May 19, 2014 DISEASE EARLY WARNING SYSTEM …moph.gov.af/Content/Media/Documents/DEWSWER19...May 19,...

May 19, 2014 DISEASE EARLY WARNING SYSTEM WER-19 (8th

Yr)

WEEKLY EPIDEMIOLOGICAL REPORT

Summary:

The surveillance data collected for this weekly report is from 10 – 16 May 2014.

Out of 382 functional Sentinel sites (SS), 380 (99.4%) have submitted reports for Week-19 of 2014.

Out of a total of 365,823 consultations (157,259 male, 208,564 female) recorded in Week-19 of 2014, 33.6% or

122,934 (59,565 male, 63,369 female) consultations were reported due to DEWS targeted diseases.

Main causes of consultations this week were Acute Respiratory Infections (ARI) (20.1%) and Acute Diarrheal

Diseases (ADD) (12.6%) from total clients in a continuing trend from the week before.

A total of 36 deaths reported due to DEWS targeted Diseases, which includes 20 deaths (11 male, 9 female) caused by

Pneumonia, 4 death (3 male, 1 female) caused by Diarrheal Diseases, 9 deaths (4 male, 5 female) caused by

Meningitis/Severely Ill Children, 2 deaths (1 male, 1 female) caused by Malaria and 1 death (1 male, 0 female) caused

by Measles.

In this reporting week, a Suspected Dog Bite Outbreak reported from Kabul province, two Suspected Measles

Outbreaks reported from Ghazni province, a Suspected Measles Outbreak reported from Urozgan province, a

Rumor of Measles Outbreak reported from Nuristan province and Scabies Outbreak reported from Herat province.

Reports Received From Reporting Sites:

As of May 16, 2014, 382 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of

Afghanistan. In this reporting week, 380 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, 2014

Region

Cen

tral

Ea

st

Cen

tral

Wes

t

No

rth

No

rth

Ea

st

Wes

t

So

uth

Ea

st

So

uth

Ea

st

To

tal

No. of Expected

Reports from

Sentinel Sites

55 33 58 52 39 51 49 45 382

No. of Reports

Received in this

week

55 33 58 52 39 49 49 45 380

ARIC&C

ARI Pn AwD BD AwDwMen/SI

CAVHep Measle Malaria

Male 18.76 3.33 10.98 2.80 0.96 0.04 0.05 0.07 0.32

Female 16.02 2.49 8.09 2.23 0.64 0.04 0.04 0.04 0.29

Total 17.20 2.85 9.33 2.48 0.78 0.04 0.05 0.06 0.31

0.002.004.006.008.00

10.0012.0014.0016.0018.0020.00

Pe

rce

nta

ge

Fig-2: Percentages of DEWS Target Diseases by Gender in W19-14

Figure-1

DEWS Sentinel Sites:

Figure-1(Map) shows the

distribution of DEWS sentinel

sites established in the

regions/provinces by May 16,

2014. Table-2 shows the SS

distribution by type of health

facility. Data on 15 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

indicate the GPS of the SS

locations.

DEWS Data in Epidemiological Week-19 of 2014: Out of a total of 361,730 clients recorded in week-19

of 2014, 17.2% (62,914) of consultations were

reported due to Cough and Cold and 2.9% (10,432) of

consultations was reported due to Pneumonia. In the

same reporting period, 12.6% or 46,034 events were

reported due to diarrheal illnesses (9.3% due to Acute

Watery Diarrhea, 2.5% due to Bloody Diarrhea and

0.8% due to Acute Watery Diarrhea with

Dehydration). In comparison with the previous week

(W18 of 2014) the percentage of ARI disease has

decreased by 0.4% to 20.1%, and the percentage of

Acute Diarrheal Disease has increased by 1.1% to

12.6%. These variations could be due to changes in

temperature /weather during the reporting week.

Figure-2 (right) shows the percentages of DEWS target diseases by gender in week-19 of 2014.

