Table-1: Status of Reports Received from DEWS Regions during Epidemiological week-34, 2012

Transcription

1 August 27, 212 DISEASES EARLY WARNING SYSTEM WER-34(6 th Yr) REPORTS RECEIVED FROM REPORTING SITES: As of August 24, 212, 312 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan. In this reporting week, all 312 sentinel sites have sent their reports on new cases of DEWS target diseases, recorded during the reporting. Out of all events recorded in DEWS sentinel sites, 15 target diseases (priority diseases) are included in DEWS weekly epidemiological reports. Table-1: Status of Reports Received from DEWS Regions during Epidemiological week-34, 212 No. of Expected Reports from Sentinel Sites No. of Reports Received in this week Central Central Total Page 1 of 8

2 DEWS Sentinel Sites: Figure-1(Map) shows the distribution of DEWS sentinel sites, already established in the relevant regions/provinces by August 24, 212 by type of health facilities. Data on15 DEWS target diseases are being collected from these sentinel sites (SS).The symbols on the map show the number of sentinel sites in each region/province, and do not indicating the GPS of the SS locations. DEWS Data in Epidemiological -34 of 212 O Table-2 Type of SS Ut of total 118,8 clients recorded in week-34 of 212, 1.3% (12253) of consultations were reported due to cough and cold and 2.3% (2673) of consultations was reported due to pneumonia. In the same reporting period, 18.9% or 22,444 events were reported due to diarrheal illnesses (15.% due to Acute Watery Diarrhea, 2.1% due to Bloody Diarrhea and 1.8% due to acute watery diarrhea with dehydration). In comparison with previous week (W33 of 212) the percentage of ARI diseases has decreased by 1.7% to12.6%, whereas the percentage of Acute Diarrheal diseases increased by 2.1% to 18.9%. These variations could be occurred due to changes in DEWS Epidemiological Regions and types of Sentinel Sites in -34, 212 Centr al Centr al temperature /weather during the reporting week.figure-2 above shows the percentages of DEWS target diseases by age groups in week-34 of 212. CHC/BHC DH PH/RH/SH Poly Clinic Total CHC=Comprehensive Health Center, DH=District hospital, PH=provincial hospital, RH= Regional hospital, SH= specialized hospital 4.% 3.% 2.% 1.%.% ARI C&C ARI Pn Aw D BD Aw Dw Pert Men AVH Mea ussi /SIC ep sle s Dip hth Total Fig-2: Percentages of DEWS Target Diseases by age Group in W34 of 212 Tet/ Mal AFP NNT aria Typ hfe v U5% % % 3.4%.2%.1%.2%.%.%.%.%.9%.6% O5% 7.5% 1.1% 8.4% 1.8% 1.%.1%.1%.%.%.%.%.%.6%.8% Tot% % % 1.8%.1%.1%.1%.%.%.%.%.7%.7% Page 2 of 8

