Weekly Epidemiological - WHO · spray in the area were done. 19‐Sep DHF Khyber Pakhtunk‐ hwa Mansehra Village Dogah Balakot 0 0 0 2 Outbreak of DHF reported from Village Dogah

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. 38 (16 - 22 September, 2011)

• 81 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 8% suspected Malaria.

• A total of 197 alerts with 47 outbreaks were reported in week-38, 2011: Altogether 94 for DHF; 44 were for AWD, 19 for Measles; 15 for Neonatal Tetanus; 10 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 (Khyber Pakhtunkhwa) and Killa Abdullah (Balochistan). As of 22 September, 2011, Pakistan has reported a total of 91 polio cases (90 type-1 cases & 1 type-3 case) from 35 districts/towns/tribal agencies/areas.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 38, Monday 26 September, 2011

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 (2009, 2010, and 2011)

Disease Wk-31 Wk-32 Wk-33 Wk-34 Wk-35 Wk-36 Wk-37 Wk-38

Acute Diarrhoea 109,255 (10%) 106,918 (10%) 101,174 (10%) 94,494 (11%) 40,403 (10%) 96,128 (11%) 109,476 (12%) 108,014 (11%)

Total consultation 1,078,912 1,040,292 988,119 880,166 389,729 864,693 930,999 979,793

Since July 29, 2010, approximately 45,576,828 patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week 38, 2011 (16 to 22 September, 2011) 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 108,014 (11%), acute respiratory infections 187,395 (19%), Skin diseases 105,735 (11%) and suspected malaria 77,356 (8%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 2009, 2010 and 2011 up until now.

0

4

8

12

16

20

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52

Percentage

Epi‐week

2009 2010 2011

Epidemiological Bulletin: DEWS, Pakistan, Week no. 38 (16 to 22 September, 2011)

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

Current week's Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

20‐Sep AJS AJK Hattian Village Bandi‐Bala‐Peran, UC Chak‐hama, Hattiyan Bala

0 4 0 1 5 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 Balochis‐tan

Bolan Village Haji shehr, tehsil Dhadar

17 21 19 11 68 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 Balochis‐tan

Kech Ginnah, UC Ginnah, Turbat

13 26 32 22 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 manage‐ment.

17‐Sep Mea‐sles

Balochis‐tan

Kalat Marjan UC Dashte Goaram tehsil Kalat

2 0 6 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.

21‐Sep Mea‐sles

Balochis‐tan

Ziarat Shereen 5 0 1 0 6 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.

19‐Sep DHF FATA Bajaur Agency Scouts Fort, Tehsil Khar

0 2 0 0 1 outbreak of DHF 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.

20‐Sep AWD Gilgit‐Baltistan

Astore FAP Fakir kot 10 5 5 10 30 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 distrib‐uted. Health education conducted in community school and to the people of the locality as well.

22‐Sep DHF Gilgit‐Baltistan

Ghizer Village Kanchi Silpi UC Gahkuch Tehsil Punial

0 1 0 0 First case of DHF 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.

16‐Sep AWD Khyber Pakhtunk‐hwa

Upper Dir Lower Dir (Village Aamriat, UC Falam, Osherey Darra)

2 2 1 3

8 cases of AWD reported. Case Investigated, 4 Water Samples collected and sent to NIH.100 ORS, 1500 aqua tabs, 10 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.

19‐Sep DHF Khyber Pakhtunk‐hwa

Abbottabad Sheikh ul Bandi 0 2 0 0 2 outbreaks of DHF 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


Haripur Village Doyain Khushkian

1 2 0 3

6 outbreaks of DHF 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 house‐hold. 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.


Mansehra Village Dogah Balakot

0 0 0 2 Outbreak of DHF reported from Village Dogah Mansehra. EDO H informed. No other case found in the area on active surveil‐lance. Necessary action taken


Shangla Kuza Hujra/Tehsil Chakesar

0 2 0 1

3 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 highlight‐ing the preventive measures, and at the same time fogging of the whole village along with household spray was started, 250 bed nets have been distributed. Active surveillance with TMA and PHED was conducted. Probable breeding sites were identi‐fied 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.


Swat Village Shaftalu, UC Kishawra, Tehsil Charbagh

0 1 0 0 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.

21‐Sep AWD Punjab Mianwali Near Railway line ,UC Rokhri

1 4 0 1 6 AWD cases reported from DHQ hospital. Stool sample sent o NIH. Education about hygiene and health given in the commu‐nity, 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.

