Islamic Republic f Afghanistan Ministry f Public Health Evaluatin & Health Infrmatin Summary: DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) Weekly Epidemilgical Reprt 48 Out f 493 functinal DEWS plus sentinel sites, 487 (98.7%) have submitted reprts this week. Out f a ttal f 434,331 new cnsultatins (182,005 male, 252,326 female) this week, 36.4% r 158,204 (75,580 male, 82,624 female) cnsultatins were reprted due t DEWS targeted diseases. Main causes f cnsultatins in this week were Diarrheal Diseases, 31,675 cases (7.3% ut f ttal new cnsultatins) and Pneumnia, 18,896 cases (4.4% ut f ttal new cnsultatins). A ttal f 181 deaths were reprted this week, f which 35 were due t DEWS targeted diseases, which includes 25 Pneumnia deaths, 6 Meningitis/SIC deaths and 3 Diarrheal Diseases deaths and 1 viral hepatitis death. There was nly ne suspected Measles utbreak reprted frm Paktya prvince. Figure1: Surveillance/DEWS-Plus Sentinel Sites with GPS lcatin by type f Health Facility د افغانستان اسالمی جمهىریت د عامه روغتیا وزارت د ارزونی او روغتیائی معلىماتى لىی ریاست جمهىری اسالمی افغانستان وزارت صحت عامه ریاست عمىمی ارزیابی و معلىمات صحی 29 Nv- 5 Dec 2015 Table 1: Cverage f DEWS-Plus Surveillance System Type f Health Facility Ttal Health Facilities (HF) HF cvered by DEWS-Plus RH/PH DH CHC/BHC Plyclinic Private Hspital Special Hspital Ttal 34 78 1,226 1 213 26 1,578 32 69 371 1 2 14 493 1
Disease Number f cases Disease % ut f ttal cnsultatins Indicatr based Surveillance: The Indicatr-based surveillance cmpnent f DEWS-plus reprts n weekly bases n 15 pririty infectius diseases frm sentinel sites. The data is cmpared with previus weeks and crrespnding week f previus years and the alert and epidemic threshld is checked t see if disease incidence has crssed these levels and necessary actin is initiated. Figure 2: DEWS targeted diseases 12 11 10 9 8 7 6 5 4 3 2 1 0 Pneum nia Percentage f Diseases ut f ttal cnsultatin during week 48 with Dehydra tin Bldy Diarrhea Meningit is Viral Hepatitis Measles < 5 years 5 years Nenatal Tetanus Malaria Typhid Fever < 5 years 8.9 9.6 2.6 0.76 0.08 0.07 0.02 0.0000 0.3 0.2 5 years 2.1 3.0 1.2 0.25 0.02 0.06 0.00 0.0003 0.4 0.3 16000 Number f cases f diseases during week 48 14000 12000 < 5 years 5 years 10000 8000 6000 4000 2000 0 Pneum nia with Dehydra tin Bldy Diarrhea Meningit is Viral Hepatitis Measles Nenata l Tetanus Malaria Typhid Fever < 5 years 12621 13634 3683 1071 107 101 31 0 422 248 5 years 6275 8933 3615 739 48 169 7 1 1066 1011 2
Percentage Precentage Percentage Percentage Vaccine Preventable Diseases (VPDs): Table 2: Cases and deaths due t VPDs by age grup during week 48, 2015 Diseases Cases Deaths <5 years 5 years Ttal <5 years 5 years Ttal CFR/100 Measles 31 7 38 0 0 0 0.00 Pertussis 0 0 0 0 0 0 0.00 Diphtheria 0 0 0 0 0 0 0.00 Tetanus 0 1 1 0 0 0 0.00 Seasnal Diseases: 5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00 Trend f Pneumnia percentage ut f ttal cnsultatin in recent weeks-2015 Current situatin Trend f with severe dehydratin percentage ut f ttal cnsultatin in recent weeks-2015 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Current situatin Average f 3 years data (2012-2014) Average f 3 years data (2012-2014) 0.030 0.025 0.020 0.015 0.010 0.005 0.000 Trend f Measles percentage ut f ttal cnsultatin in recent weeks- 2015 Current situatin Average f 3 years data (2012-2014) 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Trend f Malaria percentage ut f ttal cnsultatin in recent weeks- 2015 Current situatin Average f 3 years data (2012-2014) 3
Event-Based Surveillance: During week 48 a ttal f 1 utbreak detected, investigated and respnded t by DEWS-plus. The details are as belw: 1. Measles Outbreaks 1. Suspected Measles utbreak was reprted n 5 th December 2015 frm Pir Bagh village f Gardiz district, Paktya prvince with 12 suspected cases (6 cases in age grup under five and 6 cases in age grup ver five). The investigatin team visited the area (n specimens cllected yet). The vaccinatin cverage f the area was 80% and 70 under-five children were vaccinated in the affected area. Vitamin A supplements were distributed and health educatin sessins cnducted in the affected area. The active surveillance has been established fr detectin and investigatin f further cases. Figure 3: Outbreaks investigated during the week 46, 2015 4
Table 2: Updates n the utbreaks reprted during 2015 (01 Jan t 5 December) Disease/event N. f utbreaks N. f lab cnfd. Outbreaks N. f cases N. f deaths Measles 194 169 2742 16 CCHF 123 30 125 20 Pertussis 25 4 180 0 Suspected Rabies/dg bites 16 4 167 2 Mass psychgenic illness 14 0 1321 0 Mumps 5 0 53 0 Scabies 5 1 398 0 Viral Hepatitis 8 4 67 0 Fd pisning 5 0 350 0 Chickenpx 4 1 73 0 Pneumnia 2 0 155 8 Cnjunctivitis 3 0 131 0 Watery Diarrhea 2 0 176 0 Malaria 3 3 1426 0 Chlera 1 1 1 0 Anthrax 1 0 10 0 Leishmaniasis 1 1 19 0 Ttal 412 218 7394 46 Labratry surveillance: In this week a ttal f 39 different specimens/samples were received by CPHL, ut f which 5 specimens were psitive fr Measles, 4 were negative fr Measles and 1 specimen was psitive fr Rubella while the rest are under the prcess. (Fllw-up by CPHL). Recmmendatins: High number f cases (abve alert threshld) and deaths due t Pneumnia in the age grup less than 5 years (8.9 % Pneumnia cases amng ttal cnsultatins and 25 deaths) is a cause f cncern. This shuld be analyzed and discussed at prvincial level amng stakehlders t find ut the reasns fr high mrbidity and mrtality and take apprpriate actins. The increase in the malaria cases (as cmpared t the average f last three years) and its utbreaks shuld be given cnsideratin at the central and field levels. 5
The increase in the cases and deaths due t CCHF shuld be taken by the cncerned departments at varius levels. Early reprting and hspitalizatin f CCHF cases, IEC and strng crdinatin with animal health department and actins t be taken by them t cntrl the ticks n the animals.( CDC department f MPH shuld implement the cntrl measures in human) 6