volume 3, issue 44, wednesday 7 november 2012...

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. 44 (28 Oct to 3 Nov 2012)

Measles: 61 alerts investigated this

week, responding to 17 outbreaks involving 242 measles cases. Vitamin A was provided to cases and EDOs-H took action to improve vaccination in affect-ed areas (Page 7)

AWD: 6 alerts investigated this week

and 1 outbreak identified, involving 112 cases. Outbreak was controlled by timely measures and by case manage-ment and infection control at health facilities (Page 7)

Two new suspected CCHF cases report-

ed in week 44, 2012; (Page 6)

One new polio cases was reported in

week 44, 2012; (Page 6)

82 districts have reported to DEWS in

week 44, 2012. 2,323 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week

684,045 patients’ consultations were

reported in week 44 compared to 593,038 consultations reported in week 43, 2012.

Altogether 122 alerts were investigated

and response were provided to 22 outbreaks.

Highlights

Disease early warning system and response in Pakistan

01

Volume 3, Issue 44, Wednesday 7 November 2012

The graph (Figure-2) shows the comparison of weekly trend of Acute diarrhoea as proportional morbidity (percentage of cases out of total consultations) reported to DEWS each week in year 2011 and 2012.

Overall weekly trend of acute diarrhoea is stable in all provinces. Districts in Sindh and Khyber Pakhtunkhwa are investi-gating alerts for acute watery diarrhoea/suspected cholera.

Disease # of Cases Percentage

Acute diarrhoea 2,749,043 9%

Bloody diarrhoea 151,709 0.5%

ARI 5,877,938 18%

S. Malaria 1,687,511 5%

Skin Diseases 1,495,252 5%

Unexplained fever 1,161,049 4%

Total (All consultations) 32,330,217

Disease # of Cases Percentage

Acute diarrhoea 55,683 8%

Bloody diarrhoea 2,642 <1%

ARI 150,554 20%

S. Malaria 43,061 6%

Skin Diseases 29,114 4%

Unexplained fever 24,758 3%

Total (All consultations) 684,045

Figure-2: Weekly trend of Acute diarrhoea in Pakistan; Week-1, 2011 to week-44, 2012.

Figure-1: 82 districts reported to DEWS in week 44, 2012

Priority diseases under surveillance

in DEWS

Pneumonia Acute Watery Diarrhoea

Bloody diarrhoea Other Acute Diarrhoea

Suspected Enteric/Typhoid Fever Suspected Malaria

Suspected Meningitis Suspected Dengue fever

Suspected Viral Hemorrhagic Fever Suspected Measles

Suspected Diphtheria Suspected Pertussis

Suspected Acute Viral Hepatitis Neonatal Tetanus

Acute Flaccid Paralysis Scabies

Cutaneous Leishmaniasis

Major health events reported during the Epi-week - 44 (28 Oct to 3 Nov 2012)

Cumulative number of selected health events reported in Epi-week 1 to 44, 2012 (1 Jan - 3 Nov 2012)

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Weekly Bulletin: DEWS, Pakistan, Week no. 44 (28 Oct to 3 Nov 2012)


For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected]. 02

Current week's (44/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

2-Nov AWD Balochistan Kech Hor, UC Zareenbug, Dasht

22 29 11 42

Suspected AWD cases were reported and timely investigated. Reinforced case manage-ment. Aquatabs, pure sachet and health awareness was given. 3 samples were collected and sent to NIH. Drinking water was identified as a possible source of infection. EDOH informed.

1-Nov Leishmaniasis Balochistan Lasbela Winder, UC Winder, Tehsil Sonmiani

0 5 0 1

4 cases of cutaneous Leishmaniasis were reported and timely investigated. Patients presented with typical lesion. During active search, 2 more cases found. Lesions were found on upper and lower limbs of all cases. Proper treatment was advised. DHO was informed.

3-Nov Malaria Balochistan Jaffarabad BHU Sohbatput 12 19 15 29

46 suspected cases of Malaria reported. 29 slides were tested by RDTs. 19 slides were positive (SPR 65%) for Malaria (PF 9, PV 7, Mix 3 i.e. FR 47%). Cases were from different location. DHO office provided RDTs and antimalarial to BHU Sohbat Pur. No any preven-tive measures were taken due to shortage of bed nets and spray chemical. Due to Scar-city of funds, no fogging can either be done by DOH. Health education and awareness session was done with entire community.