21‐Sep DHF Punjab Bhakkar DHQ Hospital Bhakkar (Bhakkar & Darya Khan)

0 8 0 0

8 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 mem‐bers done.

20‐Sep DHF Punjab D. G. Khan Nishter Hospital Multan (D.G Khan)

0 6 0 2 8 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 DHF Punjab Khanewal Nishter Hospital Multan (Khanewal)

0 12 0 5 17 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 com‐munity members done. Health department at district Khanewal. Follow up in the area is on going.

20‐Sep DHF Punjab Layyah Sh. Zayed Hospital RY Khan ‐ Layyah

0 7 0 0

9 outbreaks of DHF 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.

22‐Sep DHF Punjab Multan Nishter Hospital Multan

0 23 0 3

25 confirmed cases of DHF 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 DHF Punjab Muzaffargarh Nishter Hospital Multan (Muzaffargarh)

1 7 0 1 9 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 DHF Punjab Rahim Yar Khan

Sh. Zayed Hospital RY Khan (Rahim Yar Khan)

0 17 1 3

21 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 mem‐bers done on patient care and prevention. Follow up is ongoing.



Current week's Outbreaks: Cont’d Date Disease Province District Area <5M >5M <5F >5F Action Taken

22‐Sep DHF Punjab Rajanpur Basti Danvar, UC Dajal, Tehsil Jampur, District Rajanpur

0 1 0 0

Outbreak of DHF 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 Lassi Goth Gadap tawn

4 2 6 2 14 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

16‐Sep AWD Sindh Mirpur Khas Village Muhammad Hassan Mari

3 1 1 1 Six AWD cases and 1 death reported. 1 Stool sample collected and sent to NIH for lab confirmation (result awaited). Rein‐forced case management, Health education sessions conducted. Aqua tabs, Jerry cans and IEC Material distributed

17‐Sep AWD Sindh Naushahro Feroze

Village Mashori UC Mithiani

8 4 8 0 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.

16‐Sep AWD Sindh Sanghar Village Rukun Burrira, Taluka Sinjhoro

8 7 5 5 25 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.

20‐Sep AWD Sindh Tharparkar Village Kheemabh, UC Mirwah, Taluka Nagarparkar

0 0 0 0 6 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.

18‐Sep AWD Sindh Thatta

Village Ahmed Dokey ,UC Ma‐har,taluka Shah Bunder

2 2 1 2 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 DHF Sindh Ghotki Mian Abdul Sami Muhallah UC Dahraki

1 1 0 0

2 outbreaks of DHF 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

20‐Sep Mea‐sles

Sindh Thatta Village Abdullah Ghandro UC Sonda taluka thatta

3 1 4 5 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: AJK; FATA; GB and ICT Date Disease District Area <5M >5M <5F >5F

20‐Sep AJS Hattian Village Bandi‐Bala‐Peran, UC Chakhama, 0 4 0 1

20‐Sep DHF Bagh DHQ hosp bagh UC town 0 7 0 0

19‐Sep DHF BHIMBER DHQ HOSPITAL BHIMBER AJK 0 5 0 1

20‐Sep DHF Neelum Village Islampura, UC Ashkot , Tehsil Atthmuqam.

0 1 0 0

19‐Sep Measles Bagh Vill Kotera Saliyan Mladiyalan UC dharay 1 0 0 0

19‐Sep Measles Bagh Vill Samniyan UC Dharay Tehsil bagh 0 0 1 0

21‐Sep Measles Bagh Vill Jaen na Mora UC and Tehsil Bagh 1 0 0 0

16‐Sep Pertussis Skardu Village sad para U/C Chunda Skardu 0 1 0 0

19‐Sep Typhoid skardu Village Neanor U/C Kuskmara District Skardu

0 0 0 1

19‐Sep AWD Bajaur Agency

village Kambelai of Tehsil Salarzai 0 1 0 0

19‐Sep DHF Bajaur Agency

Scouts Fort, Tehsil Khar 0 2 0 0

18‐Sep DHF Khyber Agency

Village Dwa Toai, Tirah Khyber Agency, Presently living in Malakabad Jamrud Khyber Agency.

