Afghanistan Polio Eradication Initiative

Surveillance Update Week 39 (Ending on Saturday 28 September, 2013)

National Surveillance Office September 31, 2013 AFP cases Classification,

Year 2013

Reported AFP cases 1428

Confirmed 6 Compatible 0 cVDPV2 3 Discarded 1316 Pending * 103

*81 Adequate AFP cases pending lab results 13 Inadequate AFP cases pending 60 days FUP 9 Inadequate AFP cases pending ERC Data up to 28 Sep 2013 Confirmed Polio cases & Compatibles Afghanistan 2012-2013 2012

# # # # # # # # # # # # ## # % %

% # # 2013 # NSL1=37 # ### # ##% % ## # # %# # # # #% NSL3=0 # Comp=7

No. Polio Date of Last No. Polio Date of Last # # NO Province Cases 12 Polio case 12 Cases 13 Polio case 13 ## # P1 P3 P1 P3 P1 P3 P1 P3 1 Farah 1 0 Jun-02 0 0 - - NSL1=6 2 Helmand 11 0 Nov-19 - 0 0 - - NSL3=0 3 Kandahar 11 0 Oct-20 - 0 0 - - Comp=0 4 Nangarhar 2 0 Dec-20 - 3 0 Aug 8 - Aug 27 5 Kunar 4 0 Sep-21 - 3 0 - ` 6 Uruzgan 2 0 Oct-18 - 0 0 - - NSL1 7 Paktya 2 0 Oct-01 - 0 0 - - NSL3 8 Ghor 1 0 Aug-31 - 0 0 - - Compatible 9 Khost 3 0 Nov-25 - 0 0 - - Total 37 0 - - 4 0 - -

Data up to 28 Sep 2013 P1 & P3 Poliovirus Isolates Afghanistan 1999, 04, 2011-2013 1999 2004

# ## # $## $ # $###$#

## $ $ $ # $ # $ #$$ ## $ ###$## $# # # #

#

# # # # # ##$ $ $# # ### # $ # NSL1 NSL1= 45 NSL1= 2 NSL3 NSL3= 18 NSL3= 2

2011 2012 2013

#

# # # #

# ## # # ## # # # # # # # # # # # # # # # # # # # # # # # # # # ## ## # # # ## # # # # # # # # # # # # ## # # # # # # ### # # ## # ##### # # # # ## ## #### # # ### # # # # # # ## ## # # # # # # # # NSL1= 6 # # # NSL1=80 NSL1=37 NSL3= 0 NSL3=0 NSL3=0

Data up to 28 Sep 2013 Distribution of P1, P3 & cVDPV2 by Month & District 2011-2013

2011 Jan Feb Mar Apr May Jun

NSL1= 1 NSL1= 0 NSL1= 0 NSL1= 2 NSL1= 4 NSL1= 4 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 cVDPV2= 1

2012

NSL1= 4 NSL1=1 NSL1= 1 NSL1= 0 NSL1= 4 NSL1= 3 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0

2013

NSL1= 0 NSL1= 1 NSL1= 1 NSL1= 0 NSL1= 1 NSL1= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 cVDPV2= 1 cVDPV2= 1 cVDPV2= 1

NSL1 NSL3 cVDPV2 Data up to 28 Sep 2013 Distribution of P1, P3 & cVDPV2 by Month & District 2011-2013

2011 Jul Aug Sep Oct Nov Dec

NSL1= 1 NSL1= 10 NSL1= 16 NSL1= 14 NSL1= 13 NSL1= 15 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0

2012

NSL1= 7 NL1= 6 NSL1= 3 NSL1= 2 NSL1= 4 NSL1= 2 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 NSL3= 0 cVDPV2= 2 cVDPV2= 2 cVDPV2= 7

2013

NSL1= 1 NSL1= 2 NSL1= 0 NSL3= 0 NSL3= 0 NSL3= 0

NSL1 NSL3 cVDPV2 Data up to 28 Sep 2013 List Of Confirmed Polio Cases Afghanistan, 2013

No Date of D last EPID Province District Prog Fever Asym Sex Age Routine SIAs Dstool2 Hcase LabR Cluster onset OPV

