weekly epidemiological antibodies, health education session conducted with the family members and...

Weekly Epidemiological Bulletin

This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected].

Epidemiological week no. 12 (18 to 24 March 2012)

• In week 12, 2012, total 85 districts including 3 agencies provided surveillance data to the DEWS on weekly basis from around 1,881 health facilities. Data from mobile teams is reported through sponsoring BHU or RHC.

• A total of 639,500 consultations were reported through DEWS of which 21% were acute respiratory infections (ARI); 6% were acute diarrhoea; 4% were suspected malaria; while 4% were Skin disease.

• A total of 107 alerts with 10 outbreaks were reported/identified in week 12, 2012: Alto‐gether 50 alerts for Measles; 11 for Leishmaniasis; 10 for Typhoid; 9 for ARI; 5 for Acute diar‐rhoea; 4 each for NNT; Pertussis and Scabies; 3 each for AWD, BD and Acute Jaundice Syndrome; while 1 for Dengue Fever.

• As of 26 March 2012, the total number of polio cases confirmed by the laboratory is 15 from 10 districts/towns/tribal agencies and areas.

Highlights

Disease early warning system and response in Pakistan

01

Volume 3, Issue 12, Wednesday 28 March 2012

Priority diseases under surveillance

in DEWS

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

Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐12, 2012.

• 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 each of the last 8 weeks proportional morbidity of five disease syn‐drome. Proportional morbidity of ARI is highest in Sindh, KP and FATA while acute diarrhoea is highest in Balochistan, Sindh and FATA (please see the graphs for every province in page 6 and 7).

Table 1: Most common communicable diseases syndromes reported weekly

Disease Wk-5 Wk-6 Wk-7 Wk-8 Wk-9 Wk-10 Wk-11 Wk-12

Acute diarrhoea 23,985 (5%) 29,359 (5%) 30,607 (5%) 31,623 (5%) 34,918 (5%) 38,445 (6%) 40,295 (6%) 39,461 (6%)

Total consultation 440,635 557,926 605,633 650,423 680,221 688,960 704,666 639,500

Suspected malaria 15,600 (4%) 21,813 (4%) 22,883 (4%) 23,483 (4%) 28,265 (4%) 29,612 (4%) 30,423 (4%) 28,600 (4%)

Acute respiratory infection 114,900 (26%) 141,503 (25%) 159,074 (26%) 153,111 (24%) 157,828 (23%) 155,260 (23%) 158,437 (23%) 135,275 (21%)

Bloody diarrhoea 2,203 (0.50%) 2,681 (0.48%) 2,730 (0.45%) 2,765 (0.43%) 3,094 (0.45%) 2,874 (0.42%) 3,601 (0.51%) 2,823 (0.44%)

Skin diseases 22,058 (5%) 27,267 (5%) 29,199 (5%) 28,820 (4%) 29,430 (4%) 30,934 (4%) 30,983 (4%) 27,174 (4%)

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AD BD ARI S. Malaria

Special Bulletin: DEWS, Pakistan, Week no. 12 (18 to 24 March 2012)

This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected]. 02

Previous week's (11/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

13‐Mar Diphtheria Khyber Pakhtunk‐hwa

Kohistan Village Kalan Bala Bijlee Ghar Tal 0 0 1 0

A 4 year old female of suspected diptheria was reported from Khyber teaching hospital. Throat swab was taken and sent for confirmation. 50,000 IU of ADS were provided. No vacci‐nation history. Health education session was given on routine vaccination of children and prevention of spread of the infection. Prophylactic dose of erythromycin was prescribed. DEWS coordinator informed.

12‐Mar Measles Khyber Pakhtunk‐hwa

Lower Dir

Village Manogay, UC Koto Tehsil Balmabat; Village Hasil Banda, UC Mayar, Tehsil Samar Bagh, Lower Dir

3 1 6 6

Alert for Measles reported from 2 different locations. Active Surveillance conducted, hilly area with total population of 150 and 120 houses, 14 more cases were found in the surrounding, routine outreach vaccination conducted in the area by EPI Team and vaccinated 274 children (BCG– 12, Measlse‐259, Penta‐ 33). Vit‐A was given, Blood Sample Collected for confirmation of antibodies, Health education session conducted with the family members and community, patient isolated, EDO‐H & EPI Coordinator were informed & requested for regular outreach immunzation in the area and surounding.