0 1 0 0

20‐Sep AWD Astore FAP Fakir kot 10 5 5 10

22‐Sep DHF Ghizer Village Kanchi Silpi UC Gahkuch Tehsil 0 1 0 0

19‐Sep Meningitis skardu Village hussain abad U/C H.abad district Skardu

0 1 0 0

Current week's Alerts: Province Khyber Pakhtunkhwa Date Disease District Area <5M >5M <5F >5F 19‐Sep AD Kohat Village Suleman Talab, Shahpur II 0 1 0 0

16‐Sep AWD Lower Dir Village Markharaon, Petto Darra, UC Bandagai, Timargara.

0 0 0 3

21‐Sep AWD Lower Dir Village Kashodal, UC & Tehsil Samar Bagh 0 1 0 3

22‐Sep AWD Lower Dir Village Matta, Shatai Darra, Tehsil Balmbat 1 0 0 3

19‐Sep AWD Shangla Village Machar/Alpurai 0 1 0 0

16‐Sep AWD Upper Dir Lower Dir (Village Aamriat, UC Falam, Osherey Darra)

2 2 1 3

16‐Sep AWD Upper Dir Lower Dir (Village Olagai‐Jabai, UC Falam, Osherey Darra)

1 0 0 1

20‐Sep BD Kohat Village Naakband, Union Council Bilitang 2 4 3 8

22‐Sep DHF D. I. Khan Street 06 Gilani Town D I Khan 0 1 0 0

22‐Sep DHF Lower Dir DHQ Hospital Gilgit 0 1 0 0

22‐Sep DHF Lower Dir Village Gombat Banda, UC & Tehsil Lal Qilla, Maidan, Lower Dir

0 1 0 0

17‐Sep DHF Mansehra Janbaz colony upper Chanaye 0 1 0 0

18‐Sep DHF Mansehra Village Data 0 1 0 0

18‐Sep DHF Mansehra Village Sera Gali Lassan Nawab 0 1 0 0

19‐Sep DHF Mansehra Bafa Bazar 0 1 0 0

19‐Sep DHF Mansehra Bafa Main Bazar 0 1 0 0

19‐Sep DHF Mansehra Village Dogah Balakot 0 0 0 2

19‐Sep DHF Mansehra Village Foot Gali PO Ogra 0 0 0 2

20‐Sep DHF Mansehra Chitti Dheri 0 1 0 0

20‐Sep DHF Mansehra Village Milyari Khola Phula 0 1 0 0

21‐Sep DHF Mansehra Khan Dheri Shinkiari 0 1 0 0

22‐Sep DHF Mansehra Dhodial 0 1 0 0

21‐Sep DHF Nowshera Dag Ismail Khel 0 1 0 0

21‐Sep DHF Nowshera Mohalla Mallori Speen Khak Cherat 0 0 0 1

18‐Sep DHF Shangla Kuza Hujra/Tehsil Chakesar 0 0 0 1

16‐Sep DHF Haripur Village Doyain Khushkian 0 1 0 0

17‐Sep DHF Haripur Village Baldher 1 0 0 0

19‐Sep DHF Haripur Afghan Refugee camp 16 0 1 0 0

19‐Sep DHF Haripur Village Chipra, Nariyan da Mera 0 0 0 1

20‐Sep DHF Haripur Village Siryan, Bagra 0 0 0 1

21‐Sep DHF Haripur Village Galham, Pind Hashim Khan 0 0 0 1

22‐Sep DHF Karak Village Khojaki Kala Tehsil Takht e Nasrati 0 1 0 0

19‐Sep DHF Abbottabad Ghora Bazgran, Havallian 0 1 0 0

19‐Sep DHF Abbottabad Sheikh ul Bandi 0 1 0 0

20‐Sep DHF Abbottabad Phalwali, Bodla Road, Havallian 0 1 0 0

20‐Sep DHF Abbottabad Salhad 0 1 0 0

21‐Sep DHF Abbottabad Kokal Berseen, Havallian 0 1 0 0

23‐Sep DHF Abbottabad Bandi Dhondan, Qalandarabad 0 1 0 0

23‐Sep DHF Abbottabad Mohalla Jogan, Nawansher 0 1 0 0

21‐Sep DHF D. I. Khan Village Zandar Wanda Khaliq Shah Band Kurai Tehsil PaharPur

0 1 0 0

Current week's Alerts: Province Khyber Pakhtunkhwa (Cont’d) Date Disease District Area <5M >5M <5F >5F 18‐Sep DHF Shangla Village Munz Kele Shokar/Martung 0 1 0 0

