Bala, Saleh Khana Apr Leishmaniasis Nowshera Lashkar Khel, Spin Khak 1 28Apr Leishmaniasis Nowshera Usman Khel, Inzari 1 23Apr Leishmaniasis Shangla Village Kabalgram 1 27Apr Leishmaniasis Shangla village Martung, Puran 1 23Apr Measles Abbottabad Ochar, Upper Salhad 1 24Apr Measles Bannu Koti Sadad 1 27Apr Measles Battagram Village Jabree Phagora, UC Rajdhari, 1 24Apr Measles D. I. Khan City Apr Measles D. I. Khan Daraban, Tehsil Daraban 2 24Apr Measles D. I. Khan Mandhra 1 24Apr Measles D. I. Khan Pahar Pur Urban, Tehsil Pahar Pur 2 24Apr Measles D. I. Khan Shaikh Yousaf 1 24Apr Measles D. I. Khan Shor Kot 1 24Apr Measles D. I. Khan UC City Apr Measles D. I. Khan Wanda Rorri, Tehsil Kulachi 1 27Apr Measles D. I. Khan Kachi Kot Garh, Tehsil Pahar Pur 1 27Apr Measles D. I. Khan Opposite Nawab Adda 1 27Apr Measles D. I. Khan Shah Hassan Khel, Abdul Khail 1 27Apr Measles D. I. Khan Village Garah Bakhta 2 24Apr Measles D.I. Khan Mianwali (Pharpoor) 1 27Apr Measles Hangu J 7, IDP Camp Togh Sarai 1 22Apr Measles Haripur Village Kotla, UC Muslimabad Apr Measles Haripur Village Muslimabad, UC Muslimabad Apr Measles Haripur Village Bagra, UC Bagra Apr Measles Haripur Afghan Refugee Camp 1 1 Apr Measles Haripur Village Jab, UC Pind Kamal Khan Apr Measles Haripur Police Chooki Muhallah, Haripur city 1 26Apr Measles Haripur Railway Station Muhallah,Haripur city 2 27Apr Measles Haripur Talokar Road, Naee Abadi, Haripur city 1 27Apr Measles Haripur Village Gandhian 1 26Apr Measles Karak Banda Menzai, UC Banda Dawood Shah 1 26Apr Measles Kohat Deri banda, UC Shahpur 1 26Apr Measles Kohat Near railway station, UC Khushal garh 1 26Apr Measles Kohat UC Surgul 1 Apr Measles Mansehra Charach Behali Apr Measles Mansehra Kohistan Colony Near Dedra Cho Apr Measles Mardan Village Jhanga Banda, UC Lund Khwar Apr Measles Mardan Afghan Refugee Camo, Dargai 1 26Apr Measles Mardan Village Hajiyan Kheila, UC Rashakai 1 23Apr Measles Nowshera Tent:, Block: 1, Sector: F, Phase:, Jalozai IDP's Camp. C/O Merlin J3 1 Apr Measles Nowshera Miagano Kalay, Zando Banda 1 26Apr Measles Nowshera Tent: 1, Block: 4, Phase: 3, Jalozai IDP's Camp. C/O CAMP1 Health Post 1 26Apr Measles Nowshera Tent: 72, Block: 4, Sector: g, Phase:, Jalozai IDP's Camp. C/Omerlin J3 1 27Apr Measles Nowshera Tent: 38, Block: 2, Sector: D, Phase:6, Jalozai IDP's Camp. C/O Merlin J3 1 24Apr Measles Swabi BHU Yaqoobi 2 1 Apr Measles Swat Village and UC Kanjoo, Tehsil Kabal 1 Apr Measles Swat Village and UC Shah Dherai 1 Apr Measles Swat Village Asogay, UC Bar Aba khel 1 Apr Measles Swat Village Sirsenai Shahi bagh 1 Apr Measles Swat Villege kabal babasham 1 26Apr Measles Swat Village Sher Palam, UC Pir Kale 1 27Apr Measles Swat Village and UC Dureshkhela 1 27Apr Measles Swat Village Nokhera, UC Darmai 1 Apr NNT D. I. Khan Mohallah Khair Abad, Kirri Shamozai 1 24Apr NNT Lakki Marwat Nasir Khel Siraye Naurang 1 26Apr Pertussis Swabi BMC Swabi, Zaida Apr Pertussis Swabi Private Clinic, TandKohi Apr Typhoid Nowshera Mohallah: Mari Khel, Jalozai Village 1 26Apr Typhoid Nowshera G1, Phase3 1 23Apr AD Bhakkar BHU Sial, UC Sial, Tehsil Bhakkar Apr AD Bhakkar BHU Barkat Wala, UC Daggar Qureshi Apr AD Bhakkar BHU Katchi Shahani, UC Katchi Apr AD Bhakkar DHQ Hospital Bhakakr Apr AD D. G. Khan UC Aaliwala Apr AD D. G. Khan UC Kot Chutta Apr AD Layyah BHU 136,UC Mandi Town Apr AD Mianwali RHC Kammar Machani Apr AD Mianwali BHU Paki Shah Mardan Apr AD Multan Matotali Apr AD Multan Kotla chakar Apr AD Multan Basti Malook Apr AD Muzaffargarh Basti Dhudi Wala, Moza Sh. Ali Apr AD Rahim Yar Khan Khairpur Khadali Apr AD Rahim Yar Khan Sonak Apr AD Rajanpur THQ Jampur, UC jampur Urban Apr AJS Mianwali DHQ Mianwali Apr AJS Rahim Yar Khan Trinda Sawaye Khan Apr ARI Layyah BHU 136,UC Mandi Town Apr BD Bhakkar BHU Kohawar Kalan, UC Kohawar Apr BD Bhakkar BHU Daggar Rehtas, UC Daggar Rehtas Apr BD Mianwali RHC Kammar Machani Apr BD Rahim Yar Khan Pacca Laran Apr BD Rahim Yar Khan Shahbazpur Sharqi, Liaqatpur 1 2 Apr BD Rajanpur RHC Dajal, UC Dajal, Tehsil Jampur Apr BD Rajanpur RHC mohammadpur 3 26Apr BD Rajanpur Moza Islampur, UC Bukhara Apr DHF Lahore Mughal Pura 1 23Apr DHF Lahore Ravi Town,Sadaqat Park Lahore 3 23Apr Leishmaniasis Rahim Yar Khan Basti Meeran, Rajanpur Kalan 1 23Apr Malaria Mianwali RHC Wan Bucharan Apr Measles Bhakkar UC Yousaf Shah,Tehsil Bhakkar. 