Shangla Village Khwar Kele/UC Lelonai 1 3 3 0

Alert for 1 case suspected measles by phone call from community elder of Village Khwar Kele. On investigation 07 children were found with clinical measles in the surrounding 10 houses,blood samples were taken from 2 children and sent to NIH . A total of 18 children till the age of 15yrs were analysed and unimmunized were vaccinated. Outbreak was declared by EDOH and EPI teams were sent to the area for outreach vaccination. Vitamin A was given to the affected and EPI based sessions were taken in the community. No other case has been reported since than.


Haripur Afghan Refugee camo Padhinna 1 0 0 3

During polio campaign in Afghan Refugee camp Padhinna, 4 cases of suspected measles were identified. The clinical sign and symptoms were suggestive of measles. Suspected cases were given Vit A. When investigated; it was found that these 4 cases were epidemiologically linked to outbreak of measles reported in previous week. Vaccination status of other children was also checked. Measles mop up campaign is already planned for current week which will in‐clude children between 6 months and 13 years. Microplans are being made by Save the chil‐dren. Blood samples were taken and sent to NIH. EDO Health and Save the children were also informed.

13‐Mar Typhoid Punjab Bhakkar THQ Hospital Mankera, UC Mankera, Tehsil Mankera.

0 6 0 3

9 cases of typhoid fever were reported from THQ Hospital. All cases advised Widal test which came out ‐ve for 8 patients and +ve for one patient. Medication provided to all the patients. 6 patients were from different locations (widal ‐ve) and 3 patients were from same location (widal +ve for 1 patient). There was epidemiological linkage established in 3 cases. Case definitions was discussed in detail with MO. HE imparted at the Health facility. LHW's were mobilized to conduct HE session in community. Aqua tabs, jerry cans and life straws were distributed. EHE took the water sample of area. EDO(H) was informed.

13‐Mar Typhoid Punjab Muzaffargarh Basti Tibbi Bhookan, Moza Rakh Khanpur, UC Lutkeran

1 3 0 2

Alert was received for 6 cases typhoid from eDEWS data for week‐10. All cases were diag‐nosed on clinical signs and symptoms and advised Widal test where 3 cases were confirmed. Except two cases from Tibbi Bhookan, UC Lutkeran, all were residents of different places. All cases were treated as OPD patients and treatment was advised. EH & EM availability assess‐ment was done at DHQ & BHU Dasti Wala. Confirmed case's residence was visited ; patient was found quite improved & afebrile. HE Session was conducted for community . Water sampling was also done. Possible source of infection was consumption of raw cut fruits or ice cream from street vendors. MO agreed to mobilize LHW's to conduct HE session in commu‐nity. Aqua tabs, jerry cans and water filters were distributed.

13‐Mar AJS Sindh Shikarpur Village rahiomabad UC Rahim abad Taluka Khanpur

0 5 0 2

Alert for AJS from RHC Rahimabad, team was comprised as SO DEWS, MS RHC, vaccinator. During investigation 07 cases were found & line listed. All cases were referred by MS RHC for laborotary investigation to DHQ lab, IEC material distributed & health promotion session was conducted. community was sensitized on personal hygiene & safe drinking water. immuniza‐tion provided to 2 children< 1 year , 7 children < 2 years & 11 Children >2 years, Report shared with EDH Office.

13‐Mar Measles Sindh Thatta

Village Baboo Makrani; Village Haji Khan Sahib Muhammad Ali Nahio UC Domani

4 2 5 1

Alerts for two suspected measles cases from 2 different locations, during active surveillance found 20 more cases, Vitamin (A) was given, cluster of houses was checked and found 25 childrens where immunization status was 60%, health and Hygiene education was imparted, EDOH informed and 7 Blood samples collected.

