May 27, 2012 DISEASES EARLY WARNING SYSTEM WER-21 (6th year)
DEWS WEEKLY EPIDEMIOLOGICAL REPORT EPREPORT SUMMARY: This report includes surveillance data from 19th to 25th May 2012. Out of 302 functional Sentinel sites (SS), 301 (99.7%) have sent their reports in Week-21 of 2012; Out of total 296, 943 events recorded in week-21 of 2012, 95,895 (32.3%) consultations were reported due to
DEWS target diseases.
Main causes of consultations this week are Acute Respiratory Infections/ARI (19.5%) and Acute Diarrheal Diseases/ADD (11.4%) from total clients in a continuing trend from the week before. 42 deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so that 24 deaths due to pneumonia, 8 deaths due to diarrheal diseases and 10 deaths reported due to Meningitis and Severely Ill Children. In this reporting week, four Measles outbreaks reported and investigated in Paktika, Jawzjan, Sar-i-pul, and Kunar. Two suspected Poisoning in Khost and Takhar provinces, one bloody diarrhea among Kandahar prisoners and one
pertussis outbreaks in Badakhshan province reported and investigated.
REPORTS RECEIVED FROM SITES: As of May 25, 2012, 302 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan . In this reporting week, all 301 sentinel sites have sent their reports on new cases of DEWS target diseases , recorded during the reporting. 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 Regions during Epidemiological week-21,
2012
Central Central East Central West North North East West South East South East Total No. of Expected Reports from 51 30 48 36 34 38 35 30 302 Sentinel Sites No. of Reports Received in this 51 30 48 36 34 37* 35 30 301 week In this week the report of Attghar sentinel site, Zabul province of South region did not send its weekly report.
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DEWS Sentinel Sites: Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in Figure-1(Map) shows the Week-21, 2012
distribution of DEWS sentinel
sites, already established in the
Type of
relevant regions/provinces till May SS
East Central West North North East West South East South East Total 25, 2012 by type of health Central facilities. Data on 15 DEWS target CHC/BHC 23 19 33 25 20 29 25 22 196 diseases are being collected from DH 12 7 10 7 9 4 7 4 60 these sentinel sites (SS).The PH/RH/SH 14 4 5 4 4 5 3 4 43 symbols on the map show the Poly Clinic 2 0 0 0 1 0 0 0 3 number of sentinel sites in each Total 51 30 48 36 34 38 35 30 302 region/province, and do not CHC=Comprehensive Health Center, DH=District hospital, PH=provincial indicating the GPS of the SS hospital, RH= Regional hospital, SH= specialized hospital locations. Fig-2: Percentages of DEWS Target DEWS Data in Epidemiological Week-21 of 2012 30.0% Out of total 296,943 clients recorded in week-21 of 2012, 16.7% Diseases by age Group in W21 of (49480) of consultations were reported due to cough and cold and 20.0% 2012 2.8% (8454) of consultations were reported due to pneumonia. In the same reporting period, 11.4% or 33,839 events were reported due to 10.0% diarrheal illnesses (8.2% due to Acute Watery Diarrhea, 2.2% due to Bloody Diarrhea and 1% due to acute watery diarrhea with 0.0% Me Typ ARI ARI Aw Aw AVH Mea Mal dehydration). In comparison with previous week (W20 of 2012) the BD n/SI hFe C&C Pn D Dw ep sle aria percentage of ARI diseases has decreased by 0.4% to 19.5%, whereas C v the percentage of Acute Diarrheal diseases increased by 0.7% to U5% 24.7 6.4% 17.8 3.7% 2.2% 0.1% 0.0% 0.3% 0.6% 0.3% 11.4%.This variation can be due to changes in temperature /weather O5% 13.3 1.4% 4.2% 1.6% 0.5% 0.0% 0.1% 0.0% 0.5% 0.7% during the reporting week.Figure-2 above shows the percentages of Tot% 16.7 2.8% 8.2% 2.2% 1.0% 0.0% 0.1% 0.1% 0.6% 0.6% DEWS target diseases by age groups in week-21 of 2012.
