Weekly Epidemiological Bulletin


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1 Weekly Epidemiological Bulletin Disease early warning system and response in Pakistan Volume, Issue, Monday 9 September, Highlights Epidemiological week no. (9 - September, ) districts and agencies provided surveillance data to the DEWS this week from,4 health facilities. A total of 9,9 consultations were reported through DEWS of which 9% were acute respiratory infections (ARI), % Skin disease, % acute diarrhoea, and % suspected Malaria. Over all diarrhoea has increased by % as compared to the previous few weeks. A total of alerts with 4 outbreaks were reported in week-, : Altogether alerts were for DHF; were for AWD, 4 for NNT and Tetanus, for Measles, 4 for Pertussis, each were for bloody diarrhoea and Leishmaniasis; each for acute diarrhoea and suspected malaria, while each for CCHF, Meningitis, Scabies, Mumps and Chicken pox. National Polio Eradication Initiative reported new type- confirmed polio cases this week: These include from Balochistan (one each from districts Quetta Loralai and Pishin); from Sindh (Hyderabad and Umerkot). As of th September,, Pakistan has reported a total of 9 polio cases ( type- cases & type- case) from 4 districts/towns/ tribal agencies/areas. 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 : Three years trend of Acute diarrhoea in Pakistan (9,, and ) Disease Wk- Wk- Wk- Wk- Wk-4 Wk- Wk- Wk- Acute Diarrhoea,9 (%) 9, (%),9 (%),4 (%) 9,9 (%) 9,99 (%) 9,494 (%), (%) Total consultation,9,,,9,4,9 9,9 4,4,, 9,9 Since July 9,, approximately 44,, patient consultations have been reported to the DEWS from five provinces and three agencies and state of AJK. In this week, (9 to September, ) reports were received from,4 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, (9%), Skin diseases,9 (%) and suspected malaria 4,9 (%). The above graph shows the trend of acute diarrhoea cases out of total consultations reported to DEWS in 9, and up until now. This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : +9--9,

2 Current week's Outbreaks: Date Disease Province District Area <M >M <F >F Action Taken Sep AWD AJK Neelum Village Khel Mehdan, UC Khel, Tehsil Sharda. 9 Epidemiological Bulletin: DEWS, Pakistan, Week no. (9 to September, ) AWD alert was reported from RHC Khel, Distinct Muzaffarabad. Stool sample collected and sent to NIH Islamabad for lab testing. Water sample taken for quality testing. Case management reinforced community awareness session conducted, IEC material distributed and DHO was informed. 9 Sep AD Balochistan Bolan Kili sataktzai, UC Mach, Tehsil Mach System generated alert of 4 cases of AD were reported from Killi SATAKZAI, Bolan in a week time. DDK was provided to DoH. Aqua tabs were distributed in community and health education was given. stool samples and water samples were taken. Sep AWD Lower Dir Village Khan Abad, Dokrai, UC Kotkay, Maidan, Tehsil Lal Qilla 4 AWD alert, Case Investigated, Stool sample collected for lab confirmation, Water Samples taken for any fecal contamination, during active surveillance diarrhoea cases found. ORS, Hygiene kits and Aqua tabs were distributed, health and hygiene promotion session conducted with family members. EDO H was informed. Sep DHF Haripur Chamba Masjid stop UC Kholian Bala; Village Kalawan; Village Dingi, UC Dingi; Village Ghayrihan, UC Koklian; Village Shah Maqsood UC Shah Maqsood During the week cases of DF with deaths were reported from different