DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) 18-24 Jan 2015 Weekly Epidemiological Report –03

Summary: o Out of 408 functional sentinel sites, 406 (99.5 %) have submitted reports this week. o Out of a total of 382,071 consultations (167,895 male, 214,176 female) this week, 38.5% or 147,227 (71,056 male, 76,171 female) consultations were reported due to DEWS targeted diseases. o Main causes of consultations this week were Acute Diarrheal Diseases, 19,042 cases (5%) and Pneumonia, 22.670 cases (5.9%). o A total of 231 deaths were reported this week, of which 89 were due to DEWS targeted diseases, which includes 64 Pneumonia deaths, 7 diarrheal diseases deaths and 12 Meningitis/SIC deaths, 4 Acute Viral Hepatitis deaths, 1 Tetanus death and 1 Measles death. o Total of 6 outbreaks reported this week, of which three were suspected Measles outbreaks reported from Urozgan, Ghor, and Khost Provinces. Scabies outbreak was reported from , suspected Chickenpox outbreak reported from and a suspected Acute Viral Hepatitis outbreak was reported from .

Figure1: DEWS-Plus /Surveillance Sentinel Sites with GPS Locations by type of Health Facilities

Indicator – based Surveillance

Indicator – based Surveillance

1

Figure 2: DEWS targeted diseases

Percentage of Diseases out of total Number of cases of diseases during week consultation during week 03 03 1200 36 33 < 5 years 1100 30 ≥ 5 years 1000 < 5 years

27 900

24 800 ≥ 5 years 21 700 18

15 600 500 12

9 Numberofcases 400

%out oftotal consultations 6 300 3 200 0

100 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 Diseases (VPDs):

Table 1: Cases and deaths due to VPDs by age group during week 03, 2015

Cases Deaths Diseases <5 years ≥ 5 years Total <5 years ≥ 5 years Total Measles 195 77 272 1 0 1 Pertussis 0 0 0 0 0 0 Diphtheria 0 0 0 0 0 0 Tetanus/ NNT 4 1 5 1 0 1 AVH 46 159 205 2 2 4 Total 245 237 482 4 2 6

2

Seasonal Diseases:

Trend of Pneumonia in recent weeks- Trend of AWD with severe 2014/2015 dehydration in recent weeks-2014/2015 7 0.6 6

0.5

5 0.4 4 0.3

3 Percentage 0.2 Percentage 2 1 0.1 0 0 W46 W47 W48 W49 W50 W51 W52 W01 W02 W03 W46 W47 W48 W49 W50 W51 W52 W01 W02 W03 Weeks Weeks Current situation 2014/2015 Current situation 2014/2015 Average of 3 years data(2012-2014) Average of 3 years data(2012-2014)

Trend of Measles in recent weeks- Trend of Malaria in recent weeks- 2014/2015 2014/2015 300 2500 250

200 2000

150 1500 Number

100 1000 Number 50 500 0 W46 W47 W48 W49 W50 W51 W52 W01 W02 W03 0 W46 W47 W48 W49 W50 W51 W52 W01 W02 W03 Weeks Weeks Current situation 2014/2015 Current situation 2014/2015 Average of 3 years data(2012-2014) Average of 3 years data(2012-2014)

