June 16, 2014 DISEASE EARLY WARNING SYSTEM WER-23 (8th Yr) WEEKLY EPIDEMIOLOGICAL REPORT Summary: The surveillance data collected for this weekly report is from 7 – 13 June 2014. Out of 387 functional Sentinel sites (SS), 386 (99.7%) have submitted reports for Week-23 of 2014. Out of a total of 364,787 consultations (157,408 male, 207,379 female) recorded in Week-23 of 2014, 33.9% or 123,779 (60,414 male, 63,365 female) consultations were reported due to DEWS targeted diseases. Main causes of consultations this week were Acute Respiratory Infections (ARI) (16.9%) and Acute Diarrheal Diseases (ADD) (16%) from total clients in a continuing trend from the week before. A total of 38 deaths reported due to DEWS targeted Diseases, which includes 18 deaths (10 male, 8 female) caused by Pneumonia, 8 deaths (6 male, 2 female) caused by Diarrheal Diseases, 11 deaths (7 male, 4 female) caused by Meningitis/Severely Ill Children and 1 death (1 male, 0 female) caused by Tetanus. In this reporting week, two Suspected CCHF Outbreaks reported from Herat province, two Suspected Measles Outbreaks and a Suspected Food Poisoning Outbreak reported from Paktya province and a Suspected Measles Outbreak reported from Balkh and Takhar provinces. Reports Received From Reporting Sites: As of June 13, 2014, 387 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan. In this reporting week, 386 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-23, 2014 Region Central Central East Central West North North East West South East South East Total No. of Expected Reports from 55 33 58 55 40 52 49 45 387 Sentinel Sites No. of Reports Received in this 55 33 58 55 40 51 49 45 386 week Figure-1 DEWS Sentinel Sites: Table-2: DEWS Epidemiological Regions and Figure-1(Map) shows the Sentinel Sites by type in Week- 23, 2014 distribution of DEWS sentinel sites established in the regions/provinces by June 13, Type of SS 2014. Table-2 shows the SS East Central West North North East West South East South East Total distribution by type of health Central facility. Data on 15 DEWS target CHC/BHC 28 20 43 44 26 42 39 37 279 diseases are being collected from DH 12 9 10 7 9 5 7 4 63 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 55 40 52 49 45 387 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-23 of 2014: Out of a total of 364,787 clients recorded in week-23 Fig-2: Percentages of DEWS Target Diseases by of 2014, 14.6% (53,245) of consultations were reported due to Cough and Cold and 2.3% (8,259) of 18.00 Gender in W23-14 16.00 consultations was reported due to Pneumonia. In the 14.00 same reporting period, 16% or 57,962 events were 12.00 reported due to diarrheal illnesses (12% due to Acute 10.00 8.00 Watery Diarrhea, 2.9% due to Bloody Diarrhea and Percentage 6.00 1.1% due to Acute Watery Diarrhea with 4.00 2.00 Dehydration). In comparison with the previous week 0.00 ARI Men/SI (W22 of 2014) the percentage of ARI disease has ARI Pn AwD BD AwDw AVHep Measle Malaria C&C C decreased by 0.9% to 16.9%, and the percentage of Male Acute Diarrheal Disease has increased by 1.3% to 16.07 2.63 13.93 3.23 1.22 0.06 0.05 0.06 0.52 16%. These variations could be due to changes in Female 13.48 1.99 10.46 2.60 0.94 0.05 0.04 0.03 0.40 temperature /weather during the reporting week. Total 14.60 2.26 11.96 2.87 1.06 0.05 0.04 0.04 0.45 Figure-2 (right) shows the percentages of DEWS target diseases by gender in week-23 of 2014. Percentage of ARI by Weeks and by Age Groups: In the epidemiological week-23 a total of 61,504 events of ARI were reported. 20.3 % of total clients less than 5 years of age were Cough & Cold patients and 11.9% were among the age group 5 years and over. The percentage of C&C (<5 years) consultations in week-14, in comparison with the percentage of C&C in week-23 of 2014, decreased by 9.9%, whereas in case of 5 years and above decreased by 4.3% to 11.9% 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 decreased by 4% in last 10 weeks, whereas the percentage of age group 5 years and over decreased by 0.6% to 1.2% . 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- 14-14 15-14 16-14 17-14 18-14 19-14 20-14 21-14 22-14 23-14 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 30.2 28.2 28.3 26.2 25.1 24.2 22.9 23.5 21.8 20.3 Years ≥5 16.2 15.8 15.6 14.8 13.9 13.9 13.4 13 12.4 11.9 Years ARI- <5 8.6 7.5 6.8 6.6 6.6 5.9 5.9 5.5 5.1 4.6 Pneumonia Years ≥5 1.8 1.7 1.6 1.5 1.5 1.4 1.5 1.2 1.2 1.2 Years In the reporting week-23 of 2014, the highest percentages of Cough & Cold were recorded in Khost, Parwan and Kapisa provinces with 28.4%, 26.3% and 24%, whereas the lowest percentages of C&C were reported from Nimroz, Farah and Zabul provinces with 5.4%, 5.7% and 7.2% respectively. The highest percentages of Pneumonia cases were reported from Bamyan, Balkh and Samangan provinces with 5.7%, 5.6% and 4.2% respectively, whereas the lowest percentages of Pneumonia cases were recorded in Zabul, Urozgan and Herat provinces with 0.2% and 0.3% respectively. (Fig-3) 35 Fig-3: Percentages of ARI from Total Clients in Week-23 of 2014 30 25 20 15 10 5 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 Province WAR 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) 30 Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-23 of 2014 20 10 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-14 to week-23 of 2014 from total clients, Acute Watery Diarrhea among children less than five years of age has increased from 10.4% in week-14 to 22.5% in the reporting week, whereas Acute Watery Diarrhea among age group 5 years and above has been increased by 3.8% to 6.9% (Table-4). Bloody Diarrhea in age group less than 5 years increased by 1.6% in last 10 weeks, while in case of age group 5 years and above has been increased by 0.8%. Acute Watery Diarrhea with Dehydration in age group less than 5 years show an increase by 1.1 % in last 10 weeks, while in case of five years and above AWDwD increased by 0.4% 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 14-14 15-14 16-14 17-14 18-14 19-14 20-14 21-14 22-14 23-14 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 10.4 11.1 12.4 14.7 16.7 18 17.6 20.6 21.5 22.5 Diarrhea ≥5 Years 3.1 3.5 3.8 4.5 4.6 5.3 5.3 5.9 6.3 6.9 <5 Years 2.6 2.8 3.1 3.4 3.6 3.7 3.9 3.9 4.3 4.2 Bloody Diarrhea ≥5 Years 1.4 1.5 1.6 1.6 1.7 1.9 2.1 2 2.2 2.2 Acute Watery <5 Years 0.8 1 0.8 1.2 1.4 1.3 1.6 2 1.6 1.9 Diarrhea with ≥5 Years 0.2 0.3 0.3 0.4 0.5 0.5 0.5 0.7 0.5 0.6 Dehydration Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: In the epidemiologic week-23 of Fig-5: Percentages of Meningitis, Malaria & Typhoid Fever from Total 2014, a total of 196 suspected cases Clients in W23-14 of Meningitis/Severely Ill Child 1 were reported from all regions and the highest percentage was 0.8 recorded in North, Central East and West regions.