DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) Weekly Epidemiological Report 07

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1 DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) Weekly Epidemiological Report Feb 215 Summary: o All 414 functional sentinel sites have submitted reports this week 1% reporting. o Out of a total of 379,547 new consultations (161,272 male, 218,275 female) this week, 38.3% or 145,192 (69,299 male, 75,893 female) consultations were reported due to DEWS targeted diseases. o Main causes of consultations in this week were Pneumonia, 22,829 cases (6% out of total new consultations) and Acute Diarrheal Diseases, 19,776 cases (5.2% out of total new consultations). o A total of 26 deaths were reported this week, of which 81 were due to DEWS targeted diseases, which includes 61 Pneumonia deaths, 16 Meningitis/SIC deaths and 3 Measles deaths and 1 Neonatal Tetanus death. o Total of 19 outbreaks reported this week, of which 18 were suspected Measles outbreaks reported from Khost, Ghazni, Paktika, Paktya, Jawzjan, Wardak, Nimroz, Helmand, Kandahar, Nangarhar, and Badghis provinces and a suspected Pneumonia outbreak reported from Takhar Province. Figure1: Surveillance/DEWS-Plus Sentinel Sites with GPS location by type of Health Facility Table 1: Coverage of DEWS-Plus Surveillance System Type of Health Facility Total Health Facilities (HF) HF covered by DEWS-Plus RH/PH DH CHC/BHC Polyclinic Private Hospital Special Hospital Total ,

2 Disease Number of cases Disease % out of total consultations Indicator based Surveillance The Indicator-based surveillance component of DEWS plus reports on weekly bases on 15 priority infectious diseases from sentinel sites. The data is compared with previous weeks and corresponding week of previous year and the alert and epidemic threshold is checked to see if disease incidence has crossed these levels and necessary action is initiated Figure 2: DEWS targeted diseases Percentage of Diseases out of total consultation during week 7 Pneumo nia AWD AWD with severe Dehy. ABD Meningit is Acute Viral Hepatitis Measles Neonatal Tetanus < 5 years 5 years Malaria Typhoid Fever < 5 years years Pneumo nia AWD Number of cases of diseases during week 7 AWD with severe Dehy. ABD Meningi tis Acute Viral Hepatiti s Measles < 5 years 5 years Neonat al Tetanus Malaria Typhoid Fever < 5 years years

3 Percentage Precentage Percentage Percentage Vaccine Preventable Diseases (VPDs): Table 2: Cases and deaths due to VPDs by age group during week 7, 215 Cases Deaths Diseases 5 <5 years years Total <5 years 5 years Total CFR/1 Measles Pertussis Diphtheria Neonatal Tetanus 2 2 Tetanus Seasonal Diseases: Trend of Pneumonia in recent weeks- 214/215 W5 W51 W52 W1 W2 W3 W4 W5 W6 W7 Current situation 214/215 Weeks Average of 3 years data( ) Trend of AWD with severe dehydration in recent weeks-214/215 W5 W51 W52 W1 W2 W3 W4 W5 W6 W7 Current situation 214/215 Weeks Average of 3 years data( ) Trend of Measles in recent weeks- 214/215 W5 W51 W52 W1 W2 W3 W4 W5 W6 W7 Current situation 214/215 Weeks Average of 3 years data( ) Trend of Malaria in recent weeks- 214/215 W5 W51 W52 W1 W2 W3 W4 W5 W6 W7 Weeks Current situation 214/215 Average of 3 years data( )

4 Event-Based Surveillance: 1. Measles Outbreaks During week 7 a total of 19 outbreaks detected, investigated and responded to by DEWS plus. The details are as below: 1.1 Measles outbreak was reported on 15 Feb 215 from Dehgan village of Mendoza district Khost province with 53 cases (44 in age group under five and 9 in over five). The collected specimens from 2 cases and sent vaccination coverage of the area was 2%. The team vaccinated 7 children against villages. Vitamin A supplements were conducted in the affected areas. The active surveillance has been established for investigation of 1.2 Measles outbreak was reported on 15 Feb 215 from 24 villages of Qarabagh district, Ghazni province with 58 cases (46 in age group under five and 12 in over five) and 1 death. The investigation team visited the area and collected specimens from 1 cases and sent them to CPHL for lab confirmation. The vaccination coverage of the area was 4%. The teams vaccinated 16 children against the measles in the affected and surrounding villages. Vitamin A supplements were distributed and health education sessions conducted in the affected areas. The active surveillance has been 1.3 Measles outbreak was reported on 17 Feb 215 from Ata gul village of Sharan district Paktika province with 8 cases (5 in age group under five and 3 in over five). The collected specimens from 2 cases and sent vaccination coverage of the area was 85%. The team vaccinated children against the areas. Vitamin A supplements were conducted in the affected villages. The active surveillance has been established for investigation of 1.4 Measles outbreak was reported on 18 Feb 215 from Soghri village of Sharan district Paktika province with 7 cases (5 in age group under five and 2 in over five). The collected specimens from 3 cases and sent vaccination coverage of the area was 95%. The teams vaccinated children against the areas. Vitamin A supplements were conducted in the affected villages. The active surveillance has been established for investigation of 1.5 Measles outbreak was reported on 18 Feb 215 from Hassankhil village of Ahmadkhil district Paktya province with 6 cases (4 in age group under five and 2 in 4%. The teams vaccinated 9 children surrounding area. Vitamin A supplements 1.6 Measles outbreak was reported on 18 Feb 215 from Herani village of Laja Mangar district Paktya province with 6 cases (5 in age group under five and 1 in over five). The investigation team visited the area and collected specimens from 2 cases and 4

