During July–August 2010, Pakistan experienced extreme
flooding that affected approximately 18 million persons. In
response to the emergency, Pakistan’s Ministry of Health and
the World Health Organization (WHO) enhanced an existing
disease early warning system (DEWS) for outbreak detection
and response. This report summarizes surveillance results
early after implementation, describes system usefulness, and
identifies areas for strengthening. Daily disease counts were
reported from health facilities in four provinces contain
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ing 98% of the flood-affected population. During July 29,
2010–September 15, 2010, approximately 5.6 million new
patient visits were reported. The most frequent conditions
reported were skin diseases (18.3%), acute respiratory infection
(15.1%), and acute diarrhea (13.3%). A total of 130 outbreak
alerts were documented, of which 115 (88.5%) were for acute
watery diarrhea (AWD) (suspected cholera). Of these, 55
alerts (47.8%) had at least one microbiological sample with
confirmed cholera. Overall, DEWS was useful in detecting
outbreaks, but it was limited by problems with data quality.
Improvements in DEWS have increased system usefulness in
subsequent emergencies. This report highlights the need to
follow updated WHO guidelines on early warning disease
surveillance systems to improve their usefulness (
1
).