locations. The patient presented with fever, headaches and body aches. Lab investigations revealed thrombocytopenia and leucopenia. blood samples were taken and all found positive for IgM Dengue. The patient was referred to BBS Hospital Rawalpindi but died on Sep. Epidemiological and environmental assessments were carried out in the area. A session on DF spread and prevention was conducted for the affected household. Health session was carried out during Jumma Prayers in the area. Fogging was done and bed nets were provided by EDO in the area. Sep DHF Lower Dir Abbottabad DHQ (Township, plot #, Lahore) Alert for DF, sample was collected and found positive for Dengue IgM, patient isolated at DHQ hospital, fog spray was done and bed nets were provided by EDO. Sep DHF Mansehra Village Timber Near Phulra Alert for DF reported from DHQ Hospital cases were admitted in Isolation ward by OPD, blood sample found positive for Dengue IgM, health education conducted, and bed nets provided to the patients. EDO health informed and requested for further necessary action. 4 Sep DHF Swat Village Landai Karinuna, UC Sakhra, Tehsil Matta Alert for DF, one case was reported from SGTH, blood sample found positive for dengue IGM. WHO Team along with DoH conducted a response at UC Sakhra and distributed LL INs. 4 Sep AWD Punjab Muzaffargarh Sep DHF Punjab D. G. Khan Basti Kalar Babran, Moza Ali Daha, UC Noohanwali Chah Chandnewala; Muradwala AWD alert, ERT visited the area where households were interviewed, six more cases were found and referred to RHC Baseera. Health education provided to family members. Distribution of hygiene kits, water filters, soaps, Aqua Tabs, ORS & IEC among them. Control measures and importance of awareness among general masses about safe drinking water, food & personal hygiene. alert for suspected DF cases reported from a private hospital. The cases were investigated, blood samples were taken and found positive for IgG. Patients were shifted to Dengue ward, LLINS applied around the bed to prevent spread of infection. WHO team along with CDCO and entomologist visit the area, IRS plus insecticide spray of the household and in the vicinity carried out. Dengue Prevention session was given to the community. EDO Health was informed and requested to update the provincial CDC. Sep DHF Punjab Khanewal Sep DHF Punjab Layyah Sep DHF Punjab Mianwali NHM; Mulas Pur Kabir Wala District Khanewal chak no /TDA u/ csemipurbhagal; chak no tda U/c tailindus; basti islampur u/c choubara rural Mohalla Alam Kheel,Balu Khel; Betian,PAF Road; Chidru Village and UC Chodru; Paikhel; Piplan city, Tehsil Piplan 4 Alert for suspected case of DF was reported from Nishtar hospital, the case was investigated blood sample was taken and found positive. The details and the line list are shared with the EDOH Khanewal and requested for taking further prevention measures. Alert for DF cases were reported from DHQ Hospital. blood samples were taken and found positive for IgG. Patients were shifted to Dengue ward, LLINS applied around the bed to prevent spread of infection. During field investigation Dengue Prevention session were conducted in the community. EDO Health was informed and requested to take further necessary measures. Alert for DF, cases were reported from five different locations. The cases were investigated. blood samples were taken and all found positive for IgG. Patients was shifted to Dengue ward, LLINS applied around the bed to prevent spread of infection. During