Weekly Epidemiological Bulletin

Transcription

1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume 2, Issue 3, Monday 2 September, 211 Highlights Epidemiological week no. 3 (1-22 September, 211) 1 districts and 3 agencies provided surveillance data to the DEWS this week from 2,459 health facilities. A total of 979,793 consultations were reported through DEWS of which 19% were acute respiratory infections (ARI), 11% Skin disease, 11% acute diarrhoea, and % suspected Malaria. A total of 197 alerts with 47 outbreaks were reported in week-3, 211: Altogether 94 for ; 44 were for AWD, 19 for Measles; for Neonatal Tetanus; 1 for Leishmaniasis; 3 each for Acute diarrhoea, Bloody diarrhoea and Typhoid; 2 for Malaria; while one each for Acute Jaundice Syndrome, CCHF, Meningitis and Pertussis. National Polio Eradication Initiative reported 2 new type-1 confirmed polio cases this week: One each from district Buner ( ) and Killa Abdullah (Balochistan). As of 22 September, 211, Pakistan has reported a total of 91 polio cases (9 type-1 cases & 1 type-3 case) from 35 districts/towns/tribal agencies/areas. Priority diseases under surveillance in DEWS Acute Flaccid Paralysis (AFP) Acute Jaundice Syndrome (AJS) Acute Respiratory Infections (Upper and Lower) (ARI) Acute Watery Diarrhoea (AWD)/ Suspected Cholera Acute Bloody Diarrhoea (BD) Other Acute Diarrhoeas (AD) Suspected Viral Hemorrhagic Fever (VHF) Suspected Malaria (Mal) Suspected Measles (MS) Suspected Meningitis (MG) Others Figure 1: Three years trend of Acute diarrhoea in Pakistan (29, 21, and 211) Epi week Disease Wk-31 Wk-32 Wk-33 Wk-34 Wk-35 Wk-3 Wk-37 Wk-3 Acute Diarrhoea 19,5 (1%) 1,91 (1%) 11,174 (1%) 94,494 (11%) 4,43 (1%) 9,12 (11%) 19,47 (12%) 1,14 (11%) Total consultation 1,7,912 1,4,292 9,119,1 39,729 4,93 93, ,793 Since July 29, 21, approximately 45,57,2 patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week 3, 211 (1 to 22 September, 211) reports were received from 2,459 health centers and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases 1,14 (11%), acute respiratory infections 17,395 (19%), Skin diseases,735 (11%) and suspected malaria 77,35 (%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 29, 21 and 211 up until now. 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 : , wr@pak.emro.who.int. 1

2 Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken 2 Sep AJS AJK Hattian Village Bandi Bala Peran, UC Chakhama, Hattiyan Bala Epidemiological Bulletin: DEWS, Pakistan, Week no. 3 (1 to 22 September, 211) suspected case of AJS reported. 5/5 Blood samples collected and found positive for Hepatitis E Virus. No other case was found during field investigation. 21 Sep AWD Balochistan Bolan Village Haji shehr, tehsil Dhadar suspected AWD cases reported. stool sample was taken and sent to NIH. Medicines, aqua tabs were distributed. Health and hygiene session was conducted for awareness raising in the community. 21 Sep Malaria Balochistan 17 Sep 21 Sep Kech Kalat Ginnah, UC Ginnah, Turbat Marjan UC Dashte Goaram tehsil Kalat Ziarat Shereen 5 1 Alert of 9 Measles cases including one death was received from DHQ hospital. 2 blood samples were collected and sent to NIH. Vit.A and health education was given. During field investigation other cases were also examined. This issue is discussed with DHO to use outreach team for immunization of surrounding house children. cases of suspected measles were reported. Blood sample taken and sent to NIH. Active surveillance done no more cases were found. Vit.A was given to the cases, Health and hygiene sessions were conducted with community on disease pattern and safety measures. Scouts Fort, Tehsil 19 Sep FATA Bajaur Agency Khar 2 1 outbreak of was reported from Bajour Agency. Agency Surgeon informed with request for fogging. Active surveillance carried out & no other case identified. Health education given to community regarding prevention of Dengue fever. 2 Sep 22 Sep 1 Sep 19 Sep 1 Sep 19 Sep AWD AWD 93 cases of suspected malaria were reported. 