1 AFG/06/13/018 Nangarhar Lalpoora 31-01-13 Y Y N M 12 0 0 No dose 07-02-13 N NSL1 R4

2 AFG/06/13/038 Kunar Khas kunar 28-03-13 Y Y N F 21 0 1 11-03-13 06-04-13 N NSL1 R4

3 AFG/06/13/066 Nangarhar Shinwar 06-06-13 Y Y N M 18 3 7+ 22-04-13 11-06-13 N NSL1 R4

4 AFG/06/13/081 Kunar Watapur 23-07-13 Y Y N M 18 0 0 No dose 31-07-13 N NSL1 R4

5 AFG/06/13/085 Nangarhar Batikot 08-08-13 Y Y N M 9 0 7 02-07-13 11-08-13 N NSL1 R4

6 AFG/06/13/100 Kunar Watapur 27-08 Y Y N F 9 1 2 26-08-13 01-09-13 N NSL1 R4

Data up to 28 Sep 2013 cVDPV-2 Cases Afghanistan 2012-2013 2012 No EPID PROVINCE DISTRICT DONSET SEX AGE Routine SIAs DLASTOPV DSTOOL2

1 AFG/08/12/292 KANDAHAR MAYWAND 17-10-12 M 18 0 1 03-06-11 11-11-12

2 AFG/08/12/288 KANDAHAR PANJWAYI 30-10-12 M 8 0 2 08-07-12 06-11-12

3 AFG/08/12/290 KANDAHAR SPINBOLDAK 05-11-12 M 13 1 3 15-10-12 10-11-12

4 AFG/08/12/302 HILMAND NAHR-E-SARAJ 15-11-12 F 18 0 7+ 17-09-12 21-11-12

5 AFG/08/12/340 HILMAND KAJAKI 02-12-12 M 24 0 0 Zero dose 31-12-12

6 AFG/08/12/314 HILMAND NAD-E-ALI 03-12-12 F 28 0 7 06-10-12 09-12-12

7 AFG/08/12/338 HILMAND NAD-E-ALI 20-12-12 M 12 0 0 Zero dose 31-12-12

8 AFG/08/12/334 HILMAND WASHER 20-12-12 F 18 0 2 14-10-12 30-12-12

9 AFG/08/12/330 KANDAHAR PANJWAYI 20-12-12 M 18 0 5 18-09-12 27-12-12

10 AFG/08/12/339 HILMAND NAD-E-ALI 21-12-12 F 14 0 0 Zero dose 01-01-13

11 AFG/08/12/335 HILMAND NAWZAD 24-12-12 M 26 0 0 Zero dose 22-01-13 2013 1 AFG/08/13/013 HILMAND NAD-E-ALI 22-01-13 F 22 1 2 05-10-12 30-01-13

2 AFG/08/13/038 HILMAND NAD-E-ALI 20-02-13 F 36 0 7+ 12-02-13 26-02-13

3 AFG/08/13/054 KANDAHAR SHAHWALIKOT 13-03-13 M 14 0 0 Zero dose 17-03-13

Data up to 28 Sep 2013 cVDPV-2 Cases Afghanistan 2012-2013

• Median Age is 18 months and Median OPV doses are 2 = 1 cVDPV-2 • 12/14 cases are zero routine (86%) and two have received 1 dose each • 5/ 14 cases are zero SIAs (36 %) • All cases are reported from two provinces of South: Helmand 9 cases ( 5 from Nad Ali and 1 each from Nahrisiraj , Washer , Kajaki and Nawzad districts ) Kandahar 5 cases (2 from Panjwai and 1 each from Maiwand, Spinboldak and Shahwalikot) • Most of the cases are genetically linked with 2009 &2010 circulation, while the last two cases of Maiwand are linked across the border with Baluchistan and Killa Abdullah cVDPV-2 cases

Panjwai district 10 Date of onset 20 Dec 2012 2011 2012 2013 9 Nawzad district Date of onset 24 Dec 2012 8 7 6 5 4 7 3 2 1 2 2

