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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. 26 (24 - 30 June 2012)

• Measles: 146 alerts investigated this week, re‐sponding to 23 outbreaks involving 382 measles cases, 8 deaths.

• AWD: 12 alerts investigated this week and 6 outbreaks identified in 5 districts of Sindh with 41 cases and 1 death; 1 outbreak in Thatta with confirmed V. c. Ogawa, 1 in Badin with V. c. Inaba, while 4 outbreaks are pending for labs result.

• No new CCHF case reported this week; In 2012, total of 21 confirmed cases have been reported throughout the country. Most of the cases (12) directly reported from Balochistan, 4 each KPK and Sindh and 1 from Punjab.

• No new polio case was reported; As of 2 July 2012, Pakistan has reported a total of 22 polio cases (19 type‐1, 2 type‐3 and 1 mixture type‐1 and 3) from 13 districts/tribal agencies.

• 88 districts have reported to DEWS in week 26, 2012, Please see map. 2,270 health facilities have shared weekly data to the Disease Early Warning System (DEWS) in this week

• 835,476 patients’ consultations were reported in week 26 compared to 838,795 consultations reported on week 25, 2012.

• Total 209 alerts were investigated, while re‐sponse provided to 39 outbreaks.

Highlights

Disease early warning system and response in Pakistan

01

Volume 3, Issue 26, Wednesday 4 July 2012

• The graph (Figure‐1) 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.

• Trend of acute diarrhoea is stable in all provinces. Districts in Sindh and Khyber Pakhtunkhwa are investigating alerts for acute watery diarrhoea/suspected cholera.

Disease # of Cases Percentage

Acute diarrhoea 1,346,646 8%

Bloody diarrhoea 84,324 0.5%

ARI 3,443,184 20%

S. Malaria 802,606 5%

Skin Diseases 775,032 4%

Unexplained fever 612,683 3%

Total (All consultations) 17,584,383

Disease # of Cases Percentage

Acute diarrhoea 74,941 9%

Bloody diarrhoea 3,871 0.5%

ARI 118,518 14%

S. Malaria 46,223 6%

Skin Diseases 37,742 5%

Unexplained fever 30,650 4%

Total (All consultations) 835,476

Figure‐2: Weekly trend of Acute diarrhoea in Pakistan Week‐1, 2011 to week‐26, 2012.

Figure‐1: 88 districts reported to DEWS in week 26, 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 Others Major health events reported during the

Epi‐week ‐ 26 (24 ‐ 30 June 2012)

Cumulative number of selected health events reported in Epi‐week 1 ‐ 26 (1 Jan ‐ 30 June 2012)

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Weekly Bulletin: DEWS, Pakistan, Week no. 26 (24 to 30 June 2012)

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

Current week's (26/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

25‐Jun Measles Balochistan Killa Saifullah Kili Nali, UC Nasai, Tehsil Muslim Bagh

3 0 3 0 6 suspected cases of measles were reported. Vit A drops were given to the cases. Health education imparted. None of the suspected case were found vaccinated against measles. DHO informed and re‐quested for intensified outreach vaccination activity in the locality.

25‐Jun Measles Balochistan Lasbela Allu Goth, UC Lakhra, Tehsil Lakhra

1 4 1 0

An alert of suspected measles was reported. During active search 5 more suspected cases were found. Vit A drops were given to the cases. All cases were found unvaccinated against measles. 10 children were assessed for routine immunization where BCG with scar 7(70%), M1 6(60%) and M2 0%. Information shared with DHO for outreach vaccination activity in the locality. 2 blood samples were collected for lab confirmation.

26‐Jun Measles Balochistan Kech Pullabad UC Gomazi, Tump 2 4 0 0

2 suspected cases of measles were reported. On active surveillance 4 more suspected cases were found. Vit A drops provided. 56 children were assessed for routine immunization out of which 7 were found unvaccinated against any antigen. Vaccination was done on the spot. Information was shared with DHO.

