th June 11, 2012 DISEASES EARLY WARNING SYSTEM WER-23 (6P Yr)P
DEWS WEEKLY EPIDEMIOLOGICAL REPORT
SUMMARY: This report includes surveillance data from 2nd to 8th June 2012. Out of 306 functional Sentinel sites(SS), all 306 (100%) have sent their reports in Week-23 of 2012; Out of total310,064 Consultations recorded in week-23 of 2012, 100,096 (32.3%) consultations were reported due
to DEWS target diseases.
Main causes of consultations this week are Acute Respiratory Infections/ARI (17.1%) and Acute Diarrheal Diseases/ADD (13.5%) from total clients in a continuing trend from the week before. 45 deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so that 21 deaths due to pneumonia, 15 deaths due to diarrheal diseases and 9 deaths reported due to Meningitis and Severely Ill Children. In this reporting week, seven Measles outbreaks reported and investigated in Paktya, Oruzgan Paktika, Zabul and Paktika provinces. four suspected Poisoning in Takhar province, one Pertussis outbreaks in Faryab and three
CCHF outbreaks have been reported and investigated in Hirat province.
REPORTSU RECEIVED FROM REPORTING SITES: th As of June 10P ,P 2012, 306 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan . In this reporting week, 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.
TableU -1:U Status of Reports Received from DEWS Regions during Epidemiological week-23,
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 Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in distribution of DEWS sentinel Week-23, 2012
sites, already established in the Type of relevant regions/provinces by June SS 10th, 2012 by type of health Centr al East Centr al North North East West South East South East Total facilities. Data on 15 DEWS target CHC/BHC 25 19 33 26 20 29 26 22 200 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 53 30 48 37 34 38 36 30 306 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-23 of 2012 25.0% Diseases by age Group in W23 of 2012 Out of total 310,064 clients recorded in week-23 of 2012, 14.6% 20.0% (45222) of consultations were reported due to be cough and cold and 2.6% (7939) of consultations were reported due to 15.0% pneumonia. In the same reporting period, 13.5% or 42,006 events 10.0% were reported due to diarrheal illnesses (10% due to Acute 5.0% Watery Diarrhea, 2.2% due to Bloody Diarrhea and 1.4% due to 0.0% ARI ARI AwD Men AVH Mea Mala Typh acute watery diarrhea with dehydration). In comparison with AwD BD previous week (W22 of 2012) the percentage of ARI diseases has C&C Pn w /SIC ep sle ria Fev decreased by 1% to 17.1%, whereas the percentage of Acute U5% 20.7% 5.8% 21.0% 3.4% 2.8% 0.1% 0.1% 0.3% 0.7% 0.4% Diarrheal diseases increased by 0.6% to 13.5%.This variation can O5% 11.9% 1.1% 5.2% 1.6% 0.7% 0.0% 0.1% 0.1% 0.6% 0.8% be due to changes in temperature /weather during the reporting Tot% 14.6% 2.6% 10.0% 2.2% 1.4% 0.1% 0.1% 0.2% 0.6% 0.6% week. Figure-2 above shows the percentages of DEWS target diseases by age groups in week-23 of 2012.
