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Weekly Epidemiological Bulletin

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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. 30 (22 - 28 July, 2011)

• 88 districts and 3 agencies provided surveillance data to the DEWS this week from 3,092 health facilities.

• A total of 1,010,892 consultations were reported through DEWS of which 17% were acute respiratory infections (ARI), 12% skin disease, 10% acute diar-rhoea, and 6% suspected Malaria.

• A total of 131 alerts with 20 outbreaks were reported in week-30, 2011: Alto-gether 50 alerts were for AWD; 38 for Measles; Eight for Neonatal tetanus and Tetanus; Seven for Pertussis; Four for Leishmaniasis; Three for Malaria; Two for Acute jaundice syndrome; One for Bloody diarrhoea, and 18 were for other suspected diseases.

• National Polio Eradication Initiative reported no new confirmed polio case this week. Total 60 (59=type1, and 1=type3) confirmed polio cases have been reported in 2011 from 25 districts.

Highlights

Disease early warning system and response in Pakistan

01

Volume 2, Issue 30, Monday 1 August, 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-23 Wk-24 Wk-25 Wk-26 Wk-27 Wk-28 Wk-29 Wk-30

Other Acute Diarrhoea (Not Watery) 100,753 (10%) 102,217 (10%) 103,978 (10%) 107,924 (10%) 100,320 (10%) 104,413 (10%) 107,861 (10%) 103,341 (10%)

Total consultation 1,009,254 1,028,090 1,019,724 1,087,368 994,345 1,025,647 1,034,504 1,010,892

Since July 29, 2010, approximately 38,413,010 patient consultations have been reported to the DEWS from the five provinces and three agencies and state of AJK. In this week 30, 2011 (22 to 28 July, 2011) reports were received from 3,092 health centers and the major causes for seeking health care by the communities in almost all of the provinces were diarrheal diseases, acute respiratory infections 172,676 (17%), skin diseases 123,139 (12%) and suspected malaria 57,544 (6%). 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. 30 (22 - 28 July, 2011)

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, 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 <M >M <F >F Action Taken

24‐Jul AD AJK Muzaffarabad

Village Muri, Town Committee Ghari Dupatta; Village Khutti, Muzaffarabad

24 34 64 58

An alert for AWDin two villages of Muzaffarabad was responded in a medical camp where 130 cases from one village and 50 cases from another village were treated. There was one death was reported from RHC Ghari Dupatta, one sample (was found positive for V.c. Ogawa. Community awareness session conducted, IEC material distributed. DHO was informed about situation.

28‐Jul Malaria Balochis‐tan

Jaffarabad BHU Noor Mohammad Jamali

0 0 0 0 54 suspected malaria cases were reported. 22 samples were taken and 13 verified positive (P. Falciparum 7, P.Vivax 4, mixed 2); SPR=59%, while FR=69%. The patients were treated and DHO is informed and requsted for distribution of bednets to the location.


Kharan Killi Patkin Kharan 3 7 3 8 Positive malaria cases were reported where 10 were positive for P.Vivax and 11 for P. Falciparum. Anti malarial medicines from the HF were used to treat patients. DHO was informed.


Nasirabad CD. Wahid Bukhsh 0 0 0 0 44 cases for suspected malaria were reported. 16 samples were taken and 9 came positive (P. Falciparum 5, Vivax 3, Mixed 1) (SPR=56%; FR=67%) patients treated. DHO is informed and requested to for distribution of Bed nets.

27‐Jul Pertussis Balochis‐tan

Kech Kohad, UC Bahlicha , Turbat

3 3 3 6

4 probable Pertussis cases were reported from BHU Kohad, with typical signs and symptoms. Upon field investigation 11 case with typical signs and symptoms of whooping cough were found. patients were on Tx with antibiotics (Erythromycin ) 4 sample collected and sent to NIH. information shared with DHO. Planned vaccination for the unimmunized children. health education was given.

23‐Jul AWD KPK Haripur Village Shurak, UC Bagra 0 0 0 1

AWD alerts reported by DHQ with severe dehydration. The patient is a resident of village Shurak. The patient lives close to the area where an outbreak of cholera was confirmed in the previous week. Sample was collected and found positive for V.c. Ogawa. Health and Hygiene session was conducted for the affected community. Water tank was already cleaned. Aqua tabs, ORS and soap were distributed. EDO Health was informed about the suspected case.

30‐Jul AD KPK Kohat Village Kamal Khel, UC Dhoda

7 5 8 15

35 cases of AD with mild to moderate dehydration and few cases proceeding to severe dehydration found were referred to LMH hospital, One death reported in the same area, 3 Rectal Swabs collected. Families are IDPs from Orakzai Agency, Provided ORS, Aqua tabs and hygiene kits, water samples from all households collected for microbial investigations, there are nine household of these IDPs in that area and almost all affected, each household on average has 25 people including children, MDM‐F requested for establishing mobile health clinic, EDO‐H informed and alerted, No LHW in the area for health and hygiene messages, detailed health and hygiene sessions done with all families.

22‐Jul AWD KPK Lower Dir Village Qumeera, UC Khagram, Tehsil Warri, Upper Dir.