field investigation IRS and insecticide spray of the household and in the vicinity carried out. Dengue Prevention sessions were conducted in the community. EDO Health was informed and requested to update the provincial CDC. Line listing updated. Sep DHF Punjab Multan Nishter Hospital Alert for DF, cases were reported from Nishter hospital. The cases were shifted to isolation ward. The details and the line list were shared with the EDOH Multan. WHO SO along with Health department team visited the areas and conducted house to house survey and found no more cases. two dengue awareness sessions were conducted in the feild and distributed IEC material regarding dengue prevention. Fogging of the whole union council is done by a CDC team from the health department. 4 Sep AWD Sindh Naushahro Feroze Village Bohio UC Kor Hassan 9 4 AWD alert, cases were reported from two different locations. During field investigation two samples taken and sent to NIH for lab confirmation, results awaited. Sep AD Sindh Sukkur Sukkur City Alert for AD, cases were reported from GMCH Sukkur, upon investigation cases were found with acute diarrhea, Health staff was sensitized on case definition of AD, health and hygiene session was also conducted for the affected. Sep AWD Sindh Thatta 9 Sep DHF Sindh Ghotki Village Jaind Zangeejo UC Jaind Zangeejo Sheikh Zayad Hospital RYK (Muslim Colony, Deharki) 9 Alert for AWD responded, During active surveillance cases of diarrhoea found, reinforced case management, health education, Aqua tabs distributed in community, Zinc Tabs, ORS given to patient, EDO H informed, Stool and water sample collected for lab test.. One case of DF was reported, active case finding was carried out. Nearest health facility was informed of the suspected cases and staff were briefed on case definition and early referral of the cases. EDO Health and Malaria control program officer was informed. Bed nets were distributed fumigation was done in the area. First reported case in the district. 4 Sep Malaria Sindh Thatta Village Ismial Jat UC G.M.Baran alert for suspected malaria, cases were reported, during active surveillance health education were given, Bed nets and medicines were provided, blood slides were taken and 9 were found Positive, SPR = % Sep Pertussis Sindh Dadu Goth Haji Ali Muhammad Mugheri, UC Kamal Khan Taluka Johi Alert for Pertussis, suspected cases were reported, during active surveillance health education, TSV P and Doctors were briefed for importance of rapid alerts, Erythromycin syp provided, DSC, DOH and EDO H informed and request to strengthen routine vaccination in the community. This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : +9--9,

3 Table : Leading causes of seeking health care in flood affected districts, 9 July to September, compiled from weekly reports Diseases Total Skin Diseases 4,, (%) Acute Respiratory Infection 9,9,4 (%) Epidemiological Bulletin: DEWS, Pakistan, Week no. (9 to September, ) Figure : Weekly number of reporting health facilities (Wk / to Wk /) 4 Mobile Fixed Acute Diarrhoea 4,,4 (%) Bloody Diarrhoea, (%) Suspected Malaria,,4 (%) Unexplained Fever,, (4%) Total Consultations 44,, Wk Wk Wk Wk 9 Wk 4 Wk 4 Wk 4 Wk 4 Wk 49 Wk Wk Wk Wk Wk Wk 9 Wk Wk Wk Wk Wk 9 Wk Wk Wk Wk Wk 9 Wk Wk Wk Wk Table : Total number of alerts and outbreaks reported and investigated with appropriate response Disease Post Flood (up till wk ) Current Week () Total A O A O A O A O Acute Watery Diarrhoea 9 4 Acute Jaundice Syndrome 