71 samples tested and 52 were found positive for Falciparum. DHO was informed and requested to distribute Bed nets to the affected locality and do other preventive measures and case management. Measles Balochistan Measles Balochistan Gilgit Baltistan Gilgit Baltistan Astore FAP Fakir kot Ghizer Upper Dir Village Kanchi Silpi UC Gahkuch Tehsil Punial Lower Dir (Village Aamriat, UC Falam, Osherey Darra) Abbottabad Sheikh ul Bandi 2 Haripur Mansehra Village Doyain Khushkian Village Dogah Balakot cases of AWD reported. Stool sample sent to NIH. DSM PPHI informed and asked him to arrange a medical camp in the locality. Patients with dehydration sent to DHQ hospital Gilgit.I/V fluids transferred to the concerned FAP. Aqua tabs distributed. Health education conducted in community school and to the people of the locality as well. First case of was reported. Blood sample positive for IgM Dengue. Patient has a positive travel history of Lahore. DHO Ghizer, MS DHQ Gilgit took all preventive measures including establishment of Isolation ward for Dengue, anti mosquito sprays, printing and distribution of IEC material among public for awareness, on air messages through cable and radio etc. cases of AWD reported. Case Investigated, 4 Water Samples collected and sent to NIH.1 ORS, aqua tabs, 1 hygiene kits, one straw filter, 5 Jerry Cans and IEC material were provided to affected family and surrounding families. Springs were chlorinated and HTH chorine powder provided for further chlorination. Health & Hygiene promotion Session conducted with family members and Imam of mosque. 2 outbreaks of were reported from different parts of District Abbottabad. Health Education provided to the attendants of the patient. EDO H informed for necessary action. 1 patient has a positive travel history to Lahore outbreaks of reported from different parts of District Haripur. No travel history to dengue endemic areas. A joint team of WHO and Dept of health visited the area. A session on DF spread and prevention was conducted for the affected household. LHWS of the area informed of the case. Health sessions through LHWs conducted in the area. Fogging and residual spray in the area were done. Outbreak of reported from Village Dogah Mansehra. EDO H informed. No other case found in the area on active surveillance. Necessary action taken 1 Sep Shangla Kuza Hujra/Tehsil Chakesar outbreaks from different parts of District Shangla was cross notified by SO Swat.2/3 confirmed cases had positive travel history to Lahore. A response team led by DEWS SO visited the village The community joint session was conducted highlighting the preventive measures, and at the same time fogging of the whole village along with household spray was started, bed nets have been distributed. Active surveillance with TMA and PHED was conducted. Probable breeding sites were identified and later drained. The community health committee was informed about the situation and strictly advised by the District Government to abide by the standard preventive measures according to WHO guidelines. 1 Sep Swat 21 Sep AWD Punjab Mianwali 21 Sep Punjab Bhakkar 2 Sep Punjab D. G. Khan Village Shaftalu, UC Kishawra, Tehsil Charbagh Near Railway line,uc Rokhri DHQ Hospital Bhakkar (Bhakkar & Darya Khan) Nishter Hospital Multan (D.G Khan) An outbreak of DF was reported from village Shaftalu Swat. There was no positive travel history to Dengue endemic areas. WHO Team along with DoH conducted a response at this village and distributed ITNs. AWD cases reported from DHQ hospital. Stool sample sent o NIH. Education about hygiene and health given in the community, Medicine supplied to near health facility, aqua tabs, soaps and ORS distributed to patients families. Reporting staff trained about definitions. Filters and water purification methods were also conveyed. outbreaks of DF reports provided from different locations of Tehsil Bhakkar. Positive travel history to Lahore. Necessary measures at hospital ensured. All the locations were visited one by WHO team and DoH staff. Active case finding of the area done in the respective localities. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Patients with DF reported at Nishtar Hospital Multan from different locations of DG Khan district. Positive travel history to Lahore. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department & SO DEWS district DG Khan doing the follow up in the area. 21 Sep Punjab Khanewal 2 Sep Punjab Layyah 22 Sep Punjab Multan Nishter Hospital Multan (Khanewal) Sh. Zayed Hospital RY Khan Layyah Nishter Hospital Multan confirmed cases of DF reported from different locations of Khanewal district. Necessary measures at hospital ensured. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Health department at district Khanewal. Follow up in the area is on going. 9 outbreaks of reported from different locations of district Layyah both from the city and rural areas. Present travel history to epidemic area. Necessary measures at hospital ensured. All the locations were visited one by WHO team and DoH staff. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Follow up is on going. confirmed cases of reported from different locations of Tehsil Multan and mostly from the city areas. Positive travel history to Lahore. Only 3 cases are indigenous to Multan and no travel history. Necessary measures at hospital ensured. All the locations were visited one by WHO team and DoH staff. Active case finding of the area done in the respective localities. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Follow up is on going. 22 Sep Punjab Muzaffargarh Nishter Hospital Multan (Muzaffargarh) confirmed cases (outbreak) of DF reported from different locations of Muzaffargarh district and mostly from the rural areas. Positive travel history to Lahore. Respective health authorities were informed. IRS and fumigation was conducted in all the areas. HE to the family and community members done. Follow up is on going. 19 Sep Punjab Rahim Yar Khan Sh. Zayed Hospital RY Khan (Rahim Yar Khan) confirmed cases of DF reported at Sh Zaid Hospital RY Khan from different locations of District RY Khan. Patients having travel history of epidemic area. Necessary measures at hospital ensured. All the locations were visited one by WHO team and DoH staff for active case finding. IRS and fumigation was conducted in all the areas. HE to the family and community members done on patient care and prevention. Follow up is ongoing. 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 : , wr@pak.emro.who.int. 2

3 Current week's Outbreaks: Cont d Date Disease Province District Area <5M >5M <5F >5F Action Taken 22 Sep Punjab Rajanpur Basti Danvar, UC Dajal, Tehsil Jampur, District Rajanpur Epidemiological Bulletin: DEWS, Pakistan, Week no. 3 (1 to 22 September, 211) Outbreak of from Basti Davar cross notified by SO DEWS DG Khan. Training of THQ Hospital Jampur and RHC Dajal staff on management of patients conducted. Active surveillance conducted. Provision of IEC materials to community and outreach staff by health department. Health education session conducted at the household level in area conducted IEC material distributed. 17 Sep AWD Sindh Karachi 1 Sep AWD Sindh Mirpur Khas 17 Sep AWD Sindh Naushahro Feroze 1 Sep AWD Sindh Sanghar 2 Sep AWD Sindh Tharparkar 1 Sep AWD Sindh Thatta Lassi Goth Gadap tawn Village Muhammad Hassan Mari Village Mashori UC Mithiani Village Rukun Burrira, Taluka Sinjhoro Village Kheemabh, UC Mirwah, Taluka Nagarparkar Village Ahmed Dokey,UC Mahar,taluka Shah Bunder cases, 1 death reported and 2 Stool samples taken and sent to NIH. Reinforced case management, Active Surveillance done, Health education conducted, Aqua Tabs distributed, Health staff briefed regarding Rapid alert reporting Six AWD cases and 1 death reported. 1 Stool sample collected and sent to NIH for lab confirmation (result awaited). Reinforced case management, Health education sessions conducted. Aqua tabs, Jerry cans and IEC Material distributed Responding to the alerts, on active surveillance 51 AWD cases including 3 deaths reported. 2 Stool samples collected and sent o NIH. Results awaited,. Health education conducted. AWD cases, 4 deaths reported. Reinforced case management. Health education sessions conducted. ORS sachet, Zinc tablets provided for patients, Aqua tabs, Jerry cans, IEC Material, Hygiene kits distributed in the affected community. 