Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Highlights Epidemiological week no. 44 (28 Oct to 3 Nov 212) : 61 alerts investigated this week, responding to 17 outbreaks involving 242 measles cases. Vitamin A was provided to cases and EDOsH took action to improve vaccination in affected areas (Page 7) : 6 alerts investigated this week and 1 outbreak identified, involving 112 cases. Outbreak was controlled by timely measures and by case management and infection control at health facilities (Page 7) Volume 3, Issue 44, Wednesday 7 November 212 Figure1: 82 districts reported to DEWS in week 44, 212 Two new suspected CCHF cases reported in week 44, 212; (Page 6) One new polio cases was reported in week 44, 212; (Page 6) 82 districts have reported to DEWS in week 44, 212. 2,323 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week 684,4 patients consultations were reported in week 44 compared to 93,38 consultations reported in week 43, 212. Altogether 122 alerts were investigated and response were provided to 22 outbreaks. Priority diseases under surveillance in DEWS Pneumonia Acute Watery Diarrhoea Bloody diarrhoea Other Acute Diarrhoea Suspected Enteric/ Fever Suspected Malaria Suspected Meningitis Suspected Dengue fever Suspected Viral Hemorrhagic Fever Suspected Suspected Diphtheria Suspected Suspected Acute Viral Hepatitis Neonatal Tetanus Acute Flaccid Paralysis Scabies Cutaneous Cumulative number of selected health events reported in Epiweek 1 to 44, 212 (1 Jan 3 Nov 212) Disease # of Cases Acute diarrhoea 2,749,43 9% Bloody diarrhoea 1,79.% ARI,877,938 18% S. Malaria 1,687,11 % Skin Diseases 1,49,22 % Unexplained fever 1,161,49 4% Total (All consultations) 32,33,217 Figure2: Weekly trend of Acute diarrhoea in Pakistan; Week1, 211 to week44, 212. Major health events reported during the Epiweek 44 (28 Oct to 3 Nov 212) 2 211 212 Disease # of Cases Acute diarrhoea,683 8% Bloody diarrhoea 2,642 <1% 1 ARI,4 2% S. Malaria 43,61 6% Skin Diseases 29,114 4% Epiweek Unexplained fever 24,78 3% Total (All consultations) 684,4 The graph (Figure2) shows the comparison of weekly trend of Acute diarrhoea as proportional morbidity (percentage of cases out of total consultations) reported to DEWS each week in year 211 and 212. Overall weekly trend of acute diarrhoea is stable in all provinces. Districts in Sindh and Khyber Pakhtunkhwa are investigating alerts for acute watery diarrhoea/suspected cholera. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : +92192184, Fax : +9219283; Email: wr@pak.emro.who.int. 1
Weekly Bulletin: DEWS, Pakistan, Week no. 44 (28 Oct to 3 Nov 212) Current week's (44/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken 2Nov Balochistan Kech 1Nov Balochistan Lasbela Hor, UC Zareenbug, Dasht Winder, UC Winder, Tehsil Sonmiani 22 29 11 42 1 3Nov Malaria Balochistan Jaffarabad BHU Sohbatput 12 19 29 Killi Pishingian, UC 3Oct Balochistan Killa Saifullah Nasai, Tehsil Muslim Bagh Killi Cheena Baratkhail, 1Nov Balochistan UC Batozai, Killa Saifullah Tehsil KSF 1Nov FATA Khyber Pakhtunkhwa 3Oct 31Oct 1Nov 2Nov Khyber Pakhtunkhwa Khyber Pakhtunkhwa Khyber Pakhtunkhwa Bajaur Agency Mardan Lower Dir Mansehra Haripur 31Oct Sindh Ghotki village Lara Banda, Tehsil Khar Village Alam Khan, Jauor, Sajan & Kalu khan, UC Mian Essa, Takht Bhai 4 1 1 3 3 1 1 1 1 2 1 7 village Sarlarai and Awaro, UC Manyal.. 1 3 1 1 Mera Kalan UC Sher Garh Oghi Khalabut Township Sector 3 Village Sadoro Mahar UC Bhaitoor Taluka Khan Garh 4 4 1 1 1 3 4 1 1 Suspected cases were reported and timely investigated. Reinforced case management. Aquatabs, pure sachet and health awareness was given. 3 samples were collected and sent to NIH. Drinking water was identified as a possible source of infection. EDOH informed. 4 cases of cutaneous were reported and timely investigated. Patients presented with typical lesion. During active search, 2 more cases found. Lesions were found on upper and lower limbs of all cases. Proper treatment was advised. DHO was informed. 46 suspected cases of Malaria reported. 