30-Oct Measles Balochistan Killa Saifullah Killi Pishingian, UC Nasai, Tehsil Muslim Bagh

4 1 0 1

4 suspected measles cases were reported and timely investigated. Vit A was given. Immunization status of all cases and community consisted 15 houses was checked. 50 children including affected children were found unimmunized in the community. Health awareness sessions were conducted. No vaccine was available in the district. EDOH was informed and provincial EPI has been requested for provision of vaccination to start immunization campaign immediately.

1-Nov Measles Balochistan Killa Saifullah Killi Cheena Bar-atkhail, UC Batozai, Tehsil KSF

3 3 1 1

8 suspected measles cases were reported and timely investigated. Vit A was given. Immunization status of all cases and community consisted 45 houses was checked. 200 children including affected children were found unimmunized in the community. Health awareness sessions were conducted. No vaccine was available in the district. EDOH was informed and provincial EPI has been requested for provision of vaccination to start immunization campaign immediately.

1-Nov Measles FATA Bajaur Agency

village Lara Banda, Tehsil Khar

1 1 2 1

Blood sample taken from 2 patients and sent to NIH Islamabad. 2 children died in this outbreak in the nearby houses and community. Community requested for immunization of their children. FSMO & DSV took a brisk action with the technical support of SO-DEWS and prepare teams & logistics for the coverage of this area on same day. 455 children were vaccinated against Measles, 35 for BCG & Polio, 35 for Penta-1, 5 for Penta-2 and 3 for Penta-3. 15 ladies were also vaccinated for TT. Rest of the kids were given Vitamin A after confirming not taken in last 6 months. EPI staff of the relevant CHC was instructed to improve routine immunization. EPI Coordinator was especially re-quested for confirming an outreach plan for the area.

30-Oct Leishmaniasis Khyber Pakh-tunkhwa

Mardan

Village Alam Khan, Jauor, Sajan & Kalu khan, UC Mian Essa, Takht Bhai

0 7 0 5

An Alert of CL was reported from 4 small adjacent villages of UC Mian Essa. outbreak was already declared in the UC. In response active surveillance was conducted and 12 more clinical cases were identified in the area and surroundings. Line list was updated. UNHCR was requested through FPHC Mardan Office and they supplied 200 vials of re-quired treatment for CL cases. Onjob training of health staff was conducted for Intrale-sional adminstration of Inj Glucantine. RBM focal person was informed and requested for vector control measures in the affected area. FPHC and Relief Int. will also provide support in vector control interventions in the area with RBM & PPHI. EDO Health and focal person was informed.

31-Oct Measles Khyber Pakh-tunkhwa

Lower Dir village Sarlarai and Awaro, UC Manyal..

1 3 1 1

2 Suspected Measles cases were reported from measles ward MSF, DHQ Hospital Dir Lower. WHO team investigated the cases and detailed history was taken from the pa-tients. Blood Sample collected and sent to NIH Islamabad. Health education session was conducted and Vit.A drops were given. Alert was shared with EDO-H, Coordinator LHWs, coordinator EPI to intensify Mop up campaign in village Sarlarai and Awaro, UC Manyal.

1-Nov Measles Khyber Pakh-tunkhwa

Mansehra Mera Kalan UC Sher Garh Oghi

4 4 1 0

Medical Officer of BHU Shergarh informed about the cases of suspected Measles report-ed in OPD and nearby village. Surveillance Officer along with EPI technician and LHW of concerned area visited the village and found 9 suspected measles cases. Only one child was vaccinated while others were not vaccinated for Measles. Vitamin A was given and 34 children were vaccinated for Measles out of 45 children under the age of 5 years. Two samples taken and sent to NIH for confirmation

2-Nov Typhoid Khyber Pakh-tunkhwa

Haripur Khalabut Township Sector 3

1 5 1 3

7 confirmed Enteric fever cases were reported from Sarai Naimat Khan. Epidemiological and Environmental assessments were carried out. Field investigation found possible source as contaminated water supply. No shared food intake history. 3 more cases were identified on active case finding. Water samples from source, homes were taken and assessed for contamination. Health and hygiene sessions were conducted for affected families. EDO Health was informed of the outbreak.