0 0 3 4 Alert with seven AWD cases from one village was investigated, 2 Samples taken and send to NIH and both found positive for V.c. Ogawa, EDO‐H was informed about the situation. Health and hygiene promotion session conducted with family mem‐bers, Antiseptic soap and aqua tabs were distributed.

28‐Jul AD KPK Mansehra Near RHC Chowki shaukat Abad

3 3 2 2 Alert for 7 cases of AD from one house, EH engineer assessed the area and took samples of water. Active surveillance was carried out and one stool sample taken and sent to NIH, no history of travel, samples are in process, detailed investigations underway.

25‐Jul AWD KPK Mardan Vill. Lohar, UC Mohib Banda

1 4 3 1

One AWD case reported from DHQ, on active surveillance 9 more diarrhoea cases were found, Three were admitted in different hospitals in Mardan and were rehydrated. Health and hygiene session conducted, IEC material, soap, aqua tabs distributed, sample from was found positive for V.c. Ogawa. Cases coordinated with EDOH, MS DHQH, DSM PPHI and Coordinator NP. Follow up and environmental investigations planned in the area.

22‐Jul AWD KPK Peshawar Kandey Mansoor Khel, Palosai Tarlarzai

0 1 0 0 One AWD case was investigated in KTH Peshawar. Sample sent to NIH which was found positive for V.c. Ogawa. Health Education imparted to the parents of the patient. Use of ORS stressed. The concerned PHO has planned a response in the area in consultation with EDO Health.

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

16‐Jul AWD Balochis‐tan

Lasbela Village Kud Sayan‐UC Kathore, Tehsil Bela

7 9 4 15 AWD outbreak comprising of 35 cases. 2 stool sample collected and found positive for V.c. Ogawa, 4 water sample were also collected for quality test.


Khuzdar Kehn, Barani Bhaint, UC Ornach, Tehsil Nall

6 24 2 21 AWD outbreak reported in media. Cases investigated with collaboration with DHO and health authorities staff, house to house survey revealed cases with typical sign and symptoms. Two stool and two water samples were collected and sent to NIH. Health education session conducted, water filters, aqua tabs, hygiene kits were distribute in the community.


Panjgor Union Council Tasp Sarekalat, Mohalla Johan Dun

5 4 1 2 During NID, AWD alert was reported, area visited, 12 patients found. Early response team meeting was conducted with DHO and health authorities. DTC established in BHU Tasp Bazar. Medicine, Health education sessions provided.

15‐Jul AWD KPK Haripur Village Bagra, UC Bagra 6 8 2 13

4 suspected AD cases with moderate dehydration were reported and 23 more found during active surveillance in village Barkot, Haripur. The patients presented with moderate dehydration. Initial epidemiological investigation suggested contami‐nated water was the source. Stool sample was taken sent to NIH and found positive for V.c. Ogawa. Environmental assess‐ment was carried out water samples were taken and found contaminated. 6 cases with moderate dehydration were admit‐ted in different health facilities. Aqua tabs, ORS and soap were distributed. Door to door by LHW during the polio campaign. Health and Hygiene session conducted for the affected community. Water tank was cleaned with the help of local commu‐nity. EDO Health was informed.

16‐Jul AWD KPK Mardan Mohalla Sharif Abad, Takht Bai

0 0 0 0

AWD alert was reported from DHQ hospital Mardan. The case was investigated and sample taken and found positive for V.c. Ogawa. EDO Health, DSM of PPHI, MS of DHQ and EPI Coordinator informed. On active surveillance in the area one more patient recovered from diarrhea was found. Water samples taken and being tested. Health Education conducted with households and community. IEC material, soap and aqua tabs were distributed.

15‐Jul AWD KPK Nowshera Hasan Garha UC Mera Akora Khattak Now‐shera

0 1 0 1 Two AWD cases were reported form Akora Khattak, Nowshera. 1/2 samples collected was found positive for V.c. Ogawa. Hygiene sessions were conducted, Filters and IEC material distributed. No more cases were found during field surveillance.

16‐Jul BD KPK Haripur Village Muslimabad, UC Muslimabad

0 21 0 0

Alert for BD was reported by BHU Muslimabad. 6 cases were reported from a poultry farm in the village. On active case finding 15 more diarrhoea cases were found having abdominal cramps and some with bloody diarrhoea. All these cases are resident employees of same poultry farm. Stool sample was taken and sent to NIH. Environmental assessment was carried out and water samples were taken from 2 sources and 1 found contaminated. Management of the poultry farm were advised to use the safe water source. Health and hygiene session was conducted for the staff. Aqua tabs, soap and ORS were distributed. Follow up visit was made on 20th July. No new cases were reported. EDO health was informed.

21‐Jul AWD Punjab Multan Mohalla Koharay Wala, Ghazia Abad Chowk

0 1 0 0

One AWD case reported from Nishter hospital, sample taken and found positive for V.c. Ogawa, the area was visited jointly by the SO,EHE and DEWS FP. House to house survey conducted no other cases found in the locality. Area was assessed for the WASH. Health education session conducted, health hygiene kits (Aqua tabs, Jerry cans, Multi purpose soap, Antiseptic soap, Buckets and water filter) distributed. LHWs mobilized to conduct HE sessions on hygiene in the other areas of the whole UC. shared the line list with EDO(H).