29 slides were tested by RDTs. 19 slides were positive (SPR 6%) for Malaria (PF 9, PV 7, Mix 3 i.e. FR 47%). Cases were from different location. DHO office provided RDTs and antimalarial to BHU Sohbat Pur. No any preventive measures were taken due to shortage of bed nets and spray chemical. Due to Scarcity of funds, no fogging can either be done by DOH. Health education and awareness session was done with entire community. 4 suspected measles cases were reported and timely investigated. Vit A was given. Immunization status of all cases and community consisted houses was checked. children including affected children were found unimmunized in the community. Health awareness sessions were conducted. No vaccine was available in the district. EDOH was informed and provincial EPI has been requested for provision of vaccination to start immunization campaign immediately. 8 suspected measles cases were reported and timely investigated. Vit A was given. Immunization status of all cases and community consisted 4 houses was checked. 2 children including affected children were found unimmunized in the community. Health awareness sessions were conducted. No vaccine was available in the district. EDOH was informed and provincial EPI has been requested for provision of vaccination to start immunization campaign immediately. Blood sample taken from 2 patients and sent to NIH Islamabad. 2 children died in this outbreak in the nearby houses and community. Community requested for immunization of their children. FSMO & DSV took a brisk action with the technical support of SO DEWS and prepare teams & logistics for the coverage of this area on same day. 4 children were vaccinated against, 3 for BCG & Polio, 3 for Penta1, for Penta2 and 3 for Penta3. ladies were also vaccinated for TT. Rest of the kids were given Vitamin A after confirming not taken in last 6 months. EPI staff of the relevant CHC was instructed to improve routine immunization. EPI Coordinator was especially requested for confirming an outreach plan for the area. An Alert of CL was reported from 4 small adjacent villages of UC Mian Essa. outbreak was already declared in the UC. In response active surveillance was conducted and 12 more clinical cases were identified in the area and surroundings. Line list was updated. UNHCR was requested through FPHC Mardan Office and they supplied 2 vials of required treatment for CL cases. Onjob training of health staff was conducted for Intralesional adminstration of Inj Glucantine. RBM focal person was informed and requested for vector control measures in the affected area. FPHC and Relief Int. will also provide support in vector control interventions in the area with RBM & PPHI. EDO Health and focal person was informed. 2 Suspected cases were reported from measles ward MSF, DHQ Hospital Dir Lower. WHO team investigated the cases and detailed history was taken from the patients. Blood Sample collected and sent to NIH Islamabad. Health education session was conducted and Vit.A drops were given. Alert was shared with EDOH, Coordinator LHWs, coordinator EPI to intensify Mop up campaign in village Sarlarai and Awaro, UC Manyal. Medical Officer of BHU Shergarh informed about the cases of suspected reported in OPD and nearby village. Surveillance Officer along with EPI technician and LHW of concerned area visited the village and found 9 suspected measles cases. Only one child was vaccinated while others were not vaccinated for. Vitamin A was given and 34 children were vaccinated for out of 4 children under the age of years. Two samples taken and sent to NIH for confirmation 7 confirmed Enteric fever cases were reported from Sarai Naimat Khan. Epidemiological and Environmental assessments were carried out. Field investigation found possible source as contaminated water supply. No shared food intake history. 3 more cases were identified on active case finding. Water samples from source, homes were taken and assessed for contamination. Health and hygiene sessions were conducted for affected families. EDO Health was informed of the outbreak. Suspected measles case reported by health Technician BHU Cooprative society. Upon field investigation five more cases were found. Vitamin A was given. Blood sample was collected and sent to NIH. Routine immunization status of the village was observed zero. Community was sensitized for routine immunization. Information was shared with DHMT for vaccination in the area. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : +92192184, Fax : +9219283; Email: wr@pak.emro.who.int. 2
