February 24, 2014 DISEASE EARLY WARNING SYSTEM WER-7 (8th

Yr)

WEEKLY EPIDEMIOLOGICAL REPORT

Summary:

The surveillance data collected for this week report is from 15 -21 February 2014.

Out of 377 functional Sentinel sites (SS), 377 (100%) have submitted reports for Week-7 of 2014.

Out of a total of 319,196 consultations (140,308male, 178,888 female) recorded in Week-7 of 2014, 32.6 % or

104,059 (50,081 male, 53,978 female) consultations were reported due to DEWS target diseases.

Main causes of consultations this week were Acute Respiratory Infections (ARI) (30.6%) and Acute Diarrheal

Diseases (ADD) (5.1%) from total clients in a continuing trend from the week before.

93 (56 male, 37 female) deaths resulted from Pneumonia, Diarrheal Diseases and Meningitis/Severely Ill Children,

which includes 75 deaths (47 male, 28 female) caused by Pneumonia, 4 deaths (2 male, 2 female) caused by Diarrheal

Diseases and 14 deaths (7 male, 7 female) caused by Meningitis/Severely Ill Children.

In this reporting week, two Suspected Measles Outbreaks reported from Zabul province, a Suspected Measles

Outbreak reported from Kandahar province and a Suspected Chicken Pox Outbreak reported from Takhar province.

Reports Received From Reporting Sites:

As of February 21, 2014, 377 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of

Afghanistan. In this reporting week, 377 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.

Note: One sentinel site in Kabul city has been closed temporary due to renovation of the hospital.

Table-1: Status of Reports Received from DEWS Regions during Epidemiological Week-7, 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 50 39 51 48 43 377

No. of Reports

Received in this

week

55 33 58 50 39 51 48 43 377

ARI C&C ARI Pn AwD BD AwDwMen/SI

CAVHep Measle Malaria

Male 26.5 6.7 3.9 1.5 0.3 0.1 0.1 0 0.1

Female 23.3 5 3 1.3 0.2 0 0 0 0.1

Total 24.8 5.8 3.4 1.4 0.3 0 0 0 0.1

0

5

10

15

20

25

30

Pe

rce

nta

ge

Fig-2: Percentages of DEWS Target Diseases by Gender in W7-14

Figure-1

DEWS Sentinel Sites:

Figure-1(Map) shows the

distribution of DEWS sentinel

sites already established in the

relevant regions/provinces by

February 21, 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-7 of 2014: Out of a total of 319,196 clients recorded in week-7

of 2014, 24.8% (79,003) of consultations were

reported due to Cough and Cold and 5.8% (18,365)

of consultations was reported due to Pneumonia. In

the same reporting period, 5.1% or 16,007 vents

were reported due to diarrheal illnesses (3.4% due

to Acute Watery Diarrhea, 1.4% due to Bloody

Diarrhea and 0.3% due to Acute Watery Diarrhea

with Dehydration). In comparison with the previous

week (W6 of 2014) the percentage of ARI disease

has decreased by 5.1% to 30.6%, and the

percentage of Acute Diarrheal Disease has

increased by 0.4% to 5.1%. 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-7 of 2014.

Table-2: DEWS Epidemiological Regions and

Sentinel Sites by type in Week- 7, 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 39 25 41 38 35 269

DH 12 9 10 7 9 5 7 4 63

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 50 39 51 48 43 377

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-7 a total of 97,368 events of ARI were reported. 33.9 % of total clients less than 5 years of

age were Cough & Cold patients and 20.5% were among the age group 5 years and over. The percentage of C&C (<5

years) consultations in week-51, in comparison with the percentage of C&C in week-7 of 2014, increased by 0.2%,

whereas in case of 5 years and above increased by 0.1% to 20.5% 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

increased by 1.3% in last 10 weeks, whereas the percentage of age group 5 years and over increased by 0.3% to 2.8% .