5 sent them to CPHL for lab confirmation. 45%. The teams vaccinated 18 children surrounding area. Vitamin A supplements 1.7 Measles outbreak was reported on 2 Feb 215 from Mandikhil village of Chamkani district Paktya province with 8 cases (4 in age group under five and 4 in 35%. The teams vaccinated 4 children surrounding areas. Vitamin A supplements 1.8 Measles outbreak was reported on 14 Feb 215 from Mazad village of Chakhansor district Nimroz province with 12 cases (7 in age group under five and 5 in over five). The collected specimens from 3 cases and sent vaccination coverage of the area was low. The teams vaccinated children against the 1.9 Measles outbreak was reported on 17 Feb 215 from 7 street village of Nahresaraj districts Helmand province with 1 cases (7 in age group under five and 3 in 4%. The teams vaccinated 53 children surrounding area. Vitamin A supplements 1.1 Measles outbreak was reported on 18 Feb 215 from Nowzadkhil village of Arghistan district Kandahar province with 12 cases (1in age group under five and 2 in 22%. The teams vaccinated children against the 1.11 Measles outbreak was reported on 19 Feb 215 from Loymanda village of Nadali district Helmand province with 5 cases (5 in age group under five and in over five). The collected specimens from 3 cases and sent vaccination coverage of the area was low. The teams vaccinated 188 children against the 1.12 Measles outbreak was reported on 19 Feb 215 from Dem village of Shahwalikot district Kandahar province with 15 cases (5 in age group under five and 1 in over five). The 5

6 collected specimens from 3 cases and sent vaccination coverage of the area was 2%. The teams vaccinated 73 children against the 1.13 Measles outbreak was reported on 21 Feb 215 from Loymanda village of Arghandab district Kandahar province with 11 cases (7 in age group under five and 4 in 63%. The teams vaccinated 51 children surrounding area. Vitamin A supplements 1.14 Measles outbreak was reported on 16 Feb 215 from Haidarabad village of Aqcha district Jawzjan province with 13 cases (8 in age group under five and 5 in over five). The collected specimens from 4 cases and sent vaccination coverage of the area was 53%. The teams vaccinated children against the 1.15 Measles outbreak was reported on 18 Feb 215 from Badamdara village of Saidabad district Wardak province with 16 cases (11 in age group under five and 5 in area and collected specimens from 7 cases low. The teams vaccinated children against the 1.16 Measles outbreak was reported on 15 Feb 215 from Chorkhil village of Goshta district Nangarhar province with 9 cases (5 in age group under five and 4 in over five). The collected specimens from 5cases and sent vaccination coverage of the area was low. The teams vaccinated 135 children against the 1.17 Measles outbreak was reported on 15 Feb 215 from Dareboom village of Qadis district Badghis province with 33 cases (2 in age group under five and 13 in over five). The collected specimens from 3 cases and sent vaccination coverage of the area was low. The teams vaccinated children against the 1.18 Measles outbreak was reported on 16 Feb 215 from Gulchin village of Qadis district Badghis province with 12 cases (6 in age group under five and 6 in over five) and 1 death. The investigation team visited the 6

7 low. The teams vaccinated children against the 2. Pneumonia Outbreak. 2.1 Pneumonia was reported on 16 Feb 215 from Shahri jadid of Dasht qala district, Takhar province with 95 cases (45 in age group under five and 5 in over five) and 3 deaths. The investigation team visited the area, cases were treated, and health education sessions conducted in the affected villages and the active surveillance has been Figure 3: Outbreaks investigated during the week 7, 215 7

8 Table 2: Updates on the outbreaks reported during 215 (1 Jan to 21 Feb) Disease/event No. of outbreaks No. of lab confd. Outbreaks No. of cases No. of deaths Pertussis 2 8 Measles CCHF 1 1 Chickenpox 1 9 Scabies Viral Hepatitis 1 8 Suspected Rabies/dog bites 3 2 animal sample positive 57 2 Mumps 3 2 Pneumonia Total Laboratory surveillance: In this week a total of 79 different samples were received by CPHL, out of which 23 samples were Positive (for what), 23 samples were negative for Measles, 2 samples were positive for Rubella and 1 sample was negative for CCHF while the rest are under the process. Recommendations: o o o o High number of cases and deaths (above alert threshold) due to Pneumonia in the age group less than 5 years (12.3 % pneumonia cases among total consultations and 61 deaths) is a cause of concern. This should be analyzed and discussed at provincial level among stakeholders to find out the reasons for high morbidity and mortality. The increase in the number of measles and malaria cases as compared to the previous weeks should looked into at field level to find out if any outbreak is going on. The increase in the outbreaks of Measles in South, South East, Central West and West Regions is to be given serious consideration at the provincial level. Vaccination campaign should be promoted in area where assessed vaccination coverage is low especially in South Region and West Region. 8