Table-2: DEWS Epidemiological Regions and

Sentinel Sites by type in Week- 19, 2014

Type of SS

Cen

tral

East

Cen

tral

Wes

t

Nort

h

Nort

h

East

Wes

t

Sou

th

East

Sou

th

East

Tota

l

CHC/BHC 28 20 43 40 25 41 39 37 273

DH 12 9 10 8 9 5 7 4 64

PH/RH/SH 13 4 5 4 4 5 3 4 42

Poly Clinic 2 0 0 0 1 0 0 0 3

Total 55 33 58 52 39 51 49 45 382

CHC=Comprehensive Health Center, DH=District Hospital, PH=Provincial

Hospital, RH= Regional Hospital, SH= Specialized Hospital

Percentage of ARI by Weeks and by Age Groups:

In the epidemiological week-19 a total of 73,346 events of ARI were reported. 24.2 % of total clients less than 5 years of

age were Cough & Cold patients and 13.9% were among the age group 5 years and over. The percentage of C&C (<5

years) consultations in week-10, in comparison with the percentage of C&C in week-19 of 2014, decreased by 9.6%,

whereas in case of 5 years and above decreased by 4.9% to 13.9% in this reporting week. The trend of ARI diseases in

last 10 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 10 weeks, whereas the percentage of age group 5 years and over decreased by 1.2% to 1.4% .

In the reporting week-18 of 2014, the highest percentages of Cough & Cold were recorded in Khost, Parwan and Kunar

provinces with 35.3%, 26.9% and 24.9%, whereas the lowest percentages of C&C were reported from Farah, Nimroz and

Laqghman provinces with 6.7%, 7.5% and 10% respectively. The highest percentages of Pneumonia cases were reported

from Bamyan, Balkh and Baghlan provinces with 7.7% and 5.4% respectively, whereas the lowest percentages of

Pneumonia cases were recorded in Zabul, Nimroz and Paktika provinces with 0.1% and 0.6% respectively. (Fig-3)

Percentages of Diarrheal Diseases by Weeks and by Age Groups:

Figure-4 below shows the percentages of diarrheal diseases (Acute Watery Diarrhea, Bloody Diarrhea and Acute Watery

Diarrhea with Dehydration)

0

10

20

30

40

50

NIM H

IL

KA

N

ZAB

UR

O

KA

B

KA

P

LOG

PA

N

PA

R

WA

R

BA

M

DA

Y

BD

G

HER

FAR

GH

O

NA

N

LAG

KN

R

NU

R

SAM

BA

L

JOW

FYB

SAR

BD

S

TAK

BG

L

KU

N

GH

A

PIA

PK

A

KH

O

Pe

rce

nta

ge

Province

Fig-3: Percentages of ARI from Total Clients in Week-19 of 2014

Pneumonia Cough&Cold

0

5

10

15

20

25

NIM H

IL

KA

N

ZAB

UR

O

KA

B

KA

P

LOG

PA

N

PA

R

WA

R

BA

M

DA

Y

BD

G

HER

FAR

GH

O

NA

N

LAG

KN

R

NU

R

SAM

BA

L

JOW

FYB

SAR

BD

S

TAK

BG

L

KU

N

GH

A

PIA

PK

A

KH

O

Pe

rce

nta

ge

Provinces

Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-19 of 2014

AWD BD AWDwD

Table-3: Percentages of ARI Diseases during 10 recent weeks by age groups and by weeks

Disease Age Week-

10-14

(%)

Week-

11-14

(%)

Week-

12-14

(%)

Week-

13-14

(%)

Week-

14-14

(%)

Week-

15-14

(%)

Week-

16-14

(%)

Week-

17-14

(%)

Week-

18-14

(%)

Week-

19-14

(%) ARI- C&C <5

Years

33.8 32.7 30.1 31 30.2 28.2 28.3 26.2 25.1 24.2

≥5

Years

18.8 16.9 17.9 17.6 16.2 15.8 15.6 14.8 13.9 13.9

ARI-

Pneumonia

<5

Years

11 9.5 9.1 9.6 8.6 7.5 6.8 6.6 6.6 5.9

≥5

Years

2.6 2.1 2.3 2 1.8 1.7 1.6 1.5 1.5 1.4

SR CER CWR WR ER NR NER SER

Men/SIC 0.07 0.04 0.02 0.03 0.01 0.07 0.03 0.01

Malaria 0.39 0.02 0.05 0.02 1.21 0.18 0.02 0.43

Typhoid Fev 0.90 0.16 0.36 0.33 0.98 0.45 0.38 0.76

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Pe

rce

nta

ge

Fig-5: Percentages of Meningitis, Malaria & Typhoid Fever from Total Clients in W19-14