In the reporting week-7 of 2014, the highest percentages of Cough & Cold were recorded in Khost, Logar and Kapisa

provinces with 45.4%, 41.7% and 39.3%, whereas the lowest percentages of C&C were reported from Ghor, Logar and

Farah provinces with 13.5%, 14.9% and 16.2% respectively. The highest percentages of Pneumonia cases were reported

from Samangan, Logar and Baghlan provinces with 14% and 11.8% respectively, whereas the lowest percentages of

Pneumonia cases were recorded in Urozgan, Nimroz and Ghazni provinces with 1.2% and 1.9% 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

60

NIM HIL

KA

N

ZAB

UR

O

KA

B

KA

P

LOG

PA

N

PA

R

WA

R

BA

M

DA

Y

BD

G

HER

FAR

AH

GH

O

NA

N

LAG

KN

R

NU

R

SAM

BA

L

JOW

FYB

SAR

BD

S

TAKH…

BG

L

KU

N

GH

A

PIA

PK

A

KH

O

Pe

rce

nta

ge

Fig-3: Percentages of ARI from Total Clients in Week-7 of 2014

Pneumonia Cough&Cold

0

5

10

15

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

AH

GH

O

NA

N

LAG

KN

R

NU

R

SAM

BA

L

JOW

FYB

SAR

BD

S

TAK

HA

R

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-7 of 2014

AWD BD AWDwD

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

Disease Age Week-

51-13

(%)

Week-

52-13

(%)

Week-

53-13

(%)

Week-

1-14

(%)

Week-

2-14

(%)

Week-

3-14

(%)

Week-

4-14

(%)

Week-

5-14

(%)

Week-

6-14

(%)

Week-

7-14

(%) ARI- C&C <5 Yr. 33.7 34.4 36.5 37.2 36.4 36.6 36.6 34.3 33.6 33.9

5+ 20.6 22 23.1 23.9 22.1 23.1 22.1 22.6 27.1 20.5

ARI-

Pneumonia

<5 Yr. 10.8 11.9 12 12.9 13.4 13.8 14.2 14.5 13.3 12.1

>=5Yr. 2.5 2.8 2.8 3 2.9 3.1 3.1 3.3 3.2 2.8

SR CER CWR WR ER NR NER SER

Men/SIC 0 0.1 0.1 0 0 0.1 0 0

Malaria 0.1 0 0 0 0.5 0.1 0 0.1

Typhoid Fev 0.5 0.1 0.4 0.1 0.6 0.3 0.2 0.3

0

0.2

0.4

0.6

0.8

1

Pe

rce

nta

ge

Fig-5: Percentages of Meningitis,Malaria & Typhoid Fever from Total Clients in W7-14

From week-51 to week-7 of 2014 from total clients, Acute Watery Diarrhea among children less than five years of age has

decreased from 7.9% in week-51 to 6.1% in the reporting week, whereas Acute Watery Diarrhea among age group 5 years

and above has been decreased by 0.4% to 2.1 % (Table-4). Bloody Diarrhea in age group less than 5 years has remained

the same in last 10 weeks, while in case of age group 5 years and above also has been decreased by 0.1%. Acute Watery

Diarrhea with Dehydration in age group less than 5 years show remained the same in last 10 weeks, while in case of five

years and above AWDwD has also remained the same in last 10 weeks.

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

In the epidemiologic week-7 of

2014, a total of 154 suspected cases

of Meningitis/Severely Ill Child

were reported from all regions and

the highest percentage was

recorded in Central East, North and

Central West regions. In the same

reporting week, from all regions,

371 Malaria consultations were

reported by Sentinel Sites and the

highest percentages of Malaria

cases were reported from East

region with 0.5% respectively. Out

of the total clients, 990 cases or

0.3% 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 Central West regions with 0.6%, 0.5% and 0.4% 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 154 cases in country level, 54 cases have been reported from Central East

region, 32 cases from the North region and 20 cases from the Central West 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 145 cases, 42 cases reported from Central East region, 30 cases were reported from

South East and 25 cases were reported East regions. From a total of 127 Measles cases reported in the reporting week, 69

cases were recorded in South and 37 cases were reported from the 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-

51-13

(%)

Week-

52-13

(%)

Week-

53-13

(%)

Week-

1-14

(%)

Week-

2-14

(%)

Week-

3-14

(%)

Week-

4-14

(%)

Week-

5-14

(%)

Week-

6-14

(%)

Week-

7-14

(%)

Acute Watery

Diarrhea

<5 Years 7.9 7.4 7.1 5.9 5.5 6 5.8 5.2 5.7 6.1

>= 5

Years 2.5 2.4 2.3 2 1.9 2 2 2.1 1.9 2.1

Bloody Diarrhea

<5 Years 1.9 1.8 1.9 1.8 1.9 1.9 1.6 1.7 1.8 1.9

>=5

Years 1.2 1.2 1.1 1.1 1 1.1 1 1.1 1.1 1.1

Acute Watery

Diarrhea with

Dehydration

<5 Years 0.5 0.5 0.5 0.4 0.4 0.4 0.3 0.4 0.4 0.5

≥5 Years 0.2 0.2 0.2 0.1 0.2 0.1 0.1 0.1 0.1 0.2

Table-5: Suspected Cases of Vaccine Preventable Diseases in W- 7 of 2014 by Region