1 1 1 1

0

Jul Jul Jul

Jan Jan Jan

Jun Jun Jun

Oct Oct Oct

Feb Sep Feb Sep Feb Sep

Apr Apr Apr

Dec Dec Dec

Mar Mar Mar

Aug Nov Aug Nov Aug Nov

May May May

Shahwalikot district Kandahar province cVDPV-2 tOPV Date of onset 13 Mar, 2013 Data up to 28 Sep 2013 Polio Virus Isolates By Type & Month, Afghanistan 2010-2013 20 2010 2011 2012 2013 19 18 17 16 15 14

13

12 11 10

No ofcasesNo 9 8 7 6 5 4 3 2

1

0

Jul Jul Jul Jul

Sep Oct Sep Oct Sep Oct Sep Oct

Jan Jan Jan Jan

Feb Feb Dec Feb Dec Feb Dec Dec

Jun Jun Jun Jun

Apr Apr Apr Apr

Nov Nov Nov Nov

Aug Aug Aug Aug

Mar Mar Mar Mar

May May May May NSL1 NSL3

tOPV mOPV1 mOPV3 bOPV SIAD Mop up SNID NID Data up to 28 Sep 2013 Afghanistan & Pakistan P1 and P3 isolates by genetic cluster 2013

Legend R2B R4A R4 B PEND Province boundary District boundary 1 Dot =1 Polio case

Afghanistan

Province

Pend Pakistan

R4 B R4

Nangarhar 3 0 Province

R2B R4B

R4A Pend Kunar 3 0 FATA 0 1 19 4 Total 6 0 KPK 0 0 6 1 Sindh 1 0 2 0 Punjab 0 0 2 0 Total 1 1 29 5

Data up to 28 Sep 2013 Vaccination status of Non Polio AFP cases 6-35 Months by region 2010-2013* Afghanistan

Central East Northeast North Southeast West South 100%

90% 46 66 80% 49

70% 55

109 46 79 60% 83 83 87 93 58 94107 120 93 98 28 96 115 78 81 88 31 69 35 46 19 29 50% 74 26 40%

43 30% 41 17

20% 33 5 20 18 13 20 15 10% 16 13 19 10 15 15 11 4 31 11 14 4 1 8 10 6 11 19 10 4 4 4 2 1 2 4 5 7 3 3 1 4 6 6 7 4 0% 12 3 0 1 1 2 0 1 2 0 1 1 0 1 1 0 1 4 0 Y10Y11 Y12 Y13 Y10Y11 Y12 Y13 Y10Y11 Y12 Y13 Y10Y11 Y12 Y13 Y10Y11 Y12 Y13 Y10Y11 Y12 Y13 Y10Y11 Y12 Y13

UNVACC 1-3 DOSES 4-6 DOSES 7+ Doses

*Data is revised on monthly basis Data up to 7 Sep 2013 Trend adjusted FM OPV coverage in Low Performing District ( LPD) of southern region, Afghanistan 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Kandahar SW.Kot ARGHANDAB KHAKREZ S.Boldak Maiwand Panjwaie Lashkarga Nadali Nahre saraj Sangin

Jan Feb 3-5 March 10-12 March 31 Mar-2Apr 14-16 Apr 5-7 May 19-21 May June SNID July SNID Aug NID

Trend adjusted FM OPV coverage in Low Performing District ( LPD) of (East), Afghanistan 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 ASADABAD WATAPUR SHIGAL NARANG SARKANI MARAWAR D. PECH CHAWKI KH KUNAR DANGAM BAR KONAR GHAZIABAD CH DARA NUR GUL NARAI

Sep-12 Oct-12 Dec-12 FEB SNID 13 Mar NID 13 April NID 13 19-21 May June SNID July SNID Aug NIDs

. Three districts, Watapur, Shigal (previously part of Asadabad ) and Ghaziabad (previously part of Barkunar) are new . Chapa dara: PCA not conducted since Oct 12 SIAs Regional Reference Lab Update Afghanistan, 2013