31-Oct Measles Sindh Ghotki Village Sadoro Mahar UC Bhaitoor Taluka Khan Garh

4 1 1 0

Suspected measles case reported by health Technician BHU Cooprative society. Upon field investigation five more cases were found. Vitamin A was given. Blood sample was collected and sent to NIH. Routine immunization status of the village was observed zero. Community was sensitized for routine immunization. Information was shared with DHMT for vaccination in the area.

Weekly Bulletin: DEWS, Pakistan, Week no. Week no. 44 (28 Oct to 3 Nov 2012)



Cont’d current week's (44/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

2-Nov Measles Sindh Ghotki Village Jado Kobhar UC Sain Dino Malik Taluka Daharki

2 1 4 0

Suspected measles case reported from THQ Daharki. During active search along with DSC, six cases were found, Vitamin A was given to all. Three blood samples were taken and sent to NIH. Routine immunization status was observed zero. Only one child has BCG scar. DHMT requested for vaccination in the area

31-Oct Measles Sindh Khairpur Village Allah Warayo Behleem UC Agra Taluka Gambat

10 5 6 3

Suspected measles case was reported from RHC Agra. Alert was investigated and re-sponded. During field investigation 24 more suspected cases including one death were found. All cases were linelisted. Blood samples were taken and sent to NIH. Vitamin A were given to all suspected measles cases. EPI status of ten children was checked. All had BCG scars. Information was shared with DHMT. Mop up activity regarding routine immunization was advised along with measles containment measures.

2-Nov Measles Sindh Khairpur Near Makhdoom Dargah Piryaloi city & UC Taluka Kingri

0 1 3 1

Suspected measles case was reported from local HCP. Alert was timely responded. During field investigation 4 more cases were found. All were linelisted. Blood samples were taken and sent to NIH. Vitamin A were given to all suspected measles cases. EPI cluster was taken among ten children. Six were found with BCG scar. All information was shared with DHMT and mop up activity regarding routine immunization was ad-vised along with measles containment measures.

2-Nov Measles Sindh Khairpur Vilage Sardai Jatoi UC Gambat I

7 0 9 0

Suspected measles case was reported from GIMS THQH Gambat. Alert was timely re-sponded. During field investigation 15 cases were found including one death. All were linelisted. Blood samples were taken and sent to NIH. Vitamin A were given to all sus-pected measles cases. EPI cluster of 10 children was taken, where four were found with BCG scar. All information was shared with DHMT and mop up activity regarding routine immunization was advised along with measles containment measures.

2-Nov Measles Sindh Khairpur Village Eidan chachar UC Kot Mir Muham-mad Taluka Kingri

2 0 6 1

Suspected measles case was reported from BHU Piryaloi. During field investigation, 8 more cases were found. All were linelisted. Blood samples were taken and sent to NIH. Vitamin A were given to all suspected measles cases. EPI cluster of 12 children was taken, where all children found unvaccinated. Information was shared with DHMT and mop up activity regarding routine immunization was advised along with measles con-tainment measures.

1-Nov Measles Sindh Larkana Village Allah wadha-yo lashari

2 0 2 1

One suspected case was notified from private clinic. 4 more cases were found on active case finding in the affected area. Vitamin A doses were given. sensitization done for isolation of patients. Symptomatic treatment assured for cases. Community was sensi-tized about rouitne immunization. Five blood samples collected and send to NIH for lab confirmation. DHO informed to take action about routine immunization. Vaccination status of 11 children was checked; BCG=5(45%), Penta-1=4(36%), Penta-2=3(27%), Pen-ta-3=2(18%), Mealses-1=4(36%), Mealses-2=(0%). EDOH informed.

31-Oct Measles Sindh Matiari

Village Sher Muham-mad Balouch, UC Odero lal station, taluka Matiari

8 6 7 9

Seven cases and 1 death due to Measles were reported from THQ Matiari. Active sur-veilliance was done where 23 more cases were found from same location. Vitamin A was given to all cases. Health education imparted regarding health and hygiene, and importance of immunization. 5 Blood samples collected and sent to NIH. Vaccination status of the area was checked. BCG=(50%), Penta=(40%), Measles=(20%). Information shared with EDOH.

31-Oct Measles Sindh Qambar Shahdadkot

Haithaya Boohar, UC Boohar, taluka Qambar

2 3 1 2

Suspected 3 cases of Measles were reported from private clinic. Upon filed investigation 5 more cases were found. Four children were BCG scar +ve and parents were not sure about other antigens. Three blood samples were collected and sent to NIH. Vitamin A (2 doses) were given. Health education imparted regarding importance of routine immun-ization. Routine Immunization done in the affected area. Penta-1=70, Measles-1=50 (under 1 years), Measles-1=60 (12 to 23 months), Measles-1=59 (2 to 5 years). EDOH informed.

