October22, 2012 DISEASES EARLY WARNING SYSTEM WER-42(6th Year) DEWS WEEKLY EPIDEMIOLOGICAL REPORT EPREPORT SUMMARY: th th This report includes surveillance data from 13 to 19 October 2012. Out of 318 functional Sentinel sites(SS), all 318 (100%) have sent their reports in Week-42 of 2012; Out of total 274,496 Consultations recorded in week-42 of 2012, 86,316 (31.4%) consultations were reported due to DEWS target diseases. Main causes of consultations this week are Acute Respiratory Infections/ARI (20%) and Acute Diarrheal Diseases/ADD (10.2%) from total clients in a continuing trend from the week before. 34 deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so that 22 deaths due to pneumonia, 7 deaths due to diarrheal diseases and 5 deaths reported due to Meningitis and Severely Ill Children. In this reporting week, two measles outbreaks have been reported from Paktika and Zabul provinces, and one suspected post vaccine encephalopathy case reported from Charkh district of Logar province. REPORTS RECEIVED FROM REPORTING SITES: As of October 19, 2012, 318 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan. In this reporting week, all 318 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-42, 2012 Central East Central West North North East West South East South East Total No. of Expected Reports from 53 30 49 39 34 41 38 34 318 Sentinel Sites No. of Reports Received in this 53 30 49 39 34 41 38 34 318 week Page 1 of 8 DEWS Sentinel Sites: Figure-1(Map) shows the distribution of DEWS sentinel sites, already Table-2: DEWS Epidemiological Regions and types of Sentinel Sites in established in the relevant Week-42, 2012 regions/provinces by October 19, Type of 2012 by type of health facilities. Data SS al East Centr al West North North East West South East South East Total on15 DEWS target diseases are being Centr collected from these sentinel sites CHC/BHC 25 19 34 28 20 32 28 26 212 (SS).The symbols on the map show DH 12 7 10 7 9 4 7 4 60 the number of sentinel sites in each PH/RH/SH 14 4 5 4 4 5 3 4 43 region/province, and do not indicating the GPS of the SS locations. Poly Clinic 2 0 0 0 1 0 0 0 3 DEWS Data in Epidemiological Total 53 30 49 39 34 41 38 34 318 Week-42 of 2012 CHC=Comprehensive Health Center, DH=District hospital, PH=provincial Ut of total 274,496 clients hospital, RH= Regional hospital, SH= specialized hospital recorded in week-42 of 2012, 17.2% (47344) of O consultations were reported due to cough and cold Fig-2: Percentages of DEWS Target Diseases and 2.8% (7658) of consultations was reported due to 30.0% by age Group in W42 of 2012 pneumonia. In the same reporting period, 10.2% or 28,030 25.0% events were reported due to diarrheal illnesses (7.7% due 20.0% to Acute Watery Diarrhea, 1.9% due to Bloody Diarrhea 15.0% and 0.6% due to acute watery diarrhea with dehydration). 10.0% In comparison with previous week (W41 of 2012) the 5.0% percentage of ARI diseases has increased by 0.1% 0.0% to20.0%, whereas the percentage of Acute Diarrheal ARI Men/ AVHe Malari TyphF ARI Pn AwD BD AwDw diseases decreased by 0.7% to 10.2%. These variations C&C SIC p a ev could be occurred due to changes in temperature /weather U5% 25.6% 6.0% 15.9% 2.9% 1.2% 0.1% 0.1% 0.6% 0.3% during the reporting week.Figure-2 above shows the O5% 13.4% 1.3% 3.9% 1.5% 0.3% 0.0% 0.1% 0.5% 0.6% percentages of DEWS target diseases by age groups in Tot% 17.2% 2.8% 7.7% 1.9% 0.6% 0.0% 0.1% 0.5% 0.5% week-42 of 2012. Page 