May 13, 2013 DISEASES EARLY WARNING SYSTEM WER-19 (7th Yr) DEWS WEEKLY EPIDEMIOLOGICAL REPORT EPREPORT SUMMARY: This report includes surveillance data from 4th May to 10th May 2013. Out of 349 functional Sentinel sites (SS), all 349 (100%) have sent their reports in Week-19 of 2013. Out of total 345,178 consultations (145,256 Male, 199,922 Female) recorded in week-19 of 2013, 108,054 (51,869 Male, 56,185 Female) consultations were reported due to DEWS target diseases. Main causes of consultations this week are Acute Respiratory Infections/ARI (19.8%) and Acute Diarrheal Diseases/ADD (10.6%) from total clients in a continuing trend from the week before. 51 (25 Male, 26 Female) deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so 32 deaths (16 Male, 16 Female) caused by Pneumonia, 8 deaths (2 Male, 6 Female) caused by diarrheal diseases and 11 deaths (7 Male, 4 Female) were caused by Meningitis/severely ill children. In this reporting week, Suspected Measles Outbreak reported from Qalat district of Zabul province, Suspected Cholera Outbreak reported from Shoraba district of Kandahar province, Suspected Measles Outbreak reported from Wants waygal district of Nuristan province, Suspected scabies Outbreak reported from Asadabad district of Kunar province and Suspected Measles Outbreak reported from Keshendeh district of Balkh province. REPORTS RECEIVED FROM REPORTING SITES: As of May 10, 2013, 349 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan. In this reporting week, 349 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-19, 2013 Central East Central West North North East West South East South East Total No. of Expected Reports from 56 31 57 43 37 46 43 36 349 Sentinel Sites No. of Reports Received in this 56 31 57 43 37 46 43 36 349 week DEWS Sentinel Sites: Figure-1(Map) shows the distribution of DEWS Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in Week-19, 2013 sentinel sites, already established in the relevant Type of regions/provinces by May SS al East Centr al West North North East West South East South East Total 10, 2013 by type of health Centr facilities. Data on 15 DEWS CHC/BHC 28 18 42 32 23 36 33 28 240 target diseases are being DH 12 9 10 7 9 5 7 4 63 collected from these sentinel PH/RH/SH 14 4 5 4 4 5 3 4 43 sites (SS).The symbols on Poly Clinic 2 0 0 0 1 0 0 0 3 the map show the number of Total 56 31 57 43 37 46 43 36 349 sentinel sites in each CHC=Comprehensive Health Center, DH=District hospital, PH=provincial hospital, RH= region/province, and do not Regional hospital, SH= specialized hospital indicating the GPS of the SS locations. DEWS Data in Epidemiological Week-19 of 2013: Ut of total 345,178 clients recorded in week-19 Fig-2: Percentages of DEWS Target Diseases by of 2013, 16.8% (57838) of consultations were 20 Gender in W19-13 O reported due to cough and cold and 3% (10248) of 15 consultations was reported due to pneumonia. In the same reporting period, 10.6% or 36,446 events were reported 10 due to diarrheal illnesses (7.7% due to Acute Watery 5 Percentage Diarrhea, 2.1% due to Bloody Diarrhea and 0.8% due to 0 ARI Men/S Measl Malari TyphF acute watery diarrhea with dehydration). In comparison ARI Pn AwD BD AwDw AVHep C&C IC e a ev with previous week (W18 of 2013) the percentage