15‐Jul

19‐Jul

AWD Punjab Muzaffargarh

Chah Mithoo Wala, Near by Sardar Koorey Khan School; Khoo M. Hussain Wala, Near by Taleri Nehar, UC Taleri; Basti Babrey, Moza Chah Godhar, UC Van Patafi; Dera Murad Wala, Chah Pir Wala, UC Bhutta Pur

0 0 1 3

Four AWD cases from four different locations were reported, 4/4 samples found positive for V.c. Ogawa. In the locality/area 10 households on each side were interviewed but no more similar case or suspect was found. Health education to family members in households visited. Distribution of soap, Aqua Tabs, jerry cans, buckets, water filters and IEC among them. Nearest BHU Doaba was visited and MO was given briefing on the situation, control measures and importance of awareness among general masses about safe drinking water, food and personal hygiene, it was also suggested to advise LHWs, CDC supervisor & School Health & Nutrition Supervisor to impart above said information among community while conducting their HE sessions in the catchment area. EM & EH assessment was also done at BHU.

18‐Jul AWD Sindh TM Khan Village Ali junejo,Deh jaith,UC Dhando,Taluka Tando ghulam haider

1 0 2 1 Alert for 4 cases of AWD. Reinforced case management, active surveillance done, Health education, ORS, Aqua tabs and Zinc tabs Provided, DMT & EDO‐H informed, 1 stool sample collected and found positive for V.c. Ogawa, 2 Water samples taken.

21‐Jul Pertussis Sindh Tando Allah Yar

Village Azizullah memon farm

6 3 12 3 Alert for 24 cases suspected Pertussis. Reinforced case management, active surveillance done, Health education, Erythromy‐cin provided for cases, 3 throat swab samples taken.



Province Khyber Pakhtunkhwa: • This week 21 districts reported to DEWS from 712

health facilities with a total of 179,097 patients con-sultations.

• AD cases reported were showing a consistent upward trend and accounted for 15% - 17% of the total con-sultations in last 4 weeks.

• 45 alerts were reported in this week, 21 were for

Measles, 18 for AWD, two each were for acute diar-rhoea and Leishmaniasis, while one each for Pertus-sis and DHF.

Figure-2: Three years trend of Acute diarrhoea, province KPK

Province Sindh:

• This week 21 districts reported to DEWS from 951 health centers with a total of 433,583 patient consul-tations during the reporting period of week 30, 2011.

• In Sindh, AD cases reported were 38,038 (9%), same proportional morbidity as compared with last week.

• 28 alerts were reported from Sindh in this week: 14 were for AWD, five for neonatal tetanus and tetanus, four for Measles, three for Pertussis, while one each for chicken pox and mumps.

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

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

22‐Jul AWD KPK Swabi RHC Yar Hussain, Mohallah Yar Hussain

1 1 0 0 Two AWD cases were investigated, Treatment given, Health education sessions conducted to the family as well as in the community. Active surveillance done, no other case found. 1/2 samples collected found positive for V.c. Ogawa. EDO and MS of BMC informed. District Response team was properly trained on Cholera management, and PPHI staff were also trained.

22‐Jul AWD KPK Upper Dir Khagram, Warrai 0 0 3 4 AWD alert reported from DHQ Timergara. Two cases were investigated & samples was sent to NIH for confirmation. Health Education session conducted and aqua tabs were provided.

25‐Jul AWD Punjab D. G. Khan Chah Seer wala, Chak 3 UC Kot Chutta

0 0 0 1

One case of AWD investigated, session on health education and hand washing given, sample of one case taken and sent to NIH which was found positive for V.c. Ogawa. Medicines prescribed.LHW trained and requested to give health session to the females in the families of patients and around .Doctors and staff of the nearby RHC requested to support the families and keep. Surveillance of the area done. Line listing of the cases done. Patients treated and required medicines arranged.

23‐Jul AWD Punjab Muzaffargarh Chah Mittho Wala, UC City‐2

0 0 0 1

One case of AWD investigated along with active surveillance of the area. ERT had visited the area & suspect's stool swab sample was collected & sent to NIH. In the locality/area 20 households were interviewed but no more similar case or suspect was found. Health education to family members in households visited. Distribution of soaps, Aqua Tabs, jerry cans, buckets, water filters & IEC among them. Nearest BHU visited & MO were given briefing on the situation, control measures & impor‐tance of awareness among general masses about safe drinking water, food & personal hygiene & it was also suggested along with continuous strict surveillance.

27‐Jul AWD Sindh Hyderabad Mumtaz colony, Babul islam Masjid

0 1 0 0 Reinforced case management, active surveillance found no further cases, Health education, ORS, Aqua tabs and Zinc tabs Provided, DMT & EDO‐H informed, 1 stool sample collected and found positive for V.c. Ogawa, 1 Water sample also taken.

23‐Jul AWD Sindh Jamshoro Taluka Sehwan 0 5 0 0 Reinforced case management, active surveillance found no further cases, Health education, ORS, Aqua tabs and Zinc tabs provided, DMT & EDO‐H informed, 2 stool samples were collected and both found positive for V.c. Ogawa, 3 Water samples also taken.

28‐Jul AWD Sindh Karachi Usmanabad, Saddar town

1 0 0 5 Reinforced case management, active surveillance found no further cases, Health education, ORS, Aqua tabs and Zinc tabs Provided, DMT & EDO‐H informed, 1 stool & 2 Water sample taken.