4 Bloody Diarrhoea 4 4 Dengue Fever Measles Pertussis 4 NNT + Tetanus 4 9 Malaria 4 Leishmaniasis Others 44 9 Total Province : This week districts reported to DEWS from health facilities with a total of,9 patients consultations. The proportional morbidity of AD showing decline during the last two weeks after a consistent higher proportion (%) for last almost weeks. Figure-: Three years trend of Acute diarrhoea, province KPK 9 4 alerts were reported in this week, were for DHF, for AWD, for Measles, while one for neonatal Tetanus Epi Week Province Sindh: This week districts reported to DEWS from health centers with a total of,4 patient consultations during the reporting period of week,. In Sindh, AD cases reported were 4,9 (%), % higher proportional morbidity as compared with last week. Figure-4: Three years trend of Acute diarrhoea, province Sindh 9 alerts were reported from Sindh in this week: 9 were for AWD; for NNT and Tetanus; for DHF; for Measles; while one each for BD, Leishmaniasis, Malaria, Meningitis and Mumps Epi Week This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : +9--9,

4 Province Punjab: Epidemiological Bulletin: DEWS, Pakistan, Week no. (9 to September, ) districts reported data to DEWS from Punjab province, 4 health facilities reported a total of,4 patient consultations during this week. AD cases reported were, and stabilized between % - % from last four weeks. alerts were reported in this week from Punjab; 4 were for DHF; for AWD; for Neonatal Tetanus; each were for acute diarrhoea and bloody diarrhoea; while one was for Pertussis. Figure-: Trend of acute diarrhoea, province Punjab ( August to September ) Province Balochistan: In this week, districts reported to DEWS from Balochistan province. 49 health centers reported a total of,9 patient consultations. AD reported in, (%) of the total consultations, same proportional morbidity as compared with last week. Figure-: Three years trend of Acute diarrhoea, province Balochistan 9 alerts were reported in this week from Balochistan, for Leishmaniasis; while one each for AWD, Malaria, CCHF, Scabies, Pertussis, Mumps and Chicken pox. Gilgit Baltistan: In this week, 9 health centers from districts in Gilgit Baltistan sent weekly report with a total of 9, patient consultations. ARI cases reported were 4,9 (%), while Acute Diarrhoea, (%). 4 alerts received and responded this week, one each for AWD, Measles, DHF, Pertussis. Figure-: Trend of priority communicable diseases, Gilgit Baltistan ( March to September ) 4 4 AD BD ARI S. Malaria wk wk 4 wk wk wk wk wk 9 wk wk wk wk wk 4 wk wk wk wk wk 9 wk wk wk wk wk 4 wk wk wk State of Azad Jammu and Kashmir: FATA: In this week, weekly report received from health centers from districts, with a total of 9, patient consultations. ARI cases reported were,4 (4%), while Acute diarrhoea reported, (%) cases. alerts were received and responded this week; One each for AWD, DHF and Measles. This week health centers in agencies reported from FATA, with a total of,4 patient consultations. ARI cases reported were,9 (%), while Acute diarrhoea reported, cases (%) Two alerts for Neonatal Tetanus was received and responded this week. 4 4 AD BD ARI S. Malaria 4 4 AD BD ARI S. Malaria wk wk 4 wk wk wk wk wk 9 wk wk wk wk wk 4 wk wk wk wk wk 9 wk wk wk wk wk 4 wk wk wk wk wk wk wk 9 wk wk wk wk wk 4 wk wk wk wk wk 9 wk wk wk wk wk 4 wk wk wk wk wk 9 wk wk wk wk wk 4 wk wk wk This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : +9--9, 4