26‐Jun Measles Balochistan Mastung Killi Sadeeq Abad, UC Ghulam Prinz 1 4 2 2

An alert of suspected measles was reported. On active search 9 more suspected cases were found. All the cases were refusals for routine vaccination. Health education session conducted about the impor‐tance of immunization with the community. Outreach vaccination activity planned.

27‐Jun Measles Balochistan Kech Kohad UC Balicha, Tump 2 4 0 0

4 suspected cases of measles were reported. On active surveillance 2 more suspected cases were found. Vit A drops provided. Health education imparted. Immunization status of the community was not satis‐factory. Matter was discussed with DDHO and DSM PPHI. Outreach vaccination activity planned.

27‐Jun Measles Balochistan Killa Saifullah

Nomadic popula‐tion at Kan me‐hterzai, Tehsil Muslim Bagh

3 2 2 1 8 suspected cases of measles were reported. Cases were found unvaccinated against measles. Vit A drops were given to the cases. Health education imparted. Immunization status of the community was not satisfactory. Informed DHO and requested for the intensified outreach activity in the locality.

27‐Jun Measles Balochistan Ziarat Shereen, UC Chutair, Tehsil Sinjavi

0 4 4 1

An alert of suspected measles was reported. On field investigation,8 more suspected cases were found. All the cases were found unvaccinated against measles. Vitamin A drops were given to the cases. Health education imparted. 28 children were assessed for routine immunization out of which 2 were partially immunized. On outreach activity 134 children were vaccinated. Follow up planned.

28‐Jun Leishma‐niasis Balochistan Lasbela Allah abad town,

Tehsil HUB 0 6 0 0 2 suspected cases of Cutaneous Leishmaniasis were reported. Cases were on Injection Glucantime. During active search, 4 more suspected cases were found. Information shared with DHO.

28‐Jun Pertussis Balochistan Pishin Killi Huramzai, UC Huramzai 2 0 3 0

5 suspected cases of Pertussis were reported. Erythromycin tabs and syrups provided to the cases and contacts. Health education imparted. DHO informed.

28‐Jun Measles Balochistan Pishin Moula Muham‐mad Khan yaro, UC Yaro

2 3 0 0 5 suspected cases of measles were reported. Vit A drops provided. Health education imparted. Cases were found unvaccinated against measles. Vaccination done on the spot.

29‐Jun Malaria Balochistan Jhal Magsi (RHC Jhalmagsi), UC Jhal Magsi, Tehsil Jhal magsi

11 32 9 22 74 suspected cases of Malaria were reported. 56 cases were tested and 32 found positive (SPR= 57%) for PF=11, PV=14 & mixed=7(FR=56%). ACTs were provided. All cases belongs to same locality. Information shared with DHMT and requested to take further necessary action.

29‐Jun Measles Balochistan Pishin Killa Haji Khan, UC Jaji Khan 5 1 2 0

An outbreak of suspected measles was reported. During field investigation, total of 8 suspected cases of measles were found. All the cases were found unvaccinated against measles. Vit A drops provided. Health education imparted. DHO informed about the outbreak and requested for intensified outreach activity in the locality.

26‐Jun Measles FATA Khyber Agency

Village Miwa khan,Barra Dara,UC Kambila

6 1 1 1

An outbreak and death due to suspected measles were reported. On field investigation, total of 9 cases were found including a death. Vitamin A drops were given to the suspected cases.2 blood samples col‐lected and sent to NIH for lab confirmation. Health education imparted. 107 children vaccinated for measles on outreach activity. Report shared with the Agency Surgeon, PPHI and FSMO.

25‐Jun BD Khyber Pakhtunk‐hwa

Mansehra Village Dheryal, UC Sum Ellahi Mang 0 4 0 5

An alert of Bloody Diarrhea was reported. On field investigation,9 more cases were found. 1 stool sample was taken and sent to NIH for lab confirmation. Health education imparted, Soap and Chlorine tablets Distributed, All cases were using the same source of water, EHE requested to visit the area for chlorina‐tion of tank (source)

27‐Jun Measles Khyber Pakhtunk‐hwa

Haripur Village Amgah, UC Kotehra 2 5 2 3

12 suspected of measles were reported. Vitamin A drops provided to the cases. Health education im‐parted. Outreach vaccination is scheduled subject to availability of vaccine.