26‐Jul AWD Sindh Naushahro Feroze

BHU Moro‐UC Deparja 2 1 0 0 Three AWD cases were investigated with 24 hours. 2/3 samples collected and sent to NIH were found positive for V.c. Ogawa. Health education, ORS, Aqua tabs and Zinc tabs provided.

27‐Jul AWD Punjab Muzaffargarh Mohalla Khurshid Abad, Nearby Excise Office, UC Lutkeran

0 1 0 0

One case of AWD investigated along with active surveillance of the area. Samples were collected & sent to NIH which was found positive for V.c. Ogawa. In the locality/area 20 households were interviewed but no more similar case or suspect was found. Health education to family members in households visited. Distribution of soap, Aqua Tabs, jerry cans, buckets, water filters & IEC among them. Nearest BHU visited & MO was given briefing on the situation, control measures & importance of awareness among general masses about safe drinking water, food & personal hygiene & it was also suggested along with continuous strict surveillance.

Disease Post Flood 2010 2011 Total A O A O A O A O

Acute Watery Diarrhoea 209 85 439 183 50 13 698 281

Bloody Diarrhoea 10 1 48 9 1 ‐ 59 10 Measles 48 6 1167 80 38 ‐ 1253 86 Pertussis 1 ‐ 171 17 7 1 179 18

Malaria 12 7 48 32 3 3 63 42 Leishmaniasis 1 ‐ 67 17 4 ‐ 72 17 Others 156 43 379 38 18 3 553 84 Total 447 144 2455 388 131 20 3033 552

Current Week

Acute Jaundice Syndrome 5 2 29 12 2 ‐ 36 14

NNT + Tetanus 5 ‐ 107 ‐ 8 ‐ 120 ‐

Table‐1: Total number of alerts and outbreaks reported and investigated with appropriate response

0

5

10

15

20

25

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

Percentage

Epi‐Week

2009 2010 2011

0

5

10

15

20

25

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

Percentage

Epi‐Week

2009 2010 2011


Province Balochistan:

• In this week, 16 districts reported to DEWS from Balochistan province. 341 health centers reported a total of 53,014 patient consultations.

• AD reported in 7,546 (14%) of the total consulta-tions, same proportional morbidity as compared with last week.

• 25 alerts were reported in this week from Balochis-tan, five were for chicken pox, four for measles, three each for malaria and Pertussis, two each were for acute jaundice syndrome and Leishmaniasis, while one each for acute diarrhoea, acute watery diarrhoea, mumps, typhoid, neonatal tetanus and tetanus.

Figure-5: Three years trend of Acute diarrhoea, province Balochistan

Province Punjab: • 12 districts reported data to DEWS from Punjab

province, 885 health facilities reported a total of 277,640 patient consultations during this reporting period

• AD cases reported were 20,157, and stabilized at 7% from last four weeks.

• 17 alerts were reported in this week from Punjab; 10 for AWD, four were for Acute diarrhoea, while one each for measles, neonatal tetanus and mumps.

Figure-4: Trend of acute diarrhoea, province Punjab (3 August 2010 to 28 July 2011)


State of Azad Jammu and Kashmir:

• In this week, weekly report received from 87 health centers from 10 districts, with a total of 29,121 patient consultations.

• ARI cases reported were 2,738 (9%), while Acute diarrhoea reported 2,569 (9%) cases.

• Seven alerts were received and responded this week, four were for AWD and 3 for measles.

• This week 48 health centers in 3 agencies reported from FATA, with a total of 9,826 patient consultations.

• ARI cases reported were 1,697 (17%), while Acute diarrhoea re-ported 1,146 cases (12%)

• One AWD alert was received and responded this week.

Gilgit Baltistan:

• In this week, 65 health centers from 7 districts in Gilgit Baltistan sent weekly report with a total of 26,362 patient consultations.

• ARI cases reported were 2,739 (10%), while Acute Diarrhoea 4,078 (15%).

• Eight alerts received and responded this week, five for Measles, two for AWD and one for bloody diar-rhoea.

Figure-6: Trend of priority communicable diseases, Gilgit Baltistan (25 March to 28 July 2011)

FATA:

