May 6, 2013 DISEASES EARLY WARNING SYSTEM WER-18 (7th Yr)

SUMMARY:

This report includes surveillance data from 27th

April to 3rd

May 2013.

Out of 349 functional Sentinel sites (SS), 345 (98.8%) have sent their reports in Week-18 of 2013.

Out of total 307,825 consultations (134,003 Male, 173,822 Female) recorded in week-18 of 2013, 92,175

(44,314 Male, 47,861 Female) consultations were reported due to DEWS target diseases.

Main causes of consultations this week are Acute Respiratory Infections/ARI (21.5%) and Acute Diarrheal

Diseases/ADD (10.2%) from total clients in a continuing trend from the week before.

27 (14 Male, 13 Female) deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill

children, so 12 deaths (8 Male, 4 Female) caused by Pneumonia, 4 deaths (2 Male, 2 Female) caused by

diarrheal diseases and 11 deaths (4 Male, 7 Female) were caused by Meningitis/severely ill children.

In this reporting week, Suspected poisoning reported from Sultan Razia girl high school of Kabul city of

Kabul province, Suspected viral hepatitis Outbreak reported from Herat province, Suspected Measles

Outbreak reported from Kandahar province and two Suspected Measles Outbreak reported from Paktika

province.

REPORTS RECEIVED FROM REPORTING SITES:

As of May 3, 2013, 349 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of

Afghanistan. In this reporting week, 345 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-18,

2013

Cen

tra

l

East

Cen

tra

l

Wes

t

No

rth

No

rth

East

Wes

t

Sou

th

East

Sou

th

East

Tota

l

No. of Expected

Reports from

Sentinel Sites 56 31 57 43 37 46 43 36 349

No. of Reports

Received in this

week 56 31 57 41 37 46 43 34 345

DEWS WEEKLY EPIDEMIOLOGICAL REPORT

EPREPORT

ARIC&C

ARI Pn AwD BD AwDwMen/

SICAVHe

pMeasl

eMalari

aTyphF

ev

Male 19.5 4 8.3 2.5 1 0.1 0.1 0 0.4 0.6

Female 17.2 2.8 6.4 2 0.7 0 0 0 0.3 0.5

Total 18.2 3.3 7.2 2.2 0.8 0 0 0 0.3 0.5

0

10

20

30

Pe

rce

nta

ge

Fig-2: Percentages of DEWS Target Diseases by Gender in W18-13

DEWS Sentinel Sites: Figure-1(Map) shows the

distribution of DEWS

sentinel sites, already

established in the relevant

regions/provinces by May 3,

2013 by type of health

facilities. 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

indicating the GPS of the SS

locations.

DEWS Data in Epidemiological Week-18 of 2013: Ut of total 307,825 clients recorded in week-18 of

2013, 18.2% (55985) of consultations were

reported due to cough and cold and 3.3% (10164)

of consultations was reported due to pneumonia. In the

same reporting period, 10.2% or 31,535 events were

reported due to diarrheal illnesses (7.2% due to Acute

Watery Diarrhea, 2.2% due to Bloody Diarrhea and 0.8%

due to acute watery diarrhea with dehydration). In

comparison with previous week (W17 of 2013) the

percentage of ARI disease has decreased by 0.3% to

21.5%, whereas the percentage of Acute Diarrheal disease

has increased by 0.4% to 10.2%. These variations could be occurred due to changes in temperature /weather during the

reporting week.Figure-2 above shows the percentages of DEWS target diseases by gender in week-18 of 2013.

Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in Week-18, 2013

Type of

SS

Cen

tr

al

East

Cen

tr

al

Wes

t

Nort

h

Nort

h

East

Wes

t

Sou

th

East

Sou

th

East

Tota

l

CHC/BHC 28 18 42 32 23 36 33 28 240

DH 12 9 10 7 9 5 7 4 63

PH/RH/SH 14 4 5 4 4 5 3 4 43

Poly Clinic 2 0 0 0 1 0 0 0 3

Total 56 31 57 43 37 46 43 36 349

CHC=Comprehensive Health Center, DH=District hospital, PH=provincial hospital, RH=

Regional hospital, SH= specialized hospital

O

Percentage of ARI by weeks and by Age Groups: In the epidemiological week-18, a total of 66,149 events of ARI were reported. 25.5 % of total clients less than 5 years of

age were cough & cold patients and 14.7% among the age group 5 years and over. The percentage of C&C (<5 years)

consultations in week-8,in comparison with the percentage of C&C in week-18 of 2013, decreased by 7.8%, whereas in

case of 5 years and above decreased by 4.9% to 14.7% 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

4.9% in last 11 weeks, whereas the percentage of age group 5 years and over decreased by 0.8% as in week-7.