25‐Jun Measles Punjab D. G. Khan Basti walia uc Kot Haibat 4 1 0 0

An alert of suspected measles was reported. During active search, 4 more suspected cases were found. Vit A drops were given to the cases. 1 blood sample collected and sent to NIH for lab confirmation. 11 children were assessed for routine immunization coverage and none of the child found vaccinated against any antigen. 162 children were covered in the outreach vaccination activity. Community was provided awareness through health education session for highlighting the importance of vaccination of their children against all the EPI diseases.

25‐Jun Measles Sindh Qambar Shahdadkot

Massan Muhalla, UC‐2, taluka Shahdadkot

1 1 1 1 2 deaths and 2 suspected cases of measles were reported. Vitamin (A) drops provided, health education imparted, cluster for vaccination wasn't taken due to female families were at home. Information shared with THO and request for intensified outreach vaccination activity in the area.

26‐Jun Measles Sindh Dadu Village Buthi, UC Dhani Buksh Bughio

7 4 5 0

An alert of measles was reported. During field investigation, 15 more suspected cases were found includ‐ing 1 death. Vitamin (A) drops provided. Health education imparted. 15 children were assessed for rou‐tine immunization where BCG= 12(82%), Penta1=10(64%),Penta2=9(58%), Penta3=7(48%), Measles1=8(56%), Measles2=7(49%). THO informed and 2 Blood samples collected for lab testing.

25‐Jun Measles Sindh Sukkur Sasti basti, UC Tamachani, taluka new Sukkur

3 0 2 0

2 suspected cases of Measles were reported. During field investigation 3 more suspected cases were found, 4 blood samples collected and sent to NIH for lab confirmation. Vitamin A drops were given to the cases. Health education imparted. 8 children were assessed for routine immunization where none of the child were found vaccinated against measles. Information shared with DHMT.



Cont’d current week's (26/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken

26‐Jun Pertussis Sindh Dadu Village Mureed Dero, UC Drigh Bala, taluka Johi

3 1 4 4

An alert of suspected Pertussis was reported. During field investigation total 12 suspected cases were found. Erythromycin tabs and syrups were given to the case and contacts, health education imparted. 12 children were assessed for routine immunization where BCG=5(45%), Penta1=4(36%), Penta2=3(27%), Penta3=2(21%), Measles1=3(23%), Measles2=2(18%). Information shared with EDOH, THO, EPI‐FP. 1 throat Swab collected for lab testing.

26‐Jun Measles Sindh Karachi Al Shifa football ground, Patel Para, Lasbella Chowk

4 0 1 0

An alert of suspected measles was reported. During active surveillance 4 more suspected cases were found. Vitamin (A) dose were given to all cases, health education imparted, 21 children were assessed for routine immunization where BCG=19(90%), Penta1=16(76%), Penta2=15(71%), Penta3=15(71%), Measles1=13(62%), Measles2=5(24%), DHMT informed about the case and 1 Blood sample collected for lab testing.

26‐Jun Measles Sindh Shikar‐pur

Village Ladho khan Banglani, UC Jano 4 0 2 0

2 suspected cases of Measles were reported. On active search 4 more suspected cases were found, Vitamin (A) drops were given to the cases, health education imparted, 16 children were assessed for routine immuni‐zation where none of the child were found vaccinated against measles, DHMT informed. 4 Blood samples collected for lab confirmation.

27‐Jun Measles Sindh Dadu Village Manjhi Laiyo, UC Drigh Bala, taluka Johi

4 2 5 2

An alert of suspected measles was reported. During active surveillance total 13 suspected cases were found, vitamin (A) drops provided, health education imparted. 13 children were assessed for routine immunization where BCG=5(40%), Penta1=3(26%), Penta2=2(16%), Penta3=1(13%), Measles1=2(20%), Measles2=1(14%). THO informed and request for outreach vaccination activity in the locality.2 Blood samples collected for lab confirmation.