3 Percentage of ARI by weeks and by Age Groups In the epidemiological week-34, a total of 14,926 events of ARI were reported.16.2 % of total clients less than 5 years of age were cough & Cold patients and 7.5% among the age group 5 years and over. The percentage of C&C (<5 years) Table-3: Percentages of ARI Diseases during 11 recent weeks by age groups and by weeks Disease Age ARI- C&C <5 Yr ARI- <5 Yr Pneumonia >=5 Yr consultations in week-24,in comparison with the percentage of C&C in week-34 of 212, decreased by 3.6%, whereas in case of 5 years and above decreased by 3.9% to7.5% in this reporting week. The trend of ARI diseases in last 11 weeks can be read in table-4.the percentages of consultations on Pneumonia cases of age group less than 5 years decreased by.4% in last 11 weeks, whereas the percentage of age group 5 years and over decreased by.1% to 1.1% in last 11 weeks. In the reporting week-34 of 212, the highest percentage of Cough & Cold has been recorded in Kunar and Nuristan provinces with 25% and 19% respectively, whereas the lowest percentages of C&C were reported from Ghor and Badghis provinces with 6% each. The highest percentages of Pneumonia cases reported from Faryab and Nuristan provinces with 1% and % respectively, whereas the lowest percentage of Pneumonia cases was recorded in Uruzgzn and Hirat provinces with less than.1% each. (Fig-3) 4% Fig-3: Percentages of ARI from Total Clients in week-34 of 212 3% 2% 1% % BDS BAL BA M DA Y GH FYB A HEL HE R JO W KA N KH O KDZ LO G NA N PKA PIA PAR SA M WA SAR TAK R ZAB KAB BGL BD G FRA GH O KAP PA N Pneumonia Cough&Cold 8% 8% 13%18% 4% 1% 7% 9% 11%11%16% 9% 17% 7% 14%13% 6% 8% 18% 6% 16% 8% 11% 9% 6% 7% 6% 9% 9% 15%11%25%13%19% Percentages of Diarrheal Diseases by weeks and by Age Groups The table-4 below shows the percentages of diarrheal diseases (Acute watery Diarrhea, Bloody Diarrhea and Acute watery Table-4: Percentages of Diarrheal Diseases from Total Clients during 11 recent weeks by age groups. Disease Age >=5 Years Acute W. Diarrhea <5 Years with Dehydration 5 Years diarrhea with dehydration) from week-24 to week-34 of 212, from total clients. Acute watery diarrhea among children less than five years has been increased from 23.% in week-24 to 28.9% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has increased by 2.7% to 8.4%.(Please refer to Table-5, above).bloody diarrhea, in age group less than 5 years decreased by 1.% in last 11 weeks, while in case of age group 5 years and above decreased by.1% in the same period. Acute watery diarrhea with dehydration in age group less than 5 years increased by.9% and in case of five years and above increased by.4% in last 11 weeks. NI M UR U KN R Acute Watery <5 Years Diarrhea >= 5 Years Bloody Diarrhea <5 Years LAG NU R Page 3 of 8

4 4% 3% Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-34 of 212 AWDwD BD AWD 2% 1% % BDS BAL BAM DAY FYB GHA HEL HER JOW KAN KHO KDZ LOG NAN PKA PIA PAR SAM SAR TAK WAR ZAB KAB BGL BDG FRA GHO KAP PAN NIM URU KNR LAG NUR Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: In the epidemiologic week-34 of 212, a total of %Fig -5: Percentages of Men/SIC Malaria & Typhoid Fever suspected cases of Meningitis/Sever Ill Child were from Total Clients in -34 of 212 by Region reported from all regions and the highest percentage 3.% was recorded in central east region. In the same 2.5% reporting week, from all regions 838 consultations were 2.% reported by Sentinel Sites to be malaria and the highest 1.5% percentage of Malaria cases were reported from region with 3.2%. Out of the total clients, 864 cases or 1.%.7% in national level were reported to be suspected.5% Typhoid Fever and the highest percentage of Typhoid.% Fever was reported from and east region NER NR CWR WR CER SR ER SER with 1.7%each and 1.3% respectively. Vaccine Preventable Diseases In DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, so that Men/SIC Malaria Typhoid Fev.2%.3%.5%.2%.1%.6%.3%.2%.7%.1%.%.4%.1%.2%.4%.1%.7% 1.2%.1% 3.2% 1.7%.% 1.6% 1.3% their occurrences are changing by seasonal variations. Among these diseases Meningitis/severely ill child is being reported mostly from region; Table-5: Suspected Cases of Vaccine Preventable in this week out of total 138 cases in Diseases in W34 of 212 by Region country level, 35 cases have been reported from Central east and 25 cases from Central-west and 26 case were reported from region. Regions In general the highest number of cases of Acute viral hepatitis being reported from and south regions, so that in the reporting week out of total 113 cases, cases reported from, 33 from Central Central , and the remaining cases from other regions were reported. From total 11 Central Measles cases reported in the reporting week 75 cases were recorded in and cases were reported from Central region. Total Meningitis/ Sever Ill Child Viral Hepatitis Measles Pertussis Diphtheria Tetanus /New Natal Tetanus Acute Flaccid Paralysis Page 4 of 8