0

5

10

15

20

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

5

10

15

20

25

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

Percentage

Epi‐week

2009 2010 2011

0

5

10

15

20

25

30

35

40

45

wk 13

wk 14

wk 15

wk 16

wk 17

wk 18

wk 19

wk 20

wk 21

wk 22

wk 23

wk 24

wk 25

wk 26

wk 27

wk 28

wk 29

wk 30

Percentage

AD BD ARI S. Malaria

05

1015202530354045

wk 13

wk 14

wk 15

wk 16

wk 17

wk 18

wk 19

wk 20

wk 21

wk 22

wk 23

wk 24

wk 25

wk 26

wk 27

wk 28

wk 29

wk 30

Percentage


05

1015202530354045

wk 6

wk 7

wk 8

wk 9

wk 10

wk 11

wk 12

wk 13

wk 14

wk 15

wk 16

wk 17

wk 18

wk 19

wk 20

wk 21

wk 22

wk 23

wk 24

wk 25

wk 26

wk 27

wk 28

wk 29

wk 30

Percentage




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

28‐Jul AD Panjgur Union Council Kallag , Mohallah Simsoori kallag

7 12 3 15

26‐Jul AJS Chagai Southern Bazar Tehsil and UC Nokundi 0 2 0 1

23‐Jul AJS Kech Meeri UC Sarikhan, Turbat 0 2 0 1

28‐Jul AWD Chagai Ameen Abad Chaghi village 0 0 0 1

25‐Jul Chicken Pox Kech Gokdan UC Gokdan, Turbat 1 3 1 2

26‐Jul Chicken Pox Killa Abdul‐lah

UC bughra 0 1 0 0


UC memoodabad 2, muhalla ameer Muham‐mad

0 1 1 1


UC murda karez, Killi Malik khan 0 0 0 1

23‐Jul Chicken Pox Sibi Village marghzani 1 0 1 0

26‐Jul Leishmani‐asis

Khuzdar Bazgeer UC Khand Tehsil Khuzdar 0 0 0 1

23‐Jul Leishmani‐asis

Pishin UC yaro, Killi Khatk‐e‐zai 0 1 0 0

28‐Jul Malaria Jaffarabad BHU Noor Mohammad Jamali 0 0 0 0

25‐Jul Malaria Kharan Killi Patkin Kharan 3 7 3 8

28‐Jul Malaria Nasirabad CD. Wahid Bukhsh 0 0 0 0

23‐Jul Measles Chagai Killi Haji Hamal Khan Brabcha 0 0 0 1

28‐Jul Measles Killa Abdul‐lah

Tehsil Gulistan, UC deobandi 0 0 0 0

25‐Jul Measles Lasbela Murad Gujar Goth Uc Pathra 1 0 0 0

28‐Jul Measles Loralai Bakhma Muhallah Town 1 0 0 0

27‐Jul Mumps Khuzdar Sath Marlla UC Zereena Kattan 0 1 0 1

22‐Jul NNT Jaffarabad Ghot Hamid khan Qambrani, UC Sibi Jadid 0 0 0 0

27‐Jul Pertussis Kech Kohad, UC Bahlicha , Turbat 3 3 3 6

25‐Jul Pertussis Kharan Killi Patkin Kharan 1 1 1 0

27‐Jul Pertussis Sibi Village safi 0 2 0 0

28‐Jul Tetanus Khuzdar Killi Saleh Mohammad UC Wadh 0 0 1 0

24‐Jul Typhoid Chagai Killi Qasim Khan Dalbandin town 0 2 0 2

Current week's Alerts: AJK; FATA; GB and ICT Date Disease District Area <5M >5M <5F >5F

26‐Jul AWD Bagh Village Sabokot Ranga, UC Rangla 0 1 0 0

24‐Jul AWD Muzaffara‐ Village Muri, Town Committee Ghari 15 23 49 43

25‐Jul AWD Muzaffara‐bad

Village Khutti, Town Committee Ghari Dupatta, Muzaffarabad

9 11 15 15

27‐Jul AWD Sudhnoti village Haveli Sabokot Rangla UC Rangla 0 1 0 0

27‐Jul Measles Bagh village Capriyan UC Maloot Dist Bagh 0 1 0 0

28‐Jul Measles Bagh Near National Bank Pakistan by pass raod Bagh

0 0 2 0

28‐Jul Measles Poonch Village Banni UC Singola Tehsil Rawalakot 0 0 0 1

28‐Jul AWD Bajaur Agency

Qazi Dherai, Jar, Tehsil Khar 0 0 0 1

22‐Jul AWD Ghizer Village Gulmoti UC singal Tehsil Punial 0 1 0 0

23‐Jul AWD Ghizer Village Ishkoman UC Imit Tehsil Ishkoman 0 1 0 0

22‐Jul BD Gilgit Village Sakwar Tehsil Gilgit 0 1 0 0

25‐Jul Measles Hunza Nagar

Village Mianchar UC Minapin Pisan Tehsil Nagar 2

0 1 0 0

23‐Jul Measles Skardu Sikandar Abad Oro Kumra 1 0 0 0

24‐Jul Measles Skardu Haiderabad Gangopi 0 0 0 1

24‐Jul Measles Skardu Sar Khor Rgayul Shegari Khurd 0 1 0 0

25‐Jul Measles Skardu Degree college colony jafari mohala 0 1 0 0

18

7

12

18

14

10

16

21

4 41 11 2 2

0

5

10

15

20

25

Wk‐27 Wk‐28 Wk‐29 Wk‐30

# of alerts

Epi‐week

Number of alerts detected by week, Khyber Pakhtunkhwa (Week 27 to 30, 2011)

AWD Measles Pertussis Leishmaniasis

17 16

13 14

9 810

42 11

3 3

0

5

10

15

20

25

Wk‐27 Wk‐28 Wk‐29 Wk‐30

# of alerts

Epi‐week

Number of alerts detected by week, Sindh (Week 27 to 30, 2011)

AWD Measles Leishmaniasis Malaria Pertussis

6

9

13

10

7

4 5

11

0

5

10

15

20

25

Wk‐27 Wk‐28 Wk‐29 Wk‐30

# of alerts

Epi‐week

Number of alerts detected by week, Punjab (week 27 to 30, 2011)

