DEWS-WER-10-2012.Pdf (English)

March 12, 2012 DISEASES EARLY WARNING SYSTEM WER-10 (6th Yr)

DEWS WEEKLY EPIDEMIOLOGICAL REPORT EPREPORT

SUMMARY: rd th  This report includes surveillance data from 3 to 9 March 2012.

 Out of 290 functional Sentinel sites(SS), 289 (99.6%) have sent their reports in Week-10 of 2012;

 Out of total 263,908 events recorded in week-10 of 2012, 85,818 (32.5%) consultations were reported due to DEWS

target diseases.

 Main causes of consultations this week are Acute Respiratory Infections/ARI (26.9%) and Acute Diarrheal Diseases/ADD (4.7%) from total clients in a continuing trend from the week before.  73 deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so that 59 deaths due to pneumonia, 2 deaths due to diarrheal diseases and 12 deaths reported due to Meningitis and Severely Ill Children.  In this reporting week, five Measles outbreaks reported and investigated in Khost, Daikundi, Zabul, Kunar provinces. One mumps Outbreaks in Laghman province and One Pertussis outbreak reported and investigated in Hirat province.

REPORTS RECEIVED FROM REPORTING SITES: As of March 9, 2012, 290 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan . In this reporting week, all 289 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-10, 2012

Central Central East Central West North North East West South East South East Total No. of Expected Reports from 49 30 45 36 33 34 33 30 290 Sentinel Sites No. of Reports Received in this 49 30 45 35* 33 34 33 30 289 week

*No report received from Nusaee sentinel site of Darwaz district/Badakhshan province.

Page 1 of 9

DEWS Sentinel Sites: Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in Figure-1(Map) shows the distribution of Week-10, 2012

DEWS sentinel sites, already established

in the relevant regions/provinces till Type of

March 9, 2012 by type of health SS

alEast Centr al West North North East West South East South East Total facilities. Data on 15 DEWS target Centr diseases are being collected from these CHC/BHC 21 19 30 25 19 25 23 22 184 sentinel sites (SS).The symbols on the DH 12 7 10 7 9 4 7 4 60 map show the number of sentinel sites in PH/RH/SH 14 4 5 4 4 5 3 4 43 each region/province, and do not Poly Clinic 2 0 0 0 1 0 0 0 3 indicating the GPS of the SS locations. Total 49 30 45 36 33 34 33 30 290 DEWS Data in Epidemiological Week- CHC=Comprehensive Health Center, DH=District hospital, 10 of 2012 PH=provincial hospital, RH= Regional hospital, SH= specialized Out of total 263,908 clients recorded in hospital week-10 of 2012, 22% (58291) of consultations were Fig-2: Percentages of DEWS Target reported due to cough and cold and 4.9% (12816) of 14.0% Diseases by age Group in W10 of 2012 consultations was reported due to pneumonia. In the same 12.0% reporting period, 4.7% or 12,524 events were reported due 10.0% to diarrheal illnesses (3.2% due to Acute Watery Diarrhea, 8.0% 1.3% due to Bloody Diarrhea and 0.3% due to acute watery 6.0% diarrhea with dehydration). In comparison with previous 4.0% 2.0% week (W09 of 2012) the percentage of ARI diseases has 0.0% ARI ARI AwD Men/ AVHe Malar TyphF decreased by 2% to 26.9%, whereas the percentage of Acute AwD BD AFP Diarrheal diseases increased by 0.3% to 4.7%.This variation C&C Pn w SIC p ia ev can be due to changes in temperature /weather during the U5% 11.6% 6.5% 2.0% 0.6% 0.1% 0.0% 0.2% 0.2% 0.3% 0.0% reporting week.Figure-2 above shows the percentages of O5% 2.1% 1.8% 1.0% 0.2% 0.0% 0.1% 0.0% 0.2% 0.4% 0.0% DEWS target diseases by age groups in week-10 of 2012. Tot% 4.9% 3.2% 1.3% 0.3% 0.1% 0.1% 0.1% 0.2% 0.4% 0.0%