2 Stool and 5 water sample collected and sent to NIH. death due to AWD reported. Surveillance done, Community sensitized regarding hand wash and health Hygiene session conducted. Aqua tabs, ORS and water filter distributed. Medical teams mobilized in the area. Supplies for case management provided. 7 AWD cases reported. 4 Stool and 2 water samples taken and sent to NIH. Reinforced case management. Health education sessions conducted, Aqua tabs distributed in community, Zinc tabs and ORS distributed to patients. 19 Sep Sindh Ghotki Mian Abdul Sami Muhallah UC Dahraki outbreaks of reported from different parts of District Ghotki. No travel history observed. MS was provided hospital case management guidelines. Active case finding was carried out. Nearest health facility was informed of the suspected case and staffs were briefed on case definition and early referral of the cases. EDO Health and Malaria control program officer was informed of the case. Bed nets were distributed fumigation was done in area 2 Sep Measles Sindh Thatta Village Abdullah Ghandro UC Sonda taluka thatta Current week's Alerts: Province 19 Sep AD Kohat Village Suleman Talab, Shahpur II 1 Sep AWD Lower Dir Village Markharaon, Petto Darra, UC Bandagai, Timargara Sep AWD Lower Dir Village Kashodal, UC & Tehsil Samar Bagh Sep AWD Lower Dir Village Matta, Shatai Darra, Tehsil Balmbat Sep AWD Shangla Village Machar/Alpurai 1 Sep AWD Upper Dir Lower Dir (Village Aamriat, UC Falam, Osherey Darra) Sep AWD Upper Dir Lower Dir (Village Olagai Jabai, UC Falam, Osherey Darra) Sep BD Kohat Village Naakband, Union Council Bilitang Sep Abbottabad Ghora Bazgran, Havallian 19 Sep Abbottabad Sheikh ul Bandi 2 Sep Abbottabad Phalwali, Bodla Road, Havallian 2 Sep Abbottabad Salhad 21 Sep Abbottabad Kokal Berseen, Havallian 23 Sep Abbottabad Bandi Dhondan, Qalandarabad 23 Sep Abbottabad Mohalla Jogan, Nawansher 21 Sep D. I. Khan Village Zandar Wanda Khaliq Shah Band Kurai Tehsil PaharPur 22 Sep D. I. Khan Street Gilani Town D I Khan 1 Sep Haripur Village Doyain Khushkian 17 Sep Haripur Village Baldher 1 19 Sep Haripur Afghan Refugee camp 1 19 Sep Haripur Village Chipra, Nariyan da Mera 1 2 Sep Haripur Village Siryan, Bagra 1 21 Sep Haripur Village Galham, Pind Hashim Khan 1 22 Sep Karak Village Khojaki Kala Tehsil Takht e Nasrati 22 Sep Lower Dir DHQ Hospital Gilgit 22 Sep Lower Dir Village Gombat Banda, UC & Tehsil Lal Qilla, Maidan, Lower Dir 17 Sep Mansehra Janbaz colony upper Chanaye 1 Sep Mansehra Village Data 1 Sep Mansehra Village Sera Gali Lassan Nawab 19 Sep Mansehra Bafa Bazar 19 Sep Mansehra Bafa Main Bazar 19 Sep Mansehra Village Dogah Balakot 2 19 Sep Mansehra Village Foot Gali PO Ogra 2 2 Sep Mansehra Chitti Dheri 2 Sep Mansehra Village Milyari Khola Phula 21 Sep Mansehra Khan Dheri Shinkiari 22 Sep Mansehra Dhodial 21 Sep Nowshera Dag Ismail Khel 21 Sep Nowshera Mohalla Mallori Speen Khak Cherat 1 1 Sep Shangla Kuza Hujra/Tehsil Chakesar 1 13 cases of suspected measles reported. 5 Blood sample taken and sent to NIH. Active Surveillance done, Vitamin (A) given, Health education sessions conducted, EDO H informed. Current week's Alerts: Province (Cont d) 1 Sep Shangla Village Munz Kele Shokar/Martung 21 Sep Shangla Village Kadona, Tehsil Puran 1 Sep Swabi BHU Shewa, Rashakay Swabi 21 Sep Swabi BMC swabi, Meneri Payan 21 Sep Swabi BMC swabi, Meneri Payan Mohallah Karam Khel 21 Sep Swabi BMC swabi, Mohallah Gaar, Villahe Nabi 21 Sep Swabi BMC swabi, Mohallah Safrona, Mangol Chai 1 Sep Swat Village Shaftalu, UC Kishawra, Tehsil Char 2 Sep Swat Village Dit Panai, UC Beha, Tehsil Matta 1 21 Sep Swat Village Speney Ube Malam Jabba Road, UC Kishawra, Tehsil Charbagh. 22 Sep Tank Gara Baloch Sep Tor Ghar Bartooni 22 Sep Measles Nowshera Imran Abad, Near: Masjid Akhunzada Baba, Sep Measles Peshawar Kuza Agra Sardaryab District Peshawar Sep Measles Upper Dir Yaad Gara Wari Current week's Alerts: AJK; FATA; GB and ICT 2 Sep AJS Hattian Village Bandi Bala Peran, UC Chakhama, Sep Bagh DHQ hosp bagh UC town 7 19 Sep BHIMBER DHQ HOSPITAL BHIMBER AJK Sep Neelum Village Islampura, UC Ashkot, Tehsil Atthmuqam. 