Weekly Bulletin: DEWS, Pakistan, Week no. Week no. 44 (28 Oct to 3 Nov 212) Cont d current week's (44/212) Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Suspected measles case reported from THQ Daharki. During active search along with 2Nov Sindh Ghotki Village Jado Kobhar DSC, six cases were found, Vitamin A was given to all. Three blood samples were taken UC Sain Dino Malik 2 1 4 Taluka Daharki and sent to NIH. Routine immunization status was observed zero. Only one child has BCG scar. DHMT requested for vaccination in the area 31Oct Sindh Khairpur 2Nov Sindh Khairpur 2Nov Sindh Khairpur 2Nov Sindh Khairpur 1Nov Sindh Larkana 31Oct Sindh Matiari 31Oct 1Nov Sindh Sindh Qambar Shahdadkot Qambar Shahdadkot 31Oct Sindh Shikarpur 1Nov Sindh Sukkur Village Allah Warayo Behleem UC Agra Taluka Gambat Near Makhdoom Dargah Piryaloi city & UC Taluka Kingri Vilage Sardai Jatoi UC Gambat I Village Eidan chachar UC Kot Mir Muhammad Taluka Kingri Village Allah wadhayo lashari Village Sher Muhammad Balouch, UC Odero lal station, taluka Matiari Haithaya Boohar, UC Boohar, taluka Qambar Dhani Bux Mugheri, UC Rawanti, taluka Qambar Villlage Rehan khan jamali(lakhi Morr), UC Ruk Village Wahab Burrira, UC Kandhra, taluka Rohri 1 6 3 1 3 1 7 9 2 6 1 2 2 1 8 6 7 9 2 3 1 2 7 2 6 1 2 4 1 4 1 1 Suspected measles case was reported from RHC Agra. Alert was investigated and responded. During field investigation 24 more suspected cases including one death were found. All cases were linelisted. Blood samples were taken and sent to NIH. Vitamin A were given to all suspected measles cases. EPI status of ten children was checked. All had BCG scars. Information was shared with DHMT. Mop up activity regarding routine immunization was advised along with measles containment measures. Suspected measles case was reported from local HCP. Alert was timely responded. During field investigation 4 more cases were found. All were linelisted. Blood samples were taken and sent to NIH. Vitamin A were given to all suspected measles cases. EPI cluster was taken among ten children. Six were found with BCG scar. All information was shared with DHMT and mop up activity regarding routine immunization was advised along with measles containment measures. Suspected measles case was reported from GIMS THQH Gambat. Alert was timely responded. During field investigation cases were found including one death. All were linelisted. Blood samples were taken and sent to NIH. Vitamin A were given to all suspected measles cases. EPI cluster of 1 children was taken, where four were found with BCG scar. All information was shared with DHMT and mop up activity regarding routine immunization was advised along with measles containment measures. Suspected measles case was reported from BHU Piryaloi. During field investigation, 8 more cases were found. All were linelisted. Blood samples were taken and sent to NIH. Vitamin A were given to all suspected measles cases. EPI cluster of 12 children was taken, where all children found unvaccinated. Information was shared with DHMT and mop up activity regarding routine immunization was advised along with measles containment measures. One suspected case was notified from private clinic. 4 more cases were found on active case finding in the affected area. Vitamin A doses were given. sensitization done for isolation of patients. Symptomatic treatment assured for cases. Community was sensitized about rouitne immunization. Five blood samples collected and send to NIH for lab confirmation. DHO informed to take action about routine immunization. Vaccination status of 11 children was checked; BCG=(4%), Penta1=4(36%), Penta2=3(27%), Penta3=2(18%), Mealses1=4(36%), Mealses2=(%). EDOH informed. Seven cases and 1 death due to were reported from THQ Matiari. Active surveilliance was done where 23 more cases were found from same location. Vitamin A was given to all cases. Health education imparted regarding health and hygiene, and importance of immunization. Blood samples collected and sent to NIH. Vaccination status of the area was checked. BCG=(%), Penta=(4%), =(2%). Information shared with EDOH. Suspected 3 cases of were reported from private clinic. Upon filed investigation more cases were found. Four children were BCG scar +ve and parents were not sure about other antigens. Three blood samples were collected and sent to NIH. Vitamin A (2 doses) were given. Health education imparted regarding importance of routine immunization. Routine Immunization done in the affected area. Penta1=7, 1= (under 1 years), 1=6 (12 to 23 months), 1=9 (2 to years). EDOH informed. One Death due to was reported from private clinic. During filed investigation more cases were found. 