21‐Sep DHF Shangla Village Kadona, Tehsil Puran 0 1 0 0

16‐Sep DHF Swabi BHU Shewa, Rashakay Swabi 0 1 0 0

21‐Sep DHF Swabi BMC swabi, Meneri Payan 0 1 0 0

21‐Sep DHF Swabi BMC swabi, Meneri Payan Mohallah Karam Khel

0 1 0 0

21‐Sep DHF Swabi BMC swabi, Mohallah Gaar, Villahe Nabi 0 1 0 0

21‐Sep DHF Swabi BMC swabi, Mohallah Safrona, Mangol Chai 0 1 0 0

18‐Sep DHF Swat Village Shaftalu, UC Kishawra, Tehsil Char‐ 0 1 0 0

20‐Sep DHF Swat Village Dit Panai, UC Beha, Tehsil Matta 0 0 0 1

21‐Sep DHF Swat Village Speney Ube Malam Jabba Road, UC Kishawra, Tehsil Charbagh.

0 1 0 0

22‐Sep DHF Tank Gara Baloch 0 2 0 1

19‐Sep DHF Tor Ghar Bartooni 0 1 0 0

22‐Sep Measles Nowshera Imran Abad, Near: Masjid Akhunzada Baba, 1 1 1 1

22‐Sep Measles Peshawar Kuza Agra Sardaryab District Peshawar 03005849858

1 0 0 0

22‐Sep Measles Upper Dir Yaad Gara Wari 0 1 0 0

Current week's Alerts: Province Punjab Date Disease District Area <5M >5M <5F >5F

21‐Sep AWD Bhakkar Gujjaa, UC Sial, Tehsil Bhakkar 0 1 0 0

21‐Sep AWD Bhakkar Shahnawaz Boorh Barkat Wala, UC Daggar Qureshi

1 0 0 1

21‐Sep AWD Mianwali Near Railway line ,UC Rokhri 1 4 0 1

21‐Sep AWD Mianwali Village Lallo Kheel,UC Lallo Kheel 1 2 0 2

21‐Sep DHF Bhakkar DHQ Hospital Bhakkar (Bhakkar & Darya Khan)

0 8 0 0

20‐Sep DHF D. G. Khan Nishter Hospital Multan (D.G Khan) 0 6 0 2

22‐Sep DHF Jhang DHQ Hospital Gilgit 0 1 0 0

21‐Sep DHF Khanewal Nishter Hospital Multan (Khanewal) 0 12 0 5

21‐Sep DHF Lahore Nishter Hospital Multan (Lahore City) 0 2 0 1

21‐Sep DHF Lahore Skardu (Walton Cant Lahora Punjab) 0 1 0 0

20‐Sep DHF Layyah Nishter Hospital Multan (Khanewal) 0 2 0 0

20‐Sep DHF Layyah Sh. Zayed Hospital RY Khan ‐ Layyah 0 7 0 0

19‐Sep DHF Mianwali Mohallah Ibrahim Abad, Mianwali City 0 1 0 0

18‐Sep DHF Multan Shadab Colony Near Police Line, Jhang Sadar 0 1 0 0

19‐Sep DHF Multan NHM; Moza M Pur Diwan Tehsil Jam Pur 0 2 0 0

19‐Sep DHF Multan Tehsil Ahmad Pur District Bahawal Pur 0 0 0 1

22‐Sep DHF Multan Nishter Hospital Multan 0 21 0 3

22‐Sep DHF Muzaffar‐garh

DHQ Hospital Muzaffargarh (Mzgh & R.Y Khan)

0 5 0 0

22‐Sep DHF Muzaffar‐garh

Nishter Hospital Multan (Muzaffargarh) 1 7 0 1

18‐Sep DHF Pakpattan NHM, Chak 157‐AB, Tehsil Arif Wala 0 2 0 0

19‐Sep DHF Rahim Yar Khan

Sh. Zayed Hospital RY Khan (Rahim Yar Khan) 0 6 1 1


Sh. Zayed Hospital RY Khan (Tehsil Khan Pur‐ Dist. RY Khan)

0 5 0 1


Sh. Zayed Hospital RY Khan (Tehsil Sadiqabad‐ Dist. RY Khan)

