July W23, 2012 DISEASES EARLY WARNING SYSTEM...

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July 23, 2012 DISEASES EARLY WARNING SYSTEM WER-29(6th Yr) REPORTS RECEIVED FROM REPORTING SITES: As of July 20, 2012, 312 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan. In this reporting week, 311 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-29, 2012

Cen

tral

E

ast

Cen

tral

W

est

Nor

th

Nor

th

Eas

t

Wes

t

Sout

h

Eas

t

Sout

h E

ast

Tot

al

No. of Expected Reports from Sentinel Sites

53 30 49 37 34 38 37 34 312

No. of Reports Received in this week

53 30 49 37 34 37* 37 34 311

*No Report Received from Shamulzai Sentinel Site of Zabul province, South region.

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DEWS Sentinel Sites: Figure-1(Map) shows the distribution of DEWS sentinel sites, already established in the relevant regions/provinces by July 20, 2012 by type of health facilities. Data on15 DEWS target diseases are being collected from these sentinel sites (SS).The symbols on the map show the number of sentinel sites in each region/province, and do not indicating the GPS of the SS locations. DEWS Data in Epidemiological Week-29 of 2012 Out of total 306,680 clients recorded in week-29 of 2012, 11.8% (36203) of consultations were reported due to cough and cold and 1.9% (5907) of consultations was reported due to pneumonia. In the same reporting period, 16.5% or 50,676 events were reported due to diarrheal illnesses (12.5% due to Acute Watery Diarrhea, 2.6% due to Bloody Diarrhea and 1.5% due to acute watery diarrhea with dehydration). In comparison with previous week (W28 of 2012) the percentage of ARI diseases has increased by 0.1% to13.7%, whereas the percentage of Acute Diarrheal diseases by 0.3% to 16.5%. These variations can be due to changes in temperature /weather during the reporting week.Figure-2 above shows the percentages of DEWS target diseases by age groups in week-29 of 2012.

Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in

Week-29, 2012

Type of SS C

entr

al E

ast

Cen

tral

Nor

th

Nor

th

Eas

t

Wes

t

Sout

h

Eas

t

Sout

h E

ast

Tot

al

CHC/BHC 25 19 34 26 20 29 27 26 206 DH 12 7 10 7 9 4 7 4 60 PH/RH/SH 14 4 5 4 4 5 3 4 43 Poly Clinic 2 0 0 0 1 0 0 0 3 Total 53 30 49 37 34 38 37 34 312 CHC=Comprehensive Health Center, DH=District hospital, PH=provincial hospital, RH= Regional hospital, SH= specialized hospital

ARIC&C

ARIPn

AwD BD AwDw

Men/SIC

AVHep

Measle

Malaria

TyphFev

U5% 16.5% 4.0% 25.0% 3.9% 3.1% 0.1% 0.1% 0.2% 1.0% 0.5%

O5% 9.6% 1.0% 6.7% 2.0% 0.7% 0.0% 0.1% 0.0% 0.8% 0.8%

Tot% 11.8% 1.9% 12.5% 2.6% 1.5% 0.1% 0.1% 0.1% 0.9% 0.7%

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%

Fig-2: Percentages of DEWS Target Diseases by age Group in W29 of 2012

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Percentage of ARI by weeks and by Age Groups In the epidemiological week-29, a total of 42,110 events of ARI were reported.16.5 % of total clients less than5 years of age were cough & Cold patient’s and 9.6% among the age group 5 years and over. The percentage of C&C (<5 years)

consultations in week-19,in comparison with the percentage of C&C in week-29 of 2012, decreased by 8.5%, whereas in case of 5 years and above decreased by 4.2% to 9.6% 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 2.6% in last 11 weeks, whereas the percentage of age group 5 years and over decreased by 0.3% to 1% in last 11 weeks.

n the reporting week-29 of 2012, the highest percentage of Cough & Cold has been recorded in Kapisa and Nuristan provinces with 20% and 18% respectively, whereas the lowest percentages of C&C were reported from Zabul province with 6%. The highest percentages of Pneumonia reported from Sar-i-pul, Nuristan and Jawzjan provinces

with 6% each, whereas the lowest percentage of Pneumonia was recorded in Zabul and Uruzgan provinces with less than1% each. (Fig-3)

Percentages ofDiarrheal 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

diarrhea with dehydration) from week-19 to week-29 of 2012, from total clients. Acute watery diarrhea among children less than five years has been increased from15.3% in week-19 to 25.0% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has increased by 2.8% to 6.7%.(Please refer to Table-5, above).Bloody diarrhea, in age group less than 5 years increased by 0.3% in last 11 weeks, while in case of age group 5 years and above increased by 0.1% in the same period. Acute watery diarrhea with dehydration in age group less than 5 years increased by1.3%, in case of five years and above increased by 0.2% in last 11 weeks.