9 children having BCG scar and died children was not vaccinated against. Parents were not sure about other antigen history. Vitamin A (2 doses) were given. Health education imparted regarding importance of routine immunization. 6 Blood samples were collected. Informed DHMT for vaccination and routine immunization was done on the next day. BCG=8, OPV1=3, 1=11, 2=13 under years, T.T1=, T.T2=3. case was crossnotified by SO DEWS Sukkur. During field investigations, 2 Deaths due to post complication and 1 other cases were found. Only 2 cases were found vaccinated for 1 and others were not vaccinated. Two blood samples were collected and sent to NIH. Vitamin (A) drops given to all cases. Health session was conducted on importance of routine immunization. EPI status of 16 children were assessed. 8 (%) children had BCG scars. Information shared with DHMT & PPHI for Mop up the area. Suspected case was reported from pediatric ward GMC teaching hospital. During field investigation more suspected cases were found. Two Blood samples collected. 2 doses of VitaminA given to all cases. Out of 6 cases only 1 child had BCG scar & were not vaccinated for. Community was refusal of routine immunization. Health education imparted to cases & contacts on importance of routine immunization & personal hygiene. Vaccination status of 7 children were assessed. BCG=(1%), 12=(%) according to parents and information shared with DHO & DHMT. For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : +92192184, Fax : +9219283; Email: wr@pak.emro.who.int. 3
# of consultations Weekly Bulletin: DEWS, Pakistan, Week no. Week no. 44 (28 Oct to 3 Nov 212) Figure3: Number of alerts received and responded, week 41 44, 212 Figure4: Number of consultations by age and gender, week 44, 212 4 3 73 79 77 61 18 16 14 12 2 1 CCHF Malaria 1 8 6 4 2 < 1 yr 14 yr 14 yr yr + yr Male 23261 6411 72632 11632 68 Female 2191 1789 74423 1633 293 Province Khyber Pakhtunkhwa: 4 health facilities from 16 districts of Khyber Pakhtunkhwa sent reports to DEWS with a total of 9,19 patients consultations reported in week 44, 212. Total 19 alerts were received and appropriate measures were taken. Altogether 8 alerts for ; for ; while 2 each for CCHF and ; while 1 each for AJS and DF. Acute diarrhoea trend shows minor increase as compared with last week. Figure: Trend of acute diarrhoea diseases, province Khyber Pakhtunkhwa Figure6: Number of alerts received and responded week 41 44, 212, province KPK 2 4 3 1 2 Province Sindh: 211 212 926 health facilities from 23 districts in Sindh province reported to DEWS with a total of 347,346 patients consultations in week 44, 212. Total 48 alerts received while 12 outbreaks were identified and appropriate measures were taken. Altogether 33 alerts for ; each for and NNT; 2 for Bloody diarrhoea; while 1 each for Acute diarrhoea, and. Acute Diarrhoea shows stability as compared with last week. 1 CCHF Malaria Figure7: Trend of trend of acute diarrhoea, province Sindh Figure8: Number of alerts received and responded week 41 44, 212, province Sindh 2 211 212 4 3 1 2 1 28 38 41 33 Province Punjab: 426 health facilities from 9 districts in province Punjab reported to DEWS with a total of 161,348 patients consultations in week 44, 212. Total 24 alerts were received and appropriate measures were taken. Altogether 1 alerts for ; 8 for ; 2 for NNT; while 1 each for Acute diarrhoea, ARI, Bloody diarrhoea and. AD shows a minor decreasing as compare with last week. Figure9: Trend of acute diarrhoea, province Punjab Figure1: Number of alerts received and responded week 41 44, 212, province Punjab 2 211 212 4 3 1 2 1 