5 Epidemiological Bulletin: DEWS, Pakistan, Week no. (9 to September, ) Current week's Alerts: Province Sindh Current week's Alerts: Province Punjab Date Disease District Area <M >M <F >F Date Disease District Area <M >M <F >F Sep AD RY Khan UC Akramabad, BHU Adamwali Sep AD RY Khan UC Baloqi wala, BHU Chak Abbass Tehsil and District RYKhan Sep AWD Bhakkar Khoo Pyari Pitten, UC Mankera Sep AWD Bhakkar Mohallah Khursheed Shah, Gadola Road, UC Bhakkar Urban I, Tehsil & District Bhakkar. Sep AWD DG Khan UC Gadai Sep AWD DG Khan uc Sadardin Sep AWD Multan Jameelabad, chungi no. multan Sep AWD Muzaffargarh Sadat Colony, UC KP Bagga Sher 4 Sep AWD Muzaffargarh Basti Kalar Babran, Moza Ali Daha 4 Sep AWD Muzaffargarh Basti Nai Wala, Moza Ali Daha 4 Sep AWD Muzaffargarh Pitafi Khoo Baseera, Moza Old Qureshi, UC Van 9 Sep AWD Rajanpur Basti Fateh Wala, UC Kot Tahir, Tehsil Jampur Sep AWD Rajanpur Basti Theiri, Barri gali, UC Jahan Pur Sep AWD Rajanpur Moza Mohib Ali, UC Kot Mithan 9 Sep BD Layyah Moaza chak no U/c Jamal chapri Sep BD Layyah Chak no u/c oulakh Thal kalan Sep DHF DG Khan Chah Chandnewala Sep DHF DG Khan Muradwala Sep DHF Khanewal NHM; Chak No / L, Jhanday Wali Sep DHF Khanewal NHM; Chak No..V, Tehsil & District Khanewal Sep DHF Khanewal NHM; Z Block Peoples Colony Khnewal Sep DHF Khanewal NHM; Mulas Pur Kabir Wala District Khanewal Sep DHF Layyah chak no /TDA u/csemipurbhagal Sep DHF Layyah chak no tda U/c tailindus 4 Sep DHF Layyah basti islampur u/c choubara rural Sep DHF Mianwali Mohalla Alam Kheel,Balu Khel Sep DHF Mianwali Betian,PAF Road Sep DHF Mianwali Chidru Village and UC Chodru Sep DHF Mianwali paikhel Sep DHF Mianwali Piplan city, Tehsil Piplan 9 Sep DHF Multan Feroz Pur House, Usma Street Nazd Sani 9 Sep DHF Multan NHM; Noor Ghar Dak Khana Khas Sep DHF Multan high way colony Sep DHF Multan Qasim Park, Bosan Road Neel Kot Sep DHF Multan Basti Barar Tehsil Post Office JPPW Sep DHF Multan Gulshan Faiz Colony Aqub Grid Station Sep DHF Multan Interior City Sep DHF Multan NHM; R Tehsil & District Khanewal Sep DHF Multan NHM; Basti Zahoorabad Khanewal Sep DHF Multan NHM; Chak No 4 Tehsil & District Khnewal Sep DHF Multan NHM; Qatal Pur Dak Khan Khas Kabir Sep DHF Multan NHM; Sadat Clinic GT Road Kacha Kho Sep DHF Multan NHM; Ward No 4 Multan Cantt 4 Sep DHF Multan Basti Karlo Farooqia Masjid Lodhi Colony 4 Sep DHF Multan NHM; Shah Jamal Colony Ichra Lahore 4 Sep DHF Multan Qasim Bela 4 Sep DHF Multan Shalimar Colony Multan Sep DHF Multan NHM; Street No Ghousia Colony Khanewal 9 Sep DHF RY Khan Basti Noor e wali Street No. Sep DHF RY Khan Basti Baran, Glor Maso Khan Tehsil RYK Sep DHF RY Khan Mohalla Noorabad Street No. 4 Sep DHF RY Khan Chak No. /NP Aslamabad Kot Samabad 4 Sep DHF RY Khan St #, Alnoor colony, Sadiqabad Sep DHF RY Khan Gulshan i Iqbal City Sep DHF RY Khan Habib Colony Street No. Rahim Yar Khan City Sep DHF RY Khan Noor e wali Street No. City Rahim Yar Khan Sep DHF Vehari NHM; Near Bashir soup factory, Mailsi Sep NNT DG Khan Jhok Utra Sep NNT DG Khan Basti Marha uc Lakhani 4 Sep NNT Rajanpur Basti Jaskaani, Moza Gayamal, UC Umer Kot Sep Pertussis DG Khan UC Lakhani Sep AWD Badin Village Khamiso Mallah, UC GM Nizamani Sep AWD Badin IDP Camp Tando Bago (Village Panghrio) Sep AWD Dadu Village Ali Sher Lundre Sep AWD Dadu Village Jamal khan Laghari, UC Kandi Chuki Sep AWD Dadu Village Wali Muhammad Laghari Sep AWD Ghotki Village Mohammad Azim Manek UC Bandh Sep AWD Jamshoro Village Manzoorabad, UC Manzoorabad 4 Sep AWD Karachi