BDS BAL BAM

DAY

FYB GHA

HEL HER JOW

KAN

KHO

KDZ LOG

NAN

PKA PIA PAR SAM

SAR TAK WAR

ZAB KAB BGL BDG

FRA GHO

KAP PAN

NIM

URU

KNR

LAG NUR

Pneumonia 2% 3% 3% 1% 2% 1% 1% 0% 6% 0% 1% 2% 1% 1% 1% 1% 1% 1% 6% 2% 4% 0% 2% 3% 1% 0% 2% 2% 2% 1% 0% 2% 2% 6%

Cough&Cold 10%14%15%13%13%14%10%15% 9% 8% 16%11%16%14%11%14%11%13% 9% 12%17% 6% 10%10% 9% 7% 8% 20%14% 9% 7% 17% 9% 18%

0%

10%

20%

30% Fig-3: Percentages of ARI from Total Clients in week-29 of 2012

Table-3: Percentages of ARI Diseases during 11 recent weeks by age groups and by weeks Disease Age Week

19-12 (%)

Week 20-12 (%)

Week 21-12 (%)

Week 22-12 (%)

Week 23-12 (%)

Week 24-12 (%)

Week 25-12 (%)

Week-26-12 (%)

Week-27-12 (%)

Week 28-12 (%)

Week 29-12 (%)

ARI- C&C <5 Yr. 25.0 25.4 24.7 22.6 20.7 19.8 18 17.4 16.6 16.6 16.5 5+ 13.8 13.3 13.3 12.4 11.9 11.4 10.7 10.3 10.0 9.5 9.6

ARI-Pneumonia

<5 Yr. 6.6 6.1 6.4 5.9 5.8 5.0 4.8 4.6 4.1 4.2 4.0 >=5 Yr 1.3 1.4 1.4 1.2 1.1 1.2 1.1 1.0 1.0 1.0 1.0

I

Table-4: Percentages of Diarrheal Diseases from Total Clients during 11 recent weeks by age groups.

Disease Age Week 19-12 (%)

Week 20-12 (%)

Week 21-12 (%)

Week 22-12 (%)

Week 23-12 (%)

Week 24-12 (%)

Week 25-12 (%)

Week 26-12 (%)

Week 27-12 (%)

Week 28-12 (%)

Week 29-12 (%)

Acute Watery Diarrhea

<5 Years 15.3 16.2 17.8 19.2 21.0 23.0 23.8 24.7 25.9 25.9 25.0 >= 5 Years 3.9 4.1 4.2 5.4 5.2 5.7 6.4 6.4 6.7 7.0 6.7

Bloody Diarrhea <5 Years 3.6 3.0 3.7 3.5 3.4 3.9 3.9 3.7 3.9 4.1 3.9 >=5 Years 1.9 1.5 1.6 1.6 1.6 1.9 1.9 1.9 1.9 1.9 2.0

Acute W. Diarrhea with Dehydration

<5 Years 1.8 1.9 2.2 2.4 2.8 2.5 3 2.9 3.4 3.2 3.1 ≥5 Years 0.5 0.5 0.5 0.6 0.7 0.6 0.7 0.7 0.8 0.8 0.7

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Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: In the epidemiologic week-29 of 2012, a total of 159 suspected cases of Meningitis/Sever Ill Child were reported from all regions and the highest percentage was recorded in Central East region. In the same reporting week, from all regions 2633 consultations were reported by Sentinel Sites to be malaria and the highest percentage of Malaria cases were reported from East region with 3%. Out of the total clients, 2135 cases or 0.7% in national level were reported to be suspected Typhoid Fever and the highest percentage of Typhoid Fever was reported from South East region with 1.5% and followed by South region with 1.1%. Vaccine Preventable Diseases In DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, so that their occurrences are changing by seasonal variations. Among these diseases Meningitis/severely ill child is being reported mostly from North region; but in this week out of total 159 cases in country level, 49(32%) cases have been reported from Central East region and 42 cases were recorded in North region. In general the highest number of cases of viral hepatitis being reported from East, south East and North east regions, so that in the reporting week out of total 247 cases, 84 cases reported from East, 38 from Central East, and 51 cases from South East region were reported. From total 342 Measles cases reported in the reporting week more than 28% of cases were recorded in East region, while more than 23% recorded in Central East region.