AWD Measles Pertussis

5

13

6 7

4

13 3 22 1

3 342 2 3

0

5

10

15

20

25

Wk‐27 Wk‐28 Wk‐29 Wk‐30

# of alerts

Epi‐week

Number of alerts detected by week, Balochistan (Week 27 to 30, 2011)

AWD Measles Leishmaniasis Malaria Pertussis

3 3 3 41

3

0

5

10

15

20

25

Wk‐27 Wk‐28 Wk‐29 Wk‐30

# of alerts

Epi‐week

Number of alerts detected by week, AJK (Week 27 to 30, 2011)

AWD Measles

224

1

5

1

0

5

10

15

20

25

Wk‐27 Wk‐28 Wk‐29 Wk‐30

# of alerts

Epi‐week

Number of alerts detected by week, Gilgit Baltistan (Week 27 to 30, 2011)

AWD Measles Malaria

AWD, 50

Measles, 38

NNT + Tetanus, 8

AD, 7

Pertussis, 7

Chicken pox, 6

Leishmaniasis, 4Malaria, 3

Mumps, 3

AJS, 2

BD, 1

DHF, 1

Typhoid, 1

Dsitribution of alerts by diseases, week 30 (22 ‐ 28 July, 2011) n=131



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

25‐Jul AD Haripur BHU Amgah, Village Dar Chatti, UC Kothera, Tehsil Ghazi

3 10 3 21

27‐Jul AD Kohat UC Usterzai 4 5 3 7

26‐Jul AWD Abbotta‐bad

Polyclinic Hospital Islamabad 0 1 0 0

26‐Jul AWD Buner Vill Shalbanday, Sonigram, Tehsil Gagra 1 0 0 0

28‐Jul AWD Buner Vill. Kuza Hujra, UC Daggar, Tehsil Daggar 0 1 0 0

28‐Jul AWD Buner Vill. Sawari, UC Daggar, Tehsil Daggar 1 0 0 0

23‐Jul AWD Haripur Village Shurak, UC Bagra 0 0 0 1

30‐Jul AWD Kohat Village Kamal Khel, UC Dhoda 7 5 8 15

22‐Jul AWD Lower Dir Village Qumeera, UC Khagram, Tehsil Warri, Upper Dir.