27‐Jun Measles Sindh Khairpur Settlement, near Mangi Mari, UC Sagyoon

1 0 4 0

An alert of suspected measles was reported. On active search,5 more suspected cases were found, 2 blood samples collected for lab confirmation, Vitamin (A) dose were given to the cases. None of the case were found vaccinated against measles. Information shared with DHMT and request for outreach vaccination activity in the locality.

27‐Jun Pertussis Sindh Khairpur Village Ghulam Hussain Channa, UC Sagyoon

3 0 2 0 An alert of suspected Pertussis was reported. On active search, total of 5 suspected cases were found. 10 children were assessed for routine immunization where 5 (50%) were found vaccinated against BCG. Infor‐mation shared with DHMT and 1 Nasopharyngeal Swab collected for lab confirmation.

27‐Jun Measles Sindh Qambar Shahdad‐kot

Haji Mohammad Khan Lashari, UC Kalar, taluka Qam‐bar

1 0 3 1

An alert of suspected measles was reported. On active search 4 more suspected cases were found, Vitamin (A) drops provided to the cases, health education imparted regarding routine immunization. 10 children were assessed for routine immunization where BCG=3(30%), Penta‐1=3(30%), Penta‐2=2(20%), Penta‐3=1(10%), Measles‐1=2(20%) and Measles2=(0%). DHMT informed and 3 Blood samples collected for lab confir‐mation.

27‐Jun AWD Sindh Shikar‐pur

Village lorae, near Maal puri Bypass 2 1 2 1

An alert of AWD was reported. During field investigation 5 more cases were found, water supply was the source of contamination of water, health education imparted, Aqua tabs, Zinc tabs, ORS and IEC material distributed. Information shared with DHMT, 1 Rectal swab and 4 water samples collected for lab testing.

28‐Jun AWD Sindh Ghotki Village Banho Khushk UC Jarwar 3 0 4 0

A death was reported due to AWD/suspected cholera. During field investigation, 6 more cases were found. Health education imparted. Aqua Tab & Hygiene Kits distributed. Hand pump was the source of drinking water. 4 water samples were tested and all found unfit for drinking purpose. Information shared with DHO Ghotki.

28‐Jun Pertussis Sindh Khairpur Village Fauji Ahmed Ali laghari, UC Chondiko

2 0 3 0

An alert of suspected Pertussis was reported. On field investigation, 5 more suspected cases were found. 1 Nasopharyngeal swab collected for lab confirmation. Erythromycin tabs and syrups were distributed. 10 children were assessed for routine immunization where none of the child found vaccinated against measles. Information shared with DHMT and request for outreach vaccination activity in the area.

28‐Jun Pertussis Sindh Matiari Village Wali Muham‐mad Akhund, UC Sekhat

2 0 2 1

An alert of suspected Pertussis was reported. During field investigation total 5 suspected cases were found, health education imparted, Erythromycin tabs and syrups provided to the cases and contacts. 6 children were assessed for routine immunization where BCG=3(50%), Penta =2(40%). EDOH informed and 2 Naso‐pharyngeal swabs collected for lab testing.

28‐Jun Pertussis Sindh Shaheed Benazir Abad

Village Mir khan laghari 0 0 4 2

An alert of suspected Pertussis was notified. On active search, 5 more suspected cases were found. Cluster for routine immunization was taken from 12 houses where 14 children were assessed, BCG scar=8(66%), Penta‐1‐2= 7(58%) , Penta‐3=6(42%), Measles‐1=4(28%) and Measles‐2=(0%).Information shared with DHMT.

29‐Jun AWD Sindh Dadu Alamdar road, main Guhram Gopang city 1 3 0 4

2 AWD cases were notified. During field investigation 6 more cases were found. Water supply was the source of water, Aqua tabs, Zinc tabs and ORS distributed in the community, health education imparted. EDOH, THO, DSC and FP‐National program informed. 2 Stool and 2 water samples collected for lab confirmation.

