DISEASE EARLY WARNING SYSTEM WER-40 (7 th Yr) DEWS WEEKLY EPIDEMIOLOGICAL REPORT

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1 October 7, 2013 Summary: DISEASE EARLY WARNING SYSTE WER-40 (7 th Yr) DEWS WEEKLY EPIDEIOLOGICAL REPORT This report includes surveillance data from 28 September to 4 October Out of 361 functional Sentinel sites (SS), 356 (98.6%) have submitted reports for 40 of Out of a total of 322,690 consultations (136,315 male, 186,375 female) recorded in 40 of 2013, 34.2 % or 110,263 (52,847 male, 57,416 female) consultations were reported due to DEWS target diseases. ain causes of consultations this week were Acute Respiratory Infections (ARI) (19.9%) and Acute Diarrheal Diseases (ADD) (13.1%) from total clients in a continuing trend from the week before. 42 (21 male, 21 female) deaths resulted from Pneumonia, Diarrheal Diseases and eningitis/severely Ill Children, which includes 16 deaths (9 male, 7 female) caused by Pneumonia, 8 deaths (5 male, 3 female) caused by Diarrheal Diseases and 18 deaths (7 male, 11 female) caused by eningitis/severely Ill Children. In this reporting week, an Update Suspected Cholera Outbreak and a Suspected CCH Outbreak reported from Herat province and a Cholera Outbreak and a Suspected CCH Outbreak reported from Kandahar province. Reports Received rom Reporting Sites: As of October 4, 2013, 361 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan. In this reporting week, 356 sentinel sites have sent their reports on new cases of DEWS target diseases recorded during the reporting week. 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 s during Epidemiological 40, 2013 No. of Expected Reports from Sentinel Sites No. of Reports Received in this week

2 Percentage DEWS Sentinel Sites: igure-1(ap) shows the distribution of DEWS sentinel sites already established in the relevant regions/provinces by October 4, Table-2 shows the SS distribution by type of health facility. Data on 15 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 indicate the GPS of the SS locations. Type of SS Table-2: DEWS Epidemiological s and Sentinel Sites by type in 40, 2013 CHC/BHC DH PH/RH/SH Poly Clinic CHC=Comprehensive Health Center, DH=District Hospital, PH=Provincial Hospital, RH= al Hospital, SH= Specialized Hospital DEWS Data in Epidemiological 40 of 2013: Out of a total of 322,690 clients recorded in week-40 of 2013, 17.1% (55,035) of consultations were reported due to Cough and Cold and 2.8% (8,879) of consultations was reported due to Pneumonia. In the same reporting period, 13.1% or 42,302 events were reported due to diarrheal illnesses (9.7% due to Acute Watery Diarrhea, 2.4% due to Bloody Diarrhea and 1% due to Acute Watery Diarrhea with Dehydration). In comparison with the previous week (W39 of 2013) the percentage of ARI disease has increased by 1% to 19.9%, and the percentage of Acute Diarrheal Disease has decreased by 0.3% to 13.1%. These variations could be due to changes in temperature /weather during the reporting week. igure-2 (right) shows the percentages of DEWS target diseases by gender in week-40 of Percentage of ARI by Weeks and by Age Groups: ARI C&C ig-2: Percentages of DEWS Target Diseases by Gender in W40-13 ARI Pn AwD BD AwDw en/ SIC AVHe p easl e alari a Typh ev ale emale

