Epidemiologic situation

August 2013

Reported outbreaks since first week of 2013 to dateType of outbreak Investigated Rumor Clinic-ally/labPertussis 10 10ARI 3 1 2SARI 2 2Measles 28 1 27Diarrhea 3 1 2Cholera 11 1 10Hepatitis 3 1 2Typhoid 1 1CCHF 23 23Bloody Diarrhea 2 2Chickenpox 7 7Other 38 2 36Total 131 6 125

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

15.214.6

14.013.613.714.013.913.614.3

12.6

14.515.3

16.417.1

17.919.0

19.920.020.920.5

22.022.5

24.926.1

28.329.3

28.729.4

31.232.632.332.432.4

31.6

30.529.1

28.427.4

26.125.1

24.323.423.0

22.221.821.5

19.819.1

18.217.716.5

15.614.5 14.8

14.5

13.913.914.014.213.813.4

15.4

15.715.716.816.816.5

17.717.317.616.8

18.9

15.714.714.4

13.312.012.0

10.910.210.310.3

8.88.17.87.3

6.46.96.1

5.45.24.94.74.64.74.74.74.85.25.55.86.26.87.2

8.39.0

9.810.210.612.0

12.6

14.215.2

16.6

16.817.0

17.2

16.816.817.718.1

18.718.9

17.0

Trend of ARI/ADD as Proportion; Week-25/ 2012 to Week-3/ 2013

ARI

ADD

Weeks of the Year

Perc

enta

ges

Measles cases trend

AWD cases trend – DEWS reports

AWD outbreaks 2013Rep Date

Investigation Date

Outbreak Verification #

Cases

cases by Age group

cases by sex #

dead

LocationControll

edClinic Lab <5 >5 Male Fema

le Village District Province

6-May 7-Mayyes 55 14 41 21 34 0 Karargah Shorabak Kandahar Yes

10-Jun 10-Jun 0 0 0 0 0 0

Payan-e-Bagh Kahmard Bamyan yes

17-Jun 18-Junyes 33 6 27 15 18 0

Chokar Daman KandaharYes

17Ju 17-Jun yes 115 24 91 72 43 0 Qaram qul Khan abad Kunduz Yes

15-Jun 16-Jun Yes 100 26 74 55 45 1 Shirabad Qarabagh Ghazni Yes

17-Jun 18-Jun Yes 18 5 13 13 5 0 Yousufkhil Yousufkhil Paktika Yes

21-Jun 22-Junyes 1 0 1 1 0 1

Shahbashkhil

Mahmood Raqi Kapisa Yes

Rep Date

Investigation Date

Outbreak Verification #

Cases

cases by Age group cases by sex

# dead

LocationControll

edClinic Lab <5 >5 Male Femal Village District Province

15-Jul 16-Jul yes 32 2 30 24 8 0 Mula wali Spinboldak Kandahar Yes

23-Jul 24-Julyes 12 0 12 3 9 0

Landay Achin Nangarhayes

23-Jul 24-Jul Yes 38 22 16 14 24 0 Sabzdara Yakowlang Bamyan Yes23-Jul 24-Jul yes 280 148 132 144 136 1 Segana Khairkot Paktika Yes8-Aug 8-Aug yes 1680 2 Chapa Darayem Badakhsh yes

10Au 10-Augyes 39 15 24 9 30 0

Asadkhil Achin Nangarhayes

13-Aug 13-Aug yes 283 0 Zairak Darayem Badakhsh yes

17Au 18-Aug yes 33 18 15 21 12 7 Kandring Raghistan Badakhsh ongoing2719 280 476 392 36415

37% 53% 52% 48%CFR 0.55%

Epidemiological events past 5 weeks• Cholera 2 outbreaks: Badakhshan (Drayem district 2

villages) and Nangarhar (Akim district)

• Bloody Diarrhea; Bamyan Yakolang

• Typhoid Fever: Badakhshan Shugnan

• Antrax; Khost Tani

• CCHF: Herat; Guzara 4 villages; Ghoroyan, Zanda Jan, Ingil, Obeh

• Pertussis: Kandahar(spinboldak) Parwan (Sayed Kheil)

• Food poisoning: Herat (Guzara), Kandahar (Daman)