19 Sep Measles Bagh Vill Kotera Saliyan Mladiyalan UC dharay 1 19 Sep Measles Bagh Vill Samniyan UC Dharay Tehsil bagh 1 21 Sep Measles Bagh Vill Jaen na Mora UC and Tehsil Bagh 1 19 Sep AWD Bajaur Agency village Kambelai of Tehsil Salarzai 19 Sep Bajaur Agency Scouts Fort, Tehsil Khar 2 1 Sep Village Dwa Toai, Tirah Agency, Presently living in Malakabad Jamrud Agency Agency. 2 Sep AWD Astore FAP Fakir kot Sep Ghizer Village Kanchi Silpi UC Gahkuch Tehsil 19 Sep Meningitis skardu Village hussain abad U/C H.abad district Skardu 1 Sep Pertussis Skardu Village sad para U/C Chunda Skardu 19 Sep Typhoid skardu Village Neanor U/C Kuskmara District Skardu 1 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 : , wr@pak.emro.who.int. 3

4 Epidemiological Bulletin: DEWS, Pakistan, Week no. 3 (1 to 22 September, 211) Current week's Alerts: Province Sindh Current week's Alerts: Province Punjab 2 Sep AD Badin Village Umer Malwani, UC Seerani Sep Muzaffargarh Nishter Hospital Multan (Muzaffargarh) Sep Pakpattan NHM, Chak 7 AB, Tehsil Arif Wala 2 19 Sep Rahim Yar Sh. Zayed Hospital RY Khan (Rahim Yar Khan) Khan Sep Rahim Yar Sh. Zayed Hospital RY Khan (Tehsil Khan Pur Khan Dist. RY Khan) Sep AWD Dadu Murad Nako City Dadu Sep AWD Dadu Rind Colony city Dadu 19 Sep AWD Ghotki Irrigation Colony UC II Ghoitki 2 1 Sep AWD Jamshoro Kahmir Bagh, Taluka Kotri Sep AWD Jamshoro Village Dani Buksh, Taluka Kotri Sep AWD Jamshoro Qalandar Colony Kotri Sep AWD Karachi Lassi Goth Gadap tawn Sep AWD Karachi Korangi # 5, J area, Korangi town Sep AWD Kashmore Kashmore Colony No Sep AWD Larkana Village Qalander Bux seehro Talka Dokri 1 1 Sep AWD Mirpur Khas Village Muhammad Hassan Mari, UC Khan Sep AWD NF UC Bhority 17 Sep AWD NF Village Mashori UC Darbelo Sep AWD NF Village Mashori UC Mithiani 4 19 Sep AWD NF Tharo Shah city, taluka Bhiria 1 Sep AWD Sanghar Village Rukun Burrira, Taluka Sinjhoro Sep AWD Shikarpur Near Ameer Shah Pir Sep AWD T Allah Yar City Tando Allahyar 1 19 Sep AWD T Allah Yar Manostop, Taluka Jhando Mari 1 22 Sep AWD T Allah Yar Village Ismail Makrani 22 Sep AWD T Allah Yar Village Javan, Nasarpur road 1 17 Sep AWD TM Khan Haji Khan Talpur, UC Sep AWD TM Khan Village Ali Bux Bagrani, Lakhat 2 Sep AWD Tharparkar Village Kheemabh, UC Mirwah 21 Sep AWD Tharparkar Village Jhamri, UC Peelu, Taluka Nagarparkar 1 Sep AWD Thatta Village Ahmed Dokey,UC Mahar Sep AWD Thatta IDPs camps no: 1 inside the district jail Sep AWD Thatta Village Mitho Mallah UC Googani,Taluka Jati 2 Sep AWD Thatta Village Gul Bahar Thaheem UC Kothi, THQ Jati Sep BD Thatta IDPs camps no: 1 inside the district jail 19 Sep Badin Village Talo khan Burgary, UC Khoski 3 1 Sep Ghotki Village Haji Allah Rakhyio Laghari 19 Sep Ghotki Mian Abdul Sami Muhallah UC Dahraki 1 2 Sep Ghotki Sh. Zayed Hospital RY Khan (Ghotki) 21 Sep Ghotki FFC Colony UC II Mirpur Mathelo Sep Ghotki Village Abdul Majeed Mahar UC Ali Bag 17 Sep Hyderabad civil Hospital, LUMHS 3 19 Sep Hyderabad Khata Chawk, New Cloth Market 21 Sep Hyderabad civil Hospital, LUMHS 21 Sep Hyderabad Supari Compound Street # 2 Pathan Colony 21 Sep Hyderabad Village Baksho Laghari, UC Tando Fazal 21 Sep Hyderabad Village Baksho Laghari, UC Tando Fazal 2 21 Sep Karachi Abbasi Shaheed Hospital, Liaquatabad Town Sep Kashmore Sh. Zayed Hospital RY Khan (Kashmore Sindh) 2 22 Sep Khairpur Village Dur Mohammad Maitlo 22 Sep Khairpur Village Pir Essa, UC Kamal Dero, taluka Gambat 21 Sep Larkana Village Mad Bahoo Talka Bakrani 22 Sep Qambar Village Dalil Burio Talka Miro Khan 17 Sep Sukkur Ashiyon, Kubiyon, taluka Rohri 1 2 Sep Sukkur Nusrat Colony, Old Sukkur 21 Sep T Allah Yar Village Mureed Mori Taluka Chamber Leishmaniasis 21 Sep Jacobabad UC Dastgeer Colony Leishmaniasis Shahdadkot Qambar 17 Sep Muhalla Hamd Hazoori Mero Khan city 1 Sep Malaria Badin Village Umer Otho, Pir wah, near Gaja Mori Sep Measles Qambar Shahdadkot Village Koreja UC Jean Abro Talka 1 Sep Measles Shikarpur Village Panah Udho, taluka Garhi Yaseen Sep Measles Sukkur H.No. 21/5 near 7 store, Qasim park 1 22 Sep Measles TM Khan Village Bachoo Ghanbir, U/C