Weekly Epidemiological Report – 33

16- 22 August, 2014 DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) Weekly Epidemiological Report – 33

Summary: o Out of 387 functional sentinel sites, 387 (100 %) have submitted reports this week. o Out of a total of 328,556 consultations (140,568 male, 187,988 female) recorded this week, 31.7% or 104,276 (50,641 male, 53,635 female) consultations were reported due to DEWS targeted diseases. o Main causes of consultations this week were Acute Diarrheal Diseases, 56,510 cases (17.1%) and Pneumonia, 7130 cases (2.21 %). o A total of 183 deaths were reported this week, of which 7 were due to DEWS targeted Diseases, which includes 12 Pneumonia deaths, 13 Diarrheal Diseases deaths,11 Meningitis/SIC deaths and 1 Malaria death. o Total of 5 outbreaks reported this week, of which a suspected Pertussis outbreak reported from Samangan province, a suspected CCHF outbreak reported from Urozgan and Herat provinces, a suspected Cholera outbreaks reported from Kandahar province and a suspected Conjunctivitis outbreak reported from Herat province.

Indicator – based Surveillance Figure 1: DEWS targeted diseases

Percentage of Diseases out of total Number of cases of diseases during consultation during week 33 week 33 20 1800

18 < 5 years 1600 16 ≥ 5 years 1400 < 5 years 14

12 1200 ≥ 5 years Numberofcases 10 1000

8 800 6

4 600 %out oftotal consultations 2 400 0

200 ABD

AWD 0

AVH

Pneumonia Malaria

Cough& Cold

Measles

Pertussis Diphtheria

Tetanus/NNT

Typhoid Fever Meningitis/SIC

Disease AWDwith severe Dehy. Disease Hemorrhagic Fever

Vaccine Preventable Disease (VPDs):

Table 1: Cases and deaths due to VPDs by age group during week 33, 2014

Cases Deaths Diseases <5 years ≥ 5 years Total <5 ≥ 5 Total years years Measles 63 24 87 0 0 0 Pertussis 2 0 2 0 0 0 Diphtheria 0 0 0 0 0 0

Tetanus/ NNT 3 3 6 1 0 1 AVH 28 140 168 0 0 0 Total 96 167 263 1 0 1

Seasonal Diseases:

Trend of Pneumonia in recent Trend of AWD with severe weeks-2014 2.5 2 dehydration in recent weeks-2014 1.8

1.6 1.4 1.5 1.2 1

1 0.8 Percentage Percentage 0.6 0.5 0.4 0.2 0 0 W24W25W26W27W28W29W30W31W32 w33 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 Current situation Weeks Weeks Current situation Average of 3 years data(2011-2013) Average of 3 years data (2011-2013)

Trend of Measles in recent weeks- Trend of Malaria in recent weeks- 2014 2014 250 3000

200 2500

2000 150 1500

100 Number Number 1000 50 500 0 0 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 Weeks Current situation Weeks Current situation Average of 3 years data (2011-2013) Average of 3 years data(2011-2013) 2

Event Based Surveillance: Outbreaks investigated during week 33 Update of Suspected Pertussis Outbreak: his caretakers, the active surveillance has been Reported from: Langer, khamee hafiz, dawaba established for investigation of further cases. and dehblande villages of Yaftal district, Suspected Cholera Outbreak: Reported from Badakhshan Province on Aug 11 /2014, and the Kandahar city prison of Kandahar Province on team investigated the area on August 13/2014, Aug 21 /2014, the team investigated the area on Reported vaccination coverage is poor. During the same day. During the investigation there the investigation there were 37 suspected were 74 suspected cholera cases ,it was clinical pertussis cases ,it was clinical confirm outbreak , confirm outbreak , There were no case of under There were 37 case of under five years old but five years old but 74 cases of over five years old no cases of over five years old .Based on sex, .Based on sex, there was no female but 74 male there was 18 female and 19 male cases with no cases with no deaths associated. The teams deaths associated. The teams collected 9 lab collected 5 lab samples and send them to CPHL, samples and send them to CPHL, the cases the cases treated. Health education has also been treated and health education session conducted given them; the active surveillance has been in surrounding villages; the active surveillance established for investigation of further cases. has been established for investigation of further Suspected CCHF Outbreak: Reported from cases. Kariz Akhondzada village of Guzara district of Suspected Pertussis Outbreak: Reported from Herat Province on Aug 16/2014, the team Karti Khurasan village of Aibak district, investigated the case at regional hospital on the Samangan Province on Aug 12 /2014, the team following day, During the investigation there investigated the area on the same day, Reported was one suspected CCHF cases .it was clinical vaccination coverage is 30%. During the confirm outbreak. The team collected one lab investigation there were 6 suspected pertussis sample and send them to CPHL, the case was cases ,it was clinical confirm outbreak , There treated, health education session conducted to were 3 case of under five years old and 3 cases his caretakers, the active surveillance has been of over five years old .Based on sex, there was established for investigation of further cases. 2 female and 4 male cases with no deaths Suspected Conjunctivitis Outbreak: Reported associated. The teams collected 6 lab samples from Taghi Naghi village of Zanda Jan district , and send them to CPHL, the cases treated and Herat Province on Aug 16 /2014, the team health education session conducted in investigated the area on the following day, surrounding villages; the active surveillance has During the investigation there were 41 been established for investigation of further conjunctivitis cases ,it was clinical confirm cases. outbreak , and the patients had following sign Suspected CCHF Outbreak: Reported from and symptoms eye redness, itching and some Khan village of Tarinkot district of Urozgan with discharge .There were 24 case of under Province on Aug 21/2014, the team investigated five years old and 17 cases of over five years the case at regional hospital on the same day, old .Based on sex, there was 24 female and 17 During the investigation there was one suspected male cases with no deaths associated. No lab CCHF cases .it was clinical confirm outbreak. sample collection, the cases treated and health The patient was a 15 year old girl who had education session conducted in surrounding contact with animals. The team collected one lab villages, the active surveillance has been sample and send them to CPHL, the case was established for investigation of further cases. treated, health education session conducted to

Table 2: Outbreaks reported during Week 33, 2014

Lab Lab # of # of specimens Confirmation confirm Disease Province District CFR/100 cases deaths sent to status CPHL CCHF Urozgan Tarinkot 1 0 0 1 Clinical Under Process CCHF Herat Guzara 1 0 0 1 Clinical Under Process AWD Kandahar Kandahar 74 0 0 5 Clinical Under city prison Process Pertussis Samangan Aibak 6 0 0 6 Clinical Under Process Conjunctivitis Herat Zanda Jan 41 0 0 0 Clinical Under Process

Table 3: Updates on the outbreaks reported during 2014 (Jan 1 to 22 August)

Disease/event No. of No. of lab confd. No. of cases No. of deaths outbreaks Outbreaks Pertussis 12 0 165 0 ARI 4 0 85 0 Measles 82 45 826 46 CCHF 26 6 26 1 Chickenpox 9 0 182 0 Scabies 5 0 134 0 Tinea 3 0 144 0 Dog 2 1 35 0 bites/Suspected Rabies Psychogenic Illness 2 0 43 0 Mumps 1 0 11 0 Vegetable 1 0 2 2 poisoning Food poisoning 1 0 31 0 Viral hepatitis 1 0 12 1 AWD 3 0 150 0 Conjunctivitis 1 0 41 0 Total 153 52 1887 50

Figure 1: Outbreaks investigated during the week 33, 2014

Laboratory surveillance:

In this week a total of 37 different samples were received by CPHL out of which one stool samples were negative for cholera, two sample were positive and two sample were negative for measles, ten samples were negative for pertussis and other 22 samples are under the process.

Recommendations: o High number of deaths due to Pneumonia and Acute Diarrheal Diseases can be analyzed and discussed at provincial level among stakeholders to find out the gaps results the high morbidity and mortality. o High incidence of Acute Watery Diarrhea overall up to 12.9% and 23.9% in the age group of less than five years should be analyzed and stakeholders should ensure the adequate amount of medicine for the treatment of the cases. o The increase in the outbreaks of CCHF in West region is to be given serious consideration at the provincial level coordinating agencies.