C.Area Qayoomabad, Korangi Town 4 Sep AWD Karachi Hijrat Colony, Saddar Tawn 4 Sep AWD Khairpur Village Allah Rakhio Rind UC Nizamani Sep AWD Larkana Village wakro bagi bandi talka Dokri Sep AWD Matiari Village Sakhat Taluka Matiari Sep AWD Matiari Village Sher Muhammad thora 9 Sep AWD N Feroze Village Hayat Khan UC Bulhan, Bhiria 9 Sep AWD N Feroze Village Jamal Ujan UC Palhano, Bhiria 9 Sep AWD N Feroze Village Pathan Mari UC Noor Pur Sep AWD N Feroze Village Bohio UC Kor Hassan Sep AWD N Feroze Village Kalhoro Sharif UC Kor Hassan 4 Sep AWD N Feroze Naushahro Feroze City 4 Sep AWD N Feroze Padian UC Padian 4 Sep AWD N Feroze Revenue Colony UC Kor Hassan 4 Sep AWD N Feroze Village Gadhi Mohallah Halani 4 4 Sep AWD N Feroze Village Gul Mohammad Mubejo 4 Sep AWD N Feroze Village Jamal Solangi UC Qasim Khahi 4 Sep AWD N Feroze Village Koreja Mithiani Sep AWD Q Shahdadkot Village Mubarak dhoro UC Behram Sep AWD S. Benazirabad Village Zakri pir Dargah, UC Pir Zakri Sep AWD Shikarpur Memon Mohallah near Bhittai Utaro Sep AWD Sukkur Sukkur City Sep AWD T Allah Yar Batho Stop, new Ghulam ali dal Sep AWD T Allah Yar Nago Shah Goth, Taluka Tando Allahyar Sep AWD T Allah Yar Unar Para Taluka Tando Allahyar Sep AWD T Allah Yar Village Ibrahim Aqklani usman Shahji Hary Taluka Jhando Mari Sep AWD T Allah Yar Villahe Bahar Khan Mir Jat, UC Tando Soomro, Taluka Jhando Mari 4 Sep AWD Tharparkar Village Virawah, UC Virawah Sep AWD Tharparkar Village Bheel Paro, UC & Taluka Mithi Sep AWD Thatta Village Haji Budho Jat Jhock Shareef Sep AWD Thatta Village Jaind Zangeejo UC Jaind Zangeejo 9 Sep AWD Thatta Camp no: Jail Makli Thatta Sep BD Thatta Camp no: Makli Thatta 9 Sep DHF Ghotki Sheikh Zayad Hospital RYK 9 Sep DHF Karachi Secter 4F, Orangi Tawn 4 9 Sep DHF Karachi Secter F, Orangi Tawn 9 Sep DHF Khairpur Talpur Colony Thari Mirwah Sep DHF Q Shahdadkot marora village karachi currently Sep DHF Sukkur Taluka Salehpat Sep DHF Umer Kot Village M.Hassan Gujrati, UC Bastan Leishmaniasis Sep Shikarpur Village Ahmedpur 4 Sep Malaria Thatta Village Ismial Jat UC G.M.Baran Sep Measles Jamshoro Labour Colony, Phase #, Site area Taluka Kotri 9 Sep Measles Thatta Village Gul Muhammad Malkani 9 Sep Measles Thatta Village Muhammad Khan Malkani Meningitis Sep Tharparkar Village Badhro, UC Mirwah Taluka Nagarparkar 9 Sep NNT Ghotki Village Ali Murad Jalbani UC Dhangro 9 Sep NNT Ghotki Village Gulan Laghari UC Bhand Sep NNT Ghotki Village Jaro Khan Shahani Sep NNT Kashmore Village Lal Khan near Buxapur Sep NNT Q Shahdadkot Bago daro muhalla UC kamber city Sep NNT Q Shahdadkot Village Mitho kariro talka mirokhan Sep Pertussis Dadu Goth Haji Ali Muhammad Mugheri Sep Tetanus Kashmore Kandhkot City Sep Tetanus Shikarpur Near Agha House, Taluka Garhi Yaseen This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : +9--9,

6 Epidemiological Bulletin: DEWS, Pakistan, Week no. (9 to September, ) Current week's Alerts: Province Number of alerts detected in last four weeks by province: Date Disease District Area <M >M <F >F Sep AWD Kohat Village Barh Union Council, Nasrat Khel Sep AWD Kohistan Quamabad, UC Kiyal Sep AWD Lower Dir Village Banda, Khema, Tehsil Balmbat Sep AWD Lower Dir Village Khan Abad, Dokrai, UC Kotkay, Maidan 4 Sep AWD Lower Dir Village SarBanda, UC Munjai, Tehsil Balmbat 4 Sep AWD Lower Dir Village Qilla Kambat, UC Kambat, Tehsil Samar Bagh Current week's Alerts: Province Balochistan Date Disease District Area <M >M <F >F 9 Sep AWD Bolan Kili sataktzai, UC