3 NI HIL KAN ZAB URO KAB KAP LOG PAN PAR WAR BA DAY BDG HER ARAH GHO NAN LAG KNR NUR SA BAL JOW YB SAR BDS TAKHAR BGL KUN GHA PIA PKA KHO Percentage Percentage In the epidemiological week-40 a total of 63,914 events of ARI were reported % of total clients less than 5 years of age were Cough & Cold patients and 13.7% were among the age group 5 years and over. The percentage of C&C (<5 years) consultations in week-30, in comparison with the percentage of C&C in week-40 of 2013, increased by 7.6%, whereas in case of 5 years and above increased by 3.9% to 13.7% in this reporting week. The trend of ARI diseases in last 11 weeks can be read in Table-3. The percentages of consultations on Pneumonia cases of age group less than 5 years increased by 1.5% in last 11 weeks, whereas the percentage of age group 5 years and over increased by 0.4% to 1.3%. Disease Age Table-3: Percentages of ARI Diseases during 11 recent weeks by age groups and by weeks ARI- C&C <5 Yr ARI- Pneumonia <5 Yr >=5Yr In the reporting week-40 of 2013, the highest percentages of Cough & Cold were recorded in Khost, Kapisa and Logar provinces with 31.2%, 28.9% and 27.7%, whereas the lowest percentages of C&C were reported from arah, Badghis and Zabul provinces with 9.3%, 9.6% and 10% respectively. The highest percentages of Pneumonia cases were reported from Saripul, Jowzjan and Logar provinces with 7.7%, 6.2% and 5.3% respectively, whereas the lowest percentages of Pneumonia cases were recorded in Zabul, Herat and Urozgan provinces with 0.2%, 0.5% and 0.6% respectively. (ig-3) NI HIL KA N ig-3: Percentages of ARI from Clients in week-40 of 2013 ZAB UR O KAB KAP LOG PA N PAR WA R BA DAY BD G AR GH NA HER AH O N LAGKNR NU R SA BAL JO TAK W YB SAR BDS HA BGL KU N R Percentages of Diarrheal Diseases by Weeks and by Age Groups: ig-4: Percentages of Diarrheal Diseases from Clients in week-40 of GH A PIA PKA KH O Pneumonia Cough&Cold Provinces AWD BD AWDwD

4 igure-4 above shows the percentages of diarrheal diseases (Acute Watery Diarrhea, Bloody Diarrhea and Acute Watery Diarrhea with Dehydration) from week-30 to week-40 of 2013 from total clients, Acute Watery Diarrhea among children less than five years of age has decreased from 25.6% in week-30 to 19.1% in the reporting week, whereas Acute Watery Diarrhea among age group 5 years and above has been decreased by 2.1% to 5.3 % (Table-4). Bloody Diarrhea in age group less than 5 years decreased by 0.3% in last 11 weeks, while in case of age group 5 years and above also has been decreased by 0.3%. Acute Watery Diarrhea with Dehydration in age group less than 5 years show an decrease by 1.6% in last 11 weeks, while in case of five years and above AWDwD decreased by 0.2% to 0.7% in last 11 weeks. Table-4: Percentages of Diarrheal Diseases from Clients during 11 recent weeks by age groups. Disease Acute Watery Diarrhea Bloody Diarrhea Acute Watery Diarrhea with Dehydration Age <5 Years >= 5 Years <5 Years >=5 Years <5 Years Years Percentages of suspected eningitis/sic, alaria and Typhoid ever by : In the epidemiologic week-40 of 2013, a ig-6: Percentages of eningitis,alaria & typhoid ever from total of 151 suspected cases of Clients in W40-13 eningitis/severely Ill Child were reported from all regions and the highest percentage was recorded in, and regions. In the same reporting week, from all regions, 1857 alaria consultations were reported by Sentinel Sites and the highest percentages of alaria cases were reported from, and regions with 2.4%, 0.7% and 0.4% respectively. Out of the total clients, 1767 cases or 0.5% at the SR CER CWR WR ER NR NER SER national level were reported to be en/sic suspected Typhoid ever and the highest alaria percentages of Typhoid ever cases were reported from, and Typhoid ev and regions with 1%, 0.9% and 0.8%respectively. Vaccine Preventable Diseases: Among DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, and their occurrences are changing by seasonal variations. Among these diseases eningitis/severely Ill Child is being reported mostly from the region. In this week out of total 151 cases in country level, 37 cases have been reported from region, 29 cases from the region and 27 cases from the region. In general the highest number of cases of Acute Viral Hepatitis has been reported from the and regions, so in the reporting week out of total 240 cases, 112 cases reported from region, 41 cases were reported from and 29 cases were reported from regions. rom a total of 11 easles cases reported in the reporting week, 7 cases were recorded in and 2 cases were reported from the regions. Table-5 (below) shows the distribution of vaccine preventable diseases across all reporting regions. Table-5: Suspected Cases of Vaccine Preventable Diseases in W- 40 of 2013 by

