March 17, 2014 DISEASE EARLY WARNING SYSTEM WER-10 (8th Yr) WEEKLY EPIDEMIOLOGICAL REPORT Summary: The surveillance data collected for this week report is from 8 -14 March 2014. Out of 378 functional Sentinel sites (SS), 378 (100%) have submitted reports for Week-10 of 2014. Out of a total of 305,464 consultations (132,113 male, 173,351 female) recorded in Week-10 of 2014, 32.2 % or 98,380 (47,536 male, 50,844 female) consultations were reported due to DEWS target diseases. Main causes of consultations this week were Acute Respiratory Infections (ARI) (28.9%) and Acute Diarrheal Diseases (ADD) (6.1%) from total clients in a continuing trend from the week before. 69 (44 male, 25 female) deaths resulted from Pneumonia, Diarrheal Diseases and Meningitis/Severely Ill Children, which includes 64 deaths (40 male, 24 female) caused by Pneumonia, no deaths caused by Diarrheal Diseases and 5 deaths (4 male, 1 female) caused by Meningitis/Severely Ill Children. In this reporting week, a Suspected Measles Outbreak reported from Paktya and Paktika provinces, a Rumor of Mumps Outbreak and a Suspected Measles Outbreak reported from Nangarhar province. Reports Received From Reporting Sites: As of March 14, 2014, 378 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan. In this reporting week, 378 sentinel sites have sent their reports on new cases of DEWS target diseases recorded during the reporting week. 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-10, 2014 Region Central Central East Central West North North East West South East South East Total No. of Expected Reports from 55 33 58 50 39 51 49 43 378 Sentinel Sites No. of Reports Received in this 55 33 58 50 39 51 49 43 378 week Figure-1 DEWS Sentinel Sites: Table-2: DEWS Epidemiological Regions and Figure-1(Map) shows the Sentinel Sites by type in Week- 10, 2014 distribution of DEWS sentinel sites already established in the relevant regions/provinces by Type of SS March 14, 2014. Table-2 shows East Central West North North East West South East South East Total the SS distribution by type of Central health facility. Data on 15 DEWS CHC/BHC 28 20 43 39 25 41 39 35 270 target diseases are being collected DH 12 9 10 7 9 5 7 4 63 from these sentinel sites (SS). The symbols on the map show the PH/RH/SH 13 4 5 4 4 5 3 4 42 number of sentinel sites in each Poly Clinic 2 0 0 0 1 0 0 0 3 region/province, and do not Total 55 33 58 50 39 51 49 43 378 indicate the GPS of the SS CHC=Comprehensive Health Center, DH=District Hospital, PH=Provincial locations. Hospital, RH= Regional Hospital, SH= Specialized Hospital DEWS Data in Epidemiological Week-10 of 2014: Out of a total of 305,464 clients recorded in week-10 Fig-2: Percentages of DEWS Target Diseases by of 2014, 23.6% (72,230) of consultations were Gender in W10-14 30 reported due to Cough and Cold and 5.3% (16,245) of consultations was reported due to Pneumonia. In the 25 same reporting period, 6.1% or 18,499 vents were 20 reported due to diarrheal illnesses (4.2% due to Acute 15 Watery Diarrhea, 1.6% due to Bloody Diarrhea and Percentage 10 0.3% due to Acute Watery Diarrhea with 5 Dehydration). In comparison with the previous week 0 ARI Men/SI ARI Pn AwD BD AwDw AVHep Measle Malaria (W9 of 2014) the percentage of ARI disease has C&C C remained the same, and the percentage of Acute Male 26 6.3 4.8 1.8 0.4 0.1 0.1 0 0.2 Diarrheal Disease has increased by 0.6% to 6.1%. Female 21.9 4.6 3.7 1.4 0.3 0 0 0 0.1 These variations could be due to changes in Total 23.6 5.3 4.2 1.6 0.3 0.1 0 0 0.1 temperature /weather during the reporting week. Figure-2 (right) shows the percentages of DEWS target diseases by gender in week-10 of 2014. Percentage of ARI by Weeks and by Age Groups: In the epidemiological week-10 a total of 88,475 events of ARI were reported. 