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Percentage of ARI by weeks and by Age Groups In the epidemiological week-21, a total of 57,934 events of ARI were reported. 24.7 % of total clients less than 5 years of age were cough & Cold patients and 13.3% among the age group 5 years and over. The percentage of C&C (<5 years) Table-4: Percentages of ARI Diseases during 11 recent weeks by age groups and by weeks Disease Age Week Week Week Week Week Week Week Week Week Week Week 11-12 12-12 13-12 14-12 15-12 16-12 17-12 18-12 19-12 20-12 21-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 31.6 29.1 30.3 28.3 27.1 27.6 27.8 25.6 25.0 25.4 24.7 5+ 18.0 17.2 16.3 14.6 15.0 14.3 14.6 14.5 13.8 13.3 13.3 ARI- <5 Yr. 10.2 9.7 9.2 9.0 8.6 8.0 7.5 6.7 6.6 6.1 6.4 Pneumonia >=5 Yr 2.1 2.1 1.9 1.8 1.7 1.4 1.5 1.4 1.3 1.4 1.4 consultations in week-11, in comparison with the percentage of C&C in week-21 of 2012, decreased by 6.9%, whereas in case of 5 years and above decreased by 4.7% to13.3% in this reporting week. The trend of ARI diseases in last 11 weeks can be read in table-4. The percentages of consultations on Pneumonia cases of age group less than 5 years decreased by 3.8% in last 11 weeks, whereas the percentage of age group 5 years and over decreased by 0.7% to 1.4% in last 11 weeks. In the reporting week-21 of 2012, the highest percentage of Cough & Cold has been recorded in Logar and Kapisa provinces with 29% and 24% respectively, whereas the lowest percentages of C&C were reported from Farah province with 8 %. The highest percentages of Pneumonia reported from Sar-i- Pul and Jawzjan provinces with 13% and 7% respectively, whereas the lowest percentage of Pneumonia was recorded in Zabul province with less than1%. (Fig-3) 35% Fig-3: Percentages of ARI from Total Clients in week-21 of 2012 30% 25% 20% 15% 10% 5% 0% BA DA GH HE JO KA KH LO NA PA SA WA KA BD GH PA NI UR KN NU BDS BAL FYB HEL KDZ PKA PIA SAR TAK ZAB BGL FRA KAP LAG M Y A R W N O G N R M R B G O N M U R R Pneumonia 3% 5% 4% 2% 3% 2% 2% 1% 7% 1% 1% 3% 3% 2% 2% 3% 2% 4% 13% 3% 4% 0% 4% 5% 1% 1% 3% 2% 2% 0% 1% 3% 2% 3% Cough&Cold 14%21%16%21%23%19%12%19%16%11%21%17%29%19%14%17%17%17%21%13%20%10%14%18%11% 8% 16%24%15%10%11%20%10%22%
Percentages of Diarrheal Diseases by weeks and by Age Groups The table-5 below shows the percentages of diarrheal diseases (Acute watery Diarrhea, Bloody Diarrhea and Acute watery Table-5: Percentages of Diarrheal Diseases from Total Clients during 11 recent weeks by age groups. Disease Age Week Week Week Week Week Week Week Week Week Week Week 11-12 12-12 13-12 14-12 15-12 16-12 17-12 18-12 19-12 20-12 21-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 6.3 7.2 7.7 9.3 10.6 13.2 13.6 13.6 15.3 16.2 17.8 Diarrhea >= 5 Years 1.9 2.2 2.2 2.4 2.7 3.1 3.2 3.4 3.9 4.1 4.2 Bloody Diarrhea <5 Years 2.1 2.0 2.2 2.5 2.6 3.0 2.6 3 3.6 3.0 3.7 >=5 Years 1.0 1.1 1.1 1.1 1.2 1.3 1.2 1.3 1.9 1.5 1.6 Acute W. Diarrhea <5 Years 0.6 0.7 0.7 1.0 1.1 1.5 1.7 1.6 1.8 1.9 2.2 with Dehydration ≥5 Years 0.2 0.2 0.2 0.2 0.2 0.3 0.3 0.4 0.5 0.5 0.5 diarrhea with dehydration) from week-11 to week-21 of 2012, from total clients. Acute watery diarrhea among children less than five years has been increased from 6.3% in week-11 to 17.8% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has increased by 2.3% to 4.2%.(Please refer to Table-5, above).Bloody diarrhea, in age group less than 5 years increased by 1.6% in last 11 weeks, while in case of age group 5 years and above increased by 0.6% in the same period. Acute watery diarrhea with dehydration in age group less than 5 years increased by 1.6%, in case of five years and above increased by 0.3% in last 11 weeks.
