DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) 05-11 July 2015 Weekly Epidemiological Report –27 Summary: o Out of 459functional sentinel sites, 458 (99.7%) have submitted reports this week. o Out of a total of 389,047new consultations (166,248male, 222,799female) this week, 36.3% or 141,276 (68,983 male, 72,293female) consultations were reported due to DEWS targeted diseases. o Main causes of consultations in this week were Acute Diarrheal Diseases, 73,660 cases (19% out of total new consultations) and Pneumonia, 7,763 cases (2% out of total new consultations). o A total of 238 deaths were reported this week, of which 56 were due to DEWS targeted diseases, which includes 25 Pneumonia deaths, 14 Acute Diarrheal Diseases deaths, 13 Meningitis/SIC deaths, and3 Measles deaths and 1 suspected Hemorrhagic Fever death. o Total of 13 outbreaks reported this week; of which 5 Measles outbreaks reported from Paktika, Zabul and Nuristan provinces,5 were CCHF outbreaks reported from Heratprovince, 2 Pertussis outbreaks reported from Parwan and Nangarhar provinces and 1 Acute viral Hepatitis outbreak reported from Laghman province. Figure1: Surveillance/DEWS-Plus Sentinel Sites with GPS location by type of Health Facility Table 1: Coverage of DEWS-Plus Surveillance System Type of Health Private Special RH/PH DH CHC/BHC Polyclinic Total Facility Hospital Hospital Total Health 34 78 1,226 1 213 26 1,578 Facilities (HF) HF covered by 32 69 341 1 2 14 459 DEWS-Plus 1 based Surveillance ــ Indicator The Indicator-based surveillance component of DEWS-plus reports on weekly bases on 15 priority infectious diseases from sentinel sites. The data is compared with previous weeks and corresponding week of previous years and the alert and epidemic threshold is checked to see if disease incidence has crossed these levels and necessary action is initiated. Figure 2: DEWS targeted diseases Percentage of Diseases out of total consultation during week 27 27 26 < 5 years ≥ 5 years 24 23 21 ns ns 20 18 17 15 14 12 11 9 8 6 5 3 2 % out of total consultatiototalof out% 0 Acute AWD with Acute Viral Neonatal Typhoid Pneumonia AWD Bloody Meningitis Measles Malaria Dehydration Hepatitis Tetanus Fever Diarrhea < Disease 5 years 3.9 27.5 4.6 2.6 0.10 0.04 0.2 0.000 0.7 0.3 ≥ 5 years 1.0 8.2 2.2 0.7 0.02 0.1 0.04 0.000 0.8 0.7 Number of cases of diseases during week 27 36000 33000 < 5 years ≥ 5 years 30000 27000 24000 21000 18000 15000 12000 Number of cases of Number 9000 6000 3000 0 Acute AWD with Acute Viral Neonatal Typhoid Pneumonia AWD Bloody Meningitis Measles Malaria Dehydration Hepatitis Tetanus Fever Disease Disease Diarrhea < 5 years 5086 35414 5970 3414 131 52 227 0 963 374 ≥ 5 years 2677 21196 5819 1847 53 180 106 0 2003 1705 2 Vaccine Preventable Diseases (VPDs): Table 2: Cases and deaths due to VPDs by age group during week 27, 2015 Cases Deaths Diseases CFR/100 <5 years ≥ 5 years Total <5 years ≥ 5 years Total Measles 227 106 333 3 0 3 0.90 Pertussis 1 2 3 0 0 0 0.00 Diphtheria 0 0 0 0 0 0 0.00 Neonatal Tetanus 0 0 0 0 0 0 0.00 Tetanus 0 0 0 0 0 0 0.00 Seasonal Diseases: Trend of Pneumonia in recent weeks- Trend of AWD with severe dehydration 2015 in recent weeks-2015 3.5 1.60 3 1.40 2.5 1.20 1.00 2 0.80 1.5 Percentage 0.60 Percentage 1 0.40 0.5 0.20 0 0.00 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 Weeks Weeks Current situation Current situation Average of 3 years data (2012­2014) Average of 3 years data (2012­2014) Trend of Measles in recent weeks- 2015 Trend of Malaria in recent weeks- 2015 0.12 0.80 0.10 0.70 0.60 0.08 0.50 0.06 0.40 0.30 Percentage Percentage 0.04 Precentage Precentage 0.20 0.02 0.10 0.00 0.00 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 Weeks Weeks Current situation Current situation Average of 3 years data (2012­2014) 3 Average of 3 years data (2012­2014) Event-Based Surveillance: During week 27 a total of 13 outbreaks detected, investigated and responded to by DEWS-plus. The details are as below: 1. Measles Outbreaks and sent them to CPHL for lab confirmation. 1.1 Measles outbreakwas reported on The vaccination coverage of the area was st 7 July 2015 from Khatakwalvillage of 30%. Vitamin A supplements were Sharan district, Paktika province with 16 distributed and health education sessions Suspected cases (8 cases in age group under conducted in the affected area. The active five and 8 cases in age group over five). The surveillance has been established for investigation team visited the area and detection and investigation of further cases. collected specimens from 5 cases Suspected and sent them to CPHL for lab confirmation. 