Mulakatiar 1 19 Sep Measles Thatta Village Taj Muhammad Jat Sep Measles Thatta Village Abdullah Ghandro Sep NNT Ghotki Village Faiz Muhammad shahani 1 22 Sep NNT Ghotki Village Nazeer Ahmed Khokhar 1 17 Sep NNT Karachi Surjani Tawn 2 Sep NNT Karachi Gabol Goth near Kachi Abadi Khokhrapar 17 Sep NNT Khairpur GIMS taluka Gambat 1 19 Sep NNT Khairpur Village Haji Sanghar, UC Mengho Faqir 1 1 Sep NNT Naushahro Feroze Village Buxo Khan Rind, UC Koor Hassan 1 19 Sep NNT Qambar Village Hasla Talka 1 22 Sep NNT Qambar Village Abdul Kareem brohi 1 21 Sep AWD Bhakkar Gujjaa, UC Sial, Tehsil Bhakkar 21 Sep AWD Bhakkar Shahnawaz Boorh Barkat Wala, UC Daggar Qureshi Sep AWD Mianwali Near Railway line,uc Rokhri Sep AWD Mianwali Village Lallo Kheel,UC Lallo Kheel Sep Bhakkar DHQ Hospital Bhakkar (Bhakkar & Darya Khan) 2 Sep D. G. Khan Nishter Hospital Multan (D.G Khan) 2 22 Sep Jhang DHQ Hospital Gilgit 21 Sep Khanewal Nishter Hospital Multan (Khanewal) Sep Lahore Nishter Hospital Multan (Lahore City) Sep Lahore Skardu (Walton Cant Lahora Punjab) 2 Sep Layyah Nishter Hospital Multan (Khanewal) 2 2 Sep Layyah Sh. Zayed Hospital RY Khan Layyah 7 19 Sep Mianwali Mohallah Ibrahim Abad, Mianwali City 1 Sep Multan Shadab Colony Near Police Line, Jhang Sadar 19 Sep Multan NHM; Moza M Pur Diwan Tehsil Jam Pur 2 19 Sep Multan Tehsil Ahmad Pur District Bahawal Pur 1 22 Sep Multan Nishter Hospital Multan Sep Muzaffargarh Khan) DHQ Hospital Muzaffargarh (Mzgh & R.Y 5 Rahim Yar Khan Sh. Zayed Hospital RY Khan (Tehsil Sadiqabad Dist. RY Khan) 22 Sep 1 22 Sep Rajanpur Basti Danvar, UC Dajal, Tehsil Jampur, District Rajanpur 22 Sep Sahiwal Nishter Hospital Multan (Sahiwal) 3 21 Sep Vehari Nishter Hospital Multan (Vehari) Sep Leishmaniasis D. G. Khan Farooqia Mohalla Taunsa 1 21 Sep Measles Layyah Basti kaneera u/c wara Sehra Tehsil karoor 1 21 Sep Measles Rajanpur Basti Bismillah Colony, UC Rajanpur City, Tehsil and District Rajanpur 1 17 Sep NNT D. G. Khan Kotlee Baghal chor 1 2 Sep NNT D. G. Khan Khoo Rekhwala Nawan Shumali 1 Current week's Alerts: Province Balochistan 22 Sep AD Sibi Village Talli, UC Talli Sep AWD Bolan Village Haji shehr, tehsil Dhadar Sep AWD Kalat Kapoto UC Iskalkoo Tehsil Kalat 1 1 Sep AWD Panjgur Panjgur 1 1 Sep BD Kalat Sardawa UC Lakhorian tehsil Surab Sep CCHF Sibi Bakhtyarabad, tehsil Lehri 1 17 Sep Ghot Faqeer Khosa, Near to Qaidi Shakh Jaffarabad Tehsil Jhat Pat 1 1 Sep Leishmaniasis Bolan Village Haji shehr, tehsil Dhadar 1 1 BHU Gandakha, Danwich Mohalla 22 Sep Leishmaniasis Jaffarabad Gandakha 1 1 Sep Leishmaniasis Khuzdar Chandni Chaow UC Faiz Abad tehsil Khuzdar 22 Sep Leishmaniasis Lasbela village Mangya UC Sheh Tehsile Lakhra 1 22 Sep Leishmaniasis Panjgur Union Council Khudabadan West 2 Sep Leishmaniasis Sibi WAPDA grid colony UC# 4, Sibi city 17 Sep Leishmaniasis Ziarat Sinjawi/Ziarat town 2 21 Sep Malaria Kech Ginnah, UC Ginnah, Turbat Sep Measles Chagai killi Khuda Baksh BHU kani U/C Chilgazi Sep Measles Kalat Kapoto UC Iskalkoo Tehsil Kalat 1 17 Sep Measles Kalat Marjan UC Dashte Goaram tehsil Kalat Sep Measles Lasbela Hub city 1 21 Sep Measles Ziarat Shereen Sep NNT Bolan Basti musa khan, Tehsil Dhadar 1 22 Sep NNT Chagai dasht Chaghi Village 1 22 Sep NNT Jaffarabad BHU Gandakha 1 21 Sep NNT Nasirabad Nursery ward of DHQ Hospital D.M.J Sep Typhoid Kalat Sardawa UC Lakhorian tehsil Surab Sep Typhoid Kharan Haji Rafique Sasoli BHU Lijjay U/C sarawan 2 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 : , wr@pak.emro.who.int. 4

5 Table 1: Leading causes of seeking health care in flood affected districts, 29 July 21 to 22 September 211, compiled from weekly reports Epidemiological Bulletin: DEWS, Pakistan, Week no. 3 (1 to 22 September, 211) Figure 2: Weekly number of reporting health facilities (Wk 33/21 to Wk 3/211) Diseases Total Skin Diseases 4,9,44 (11%) Acute Respiratory Infection 1,,179 (22%) Acute Diarrhoea 4,39,2 (1%) Bloody Diarrhoea 3,732 (1%) Suspected Malaria 2,71,421 (%) Unexplained Fever 1,74,437 (4%) Total Consultations 45,57, Mobile Fixed Wk 33 Wk 35 Wk 37 Wk 39 Wk 41 Wk 43 Wk 45 Wk 47 Wk 49 Wk 51 Wk 1 11 Wk 3 Wk 5 Wk 7 Wk 9 