0 6 0 1

22‐Sep DHF Rajanpur Basti Danvar, UC Dajal, Tehsil Jampur, District Rajanpur

0 1 0 0

22‐Sep DHF Sahiwal Nishter Hospital Multan (Sahiwal) 0 3 0 0

21‐Sep DHF Vehari Nishter Hospital Multan (Vehari) 0 13 0 1

17‐Sep Leishmaniasis D. G. Khan Farooqia Mohalla Taunsa 0 0 0 1

21‐Sep Measles Layyah Basti kaneera u/c wara Sehra Tehsil karoor 1 0 0 0

21‐Sep Measles Rajanpur Basti Bismillah Colony, UC Rajanpur City, Tehsil and District Rajanpur

0 0 1 0

17‐Sep NNT D. G. Khan Kotlee Baghal chor 0 0 1 0

20‐Sep NNT D. G. Khan Khoo Rekhwala Nawan Shumali 0 0 1 0



Current week's Alerts: Province Sindh Date Disease District Area <5M >5M <5F >5F

20‐Sep AD Badin Village Umer Malwani, UC Seerani 2 0 1 1

22‐Sep AWD Dadu Murad Nako City Dadu 2 0 1 0

22‐Sep AWD Dadu Rind Colony city Dadu 0 1 0 0

19‐Sep AWD Ghotki Irrigation Colony UC II Ghoitki 0 0 0 2

16‐Sep AWD Jamshoro Kahmir Bagh, Taluka Kotri 2 2 0 0

16‐Sep AWD Jamshoro Village Dani Buksh, Taluka Kotri 1 0 0 2

17‐Sep AWD Jamshoro Qalandar Colony Kotri 0 1 0 1

17‐Sep AWD Karachi Lassi Goth Gadap tawn 4 2 6 2

20‐Sep AWD Karachi Korangi # 5, J‐area, Korangi town 0 1 0 2

17‐Sep AWD Kashmore Kashmore Colony No.1 0 0 0 1

22‐Sep AWD Larkana Village Qalander Bux seehro Talka Dokri 0 0 0 1

16‐Sep AWD Mirpur Khas Village Muhammad Hassan Mari, UC Khan 3 1 1 1

17‐Sep AWD NF UC Bhority 0 1 0 0

17‐Sep AWD NF Village Mashori UC Darbelo 3 0 1 0

17‐Sep AWD NF Village Mashori UC Mithiani 8 4 8 0

19‐Sep AWD NF Tharo Shah city, taluka Bhiria 0 1 0 0

16‐Sep AWD Sanghar Village Rukun Burrira, Taluka Sinjhoro 8 7 5 5

16‐Sep AWD Shikarpur Near Ameer Shah Pir 1 0 3 0

19‐Sep AWD T Allah Yar City Tando Allahyar 0 0 0 1

19‐Sep AWD T Allah Yar Manostop, Taluka Jhando Mari 0 0 0 1

22‐Sep AWD T Allah Yar Village Ismail Makrani 0 0 0 0

22‐Sep AWD T Allah Yar Village Javan, Nasarpur road 0 0 0 1

17‐Sep AWD TM Khan Haji Khan Talpur, UC‐1 1 0 0 0

22‐Sep AWD TM Khan Village Ali Bux Bagrani, Lakhat 0 0 0 0

20‐Sep AWD Tharparkar Village Kheemabh, UC Mirwah 0 0 0 0

21‐Sep AWD Tharparkar Village Jhamri, UC Peelu, Taluka Nagarparkar 0 0 0 0

18‐Sep AWD Thatta Village Ahmed Dokey ,UC Mahar 2 2 1 2

19‐Sep AWD Thatta IDPs camps no: 01 inside the district jail 0 1 0 1

19‐Sep AWD Thatta Village Mitho Mallah UC Googani ,Taluka Jati 0 1 0 0

20‐Sep AWD Thatta Village Gul Bahar Thaheem UC Kothi, THQ Jati 1 2 0 1

22‐Sep BD Thatta IDPs camps no: 01 inside the district jail 0 1 0 0

19‐Sep DHF Badin Village Talo khan Burgary, UC Khoski 0 3 0 0