14‐Mar Measles Sindh Karachi Maripur Grax Kimari Town 2 0 2 1

Alert for suspected measles from NICH, during active surveilliance found 4 more cases, Vita‐min A was given, immunization status was checked and found (Meas 1 52% and Meas 2 48%), health education was imparted regarding isolation and vaccination, THMT informed and requested to send outreach team to the area and 1 Blood sample collected.

13‐Mar Pertussis Sindh Ghotki

Village Lal Shah UC Mithri Taluka Khan Garh; Village Drago Chachar, UC Adilpur taluka Ghotki

17 26 21 25

89 cases of suspected Pertussis were investigated in 2 different locations. Samples were not taken as cases have already taken antibiotics. Erythromycin privided to all suspected cases and close contacts. 78 children were checked for routine immunization and no one was im‐munized. Health education imparted and EDOH & DSV informed.

12‐Mar Pertussis Sindh Qambar Shahdadkot

Village Hoat Khan Chan‐dio , UC kalar , Taulka Kambar

7 6 5 4 Suspected case for Pertussis was informed by Community, active surveilliance was done and found 21 more cases, Erythromicine was given, DHMT informed and request for immuniza‐tion.

13‐Mar Pertussis Sindh Jamshoro Loco Sheed Khanpur, UC HM Shoro, taluka Kotri 2 1 1 1

5 cases of suspected Pertussis were investigated. 2 throat samples were taken. on active surveillance,3 children were vaccinated againt DPT whereas 90% children were vaccinated for BCG and 60 % for Measles. Erythromicine, Priton and Calpol was provided. Health education was imparted and EDOH informed.

13‐Mar Leishmaniasis AJK Bagh vill Mora,Bagla UC Chirala Tehsil Dhirkot 1 4 0 9

14 cases of Cutaneous Leishmaniasis were reported. No other case was found during active search. Injection Glucantime provided to health facility incharge and advised to give proper treatment and if new case will report then inform. The outbreak was discussed with DHO and requested to distribute bed nets and conduct household spraying. Health education session was conducted with the community for their personal protection from sand fly as well as screening of doors and windows.

16‐Mar Leishmaniasis AJK Poonch Sheikh Zaid hosp Rawala‐kot 1 0 1 4

8 cases of Cutaneous Leishmaniasis was reported. HCPs were requested to report any new case of cutaneous Leishmaniasis report to HF.DOH as well as CDC department were in‐formed. Health education session was conducted with the patients for their personal protec‐tion from sand fly as well as screening of doors and windows.



Cont’d previous week's (11/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

14‐Mar Leishmaniasis Balochistan Killa Saifullah Village Urgas 0 0 0 7 7 cases of Cutaneous Leishmaniasis were reported. Patients were investigated and mostly lesions found on nose, arms and legs. No travel history. Treatment as per WHO protocol was given. Information shared with DHMT.

13‐Mar Leishmaniasis Balochistan Khuzdar Village Notani, UC Baghbana ,Tehsil Khuzdar 0 2 1 2

5 cases of C Leishmaniasis were investigated and reponded. Cases were presented with typical lesions. Lab results came out positive. Injection Glucantime was provided with health and hygiene education.

12‐Mar Leishmaniasis Balochistan Jhal Magsi DHQ Hospital, Village & UC Gandawah 1 1 2 0

4 cases of Cutaneous Leishmaniasis were reported from DHQ Hospital. No traveling history found. Injection Glucantime was advised and provided to DHQ Hospital and guided the patient for completing treatment. Information was shared with DHMT for further action.

12‐Mar Malaria Balochistan Harnai Village UC & Tehsil Shahrig 0 0 0 0

Alert was declared through slide positivity rate. Total 11 slides were tested and 8 were positive for P. Falciparum, FPR was 73%. Matter was discussed with the Merlin focal person and DHO Harnai. Patients are under treatment. Health education imparted.

12‐Mar Malaria Balochistan Harnai Village Shahrig, UC Shahrig, Tehsil Shahrig 0 0 0 0

Alert was received in weekly DEWS data. Alert was declared through slide positivity rate. Total 15 slides were tested and 10 were positive for P.falciperum, FPR is 67%. Matter was discussed with the Merlin focal person and DHO Harnai. Patients are under treatment. Health education imparted and follow up planned.

