July 2, 2012 DISEASES EARLY WARNING SYSTEM WER-26 (6th Yr) DEWS WEEKLY EPIDEMIOLOGICAL REPORT EPREPORT SUMMARY: rd th This report includes surveillance data from 23 to 29 June 2012. Out of 306 functional Sentinel sites(SS), 306 (100%) have sent their reports in Week-26 of 2012; Out of total 304,668 Consultations recorded in week-26 of 2012, 97,678 (32.1%) consultations were reported due to DEWS target diseases. Main causes of consultations this week are Acute Respiratory Infections/ARI (14.6%) and Acute Diarrheal Diseases/ADD (15.7%) from total clients in a continuing trend from the week before. 54 deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so that 30 deaths due to pneumonia, 16 deaths due to diarrheal diseases and 8 deaths reported due to Meningitis and Severely Ill Children. In this reporting week, nine Measles outbreaks reported and investigated in Paktika,Ghazni and Nuristan provinces. Four suspected Poisoning in Bamyan , Nimroz, Hilmand and Badghis provinces, and one Cholera outbreaks in Samangan province have reported /investigated. REPORTS RECEIVED FROM REPORTING SITES: As of June 30, 2012, 306 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan . In this reporting week, all 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. Table-1: Status of Reports Received from DEWS Regions during Epidemiological week-26, 2012 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 Page 1 of 10 DEWS Sentinel Sites: Figure-1(Map) shows the distribution Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in of DEWS sentinel sites, already Week-26, 2012 established in the relevant Type of regions/provinces by June 29, 2012 by SS al East Centr al West North North East West South East South East Total type of health facilities. Data on 15 Centr DEWS target diseases are being CHC/BHC 25 19 33 26 20 29 26 22 200 collected from these sentinel sites DH 12 7 10 7 9 4 7 4 60 (SS).The symbols on the map show PH/RH/SH 14 4 5 4 4 5 3 4 43 the number of sentinel sites in each region/province, and do not indicating Poly Clinic 2 0 0 0 1 0 0 0 3 the GPS of the SS locations. Total 53 30 48 37 34 38 36 30 306 CHC=Comprehensive Health Center, DH=District hospital, PH=provincial hospital, RH= Regional hospital, SH= specialized hospital DEWS Data in Epidemiological Week-26 of 2012 Fig-2: Percentages of DEWS Target Out of total 304,668 clients recorded in week-26 of 2012, 12.5% Diseases by age Group in W26 of 2012 (38039) of consultations were reported due to cough and cold and 30.0% 2.1% (6423) of consultations were reported due to pneumonia. In 25.0% the same reporting period, 15.7% or 47,788 events were reported 20.0% due to diarrheal illnesses (12.0% due to Acute Watery Diarrhea, 15.0% 2.4% due to Bloody Diarrhea and 1.3% due to acute watery 10.0% diarrhea with dehydration). In comparison with previous week 5.0% 0.0% (W25 of 2012) the percentage of ARI diseases has decreased by ARI ARI AwD Men AVH Mea Mala Typh AwD BD 0.6% to 14.6%, whereas the percentage of Acute Diarrheal C&C Pn w /SIC ep sle ria Fev diseases remained the same by15.7%.This variation can be due to U5% 17.4% 4.6% 24.7% 3.7% 2.9% 0.1% 0.1% 0.3% 0.9% 0.4% changes in temperature /weather during the reporting week. O5% 10.3% 1.0% 6.4% 1.9% 0.7% 0.0% 0.1% 0.1% 0.8% 0.8% Figure-2 above shows the percentages of DEWS target diseases Tot% 12.5% 2.1% 12.0% 2.4% 1.3% 0.1% 0.1% 0.1% 0.8% 0.7% by age groups in week-26 of 2012. Page 2 of 10 Percentage of ARI by weeks and by Age Groups In the epidemiological week-26, a total of 44,462 events of ARI were reported. 17.4 % of total clients less than 5 years of age were cough & Cold patients and 10.3% 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- 16-12 17-12 18-12 19-12 20-12 21-12 22-12 23-12 24-12 25-12 26-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 27.6 27.8 25.6 25.0 25.4 24.7 22.6 20.7 19.8 18 17.4 5+ 14.3 14.6 14.5 13.8 13.3 13.3 12.4 11.9 11.4 10.7 10.3 ARI- <5 Yr. 8.0 7.5 6.7 6.6 6.1 6.4 5.9 5.8 5.0 4.8 4.6 Pneumonia >=5 Yr 1.4 1.5 1.4 1.3 1.4 1.4 1.2 1.1 1.2 1.1 1.0 consultations in week-16, in comparison with the percentage of C&C in week-26 of 2012, decreased by 10.2%, whereas in case of 5 years and above decreased by 4.0% to10.3% 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 0.4% to 1% in last 11 weeks. In the reporting week-26 of 2012, the highest percentage of Cough & Cold has been recorded in Kapisa and Bamyan provinces with 22% and 19% respectively, whereas the lowest percentages of C&C were reported from Uruzgan and Zabul provinces with 6 % and 7% respectively. The highest percentages of Pneumonia reported from Sar-i- Pul and Nuristan provinces with 6% and 5% respectively, whereas the lowest percentage of Pneumonia was recorded in Zabul province with less than1%. (Fig-3) 30% Fig-3: Percentages of ARI from Total Clients in week-26 of 2012 20% 10% 0% BA DA GH HE JO KA KH LO NA PA SA WA KA BD GH PA NI UR KN LA NU BDS BAL FYB HEL KDZ PKA PIA SAR TAK ZAB BGL FRA KAP M Y A R W N O G N R M R B G O N M U R G R Pneumonia 2% 2% 4% 1% 2% 1% 1% 0% 5% 0% 2% 1% 2% 2% 1% 1% 1% 2% 6% 4% 4% 0% 3% 3% 1% 1% 2% 2% 3% 1% 1% 2% 3% 5% Cough&Cold 12%15%19%15%16%12%10%13%12% 7% 15%14%18%15%13%14%13%13%14%10%17% 7% 10%11% 8% 8% 10%22%16%11% 6% 18%10%19% 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 16-12 17-12 18-12 19-12 20-12 21-12 22-12 23-12 24-12 25-12 26-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 13.2 13.6 13.6 15.3 16.2 17.8 19.2 21.0 23.0 23.8 24.7 Diarrhea >= 5 Years 3.1 3.2 3.4 3.9 4.1 4.2 5.4 5.2 5.7 6.4 6.4 Bloody Diarrhea <5 Years 3.0 2.6 3 3.6 3.0 3.7 3.5 3.4 3.9 3.9 3.7 >=5 Years 1.3 1.2 1.3 1.9 1.5 1.6 1.6 1.6 1.9 1.9 1.9 Acute W. Diarrhea <5 Years 1.5 1.7 1.6 1.8 1.9 2.2 2.4 2.8 2.5 3 2.9 with Dehydration ≥5 Years 0.3 0.3 0.4 0.5 0.5 0.5 0.6 0.7 0.6 0.7 0.7 diarrhea with dehydration) from week-16 to week-26 of 2012, from total clients. Acute watery diarrhea among children less than five years has been increased from 13.2% in week-16 to 24.7% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has increased by 3.3% to 6.4%.(Please refer to Table-5, above).Bloody diarrhea, in age group less than 5 years increased by 0.7% in last 11 weeks, while in case of age group 5 years and above increased by 0.6% in the same period. Acute watery diarrhea with dehydration in age group less than 5 years increased by 1.4%, in case of five years and above increased by 0.4% in last 11 weeks.