July 2, 2012 DISEASES EARLY WARNING SYSTEM WER-26 (6Th Yr)

July 2, 2012 DISEASES EARLY WARNING SYSTEM WER-26 (6th Yr)

DEWS WEEKLY EPIDEMIOLOGICAL REPORT EPREPORT SUMMARY:  This report includes surveillance data from 23rd to 29th June 2012.  Out of 306 functional Sentinel sites(SS), 306 (100%) have sent their reports in Week-26 of 2012;  Out of total 304,668 Consultations recorded in week-26 of 2012, 97,678 (32.1%) consultations were reported due

to DEWS target diseases.

 Main causes of consultations this week are Acute Respiratory Infections/ARI (14.6%) and Acute Diarrheal Diseases/ADD (15.7%) from total clients in a continuing trend from the week before.  54 deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so that 30 deaths due to pneumonia, 16 deaths due to diarrheal diseases and 8 deaths reported due to Meningitis and Severely Ill Children.  In this reporting week, nine Measles outbreaks reported and investigated in Paktika,Ghazni and Nuristan provinces. Four suspected Poisoning in Bamyan , Nimroz, Hilmand and Badghis provinces, and one Cholera outbreaks in

Samangan province have reported /investigated.

REPORTS RECEIVED FROM REPORTING SITES: As of June 30, 2012, 306 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan . In this reporting week, all 306 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-26,

2012

Central Central East Central West North North East West South East South East Total No. of Expected Reports from 53 30 48 37 34 38 36 30 306 Sentinel Sites No. of Reports Received in this 53 30 48 37 34 38 36 30 306 week

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

of DEWS sentinel sites, already Week-26, 2012

established in the relevant

Type of regions/provinces by June 29, 2012 by

alEast Centr al West North North East West South East South East Total type of health facilities. Data on 15 Centr DEWS target diseases are being CHC/BHC 25 19 33 26 20 29 26 22 200 collected from these sentinel sites DH 12 7 10 7 9 4 7 4 60 (SS).The symbols on the map show PH/RH/SH 14 4 5 4 4 5 3 4 43 the number of sentinel sites in each region/province, and do not indicating Poly Clinic 2 0 0 0 1 0 0 0 3 the GPS of the SS locations. Total 53 30 48 37 34 38 36 30 306 CHC=Comprehensive Health Center, DH=District hospital, PH=provincial hospital, RH= Regional hospital, SH= specialized hospital DEWS Data in Epidemiological Week-26 of 2012 Fig-2: Percentages of DEWS Target Out of total 304,668 clients recorded in week-26 of 2012, 12.5% Diseases by age Group in W26 of 2012 (38039) of consultations were reported due to cough and cold and 30.0% 2.1% (6423) of consultations were reported due to pneumonia. In 25.0% the same reporting period, 15.7% or 47,788 events were reported 20.0% due to diarrheal illnesses (12.0% due to Acute Watery Diarrhea, 15.0% 2.4% due to Bloody Diarrhea and 1.3% due to acute watery 10.0% diarrhea with dehydration). In comparison with previous week 5.0% 0.0% (W25 of 2012) the percentage of ARI diseases has decreased by ARI ARI AwD Men AVH Mea Mala Typh AwD BD 0.6% to 14.6%, whereas the percentage of Acute Diarrheal C&C Pn w /SIC ep sle ria Fev diseases remained the same by15.7%.This variation can be due to U5% 17.4% 4.6% 24.7% 3.7% 2.9% 0.1% 0.1% 0.3% 0.9% 0.4% changes in temperature /weather during the reporting week. O5% 10.3% 1.0% 6.4% 1.9% 0.7% 0.0% 0.1% 0.1% 0.8% 0.8% Figure-2 above shows the percentages of DEWS target diseases Tot% 12.5% 2.1% 12.0% 2.4% 1.3% 0.1% 0.1% 0.1% 0.8% 0.7% by age groups in week-26 of 2012.