From week-10 to week-19 of 2014 from total clients, Acute Watery Diarrhea among children less than five years of age

has increased from 7.5% in week-10 to 18% in the reporting week, whereas Acute Watery Diarrhea among age group 5

years and above has been increased by 2.7% to 5.3% (Table-4). Bloody Diarrhea in age group less than 5 years increased

by 1.6% in last 10 weeks, while in case of age group 5 years and above has been increased by 0.6%. Acute Watery

Diarrhea with Dehydration in age group less than 5 years show an increase by 0.7% in last 10 weeks, while in case of five

years and above AWDwD increased by 0.3% in last 10 weeks.

Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region:

In the epidemiologic week-19 of

2014, a total of 143 suspected

cases of Meningitis/Severely Ill

Child were reported from all

regions and the highest

percentage was recorded in

North, South and Central East

regions. In the same reporting

week, from all regions, 1118

Malaria consultations were

reported by Sentinel Sites and the

highest percentages of Malaria

cases were reported from East,

South East and South regions

with 1.21%, 0.43% and 0.39%

respectively. Out of the total

clients, 1896 cases or 0.5% at the

national level were reported to be

suspected Typhoid Fever and the

highest percentages of Typhoid

Fever cases were reported from East, South and South East regions with 0.98%, 0.90% and 0.76% respectively.

Vaccine Preventable Diseases:

Among DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, and their occurrences

are changing by seasonal variations. Among these diseases Meningitis/Severely Ill Child is being reported mostly from

the North region. In this week out of total 143 cases in country level, 46 cases have been reported from North region, 33

cases from the Central East region and 25 cases from the South region.

In general the highest number of cases of Acute Viral Hepatitis has been reported from the East and South East regions, so

in the reporting week out of total 166 cases, 59 cases reported from Central East region, 22 cases were reported from

South East and South East regions. From a total of 205 Measles cases reported in the reporting week, 57 cases were

recorded in South, 49 cases were reported from East and 48 cases were reported from North regions. Table-5 (below)

shows the distribution of vaccine preventable diseases across all reporting regions.

Table-4: Percentages of Diarrheal Diseases from Total Clients during 10 recent weeks by age groups

Disease Age

Week-

10-14

(%)

Week-

11-14

(%)

Week-

12-14

(%)

Week-

13-14

(%)

Week-

14-14

(%)

Week-

15-14

(%)

Week-

16-14

(%)

Week-

17-14

(%)

Week-

18-14

(%)

Week-

19-14

(%)

Acute Watery

Diarrhea

<5 Years 7.5 7.7 8.3 9.2 10.4 11.1 12.4 14.7 16.7 18

≥5 Years 2.6 2.3 2.8 2.9 3.1 3.5 3.8 4.5 4.6 5.3

Bloody Diarrhea <5 Years 2.1 2.3 2.4 2.4 2.6 2.8 3.1 3.4 3.6 3.7

≥5 Years 1.3 1.1 1.4 1.3 1.4 1.5 1.6 1.6 1.7 1.9

Acute Watery

Diarrhea with

Dehydration

<5 Years 0.6 0.6 0.7 0.6 0.8 1 0.8 1.2 1.4 1.3

≥5 Years 0.2 0.2 0.2 0.2 0.2 0.3 0.3 0.4 0.5 0.5

Table-5: Suspected Cases of Vaccine Preventable Diseases in W- 19 of 2014 by Region

Regions

Meningitis/

Severely Ill

Children

Acute Viral

Hepatitis Measles Pertussis Diphtheria Tetanus

Acute Flaccid

Paralysis Total

SR 25 18 57 0 0 1 1 102

CER 33 59 17 0 0 0 11 120

CWR 6 8 6 1 0 0 2 23

WR 12 14 2 0 0 0 1 29

ER 4 21 49 0 0 2 0 76

NR 46 2 48 0 0 0 2 98

NER 13 22 6 0 0 0 1 42

SER 4 22 20 0 0 0 0 46

Total 143 166 205 1 0 3 18 536

Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks (trend from W24 of 2013 to W19 of 2014):