Badakhshan choleraDarayem districtEvents:Chapa Village• Alert 7 Aug from Chapa village; investigation and response

initiated on 8 Aug CAF, DEWS, Kinderberg, • Majority of cases reported on 8,9,10 Aug; around 450-500

cases per day treated.• Few cases after 13 Aug: control achieved in Chapa on 25th • Total cases 1690: two death – CFR 0.12%Zairak Village• 13 Aug – cases reported in Zairak village 65 km away

from Chapa; no HF in the village

• Mobile team established Kinderberg; 280 cases • Control achieved on 25th CFR: 0%• Actions: • Additional stock – WHO/ Health cluster• Surveillance DEWS daily – WHO, MOPH, NGOs. • Prompt treatment of cases; existing HFs and

establishment of temporary CTC in Chapa village; CAF, Merlin, WHO/Health Cluster funding

• Health Education – NGOs, MoPH, WHO• Chlorination of water sources ; MoPH, UNICEF • Plan to improve water sources in district: MoRRD

&UNICEF

Darayem district

0

100

200

300

400

500

600

0

0.2

0.4

0.6

0.8

1

1.2

1

25

534

456 464

35 365 4 4 3 4 14 18 6 5 2 1 0 0

Cholera outbreak Chapa village ,Darayem August 2013 No=1680

Deaths Cholera cases

date

Num

ber o

f cas

es a

nd d

eath

13-08-13

14-08-13

15-08-13

16-08-13

17-08-13

18-08-13

19-08-13

20-08-13

21-08-13

22-08-13

23-08-13

24-08-13

25-08-130

10

20

30

40

50

60

70

80

90

53

82

04

0 0

50 49

31

8 8

0 0

Cholera outbreak: Zairak, Darayem distric; Badakhshan August 2013; cases 283

date

Num

ber

Report on HelmandOutpatients injuries (war related) reported by BRAC and ACTD

No Name & type of HF District# of treated wounded patients

(April.2013 May (2013) June (2013) Total 1 Musakalala DH

Musakala55 87 121 263

2 Landi Nawa CHC 34 65 69 1683 Kani Mandah BHC 26 29 58 1134 Sangeen CHC

Sangeen

125 149 219 4935 Puza CHC 9 21 42 726 Malmand BHC 0 0 0 07 Nasozi BHC 80 238 160 4788 Katozi SHC 28 15 49 929 Mermindab BHC

Nah-e-seraj34 49 96 179

10 Shoraki BHC 473 610 750 183311 Nahr-e-seraj MHT 0 10 89 9912 Kajaki Kajaki 80 80

TOTAL 3870EMERGENCY four First Aid Trauma Post reported out patients injuries 2485Total reported outpatient injuries treated 6355

Total reported hospitalised injuries past 3 months (until end June)Number of war casualty referred by FATP to Lashkargar trauma hospital 492Inpatients brought by family 116

Action taken• CERF support for 2 mobile team – very timely• WHO health cluster supported – 24/7 services

2 ACTD clinics, 2 additional ambulances and• Training on the first aid for CHW in high risk

areas• Waiting feed back from ACTD on community

level intervention– is proved added value we can expand

Ghor contingency plan• “Dryness” – stressed food security –can go to crisis• WFP- 180,000 people at high risk the Government

780,000• Most affected: Charsada, Chigcharan, Pasaband, and

Duleena• Second most affected: Taywara, Tulak, Saghar, Shahrak• Potential health impacts1. Cholera2. > communicable diseases (>pop vulnerability) during

winter3. Micronutrient and . Risk acute malnutrition

Mitigation Plan Outcome Activities Respons

ible Support Target

districts/villagesTimeline Qty/

cost1.Prevention and preparedness Cholera outbreak

Stock: medicines, tents, equipment

ACTD, MoPH

WHO Provincial center 30 Aug $ 7000

Chlorine powder and tablets

MoRRD UNICEF Provincial center 30 Aug

HP materials distributed to HF and schools

MoPH WHO, UNICEF

Districts at risk (XX

5 Sept

Systematic Water Quality t MoPH/MoRRD

WHO, UNICEF

1o Sept

Early Warning community level linked with DEWS: CHW, Mullas

ACTD/MoPH

WHO/ DEWS

Food insecurity &isolation winter

30 Sept

2.Prevention and preparedness to increase communicable diseases and ARI

Five months + emergency stock in high risk districts and HF+ mobile services

ACTD WHO/ UNICEF

1st Nov $ 6000

Early warning community level during winter

ACTD WHO/ DEWS

Mass media campaign prevention ARI

ACTD, MoPH

WHO Province 3

Deworming + Vit A preschool children

ACTD, MoPH

WHO Risk district Oct

3.Monitor nutrition situation