16‐Sep DHF Ghotki Village Haji Allah Rakhyio Laghari 0 1 0 0

19‐Sep DHF Ghotki Mian Abdul Sami Muhallah UC Dahraki 1 0 0 0

20‐Sep DHF Ghotki Sh. Zayed Hospital RY Khan (Ghotki) 0 1 0 0

21‐Sep DHF Ghotki FFC Colony UC II Mirpur Mathelo 0 2 0 2

21‐Sep DHF Ghotki Village Abdul Majeed Mahar UC Ali Bag 0 1 0 0

17‐Sep DHF Hyderabad civil Hospital, LUMHS 0 3 0 0

19‐Sep DHF Hyderabad Khata Chawk, New Cloth Market 0 1 0 0

21‐Sep DHF Hyderabad civil Hospital, LUMHS 0 1 0 0

21‐Sep DHF Hyderabad Supari Compound Street # 2 Pathan Colony 0 1 0 0

21‐Sep DHF Hyderabad Village Baksho Laghari, UC Tando Fazal 0 1 0 0

21‐Sep DHF Hyderabad Village Baksho Laghari, UC Tando Fazal 0 2 0 0

21‐Sep DHF Karachi Abbasi Shaheed Hospital, Liaquatabad Town 0 4 0 4

20‐Sep DHF Kashmore Sh. Zayed Hospital RY Khan (Kashmore Sindh) 0 2 0 0

22‐Sep DHF Khairpur Village Dur Mohammad Maitlo 0 1 0 0

22‐Sep DHF Khairpur Village Pir Essa, UC Kamal Dero, taluka Gambat 0 1 0 0

21‐Sep DHF Larkana Village Mad Bahoo Talka Bakrani 0 1 0 0

22‐Sep DHF Qambar Village Dalil Burio Talka Miro Khan 0 1 0 0

17‐Sep DHF Sukkur Ashiyon, Kubiyon, taluka Rohri 1 0 0 0

20‐Sep DHF Sukkur Nusrat Colony‐6, Old Sukkur 0 1 0 0

21‐Sep DHF T Allah Yar Village Mureed Mori Taluka Chamber 0 0 0 0

21‐Sep Leishma‐niasis

Jacobabad UC Dastgeer Colony 0 1 0 0

17‐Sep Leishma‐niasis

Qambar Shahdadkot

Muhalla Hamd Hazoori Mero Khan city 0 1 0 0

16‐Sep Malaria Badin Village Umer Otho, Pir wah, near Gaja Mori 0 2 0 1

22‐Sep Measles Qambar Shahdadkot

Village Koreja UC Jean Abro Talka 0 1 0 0

16‐Sep Measles Shikarpur Village Panah Udho, taluka Garhi Yaseen 1 1 1 1

17‐Sep Measles Sukkur H.No. 261/5 near 786 store, Qasim park 0 0 1 0

22‐Sep Measles TM Khan Village Bachoo Ghanbir, U/C Mulakatiar 1 0 0 0

19‐Sep Measles Thatta Village Taj Muhammad Jat 0 1 0 1

20‐Sep Measles Thatta Village Abdullah Ghandro 3 1 4 5

16‐Sep NNT Ghotki Village Faiz Muhammad shahani 1 0 0 0

22‐Sep NNT Ghotki Village Nazeer Ahmed Khokhar 0 0 1 0

17‐Sep NNT Karachi Surjani Tawn 0 0 0 0

20‐Sep NNT Karachi Gabol Goth near Kachi Abadi Khokhrapar 0 0 0 0

17‐Sep NNT Khairpur GIMS taluka Gambat 0 0 1 0

19‐Sep NNT Khairpur Village Haji Sanghar, UC Mengho Faqir 1 0 0 0

18‐Sep NNT Naushahro Feroze

Village Buxo Khan Rind, UC Koor Hassan 1 0 0 0

19‐Sep NNT Qambar Village Hasla Talka 0 0 1 0

22‐Sep NNT Qambar Village Abdul Kareem brohi 1 0 0 0

Current week's Alerts: Province Balochistan Date Disease District Area <5M >5M <5F >5F