of ARI Male 18.5 3.6 9.1 2.5 1 0.1 0.1 0 0.4 0.6 disease has decreased by 1.7% to 19.8%, whereas the Female 15.5 2.5 6.6 1.8 0.7 0 0 0 0.4 0.5 percentage of Acute Diarrheal disease has increased by 0.4% to 10.6%. These variations could be occurred due to Total 16.8 3 7.7 2.1 0.8 0 0 0 0.4 0.5 changes in temperature /weather during the reporting week.Figure-2 above shows the percentages of DEWS target diseases by gender in week-19 of 2013. Percentage of ARI by weeks and by Age Groups: In the epidemiological week-19, a total of 68,086 events of ARI were reported. 24.1 % of total clients less than 5 years of age were cough & cold patients and 13.5% 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- 09-13 10-13 11-13 12-13 13-13 14-13 15-13 16-13 17-13 18-13 19-13 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 31.6 32.3 30.9 29.5 28.6 28.7 27.4 26.6 25.8 25.5 24.1 5+ 19.1 18.2 17.4 16.8 16.3 15.4 15.6 15.0 14.8 14.7 13.5 ARI- <5 Yr. 11.7 11.1 10.0 9.6 9.3 8.6 8.3 7.7 7.7 7.0 6.6 Pneumonia >=5Yr. 2.3 2.2 2.0 1.9 1.9 1.8 1.7 1.6 1.6 1.6 1.3 consultations in week-9,in comparison with the percentage of C&C in week-19 of 2013, decreased by 7.5%, whereas in case of 5 years and above decreased by 5.6% to 13.5% 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 decreased by 5.1% in last 11 weeks, whereas the percentage of age group 5 years and over decreased by 1% to 1.3%. In the reporting week-19 of 2013, the highest percentage of Cough & Cold has been recorded in Kapisa, Daykundi and Bamyan provinces with 26.3%, 24.1% and 23.9%, whereas the lowest percentages of C&C were reported from Laghhman, Farah and Nimroz provinces with 6.7%, 7.7% and 8.7% respectively. The highest percentages of Pneumonia cases reported from Samangan, Saripul and Balkh provinces with 5.8%, 5.6% and 5.5% respectively, whereas the lowest percentage of Pneumonia cases was recorded in Zabul, Nimroz and Urozgan provinces with 0.3%, 0.4% and 0.7% respectively. (Fig-3) 40 Fig-3: Percentages of ARI from Total Clients in week-19 of 2013 30 20 10 Percentage 0 TAK NI KA UR PA WA BA BD FAR GH NA NU SA JO KU GH KH HIL ZAB KAB KAP LOG PAR DAY HER LAGKNR BAL FYB SAR BDS HA BGL PIA PKA M N O N R M G AH O N R M W N A O R Pneumonia 0.4 0.9 1.9 0.3 0.7 4.7 2.6 3.1 3.7 1.9 2.1 3.9 2.4 1.4 0.9 1 2.2 1.6 2 3 3.7 5.8 5.5 5.4 2.7 5.6 3 4.7 5.2 2.2 1.3 1.4 1.1 1.7 Cough&Cold 8.7 11 13 10 14 16 26 20 21 21 19 24 24 9.8 18 7.7 13 20 6.7 20 22 19 21 14 19 14 17 16 14 15 15 23 13 22 Fig-4: Percentages of ARI from Total Clients Among Male/Female Population in W19 of 30 P 2013 e Male Female Total r 25 c e 20 n t a 15 g e 10 5 0 SR CER CWR WR ER NR NER SER 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- 09-13 10-13 11-13 12-13 13-13 14-13 15-13 16-13 17-13 18-13 19-13 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 6.4 7.3 7.4 8.1 9.2 9.9 11.5 12.9 13.8 14.2 15.3 Diarrhea >= 5 Years 2.1 2.1 2.3 2.6 2.8 2.9 3.5 3.6 4 3.9 4.2 Bloody Diarrhea <5 Years 2.0 2.2 2.3 2.3 2.5 2.5 2.7 2.9 3.3 3.4 3.2 >=5 Years 1.1 1.1 1.2 1.2 1.3 1.3 1.3 1.5 1.6 1.7 1.6 Acute W. Diarrhea <5 Years 0.5 0.6 0.7 0.8 0.8 0.9 1.2 1.3 1.1 1.5 1.7 with Dehydration ≥5 Years 0.2 0.2 0.2 0.2 0.3 0.2 0.3 0.4 0.4 0.5 0.4 diarrhea with dehydration) from week-9 to week-19of 2013, from total clients.