Page 2 of 9

Percentage of ARI by weeks and by Age Groups In the epidemiological week-10, a total of 71,107 events of ARI were reported. 32.4 % of total clients less than 5 years of age were cough & Cold patients and 17.9% 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 52-11 01-12 02-12 03-12 04-12 05-12 06-12 07-12 08-12 09-12 10-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 33.7 34.3 33.9 35.0 34.9 34.8 33.6 32.7 33.5 34.4 32.4 5+ 20.4 20.2 20.6 21.1 21.1 20.7 20.7 19.7 19.8 19.3 17.9 ARI-Pneumonia <5 Yr. 11 11.8 12.1 12.7 12.8 12.9 12.6 13.1 12.1 11.3 11.6 >=5 Yr 2.4 2.4 2.8 2.5 2.7 2.5 2.6 2.7 2.4 2.5 2.1 consultations in week-52 of 2011, in comparison with the percentage of C&C in week-10 of 2012, decreased by 1.3%, whereas in case of 5 years and above decreased by 2.5% to17.9% in 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 increased by 0.6% in last 11 weeks, whereas the percentage of age group 5 years and over decreased by 0.3% to 2.1% in last 11 weeks. In the reporting week-10 of 2012, the highest percentage of Cough & Cold has been recorded in Kapisa and Paktya provinces with 37% and 35% respectively, whereas the lowest percentages of C&C were reported from Farah and Badghis provinces with 16% and 14% respectively. The highest percentages of Pneumonia reported from Baghlan and Sar-i-pol provinces with12% each, whereas the lowest percentage was recorded in Zabul and Nimroz provinces with 1% each. (Fig-3) 50% Percentages of ARI from Total Clients in week-10 of 2012 40% 30%

20%

10%

0% Bad Sa Ba Day Hil Kan Nan Par Wa Bag Pan Uru Lag Nur akh Bal Far Gha Hira Jaw Kho Kun Log Pak Pak ma Sari Tak Zab Kab Bad Far Gho Kap Nim Kun my kun ma dah gar wa rda hla jshe zga hm ista sha kh yab zni t zjan st duz ar tika tya nga Pul har ul ul ghis ah r isa roz ar an di nd ar har n k n r n an n n n Pneumonia 6% 5% 7% 6% 4% 3% 3% 2% 11% 5% 2% 6% 8% 4% 3% 3% 2% 7% 12% 4% 5% 1% 5% 12% 4% 2% 5% 4% 5% 1% 2% 4% 8% 7% Cough&Cold 20% 19% 24% 33% 26% 24% 29% 25% 18% 27% 26% 22% 30% 26% 29% 36% 26% 18% 22% 19% 23% 19% 15% 28% 14% 16% 18% 37% 22% 18% 19% 28% 16% 31% 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 Wee 52-11 01-12 02-12 03-12 04-12 05-12 06-12 07-12 08-12 09- (10-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) 12(%) (%) Acute Watery <5 Years 6.6 6.5 6.0 6.1 5.9 5.6 5.5 5.2 4.8 5.9 6.5 Diarrhea >= 5 Years 1.9 1.9 1.8 1.8 1.7 1.7 1.8 1.7 1.6 1.7 1.8 Bloody Diarrhea <5 Years 2.0 1.9 1.8 1.8 1.7 1.7 1.7 1.4 1.6 1.9 2 >=5 Years 0.9 0.9 0.9 0.9 1.0 0.9 1.0 0.9 1.0 1.0 1 Acute W. Diarrhea <5 Years 0.7 0.7 0.6 0.7 0.6 0.5 0.5 0.5 0.4 0.6 0.6 with Dehydration ≥5 Years 0.1 0.2 0.1 0.2 0.1 0.1 0.1 0.2 0.1 0.1 0.2 diarrhea with dehydration) from week-52 of 2011to week-10 of 2012, from total clients. Acute watery diarrhea among children less than five years has been decreased from 6.6% in week-52 of 2011 to 6.5% in the reporting week, whereas acute watery diarrhea among age group 5 years and above decreased by 0.1% to 1.8% in last 11weeks (Please refer to Table-5, above).Bloody diarrhea, in age group less than 5 years after some small changes during last 11 weeks reached again the level of week-52 of 2011 i.e. 2.0% in week-10 of 2012; in case of age group 5 years and above increased by 0.1% in the same

Page 3 of 9 period. Acute watery diarrhea with dehydration among age groups less than five years decreased by 0.1% and in case of age group 5 years and over increased by 0.1% in last 11 weeks. 12% Percentages of Diarrheal Diseases from Total Clients in week-10 of 2012 10% AWDwD BD AWD 8% 6% 4% 2%