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Percentage of ARI by weeks and by Age Groups In the epidemiological week-26, a total of 44,462 events of ARI were reported. 17.4 % of total clients less than 5 years of age were cough & Cold patients and 10.3% 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- 16-12 17-12 18-12 19-12 20-12 21-12 22-12 23-12 24-12 25-12 26-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 27.6 27.8 25.6 25.0 25.4 24.7 22.6 20.7 19.8 18 17.4 5+ 14.3 14.6 14.5 13.8 13.3 13.3 12.4 11.9 11.4 10.7 10.3 ARI- <5 Yr. 8.0 7.5 6.7 6.6 6.1 6.4 5.9 5.8 5.0 4.8 4.6 Pneumonia >=5 Yr 1.4 1.5 1.4 1.3 1.4 1.4 1.2 1.1 1.2 1.1 1.0 consultations in week-16, in comparison with the percentage of C&C in week-26 of 2012, decreased by 10.2%, whereas in case of 5 years and above decreased by 4.0% to10.3% 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 3.4% in last 11 weeks, whereas the percentage of age group 5 years and over decreased by 0.4% to 1% in last 11 weeks. In the reporting week-26 of 2012, the highest percentage of Cough & Cold has been recorded in Kapisa and Bamyan provinces with 22% and 19% respectively, whereas the lowest percentages of C&C were reported from Uruzgan and Zabul provinces with 6 % and 7% respectively. The highest percentages of Pneumonia reported from Sar-i- Pul and Nuristan provinces with 6% and 5% respectively, whereas the lowest percentage of Pneumonia was recorded in Zabul province with less than1%. (Fig-3) 30% Fig-3: Percentages of ARI from Total Clients in week-26 of 2012

20%

10%

0% BA DA GH HE JO KA KH LO NA PA SA WA KA BD GH PA NI UR KN LA NU BDS BAL FYB HEL KDZ PKA PIA SAR TAK ZAB BGL FRA KAP M Y A R W N O G N R M R B G O N M U R G R Pneumonia 2% 2% 4% 1% 2% 1% 1% 0% 5% 0% 2% 1% 2% 2% 1% 1% 1% 2% 6% 4% 4% 0% 3% 3% 1% 1% 2% 2% 3% 1% 1% 2% 3% 5% Cough&Cold 12%15%19%15%16%12%10%13%12% 7% 15%14%18%15%13%14%13%13%14%10%17% 7% 10%11% 8% 8% 10%22%16%11% 6% 18%10%19%

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 16-12 17-12 18-12 19-12 20-12 21-12 22-12 23-12 24-12 25-12 26-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 13.2 13.6 13.6 15.3 16.2 17.8 19.2 21.0 23.0 23.8 24.7 Diarrhea >= 5 Years 3.1 3.2 3.4 3.9 4.1 4.2 5.4 5.2 5.7 6.4 6.4 Bloody Diarrhea <5 Years 3.0 2.6 3 3.6 3.0 3.7 3.5 3.4 3.9 3.9 3.7 >=5 Years 1.3 1.2 1.3 1.9 1.5 1.6 1.6 1.6 1.9 1.9 1.9 Acute W. Diarrhea <5 Years 1.5 1.7 1.6 1.8 1.9 2.2 2.4 2.8 2.5 3 2.9 with Dehydration ≥5 Years 0.3 0.3 0.4 0.5 0.5 0.5 0.6 0.7 0.6 0.7 0.7 diarrhea with dehydration) from week-16 to week-26 of 2012, from total clients. Acute watery diarrhea among children less than five years has been increased from 13.2% in week-16 to 24.7% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has increased by 3.3% to 6.4%.(Please refer to Table-5, above).Bloody diarrhea, in age group less than 5 years increased by 0.7% 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 1.4%, in case of five years and above increased by 0.4% in last 11 weeks.

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30% Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-26 of 2012AWDwD BD AWD 20%

10%

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-26 of 2012, a total of 3.5%Fig -5: Percentages of Men/SIC Malaria & Typhoid Fever from 175 suspected cases of Meningitis/Sever Ill Child Total Clients in Week-26 of 2012 by Region 3.0% were reported from all regions and the highest percentage was recorded in North region. In the 2.5% same reporting week, from all regions 2506 2.0% consultations were reported by Sentinel Sites to 1.5% be malaria and the highest percentage of Malaria 1.0% cases were reported from East region with 3%. Out of the total clients, 2080 cases or 0.7% in 0.5% 0.0% national level were reported to be suspected NER NR CWR WR CER SR ER SER Typhoid Fever and the highest percentage of Men/SIC 0.1% 0.1% 0.0% 0.1% 0.0% 0.0% 0.0% 0.0% Typhoid Fever was reported from South East Malaria 0.3% 0.4% 0.3% 0.2% 0.2% 0.8% 3.0% 1.5% region with 1.7% and followed by East region Typhoid Fev 0.6% 0.5% 0.6% 0.4% 0.3% 1.0% 1.0% 1.7% with 1%. Vaccine Preventable Diseases In DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, so that their occurrences are changing by seasonal variations. Among these diseases Table-6: Suspected Cases of Vaccine Preventable Meningitis/severely ill child is being Diseases in W26 of 2012 by Region