1-Nov Measles Sindh Qambar Shahdadkot

Dhani Bux Mugheri, UC Rawanti, taluka Qambar

7 2 6 1

One Death due to Measles was reported from private clinic. During filed investigation 15 more cases were found. 9 children having BCG scar and died children was not vaccinated against Measles. Parents were not sure about other antigen history. Vitamin A (2 doses) were given. Health education imparted regarding importance of routine immunization. 6 Blood samples were collected. Informed DHMT for vaccination and routine immunization was done on the next day. BCG=8, OPV-1=3, Mea-sles-1=11, Measles-2=135 under 5 years, T.T-1=5, T.T-2=3.

31-Oct Measles Sindh Shikarpur Villlage Rehan khan jamali(Lakhi Morr), UC Ruk

5 2 4 1

Measles case was cross-notified by SO DEWS Sukkur. During field investigations, 2 Deaths due to post Measles complication and 10 other cases were found. Only 2 cases were found vaccinated for Measles-1 and others were not vaccinated. Two blood sam-ples were collected and sent to NIH. Vitamin (A) drops given to all cases. Health session was conducted on importance of routine immunization. EPI status of 16 children were assessed. 8 (50%) children had BCG scars. Information shared with DHMT & PPHI for Mop up the area.

1-Nov Measles Sindh Sukkur Village Wahab Burrira, UC Kandhra, taluka Rohri

4 1 1 0

Suspected Measles case was reported from pediatric ward GMC teaching hospital. Dur-ing field investigation 5 more suspected cases were found. Two Blood samples collect-ed. 2 doses of Vitamin-A given to all cases. Out of 6 cases only 1 child had BCG scar & were not vaccinated for Measles. Community was refusal of routine immunization. Health education imparted to cases & contacts on importance of routine immunization & personal hygiene. Vaccination status of 7 children were assessed. BCG=(10%), Mea-sles-1-2=(0%) according to parents and information shared with DHO & DHMT.




Province Khyber Pakhtunkhwa: 450 health facilities from 16 districts of Khyber Pakhtunkhwa sent reports to DEWS with a total of 90,019 patients consultations reported in week 44, 2012. Total 19 alerts were received and appropriate measures were taken. Altogether 8 alerts for Measles; 5 for Leishmaniasis; while 2 each for CCHF and Typhoid; while 1 each for AJS and DF. Acute diarrhoea trend shows minor increase as compared with last week.

Figure-5: Trend of acute diarrhoea diseases, province Khyber Pakhtunkhwa

Province Sindh:

Figure-3: Number of alerts received and responded, week 41 - 44, 2012 Figure-4: Number of consultations by age and gender, week 44, 2012

Province Punjab:

Figure-6: Number of alerts received and responded week 41 - 44, 2012, province KPK

Figure-7: Trend of trend of acute diarrhoea, province Sindh

926 health facilities from 23 districts in Sindh province reported to DEWS with a total of 347,346 patients consultations in week 44, 2012. Total 48 alerts re-ceived while 12 outbreaks were identified and appropriate measures were taken. Altogether 33 alerts for Measles; 5 each for AWD and NNT; 2 for Bloody diarrhoea; while 1 each for Acute diarrhoea, Pertussis and Typhoid. Acute Diarrhoea shows stability as compared with last week.

Figure-8: Number of alerts received and responded week 41 - 44, 2012, province Sindh

Figure-9: Trend of acute diarrhoea, province Punjab Figure-10: Number of alerts received and responded week 41 - 44, 2012, province Punjab

426 health facilities from 9 districts in province Punjab reported to DEWS with a total of 161,348 patients consultations in week 44, 2012. Total 24 alerts were received and appropriate measures were taken. Altogether 10 alerts for Typhoid; 8 for Measles; 2 for NNT; while 1 each for Acute diarrhoea, ARI, Bloody diarrhoea and Leishmaniasis. AD shows a minor decreasing as compare with last week.