0 0 3 4

27‐Jul AWD Lower Dir Village Ghanderay Payeen, UC Mayar, Samr Bagh

0 3 0 1

28‐Jul AWD Lower Dir Village Ossori Ziyarat, UC Dislore, Tehsil Warri 0 0 0 1

28‐Jul AWD Mansehra Near RHC Chowki shaukat Abad 3 3 2 2

25‐Jul AWD Mardan Vill. Lohar, UC Mohib Banda 1 4 3 1

22‐Jul AWD Peshawar Gulabad board area 0 4 0 0

22‐Jul AWD Peshawar Gulberg No. 4 0 0 0 1

22‐Jul AWD Peshawar Kandey Mansoor Khel, Palosai Tarlarzai 0 1 0 0

29‐Jul AWD Peshawar Mohallah Yousafzai, UC Regi 0 0 1 0

22‐Jul AWD Swabi RHC Yar Hussain, Mohallah Yar Hussain 1 1 0 0

26‐Jul AWD Swabi BMC Swabi, Mohallah Dina Khel, Kunda 1 0 0 0

22‐Jul AWD Upper Dir Khagram, Warrai 0 0 3 4

26‐Jul DHF Haripur Khalabut Township Sector 3, UC Khalabut 0 1 0 0

28‐Jul Leishmaniasis Lower Dir Village Jalley, UC Munjai 0 0 6 7

28‐Jul Leishmaniasis Shangla Kuzbat Kot 0 3 0 2

27‐Jul Measles Charsadda Vill. Abbass Kalay 1 0 0 0

27‐Jul Measles Charsadda Vill. Ibrahimzai, Mohallah Miangan 1 0 0 0

22‐Jul Measles Haripur Muhallah Khattak Abadi, Ghazi, UC Ghazi 2 0 0 0

26‐Jul Pertussis Swabi BHU Zaida, Mohallh Barghandi Dudher 0 0 0 1

22‐Jul Measles Haripur Near Ghazi High School, Ghazi city, UC Ghazi 0 1 0 0

27‐Jul Measles Swat Village Islampur Mohallah Kar, UC Islampur, Tehsil Babuzai

0 0 1 0

27‐Jul Measles Swat Village Shagai , UC Saidu Sharif , Tehsil Ba‐buzai

0 0 1 0

28‐Jul Measles Swat Village Kanju Mohallah Niamat Abad, UC Kanju, Tehsil Kabal

0 1 0 0

28‐Jul Measles Swat Village Shakardara Miangano Cham, UC Matta 0 0 1 0

28‐Jul Measles Swat Village Tahir Abad,UC Band Mingora, Tehsil Babuzai

0 1 0 0

26‐Jul Measles Tank Waraspoon kiri maghzai 0 0 1 0

22‐Jul Measles Haripur Village Moin Banda, UC Ghazi 1 0 0 0

23‐Jul Measles Mansehra Daana NJear Police Lines Jaloo 0 1 0 0

23‐Jul Measles Shangla Village Qut Bigas, UC Pirabad 1 0 0 0

26‐Jul Measles Swabi BMC Swabi, Punjpir 1 0 0 0

23‐Jul Measles Swat Village Aligrama, Mohallah Ghatoo Jumat, UC Kabal

0 1 0 0

23‐Jul Measles Swat Village Saidu Sharif, Mohallah Nasir Khail, UC Saidu Sharif

0 0 0 1

24‐Jul Measles Swat Village Baba Jee, UC Barikot 0 0 1 0

24‐Jul Measles Swat Village Balogram Mohallah Ranjo Gat, UC Qambar

0 1 0 0

24‐Jul Measles Swat Village Saidu Sharif near Police station, UC Saidu Sharif

1 0 0 0

26‐Jul Measles Swat Village Kota, Mohallah Saidan, UC Barikot 1 0 0 0

26‐Jul Measles Swat Village Shin, Mohallah Momin Abad, UC Shin, Tehsil Khwazakhela

1 0 0 0

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

22‐Jul AWD Badin Village Chak# 40,Deh Jhol,Taluka golarchi 0 0 0 1

27‐Jul AWD Hyderabad Mumtaz colony, Babul islam Masjid 0 1 0 0

23‐Jul AWD Jamshoro Taluka Sehwan 0 5 0 0

28‐Jul AWD Karachi Usmanabad, Saddar town 1 0 0 5

22‐Jul AWD Matiari UC‐2, Hala Pir Mola Buksh Colony City Hala

0 0 2 0

25‐Jul AWD Mirpur Khas Street # 2, Near Bismillah Masjid 0 1 0 0

26‐Jul AWD Naushahro Feroze

BHU Moro‐UC Deparja 2 1 0 0

26‐Jul AWD Qambar Shahdadkot

Village Phulla 1 0 0 0

22‐Jul AWD Shikarpur UC Jhali Kalwari, Tehsil Lakhi 0 0 1 0

22‐Jul AWD Shikarpur Village Ruk, Tehsil Lakhi 0 0 1 0

27‐Jul AWD Shikarpur Village Sojhro Khan 1 0 0 0

26‐Jul AWD Sukkur Newpind 1 0 0 0

27‐Jul AWD Tando Allah Yar

Village Dito Kalro Brisar Batha 0 1 0 0

23‐Jul AWD Tando Muham‐mad Khan

Village Jang Katiar, UC Saeed Matto,Deh Bhala, Taluka BSK

1 0 2 3

26‐Jul Chicken Pox

Qambar Shahdadkot

Village Karam Khan Mugeri 0 2 0 0

26‐Jul Measles Badin Village Umer Khaskheli, UC Talhar 2 0 1 0

22‐Jul Measles Karachi Lines area UC‐9 Jamshed Tawn 3 0 1 0

25‐Jul Measles Khairpur Village Nabi Bux UC Thehri 1 0 0 0

28‐Jul Measles Thatta Soomar Khan Chandio, Mirpur Sakiro 1 0 0 0

27‐Jul Mumps Thatta Sapa Mori Taluka Jharak 0 6 0 2

28‐Jul NNT Ghotki Bago Wah, Hussain Beli road, UC III 1 0 0 0

27‐Jul NNT Khairpur Village Mehrab Butto 1 0 0 0

26‐Jul NNT Umer Kot Otaque Ali Murad Rajar,Near Saheban‐jo‐kot, UC Atta Muhammad Palli