Month of Cases under process Negative NPEV Within 14 Positive cases Cases NPEV % onset cases positive days Culture ITD Wild Vaccine Jan 165 0 0 133 25 15% 100% 1 6 Feb 172 0 0 137 21 12% 100% 0 14 Mar 182 0 0 127 27 15% 100% 1 27 Apr 143 0 0 111 23 16% 100% 0 9 May 155 0 0 105 44 28% 100% 0 6 Jun 172 0 0 126 39 23% 100% 1 6 Jul 153 0 0 111 41 27% 100% 1 0 Aug 163 4 0 107 45 28% 98% 2 5 Sep 39 8 0 20 8 21% 79% 0 3 Week 1 Sep 29 26 0 2 1 3% 10% 0 0 Week 2 Sep 23 23 0 0 0 0% 0% 0 0 Week 3 Sep 0 0 0 0 0 0% 0% 0 0 Week 4 Sep total 91 57 0 22 9 10% 38% 0 3 T. AFP cases 1396 61 0 979 274 20% 96% 6 76

Contacts 631 36 0 418 144 23% 94% 0 33

Data up to 28 Sep 2013 AFP Cases Labeled As Hot & Pending in Lab Afghanistan, 2013

Date of last Site of Dstool2 Hot by Hot by EPID DONSET Province District Sex Age Doses OPV Paralysis (or 1) field criteria

AFG/03/13/258 14-09-13 HIRAT GHORYAN M 12 7+ 25-08-13 Left arm 18-09-13 YES YES

Left leg AFG/03/13/259 17-09-13 HIRAT GUZARA F 32 7+ 25-08-13 21-09-13 YES YES Right arm

Right leg AFG/03/13/262 18-09-13 FARAH KHAK-E-SAFED M 38 7+ 25-08-13 20-09-13 YES YES Right arm

AFG/03/13/261 23-09-13 HIRAT HERAT M 28 7+ 22-04-13 Left leg 24-09-13 YES YES

AFG/03/13/263 18-09-13 HIRAT GUZARA F 15 7+ 26-08-13 Right leg 23-09-13 YES YES

AFG/06/13/115 19-09-13 KUNAR NARANG F 17 7+ 16-09-13 Left leg 23-09-13 YES YES

AFG/06/13/116 18-09-13 NANGARHAR SHINWAR M 13 7+ 26-08-13 Left leg 25-09-13 YES YES

Right leg AFG/07/13/070 17-09-13 GHAZNI QARABAGH M 8 5 25-08-13 20-09-13 YES YES Right arm

Right leg AFG/08/13/250 20-09-13 KANDAHAR MARUF M 23 6 26-08-13 24-09-13 YES YES Right arm

Hot by criteria=AFP cases have (Fever + rapid progress+ Asymmetric paralysis + Age <48 month) Data up to 28 Sep 2013 AFP Cases Pending ERC Afghanistan, 2013

Dstool2 (or 60d follow-up EPID DONSET Province District Sex Age Doses Lab result 1) result

AFG/02/13/156 31-05-13 BILCHERAGH FARYAB F 48 7+ 30-07-13 NVI RES WEAK

AFG/06/13/073 01-06-13 JALALABAD NANGARHAR F 72 0 02-07-13 SL1 RES WEAK

NO AFG/08/13/176 05-06-13 SANGIN HILMAND M 50 7+ . DIED STOOLS

AFG/05/13/235 20-06-13 NEJRAB KAPISA F 6 6 06-08-13 NVI RES WEAK

AFG/03/13/211 30-06-13 HERAT HIRAT F 84 7+ 03-08-13 NVI RES WEAK

AFG/02/13/178 10-07-13 BALKH F 60 7+ 24-08-13 NVI RES WEAK

AFG/08/13/192 11-07-13 MIZAN ZABUL M 24 2 28-07-13 NVI RES WEAK

AFG/08/13/206 13-07-13 LASHKARGAH HILMAND F 3 4 15-08-13 NVI RES WEAK

AFG/05/13/231 14-07-13 HISA-E- AWAL-E- KOHE KAPISA M 2 1 05-08-13 NVI RES WEAK

Data up to 28 Sep 2013 AFP Cases Pending Classification >90 days, Afghanistan

Dstool2 Days since Reason for not EPID DONSET Province District Sex Age Doses Lab result (or 1) onset being classified