Hirat

Ghor

Logar

Zabul

Balkh

Farah

Kabul

Khost

Kunar

Kapisa

Faryab

Paktya

Ghazni

Takhar

Nimroz

Paktika

Kunduz

Sari Pul Sari

Parwan

Badghis

Jawzjan

Wardak

Baghlan

Bamyan

Uruzgan

Hilmand

Nuristan

Panjsher

Laghman

Daykundi

Kandahar

Samangan Nangarhar

Badakhshan

Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: 1.0% Fig -5: Percentages of Men/SIC Malaria & Typhoid In the epidemiologic week-10 of 2012, a total of 171 Fever from Total Clients in Week-10 of 2012 by Region suspected cases of Meningitis/Sever Ill Child were reported 0.8% from all regions and the highest percentage was recorded in 0.6% North region. In the same reporting week, from all regions 597 consultations were reported by Sentinel Sites to be malaria and 0.4% the highest percentage of Malaria cases were reported from 0.2% East region with 0.9%. Out of the total clients, 1037 cases or 0.0% 0.4% in national level were reported to be suspected Typhoid North Centra Centra South North West South East Fever and the highest percentage of Typhoid Fever was East l West l East East reported from South region with 0.9% and followed by East Men/SIC 0.0% 0.1% 0.1% 0.1% 0.0% 0.0% 0.1% 0.0% region with 0.7%. Malaria 0.1% 0.2% 0.0% 0.0% 0.0% 0.3% 0.9% 0.3% Vaccine Preventable Diseases Typh Fev 0.3% 0.2% 0.4% 0.2% 0.2% 0.9% 0.7% 0.5% In DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, so Table-6: Suspected Cases of Vaccine Preventable that their occurrences are changing by seasonal Diseases in W10 of 2012 by Region

variations. Among these diseases

Meningitis/severely ill child is being reported

mostly in North region, in this week out of total Regions 171 cases in country level, more than 31% has

been reported from North region and more than Viral

Meningitis Ill Sever Child Hepatitis Measles Pertussis Diphtheria Tetanus Natal /New Tetanus Acute Flaccid Paralysis 30% of cases were recorded in central east and East regions. North East 13 9 13 0 0 0 0 In general the highest cases of viral hepatitis North 54 3 23 2 0 0 3 being reported from East, south East and Central West 11 2 1 0 0 0 1 central east regions, so that in the reporting West 17 19 19 0 0 0 2 week 37 cases from central east, 33 cases from Central East 31 37 14 3 0 0 2 East and 41 cases were reported from South- South 13 6 18 0 0 2 1 east region. From total 209 Measles cases East 26 33 108 1 0 0 1 reported in the reporting week, and more than South East 6 41 13 0 0 1 0 50% of cases were recorded in East region. Total 171 150 209 6 0 3 10

Page 4 of 9

Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks(from W22 of 2011 to W10 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-10 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 date, 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 will started decreasing, while ADD started increasing. In this week (Week-10 of 2012) in comparison with previous week, ARI decreased by 2.0% to 26.9%, while the percentage of ADD increased by 0.3% to 4.7%.

Trend of ARI/ADD as Propotion of Total Clients From Week-22 of 2011 to Week-10 of 2012 35

30 31.2 31.5 30.8 29.9 30.5 30.5 29.9 P 29.5 29.3 28.9 28.1 28 e 25 26.9 26.1 r 25.7 c 23.2 20 21.8 22 17.1 e 16.2 16.8 16.2 20.7 15.5 15.8 16.1 16 15.9 15.8 16.1 15.8 20 15.3 15 18.8 n 14.1 17.9 15 13.5 13.3 17.6 16.312.4 t 15.4 11.1 14.9 14.3 13.8 13.9 13.6 13.8 10.1 10.1 a 13.4 13 13.2 12.9 13.4 9.2 10 12.8 12.4 12.8 12.8 8.5 8.2 g 11.5 7 7.3 6.6 6.2 5.7 5.5 e 4.9 4.9 4.7 4.7 ARI 4.6 4.5 4.3 4.4 4.2 4.0 4.4 s 5 ADD 0

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" 0700290955 or the WHO CSR/DEWS Technical Officer, 0708811856,[email protected]

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

Percentages 8

Reporting Weeks

Mortality: Among DEWS target diseases Pneumonia, Diarrheal Table-7: Deaths by Main Causes of Mortality and by Region in W10 of 2012

diseases and Meningitis/ Main

Severely Ill Children (SIC)