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25% Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-21 of 2012 20% AWDwD BD AWD 15%
10%
5%
0%
PIA
FYB
HEL
BAL
BGL
FRA
SAR
ZAB
TAK
KDZ
BDS
LAG
HER
PKA KAP
PAR
KAB
LOG
DAY
KNR
PAN
NIM
KAN
BDG
KHO
URU
GHA NUR
JOW
NAN
GHO
SAM
BAM WAR
Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region:
In the epidemiologic week-21 of 2012, a total of 136 2.5% Fig -5: Percentages of Men/SIC Malaria & Typhoid Fever suspected cases of Meningitis/Sever Ill Child were from Total Clients in Week-21 of 2012 by Region reported from all regions and the highest percentage 2.0% was recorded in Central region. In the same reporting 1.5% week, from all regions 1675 consultations were reported by Sentinel Sites to be malaria and the highest 1.0% percentage of Malaria cases were reported from East region with 2.1%. Out of the total clients, 1755cases or 0.5% 0.6% in national level were reported to be suspected 0.0% Typhoid Fever and the highest percentage of Typhoid NER NR CWR WR CER SR ER SER Fever was reported from South region with 1.1% and Men/SIC 0.0% 0.1% 0.0% 0.1% 0.0% 0.0% 0.1% 0.0% followed by South East region with 1%. Malaria 0.3% 0.3% 0.2% 0.1% 0.1% 0.5% 2.1% 1.2% Vaccine Preventable Diseases Typhoid Fev 0.5% 0.6% 0.4% 0.3% 0.3% 1.1% 0.9% 1.0% In DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, so that their occurrences are changing by Table-6: Suspected Cases of Vaccine Preventable seasonal variations. Among these diseases Diseases in W21 of 2012 by Region
Meningitis/severely ill child is being
reported mostly in North region; in this Ill Ill week out of total 136 cases in country Regions
level, 29 cases have been reported from
Viral
Sever Child Hepatitis Measles Pertussis Diphtheria Tetanus Natal /New Tetanus Acute Flaccid Paralysis central east region and 24 cases were Meningitis/ recorded in North region. North East 14 11 30 0 0 0 1 In general the highest number of cases of North 24 5 55 0 0 0 2 viral hepatitis being reported from East, Central West 9 3 23 0 0 0 1 south East and central east regions, so that West 21 13 10 0 0 0 0 in the reporting week out of total 158 cases, 58 cases from Central-east 29 from Central East 29 58 33 1 0 0 5 East, and 33 cases from South East region South 12 6 14 0 0 3 1 were reported. From total 380 Measles East 22 29 163 3 0 0 0 cases reported in the reporting week, more South East 5 33 52 0 0 0 0 than 42% of cases were recorded in East Total 136 158 380 4 0 3 10 region, while more than 14% in North region.
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Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks(from W22 of 2011 to W21 of 2012) Among the DEWS target diseases, Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) as 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-22 of 2011 to week-21 of 2012. In week- 22 of 2011, the ARI and ADD curves crossed each other, so that ARI started decreasing and ADD changed its course to increase. By the end of Summer season of 2011 these curves crossed one another again in week-37 and from that time to week 6 of 2012, in general the percentage of ARI was increasing, while the percentages of ADD were falling /decreasing, but week-09 of 2012 was a turning point for both categories of ARI and Diarrheal diseases i.e. ARI started decreasing, while ADD started increasing. In this week (Week-21 of 2012) in comparison with previous week, ARI decreased by 0.4% to 19.5%, while the percentage of ADD increased by 0.7% to 11.4%.