3

Event- Based Surveillance: Outbreaks investigated during week 03 Suspected Scabies Outbreak: Reported treated, vaccination campaign has been from Sharan jail of Paktika province on Jan conducted and 326 children have been 18 /2015.The team investigated the area on vaccinated , and Vita A supplements was the same day, and during the investigation distributed and health education session there was 28 scabies cases .it was clinical conducted in surrounding villages, the active confirm outbreak, There were 28 cases of surveillance has been established for adult patients .The cases treated and health investigation of further cases. education session conducted in jail, the Suspected Viral Hepatitis Outbreak: active surveillance has been established for Reported from Shahi Kotala village of investigation of further cases. of Laghman province on Jan Suspected Measles Outbreak: Reported 20 /2015, the team investigated the area on from Dani Sarokhail village of Jajimedan the same day, During the investigation there district of on Jan 17 /2015, was 8 suspected viral hepatitis cases .it was the team investigated the area on Jan18/2015 clinical confirm outbreak, There was no case day. Reported vaccination coverage was of under five years old but 8 cases of over poor, During the investigation there was 14 five years old .Based on sex, there was 3 suspected measles cases .it was clinical female and 5 male cases with no deaths confirm outbreak, There were 9 case of associated. The teams collected 8 lab under five years old and 6 case of over five samples have been collected the cases years old .Based on sex, there was 8 female treated, and health education session and 6 male cases with no deaths associated. conducted in surrounding villages, the active The teams collected 2 lab samples have been surveillance has been established for collected the cases treated, vaccination investigation of further cases. campaign has been conducted and 43 Suspected Measles Outbreak: Reported children have been vaccinated , and Vita A from Sarband Sad-Sai village of Chag supplements was distributed and health charan district of on Jan 19 education session conducted in surrounding /2015, the team investigated the area on the villages, the active surveillance has been following day. Reported vaccination established for investigation of further cases. coverage was 10%, During the investigation Suspected Measles Outbreak: Reported there was 17 suspected measles cases .it from Langer village of Chora district of was clinical confirm outbreak, There were Urozgan province on Jan 20 /2015, the team 12 case of under five years old and 5 case of investigated the area on the following day. over five years old .Based on sex, there was Reported vaccination coverage was poor, 6 female and 11 male cases with no deaths During the investigation there was 43 associated. The teams collected 4 lab suspected measles cases .it was clinical samples have been collected the cases confirm outbreak, There were 16 case of treated, vaccination campaign has been under five years old and 27 case of over conducted, and Vita A supplements was five years old .Based on sex, there was 19 distributed and health education session female and 24 male cases with no deaths conducted in surrounding villages, the active associated. The teams collected 6 lab surveillance has been established for samples have been collected the cases investigation of further cases.

4

Suspected Chicken pox Outbreak: of under five years old and 9 case of over Reported from Boje village of Fayzabad five years old .Based on sex, there was 2 district of Badakhshan province on Jan 19 female and 7 male cases with no deaths /2015, the team investigated the area on the associated. The patients treated and health same day. During the investigation there education session conducted in surrounding was 9 suspected chickenpox cases .it was villages, the active surveillance has been clinical confirm outbreak, There was no case established for investigation of further cases.

Table 2: Outbreaks reported during Week 03, 2015

Lab # of # of specimens Confirmati Disease Province District Lab confirm cases deaths sent to on status CPHL

Measles Urozgan Chora 43 0 6 Clinical Under Process

Measles Khost Jaji Maidan 19 0 2 Clinical Under Process

Measles Ghor Chag charan 17 0 4 Clinical Under Process

Scabies Paktika Sharan 28 0 0 Clinical Under Process

AVH Laghman Alingar 8 0 8 Clinical Under Process

Chicken Pox Badakhshan Faizabad 9 0 0 Clinical Under Process

Table 3: Updates on the outbreaks reported during 2015 (01 to 24 Jan)

No. of No. of lab confd. Disease/event No. of cases No. of deaths outbreaks Outbreaks Measles 12 0 391 2 Pertussis 2 0 8 0 CCHF 1 0 1 0 Chickenpox 1 0 9 0 Scabies 2 0 191 0 Viral hepatitis 1 0 8 0

Total 19 0 608 2

5

Figure 3: Outbreaks investigated during the week 03, 2015

Laboratory surveillance:

In this week, a total of 102 different samples were received by CPHL out of which all 11 were negative for pertussis while the rest is under process.

Recommendations: o High number of cases and deaths (above alert threshold) due to Pneumonia in the age group less than 5 years (12 % pneumonia cases among total consultations and 64 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. o The increase in the number of measles and malaria cases as compared to the previous weeks should looked into at field level to find out if any outbreak is going on. o The increase in the outbreaks of Measles in South, South East and West Regions is to be given serious consideration at the provincial level. o Vaccination campaign should be promoted in area where assessed vaccination coverage is low, especially in South Region and West Region. o Seek health care as soon as possible to prevent the spread of the diseases.

6