reported mostly from North region; in this

week out of total 175 cases in country Natal Natal level, 40(22%) cases have been reported Regions

from North region and 38 cases were

Viral

Sever Ill Ill Sever Child Hepatitis Measles Pertussis Diphtheria Tetanus /New Tetanus Acute Flaccid Paralysis recorded in North east region. Meningitis/ In general the highest number of cases of North East 38 16 36 19 8 0 2 viral hepatitis being reported from East, North 40 2 61 5 0 0 2 south East and North east regions, so that Central West 7 13 37 0 0 0 0 in the reporting week out of total 203 West 18 11 1 0 0 1 1 cases, 90 cases from East, 29 from Central East, and 27 cases from South East region Central East 35 29 54 0 0 1 0 were reported. From total 410 Measles South 12 15 22 3 0 5 0 cases reported in the reporting week more East 21 90 118 0 0 0 1 than 28% of cases were recorded in East South East 4 27 81 2 0 1 0 region, while more than 14% recorded in Total 175 203 410 29 8 8 6 region.

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Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks(from W22 of 2011 to W26 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-26 of 2012(more than one complete cycle). 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, 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-26 of 2012) the curves of ARI and ADD after crossing each other, continuing their courses paradox from one another. Comparing this week data with previous week, ARI decreased by 0.6% to 14.6%, while the percentage of ADD remained by 15.7% without changes.

35 Trend of ARI/ADD as Propotion of Total Clients From Week-22 of 2011 to Week-26 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 22.4 c 20 21.8 22 22.5 21.521.7 18.1 16.8 17.1 20.7 20.9 16.215.8 16.1 1615.9 16.2 15.8 16.1 15.8 20 20.119.9 15.7 e 15.315.5 15 19.5 17.1 15.7 14.1 18.8 n 15 13.5 13.3 17.617.9 16.3 16.312.4 t 15.4 11.1 11.4 14.715.2 14.9 14.3 10.610.7 14.6 13.813.9 13.6 13.8 10.110.1 13.5 a 13.4 13 13.212.9 13.4 9.2 9.0 12.9 10 12.812.4 12.8 12.8 8.5 8.2 8.5 8.6 11.5 7 7.3 7.2 g 6.6 6.2 6.3 5.7 5.5 5.5 5.6 4.9 4.9 4.7 4.7 4.9 e ARI 4.6 4.5 4.3 4.4 4.2 4.0 4.4 5 s ADD

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 W22 W23 W24 W25 W26 W27

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" 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

8 Percentages

Reporting Weeks

Mortality: Among DEWS target diseases Pneumonia, Table-7: Deaths by Main Causes of Mortality and by Region in W26 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 4 7 0 2 9 0 5 3 30 surveillance target diseases. Diarrheal Usually deaths due to Diseases 1 5 0 4 0 3 1 2 16 diarrheal diseases increases Meningitis during summer season, 2 4 0 2 0 0 0 0 8 while the number of deaths due to Pneumonia increases during cold period/Winter Season. In this week out of 54 deaths reported from all regions, 30 deaths caused by Pneumonia, 8 deaths caused by Meningitis/severely ill children and 16 deaths were caused by diarrheal diseases. (Table-7)

Number of Outbreaks investigated in 2012 with details of W25/W26

Reported outbreaks since first week of 2012 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis 22 2 20 Avian/Swine Flu ARI 7 7 Measles 156 6 150 Diarrhea 3 3 Meningitis Hepatitis 2 2 Malaria Typhoid CCHF 6 6 Bl. Diarrhea 1 1 Chickenpox Other 34 2 32 Total 231 10 221 Epidemiological week-25  Suspected cholera Outbreak: reported from Davidy village of Kohistan2 district of Kapesa province on June19 /2012, the team investigated the area on the same day and during the investigation there were one suspected cholera case with no death , the team collected the specimens and send it to CPHL , the case treated and the health education session conducted in surrounding villages, the team is investigating for further cases.  Rumor of suspected Measles Outbreak: reported from Bagalkandoo village of Asterterli district of Diakondi province on June 14/2012, the team investigated the area on the following day and during the investigation there was no case suspected measles .It was a rumor.  Suspected poisoning: reported Mulaghulam school of Bamyan city of Bamyan province on June 19 /2012 and investigated on the same day, and the health team investigated the affected