35 Fig-6: Trend of ARI/ADD as Propotion of Total Clients From Week-22 of 2011 to Week-21 of 2012
30 31.231.5 30.8 29.930.5 30.529.9 P 29.5 29.328.9 28.1 28 25 26.926.8 e 26.1 25.7 25.3 r 24.4 23.2 c 22.4 20 21.8 22 22.5 21.521.7 16.8 17.1 20.9 e 16.2 16.2 20.7 20.1 15.5 15.816.1 16 15.9 15.816.1 15.8 20 19.919.5 15.3 15 18.8 n 14.1 17.9 15 13.5 13.3 17.6 t 16.312.4 10.7 11.4 15.4 11.1 14.9 14.3 10.6 a 13.813.9 13.6 13.8 10.110.1 13.4 13 13.212.9 12.8 13.412.8 12.8 9.2 9.0 10 12.4 8.5 8.2 8.5 8.6 g 11.5 7 7.3 7.2 6.6 6.2 6.3 5.7 5.5 5.5 5.6 e 4.9 4.9 4.7 4.7 4.9 ARI 4.6 4.5 4.3 4.4 4.2 4.0 4.4 s 5 ADD
0
w8
W7 W9
w52 w10
W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21
W2-12 W3-12 W4-12 W5-12 W6-12
W-1-12 W22-11 Weeks of the Year
All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point – "Director Surveillance"
ARI Dis & ADD from Week-21 to Week-38 of 2008
18 16.8 ARI 16.4 16.4 16.316.1 Dis 16 15.3 16.716.9 16.6 16.5 ADD 16.2 14.4 13.9 14.9 13.713.613.3 14 14.8 1312.8 14.2 12.2 14 12.1 13.5 11.3 11.2 12 10.9 11.2 10.7 10.810.9 10.7 11.8 10.7 10 10.6
8 Percentages
6
4
2
0
Reporting Weeks
Mortality: Among DEWS target diseases Pneumonia, Table-7: Deaths by Main Causes of Mortality and by Region in W21 of 2012
Diarrheal diseases and Main
Meningitis/ Severely Ill
Causes of
Children (SIC) are main Deaths
East North Central West West Central East South East South East Total causes of mortality which North make in general more than Pneumonia 95% of total deaths of 2 8 3 1 1 2 4 3 24 surveillance target diseases. Diarrheal Usually deaths due to Diseases 1 2 0 0 0 4 0 1 8 diarrheal diseases increases Meningitis during summer season, 0 2 0 4 1 2 1 0 10 while the number of deaths due to Pneumonia increases during cold period/Winter Season. In this week out of 42 deaths reported from all regions, 24 deaths caused by Pneumonia, 10 deaths caused by Meningitis/severely ill children and 8 deaths were caused by diarrheal diseases. (Table-7)
Number of Outbreaks investigated in 2012 with details of W20/W21
Reported outbreaks since first week of 2012 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis 16 1 15 Avian/Swine Flu ARI 7 7 Measles 128 3 125 Diarrhea Meningitis Hepatitis 2 2 Malaria Typhoid CCHF 2 2 Bl. Diarrhea 1 1 Chickenpox Other 18 2 16 Total 174 6 168 Epidemiological week-20 Suspected Measles Outbreak: reported from Mia Noor villages of Gardiz district of Paktya province on May 08 /2012, the team investigated the area on the following day and during the investigation there were 14 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is controlled. Suspected Measles Outbreak: reported from Mamuzi villages of Ahmad aba district of Pakyta province on May 08 /2012, the team investigated the area on the following day and during the investigation there were 10 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is controlled .