1 24Apr Measles Bhakkar Tiba Hamid Shah, UC Angra 1 Apr Measles Bhakkar Chak # 6/61 TDA UC Notak 1 24Apr Measles D. G. Khan Chah Bhatti wala Drahma 1 24Apr Measles D. G. Khan Shehzad Colony uc Choratta 1 26Apr Measles D. G. Khan Bank DG Canal uc Wadore Apr Measles Lahore R.A Bazar 1 24Apr Measles Lahore Barsinda road 1 Apr Measles Lahore Gulberg Town 1 1 Apr Measles Multan Pir Khursheed colony, chungi no. 8 1 Apr Measles Muzaffargarh Basti Baat Wala, Moza & UC Jhuggi 1 1 Apr Measles Muzaffargarh Mohallah Master Sharif Dogar 1 26Apr Measles Muzaffargarh Basti Gharib Abad Colony 1 26Apr Measles Muzaffargarh Basti Qaim Pur, Moza Dittan Wali 1 24Apr Measles Rajanpur Basti jamal Shah, Moza Wang Apr Measles Rajanpur Basti Rakh Maarri 1 26Apr Measles Rajanpur Moza Islampur, UC Bukhara Apr Measles Rajanpur Dajal bypass road, UC Basti Rndan 1 Apr Scabies Layyah BHU Shahuwala, UC Sahuwala Apr Scabies Rahim Yar Khan Kot Haq Nawaz Apr Tetanus Lahore Nishter town 1 Apr Typhoid Bhakkar BHU Chak No 73, UC Chak No 67/ML Apr Typhoid Bhakkar THQ Hospital Mankera, UC Mankera Apr Typhoid Layyah BHU 3,UC Aulakh Thal Kalan 2 23Apr Typhoid Layyah BHU Jherkal, UC Samtia, Tehsil Karoor 4 23Apr Typhoid Layyah RHC Chowk Azam, UC Chowk Azam Apr Typhoid Mianwali RHC Kammar Machani Apr Typhoid Muzaffargarh DHQ Muzaffargarh Apr Typhoid Muzaffargarh RHC DD Panah, Kotaddu Apr Typhoid Muzaffargarh RHC Sinanwan, Kotaddu Apr Typhoid Muzaffargarh RHC Khangarh, Tehsil MZG Apr Typhoid Muzaffargarh Thatha Qureshi, Tehsil MZG 1 1 Apr Typhoid Muzaffargarh BHU Utra Sandhila 1 1 Apr Typhoid Rahim Yar Khan Trinda Sawaye Khan 4 3 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 6

7 Table1: Leading causes of seeking health care in districts, Wk31, 2 to Wk 17, 212, compiled from weekly reports Diseases Number of Consultations Acute respiratory infection,44,17 (23%) Skin diseases 6,466,7 (%) Acute diarrhoea,986,366 (9%) Bloody diarrhoea 16,717 (<1%) Suspected malaria 3,994,71 (6%) Unexplained fever 2,36,3 (4%) Total consultations 67,79,248 Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) Figure2: Number of consultations by age and gender, week 17, 212 number of cases 2 < 1 yr 14 yr 14 yr yr + yr Male Female Table2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease (up till week 17) 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 Pakhtunkhwa: 9 health facilities from 18 districts of Pakhtunkhwa reported to DEWS on weekly basis with a total of 139,17 patients consultations in week 17, 212. Figure-3: Trend of priority communicable diseases, province KPK 4 69 alerts were reported in week 17; Altogether 49 for Measles; 13 for Leishmaniasis; 2 each for NNT, Pertussis and Typhoid; while 1 for Acute diarrhoea. 2 outbreaks, 1 each for Leishmaniasis and Pertussis were identified and appropriate measure were taken wk 21 wk 23 wk wk 27 wk wk 41 wk 43 wk wk 47 wk Province Sindh: 3 health facilities from 23 districts in Sindh reported on weekly basis to DEWS with a total of 279,2 patient consultations in week 17, 212. Figure-4: Trend of priority communicable diseases, province Sindh 4 76 alerts were reported; Altogether 49 for Measles; 16 for AWD; 6 for Pertussis; 3 for NNT; while 1 each for Typhoid and Scabies. 18 outbreaks, 11 for Measles; 4 for Pertussis; while 3 for AWD were identified and appropriate measures were taken wk 21 wk 23 wk wk 27 wk wk 41 wk 43 wk wk 47 wk For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 7

