A new, possibly dangerous development was announced Thursday when a World Health Organization official said 17 cases of tetanus have been reported in the quake-stricken area, and three people have already died.
"We are on alert already," he said. "We are trying to get as many people immunized as soon as possible," said WHO senior surveillance officer Sarfaraz Tan Afridi.
Asif Iqbal Daudzai, information minister for Pakistan's North West Frontier Province, said Wednesday that 37,958 people died in the province and at least 23,172 were injured, the vast majority of them in Mansehra district. He said the figures were based on reports from local government and hospital officials, and that the toll was likely to rise.
The prime minister of neighboring Pakistani-held Kashmir, Sikander Hayat Khan, said at least 40,000 people died in that region. India has reported 1,360 deaths in the part of Kashmir that it controls.
The new toll by local officials is higher than the official count provided each day by the central government. That number was raised to 47,700 confirmed dead as of Wednesday, with a warning that it would rise further. The central government count has lagged behind the local count since the early days of the disaster.
Wednesday morning's 5.8-magnitude aftershock struck 80 miles north of Islamabad, near the epicenter of the main quake, according to the U.S. National Earthquake Center in Colorado. It was followed by another in the same area about 45 minutes later that registered 5.6.
The first aftershock caused a landslide in Balakot, one of the cities hardest hit by the initial quake. Debris covered the road to nearby Mansehra, but it was quickly cleared, said Pakistani Army Lt. Col. Saeed Iqbal, who is in charge of relief efforts in the area.
A landslide also blocked a road out of Muzaffarabad, the capital of Pakistani Kashmir, but it was expected to be cleared later in the day.
Iqbal said the aftershock was "very heavy" and that he saw dust rising from the Kaghan Valley north of Balakot, possibly indicating an additional landslide. He said he had no immediate reports from his 60 teams of soldiers that were carrying in relief goods in the vicinity.
In Indian-held Kashmir, the new tremors startled thousands of people in relief camps, including those in the worst-hit Uri and Tangdar districts close to the boundary with Pakistan-held territory. Police said there were no reports of landslides or damage to buildings.
Hundreds of aftershocks have struck the region since the Oct. 8 quake.
"They're not over," said Waverly Person, a seismologist at the U.S. quake center. "For a shallow-depth earthquake like this they go on, sometimes for a year."
Despite brisk sorties of helicopters delivering aid to quake victims, an estimated half-million survivors, many of them in Pakistan's portion of Kashmir, have yet to receive any help since the monster 7.6-magnitude quake leveled entire villages.
The problem is worst in the estimated 1,000 settlements outside the main cities and towns, said regional U.N. disaster coordinator Rob Holden.
"Many people out there, we are not going to get to in time," Holden said. "Some people who have injuries don't have a chance of survival."