Causes of

are main causes of Deaths

East North Central West West Central East South East South East Total mortality which make in North general more than 95% of Pneumonia total deaths of surveillance 9 16 4 5 13 3 7 2 59 target diseases. Usually Diarrheal deaths due to diarrheal Diseases 1 0 0 0 1 0 0 0 2 diseases increases during Meningitis summer season, while the 2 1 1 3 2 3 0 0 12 number of deaths due to Pneumonia increases during cold period/Winter Season. In this week out of 73 deaths reported from all regions, 59 deaths caused by Pneumonia, 12 deaths caused by Meningitis/severely ill children and 2 deaths were caused by diarrheal diseases.(Table-7)

Outbreak Investigation and Response in the epidemiological weeks 9-10 /2012

Reported outbreaks since first week of 2012 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis 4 4 Avian/Swine Flu ARI 6 6 Measles 52 3 49 Diarrhea Meningitis Hepatitis 1 1 Malaria Typhoid CCHF Bl. Diarrhea Chickenpox Other 6 1 5 Total 69 4 65 Epidemiological week-9  Suspected Measles Outbreak: reported from Alam khile Masjid kalan village of Balkh district , Balkh province on Feb 28 /2012, the team investigated the area on following day and during the investigation there were 12 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, outbreak is controlled  Suspected Measles Outbreak: reported from Khojasayaran village of Charikar district , Perwan province on Feb 25 /2012, the team investigated the area on following day and during the investigation there were 11 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, outbreak is controlled

 Suspected Measles Outbreak: reported from Samarkhil village of Behsood district , Nangarhar province on Feb 25 /2012, the team investigated the area on following day and during the investigation there were 6 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, outbreak is controlled  Suspected Measles Outbreak: reported from Sarangi Dawar khil village of Goshta district , Nangarhar province on Feb 26 /2012, the team investigated the area on following day and during the investigation there were 8 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, outbreak is controlled  Rumor of Suspected Diphtheria : reported from Nawram village of Alishang district , Laghman province on Mar 3 /2012, the team investigated the area on the same day and during the investigation there were no cases of suspected Diphtheria and that was a rumor of the suspected Diphtheria  Suspected Measles Outbreak: reported from Tajarmin village of Chesht-e- sharif district , Hirat province on Feb 26 /2012, the team investigated the area on following day and during the investigation there were 11 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, outbreak is controlled  Suspected ARI /pneumonia Outbreak: reported from Siagashak village of Chaghcharan district , Ghor province on Feb 29 /2012, the team investigated the area on March 1/2012 and during the investigation there were 43 suspected ARI cases out them 3cases were ARI with measles , the patients treated and health education sessions conducted for villagers , the vaccination campaign conducted in surrounding villages ,the team is investigating for further cases .  Suspected Measles Outbreak: reported from Lagzayee village of Karukh district , Hirat province on March 01 /2012, the team investigated the area on same day and during the investigation there were 9 suspected measles cases ,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 Epidemiological week-10  Suspected Measles Outbreak: reported from Zadran Hasinzi village of Mandazi district , Khost province on March 06 /2012, the team investigated the area on same day and during the investigation there were 53 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is control.  Suspected Measles Outbreak: reported from Abduarzaq, perkas village of Ashterlai district , Daikondi province on March 03 /2012, the team investigated the area on March 05/2012 and during the investigation there were 11 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is control.  Suspected Measles Outbreak: reported from Kala village of Qalat district , Zabul province on March 06/2012, the team investigated the area on same day and during the investigation there were 9 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is control

 Suspected Measles Outbreak: reported from Shumash village of Norgal district , Kunar province on March 01/2012, the team investigated the area on March o3 /2012 and during the investigation there were 12 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is control  Suspected Measles Outbreak: reported from Badgoor, Mazar Tangi village of Nurgal district , Kunar province on March 04/2012, the team investigated the area on March 04/2012 and during the investigation there were 13 suspected measles cases ,the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is control  Suspected Mumps Outbreak: reported from Nawram village of Alishang district , Laghman province on March 04/2012, the team investigated the area on March 04/2012 and during the investigation there were 8 suspected mumps cases , the cases treated and health education conducted in surrounding villages, the outbreak is control Suspected Pertusis Outbreak: reported from Koh-e-zor village of Shindand district , Hirat province on Feb 26 /2012, the team investigated the area on Feb 28 /2012 and during the investigation there were 160 suspected Pertusis cases ,out of them 19death the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is control.

Annex: Mapping of DEWS Seasonal Disease Cases/ Percentage in week-06 of 2012: