Weekly Epidemiological Report –27

Home , Mata Khan District, Shahjoy District

DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) 05-11 July 2015 Weekly Epidemiological Report –27

Summary: o Out of 459functional sentinel sites, 458 (99.7%) have submitted reports this week. o Out of a total of 389,047new consultations (166,248male, 222,799female) this week, 36.3% or 141,276 (68,983 male, 72,293female) consultations were reported due to DEWS targeted diseases. o Main causes of consultations in this week were Acute Diarrheal Diseases, 73,660 cases (19% out of total new consultations) and Pneumonia, 7,763 cases (2% out of total new consultations). o A total of 238 deaths were reported this week, of which 56 were due to DEWS targeted diseases, which includes 25 Pneumonia deaths, 14 Acute Diarrheal Diseases deaths, 13 Meningitis/SIC deaths, and3 Measles deaths and 1 suspected Hemorrhagic Fever death. o Total of 13 outbreaks reported this week; of which 5 Measles outbreaks reported from Paktika, Zabul and Nuristan provinces,5 were CCHF outbreaks reported from Heratprovince, 2 Pertussis outbreaks reported from Parwan and Nangarhar provinces and 1 Acute viral Hepatitis outbreak reported from Laghman province. Figure1: Surveillance/DEWS-Plus Sentinel Sites with GPS location by type of Health Facility

Table 1: Coverage of DEWS-Plus Surveillance System

Type of Health Private Special RH/PH DH CHC/BHC Polyclinic Total Facility Hospital Hospital Total Health 34 78 1,226 1 213 26 1,578 Facilities (HF) HF covered by 32 69 341 1 2 14 459 DEWS-Plus

based Surveillance ــ Indicator

The Indicator-based surveillance component of DEWS-plus reports on weekly bases on 15 priority infectious diseases from sentinel sites. The data is compared with previous weeks and corresponding week of previous years and the alert and epidemic threshold is checked to see if disease incidence has crossed these levels and necessary action is initiated. Figure 2: DEWS targeted diseases

Percentage of Diseases out of total consultation during week 27

27 26 < 5 years ≥ 5 years 24 23 21 ns ns 20 18 17 15 14 12 11 9 8 6 5 3 2 % out of total consultatiototalof out% 0 Acute AWD with Acute Viral Neonatal Typhoid Pneumonia AWD Bloody Meningitis Measles Malaria Dehydration Hepatitis Tetanus Fever Diarrhea < Disease 5 years 3.9 27.5 4.6 2.6 0.10 0.04 0.2 0.000 0.7 0.3 ≥ 5 years 1.0 8.2 2.2 0.7 0.02 0.1 0.04 0.000 0.8 0.7

Number of cases of diseases during week 27 36000 33000 < 5 years ≥ 5 years 30000 27000 24000 21000 18000 15000 12000

Number of cases of Number 9000 6000 3000 0 Acute AWD with Acute Viral Neonatal Typhoid Pneumonia AWD Bloody Meningitis Measles Malaria Dehydration Hepatitis Tetanus Fever

Disease Disease Diarrhea < 5 years 5086 35414 5970 3414 131 52 227 0 963 374 ≥ 5 years 2677 21196 5819 1847 53 180 106 0 2003 1705

Vaccine Preventable Diseases (VPDs): Table 2: Cases and deaths due to VPDs by age group during week 27, 2015

Cases Deaths Diseases CFR/100 <5 years ≥ 5 years Total <5 years ≥ 5 years Total Measles 227 106 333 3 0 3 0.90 Pertussis 1 2 3 0 0 0 0.00 Diphtheria 0 0 0 0 0 0 0.00 Neonatal Tetanus 0 0 0 0 0 0 0.00 Tetanus 0 0 0 0 0 0 0.00

Seasonal Diseases:

Trend of Pneumonia in recent weeks- Trend of AWD with severe dehydration 2015 in recent weeks-2015 3.5 1.60 3 1.40 2.5 1.20 1.00 2 0.80 1.5 Percentage 0.60 Percentage 1 0.40 0.5 0.20

0 0.00

W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27

Weeks Current situation Weeks Current situation Average of 3 years data (20122014) Average of 3 years data (20122014)

Trend of Measles in recent weeks- 2015 Trend of Malaria in recent weeks- 2015

0.12 0.80

0.10 0.70 0.60 0.08 0.50 0.06 0.40 0.30

Percentage Percentage 0.04

Precentage Precentage 0.20 0.02 0.10 0.00 0.00 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 Weeks Weeks Current situation Current situation Average of 3 years data (20122014) 3 Average of 3 years data (20122014)

Event-Based Surveillance: During week 27 a total of 13 outbreaks detected, investigated and responded to by DEWS-plus. The details are as below:

1. Measles Outbreaks and sent them to CPHL for lab confirmation. 1.1 Measles outbreakwas reported on The vaccination coverage of the area was st 7 July 2015 from Khatakwalvillage of 30%. Vitamin A supplements were Sharan district, Paktika province with 16 distributed and health education sessions Suspected cases (8 cases in age group under conducted in the affected area. The active five and 8 cases in age group over five). The surveillance has been established for investigation team visited the area and detection and investigation of further cases. collected specimens from 5 cases Suspected and sent them to CPHL for lab confirmation. 1.4 Measles outbreak was reported on th The vaccination coverage of the area was 6 July 2015 from Abdullah Khan village of 70%. Vitamin A supplements were Shahjoy district, Zabul province with 7 distributed and health education sessions Suspected cases (3 cases in age group under conducted in the affected area. The active five and 4 cases in age group over five). The surveillance has been established for investigation team visited the area and detection and investigation of further cases. collected specimens from 5 suspected cases and sent them to CPHL for lab confirmation. 1.2 Measles outbreak was reported on The vaccination coverage of the area was th 8 July 2015 from Tatiwalvillage of Sharan 17%. The team vaccinated 23 (6m-5y) district, Paktika province with 11 Suspected children against the measles in the cases (5 cases in age group under five and 6 surrounding villages of the affected area. cases in age group over five). The Vitamin A supplements were distributed and investigation team visited the area and health education sessions conducted in the collected specimens from 4 Suspected cases affected area. The active surveillance has and sent them to CPHL for lab confirmation. been established for detection and The vaccination coverage of the area was investigation of further cases. 80%. Vitamin A supplements were distributed and health education sessions 1.5 Measles outbreak was reported on th conducted in the affected area. The active 7 July 2015 from Prons village of Paroon surveillance has been established for district, Nuristan province with 5 Suspected detection and investigation of further cases. cases (3 cases in age group under five and 2 cases in age group over five). The 1.3 Measles outbreak was reported on investigation team visited the area and th 8 July 2015 from Tawda China, village of collected specimens from 3 suspected cases Mata khan district, Paktika province with 18 and sent them to CPHL for lab confirmation. Suspected cases (9 cases in age group under The vaccination coverage of the area was five and 9 cases in age group over five). The 78%. The team vaccinated 48 less than 10 investigation team visited the area and years children against the measles in the collected specimens from 10 suspected cases surrounding villages of the affected area.

Vitamin A supplements were distributed and Treatment was started and health education health education sessions conducted in the session conducted to him and his caretakers. affected area. The active surveillance has 2.5 CCHF Outbreak: Suspected CCHF case was reported from Hawa dah, village of been established for detection and Mata khanInjil, Herat province on 11thJuly investigation of further cases. 2015. The case was a 25 years old male having continuous contact with the domestic 2. CCHF Outbreaks animals. The investigation team collected 2.1 CCHF Outbreak: Suspected CCHF blood specimen and send it to CPHL for lab case was reported from Boshron, village of confirmation (The specimen will be shipped Injil district, Herat province on 6th July to Kabul CPHL this week). Treatment was 2015. The case was 37 years old male started and health education session farmer having continuous contact with the conducted to him and his caretakers. domestic animals. No specimen was

collected. Treatment was started and health

education session conducted to him and his 3. Pertussis. caretakers. 3.1 Pertussis outbreak was reported on 2.2 CCHF Outbreak: Suspected CCHF 7thJuly 2015 from Pol-e-Mattakvillage of case was reported from Sar Asiab, village of Jabalseraj district, Parwan province with 3 Obeh district, Herat province on 6thJuly Suspected cases (1case in age group under 2015. The case was a 40 years old house five and 2 cases in age group over five). The wife having continuous contact with the investigation team visited the area and domestic animals. No specimen was collected specimens from 3 Suspected cases collected Treatment was started and health and sent them to CPHL for lab confirmation. education session conducted to him and his The vaccination coverage of the area was caretakers. low%. The active surveillance has been 2.3 CCHF Outbreak: Suspected CCHF established for detection and investigation of case was reported from Kababian, village of further cases. Health education sessions Injil district, Herat province on 11thJuly conducted in the affected area. 2015. The case was a 50 years old male 3.2 Pertussis outbreak was reported on farmer having continuous contact with the 7thJuly 2015 from Daman village of domestic animals. The investigation team Behsood district, Nangarhar province with 7 collected blood specimen and send it to Suspected cases (5 case in age group under CPHL for lab confirmation (The specimen five and 2 cases in age group over five). The will be shipped to Kabul CPHL this week). investigation team visited the area and Treatment was started and health education collected specimens from 6 Suspected cases session conducted to him and his caretakers. and sent them to CPHL for lab confirmation. 2.4 CCHF Outbreak: Suspected CCHF The vaccination coverage of the area was case was reported from Shale Bara, village 30%. The team vaccinated 47 less than 10 of Injil district, Herat province on 11thJuly years children against the pertussis in the 2015. The case was a 40 years old house affected area the active surveillance has wife having continuous contact with the been established for detection and domestic animals. The investigation team investigation of further cases. Health collected blood specimen and send it to education sessions conducted in the affected CPHL for lab confirmation (The specimen area. will be shipped to Kabul CPHL this week). 4. Viral Hepatitis

4.1 Acute Viral Hepatitis Outbreak was five). The investigation team visited the area reported fromSanzalay village of Badpakh and collected specimens from 8 Suspected district of Laghman province on 7thJuly cases and sent them to CPHL for lab 2015, the team investigated the area on the confirmation. The cases treated, and health following day. During the investigation education session conducted in surrounding there were 8 Suspected cases (1 case in age villages, the active surveillance has been group under five and 7 in age group over established for investigation of further cases.

Figure 3: Outbreaks investigated during the week 27, 2015

Table 2: Updates on the outbreaks reported during 2015 (01 Jan to 11 July)

No. of No. of lab confd. Disease/event No. of cases No. of deaths outbreaks Outbreaks Pertussis 16 1 85 0 Measles 175 139 2514 16 CCHF 41 9 41 9 Chickenpox 3 0 60 0 Scabies 4 1 357 0 Viral Hepatitis 4 3 34 0

Suspected 10 2 129 2 Rabies/dog bites Mumps 5 0 53 0 Pneumonia 2 0 155 8 Conjunctivitis 2 0 86 0 Food poisoning 4 0 308 0 Mass psychogenic 9 0 387 0 illness Total 275 155 4209 35

Laboratory surveillance: In this week a total of 154different samples were received by CPHL, out of which35samples were positive for measles and 18 samples were negative for Measles, 3 samples were negative for Pertussis, 1 sample was negative for Acute Viral Hepatitis B and 1 sample was negative for Cholera while the rest are under the process.

Recommendations: o High number of cases (above alert threshold) and deaths due to Acute diarrheal Diseases in the age group less than 5 years (9.6 % Acute Diarrheal Diseases cases among total consultations and 14 deaths) is a cause of concern. This should be analyzed and discussed at provincial level among stakeholders to find out the reasons for high morbidity and mortality and take appropriate actions. o The increase in the number of measles (as compared to the average of last three years) and malaria cases (as compared to the previous weeks) should looked into at field level and take appropriate response at field and national Levels. The increase in the outbreaks of Measles in South, South East and Central West is to be given serious consideration at the provincial level among stakeholders. o Measles vaccination campaign should be conducted in areas where assessed vaccination coverage is low and many outbreaks reported, especially in South East Region. o Early reporting and hospitalization of CCHF cases, IEC and strong coordination with animal health department and actions to be taken by them to control the ticks on the animals

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