area and they found 148 cases of mass fainting ,dizziness and weakness with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control.  Suspected food poisoning : reported Haji Ghouse of Zaranj district of Nimroz province on June 20 /2012 and investigated on the same day, and the health team investigated the affected area and they found 12 cases of vomiting ,diarrhea ,Nausea and abdominal pain with no deaths case and the patients treated and health education and hygiene session conducted for the villagers, outbreak is under control.  Suspected Pertussis Outbreak: reported from Hajyano Qala village of Arghandab district of Kandahar province, on June 20/2012 and investigated on June 21 /2012, during the investigation there were 7 suspected cases of Pertussis and specimen collected and send to CPHL, and patients treated ,vaccination campaign conducted in surrounding villages and health education session conducted to villagers , the team is investigating for further cases.  Suspected Measles Outbreak: reported from center of Khawaja Bahawodin district of Badakhshan province on June 16/2012, the team investigated the area on the same 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 team is investigating for further cases  Suspected Scabies outbreak: reported from Shamulmadris Darululoom, of Faizabad district of Takhar province on June 20 /2012, the team investigated on the following day and during the investigation there was 115 suspected scabies cases, the cases treated and the health education was given to them , the team is investigating for further cases.  Suspected Pertussis Outbreak: reported from Arwij village of Chasht-e- sharif district of Hirat province, on June 10/2012 and investigated on June 12 /2012, during the investigation there were 115 suspected cases of Pertussis with one death and no sample has been taken, and patients treated , vaccination campaign conducted in surrounding villages and health education session conducted to villagers , the team is investigating for further cases. Epidemiological week-26  Suspected Measles Outbreak: reported from Khawja khil village of Sharana district of Paktika province on June 15/2012, 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 Dalo village of Sharana district of Paktika province on June 17/2012, the team investigated the area on the following 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 Marjan village of Wamamai district of Paktika province on June 19/2012, 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 Measles Outbreak: reported from Janat khil village of Urgon district of Paktika province on June 18/2012, the team investigated the area on the following day and during the investigation there were 5 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 Khani kala village of Mata khan district of Paktika province on June 19/2012, the team investigated the area on the following day and during the investigation there were 6 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 Meast village of Yousuf khil district of Paktika province on June 20/2012, the team investigated the area on the following day and during the investigation there were 4 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 Shohada village of Jaghory district of Ghazni province on June 23/2012, the team investigated the area on the following day and during the investigation there were 15 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 cholera Outbreak: reported from Chobaky village of Dara Souf Payeen district of Samangan province on June28 /2012, the team investigated the area on the same day and during the investigation there were one suspected cholera case with no death , the team collected the specimens and send it to CPHL , the case treated and the health education session conducted in surrounding villages, the team is investigating for further cases.  Suspected poisoning : reported Mulaghulam school of Bamyan city of Bamyan province on June 28 /2012 and investigated on the same day, and the health team investigated the affected area and they found 6 cases of mass fainting ,dizziness and weakness with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control.  Suspected food poisoning : reported Police academy of Lashkarga district of Helmand province on June 25 /2012 and investigated on the same day, and the health team investigated the affected area and they found 83 cases of vomiting ,diarrhea ,Nausea and abdominal pain with no deaths case and no sample has been taken, the patients treated and health education and hygiene session conducted for the villagers, outbreak is under control  Suspected food poisoning : reported Mula habib of Zaranj district of Nimroz province on June 28 /2012 and investigated on the same day, and the health team investigated the affected area and they found 7 cases of vomiting ,diarrhea ,Nausea and abdominal pain with no deaths case and the patients treated and health education and hygiene session conducted for the villagers, outbreak is under control  Suspected Measles Outbreak: reported from Gadwal bala village of Mandol district of Nuristan province on June 21 /2012, the team investigated the area on the following day and during the investigation there were 11 suspected measles cases with 5 deaths , 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

 Rumor of suspected Measles Outbreak: reported from Quisht village of Mandol district of Nuristan province on June 17/2012, the team investigated the area on the following day and during the investigation there was no case suspected measles .It was a rumor.  Suspected poisoning : reported Jamait high school of Qadis district of Badghais province on June 27 /2012 and investigated on the same day, and the health team investigated the affected area and they found 10 cases of mass fainting ,dizziness and weakness with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control.

ANNEX: Mapping of Percentages/Cases of Selected Diseases in Week-26 of 2012 by Province