13‐Mar Measles Balochistan Ziarat Village Chawatra, UC Zindra, Tehsil Ziarat 1 0 4 4

3 cases of Measles alert received from DDHO Ziarat. On field investigation 9 more cases was found. 3 Samples were taken. none of the child were vaccinated against measles vaccine. Vitamin A was provided to suspected cases and to the exposed. Health education imparted. Information was shared with DHO and EPI Incharge.

16‐Mar Measles Balochistan Kech Village Baloch abad, UC Turbat 2 1 1 1

3 cases of Suspected Measles were reported from private hosp; cases had been admitted with post measles complication (Pneumonia and Diarrhea). The cases had received VitA; 3 blood samples were taken and sent to NIH. Another two cases were found on field investigation. DHO was also informed and requested for vaccination to children in surrounding houses. 2 unimmunized children were vaccinated.

Current week's (12/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

19‐Mar Leishmaniasis Balochistan Lasbela Village Dovina, Tehsil Lakhra 1 2 1 3

2 suspected cases of Leishmaniasis were reported from RHC Lakhra and 5 more cases found during active surveillance. Patients having no travel history. Inj Glucantime was advised and guided to take regular treatment. Information was shared with DHMT and requested to take intervention as cases were received on regular basis.

19‐Mar Measles Balochistan Nasirabad Goth Yar Muhammad Pindarani, UC Quba 0 0 0 0

6 suspected cases for Measles investigated and Vit‐A was administered, while 3 samples were taken and sent to NIH. DHMT was informed.

19‐Mar AWD KPK Upper Dir Village Jattgram, UC Nihagdarra, Tehsil Wari 2 2 1 1

6 AWD cases from one family at Village Jattgram, Tehsil Wari, Dir Upper reported from RHC Wari . One stool sample collected and sent to NIH but found negative for Cholera. Unpro‐tected spring water was the suspected source. Line list of cases maintained and shared with EDO‐H, In charge RHC Wari and health authorities. WHO provided 1430 Aqua tabs, 100 ORS, 7 Hygiene kits, 10 jerry cans, 144 soaps and 2 straw filters to the affected families, while EHE chlorinated the main source; Shock chlorination of springs, water storage tanks. On job train‐ing of community on disinfection of water sources, clothes and utensils and emphasis was given on use of boiling water for drinking. IEC material provided to the villagers.

19‐Mar Measles KPK Haripur Khalabut Township UC Khalabut 2 1 1 1

An alert for measles 5 cases reported from two different locations (CD KTS3 and CH Khalabut). 31 houses were assessed in 2 both locations 37 children between 9 months to 5 years were assessed. 16 children had measles 1 and 25 children with measles 2 vaccine. 9 children were below 9 months. EPI coordinator and EDO Health were informed. Measles campaign is planned in 5 UC of District Haripur adjoining Afghan Refugee camp. Health session was con‐ducted on prevention and spread for the affected families

19‐Mar Measles KPK Haripur Makhan Colony UC Sikandarpur 1 2 2 3

An alert of suspected measles case was reported from BHU Sikandarpur. Active surveillance was carried out and 78 more cases were identified. Vit A given to the cases. Vaccination status was assessed in the surrounding out of seven houses that were assessed, found 15 children with no vaccination history of any sort. No BCG scar was seen in any of the children. EPI coordinator and EDO Health were informed. Immediate mop up campaign was launched in the area for measles, Pentavalent and OPV. Blood samples were taken and set to NIH. Follow‐up is planned.

18‐Mar Measles KPK Swat Village Sar Sardarey Bar Jabar, UC Aka Maruf Bamikhel, Tehsil Babuzai

8 1 0 1

During routine visit to SGTH WHO Swat team found three cases of Suspected Measles belong‐ing to the same village. Detailed histories were taken from the patients and Blood Samples were collected, while Vitamin A doses provided. WHO along with a team from DoH went to area for active surveillance and eight more cases were found in the village. Outreach vaccina‐tion was conducted in the area in which 347 children were vaccinated. Health education session was conducted in the community regarding the importance of routine immunization.

24‐Mar Measles Sindh Shikarpur Sethaar verho Village borriri UC taib taluka lakhi

2 0 1 2 Suspected case of measles was reported from GD Boriri, during active surveillance Vit(A) dose was given, immunization status was not good, health education was imparted, EDOH in‐formed and 4 Blood samples were collected and sent to NIH.

24‐Mar Pertussis Sindh Khairpur village Ulra Jageer taluka Kingri 3 5 4 2

Probable Pertussis cases was found by SO DEWS Sukkur, during active surveillance found 14 cases in 5 houses where only 4 children were found vaccinated, index case has been taken to Agha khan hospital karachi, health education was imparted, health promotion activity planned with EPI vaccinator and LHWs.

24‐Mar Pertussis Sindh Shaheed Benazirabad

village haji Achar Chandio taluka Qazi Ahmed 0 0 2 6

Probable Pertussis case was investigated at village haji Achar Chandio; During active surveil‐lance 7 more cases found. Only one child was fully vaccinated found among 10 children under 2 years of age, while 3 cases were admitted in hospital. Syrup Erythromycin provided to all the suspects. EDO‐H informed.



Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

As of 26 March 2012, the total number of polio cases confirmed by the labo‐ratory is 15 from 10 districts/towns/tribal agencies and areas.