8 Province Punjab: health facilities from 8 districts reported data to DEWS in Punjab with a total of 219,618 patient consultations. A total of 6 alerts were reported in this week; Altogether 18 for Measles; 16 for AD; 13 for Typhoid; 8 for BD; 2 each for AJS, DF and Scabies; while 1 each for ARI, Leishmaniasis, Malaria and Tetanus. 1 outbreak for Measles was identified and appropriate measures were taken. Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) Figure-: Trend of priority communicable diseases, province Punjab wk 21 wk 23 wk wk 27 wk wk 41 wk 43 wk wk 47 wk Province Balochistan: 444 health facilities from 22 districts in Balochistan reported to DEWS, with a total of 66,843 patient consultations. 18 alerts were reported in week 18 from Balochistan; Altogether 7 for Leishmaniasis; 4 for Measles; 2 each for AWD and Typhoid; while 1 each for AJS, NNT and Pertussis. 3 outbreaks, 1 each for AWD, Leishmaniasis and Measles were identified and appropriate measures were taken. Figure-6: Trend of priority communicable diseases, province Balochistan wk 2 wk 4 wk wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 wk 48 2 wk 2 wk 4 wk Province Gilgit Baltistan: 28 health facilities from 4 districts in Gilgit Baltistan reported to DEWS in week 17, with a total of 13,9 patient consultations. Less number of report were received because of ongoing unstable situation in Gilgit Baltistan. 1 alert for Measles was received and appropriate measures were taken. State of Azad Jammu and Kashmir: Figure-7: Trend of priority communicable diseases, Gilgit Baltistan wk 2 wk 21 wk 22 wk 23 wk 24 wk wk 26 wk 27 wk 28 wk wk 4 wk 41 wk 42 wk 43 wk 44 wk wk 46 wk 47 wk 48 wk wk 2 wk 4 wk FATA: 14 health facilities from districts reported to DEWS in this week with a total of 29,69 patient consultations. 6 alerts, 3 each for Leishmaniasis and Measles were received and appropriated measures were taken. 38 health facilities from 2 agencies reported from FATA in this week, with a total of 11, patient consultations. alerts, for Measles; 4 for NNT; while 1 for Leishmaniasis were received and appropriate measures were taken wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 wk 48 2 wk 2 wk 4 wk wk wk 2 wk 22 wk 24 wk 26 wk wk 4 wk 42 wk 44 wk 46 wk 48 2 wk 2 wk 4 wk For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 8

9 Focus on: Acute Watery Diarrhea/Cholera Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholera present in faecally contaminated water or food. Primarily linked to insufficient access to safe water and proper sanitation, its impact can be even more dramatic in areas where basic environmental infrastructures are disrupted or have been destroyed. Countries facing complex emergencies are particularly vulnerable to cholera outbreaks. Massive displacement of IDPs or refugees to overcrowded settings, where the provision of potable water and sanitation is challenging, constitutes also a risk factor. Every year, there are an estimated 3 million cholera cases and, 12, deaths due to cholera worldwide. Cholera is characterized in its most severe form by a sudden onset of acute watery diarrhea that can lead to death by severe dehydration. The extremely short incubation period two hours to five days enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 7% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their feces for 7 to 14 days and are shed back into the environment, possibly infecting other individuals. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrheal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by cholera. Cholera is endemic in Pakistan. In 2, the Ministry of Health in Pakistan reported laboratory confirmation of 99 cases of Vibrio cholera. These cases have been reported sporadically from a wide geographical area in the floodaffected provinces of Sindh, Punjab and KPK. In 211, total of 41 outbreaks, 11,811 suspected cases out of which 19 were confirmed cases and 218 deaths with suspected Cholera had also been reported. WHODEWS team, department of health and health partners jointly responded to these outbreaks. Table shows the distribution of outbreaks by Province in 211. Although in 212 no confirmed outbreaks of cholera have been reported so far but with the start of the diarrhoea season the risk of Acute Watery Diarrhoea (AWD) outbreaks has also increased now. Risk factors for Acute Watery Diarrhoea: Lack of safe water, inadequate quantity and quality of water, poor personal hygiene, poor washing facilities, insufficient soap for washing hands, Poor sanitation, inadequate cooking facilities, Overcrowding, population movement/displacement. Key