0 0 0 0

22‐Jul Pertussis Kashmore Village Khan Mazari 1 0 0 0

25‐Jul Pertussis Matiari Village Haji Nazir Memon 4 0 1 0

25‐Jul Pertussis Tharparkar Village Choopni samejo, UC Malenhore veena, Mithi

0 0 0 3

25‐Jul Tetanus Karachi Khada Market, Lyari Town 0 1 0 0

28‐Jul Tetanus Larkana Village Chutto Khan 0 0 1 0

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

25‐Jul AD Bhakkar Sial City, UC Sial, Tehsil Bhakkar 7 5 2 0

26‐Jul AD Bhakkar Moza Bisal, UC litten, Tehsil Mankera 1 8 1 2

22‐Jul AD Layyah BHU Marhan wali UC Samtia Tehsil karoor 13 9 14 10

25‐Jul AD Rahim Yar Khan

UC Ameengarh, BHU Khairpur Khadali, Tehsil Rahim Yar Khan

14 21 8 36

28‐Jul AWD Bhakkar Junubi Eid Gah, UC bhakkar Urban II, Tehsil Bhakkar

0 1 0 0

25‐Jul AWD D. G. Khan Chah Seer wala, Chak 3 UC Kot Chutta 0 0 0 1

24‐Jul AWD Multan Basti Anwal Wali Bhatta Laj Pal Hamid Pur Kanora

0 1 0 0

24‐Jul AWD Multan Sikandar Town Industrial State 0 1 0 0

24‐Jul AWD Multan Wal Wat Morh Basti Tikhay Sial Chah Hansalay Wala

0 1 0 0

26‐Jul AWD Murree Polyclinic Hospital Islamabad 0 1 0 1

22‐Jul AWD Muzaffargarh Basti Janey Wala, Khoo Bashkan Wala, UC Noohan Wali

2 0 0 0

22‐Jul AWD Muzaffargarh Gali # 4, Tibba Karim Abad, UC Lutkeran 0 0 0 1

23‐Jul AWD Muzaffargarh Chah Mittho Wala, UC City‐2 0 0 0 1

27‐Jul AWD Muzaffargarh Mohalla Khurshid Abad, Nearby Excise Office, UC Lutkeran

0 1 0 0

28‐Jul Measles DG Khan More kot qaisrani distri uc Nari Tehsil Taunsa 0 0 0 1

27‐Jul Mumps Rahim Yar Khan

UC 125 P tehsil Rahim Yar Khan 3 0 1 1

26‐Jul NNT Layyah Mauza ladhana UC Ladhana tehsil Layyah 0 0 1 0



Distribution of Wild Polio Virus cases Pakistan 2010 and 2011

Year 2010: The total number of polio cases reported in 2010 is 144 including 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 60 (59=type‐1, and 1=type3) till date from 25 districts.

Focus on: Partners for health and hygiene awareness in Khyber Pakhtunkhwa

In the context of some outbreaks of Acute Diarrhoea in some districts of Khyber Pakhtunkhwa, WHO has called different partners for a con‐sultation meeting on 2 August 2011 with the main goal to strengthen the Hygiene Promotion activities and dissemination of messages among the affected communities and to jointly ensure a coordinated response to control outbreaks and to reduce morbidity and mortality. Participants were from: MOH; UNICEF; MSF; Merlin; PRC; IOM Hum Com; Medecins du Monde, Abbasi Foundation.

Action points from the meeting:

Every organization should share on daily basis interventions implemented.

WHO: i) Circulate the matrix with main interventions for each district and related leading organization for following up and monitoring of activities; ii) provide supplies to IOM IOs; iii) share with partners daily report and updated figures/data; iv) explore the involvement of other organizations through health cluster mechanism (Health).

UNICEF as the leading agency on WASH will: i) ensure the involvement of the LHWs in the affected districts; ii) facilitate a meeting at provin‐cial level with LHWs Program, most probably on Thursday 4 August 2011; iii) provide ORS to PRC; iv) share with partners IEC materials; v) update on WASH every two weeks.

MERLIN: share with partners IEC materials. MSF: explore possibilities to collaborate in the affected districts for this joint response to AWD. PRC: i) Mobilize network of volunteers for targeting communities in the district of Mansehra; ii) Collaborate with WHO will in Kohistan; iii)

involve other partners in the PHAST Training starting on 13 August in Kohistan and Shangla (other community‐based workers such as IOM IOs will be involved in this training including LHWs); iv) share the list of PRC Focal Persons at district level.

IOM: i) provide details of radio channels utilized for this campaign; ii) explore possibilities of spreading education messages on AWD through newspapers; iii) mobilize religious leaders through the human network by focusing on the most affected districts

MOH: recommend to partners to involve PPHI. While the MOH recognized these joint efforts from the partners, it was also pointed out the importance to explore long‐term solutions. Interventions last year in flood‐affected districts have prevented AWD outbreaks in the same districts this year. The meeting was a good exercise for sharing responsibilities and expertise in such a critical situation and partners were active in finding solu‐tions and exploring possibilities of expanding activities by mobilizing human resources in the affected districts.

Figure‐7: Weekly number of reporting health facilities (Wk 33/2010 to Wk 30/2011) Table‐2: Leading causes of seeking health care in flood affected districts, 29 July 2010 to 28 July 2011, compiled from weekly reports

Diseases Total

Skin Diseases 4,098,958 (11%) Acute Respiratory Infection 8,866,598 (23%) Acute Diarrhoea 3,603,596 (9%) Bloody Diarrhoea 330,047 (1%) Suspected Malaria 2,244,250 (6%) Unexplained Fever 1,469,679 (4%) Total Consultations 38,413,010

Province Cases 2010 Cases 2011 P1 P3 P1 P3

Punjab 6 1 - -

Sindh 26 1 14 -

Khyber Pakhtunkhwa 19 5 6 -

FATA 63 11 19 1

Balochistan 6 6 19 -

AJK - - - -

Gilgit‐Baltistan - - 1 -

Islamabad - - - -

Total 120 24 59 1

949

1073

1143

111

111

30

1158

1167

1113

1067

999

879

854

967

128

912

1514

63 1797

1680 2022

2021

2262

2349

2255

2199

2251

2322

2450

2466

240

425

4727

85

2745

2909

2935

2982

3120

3021

3022

3058

319

632

5032

15

3259

3354

3375

336

3323

432

59

325

130

92

361 375 41

1

331 400

215

192

153

128

105

81 58

46

26

26

11

8

12

8 11

11

11 1188 888 86

6 6 13

8 6 6 7 7 78

7 7 3

6 6 6

2 2

0

500

1000

1500

2000

2500

3000

3500

4000

Wk 33

Wk 35

Wk 37

Wk 39

Wk 41

Wk 43

Wk 45

Wk 47

Wk 49

Wk 51

Wk 1‐11

Wk 3

Wk 5

Wk 7

Wk 9

Wk 11

Wk 13

Wk 15

Wk 17

Wk 19

Wk 21

Wk 23

Wk 25

Wk 27

Wk 29

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Alerts and outbreaks, week 30, 2011

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