Wk 11 Wk 13 Wk Wk 17 Wk 19 Wk 21 Wk 23 Wk Wk 27 Wk 29 Wk 31 Wk 33 Wk 35 Wk Table 2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease Post Flood (up till wk 37) Current Week (3) 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 : Figure-3: Three years trend of Acute diarrhoea, province KPK This week 19 districts reported to DEWS from 7 health facilities with a total of 172,32 patients consultations. The proportional morbidity of AD showing decline during the last three weeks after a consistent higher 2 proportion (1%) for almost 1 weeks alerts were reported in this week, 44 were for, for AWD, 3 for Measles, while one each for 5 Acute diarrhoea and Bloody diarrhoea. 7 outbreaks identified and responded. Province Sindh: This week 2 districts reported to DEWS from 42 health centers with a total of 43,2 patient consultations. In Sindh, AD cases reported were 52,22 (12%), same proportional morbidity as compared with last week. 7 alerts were reported from Sindh in this week: 29 were for AWD; 21 for ; 9 for Neonatal Tetanus; for Measles; 2 for Leishmaniasis; while one each for Acute diarrhoea, Bloody diarrhoea and Malaria. outbreaks identified and responded Figure-4: Three years trend of Acute diarrhoea, province Sindh 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 : , 5 wr@pak.emro.who.int. Epi Week Epi Week

6 Province Punjab: Epidemiological Bulletin: DEWS, Pakistan, Week no. 3 (1 to 22 September, 211) 7 districts reported data to DEWS from Punjab province, 39 health facilities reported a total of 27,41 patient consultations during this week. AD cases reported were 1,95 and stabilize between % - % from last four weeks. 31 alerts were reported in this week from Punjab; 22 were for ; 4 for AWD; 2 each were for Measles and Neonatal Tetanus; while one was for Leishmaniasis. 12 outbreaks identified and controlled Province Balochistan: In this week, 1 districts reported to DEWS from Balochistan province. 453 health centers reported a total of 79,2 patient consultations. AD reported in 9,44 (12%) of the total consultations, same proportional morbidity as compared with last week. 2 alerts were reported in this week from Balochistan, 7 were for Leishmaniasis; 5 for Measles; 4 for Neonatal Tetanus; 3 for AWD; 2 for Typhoid; while one each for Acute diarrhoea, Bloody diarrhoea, CCHF, and Malaria. 4 outbreaks identified and controlled. Gilgit Baltistan: In this week, 2 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 2,7 patient consultations. ARI cases reported were 5,1 (1%), while Acute Diarrhoea 4,35 (17%). 5 alerts received and responded this week, one each for AWD,, Pertussis, Meningitis and Typhoid. Figure-5: Trend of acute diarrhoea, province Punjab (3 August 21 to 22 September 211) Epi week Figure-: Three years trend of Acute diarrhoea, province Balochistan Epi week Figure-7: Trend of priority communicable diseases, Gilgit Baltistan ( March to 22 September 211) AD BD ARI S. Malaria wk 13 wk 14 wk wk 1 wk 17 wk 1 wk 19 wk 2 wk 21 wk 22 wk 23 wk 24 wk wk 2 wk 27 wk 2 wk 29 wk 3 wk 31 wk 32 wk 33 wk 34 wk 35 wk 3 wk 37 wk 3 State of Azad Jammu and Kashmir: In this week, weekly report received from 114 health centers from 1 districts, with a total of 4,9 patient consultations. ARI cases reported were,431 (1%), while Acute diarrhoea reported 2,57 (%) cases. 7 alerts were received and responded this week; 3 each for and Measles; while one for acute Jaundice Syndrome. FATA: This week 55 health centers in 3 agencies reported from FATA, with a total of 12,47 patient consultations. ARI cases reported were 2,3 (1%), while Acute diarrhoea reported 1,114 cases (9%) Three alerts received and responded this week; 2 for and one for AWD AD BD ARI S. Malaria wk 13 wk 14 wk wk 1 wk 17 wk 1 wk 19 wk 2 wk 21 wk 22 wk 23 wk 24 wk wk 2 wk 27 wk 2 wk 29 wk 3 wk 31 wk 32 wk 33 wk 34 wk 35 wk 3 wk 37 wk AD BD ARI S. Malaria wk wk 7 wk wk 9 wk 1 wk 11 wk 12 wk 13 wk 14 wk wk 1 wk 17 wk 1 wk 19 wk 2 wk 21 wk 22 wk 23 wk 24 wk wk 2 wk 27 wk 2 wk 29 wk 3 wk 31 wk 32 wk 33 wk 34 wk 35 wk 3 wk 37 wk 3 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 : , wr@pak.emro.who.int.