Province Cases 2011 Cases 2012 P1 P3 P1 P1+P3

Punjab 9 ‐ 1 ‐

Sindh 33 ‐ 2 ‐

Khyber Pakhtunkhwa 23 ‐ 4 ‐

FATA 57 2 4 1

Balochistan 73 ‐ 2 ‐

AJ&K ‐ ‐ ‐ ‐

Gilgit‐Baltistan 1 ‐ ‐ ‐

Islamabad ‐ ‐ ‐ ‐

Total 196 2 13 1

P3 ‐ ‐ ‐ 1 ‐ ‐ ‐ ‐ 1

Number o alerts by province, week 12, 2012

Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F

19‐Mar AWD Upper Dir Village Jattgram, Tehsil Wari 2 2 1 1

19‐Mar Measles Haripur Khalabut Township UC Khalabut 2 1 1 1

19‐Mar Measles Abbottabad Harno, Sarpana 1 0 0 0

19‐Mar Measles Abbottabad Kasel, Banda Atti Khan 1 0 0 0

19‐Mar Measles D. I. Khan Awan Abad, Bannu, Road 1 0 1 0

19‐Mar Measles D. I. Khan Mallana, Multan Road 1 0 0 0

19‐Mar Measles D. I. Khan Pusha Pul, Bannu Road 1 0 0 0

19‐Mar Measles D. I. Khan Village Dahotar, Chashma Road, 0 1 0 0

19‐Mar Measles D. I. Khan Village Roda, Tehsil Kulachi 0 1 0 0

19‐Mar Measles Haripur Makhan Colony UC Sikandarpur 1 2 2 3

18‐Mar Measles Swat Village Sar Sardarey Bar Jabar, Babuzai 8 1 0 1

19‐Mar Measles Kohat UC Jarma 1 0 0 1

19‐Mar Measles Kohat UC Mohammad Zai 1 0 2 0

19‐Mar Measles Lower Dir Village Qalagai, UC Koto 0 1 1 0

19‐Mar Measles Swat Village and UC Manglore 1 0 0 0

19‐Mar Measles Swat Village and UC Odigram, Tehsil Babuzai 1 0 0 0

19‐Mar Measles Swat Village Kandow khas shengrai 1 0 0 0

19‐Mar Typhoid Haripur Khalabut Township UC Khalabut 0 1 0 2

20‐Mar Leishmaniasis Shangla Village Munz Kele Shokar/Martung 3 2 0 0

20‐Mar Measles Abbottabad Banda Sahib Khan, Havallian 1 0 0 0

20‐Mar Measles D. I. Khan Eid Gah Road 1 0 0 0

20‐Mar Measles D. I. Khan Kulachi 1 0 0 0

20‐Mar Measles Haripur Muhallah Eid Gah 1 0 0 0

20‐Mar Measles Haripur Noor Colony Haripur 0 1 0 0

20‐Mar Measles Lower Dir Village Ranredaly, UC Miskenay 1 0 0 0

21‐Mar Measles Lower Dir Katyandi 1 0 0 0

21‐Mar Measles Swat Village Dangram, UC Sangota 1 0 0 0

21‐Mar Measles Swat Village Magowar murad Abad 1 0 0 0

21‐Mar Measles Swat Village Odigarm Hafiz Abad 0 1 0 0

22‐Mar Measles D. I. Khan Village Choora, UC Bilot 0 0 1 0

22‐Mar Measles Swat Village Sher Atraf, UC Islampur 1 0 0 0

23‐Mar Measles Kohat College town area 0 0 1 0

23‐Mar Measles Kohat UC Sheikhaan 0 0 0 1

23‐Mar Measles Kohat Village Dawood Khel 0 1 0 0

24‐Mar Measles Hangu Jawar Ghundi, UC Doaba 0 0 1 0

Province Sindh Date Disease District Area <5M >5M <5F >5F

19‐Mar AWD Tando Allah Yar Pathan colony city Tando Allahyar 0 0 1 1 19‐Mar AWD Tando Allah Yar Soomra colony UC 3 0 1 0 1 19‐Mar Leishmaniasis S. Benazirabad Village faqeer Muhammad Brohi 0 0 0 1 19‐Mar Measles Badin Village Karim Buksh Jamali 1 1 1 0 19‐Mar Measles Hyderabad Latifabad 0 0 1 0 19‐Mar Measles Matiari Latif colony, Bhit shah taluka Matiari 1 0 0 0 19‐Mar Measles N. Feroze village dilawar solangi 0 0 2 2 19‐Mar Measles Thatta Village Akbar Baloch UC Haji Girano 2 2 0 0 19‐Mar Pertussis Hyderabad Latifabad #8, Khawaja Colony 0 0 1 0 20‐Mar Measles Karachi lyari town Karachi 0 0 1 0 20‐Mar Measles Karachi Pnjgoori Mohalla 1 0 1 0 23‐Mar Typhoid Larkana Kausar mill Larkana city 1 1 0 0 24‐Mar Measles Khairpur Village Bindi Motayo 1 0 0 0 24‐Mar Measles Shikarpur Sethaar verho Village borriri 2 0 1 2 24‐Mar NNT Q Shahdadkot Ali Je Wandh , Taulka Mirokhan 1 0 0 0 24‐Mar Pertussis Khairpur village Ulra Jageer taluka Kingri 3 5 4 2 24‐Mar Pertussis S Benazirabad village haji Achar Chandio 0 0 2 6 24‐Mar scabies N. Feroze Muhala Pir Pagara Colony City Moro 0 2 4 8 24‐Mar Typhoid Q Shahdadkot Village Datoo Tewana 0 0 0 2

Province Balochistan Date Disease District Area <5M >5M <5F >5F

18‐Mar Leishmaniasis Bolan Village Mitiri 0 1 0 0 18‐Mar Leishmaniasis Khuzdar Village Rabath, UC Gresha, Tehsil Nall 0 1 0 0 18‐Mar Leishmaniasis Nasirabad Ouch Power project area 0 1 0 0 18‐Mar Measles Chagai BHU Charser, UC Padag 1 0 0 1 19‐Mar Leishmaniasis Lasbela Village Dovina, Tehsil Lakhra 1 2 1 3 19‐Mar Measles Nasirabad Goth Yar Muhammad Pindarani 0 0 0 0 19‐Mar Leishmaniasis Awaran Village Marasham, Tehsil Awaran 0 0 1 0 19‐Mar Leishmaniasis Jaffarabad Civil Hospital Usta Mohammad 0 2 0 0 19‐Mar NNT Kohlu DGKhan (waara district Kohlu) 0 0 1 0 19‐Mar Pertussis Chagai BHU Sargaisha, UC Chilgazi 1 1 1 0 20‐Mar Leishmaniasis Nasirabad Town Area Dera murad Jamali 0 0 1 0 20‐Mar Leishmaniasis Ziarat Killi Raheem, UC & Tehsil Sinjavi 0 1 0 0 21‐Mar Leishmaniasis Kalat Village & UC Iskalkoo 1 0 0 0 21‐Mar Measles Kharan Wapda colony, Town Kharan 0 1 1 2 21‐Mar NNT Barkhan Multan (District Barkhan) 1 0 0 0