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : +92192184, Fax : +9219283; Email: wr@pak.emro.who.int. 4
Province Balochistan: Weekly Bulletin: DEWS, Pakistan, Week no. Week no. 44 (28 Oct to 3 Nov 212) 333 health facilities from 19 districts in province Balochistan reported to DEWS with a total of 44,494 patients consultations in week 44, 212. Total 2 alerts reported and outbreaks were identified and appropriate measures were taken in week 44, 212. Altogether 8 for ; for ; 3 for Malaria; 2 for Acute diarrhoea; while 1 each for and. An increase noted in AD trend as compared with last weeks. Figure11: Trend of acute diarrhoea, province Balochistan Figure12: Number of alerts received and responded week 41 44, 212, Balochistan 2 211 212 4 3 1 2 Malaria 1 CCHF Province Gilgit Baltistan: 16 health facilities from 2 districts in Gilgit Baltistan reported to DEWS with a total of 9,141 patients consultations in week 44, 212. 3 alerts for measles were reported in week 44, 212. AD showing decrease from last few weeks. Figure13: Trend of acute diarrhoea, province Gilgit Baltistan 2 211 212 Figure14: Number of alerts received and responded week 41 44, 212, Gilgit Baltistan 4 3 1 2 1 FATA: 4 health facilities from 3 agencies in FATA reported to DEWS with a total of 8, patients consultations in week 44, 212. 7 alerts; 3 for ; while 2 each were for and NNT were reported in week 44, 212 and appropriate measures were taken. An increase in AD is noted this week. Figure: Trend of acute diarrhoea, FATA Figure16: Number of alerts received and responded week 41 44, 212, FATA 2 211 212 4 3 1 2 1 State of Azad Jammu and Kashmir: 13 health facilities from 9 districts in AJ&K reported to DEWS with a total of 2,89 patients consultations in week 44, 212. One alert for was reported in week 44, 212. AD showing a decreasing trend last few weeks. Figure17: Trend of acute diarrhoea, AJ&K Figure18: Number of alerts received and responded week 41 44, 212, AJ&K 2 211 212 4 3 1 2 1 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : +92192184, Fax : +9219283; Email: wr@pak.emro.who.int.
# of cases Weekly Bulletin: DEWS, Pakistan, Week no. Week no. 44 (28 Oct to 3 Nov 212) Table1: Number of alerts and outbreaks reported and investigated with appropriate response Disease 211 212 (up till week 43) Current week 44, 212 Total for 212 (week 144, 212) A O A O A O A O Acute watery diarrhoea 13 43 9 161 6 1 61 162 Acute jaundice syndrome 1 17 11 19 1 12 19 Bloody diarrhoea 98 2 1 11 3 118 11 CCHF 17 3 61 39 2 63 39 Dengue fever 78 111 9 29 1 16 29 Diphtheria 4 19 3 1 3 1 178 11 4826 6 61 17 4887 23 287 81 3 14 2 32 14 NNT + tetanus 399 466 9 47 Malaria 131 88 118 61 3 1 121 62 298 33 726 66 16 2 742 68 Others 88 47 1283 6 18 1 131 7 Total 72 172 883 198 122 22 897 112 Distribution of Wild Polio Virus cases Pakistan 211 and 212 In week 44, 212 one new type1 polio case was reported from Federally Administered Tribal Areas (Bajour Agency). As of 3 November 212, Pakistan has reported a total of 48 polio cases including 4 type 1, 2 type3 and 1 mixture type1 and 3 polio cases from 26 districts/tribal agencies. Province Cases 211 Cases 212 P1 P3 P1 P3 P1+P3 Punjab 9 2 Sindh 33 4 Khyber Pakhtunkhwa 23 19 FATA 7 2 2 1 Balochistan 73 4 AJ&K GilgitBaltistan 1 1 Islamabad Total 196 2 4 2 1 Follow up of CCHF, and Dengue CCHF: CCHF is a serious viral hemorrhagic fever with up to % case fatality rate, caused by an RNA virus of family Bunyaviridae, genus Nairovirus, carried by Hyalomma species of ticks. Human beings become infected by tick bites or crushing the ticks, which are usually found on sheep, cattle, goats or camels, and their slaughtered skins. They may also be exposed to the virus in blood or tissues of a viremic animal during its slaughter and butchering; or by contact with infected blood or secretions of acute human cases in home or hospital setting. Two new suspected cases of CCHF in week 44. In 212, So for a total of 7 suspected cases have been reported throughout the country with 4 confirmed to date and 14 deaths; (CFR is 3.%). 