2 of 8 Percentage of ARI by weeks and by Age Groups In the epidemiological week-42, a total of 55,002 events of ARI were reported.25.6 % of total clients less than 5 years of age were cough & Cold patients and 13.4% among the age group 5 years and over. The percentage of C&C (<5 years) Table-3: 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 32-12 33-12 34-12 35-12 36-12 37-12 38-12 39-12 40-12 41-12 42-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 16.4 16.9 16.2 18.3 18.4 21.5 21.6 21.7 23.1 24.2 25.6 5+ 9.7 10.2 7.5 10.1 11.0 10.9 11.8 12.6 13.3 13.6 13.4 ARI- <5 Yr. 3.7 3.8 4.6 4.0 4.3 4.7 4.8 4.9 5.5 6.2 6.0 Pneumonia >=5 Yr 0.8 1.0 1.1 0.9 1.0 1.1 1.0 1.2 1.2 1.5 1.3 consultations in week-32,in comparison with the percentage of C&C in week-42 of 2012, increased by 9.2%, whereas in case of 5 years and above increased by 3.7% to 13.4% in this reporting week. The trend of ARI diseases in last 11 weeks can be read in table-3.The percentages of consultations on Pneumonia cases of age group less than 5 years increased by 2.3% in last 11 weeks, whereas the percentage of age group 5 years and over shows an increase of 0.5% in last 11 weeks. n the reporting week-42 of 2012, the highest percentage of Cough & Cold has been recorded in Paktika and Nuristan provinces with 36% and 29% respectively, whereas the lowest percentages of C&C were reported from Farah I province with 7% . The highest percentages of Pneumonia cases reported from Sar-pul and Baghlan provinces with 8% and 7%, whereas the lowest percentage of Pneumonia cases was recorded in Uruzgan province with less than one percent. (Fig-3) 40% Fig-3: Percentages of ARI from Total Clients in week-42 of 2012 20% 0% BD BA DA GH HE JO KA KH LO NA PK PA SA WA KA BD GH KA PA NI UR KN LA NU BAL FYB HEL KDZ PIA SARTAK ZAB BGL FRA S M Y A R W N O G N A R M R B G O P N M U R G R Pneumonia 2% 4% 6% 2% 3% 1% 2% 1% 7% 1% 2% 3% 3% 3% 1% 2% 2% 4% 8% 3% 4% 1% 3% 7% 1% 1% 2% 2% 2% 1% 0% 2% 4% 6% Cough&Cold 17%20%20%20%19%14%15%18%14%15%22%17%22%21%36%20%12%20%19%14%18%13%14%18%17% 7% 13%21%18%12%11%25%17%29% Percentages of Diarrheal Diseases by weeks and by Age Groups The table-4 below shows the percentages of diarrheal diseases (Acute watery Diarrhea, Bloody Diarrhea and Acute watery Table-4: 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 32-12 33-12 34-12 35-12 36-12 37-12 38-12 39-12 40-12 41-12 42-12 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 27.2 25.0 28.9 24.0 21.6 20.9 20.5 19.2 18.5 16.6 15.9 Diarrhea >= 5 Years 6.9 6.8 8.4 6.6 6.3 6.4 5.2 5.0 4.5 4.2 3.9 Bloody Diarrhea <5 Years 4.1 4.1 2.9 3.8 3.8 3.7 3.4 3.3 3.5 3.1 2.9 >=5 Years 2.0 1.9 1.8 1.9 1.8 1.9 1.7 1.7 1.7 1.5 1.5 Acute W. Diarrhea <5 Years 3.1 3.1 3.4 2.5 2.3 2.1 2.0 1.9 1.5 1.6 1.2 with Dehydration ≥5 Years 0.8 0.7 1.0 0.6 0.6 0.6 0.5 0.5 0.4 0.4 0.3 diarrhea with dehydration) from week-32 to week-42 of 2012, from total clients. Acute watery diarrhea among children less than five years of age has been decreased from 27.2% in week-32 to 15.9% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has been decreased by 3% to 3.9%.(Please refer to Table-4, above).Bloody diarrhea, in age group less than 5 years decreased by 1.2% in last 11 weeks, while in case of age group 5 years and above decreased by 0.5%. Acute watery diarrhea with dehydration in age group less than 5 years decreased by 1.9% and in case of five years and above decreased by 0.5% in last 11 weeks.