0%

10%

20%

30%

40%

BDS

BAL

BAM

DAY

FYB

GHA HE

LHE

RJO

WKA

NKH

OKD

ZLO

GN

AN PKA

PIA

PAR

SAM

SAR

TAK

WAR ZA

BKA

BBG

LBD

GFR

AG

HO KAP

PAN

NIM

URU KN

RLA

GN

UR

Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-29 of 2012AWDwD BD AWD

Table-5: Suspected Cases of Vaccine Preventable Diseases in W29 of 2012 by Region

Regions

Men

ingi

tis/

Seve

r Il

l C

hild

V

iral

H

epat

itis

Mea

sles

Pert

ussi

s

Dip

hthe

ria

Tet

anus

/N

ew N

atal

T

etan

us

Acu

te

Flac

cid

Para

lysi

s North East 17 16 21 2 0 0 0 North 42 9 41 4 0 0 1 Central West 2 27 31 0 0 0 2 West 17 10 4 0 0 0 3 Central East 49 38 79 0 0 0 2 South 12 12 10 0 0 0 5 East 12 84 99 0 0 1 1 South East 8 51 57 0 0 0 0 Total 159 247 342 6 0 1 14

NER NR CWR WR CER SR ER SER

Men/SIC 0.1% 0.1% 0.0% 0.1% 0.1% 0.0% 0.0% 0.0%

Malaria 0.4% 0.3% 0.3% 0.2% 0.1% 0.8% 3.0% 1.9%

Typhoid Fev 0.7% 0.6% 0.7% 0.4% 0.3% 1.0% 1.1% 1.5%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5% Fig -5: Percentages of Men/SIC Malaria & Typhoid Fever from Total Clients in Week-29 of 2012 by Region

All cases of suspected measles, pertussis, diphtheria, meningitis, or cholera, and unusual increases in incidence of any disease, and animal outbreaks of avian influenza, anthrax, brucellosis or other zoonoses should be reported immediately to the DEWS team in the relevant province or the national focal point – "Director Surveillance"<[email protected]> 0700290955 or the WHO CSR/DEWS Technical Officer, 0708811856,[email protected]

Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks(from W22 of 2011 to W29 of 2012) Among the DEWS target diseases, Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) as leading causes of morbidity and mortality, having the highest frequency of consultations. The following Line-Chart shows the trend of ADD and ARI from week-22 of 2011 to week-29 of 2012(more than one complete cycle).In week-22 of 2011, the ARI and ADD curves crossed each other, so that ARI started decreasing and ADD changed its course to increase. By the end of Summer season of 2011these curves crossed one another again in week-37and from that time to week-6 of 2012, the percentage of ARI was increasing, while the percentages of ADD were falling /decreasing, but week-09 of 2012 was a turning point for both categories of ARI and Diarrheal diseases i.e. ARI started decreasing, while ADD started increasing. Comparing this week data with previous week, ARI slightly increased by 0.1% to13.7%, while the percentage of ADD decreased by 0.3% to 16.5% unexpectedly.

13.813.913.413 13.614.9

13.212.913.8

12.812.413.412.8

11.512.8

14.315.4

16.317.617.9

2020.7

21.8

18.8

2223.2

26.125.7

28.1 2829.529.930.5

31.231.530.830.529.929.328.9

26.926.825.3

24.4

22.5 22.421.521.7

20.920.119.919.5

18.1

17.116.3

15.214.614.013.613.7

13.5

15.315.516.215.816.116.816 15.916.215.816.115.8

17.1

1514.1

13.312.4

11.110.110.1

9.2 8.5 8.27 7.3 6.6 6.2 5.7 5.5 4.9 4.9 4.6 4.7 4.5 4.3 4.4 4.2 4.0 4.4 4.7 4.9 5.5 5.6 6.3

7.28.5 8.6 9.0

10.610.711.4

12.9 13.5

14.7

15.7 15.716.816.8 16.5

0

5

10

15

20

25

30

35

Percentages

Weeks of the Year

Trend of ARI/ADD as Propotion of Total Clients From Week-22 of 2011 to Week-29 of 2012

ARI

ADD


Mortality: Among DEWS target diseases Pneumonia, Diarrheal diseases and Meningitis/ Severely Ill Children (SIC) are main causes of mortality which make in general more than 95% of total deaths of surveillance target diseases. Usually deaths due to diarrheal diseases increases during summer season, while the number of deaths due to Pneumonia increases during cold period/Winter Season. In this week out of 46 deaths reported from all regions, 24 deaths caused by Pneumonia, 11 deaths caused by diarrheal diseases and 11 deaths were caused by Meningitis/severely ill children. (Table-7)

Number of Outbreaks investigated in 2012 with details of W28/W29

Epidemiological week-28 Suspected Poisoning: reported Zashowiee high school of Nijrab district of Kapesa

province on July 11 /2012 and investigated on the same day, and the health team investigated the affected area and they found 29 cases of dyspenia , vomiting , skin rash and headache with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control.