5 W25 W27 W29 W31 W33 W35 W37 W39 W41 W43 W45 W47 W49 W51 W1 W3 W5 W7 W9 W11 W13 W15 W17 W19 W21 W23 W25 W27 W29 W31 W33 W35 W37 W39 Percentages s SR CER CWR WR ER NR NER SER eningitis/ Severely Ill Children Acute Viral Hepatitis easles Pertussis Diphtheria Tetanus Acute laccid Paralysis Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks (trend from W25 of 2012 to W40 of 2013): Among the DEWS target diseases, Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) are the 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-25 of 2012 to week-40 of In week-25 of 2012, the ARI and ADD curves crossed each other, as ARI started decreasing and ADD changed its course to increase. By the end of the summer season in 2012, these curves crossed one another again in week-36 and from that time to week-06 of 2013; the percentages of ARI were increasing, while the percentages of ADD were decreasing. Both of these groups of diseases reached their extreme points (maximum and minimum values) respectively. In this regard we can say that week-6 of current year was a turning point for both of these groups of diseases, as ARI percentages decreased while ADD percentages increased until the end of summer season. In week-24 and in week-35 the ARI and ADD curves crossed each other. In comparison with previous week the percentage of ARI increased by 1% to 19.9%, while the percentage of ADD decreased by 0.3% to 13.1% (ig-7) ig.-7: Trend of ARI/ADD as Propotion of Clients rom 25 of 2012 to 40 of ARI ADD Weeks of the Year ortality:

6 Among DEWS target diseases Pneumonia, Diarrheal Diseases and eningitis/severely Ill Children (SIC) are main causes of mortality which generally amount to more than 95% of total deaths of surveillance target diseases. Usually deaths due to diarrheal diseases increase during the summer season, while the number of deaths due to Pneumonia increases during the cold period/winter Season. In this week out of 42 (21 male, 21 female) deaths reported from all regions, 16 deaths (9 male, 7 female) were caused by Pneumonia, 8 deaths (5 male, 3 female) were caused by diarrheal diseases and 18 deaths (7 male, 11 female) were caused by eningitis/severely Ill Children. (Table-6) Table-6: Deaths by ain Causes of ortality and by in W40 of 2013 ain Causes of Deaths Grand Pneumonia Diarrheal Diseases eningitis/s IC : ale : emale Number of Outbreaks investigated in 2013 with details of W39/W40: Reported outbreaks since first week of 2013 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis Avian/Swine lu ARI SARI 2 2 easles Diarrhea Cholera eningitis Hepatitis alaria Typhoid 1 1 CCH Bloody Diarrhea 2 2 Chickenpox 7 7 Other Epidemiological week- 39 Update Suspected Cholera Outbreak: Reported from Sayed village of Khulm district Balkh province on Sept 15, An investigation was conducted on the same day. The health team investigated the affected area and they found 370 cases of suspected cholera cases. There were 182 cases of under five years old and 188 cases of over five years old.based on sex, there were 202 female and 168 male cases with one deaths associated. It was a clinically confirmed outbreak.the team collected the specimens and sent them to CPHL. The patients were treated and health education and hygiene sessions were conducted for caregivers and surrounding villages in addition to also the wells chlorination campaign. The outbreak is controlled. Suspected easles Outbreak: Reported from baghka angal Abad village of Gardiz district, Paktya province on Sept 21 /2013, the team investigated the area on Sept22/2013, Vaccination coverage is around 40%. During the