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Percentage of ARI by weeks and by Age Groups In the epidemiological week-23, a total of 53,161 events of ARI were reported. 20.7 % of total clients less than 5 years of age were cough & Cold patients and 11.9% 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 13-12 14-12 15-12 16-12 17-12 18-12 19-12 20-12 21-12 22-12 23-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 30.3 28.3 27.1 27.6 27.8 25.6 25.0 25.4 24.7 22.6 20.7 5+ 16.3 14.6 15.0 14.3 14.6 14.5 13.8 13.3 13.3 12.4 11.9 ARI- <5 Yr. 9.2 9.0 8.6 8.0 7.5 6.7 6.6 6.1 6.4 5.9 5.8 Pneumonia >=5 Yr 1.9 1.8 1.7 1.4 1.5 1.4 1.3 1.4 1.4 1.2 1.1 consultations in week-13, in comparison with the percentage of C&C in week-23 of 2012, decreased by 9.6%, whereas in case of 5 years and above decreased by 4.4% to11.9% 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 0.8% to 1.1% in last 11 weeks. In the reporting week-23 of 2012, the highest percentage of Cough & Cold has been recorded in Logar and Nuristan provinces with 26% and 22% respectively, whereas the lowest percentages of C&C were reported from Farah and Uruzgan provinces with 7 % each. The highest percentages of Pneumonia reported from Sar-i- Pul and Jawzjan provinces with 8% and 7% respectively, whereas the lowest percentage of Pneumonia was recorded in Zabul province with less than1%. (Fig-3) 30% Percentages of ARI from Total Clients in week-23 of 2012
25%
20%
15%
10%
5%
0% BA DA GH JO KA KH LO NA SA WA BD GH PA NI UR KN NU BDS BAL FYB HEL HER KDZ PKA PIA PAR SAR TAK ZAB KAB BGL FRA KAP LAG M Y A W N O G N M R G O N M U R R Pneumonia 4% 4% 3% 1% 3% 1% 2% 1% 7% 1% 1% 2% 2% 2% 1% 1% 1% 3% 8% 2% 3% 0% 4% 5% 1% 0% 2% 2% 3% 1% 1% 3% 2% 5% Cough&Cold 15% 17% 22% 17% 19% 14% 10% 17% 13% 9% 17% 15% 26% 15% 15% 14% 15% 16% 14% 12% 21% 10% 13% 16% 8% 7% 13% 20% 17% 14% 7% 19% 9% 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 13-12 14-12 15-12 16-12 17-12 18-12 19-12 20-12 21-12 22-12 23-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 7.7 9.3 10.6 13.2 13.6 13.6 15.3 16.2 17.8 19.2 21.0 Diarrhea >= 5 Years 2.2 2.4 2.7 3.1 3.2 3.4 3.9 4.1 4.2 5.4 5.2 Bloody Diarrhea <5 Years 2.2 2.5 2.6 3.0 2.6 3 3.6 3.0 3.7 3.5 3.4 >=5 Years 1.1 1.1 1.2 1.3 1.2 1.3 1.9 1.5 1.6 1.6 1.6 Acute W. Diarrhea <5 Years 0.7 1.0 1.1 1.5 1.7 1.6 1.8 1.9 2.2 2.4 2.8 with Dehydration ≥5 Years 0.2 0.2 0.2 0.3 0.3 0.4 0.5 0.5 0.5 0.6 0.7 diarrhea with dehydration) from week-13 to week-23 of 2012, from total clients. Acute watery diarrhea among children less than five years has been increased from 7.7% in week-13 to 21% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has increased by 3% to 5.2%.(Please refer to Table-5, above).Bloody diarrhea, in age group less than 5 years increased by 1.2% in last 11 weeks, while in case of age group 5 years and above increased by 0.5% in the same period. Acute watery diarrhea with dehydration in age group less than 5 years increased by 2.1%, in case of five years and above increased by 0.5% in last 11 weeks. Page 3 of 10
25% Percentages of Diarrheal Diseases from Total Clients in week-23 of 2012 20% AWDwD BD AWD 15% 10% 5% 0%
PIA FYB HEL BAL BGL FRA SAR TAK ZAB KDZ LAG BDS KAP HER PKA PAR KAB LOG DAY KNR PAN NIM KAN BDG KHO URU NUR GHA JOW NAN GHO SAM BAM WAR
Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: In the epidemiologic week-23 of 2012, a total of 173 3.0% Fig -5: Percentages of Men/SIC Malaria & Typhoid Fever suspected cases of Meningitis/Sever Ill Child were from Total Clients in Week-23 of 2012 by Region reported from all regions and the highest percentage 2.5% was recorded in Central East region. In the same reporting week, from all regions 2015 consultations 2.0% were reported by Sentinel Sites to be malaria and the 1.5% highest percentage of Malaria cases were reported from East region with 2.5%. Out of the total clients, 1.0% 2006 cases or 0.6% in national level were reported to be suspected Typhoid Fever and the highest 0.5% percentage of Typhoid Fever was reported from 0.0% South East region with 1.3% and followed by South NER NR CWR WR CER SR ER SER region with 1.2%. Men/SIC 0.1% 0.1% 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% Vaccine Preventable Diseases Malaria 0.1% 0.3% 0.1% 0.1% 0.2% 0.6% 2.5% 1.4% Typhoid Fev 0.7% 0.6% 0.4% 0.3% 0.3% 1.2% 0.9% 1.3% In DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, so that their occurrences are changing by seasonal variations. Among these diseases Meningitis/severely ill child is being reported mostly from North Table-6: Suspected Cases of Vaccine Preventable region; but in this week out of total 173 Diseases in W23 of 2012 by Region cases in country level, 42(24%) cases have
been reported from Central East region and
41 cases were recorded in North region. Regions In general the highest number of cases of