Mach, Tehsil Mach Sep CCHF Loralai DHQ Loralai, al Jamiat mohalla hashim colony Sep Chicken Pox Ziarat Ziarat town Sep Leishmaniasis Awaran Village Haji Shahar UC Camp Jahoo, Tehsil Jhal Jhaoo Sep Leishmaniasis Lasbela Akram colony U/C Beroot Tehsil HUB 9 Sep Malaria Ziarat Ahmadon 4 Sep Mumps Ziarat Sinjawi/Ziarat 4 Sep Pertussis Ziarat Rozai Ziarat Sep Scabies Ziarat Kan Bungalow Current week's Alerts: AJK; FATA; GB and ICT Sep AWD Shangla Village Rangmala Colony/ UC Malakkhel Kotkay Sep AWD Shangla Village Wahab Khel/ UC malakhel Kotkay 4 Sep AWD Swabi BMC Swabi, Shahmansoor 4 Sep AWD Swat Village and UC Barthana, Tehsil Matta 4 Sep AWD Swat Village Bar Sherpalan School Mohallah, UC Sherpalam, Tehsil Matta. Sep DHF Abbottabad Kunj Kehal 4 Sep DHF Abbottabad Kunj Kadim Sep DHF Abbottabad Mohalla Narian, Cantt. Sep DHF Battagram ATH (Kandar, Chapar Gram, UC Ajmaira) Sep DHF Haripur Chamba Masjid stop UC Kholian Bala Sep DHF Haripur Village Kalawan Sep DHF Haripur Village Dingi, UC Dingi Sep DHF Haripur Village Ghayrihan, UC Koklian Sep DHF Haripur Village Shah Maqsood UC Shah Maqsood Sep DHF Lahore Abbottabad DHQ Sep DHF Mansehra Village Timber Near Phulra Sep DHF Mansehra Capt. Safdar Road Dab # Mansehra City Sep DHF Mansehra Village Kandar PO Madserian Phulra Sep DHF Mansehra Village Perhenna, Phulra 4 Sep DHF Mansehra Mari Khan Khail Hamsherian 4 Sep DHF Mansehra Villlage Labarkot UC Labarkot Sep DHF Mansehra Hazeera chakia road Sep DHF Mansehra Jandar Banda Sep DHF Mansehra Mandiar Attershisha Sep DHF Mansehra Village Mundi Nakka Lassan Nawab 4 Sep DHF Swat Village Landai Karinuna, Tehsil Matta Sep Measles Charsadda Azizabad Sep Measles Charsadda Mandukhel Sep Measles Charsadda Shekhabad Sep Measles Charsadda Toot Kallay 4 Sep Measles Lower Dir Village Khan Khero,Arang, Sep Measles Mardan Farm Korona, Canal Machine Sep Measles Nowshera Mohallah: Landay Khel Sep NNT Lower Dir Village Raidano Dag, Gardai, Arang Date Disease District Area <M >M <F >F Sep AWD Neelum Village Khel Mehdan, UC Khel. 9 4 Sep DHF Bagh Vill Chanar Colony Chattar no 4 Sep Measles Poonch Vill Chanday Na Mora 4 Sep NNT Bajaur Village Amankot, Tehsil Barang 4 Sep NNT Bajaur Village Bandarai, Tehsil Mamoond Sep AWD Gilgit Village and UC Sharote district Gilgit Sep DHF Astore ATH Abbottabad (Chilas) 9 Sep Measles Skardu village Rsasna U/C Gamba skardu Sep Pertussis Skardu Village sad para U/C Chunda Skardu This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : +9--9, Province Sindh Wk 4 Wk Wk Wk Province 9 AWD DHF leishmaniasis Malaria Measles Wk 4 Wk Wk Wk AWD DHF Measles 4 4 Province Punjab AWD DHF leishmaniasis Measles Wk 4 Wk Wk Wk Province Balochistan 9 4 AWD leishmaniasis Malaria Measles 4 Wk 4 Wk Wk Wk Province Gilgit Baltistan AWD leishmaniasis Malaria Measles DHF Wk 4 Wk Wk Wk Province AJ&K Wk 4 Wk Wk Wk AWD DHF Measles

7 Focus on: Dengue Fever What is Dengue? Dengue is the most widespread mosquito borne infection in human beings, which in recent years has become a major international public health concern. Over the last years, we have witnessed a dramatic increase in the global incidence of dengue and its severe manifestations such as dengue hemorrhagic fever. Dengue fever is a severe, flu like illness with fever, headache and muscle and joint pains that affects children and adults, but seldom causes death. Dengue hemorrhagic fever (DHF) is a potentially deadly complication in about % of cases that begins with a sudden rise in temperature which usually continues for two to seven days and can be as high as 4 4 C. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever when the temperature drops, followed by signs of circulatory failure. With modern intensive supportive therapy, the fatality rates can be reduced to less than %. How Dengue spreads? Dengue spreads through the bite of infected Aedes Aegypti mosquito. The mosquito gets the virus by biting infected person. The symptoms appear of the disease about days after the infected bite. There is no way to tell if a mosquito is carrying the Dengue virus. Therefore, people must protect themselves from all mosquito bites. How can we prevent Dengue? Prevent mosquito bites Dengue mosquitoes bite during the daytime, protect yourself from the bite. Wear full sleeve clothes and long dresses to cover the limbs. Avoid wearing black color. Use repellents. Care should be taken in using repellents on very young children or the elderly Use mosquito coils and electric vapor mats during the daytime Use insecticide treated nets (ITNs) to protect young children, pregnant women, old people, in addition to others who may rest during thy day. Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes. Epidemiological Bulletin: DEWS, Pakistan, Week no. (9 to September, ) Where do mosquitoes live and breed? Dengue mosquitoes breed in stored, exposed, water collection systems. The favoured breeding places are: barrels, drums, jars, pots, buckets, flower vases, plant saucers, tanks, discarded bottles/tins, tyres, or water coolers, and other places where rainwater collects or is stored. Drain out the water from window air coolers when not in use, as well as draining all unused tanks, barrels, drums, and buckets. Remove all objects containing water such as plant saucers from the house. All stored water containers should be kept covered at all times. Collect and destroy discarded containers in which water collects, such as bottles, plastic bags, tins, tyres, etc. Efficient disposal of all solid waste/garbage. How should we take care of a Dengue patient? Keep body temperature below 9 o C. Give the patient paracetamol (not more than four times in 4 hours). Fever can also be reduced by sponging patient with tepid water. Do not give the patient Aspirin or Ibuprofen (Brufen) or similar medicine for fever or pain. Give only paracetamol. Give large amounts of fluids (water, soups, milk and juices) along with the patient s normal diet The patient should rest Immediately consult your physician if any of the following manifestations appear: Red spots or points on the skin; bleeding from the nose or gums; frequent vomiting; vomiting with blood; black stools; sleepiness; constant crying; abdominal pain; excessive thirst (dry mouth); pale, cold or clammy skin; or difficulty in breathing. Distribution of Wild Polio Virus cases Pakistan and Year : The total number of polio cases reported in is 44 including type cases and 4 type from 4 infected districts/towns/ agencies. Year : The total number of polio cases confirmed by the laboratory is 9 (=type, and =type) till date from 4 districts. Province Cases Cases P P P P Punjab - Sindh FATA Balochistan - AJK Gilgit Baltistan Islamabad Total 4 This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : +9--9,

8 Alerts and outbreaks, week, Epidemiological Bulletin: DEWS, Pakistan, Week no. (9 to September, ) This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: WHO: Tel : , Fax : +9--9,

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