AFG/03/13/211 30-06-13 HIRAT HERAT F 84 7+ 03-08-13 NVI 92 PEND ERC

AFG/06/13/074 29-06-13 NANGARHAR SHINWAR F 24 7+ 03-07-13 SL 93 PEND ERC

AFG/05/13/235 20-06-13 KAPISA NEJRAB F 6 6 06-08-13 NVI 102 PEND ERC

AFG/12/13/036 06-06-13 BADAKHSHAN SHIGHNAN M 72 7+ 12-07-13 EV 116 PEND FUP

NO AFG/08/13/176 05-06-13 HILMAND SANGIN M 50 7+ . 117 PEND ERC STOOLS

AFG/06/13/073 01-06-13 NANGARHAR JALALABAD F 72 0 02-07-13 SL1 121 PEND ERC

AFG/02/13/156 31-05-13 FARYAB BILCHERAGH F 48 7+ 30-07-13 NVI 122 PEND ERC

Data up to 28 Sep 2013 Reported AFP Cases, Comparison By Month, Afghanistan 2010-2013

@ of 2/100,0000 <15 year @ of 1/100,0000 <15 year

190 180 170 160 150

140 130 120 110 100 90 80 70 60 Number of cases of Number 50 40 30 20

10

0

Jul Jul Jul Jul

Oct Oct Oct Oct

Jan Sep Jan Sep Jan Sep Jan Sep

Feb Dec Feb Dec Feb Feb Dec

Jun Jun Jun Jun

Apr Apr Nov Nov Apr Nov Apr Nov

Aug Aug Aug Aug

Mar Mar Mar Mar

May May May May DEC 2010 2011 2012 2013

Data up to 28 Sep 2013 AFP Cases By Week Of Onset Afghanistan 2013

Week Number AFP Cases

Region Region 30 31 32 33 34 35 36 37 38 39

GBS, TM, TN

Expect“2”

Labeled Labeled as

AFPcases

10 17 24 31

Reported

21 14 29

28

3

7

-

-

- - - -

Aug

- - -

Sep

-

Aug Aug Aug Aug

Sep Sep Sep

Jul

Badakhshan 11 48 20 0 1 1 2 2 2 1 0 1 0

Central 87 280 123 2 9 2 6 6 9 5 4 10 1

Eastern 38 116 47 4 1 6 4 4 5 8 1 5 0

Northeastern 43 188 63 3 2 6 1 7 7 2 1 3 0

Northern 47 206 62 5 7 6 7 6 4 5 7 3 2

South East 41 73 30 2 4 2 0 4 1 1 1 4 1

Southern 66 251 108 9 6 3 7 6 5 10 5 6 0

Western 51 266 117 5 6 6 5 6 6 8 11 5 2

Afghanistan 380 1428 570 30 36 32 32 41 39 40 30 37 6

Expected 2= Two cases/100,000 <15 yrs Week (Sun-Sat) Data up to 28 Sep 2013 % of AFP cases reported within 7 days of paralysis onset by region Afghanistan 2011-2013

100 90 80

70

60 50

40 Percentage 30 20 10 0

2011 2012 2013 Data up to 28 Sep 2013 Proportion of Adequate Stools By Region Afghanistan 2011-2013

100 90 80 70

60 50

Percentage 40 30 20 10 0

2011 2012 2013

Data up to 28 Sep 2013 % AFP Cases with Stool Specimen Reaching The RRL Within 3 and 7 Days of 2nd Specimen Collection By Region, Afghanistan 2011-2013 100 90 80 70 60 50 40 30 Within 3 days 20 10 0

2011 2012 2013

100 90 80 70 60 Within 7 days 50 40 30 20 10 0

2011 2012 2013 Data up to 28 Sep 2013 % of Entero -Virus and SL Isolation Afghanistan 11-13

35 Entero Virus EV % by month 11-13 35 30 30 25

25 20 20 15

Percentage 15 Percentage 10 10 5 5

0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Y11 Y12 Y13

22 Y11 Y12 Y13 20 SL % by month 11-13 18 22 16 SL 20 18 14 16 12 14

10 12 Percentage 8 10 6 8 Percentage 6 4 4 2 2 0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Y11 Y12 Y13

Y11 Y12 Y13 Data up to 28 Sep 2013