22 confirmed cases have been reported from Balochistan; 7 from Sindh; 6 from Khyber Pakhtunkhwa and from Punjab. Chart at right illustrates current situation of CCHF cases in 212. Approximately all the cases have contact history with animal trading/handling, tick bite, contact with patient, tannery worker, butcher/animals slaughtering, a traditional practice of wearing fresh animal skin (posti) to treatment ailment. These animals and their skins have continuous movement intra Pakistan and between neighboring countries (Afghanistan and Iran). Any contact of a CCHF patient should monitor his/her temperature for 14 days and see a doctor if fever develops. The anti viral medicine Ribavirin has been effective in saving lives of patients who report early to the health facility. 1 8 6 4 2 Number of CCHF cases (week 1 to 44, 212), Pakistan Suspeceted Positive Deaths 1 3 7 9 11 13 17 19 21 23 2 27 29 31 33 3 37 39 41 43 For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : +92192184, Fax : +9219283; Email: wr@pak.emro.who.int. 6
# of cases Weekly Bulletin: DEWS, Pakistan, Week no. Week no. 44 (28 Oct to 3 Nov 212) : As of 2 October 212, more measles cases and deaths have been reported in Pakistan than in 12 months last year. Table 1 summarizes the situation of measles in 212 up to 3 November; and table 2 illustrates the alerts and outbreaks in week 44 (28 Oct to 3 Nov, 212). Table1 212 (Week 1 44) Table2 Epi week 44, 212 Province # of Alerts # of Outbreaks # of Cases # of Deaths Province # of Alerts # of Outbreaks # of Cases # of Deaths AJ&K 3 243 Balochistan 386 12 7 21 FATA 181 27 498 13 Gilgit Baltistan 2 26 ICT 2 2 Khyber Pakhtunkhwa 1818 94 3236 34 Punjab 719 31 1 Sindh 91 264 4389 8 Total 4893 2 11172 168 AJ&K 1 1 Balochistan 2 17 FATA 3 1 1 Gilgit Baltistan 3 3 ICT Khyber Pakhtunkhwa 8 2 22 Punjab 8 11 Sindh 33 12 178 7 Total 61 17 242 7 As it is shown in the above table that majority of the measles cases have been reported from Sindh and Khyber Pakhtunkhwa provinces. Both of these provinces have announced the EPI facilities will be providing measles vaccine twice a week for all children under age. Dengue: The chart at right showing the weekly number of confirmed Dengue cases reported by surveillance focal points from the Departments of Health in Sindh and Punjab in 212. Total number of confirmed dengue cases to date in 212 is 369 in Sindh and 338 in Punjab. Month of peak incidence in 21 was November while peak incidence in 211 was in September and October. 1 8 6 4 2 Weekly trend of positive Dengue cases reported from Sindh and Punjab, week 1 to 44, 212 Punjab Sindh 1 3 7 9 11 13 17 19 21 23 2 27 29 31 33 3 37 39 41 43 Malaria: The chart at right shows the Malaria slide positivity and Falciparum rate reported in week 44, 212. Total number of malaria cases tested in this week is 14,114, out of which 222 were found positive; 137 for P. Vivax; 62 for P. Falciparum; while 3 for Mixed (SPR = 14.33%; F. R = 3.36%). : The surveillance definition for a case of Acute Watery Diarrhoea () or suspected cholera in an endemic area, is any case over age 2 years with severe dehydration or death due to diarrhoea of 3 or more stools in 24 hours. An outbreak is defined as a cluster of 6 or more cases of or any number of cases with at least one confirmed case of Vibrio cholera. The table at right summarizes the situation of in last four weeks, 7 October to 3 November 212. During the period, a total of 42 alerts were reported and 18 confirmed out breaks were identified and were responded very efficiently and in systematic manner. The Surveillance Officers in the districts with the close coordination of trained rapid response teams from Department of Health and partners address the outbreaks. 4 3 2 1 Week 41 44, 212 Province Malaria slide positivity and falciparum rate, week 44, 212 Balochistan Sindh FATA Punjab KPK GB AJK ICT Outbreaks # of Alerts # of Outbreaks with confirmed # of Cases # of Deaths V. cholera AJ&K Balochistan 7 6 2 4 2 FATA Gilgit Baltistan ICT Khyber Pakhtunkhwa 7 3 3 8 Punjab 4 1 1 2 1 Sindh 24 8 7 81 1 Total 42 18 13 9 4 SPR FR For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : +92192184, Fax : +9219283; Email: wr@pak.emro.who.int. 7
Alerts and outbreaks, week 44, 212 Weekly Bulletin: DEWS, Pakistan, Week no. Week no. 44 (28 Oct to 3 Nov 212) For Correspondence: NIH: eic.nih@gmail.com; WHO: Tel : +92192184, Fax : +9219283; Email: wr@pak.emro.who.int. 8