29‐Jun AWD Sindh Dadu Ghareebabad Muhalla, near Girls degree college

1 1 2 1 An alert of AWD was reported. During field investigation 4 more cases were found, Water supply was the source of water, Aqua tabs, Zinc tabs and ORS distributed, health education imparted. EDOH, THO, DSC and FP‐National program informed. 1 Stool and 2 water samples collected for lab testing.

29‐Jun Measles Sindh Ghotki Ghulam abad near Degree college UC I Mirpur Mathelo

3 0 2 1

An alert of suspected measles was reported. During active search 5 more suspected cases were found. Vita‐min A drops provided. 2 blood samples collected and sent to NIH for lab testing. Health education imparted to the community regarding the importance of routine immunization, 13 children were assessed for routine immunization where 1 child was found with BCG scar and rest of the children were totally unvaccinated. Information shared with DHMT and requested for vaccination in the area.

29‐Jun Measles Sindh Larkana Village yar ali chandio 3 1 6 2

An alert of suspected measles was notified. On active search 11 more suspected cases were found, Vitamin (A) drops were given to the cases, health education imparted. 12 children were assessed for routine immuni‐zation where BCG 2(20%) and rest of the children were found totally unvaccinated. DHO informed about the situation and 6 Blood samples collected for lab confirmation.

29‐Jun Measles Sindh Qambar Shahdad‐kot

Wanji Khoso, UC Lakha, taluka Naseerabad

1 0 4 0

An alert of suspected Measles case was reported. On active search 4 more suspected cases were found, Vitamin (A) drops provided to the cases, health education imparted. 10 children were assessed for routine immunization where BCG=3(30%), Penta‐1=3(30%), Penta‐2=2(20%), Penta‐3=1(10%), Measles‐1=2(20%) and Measles2=(0%). DHMT informed and 5 Blood samples collected for lab confirmation.

18‐Jun AWD Sindh Thatta Village Muhammad Khan Jatoi, taluka Mirpur Bathoro

0 1 0 1 An alert of AWD was reported. On active search 1 more case was found, Hand Pump was the source of water, Aqua tabs, Zinc tabs and ORS distributed, health education imparted. 1 Stool sample collected which resulted positive for Vibrio Cholera‐Ogawa. Information shared with EDOH for further necessary action.

25‐Jun AWD Sindh Badin Village Moosa Malah, UC Abdullah shah

1 1 1 1 An alert of AWD was reported. During field investigation 3 more cases were found, Hand pump was the source of water, Aqua tabs, Zinc tabs, ORS and Dettol soaps distributed, health education imparted, DHMT and MS informed, 1 Stool sample tested which resulted positive for Vibrio Cholera Inaba.



Province Khyber Pakhtunkhwa: 444 health facilities from 18 districts of Khyber Pakhtunkhwa reported to DEWS with a total of 133,091 patients consultations reported in week 26, 2012. Total 32 alerts were received while 3 outbreaks were identified and appropriate measures were taken. Altogether 29 alerts for Measles; while 1 each for BD, Leishmaniasis, and Typhoid. Acute diarrhoea shows a slightly upward trend in KP.

Figure-5: Trend of acute diarrhoea diseases, province KPK

Province Sindh:

Figure‐3: Number of alerts received and responded, week 26, 2012 Figure‐4: Number of consultations by age and gender, week 26, 2012

Province Punjab:

Figure-6: Number of alerts received and responded week 23 - 26, 2012, province KPK

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

742 health facilities from 23 districts in province Sindh were reported to DEWS with a total of 379,356 patients consultations in week 26, 2012. Total 92 alerts received while 21 outbreaks were identified and appropriate measure were taken. Altogether 62 alerts for Measles; 9 for AWD; 7 for Typhoid; 6 for Pertussis; 4 for NNT; 2 for Scabies; while 1 each for Diphtheria and Leishmaniasis. The AD shows a steady trend in Sindh.