7 investigation there were 25 suspected measles cases,it was clinical confirm, There were 15 cases of under five years old and 3 cases of over five years old.based on sex, there were 7 female and 11 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases. Rumor of suspected Rabies Outbreak: Reported from Charahi Qumber of district five of Kabul province on Sept 21/2013, the team investigated the area on the same day. During the investigation there was one case of suspected dog bit, and it was a rumor not an outbreak. Cholera Outbreak: Reported from Dahan-e-kamaq village of Injil district Herat province on Sept 23, An investigation was conducted on the same day. The health team investigated the affected area and they found 23 cases of cholera cases. There were no cases of under five years old and 23 cases of over five years old.based on sex, there were 9 female and 14 male cases with no deaths associated. It was a clinically and lab confirmed outbreak.the team collected the specimens and sent them to CPHL and the result was positive. The patients were treated and health education and hygiene sessions were conducted for caregivers and surrounding villages in addition to also the wells chlorination campaign. Active surveillance system is in place for investigation of further cases. Suspected CCH Outbreak: Reported from Karte Khursan of district four of azar sharif city Balkh province on Sept 24, 2013.The team investigated the case on the following day.the patient has been admitted at the regional hospital. During the investigation, there was one suspected CCH case and field investigation has been perform.it was a clinically confirmed outbreak and the patient was 63 years old man.he had contact with animal. The team collected lab samples and send them to CPHL.The case was treated and health education session was conducted for his family members and other.the team is investigating for further cases. Suspected CCH Outbreak: Reported from Sawristan village of Injil district of Herat province on Sept 25, 2013.The team investigated the case on the following day.the patient has been admitted at the regional hospital. During the investigation, there was one suspected CCH case and field investigation has been perform.it was a clinically confirmed outbreak and the patient was 20 years old man.he had contact with animal. The team collected lab samples and send them to CPHL.The case was treated and health education session was conducted for his family members and other.the team is investigating for further cases. Suspected Cholera Outbreak: Reported from anda village of Qalat district Zabul province on Sept 26, An investigation was conducted on the following day. The health team investigated the affected area and they found 22 cases of suspected cholera cases. There were no case of under five years old and 22 cases of over five years old.based on sex, there were 10 female and 12 male cases with no deaths associated. It was a clinically confirmed outbreak.the team collected the specimens and sent them to CPHL. The patients were treated and health education and hygiene sessions were conducted for caregivers and surrounding villages in addition to also the wells chlorination campaign. Active surveillance system is in place for investigation of further cases. Epidemiological week- 40 Update Suspected Cholera Outbreak: Reported from Dahan-e-kamaq village of Injil district Herat province on Sept 23, An investigation was conducted on the same day. The health team investigated the affected area and they found 33 cases admitted into the Hospital and 89 cases treated in site by CTC. There was one death associated. It was a clinically and lab confirmed outbreak.the team collected the specimens and sent them to CPHL and the result was positive. The patients were treated and health education and hygiene sessions were conducted for caregivers and surrounding villages in addition to also the wells chlorination campaign. Active surveillance system is in place for investigation of further cases. Suspected CCH Outbreak: Reported from Poste No 1, Herat city Herat province on Sept 29, The team investigated the case on the same day.the patient has been admitted at the regional hospital. During the investigation, there was one suspected CCH case and field investigation has been performed. The patient was 25 years old man his married and has one child. He is slaughter and has occupational contact with animal blood. The team collected lab samples and send them to CPHL.The case was treated and health education session was conducted for his family members and other.the team is investigating for further cases. Suspected Cholera Outbreak: Reported from Kariz Village Shorabak district Kandahar province on Sept 27, The team investigated the case on Sept 28, The health team investigated the affected area and they found 120 cases of suspected cholera cases and (the majority of patients belongs to border police). There were one case of under five years old and 119 cases of over five years old

8 .Based on sex, there were 2 female and 118 male cases with no deaths associated. Result is pending. The patients were treated and health education and hygiene sessions were conducted for caregivers in addition to also the wells chlorination campaign. Active surveillance system is in place for investigation of further cases.

9 ANNEX: apping of Density Cases of Selected Diseases in 40 of 2013 by Province

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