Among the DEWS target diseases, Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) are the

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-24 of 2013 to week-19 of 2014. In week-24 of 2013, the ARI and ADD

curves crossed each other, as ARI started decreasing and ADD changed its course to increase. By the end of the summer

season in 2013, these curves crossed one another again in week-35 and from that time to week-7 of 2014; the

percentages of ARI were increasing, while the percentages of ADD were decreasing and both of these groups of

diseases reached their Extreme points (maximum and minimum values) respectively, In this regard we can say that

week-7 of current year was a turning point for both of these groups of diseases, namely ARI percentages will decrease,

while ADD percentages will increase till end of summer season. Comparing this week data with previous week-18 of

2014, ARI decreased by 0.4% to 20.1%, while ADD increased by 1.1% to 12.6% (Fig-6).

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

W24 W26 W28 W30 W32 W34 W36 W38 W40 W42 W44 W46 W48 W50 W52 W1 W3 W5 W7 W9 W11 W13 W15 W17 W19

Per

cen

tage

s

Weeks of the Year

Fig-6: Trend of ARI/ADD as Propotion of Total Clients From Week-24 of 2013 to Week-19 of 2014

ARI ADD

Mortality: Among DEWS target diseases Pneumonia, Diarrheal Diseases and Meningitis/Severely Ill Children (SIC) are main causes

of mortality which generally amount to more than 95% of total deaths of surveillance target diseases. Usually deaths due

to diarrheal diseases increase during the summer season, while the number of deaths due to Pneumonia increases during

the cold period/Winter Season. In this week a total of 36 deaths reported due to DEWS targeted Diseases, which includes

20 deaths (11 male, 9 female) caused by Pneumonia, 4 death (3 male, 1 female) caused by Diarrheal Diseases, 9 deaths (4

male, 5 female) caused by Meningitis/Severely Ill Children, 2 deaths (1 male, 1 female) caused by Malaria and 1 death (1

male, 0 female) caused by Measles. (Fig-7)

Report of Outbreaks:

Last week, a Suspected Measles Outbreak reported from Kabul, Paktya, Bamyan, Zabul, Nuristan and Herat provinces

and in this reporting week a Suspected Dog Bite Outbreak reported from Kabul province, two Suspected Measles

Outbreaks reported from Ghazni province, a Suspected Measles Outbreak reported from Urozgan province, a Rumor of

Measles Outbreak reported from Nuristan province and Scabies Outbreak reported from Herat province.Table-7 (below)

shows the number of outbreaks investigated in 2014 with details of week-18 and week-19 of 2014.

11.17%

2.23%

5.03% 0.56%

1.12%

79.89%

Fig-7: Deaths due to DEWS targeted diseases in week-19 of 2014

Pn

Diarrheal Disease

Men/SIC

Measeles

Malaria

Other

Table-7: Reported outbreaks since first week of 2014 to date

Type of outbreak Investigated Rumor Clinic-ally/lab

Pertussis 1 1

Avian/Swine Flu 1 1

ARI 4 2 2

Measles 52 1 48

Diarrhea

Meningitis

Hepatitis

Malaria

Typhoid

CCHF 4 4

Bl. Diarrhea

Chickenpox 6 6

Other 11 1 8

Total 79 4 75

Epidemiological week- 18

Suspected Measles Outbreak: Reported from Khawja Cheshet Village Deh-Sebaz district Kabul Province on

May 7 /2014, the team investigated the area on the following day, Vaccination coverage is unknown. During the

investigation there were 8 suspected measles cases ,it was clinical confirm outbreak , There were 5 cases of

under five years old and 3 cases of over five years old .Based on sex, there was one female and 7 male cases

with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated.

Vaccination campaign was conducted, Vita A supplements was distributed and health education session

conducted in surrounding villages, the active surveillance has been established for investigation of further cases.