Province Punjab Date Disease District Area <5M >5M <5F >5F

18‐Mar DHF Lahore Abdul Karim road lahore 0 1 0 0 18‐Mar Measles Lahore Chowk Yateem Khana 0 1 0 0 18‐Mar Typhoid Multan u/c urban 113, JPP 0 5 0 2 19‐Mar AD Bhakkar BHU Yousaf Shah, UC Yousaf Shah 9 6 3 6 19‐Mar AD R Y Khan Trinda Mohammad Pannah 14 17 18 16 19‐Mar AJS Mianwali DHQ Hospital Mianwali 5 9 6 11 19‐Mar ARI Multan UC they khalan 3 19 5 11 19‐Mar ARI R Y Khan Trinda Mohammad Pannah 16 19 21 26 19‐Mar BD Layyah BHU Paharpur, UC Pahar Pur 0 1 2 0 19‐Mar BD Layyah BHU Shahuwala, UC Sahuwala, Tehsil Kror 0 4 1 1 19‐Mar Measles Lahore Beer pand Johar Town Lahore 0 1 0 0 19‐Mar Measles Multan Sindhi Gate, Shujabad,Multan 0 0 0 1 19‐Mar Measles Muzaffargarh Sunrays Mills Colony 0 0 1 0 19‐Mar NNT D. G. Khan Rakh Azmatullah tehsil Dajal 1 0 0 0 19‐Mar Scabies R Y Khan Trinda Mohammad Pannah 5 17 3 11 19‐Mar Typhoid Bhakkar BHU Dhandla, UC Dhandla, Tehsil Bhakkar 0 3 0 0 19‐Mar Typhoid Bhakkar RHC Behal, UC Behal, Tehsil Bhakkar 0 0 0 3 19‐Mar Typhoid Layyah BHU Shauwala, UC Sahuwala, Tehsil Kror 0 1 0 2 19‐Mar Typhoid Mianwali DHQ Hospital Mianwali 1 6 1 3 20‐Mar AD R Y Khan Mianwali Qureshian, tehsil RYKhan 13 15 17 22 20‐Mar AJS Lahore Masri Shah lahore 0 2 0 1 20‐Mar ARI R Y Khan BHU Rukanpur, Tehsil Rahim Yar Khan 51 82 63 89 20‐Mar Measles Mianwali Mohallah Ahmed Gul Khan 0 0 1 0 20‐Mar Scabies Mianwali BHU Bani Afghan 6 9 8 22 20‐Mar Typhoid Mianwali THQ Hospital Kalabagh 4 12 5 10 20‐Mar Typhoid Rajanpur BHU Tatar Wala, UC Tatar Wala 0 3 0 1 21‐Mar AD R Y Khan Chak 92 P , Tehsil Khanpur 11 3 9 8 21‐Mar AD R Y Khan Trinda Sawaye Khan 11 20 14 17 21‐Mar AJS Lahore Kamhyan Village 0 2 0 1 21‐Mar ARI Bhakkar BHU Noora, UC Jandanwala Rural 14 6 18 5 21‐Mar BD Rajanpur RHC Muhamamdpur, UC Muhamamdpur 0 2 0 1 22‐Mar Scabies Bhakkar BHU Muslim kot, UC Kararikot 3 11 4 13 23‐Mar Measles Mianwali Village Chora,UC Billot Sharif 0 0 1 0



Province Khyber Pakhtunkhwa:

• 464 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS on weekly basis with a total of 114,750 patients consultations in week 12, 2012.

• 35 alerts were reported in week 11; Altogether 32 for Measles; while 1 each for AWD, Leishmaniasis and Typhoid.

