World Health Organization Afghanistan Health Update 2 January 2003 Afghan Ministry of Health and international humanitarian agencies join forces for cross-border outbreak response KABUL - On 2 January 2003, an emergency team travelled with an Afghan Ministry of Defence helicopter from Faizabad, the provincial capital of Badakhshan, to Darwaz district, to stop here an outbreak of pertussis (whooping cough) threatening the lives of an estimated 40,000 infants and young children. The mission of the Afghan Ministry of Health has received support from the highest political authorities in Afghanistan and Tajikistan; as well as from several United Nations agencies (including WHO, UNICEF, UNAMA, UNJLC, UNOCHA, WFP) and the Aga Khan Development Network (AKDN), working together in the two countries. Early November, pertussis had been confirmed by WHO clinical criteria in Kufob sub-district of Khwahan district. An investigation and response team of the Ministry of Health, WHO, and AKDN found 115 cases including 17 deaths in 4 villages. Since then, the antibiotic drug erythromycin had been provided to treat and protect about 2,000 children and mothers. Latest reports from Badakhshan province in North Eastern Afghanistan, indicate that the disease has now possibly affected all sub-districts (Shekay, Nusai and Maymay) of Darwaz district, north from Khwahan district. Exact numbers of the affected persons or deaths are unknown, whereas laboratory confirmation is pending. In populations which are not vaccinated, especially those with underlying malnutrition and other infections, a whooping cough outbreak can lead to a mortality rate of 15%. In these settings, pertussis is among the most lethal diseases of infants and young children. A two-week course of the life-saving drug erythromycin protects non-immunized individuals from the highly contagious disease. In North Eastern Afghanistan, 100 community workers and trainers who have experience giving vaccinations during the National Immunization Days (NID) for polio eradication will administer the erythromycin. During the last three years of NID campaigns, they have garnered considerable expertise on setting up distribution systems for their local communities, which will be extremely valuable to ensure that all those in need in the two affected districts will be reached. They will receive training and guidance on pertussis outbreak response from the team arriving in Darwaz district on 2 January 2003. This team, composed of two health workers from the Afghan Ministry of Health, two doctors of WHO, and a member of AKDN, will also assess the extent of the epidemic, and take samples for laboratory confirmation. At both sides of the border emergency assistance for Darwaz district will be facilitated. To reach affected Afghan villages as quickly as possible, team members will use the only accessible road on the Tajik side of the border, and cross the Omu river with small boats. President Karzai of Afghanistan and First Deputy Minister Kasimov of Tajikistan have expressed their full support for the cross-border operation. International humanitarian agencies and authorities in Kabul and Faizabad, Afghanistan, as well as in Dushanbe and Ishkashim, Tajikistan, are supporting the operations on the field. Later next week, a UN helicopter is planned to airlift extra supplies of erythromycin, and of vaccines and vaccination equipment procured by UNICEF to the affected area. The equipment and vaccines will allow Darwaz district health workers to accelerate providing immunization services to the population. Currently, routine immunization coverage in Afghanistan is less than 40%, making children in remote areas, such as Darwaz, particularly vulnerable. Immunization provides the best and most cost-effective form of defence against the spread of pertussis and of other vaccine-preventable diseases. For more information, please contact: WHO Afghanistan Office (Yon Fleerackers) 00-93-70-282-356.