steps for prevention and control: Ensuring adequate safe drinking water supply and proper sanitation are the most important means of protection against severe diarrhoeal diseases including cholera epidemics. Safe drinking water: In areas where the infrastructure for provision of safe drinking water does not exists simple inexpensive measures can be used to make water safe for drinking at household level as follows. Boiling: Bringing water to a vigorous, rolling boil and keep it boiling for one minute will kill Vibrio cholera O1 and most other organisms that cause diarrhoea. Chlorination at household: First prepare stock solution by mixing 33 gm of bleaching powder in one litre of water and store it in a brown glass bottle. Then put 3 drops (.6 ml) of stock solution in one litre of water or 3 drops (6 ml) in litres of water or 6 ml in litres. Do not cover the container for first 3 minutes after adding stock solution in it and wait 3 minutes before drinking or using the water. Alternatively, water disinfection tablets (eg. Aquatabs) can be added to the water according to package instructions. Solar water disinfection: Another smallscale and costeffective immediate technique is solar water disinfection (SODIS) by which transparent plastic bottles filled with water are placed horizontally on a flat surface and exposed to solar light for about hours in order to let the ultraviolet light in solar irradiation kill the pathogens. The effect of solar irradiation can be enhanced by painting the bottom half of the bottle black or placing them on a black background. (Note: In case of Cholera outbreak Chlorination is the only option to make the water safe for consumption) Handwashing Studies of diarrhoea show that washing hands with soap and water (where soap is not available one may use ash) reduces the incidence of diarrhoea by up to %. Hands must be washed: After defecation; After any direct or indirect contact with stools; Before preparing and distributing food; Before eating; Before feeding children. Sanitation Improvements in water supply and environmental sanitation will reduce the incidence of diarrhoeal diseases in the long run. Even where sanitation is poor, simple measures help ensure the safe disposal of stools and must be followed particularly in the case of outbreaks of diarrhoeal diseases: No defecation on the open ground cover stool with soil (or use trench latrines that are regularly covered); No defecation near a water supply/source; Disposal of children s stools in toilets or latrines or buried in the ground; Washing hands with soap (or ash) after any contact with stools; Build and use latrines a pit latrine 2 metres deep with an opening of 1 metre by 1 metre can be used by a family of persons for a period of 2 to 4 years. Latrines must be sited downhill and away from sources of drinkingwater (at least 3 metres), wash daily and regularly disinfected with cresol or bleaching powder. Province # of outbreaks # of suspected cases # of Labconfirmed cases # of deaths Sindh Pakhtunkhwa Punjab Baluchistan FATA GB AJK Total Key messages: Cholera is transmitted through contaminated water or food. Prevention and preparedness of cholera require a coordinated multidisciplinary approach Cholera can rapidly lead to severe dehydration and death if left untreated Once Vibrio cholera is confirmed, the WHO clinical case definition is sufficient to diagnosis and management of cases. Laboratory testing is required only for antimicrobial sensitivity testing and for confirming the end of an outbreak. Provision of safe water, proper sanitation, and food safety are critical for preventing occurrence of cholera Health education aims at communities adopting preventive behavior for averting contamination ORS can successfully treat 8% of cholera cases Appropriate antibiotics can reduce the duration of Vibrio Cholera bacterium in the patient stool For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : , Fax : ; wr@pak.emro.who.int. 9

10 Weekly Bulletin: DEWS, Pakistan, Week no. 17 (22 to 28 April 212) Alerts and outbreaks, week 17, 212 For Correspondence: NIH: WHO: Tel : , Fax : ; wr@pak.emro.who.int.