73

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Measles

Leishmaniasis

AWD

Typhoid

Pertussis

CCHF

Malaria< 1 yr 1-4 yr 5-14 yr 15-50 yr 50 + yr

Male 23261 56411 72632 116532 50608

Female 21901 51789 74423 163535 52953

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State of Azad Jammu and Kashmir:

Province Gilgit Baltistan:

FATA:

Province Balochistan:

Figure-11: Trend of acute diarrhoea, province Balochistan Figure-12: Number of alerts received and responded week 41 - 44, 2012, Balochistan

333 health facilities from 19 districts in province Balochistan reported to DEWS with a total of 44,494 patients consultations in week 44, 2012. Total 20 alerts reported and 5 outbreaks were identified and appropriate measures were taken in week 44, 2012. Altogether 8 for Leishmaniasis; 5 for Measles; 3 for Malaria; 2 for Acute diarrhoea; while 1 each for AWD and Pertussis. An increase noted in AD trend as compared with last weeks.

16 health facilities from 2 districts in Gilgit Baltistan reported to DEWS with a total of 9,141 patients consultations in week 44, 2012. 3 alerts for measles were reported in week 44, 2012. AD showing decrease from last few weeks.

Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week 41 - 44, 2012, Gilgit Baltistan

Figure-15: Trend of acute diarrhoea, FATA

54 health facilities from 3 agencies in FATA reported to DEWS with a total of 8,500 patients consultations in week 44, 2012. 7 alerts; 3 for Measles; while 2 each were for Leishmaniasis and NNT were reported in week 44, 2012 and appropriate measures were taken. An increase in AD is noted this week.

Figure-16: Number of alerts received and responded week 41 - 44, 2012, FATA

Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 41 - 44, 2012, AJ&K

103 health facilities from 9 districts in AJ&K reported to DEWS with a total of 20,089 patients consultations in week 44, 2012. One alert for Measles was reported in week 44, 2012. AD showing a decreasing trend last few weeks.

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Typhoid




Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

In week 44, 2012 one new type-1 polio case was reported from Federally Administered

Tribal Areas (Bajour Agency).

As of 3 November 2012, Pakistan has reported a total of 48 polio cases including 45 type-

1, 2 type-3 and 1 mixture type-1 and 3 polio cases from 26 districts/tribal agencies.

Province Cases 2011 Cases 2012

P1 P3 P1 P1+P3 P3

Punjab 9 - 2 - -

Sindh 33 - 4 - -

Khyber Pakhtunkhwa 23 - 19 - -

FATA 57 2 15 1 2

Balochistan 73 - 4 - -

AJ&K - - - - -

Gilgit-Baltistan 1 - 1 - -

Islamabad - - - - -

Total 196 2 45 1 2

Table-1: Number of alerts and outbreaks reported and investigated with appropriate response

CCHF: CCHF is a serious viral hemorrhagic fever with up to 50% case fatality rate, caused by an RNA virus of family Bunyaviridae, genus

Nairovirus, carried by Hyalomma species of ticks. Human beings become infected by tick bites or crushing the ticks, which are usually found on sheep, cattle, goats or camels, and their slaughtered skins. They may also be exposed to the virus in blood or tissues of a viremic animal during its slaughter and butchering; or by contact with infected blood or secretions of acute human cases in home or hospital setting.

Two new suspected cases of CCHF in week 44. In 2012, So for a total of 57 suspected cases have been reported throughout the country with 40 confirmed to date and 14 deaths; (CFR is 35.00%). 22 confirmed cases have been reported from Balochistan; 7 from Sindh; 6 from Khyber Pakhtunkhwa and 5 from Punjab. Chart at right illus-trates current situation of CCHF cases in 2012.

Approximately all the cases have contact history with animal trading/handling, tick bite, contact with patient, tannery worker,

butcher/animals slaughtering, a traditional practice of wearing fresh animal skin (posti) to treatment ailment. These animals and their skins have continuous movement intra Pakistan and between neighboring countries (Afghanistan and Iran).

Any contact of a CCHF patient should monitor his/her temperature for 14 days and see a doctor if fever develops. The anti viral medicine Ribavirin has been effective in saving lives of patients who report early to the health facility.