33.8 % of total clients less than 5 years of age were Cough & Cold patients and 18.8% were among the age group 5 years and over. The percentage of C&C (<5 years) consultations in week-1, in comparison with the percentage of C&C in week-10 of 2014, decreased by 3.4%, whereas in case of 5 years and above decreased by 5.1% to 18.8% in this reporting week. The trend of ARI diseases in last 10 weeks can be read in Table-3. The percentages of consultations on Pneumonia cases of age group less than 5 years increased by 1.9% in last 10 weeks, whereas the percentage of age group 5 years and over decreased by 0.4% to 2.6% . Table-3: Percentages of ARI Diseases during 10 recent weeks by age groups and by weeks Disease Age Week- Week- Week- Week- Week- Week- Week- Week- Week- Week- 1-14 2-14 3-14 4-14 5-14 6-14 7-14 8-14 9-14 10-14 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 37.2 36.4 36.6 36.6 34.3 33.6 33.9 33.6 33.4 33.8 Years ≥5 23.9 22.1 23.1 22.1 22.6 27.1 20.5 19.7 19.1 18.8 Years ARI- <5 12.9 13.4 13.8 14.2 14.5 13.3 12.1 12.6 11.4 11 Pneumonia Years ≥5 3 2.9 3.1 3.1 3.3 3.2 2.8 2.5 2.4 2.6 Years In the reporting week-10 of 2014, the highest percentages of Cough & Cold were recorded in Logar, Khost and Kapisa provinces with 49.1%, 46.3% and 37.4%, whereas the lowest percentages of C&C were reported from Farah, Laghman and Zabul provinces with 12.2%, 12.7% and 16.2% respectively. The highest percentages of Pneumonia cases were reported from Logar, Bamyan and Baghlan provinces with 13.9%, 12.5% and 11.9% respectively, whereas the lowest percentages of Pneumonia cases were recorded in Urozgan, Zabul and Kandahar provinces with 1.3%, 1.6% and 1.7% respectively. (Fig-3) 70 Fig-3: Percentages of ARI from Total Clients in Week-10 of 2014 60 50 40 30 20 Percentage 10 0 HIL PIA FYB BAL BGL FAR SAR ZAB TAK BDS LAG HER KAP PKA PAR KAB LOG DAY KNR PAN NIM KAN BDG KHO KUN NUR GHA URO JOW NAN GHO SAM BAM WAR Province Pneumonia Cough&Cold Percentages of Diarrheal Diseases by Weeks and by Age Groups: Figure-4 below shows the percentages of diarrheal diseases (Acute Watery Diarrhea, Bloody Diarrhea and Acute Watery Diarrhea with Dehydration) 15 Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-10 of 2014 10 5 Percentage Percentage 0 HIL PIA FYB BAL BGL FAR SAR ZAB TAK BDS LAG HER KAP PKA PAR KAB LOG DAY KNR PAN NIM KAN BDG KHO KUN NUR GHA URO JOW NAN GHO SAM BAM WAR Provinces AWD BD AWDwD From week-1 to week-10 of 2014 from total clients, Acute Watery Diarrhea among children less than five years of age has increased from 5.9% in week-1 to 7.5% in the reporting week, whereas Acute Watery Diarrhea among age group 5 years and above has been increased by 0.6% to 2.6 % (Table-4). Bloody Diarrhea in age group less than 5 years increased by 0.3% in last 10 weeks, while in case of age group 5 years and above has been increased by 0.2%. Acute Watery Diarrhea with Dehydration in age group less than 5 years show an increase by 0.2% in last 10 weeks, while in case of five years and above AWDwD increased by 0.1% to 0.2% in last 10 weeks. Table-4: Percentages of Diarrheal Diseases from Total Clients during 10 recent weeks by age groups Week- Week- Week- Week- Week- Week- Week- Week- Week- Week- Disease Age 1-14 2-14 3-14 4-14 5-14 6-14 7-14 8-14 9-14 10-14 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 5.9 5.5 6 5.8 5.2 5.7 6.1 6.7 6.9 7.5 Diarrhea ≥5 Years 2 1.9 2 2 2.1 1.9 2.1 2.2 2.3 2.6 <5 Years 1.8 1.9 1.9 1.6 1.7 1.8 1.9 2 2 2.1 Bloody Diarrhea ≥5 Years 1.1 1 1.1 1 1.1 1.1 1.1 1.1 1.2 1.3 Acute Watery <5 Years 0.4 0.4 0.4 0.3 0.4 0.4 0.5 0.5 0.6 0.6 Diarrhea with ≥5 Years 0.1 0.2 0.1 0.1 0.1 0.1 0.2 0.2 0.3 0.2 Dehydration Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: In the epidemiologic week-10 of Fig-5: Percentages of Meningitis,Malaria & Typhoid Fever from Total 2014, a total of 153 suspected Clients in W10-14 cases of Meningitis/Severely Ill 1 Child were reported from all regions and the highest 0.8 percentage was recorded in North, Central East and North 0.6 East regions.