Suspected Measles Outbreak: Reported from Baghshah Village Gardiz district Paktya Province on May

04/2014, the team investigated the area on the following day, Vaccination coverage is 20%. During the


under five years old and 3 cases of over five years old .Based on sex, there was 2 female and 4 male cases with

no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination

campaign was conducted, Vita A supplements was distributed and health education session conducted in

surrounding villages, the active surveillance has been established for investigation of further cases.

Suspected Measles Outbreak: Reported from Shashburja, Jawqul, Paikotal of Kaloo Villages Shibar district

Bamyan Province on May 05 /2014, the team investigated the area on the following day, and Vaccination

coverage is poor. During the investigation there were 5 suspected measles cases ,it was clinical confirm outbreak

, There were 5 cases of under five years old but no cases of over five years old .Based on sex, there was 2

female and 3 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the

cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education

session conducted in surrounding villages, the active surveillance has been established for investigation of

further cases.

Suspected Measles Outbreak: Reported from Rasala Village Qalat district Zabul Province on May 04/2014, the

team investigated the area on the following day, Vaccination coverage is 41%. During the investigation there

were 13 suspected measles cases ,it was clinical confirm outbreak , There were 5 cases of under five years old

and 8 cases of over five years old .Based on sex, there was 6 female and 7 male cases with no deaths associated.

The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted,

Vita A supplements was distributed and health education session conducted in surrounding villages, the active

surveillance has been established for investigation of further cases.

Suspected Measles Outbreak: Reported from Kamdish, Bar Mandagal, Mandagal and Kamo village Kamdish

district Nuristan on May 01/2014, the team investigated the area on the May 03/2014, and Vaccination coverage

is 15%. During the investigation there were 121 suspected measles cases ,it was clinical confirm outbreak ,

There were 96 cases of under five years old and 25 cases of over five years old .Based on sex, there was 72

female and 49 male cases with 39 deaths associated. The team collected lab samples and send them to CPHL, the

cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education

session conducted in surrounding villages, the active surveillance has been established for investigation of

further cases.

Suspected Measles Outbreak: Reported from Paye Manareha Villages Herat city, Herat Province on May 05

/2014, the team investigated the area on the same day, Vaccination coverage is 100%. During the investigation

there were 5 suspected measles cases ,it was clinical confirm outbreak , There were 5 cases of under five years

old but no cases of over five years old .Based on sex, there was 2 female and 3 male cases with no deaths

associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was

conducted, Vita A supplements was distributed and health education session conducted in surrounding villages,

the active surveillance has been established for investigation of further cases.

Epidemiological week- 19

Suspected Dog bite Outbreak: Reported from Shahrara area of district one of Kabul city, Kabul Province on

May 11 /2014; the team investigated the area on the following day. During the investigation there were 5

suspected Dog bite cases ,It was stray dog There were one cases of under five years old and 4 cases of over

five years old .Based on sex, there was one female and 4 male cases with no deaths associated. The patients were

treated, refer to vaccination center and health education session conducted in surrounding villages, the active

surveillance has been established for investigation of further cases.

Suspected Measles Outbreak: Reported from Meri Villages of Ander district, Ghazni Province on May 09

/2014, the team investigated the area on the following day, Vaccination coverage is 20%. During the






Suspected Measles Outbreak: Reported from Touri Villages of Tarinkot district, Urozgan Province on May 12

/2014, the team investigated the area on the following day, Vaccination coverage is poor. During the






Rumor of Measles Outbreak: Reported from Kulant Village of Nurgram district, Nuristan Province on May 10

/2014, the team investigated the area on the following day. During the investigation there were no any case of

measles, it was a rumor and not an Outbreak.

Scabies Outbreak: Reported from Char Kabotan khana Villages of Guzara district, Herat Province on May 14

/2014, the team investigated the area on the following day. During the investigation there were 41 scabies cases

,it was clinical confirm outbreak , There were 13 cases of under five years old and 28 cases of over five years

old .Based on sex, there was 12 female and 29 male cases. The patients treated and health education session

conducted in surrounding villages, the active surveillance has been established for investigation of further cases.