Regions

Meningitis/

Severely Ill

Children

Acute Viral

Hepatitis Measles Pertussis Diphtheria Tetanus

Acute Flaccid

Paralysis Total

SR 11 16 69 0 0 2 1 99

CER 54 42 5 1 0 0 1 103

CWR 20 5 6 0 0 0 0 31

WR 11 13 2 0 0 0 1 27

ER 3 25 8 0 0 0 0 36

NR 32 5 37 0 0 1 2 77

NER 18 9 0 0 0 0 3 30

SER 5 30 0 0 0 0 0 35

Total 154 145 127 1 0 3 8 438

Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks (trend from W24 of 2013 to W7 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-7 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, it is expected that these courses will continue till end of

winter season. Comparing this week data with previous week the percentage of ARI decreased by 5.1% to 30.6%, while

the percentage of ADD increased by 0.4% to 5.1% (Fig-7).

15.6 14.5 14.8 14.5 13.9 13.9 14.0 14.2 13.8 13.4

15.4 16.3

17.3 17.2 18.1

18.9 19.9

20.8 19.3

21.6 22.8

25.0 25.5 25.8 27.0

27.7 29.1

30.2

31.9 33.3

34.6 33.0

34.3 33.7 33.6

35.7

30.6

16.6 16.8 17.0 17.2 16.8 16.8 17.7 18.1

18.7 18.9

17.0 16.0 15.7

15.1 14.4

13.4 13.1 12.7 12.2 10.8

9.2 9.0 8.2 8.2

7.3 7.0 6.8 6.0 5.8 5.6

4.8 4.6 5.0 4.7 4.6 4.7 5.1

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

W2

4

W2

5

W2

6

W2

7

W2

8

W2

9

W3

0

W3

1

W3

2

W3

3

W3

4

W3

5

W3

6

W3

7

W3

8

W3

9

W4

0

W4

1

W4

2

W4

3

W4

4

W4

5

W4

6

W4

7

W4

8

W4

9

W5

0

W5

1

W5

2

W5

3

W1

W2

W3

W4

W5

W6

W7

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-7 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 out of 93 (56 male, 37

female) deaths reported from all regions, 75 deaths (47 male, 28 female) were caused by Pneumonia, 4 deaths

(2 male, 2 female) were caused by diarrheal diseases and 14 deaths (7 male, 7 female) were caused by

Meningitis/Severely Ill Children. (Table-6)

Table-6: Deaths by Main Causes of Mortality and by Region in W7 of 2014

Grand

Total

Main Causes

of Deaths So

uth

Reg

ion

Cen

tra

l

Reg

ion

Cen

tra

l

Wes

t

Reg

ion

Wes

t

Reg

ion

Ea

st

Reg

ion

No

rth

Reg

ion

No

rth

Ea

st

Reg

ion

So

uth

Ea

st

Reg

ion

Total

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

Pneumonia 1 3 4 9 2 0 6 2 8 3 17 7 6 4 3 0 47 28 75

Diarrheal

Diseases

0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 2 2 4

Meningitis/S

IC

1 2 0 0 1 1 0 0 0 0 3 3 2 1 0 0 7 7 14

Total

2 5 4 10 3 1 6 2 8 3 21 10 9 6 3 0 56 37 93

M: Male F: Female

Report of Outbreaks:

Last week a Suspected Measles Outbreaks reported from Zabul and a Suspected Vegetable Poisoning Outbreak: reported

from Parwan provinces and in this reporting week, two Suspected Measles Outbreaks reported from Zabul province, a

Suspected Measles Outbreak reported from Kandahar province and a Suspected Chicken Pox Outbreak reported from

Takhar province. Table-7 (below) shows the number of outbreaks investigated in 2014 with details of week-6 and week-7

of 2014.