5 Percentages of ARI & Diarrheal Diseases by Epidemiological s(from W22 of 211 to W34 of 212) A mong the DEWS target diseases, Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) as leading causes of morbidity and mortality, having the highest frequency of consultations. The following Line-Chart shows the trend of ADD and ARI from week-22 of 211 to week-34 of 212(more than one complete cycle).in week-22 of 211, the ARI and ADD curves crossed each other, so that ARI started decreasing and ADD changed its course to increase. By the end of Summer season in 211, these curves crossed one another again in week-37and from that time to week-6 of 212, the percentage of ARI was increasing, while the percentages of ADD were falling /decreasing, but week-9 of 212 was a turning point for both categories of ARI and Diarrheal diseases i.e. ARI started decreasing, while ADD started increasing. Comparing this week data with previous week-33, ARI decreased by 1.7% to12.6%, while the percentage of ADD increased by 2.1% to 18.9%. P e r c e n t a g e s ARI ADD Fig.-6: Trend of ARI/ADD as Propotion of Total Clients From -22 of 211 to -34 of s of the Year All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point "Director Surveillance"<director.surveillance@gmail.com> or the WHO CSR/DEWS Technical Officer, ,banor@emro.who.int

6 Mortality: Among DEWS target diseases Pneumonia, Table-6: Deaths by Main Causes of Mortality and by Region in W34 of 212 Diarrheal diseases Main Causes and Meningitis/ of Deaths Severely Ill Children (SIC) are main causes of mortality Pneumonia which make in general more than Diarrheal 95% of total deaths Diseases of surveillance target Meningitis/SIC diseases. Usually deaths due to Total diarrheal diseases increases during summer season, while the number of deaths due to Pneumonia increases during cold period/winter Season. In this week out of 43 deaths reported from all regions, 21 deaths caused by Pneumonia, 13 deaths caused by diarrheal diseases and 9 deaths were caused by Meningitis/severely ill children. (Table-7) Central Number of Outbreaks investigated in 212 with details of W33/W34 Central Total Reported outbreaks since first week of 212 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis Avian/Swine Flu ARI 7 7 Measles Diarrhea 4 4 Meningitis Hepatitis 2 2 Malaria Typhoid 1 1 CCHF Bl. Diarrhea 2 2 Chickenpox 1 1 Other Total Epidemiological week-33 Suspected Diphtheria Outbreak: reported from Aranz of village of Waigal district of Nuristan province on August 12 /212, the team investigated the area on the same day and during the investigation there was one suspected diphtheria case with no deaths, the team collected the specimens and send it to CPHL, the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point "Director Surveillance"<director.surveillance@gmail.com> or the WHO CSR/DEWS Technical Officer, ,banor@emro.who.int

7 Suspected Measles Outbreak: reported from Makhmal village of Yangi Qala district of Takhar province on August 14 /212, the team investigated the area on the same day and during the investigation there were 19 suspected measles cases with no deaths, the team collected the specimens and send it to CPHL, the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases Suspected Measles Outbreak: reported from Nomads Qala village of Dehyak district of Ghazni province on August 13 /212, the team investigated the area on the following day and during the investigation there were 1 suspected measles cases with no deaths, the team collected the specimens and send it to CPHL, the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases CCHF outbreak: : reported from Charburjak village of Guzara district of Hirat province on August 11 /212, the team investigated the area on the following day and during the investigation there was one suspected CCHF case, the team collected the specimens and send it to CPHL,the cases treated and health education session conducted to villagers and the team is investigating for further cases. Epidemiological week-34 No outbreak has been reported /investigated during this week. All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point "Director Surveillance"<director.surveillance@gmail.com> or the WHO CSR/DEWS Technical Officer, ,banor@emro.who.int

8 ANNEX: Mapping of Percentages/Cases of Selected Diseases in -34 of 212 by Province All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point "Director or the WHO CSR/DEWS Technical Officer,