1.4 Measles outbreak was reported on th The vaccination coverage of the area was 6 July 2015 from Abdullah Khan village of 70%. Vitamin A supplements were Shahjoy district, Zabul province with 7 distributed and health education sessions Suspected cases (3 cases in age group under conducted in the affected area. The active five and 4 cases in age group over five). The surveillance has been established for investigation team visited the area and detection and investigation of further cases. collected specimens from 5 suspected cases and sent them to CPHL for lab confirmation. 1.2 Measles outbreak was reported on The vaccination coverage of the area was th 8 July 2015 from Tatiwalvillage of Sharan 17%. The team vaccinated 23 (6m-5y) district, Paktika province with 11 Suspected children against the measles in the cases (5 cases in age group under five and 6 surrounding villages of the affected area. cases in age group over five). The Vitamin A supplements were distributed and investigation team visited the area and health education sessions conducted in the collected specimens from 4 Suspected cases affected area. The active surveillance has and sent them to CPHL for lab confirmation. been established for detection and The vaccination coverage of the area was investigation of further cases. 80%. Vitamin A supplements were distributed and health education sessions 1.5 Measles outbreak was reported on th conducted in the affected area. The active 7 July 2015 from Prons village of Paroon surveillance has been established for district, Nuristan province with 5 Suspected detection and investigation of further cases. cases (3 cases in age group under five and 2 cases in age group over five). The 1.3 Measles outbreak was reported on investigation team visited the area and th 8 July 2015 from Tawda China, village of collected specimens from 3 suspected cases Mata khan district, Paktika province with 18 and sent them to CPHL for lab confirmation. Suspected cases (9 cases in age group under The vaccination coverage of the area was five and 9 cases in age group over five). The 78%. The team vaccinated 48 less than 10 investigation team visited the area and years children against the measles in the collected specimens from 10 suspected cases surrounding villages of the affected area. 4 Vitamin A supplements were distributed and Treatment was started and health education health education sessions conducted in the session conducted to him and his caretakers. affected area. The active surveillance has 2.5 CCHF Outbreak: Suspected CCHF case was reported from Hawa dah, village of been established for detection and Mata khanInjil, Herat province on 11thJuly investigation of further cases. 2015. The case was a 25 years old male having continuous contact with the domestic 2. CCHF Outbreaks animals. The investigation team collected 2.1 CCHF Outbreak: Suspected CCHF blood specimen and send it to CPHL for lab case was reported from Boshron, village of confirmation (The specimen will be shipped Injil district, Herat province on 6th July to Kabul CPHL this week). Treatment was 2015. The case was 37 years old male started and health education session farmer having continuous contact with the conducted to him and his caretakers. domestic animals. No specimen was collected. Treatment was started and health education session conducted to him and his 3. Pertussis. caretakers. 3.1 Pertussis outbreak was reported on 2.2 CCHF Outbreak: Suspected CCHF 7thJuly 2015 from Pol-e-Mattakvillage of case was reported from Sar Asiab, village of Jabalseraj district, Parwan province with 3 Obeh district, Herat province on 6thJuly Suspected cases (1case in age group under 2015. The case was a 40 years old house five and 2 cases in age group over five). The wife having continuous contact with the investigation team visited the area and domestic animals. No specimen was collected specimens from 3 Suspected cases collected Treatment was started and health and sent them to CPHL for lab confirmation. education session conducted to him and his The vaccination coverage of the area was caretakers. low%. The active surveillance has been 2.3 CCHF Outbreak: Suspected CCHF established for detection and investigation of case was reported from Kababian, village of further cases. Health education sessions Injil district, Herat province on 11thJuly conducted in the affected area. 2015. The case was a 50 years old male 3.2 Pertussis outbreak was reported on farmer having continuous contact with the 7thJuly 2015 from Daman village of domestic animals.