Figure-8: Number of alerts received and responded week 23 - 26, 2012, province Sindh

Figure-9: Trend of acute diarrhoea, province Punjab Figure-10: Number of alerts received and responded week 23 - 26, 2012, province Punjab

399 health facilities from 9 districts in province Punjab reported to DEWS with a total of 188,188 patients consultations in week 26, 2012. Total 48 alerts were received and appropriate measures were taken. Altogether 30 alerts for Measles; 2 each for Acute diarrhoea, AJS, ARI and Scabies; while 1 each for AWD, BD, DF and Tetanus. A steady trend noted in the proportion of AD consultation in Punjab during the last few week.

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2011 2012

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2011 2012

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

Male 26997 64793 86262 131857 57930

Female 26746 61937 90391 219942 68621

0

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100000

150000

200000

250000

# of cases

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10

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30

40

50

Wk‐23 Wk‐24 Wk‐25 Wk‐26

# of alerts

AWD

DF

Leishmaniasis

Malaria

Measles

175 173 181 146

0

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30

40

50

Wk‐23 Wk‐24 Wk‐25 Wk‐26

# of alerts

AWD

CCHF

DF

Leishmaniasis

Malaria

Measles

Pertussis

65 53 53

29

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AWD

CCHF

DF

Leishmaniasis

Measles

Pertussis

37

57 58 62

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AWD

Leishmaniasis

Malaria

Measles

Pertussis



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 23 - 26, 2012, Balochistan

471 health facilities from 21 districts in province Balochistan reported to DEWS with a total of 74,077 patients consultations in week 26, 2012. Total 26 alerts reported while 12 outbreaks were identified and appropriate measures were taken in week 26, 2012. Altogether 15 alerts for Measles; 4 for Leishmaniasis; 2 each for Malaria, AWD and chicken pox; while 1 for Pertussis. An upward trend noted in AD.

27 health facilities from 4 districts in Gilgit Baltistan reported to DEWS with a total of 12,255 patients consultations in week 26, 2012. 2 alerts for measles were reported in week 26, 2012. AD showing a slightly upward trend.

Figure-13: Trend of acute diarrhoea, province Gilgit Baltistan Figure-14: Number of alerts received and responded week 23 - 26, 2012, Gilgit Baltistan

Figure-15: Trend of acute diarrhoea, FATA

53 health facilities from 3 agencies in FATA reported to DEWS with a total of 16,103 patients consultations in week 26, 2012. 1 alert for Measles was reported in week 26, 2012 and appropriated measures were taken.

Figure-16: Number of alerts received and responded week 23 - 26, 2012, FATA

Figure-17: Trend of acute diarrhoea, AJ&K Figure-18: Number of alerts received and responded week 23 - 26, 2012, AJ&K

122 health facilities from 9 districts in AJ&K reported to DEWS with a total of 27,854 patients consultations in week 26, 2012. 6 alerts for Measles reported in week 26, 2012 and appropriate measures were taken.

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2011 2012

0

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25

30

35

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Percen

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2011 2012

0

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2011 2012

0

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2011 2012

0

10

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30

40

50

Wk‐23 Wk‐24 Wk‐25 Wk‐26

# of alerts

AWD

CCHF

Leishmaniasis

Malaria

Measles

Pertussis

0

10

20

30

40

50

Wk‐23 Wk‐24 Wk‐25 Wk‐26

# of alerts Leishmaniasis

Measles

Pertussis

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30

40

50

Wk‐23 Wk‐24 Wk‐25 Wk‐26

# of alerts

Leishmaniasis

Measles

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# of alerts

Leishmaniasis

Measles



Distribution of Wild Polio Virus cases Pakistan 2011 and 2012

• In week 26, 2012 no new type‐1 polio case was reported.

• As of 2 July 2012, Pakistan has reported a total of 22 polio cases (19 type‐1, 2 type‐3 & 1 mixture type‐1 & 3) from 13 districts/tribal agencies.

Province Cases 2011 Cases 2012

P1 P3 P1 P1+P3

Punjab 9 ‐ 2 ‐

Sindh 33 ‐ 3 ‐

Khyber Pakhtunkhwa 23 ‐ 4 ‐

FATA 57 2 8 1

Balochistan 73 ‐ 2 ‐

AJ&K ‐ ‐ ‐ ‐

Gilgit‐Baltistan 1 ‐ ‐ ‐

Islamabad ‐ ‐ ‐ ‐

Total 196 2 19 1

P3

‐

‐

‐

2

‐

‐

‐

‐

2

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

2011 2012 (up till week 25) Current week 26, 2012

A O A O A O A O

Acute watery diarrhoea 1350 543 234 21 12 5 246 26

Acute jaundice syndrome 51 17 68 7 3 0 71 7

Bloody diarrhoea 98 20 75 5 2 1 77 6

Dengue fever 785 111 53 2 1 0 54 2

Measles 1708 110 2885 275 146 23 3031 298

Pertussis 287 81 275 113 7 6 282 119

NNT + tetanus 399 0 276 0 5 0 281 0

Malaria 131 88 73 45 2 1 75 46

Leishmaniasis 298 33 485 41 6 1 491 42

Others 645 69 795 68 25 2 820 70

Total 5752 1072 5219 577 209 39 5428 616

Total for 2012 (week 1‐26, 2012)

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.

In 2012, total of 28 suspected cases have been reported throughout the country with 21 confirmed to date and 6 deaths; (CFR is 30%). 17 cases have been reported from Balochistan; 4 each from KP and Sindh and 3 from Punjab. Chart at right illustrates 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 ani‐mals 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

0

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6

8

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# of cases

Epi‐week

Number of CCHF cases (week 1 to 26, 2012), Pakistan

Cases Positive Deaths



Table‐1

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

AJ&K 86 4 132 0

Balochistan 252 67 1131 9

FATA 104 18 308 5

Gilgit Baltistan 15 0 16 0

ICT 11 2 41 0

Khyber Pakhtunk‐hwa 1192 62 2186 29

Punjab 432 22 747 14

Sindh 939 123 2379 44

Total 3031 298 6940 101

2012 (Week 1 ‐ 26)

Province

Table‐2

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

AJ&K 6 0 7 0

Balochistan 15 9 79 0

FATA 1 1 9 1

Gilgit Baltistan 2 0 2 0

ICT 1 0 3 0

Khyber Pakhtunk‐hwa 29 1 53 0

Punjab 30 1 54 1

Sindh 62 11 175 6

Total 146 23 382 8

Epi ‐ week 26, 2012

Province

Measles: As of 30 June 2012, more measles cases and deaths have been reported in Pakistan than in 12 months last year. Table 1 summarizes the situation of measles in 2012 up to 30 June; and table 2 illustrates the alerts and outbreaks in week 26 (24‐30 June, 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 show the weekly number of confirmed Dengue cases reported by surveillance focal points from the Departments of Health in Sindh and Punjab in 2012. Total number of confirmed dengue cases to date in 2012 is 68 in Sindh and 72 in Punjab. Month of peak incidence in 2010 was November while peak incidence in 2011 was in September and October. Malaria:

The chart at right shows the malaria slide posi‐tivity rate and Falciparum rate reported in week 26, 2012. Total number of malaria cases tested in week 26, 2012 is 20013, out of which 3812 were found positive; 2858 for P. Vivax; 598 for P. Falciparum; while 356 for Mixed (SPR = 19.05%; F. R = 25.03%)

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Weekly trend of positive Dengue cases, week 1 to 26, 2012

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Balochistan Sindh KP FATA Punjab AJK GB ICT

SPR 21.1 19.35 25.12 22.58 10.47 1.46 0 0

F. R 48.48 25.41 8.01 2.4 4 0 0 0

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Malaria slide positivity and Falciparum rate, week 26, 2012



Alerts and outbreaks, week 26, 2012

weekly epidemiological - whovillage miwa khan,barra dara,uc kambila 6 1 1 1 an outbreak and death...

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