Epidemiological week- 6

Suspected Measles Outbreak: Reported from Towra village of Qalat district, Zabul province on Feb10 /2014,

the team investigated the area on Feb 11/2014, Vaccination coverage is 40%. During the investigation there were

12 suspected measles cases ,it was clinical confirm outbreak , There were 5 cases of under five years old and 7

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

Type of outbreak Investigated Rumor Clinic-ally/lab

Pertussis 0 0 0

Avian/Swine Flu 1 0 1

ARI 0 0 0

Measles 12 0 12

Diarrhea 0 0 0

Meningitis 0 0 0

Hepatitis 0 0 0

Malaria 0 0 0

Typhoid 0 0 0

CCHF 2 0 2

Bl. Diarrhea 0 0 0

Chickenpox 1 0 1

Other 4 0 4

Total 20 0 20

cases of over five years old .Based on sex, there were 5 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 vegetable poisoning outbreak: reported from Bayan e Payen village of Charikar District of Parwan

province on Feb 11 /2013, the team investigated the area on the same day and during the investigation there were

no any other cases of suspected vegetable poisoning but two children who ate some vegetable name Margezanan,

have been died. Health education session conducted in surrounding villages.

Epidemiological week- 7

Suspected Measles Outbreak: Reported from Khan Taraki village of Qalat district, Zabul province on Feb16

/2014, the team investigated the area on Feb 17/2014, Vaccination coverage is 90%. During the investigation

there were 14 suspected measles cases ,it was clinical confirm outbreak , There were 5 cases of under five years

old and 9 cases of over five years old .Based on sex, there were 5 female and 9 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 Salimankhil village of Qalat district, Zabul province on Feb19

/2014, the team investigated the area on Feb 20/2014, Vaccination coverage is 50%. During the investigation

there were 7 suspected measles cases ,it was clinical confirm outbreak , There were 3 cases of under five years

old and 4 cases of over five years old .Based on sex, there were 3 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 Bakhto and Chinarto village of Shawalikot district, Kandahar

province on Feb16 /2014, the team investigated the area on Feb 17/2014, Vaccination coverage is poor. During

the investigation there were 111 suspected measles cases ,it was clinical confirm outbreak , There were 103 cases

of under five years old and 8 cases of over five years old .Based on sex, there were 44 female and 67 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 CCHF Outbreak: Reported from Pashaye village of Mahterlam city of Laghman province on Feb

16, 2013. The team investigated the case on the same day .The patient has been admitted at the provincial

hospital. During the investigation, there was one suspected CCHF case and field investigation has been

performed. The patient was 28 years old man. The team collected lab samples and send them to CPHL .The case

was treated and health education session was conducted for his family members and other, the team is

investigating for further cases.

Suspected Chicken pox Outbreak: Reported from Sihgul village of Rustag district, Takhar province on Feb18

/2014, the team investigated the area on Feb 19 /2014, During the investigation there were 47 suspected chicken

pox cases, it was clinical confirm outbreak, There were 20 cases of under five years old and 27 cases of over five

years old .Based on sex, there were 16 female and 31 male cases with no deaths associated, the cases treated.

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 North, Central East

and East regions.

High incidence of Pneumonia overall up to 5.8% and 12.1% 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 and North should be analyzed at peripheral level.

The increase in the outbreaks of Measles in South East region 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-7 of 2013 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-7 of 2014

8

In this week 377 sentinel sites sent their report

Legend

Province_34

Pn

62.000000

62.000001 - 149.000000

149.000001 - 187.000000

187.000001 - 204.000000

204.000001 - 295.000000

295.000001 - 389.000000

389.000001 - 725.000000

725.000001 - 905.000000

905.000001 - 1314.000000

1314.000001 - 3911.000000

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 Typhoid Fever in Week-7 of 2014

8

In this week 377 sentinel sites sent their report

Legend

Province_34

TF

2.000000 - 3.000000

3.000001 - 6.000000

6.000001 - 11.000000

11.000001 - 16.000000

16.000001 - 22.000000

22.000001 - 27.000000

27.000001 - 39.000000

39.000001 - 57.000000

57.000001 - 74.000000

74.000001 - 108.000000

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 Malaria in Week-7 of 2014

8

In this week 377 sentinel sites sent their report

Legend

Province_34

Mal

0.000000

0.000001 - 2.000000

2.000001 - 3.000000

3.000001 - 4.000000

4.000001 - 8.000000

8.000001 - 13.000000

13.000001 - 16.000000

16.000001 - 21.000000

21.000001 - 43.000000

43.000001 - 132.000000

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 Acute Viral Hepatitis in Week-7 of 2014

8

In this week 377 sentinel sites sent their report

Legend

Province_34

AVH

0.000000

0.000001 - 1.000000

1.000001 - 2.000000

2.000001 - 3.000000

3.000001 - 4.000000

4.000001 - 5.000000

5.000001 - 8.000000

8.000001 - 15.000000

15.000001 - 25.000000

25.000001 - 42.000000