All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point – "Director Surveillance"
Suspected Measles Outbreak: reported from Shirdagagh villages of Malistan district of Ghazni province on May 14 /2012, the team investigated the area on the following day and during the investigation there were 16 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases . Suspected poisoning : reported Worza village school at Mandozi district of Khost province on May 15 /2012 and investigated on the same day, and the health team investigated the affected area and they found 397 cases of fainting ,vomiting and Abdominal pain which was due to drinking water and there was with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control, Suspected Measles Outbreak: reported from Mangoor villages of Shahristan district of Diakondy province on May 16 /2012, the team investigated the area on the following day and during the investigation there were 10 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases . Suspected Pertussis Outbreak: reported from Mulah Wali village of Spin Boldak district of Kandahar province, on May 12/2012 and investigated on the following day, during the investigation there were 43 suspected cases of Pertussis with no death and specimen collected and send to CPHL, and patients treated, the team is investigating for further cases. Suspected Measles Outbreak: reported from Waigal villages of Darinoor district of Nangarhar province on May 13 /2012, the team investigated the area on the following day and during the investigation there were 10 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases. Suspected Measles Outbreak: reported from Kosht villages of Paroon district of Nooristan province on May 12 /2012, the team investigated the area on the same day and during the investigation there were 8 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is controlled. Suspected Measles Outbreak: reported from Kotkay villages of Narage district of Kunar province on May 14 /2012, the team investigated the area on the same day and during the investigation there were 13 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases. Suspected Measles Outbreak: reported from Koh –e-Zairat villages of Dawalat yar district of Ghor province on May 13 /2012, the team investigated the area on the same day and during the investigation there were 8 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is controlled. Suspected Pertussis Outbreak: reported from four village of Shindand district of Hirat province, on May 01/2012 and investigated on the following day, during the investigation there were 200 suspected cases of Pertussis with 4 deaths and specimen collected and send to CPHL, and patients treated, the team is investigating for further cases .
All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point – "Director Surveillance"
Update of Suspected Pertussis Outbreak: reported from Khasar village of Shahribuzurg district of Badakhshan province, on May 10 /2012 and investigated on the same day, during the investigation there were 250 suspected cases of Pertussis with 3 deaths and specimen collected and send to CPHL, and patients treated, the team is investigating for further cases Epidemiological week-21
Suspected poisoning : reported Worza village school at Mandozi district of Khost province on May 20 /2012 and investigated on the same day, and the health team investigated the affected area and they found 47 cases of fainting ,vomiting and Abdominal pain which was due to drinking water and there was with no deaths case and the patients treated and health education and hygiene session conducted for students, the team is investigating for further cases Suspected Measles Outbreak: reported from Kamal ,Migar and Mani villages of Giyan district of Paktika province on May 20 /2012, the team investigated the area on the following day and during the investigation there were 25 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases. Suspected Measles Outbreak: reported from Lab jar Taghan villages of Khawja do kuh district of Jawzjan province on May 23 /2012, the team investigated the area on the same day and during the investigation there were 8 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases. Suspected Measles Outbreak: reported from Bagh Isaque villages of Sozma qala district of Saripul province on May 20 /2012, the team investigated the area on the following day and during the investigation there were 19 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases. Suspected Bloody diarrhea Outbreak: reported from Kandahar prison ,Kandahar province on May 23 /2012 and team investigated on the area same day, and during the investigated there were 35 cases of bloody diarrhea with no deaths, the team collected the specimen and sent to CPHL , and the patients treated and health education and hygiene session conducted for villagers, outbreak is under control Suspected Measles Outbreak: reported from Dandona villages of Narage district of Kunar province on May 20 /2012, the team investigated the area on the following day and during the investigation there were 7 suspected measles cases with no death , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases. Suspected Pertussis Outbreak: reported from Wadian village of Shahribuzurg district of Badakhshan province, on May 21 /2012 and investigated on May 23 /2012, during the investigation there were 25 suspected cases of Pertussis and specimen collected and send to CPHL, and patients treated, the team is investigating for further cases Suspected poisoning : reported Bibi hajera school at Taloqan city of Takhar province on May 21 /2012 and investigated on the same day, and the health team investigated the affected area and they found 104 cases of mass fainting , which was due to bad smell of possibly gas, with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control,
All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point – "Director Surveillance"
ANNEX: Mapping of Percentages/Cases of Selected Diseases in Week-21 of 2012 by Province
All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point – "Director Surveillance"