Suspected Measles Outbreak: reported from Ahmad shah baba Maina of Kabul city of Kabul province on July 10 /2012, the team investigated the area on the same day and during the investigation there were 6 suspected measles cases with no deaths , the team collected the

Table-6: Deaths by Main Causes of Mortality and by Region in W29 of 2012

Main Causes of Deaths

Nor

th

East

Nor

th

Cen

tral

W

est

Wes

t

Cen

tral

Ea

st

Sout

h

East

Sout

h Ea

st

Tota

l

Pneumonia 1 3 3 4 7 0 3 3 24

Diarrheal Diseases 0 4 0 5 0 1 0 1 11 Meningitis

1 2 1 6 0 1 0 0 11

Total 2 9 4 15 7 2 3 4 46

Table 7: Reported outbreaks since first week of 2012 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis 23 2 21 Avian/Swine Flu ARI 7 7 Measles 165 7 158 Diarrhea 3 3 Meningitis Hepatitis 2 2 Malaria Typhoid 1 1 CCHF 8 8 Bl. Diarrhea 1 1 Chickenpox 1 1 Other 43 2 41 Total 255 11 244


specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is controlled .

Suspected Measles Outbreak: reported from Halem kala of village of Gardez district of Paktia province on July 08 /2012, the team investigated the area on the following day and during the investigation there were 14 suspected measles cases with no deaths , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the outbreak is controlled .

Suspected poisoning : reported dyspenia , vomiting , skin rash and headache of Behsood village of Sari pul city of Sari pul province on July 05 /2012 and investigated on the same day, and the health team investigated the affected area and they found 45 cases of anxiety, crying, Nausea, and drowsy with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control.

Suspected poisoning : reported Yakbagh high school of Sheberghan city of Jawzjan province on July 07/2012 and investigated on the same day, and the health team investigated the affected area and they found 89 cases of anxiety, crying, Nausea, and drowsy with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under control

Suspected poisoning : reported Baba ali school of Sheberghan city of Jawzjan province on July 08/2012 and investigated on the same day, and the health team investigated the affected area and they found 39 cases of anxiety, crying, Nausea, and drowsy with no deaths case and the patients treated and health education and hygiene session conducted for students, outbreak is under controlled

Suspected chicken pox outbreak: reported from Naqoom, Janmahammad, Qadisang of village of Yakowlang district of Bamyan province on July 08 /2012, the team investigated the area on the following day and during the investigation there were 49 suspected chicken pox cases with no deaths , the team collected the specimens and send it to CPHL , the cases treated and the health eduction campaign conducted in surrounding villages, the outbreak is controlled .

Suspected CCHF outbreak: : reported from Bridge village of Kama district of Nangarhar province on July 07 /2012, the team investigated the area on the same day and during the investigation there was one suspected CCHF case , the team collected the specimens and send it to CPHL , the cases treated , the team is investigating for further cases

Epidemiological week-29 Suspected Measles Outbreak: reported from Qadam khil village of Kohistan 1 district of

Kapesa province on July 15 /2012, the team investigated the area on the same day and during the investigation there were 5 suspected measles cases with no deaths, the team collected the specimens and send it to CPHL, the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases.

Suspected Measles Outbreak: reported from Kotwal village of Sharana district of Paktika province on July 06 /2012, the team investigated the area on the following day and during the investigation there were 6 suspected measles cases with no deaths , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases

Suspected Measles Outbreak: reported from Kari khil village of Mata khan district of Paktika province on July 07 /2012, the team investigated the area on the following day and


during the investigation there were 6 suspected measles cases with no deaths , the team collected the specimens and send it to CPHL , the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases

Suspected Measles Outbreak: reported from Kordar village of Wama district of Nuristan province on July 02 /2012, the team investigated the area on the following day and during the investigation there were 13 suspected measles cases with no deaths, the team collected the specimens and send it to CPHL, the cases treated and the vaccination campaign conducted in surrounding villages, the team is investigating for further cases.

CCHF outbreak: : reported from Neshar village of Belcheragh district of Faryab province on July 07 /2012, the team investigated the area on the same day and during the investigation there was one suspected CCHF case , the team collected the specimens and send it to CPHL ,the result was positive , the cases treated , the team is investigating for further cases


ANNEX: Mapping of Percentages/Cases of Selected Diseases in Week-29 of 2012 by Province

July W23, 2012 DISEASES EARLY WARNING SYSTEM...

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