22‐Sep AD Sibi Village Talli, UC Talli 9 11 21 8

21‐Sep AWD Bolan Village Haji shehr, tehsil Dhadar 17 21 19 11

16‐Sep AWD Kalat Kapoto UC Iskalkoo Tehsil Kalat 0 0 0 1

18‐Sep AWD Panjgur Panjgur 0 0 0 1

18‐Sep BD Kalat Sardawa UC Lakhorian tehsil Surab 0 2 0 3

20‐Sep CCHF Sibi Bakhtyarabad, tehsil Lehri 0 0 0 1

17‐Sep DHF Jaffarabad Ghot Faqeer Khosa, Near to Qaidi Shakh Tehsil Jhat Pat

0 0 0 1

16‐Sep Leishmaniasis Bolan Village Haji shehr, tehsil Dhadar 0 1 0 1

22‐Sep Leishmaniasis Jaffarabad BHU Gandakha, Danwich Mohalla Gandakha

0 0 0 1

18‐Sep Leishmaniasis Khuzdar Chandni Chaow UC Faiz Abad tehsil Khuz‐dar

0 1 0 0

22‐Sep Leishmaniasis Lasbela village Mangya UC Sheh Tehsile Lakhra 0 0 0 1

22‐Sep Leishmaniasis Panjgur Union Council Khudabadan West 0 1 0 0

20‐Sep Leishmaniasis Sibi WAPDA grid colony UC# 4, Sibi city 0 1 0 0

17‐Sep Leishmaniasis Ziarat Sinjawi/Ziarat town 0 2 0 0

21‐Sep Malaria Kech Ginnah, UC Ginnah, Turbat 13 26 32 22

18‐Sep Measles Chagai killi Khuda Baksh BHU kani U/C Chilgazi 1 1 0 0

16‐Sep Measles Kalat Kapoto UC Iskalkoo Tehsil Kalat 0 0 1 0

20‐Sep Typhoid Kharan Haji Rafique Sasoli BHU Lijjay U/C sarawan 0 2 0 2

17‐Sep Measles Kalat Marjan UC Dashte Goaram tehsil Kalat 2 0 6 1

21‐Sep Measles Lasbela Hub city 0 0 1 0

21‐Sep Measles Ziarat Shereen 5 0 1 0

20‐Sep NNT Bolan Basti musa khan, Tehsil Dhadar 1 0 0 0

22‐Sep NNT Chagai dasht Chaghi Village 1 0 0 0

22‐Sep NNT Jaffarabad BHU Gandakha 1 0 0 0

21‐Sep NNT Nasirabad Nursery ward of DHQ‐ Hospital D.M.J 3 0 2 0

18‐Sep Typhoid Kalat Sardawa UC Lakhorian tehsil Surab 0 3 0 1



Province Khyber Pakhtunkhwa: • This week 19 districts reported to DEWS from 715

health facilities with a total of 172,302 patients con-sultations.

• The proportional morbidity of AD showing decline during the last three weeks after a consistent higher proportion (16%) for almost 10 weeks.

• 55 alerts were reported in this week, 44 were for DHF, 6 for AWD, 3 for Measles, while one each for Acute diarrhoea and Bloody diarrhoea.

• 7 outbreaks identified and responded.

Figure-3: Three years trend of Acute diarrhoea, province KPK

Province Sindh:

• This week 20 districts reported to DEWS from 642 health centers with a total of 438,020 patient consul-tations.

• In Sindh, AD cases reported were 52,226 (12%), same proportional morbidity as compared with last week.

• 70 alerts were reported from Sindh in this week: 29 were for AWD; 21 for DHF; 9 for Neonatal Tetanus; 6 for Measles; 2 for Leishmaniasis; while one each for Acute diarrhoea, Bloody diarrhoea and Malaria.

• 8 outbreaks identified and responded.

Figure-4: Three years trend of Acute diarrhoea, province Sindh

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

Post Flood 2010 2011 (up till wk 37) Current Week (38) Total

A O A O A O A O

Acute Watery Diarrhoea 209 85 1013 445 44 10 1266 540 Acute Jaundice Syndrome 5 2 39 14 1 1 45 17

Bloody Diarrhoea 10 1 80 14 3 1 93 16 Dengue Fever 81 32 271 96 94 35 446 163

Measles 48 6 1350 83 19 3 1417 92 Pertussis 1 ‐ 217 23 1 ‐ 219 ‐

NNT + Tetanus 5 ‐ 200 ‐ 15 ‐ 220 ‐ Malaria 12 7 72 50 2 1 86 58

Leishmaniasis 1 ‐ 129 22 10 ‐ 140 ‐ Others 75 11 462 49 8 1 545 61 Total 447 144 3833 796 197 52 4477 992

Table‐1: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 22 September 2011, compiled from weekly reports

Diseases Total

Skin Diseases 4,966,044 (11%)

Acute Respiratory Infection 10,165,179 (22%)

Acute Diarrhoea 4,369,215 (10%)

Bloody Diarrhoea 388,732 (1%)

Suspected Malaria 2,716,421 (6%)

Unexplained Fever 1,746,437 (4%) Total Consultations 45,576,828

Figure‐2: Weekly number of reporting health facilities (Wk 33/2010 to Wk 38/2011)