• 4 outbreaks, 3 for Measles; while 1 for AWD were iden-tified and appropriate measure were taken.

Figure-3: Trend of priority communicable diseases, province KPK

Province Sindh:

• 441 health facilities from 23 districts in Sindh reported on weekly basis to DEWS with a total of 245,106 patient consultations in week 12, 2012.

• 19 alerts were reported; Altogether 9 for Measles; 3 for Pertussis; 2 each for AWD and Typhoid; while 1 each for Leishmaniasis, NNT and Scabies.

• 3 outbreaks, 2 for Pertussis; while 1 for Measles were identified and appropriate measures were taken.

Figure-4: Trend of priority communicable diseases, province Sindh

Table‐2: Total number of alerts and outbreaks reported and investigated with appropriate response Disease

2010 2011 2012 (up till week 12) Total A O A O A O A O

Acute watery diarrhoea 209 85 1350 543 74 3 1633 631 Acute jaundice syndrome 5 2 51 17 36 2 92 21 Bloody diarrhoea 10 1 98 20 33 3 141 24 Dengue fever 81 32 785 111 18 1 884 144 Measles 48 6 1710 91 808 25 2566 122 Pertussis 1 0 287 81 159 54 447 135 NNT + tetanus 5 0 399 0 172 576 0 Malaria 12 7 131 88 18 7 161 102 Leishmaniasis 1 0 298 33 229 24 528 57 Others 75 11 643 69 337 42 1055 122 Total 447 144 5752 1053 1884 161 8083 1358

Table‐1: Leading causes of seeking health care in districts, Wk‐31, 2010 to Wk 12, 2012, compiled from weekly reports

Diseases Number of Consultations

Acute respiratory infection 14,752,063 (23%)

Skin diseases 6,317,275 (10%) Acute diarrhoea 5,688,283 (9%) Bloody diarrhoea 499,831 (<1%) Suspected malaria 3,835,314 (6%) Unexplained fever 2,406,228 (4%) Total consultations 64,135,263

Figure‐2: Number of consultations by age and gender, week 12, 2012

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< 1 yr 1‐4 yr 5‐14 yr 15‐50 yr 50 + yr

Male 21461 48790 64987 101405 47410

Female 20257 45403 69276 165451 55060

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Special Bulletin: DEWS, Pakistan, Week no. 12 (18 to 24 March 2012) Province Punjab: • 350 health facilities from 8 districts reported data to

DEWS in Punjab with a total of 165,577 patient con-sultations.

• A total of 38 alerts were reported in in this week; Alto-gether 9 for ARI; 7 for Typhoid; 6 for Measles; 5 for Acute diarrhoea; 3 each for AJS, BD, and Scabies; while 1 each for NNT and Dengue fever.

• 1 outbreak for Scabies was identified and appropriate measures were taken.

Figure-5: Trend of priority communicable diseases, province Punjab


State of Azad Jammu and Kashmir:

• 137 health facilities from 10 districts reported to DEWS in this week with a total of 27,719 patient consultations.

• No alert was received for any disease from any area in AJ&K.

• 41 health facilities from 3 agencies reported from FATA in this week, with a total of 9,775 patient consultations.

• No alert was received for any disease from any area in FATA.

Province Gilgit Baltistan:

• 36 health facilities from 4 districts in Gilgit Baltistan reported to DEWS in week 12, with a total of 14,257 patient consultations.

• No alert was received for any disease from any area in Gilgit Baltistan.

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan

FATA:

Province Balochistan:

• 411 health facilities from 18 districts in Balochistan reported to DEWS, with a total of 60,047 patient con-sultations.

• 15 alerts were reported in week 12 from Balochistan; Altogether 9 for Leishmaniasis; 3 for Measles; 2 for NNT; while 1 for Pertussis.

• 2 outbreaks, 1 each for Leishmaniasis and Measles were identified and appropriate measures were taken.

Figure-6: Trend of priority communicable diseases, province Balochistan

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Alerts and outbreaks, week 12, 2012

weekly epidemiological antibodies, health education session conducted with the family members and...

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