7 Focus on: Dengue Fever What is Dengue? Dengue is the most widespread mosquito borne infection in human beings, which in recent years has become a major international public health concern. Over the last years, we have witnessed a dramatic increase in the global incidence of dengue and its severe manifestations such as dengue hemorrhagic fever. Dengue fever is a severe, flu like illness with fever, headache and muscle and joint pains that affects children and adults, but seldom causes death. Dengue hemorrhagic fever () is a potentially deadly complication in about 1 3% of cases that begins with a sudden rise in temperature which usually continues for two to seven days and can be as high as 4 41 C. In moderate cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever when the temperature drops, followed by signs of circulatory failure. With modern intensive supportive therapy, the fatality rates can be reduced to less than 1%. How Dengue spreads? Dengue spreads through the bite of infected Aedes Aegypti mosquito. The mosquito gets the virus by biting infected person. The symptoms of the disease appear about 5 7 days after the infected bite. There is no way to tell if a mosquito is carrying the Dengue virus. Therefore, people must protect themselves from all mosquito bites. How can we prevent Dengue? Prevent mosquito bites Dengue mosquitoes bite during the daytime, protect yourself from the bite. Wear full sleeve clothes and long dresses to cover the limbs. Avoid wearing black color. Use repellents. Care should be taken in using repellents on very young children or the elderly Use mosquito coils and electric vapor mats during the daytime Use insecticide treated nets (ITNs) to protect young children, pregnant women, old people, in addition to others who may rest during the day. Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes. Epidemiological Bulletin: DEWS, Pakistan, Week no. 3 (1 to 22 September, 211) Where do mosquitoes live and breed? Dengue mosquitoes breed in stored, exposed, water collection systems. The favoured breeding places are: barrels, drums, jars, pots, buckets, flower vases, plant saucers, tanks, discarded bottles/tins, tyres, or water coolers, and other places where rainwater collects or is stored. Drain out the water from window air coolers when not in use, as well as draining all unused tanks, barrels, drums, and buckets. Remove all objects containing water such as plant saucers from the house. All stored water containers should be kept covered at all times. Collect and destroy discarded containers in which water collects, such as bottles, plastic bags, tins, tyres, etc. Efficient disposal of all solid waste/garbage. How should we take care of a Dengue patient? Keep body temperature below 39 o C. Give the patient paracetamol (not more than four times in 24 hours). Fever can also be reduced by sponging patient with tepid water. Do not give the patient Aspirin or Ibuprofen (Brufen) or similar medicine for fever or pain. Give only paracetamol. Give large amounts of fluids (water, soups, milk and juices) along with the patient s normal diet The patient should rest Immediately consult your physician if any of the following manifestations appear: Red spots or points on the skin; bleeding from the nose or gums; frequent vomiting; vomiting with blood; black stools; sleepiness; constant crying (children); abdominal pain; excessive thirst (dry mouth); pale, cold or clammy skin; or difficulty in breathing. 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 polio cases confirmed by the laboratory is 91 (9=type 1, and 1=type3) till date from 35 districts. Province Cases 21 Cases 211 P1 P3 P1 P3 Punjab Sindh FATA Balochistan 3 - AJK Gilgit Baltistan Islamabad 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 : , 7 wr@pak.emro.who.int.

8 Alerts and outbreaks, week 3, 211 Epidemiological Bulletin: DEWS, Pakistan, Week no. 3 (1 to 22 September, 211) 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 : , wr@pak.emro.who.int.