Follow up of CCHF, Measles and Dengue

Disease 2011 2012 (up till week 43) Current week 44, 2012 Total for 2012 (week 1-44, 2012)

A O A O A O A O

Acute watery diarrhoea 1350 543 595 161 6 1 601 162

Acute jaundice syndrome 51 17 101 19 1 0 102 19

Bloody diarrhoea 98 20 115 11 3 0 118 11

CCHF 17 3 61 39 2 0 63 39

Dengue fever 785 111 159 29 1 0 160 29

Diphtheria 40 19 35 10 0 0 35 10

Measles 1708 110 4826 506 61 17 4887 523

Pertussis 287 81 350 140 2 0 352 140

NNT + tetanus 399 0 466 0 9 0 475 0

Malaria 131 88 118 61 3 1 121 62

Leishmaniasis 298 33 726 66 16 2 742 68

Others 588 47 1283 56 18 1 1301 57

Total 5752 1072 8835 1098 122 22 8957 1120

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Number of CCHF cases (week 1 to 44, 2012), Pakistan

Suspeceted Positive Deaths




Table-1 2012 (Week 1 - 44)

# of Alerts # of Outbreaks # of Cases # of Deaths Province

AJ&K 153 5 243 0

Balochistan 386 102 1570 21

FATA 181 27 498 13

Gilgit Baltistan 25 0 26 0

ICT 20 2 55 0

Khyber Pakhtunkhwa 1818 94 3236 34

Punjab 719 31 1155 15

Sindh 1591 264 4389 85

Total 4893 525 11172 168

Table-2 Epi - week 44, 2012


AJ&K 1 0 1 0

Balochistan 5 2 17 0

FATA 3 1 10 0

Gilgit Baltistan 3 0 3 0

ICT 0 0 0 0

Khyber Pakhtunkhwa 8 2 22 0

Punjab 8 0 11 0

Sindh 33 12 178 7

Total 61 17 242 7

Measles: As of 20 October 2012, more measles cases and deaths have been reported in Pakistan than in 12 months last year. Table 1 sum-marizes the situation of measles in 2012 up to 3 November; and table 2 illustrates the alerts and outbreaks in week 44 (28 Oct to 3 Nov, 2012).

As it is shown in the above table that majority of the measles cases have been reported from Sindh and Khyber Pakhtunkhwa provinces. Both of these provinces have announced the EPI facilities will be providing measles vaccine twice a week for all children under age 5.

Dengue:

The chart at right showing the weekly number of confirmed Dengue cases reported by surveillance focal points from the Depart-ments of Health in Sindh and Punjab in 2012. Total number of con-firmed dengue cases to date in 2012 is 369 in Sindh and 338 in Pun-jab. Month of peak incidence in 2010 was November while peak inci-dence in 2011 was in September and October.

Malaria:

The chart at right shows the Malaria slide positivity and Falciparum rate reported in week 44, 2012. Total number of malaria cases tested in this week is 14,114, out of which 2022 were found positive; 1307 for P. Vivax; 562 for P. Falciparum; while 153 for Mixed (SPR = 14.33%; F. R = 35.36%).

AWD:

The surveillance definition for a case of “Acute Watery Diar-

rhoea” (AWD) or suspected cholera in an endemic area, is any case over age 2 years with severe dehydration or death due to diarrhoea of 3 or more stools in 24 hours.

An AWD outbreak is defined as a cluster of 6 or more cases of

AWD or any number of cases with at least one confirmed case of Vibrio cholera.

The table at right summarizes the situation of AWD in last four

weeks, 7 October to 3 November 2012. During the period, a total of 42 AWD alerts were reported and 18 confirmed AWD out breaks were identified and were responded very efficiently and in systematic manner.

The Surveillance Officers in the districts with the close coordi-

nation of trained rapid response teams from Department of Health and partners address the outbreaks.

AWD Week 41 - 44, 2012


Outbreaks with

confirmed V. cholera

AJ&K 0 0 0 0 0

Balochistan 7 6 400 2 2

FATA 0 0 0 0 0

Gilgit Baltistan 0 0 0 0 0

ICT 0 0 0 0 0

Khyber Pakhtunkhwa 7 3 8 0 3

Punjab 4 1 20 1 1

Sindh 24 8 81 1 7

Total 42 18 509 4 13

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Weekly trend of positive Dengue cases reported from Sindh and Punjab, week 1 to 44, 2012 Punjab Sindh

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Balochistan Sindh FATA Punjab KPK GB AJK ICT

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Malaria slide positivity and falciparum rate, week 44, 2012

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Alerts and outbreaks, week 44, 2012

volume 3, issue 44, wednesday 7 november 2012...

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