949

107

3114

3111

111

3011

5811

6711

13

1067

999

879

854

967

1289

1215

146

3179

716

80 2022

2021

2262

234

9225

521

99225

123

22

245

024

66

240

425

47 2785

2745

290

929

3529

8231

20

302

130

22

305

831

9632

50

321

532

59

335

433

75

336

3323

432

59

3251

3142

3329

3156

310

9275

214

8825

22

256

2245

9361

375 411

331

400

215

192

153

128

105

81 58 4626

2611

812

8 1111 11 11

8 8 8 8 8 866 6 138 6 6 7 7 7 8

7 7 36 6 6 2 2

0

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Percentage

Epi‐Week

2009 2010 2011

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2009 2010 2011

Epidemiological Bulletin: DEWS, Pakistan, Week no. 38 (16 to 22 September, 2011) Province Punjab: • 7 districts reported data to DEWS from Punjab prov-

ince, 398 health facilities reported a total of 207,410 patient consultations during this week.

• AD cases reported were 16,958 and stabilize between 6% - 8% from last four weeks.

• 31 alerts were reported in this week from Punjab; 22 were for DHF; 4 for AWD; 2 each were for Measles and Neonatal Tetanus; while one was for Leishmani-asis.

• 12 outbreaks identified and controlled

Figure-5: Trend of acute diarrhoea, province Punjab (3 August 2010 to 22 September 2011)


State of Azad Jammu and Kashmir:

• In this week, weekly report received from 114 health centers from 10 districts, with a total of 40,669 patient consultations.

• ARI cases reported were 6,431 (16%), while Acute diarrhoea re-ported 2,567 (6%) cases.

• 7 alerts were received and responded this week; 3 each for DHF and Measles; while one for acute Jaundice Syndrome.

• This week 55 health centers in 3 agencies reported from FATA, with a total of 12,847 patient consultations.

• ARI cases reported were 2,315 (18%), while Acute diarrhoea re-ported 1,114 cases (9%)

• Three alerts received and responded this week; 2 for DHF and one for AWD.

Gilgit Baltistan:

• In this week, 82 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 28,725 patient consultations.

• ARI cases reported were 5,106 (18%), while Acute Diarrhoea 4,835 (17%).

• 5 alerts received and responded this week, one each for AWD, DHF, Pertussis, Meningitis and Typhoid.

Figure-7: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 22 September 2011)

FATA:

Province Balochistan:

• In this week, 18 districts reported to DEWS from Balochistan province. 453 health centers reported a total of 79,820 patient consultations.

• AD reported in 9,464 (12%) of the total consulta-tions, same proportional morbidity as compared with last week.

• 26 alerts were reported in this week from Balochis-tan, 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, DHF and Malaria.

• 4 outbreaks identified and controlled.

Figure-6: Three years trend of Acute diarrhoea, province Balochistan

0

5

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25

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52

Percentage

Epi‐week

2010 2011

0

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1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52

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Epi‐week 2009 2010 2011

0

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wk 13

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AD BD ARI S. Malaria

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wk 13

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Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases reported in 2010 is 144 includ‐ing 120 type‐1 cases and 24 type‐3 from 40 infected districts/towns/agencies. Year 2011: The total number of polio cases confirmed by the laboratory is 91 (90=type‐1, and 1=type3) till date from 35 districts.

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 con‐cern. Over the last 15 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 (DHF) 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 40‐41°C. In moderate DHF 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 dis‐ease 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 them‐selves 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.

Province Cases 2010 Cases 2011 P1 P3 P1 P3

Punjab 6 1 1 -

Sindh 26 1 17 -

Khyber Pakhtunkhwa 19 5 8 -

FATA 63 11 25 1

Balochistan 6 6 38 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 90 1

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 39oC. 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 medi‐cine 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 manifesta‐tions appear: Red spots or points on the skin; bleeding from the nose or gums; frequent vomiting; vomiting with blood; black stools; sleepi‐ness; constant crying (children); abdominal pain; excessive thirst (dry mouth); pale, cold or clammy skin; or difficulty in breathing.



Alerts and outbreaks, week 38, 2011

Documents

Weekly Epidemiological - WHO · spray in the area were done. 19‐Sep DHF Khyber Pakhtunk‐ hwa Mansehra Village Dogah Balakot 0 0 0 2 Outbreak of DHF reported from Village Dogah