viral hepatitis being reported from East, Meningitis/ Ill Sever Child Viral Hepatitis Measles Pertussis Diphtheria Tetanus /New Natal Tetanus Acute Flaccid Paralysis south East and central east regions, so that 31 16 59 0 0 0 2 in the reporting week out of total 214 North East cases, 74 cases from Central East, 62 from North 41 5 43 4 0 0 5 East, and 28 cases from South East region Central West 7 7 27 0 0 0 1 were reported. From total 473 Measles West 13 9 4 0 0 0 5 cases reported in the reporting week more Central East 42 74 54 0 0 0 4 than 50% of cases were recorded in East South 11 13 16 0 0 3 2 region, while more than 11% recorded in East 19 62 238 7 0 0 1 central east region. South East 9 28 32 8 0 0 0 Total 173 214 473 19 0 3 20
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Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks(from W22 of 2011 to W23 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-23 of 2012(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, 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-23 of 2012) in comparison with previous week, ARI decreased by 1% to 17.1%, while the percentage of ADD increased by 0.6% to 13.5%.
35 Trend of ARI/ADD as Propotion of Total Clients From Week-22 of 2011 to Week-23 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 18.1 16.8 17.1 20.9 e 16.2 16.2 20.7 20.1 15.5 15.816.1 1615.9 15.816.1 15.8 20 19.919.5 15.3 15 18.8 17.1 n 14.1 17.9 15 13.5 13.3 17.6 t 12.416.3 15.4 11.1 11.4 14.9 14.3 10.610.7 a 13.813.9 13.6 13.8 10.110.1 13.50 13.4 13 13.212.9 12.8 13.412.8 12.8 9.2 9.0 12.9 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 12 12 12 12 11 12 12 w8 - - - - - W9 W7 w10 w52 1 - W11 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 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W23 - W3 W4 W5 W6 W2 W W22 - 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"
Mortality: Among DEWS target diseases Pneumonia, Table-7: Deaths by Main Causes of Mortality and by Region in W23 of 2012 Diarrheal diseases and Main
Meningitis/ Severely Ill
Causes of Children (SIC) are main Deaths
causes of mortality which North East North Central West West Central East South East South East Total make in general more than Pneumonia 95% of total deaths of 2 2 3 2 6 1 4 1 21 surveillance target diseases. Diarrheal Usually deaths due to Diseases 0 2 0 2 9 1 0 1 15 diarrheal diseases increases Meningitis during summer season, 0 6 1 0 1 1 0 0 9 while the number of deaths due to Pneumonia increases during cold period/Winter Season. In this week out of 45 deaths reported from all regions, 21 deaths caused by Pneumonia, 9 deaths caused by Meningitis/severely ill children and 15 deaths were caused by diarrheal diseases. (Table-7)
Number of Outbreaks investigated in 2012 with details of W22/W23 Reported outbreaks since first week of 2012 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis 18 2 16 Avian/Swine Flu ARI 7 7 Measles 141 4 137 Diarrhea Meningitis Hepatitis 2 2 Malaria Typhoid CCHF 6 6 Bl. Diarrhea 1 1 Chickenpox Other 25 2 23 Total 200 8 192 Epidemiological week-22 • Suspected Measles Outbreak: reported from Alagadakhil villages of Chamkani district of Paktya province on May 23 /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 Khowjekhil villages of Gardez district of Paktya province on May 25 /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
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"
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 Askary family villages of Gardez district of Paktya province on May 26 /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 Sawanikhil villages of Jaji aryob district of Paktya province on May 29 /2012, the team investigated the area on the following day and during the investigation there were 50 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 Tera villages of Gardez district of Paktya province on May 30 /2012, the team investigated the area on the same day and during the investigation there were 9 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 • Measles Outbreak: reported from Tori villages of Tarinkot district of Urozgan province on May 29 /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 results were positive , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases • Suspected poisoning : reported Alafaroq Ahandara girl high school at Taloqan city of Takhar province on May 29 /2012 and investigated on the same day, and the health team investigated the affected area and they found 166 cases of mass fainting , with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control. • Rumor of Suspected Pertussis Outbreak: reported from Adraskan district of Hirat province, on May 27/2012 and investigated on May 29/2011, during the investigation there was no suspected cases of Pertussis, it was a rumor • Rumor of Suspected Measles Outbreak: reported from Yakhdan villages of Duliana district of Ghor province on May 24 /2012, the team investigated the area on May26 /2012 and during the investigation there were no suspected measles cases with no death s, the team is investigated the area and it was a rumor . • Suspected Scabies outbreak: reported from Prison of Hirat city, Hirat province on May 27 /2012, the team investigated on May 28/2012 and during the investigation there was 156 suspected scabies cases, the cases treated and the health education was given to them , the team is investigating for further cases. • Suspected CCHF outbreak: : reported from Hirat city of Hirat province on May 28 /2012, the team investigated the area on the following day and during the investigation there was one suspected CCHF case , the team collected the specimens and send it to CPHL , the cases 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"
• Suspected poisoning : reported Safid sang village at Mohmmad Aga district of Logar province on June 02 /2012 and investigated on the same day, and the health team investigated the affected area and they found 127 cases of dizziness, headache ,fainting , with no deaths case and the patients treated and health education and hygiene session conducted for students, the team is investigating for further cases . Epidemiological week-23
• Suspected Pertussis Outbreak: reported from Dewana Khana & Bokharai Qala villages of Almar district of Faryab province, on June 05 /2012 and investigated on June 06 /2012, during the investigation there were 3 suspected cases of Pertussis and specimen collected and send to CPHL, and patients treated, the team is investigating for further cases. • Suspected Measles Outbreak: reported from Tamazan village of Gizab district of Urozgan province on May 30 /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 outbreak is controlled . • Suspected Measles Outbreak: reported from Sayed Jan village of Qalat district of Zabul province on June 01 /2012, the team investigated the area on the following day and during the investigation there were 12 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 poisoning: reported Basheer abad girl high school at Taloqan city of Takhar province on June 02 /2012 and investigated on the same day, and the health team investigated the affected area and they found 70 cases of mass fainting , dizziness with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control. • Suspected poisoning: reported Naheed shahed high school at Farkhar district of Takhar province on June 03 /2012 and investigated on the same day, and the health team investigated the affected area and they found 61 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 poisoning: reported Rostaq girl school at Rostaq district of Takhar province on June 05 /2012 and investigated on the same day, and the health team investigated the affected area and they found 46 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 poisoning: reported Khawja Ghar girl school at Khawja ghar district of Takhar province on June 05 /2012 and investigated on the same day, and the health team investigated the affected area and they found 30 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 Measles Outbreak: reported from Yeskin village of Warsag district of Takhar province on June 07 /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
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"
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 CCHF outbreak: : reported from Jakan Hirat city of Hirat province on June 02 /2012, the team investigated the area on the same day and during the investigation there was one suspected CCHF case , the team collected the specimens and send it to CPHL , the cases treated , the team is investigating for further cases • Suspected CCHF outbreak: : reported from Bichagi village of Guzara district of Hirat province on June 06 /2012, the team investigated the area on the same day and during the investigation there was one suspected CCHF case , the team collected the specimens and send it to CPHL , the cases treated , the team is investigating for further cases • Suspected CCHF outbreak: : reported from Poli-salar of Injil district of Hirat province on May29 /2012, the team investigated the area on the following day and during the investigation there was one suspected CCHF case , the team collected the specimens and send it to CPHL , the cases treated , the outbreak is controlled . • Suspected Measles Outbreak: reported from Baghesha village of Gadiz district of Paktya province on June 03 /2012, the team investigated the area on the same 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 Omer khil village of Sharana district of Paktika province on June 06 /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 Srakala village of Sharana district of Paktika province on June 07 /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.
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-23 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"