Measles Outbreak: Reported from Shawz Villages ,Shindand district, Ghazni Province on May 08 /2014, the

team investigated the area on the following day, Vaccination coverage is poor. During the investigation there

were 30 suspected measles cases associated with two deaths, the team collected lab samples and send them to

CPHL and the result was positive, the cases treated. Vaccination campaign was conducted, Vita A supplements

was distributed and health education session conducted in surrounding villages, the active surveillance has been

established for investigation of further cases.

Recommendations:

High number of deaths due to Pneumonia and Meningitis/SIC can be analyzed/discussed at provincial level

among stakeholders to find out the gaps results the high morbidity and mortality, especially in Central East

region.

High incidence of Pneumonia overall up to 2.9% and 5.9% in the age group of less than five years should be

analyzed and stakeholders should ensure the adequate amount of medicine for the treatment of the cases.

The high number of Meningitis in North, high number of Meningitis and Acute Viral Hepatitis cases in Central

East, high number of Measles cases in South, North and East regions should be analyzed at peripheral level.

The increase in the outbreaks of Measles in South East and South regions is to be given serious consideration at

the provincial level coordinating agencies.

DEWS focal points should coordinate AFP cases with the provincial AFP surveillance focal point.

ANNEX: Mapping of Density Cases of Selected Diseases in Week-19 of 2014 by Province

Herat

Farah

Helmand

Nimruz

Ghowr

Kandahar

Badakhshan

Ghazni

Faryab

Balkh

Paktika

BadghisBamian

Baghlan

Takhar

Daykondi

Sar-e Pol

Jowzjan

Zabol (Zabul)

Samangan

Nurestan

Nangarhar

Paktia

Lowgar

Vardak (Wardag)

Oruzgan (Uruzgan)

Khowst

Kondoz (Kunduz)

Panjshir

LaghmanKonar (Kunar)Parvan (Parwan)

Kabol (Kabul)

Density Cases of Pneumonia in Week-19 of 2014

8

Legend

Province_34

Pn

4.0 - 59.0

59.1 - 156.0

156.1 - 332.0

332.1 - 934.0

934.1 - 2583.0

Herat

Farah

Helmand

Nimruz

Ghowr

Kandahar

Badakhshan

Ghazni

Faryab

Balkh

Paktika

BadghisBamian

Baghlan

Takhar

Daykondi

Sar-e Pol

Jowzjan

Zabol (Zabul)

Samangan

Nurestan

Nangarhar

Paktia

Lowgar

Vardak (Wardag)

Oruzgan (Uruzgan)

Khowst

Kondoz (Kunduz)

Panjshir


Kabol (Kabul)

Density Cases of Typhoid Fever in Week-19 of 2014

8

Legend

Province_34

TF

1.0 - 12.0

12.1 - 25.0

25.1 - 46.0

46.1 - 96.0

96.1 - 193.0

Herat

Farah

Helmand

Nimruz

Ghowr

Kandahar

Badakhshan

Ghazni

Faryab

Balkh

Paktika

BadghisBamian

Baghlan

Takhar

Daykondi

Sar-e Pol

Jowzjan

Zabol (Zabul)

Samangan

Nurestan

Nangarhar

Paktia

Lowgar

Vardak (Wardag)

Oruzgan (Uruzgan)

Khowst

Kondoz (Kunduz)

Panjshir


Kabol (Kabul)

Density Cases of Malaria in Week-19 of 2014

8

Legend

Province_34

Mal

0.0 - 14.0

14.1 - 34.0

34.1 - 93.0

93.1 - 191.0

191.1 - 459.0

Herat

Farah

Helmand

Nimruz

Ghowr

Kandahar

Badakhshan

Ghazni

Faryab

Balkh

Paktika

BadghisBamian

Baghlan

Takhar

Daykondi

Sar-e Pol

Jowzjan

Zabol (Zabul)

Samangan

Nurestan

Nangarhar

Paktia

Lowgar

Vardak (Wardag)

Oruzgan (Uruzgan)

Khowst

Kondoz (Kunduz)

Panjshir


Kabol (Kabul)

Density Cases of Acute Viral Hepatitis in Week-19 of 2014

8

Legend

Province_34

AVH

0.0 - 1.0

1.1 - 5.0

5.1 - 10.0

10.1 - 19.0

19.1 - 56.0

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