In the reporting week-18 of 2013, the highest percentage of Cough & Cold has been recorded in Kapisa, Paktiya and

Panjsher provinces with 30.1%, 27% and 26.6%, whereas the lowest percentages of C&C were reported from Farah,

Laghman and Nimroz provinces with 6.6%, 9.5% and 11.1% respectively. The highest percentages of Pneumonia cases

reported from Saripul, Samangan and Jowzjan provinces with 7.9%, 7.4% and 6.7% respectively, whereas the lowest

percentage of Pneumonia cases was recorded in Zabul, Nimroz and Hilmand provinces with 0.1%, 0.3% and 0.9%

respectively. (Fig-3)

Percentages of Diarrheal Diseases by weeks and by Age Groups:

NIM

HIL KAN ZABURO

KAB KAP LOGPAN PARWA

RBAM

DAYBDG

HERFARAH

GHO

NAN

LAG KNRNUR

SAM

BALJOW

FYB SAR BDSTAKHAR

BGLKUN

GHA

PIA PKAKHO

Pneumonia 0.3 0.9 1.9 0.1 1 5.2 2.9 3.1 6.4 2.3 2.9 4.4 2.2 1.8 1.1 1 2.2 1.8 2.6 3.5 4.9 7.4 5.3 6.7 2.5 7.9 3.5 5.2 4.7 2.8 1.4 1.2 2.9 1.5

Cough&Cold 11 12 15 15 19 17 30 23 27 18 20 24 25 11 18 6.6 16 21 9.5 23 22 18 23 15 19 14 20 19 12 15 15 27 12 25

0

10

20

30

40

Pe

rce

nta

ge

Fig-3: Percentages of ARI from Total Clients in week-18 of 2013

0

5

10

15

20

25

30

SR CER CWR WR ER NR NER SER

P

e

r

c

e

n

t

a

g

e

Fig-4: Percentages of ARI from Total Clients Among Male/Female Population in W18 of 2013

Male Female Total

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

Disease Age Week-

08-13

(%)

Week-

09-13

(%)

Week-

10-13

(%)

Week-

11-13

(%)

Week-

12-13

(%)

Week-

13-13

(%)

Week-

14-13

(%)

Week-

15-13

(%)

Week-

16-13

(%)

Week-

17-13

(%)

Week-

18-13

(%)

ARI- C&C <5 Yr. 33.3 31.6 32.3 30.9 29.5 28.6 28.7 27.4 26.6 25.8 25.5

5+ 19.6 19.1 18.2 17.4 16.8 16.3 15.4 15.6 15.0 14.8 14.7

ARI-

Pneumonia

<5 Yr. 11.9 11.7 11.1 10.0 9.6 9.3 8.6 8.3 7.7 7.7 7.0

>=5Yr. 2.4 2.3 2.2 2.0 1.9 1.9 1.8 1.7 1.6 1.6 1.6

SR CER CWR WR ER NR NER SER

Men/SIC 0.1 0.1 0 0 0 0.1 0.1 0

Malaria 0.3 0 0.1 0.1 1.4 0.2 0.1 0.2

Typhoid Fev 1 0.2 0.4 0.3 1.1 0.4 0.3 0.9

Fig-6: Percentages of Meningitis,Malaria & typhoid Fever from Total Clients in W18-13

The table-4 below shows the percentages of diarrheal diseases (Acute watery Diarrhea, Bloody Diarrhea and Acute watery

diarrhea with dehydration) from week-8 to week-18of 2013, from total clients. Acute watery diarrhea among children less

than five years of age has been increased from 6.3% in week-8 to 14.2% in the reporting week, whereas acute watery

diarrhea among age group 5 years and above has been increased by 1.9% to 3.9%.(Please refer to Table-4, above).Bloody

diarrhea, in age group less than 5 years increased by 1.4% in last 11 weeks, while in case of age group 5 years and above

has been increased by 0.7%. Acute watery diarrhea with dehydration in age group less than 5 years show an increase by

1.0% in last 11 weeks, while in case of five years and above has increased by 0.4% to 0.5% in last 11 weeks.

Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: In the epidemiologic week-18 of 2013, a

total of 140 suspected cases of

Meningitis/Sever Ill Child were reported

from all regions and the highest percentage

was recorded in South, Central East and

North East regions. In the same reporting

week, from all regions 1032 consultations

were reported by Sentinel Sites to be

malaria and the highest percentages of

Malaria cases were reported from East and

South and South East regions with 1.4%,

0.3% and 0.2%. Out of the total clients,

1684 cases or 0.5% in national level were

reported to be suspected Typhoid Fever

and the highest percentages of Typhoid

Fever were reported from East, South and

South East regions with 1.1%, 1% and

0.9% respectively.

0

5

10

15

20

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-18 of 2013

AWD BD AWDwD

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

Disease Age Week-

08-13

(%)

Week-

09-13

(%)

Week-

10-13

(%)

Week-

11-13

(%)

Week-

12-13

(%)

Week-

13-13

(%)

Week-

14-13

(%)

Week-

15-13

(%)

Week-

16-13

(%)

Week-

17-13

(%)

Week-

18-13

(%) Acute Watery

Diarrhea

<5 Years 6.3 6.4 7.3 7.4 8.1 9.2 9.9 11.5 12.9 13.8 14.2 >= 5 Years 2.0 2.1 2.1 2.3 2.6 2.8 2.9 3.5 3.6 4 3.9

Bloody Diarrhea <5 Years 2 2.0 2.2 2.3 2.3 2.5 2.5 2.7 2.9 3.3 3.4 >=5 Years 1 1.1 1.1 1.2 1.2 1.3 1.3 1.3 1.5 1.6 1.7

Acute W. Diarrhea

with Dehydration

<5 Years 0.5 0.5 0.6 0.7 0.8 0.8 0.9 1.2 1.3 1.1 1.5 ≥5 Years 0.1 0.2 0.2 0.2 0.2 0.3 0.2 0.3 0.4 0.4 0.5

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; in

this week out of total 140 cases in

country level, 58 cases have been

reported from Central East region, 26

cases from North and 21 cases were

reported from South regions.

In general the highest number of

cases of Acute viral hepatitis been

reported from East and South East regions, so that in the reporting week out of total 134 cases, 36 cases

reported from Central East region,26 cases were reported from South East and 21 cases were reported from

South regions. From total 58 Measles cases reported in the reporting week 29 cases were recorded in South and

12 cases were reported from North regions.

Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks (from W25 of 2012 to W18 of 2013) mong 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-25 of 2012 to week-18 of 2013. In week-25 of 2012, 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 in 2012, these curves crossed one another again in week-36 and from that time to week-06 of

2013, the percentage 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-6 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-17 of

2013, ARI decreased by 0.3% to 21.5%, while ADD increased by 0.4% to 10.2% (Please refer to Fig-7).

15.2 14.6 14.0 13.6 13.7 14.0 13.9 13.6 14.3

12.6

14.5 15.3

16.4 17.1

17.9 19.0

19.9 20.0 20.9 20.5

22.0 22.5

24.9 26.1

28.3 29.3 28.7

29.4

31.2 32.6 32.3 32.4 32.4

31.6

30.5 29.1

28.4 27.4

26.1 25.1

24.3 23.4 23.0

22.2 21.8 21.5

15.7 15.7 16.8 16.8 16.5

17.7 17.3 17.6 16.8

18.9

15.7 14.7 14.4

13.3 12.0 12.0

10.9 10.2 10.3 10.3

8.8 8.1 7.8 7.3

6.4 6.9 6.1

5.4 5.2 4.9 4.7 4.6 4.7 4.7 4.7 4.8 5.2 5.5 5.8 6.2 6.8 7.2

8.3 9.0

9.8 10.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

W2

5W

26

W2

7W

28

W2

9W

30

W3

1W

32

W3

3W

34

W3

5W

36

W3

7W

38

W3

9W

40

W4

1W

42

W4

3W

44

W4

5W

46

W4

7W

48

W4

9W

50

W5

1W

52

W1

W2

W3

W4

W5

W6

W7

W8

W9

W1

0W

11

W1

2W

13

W1

4W

15

W1

6W

17

W1

8

Per

cen

tage

s

Weeks of the Year

Fig.-7: Trend of ARI/ADD as Propotion of Total Clients From Week-25 of 2012 to Week-18 of 2013

ARI

ADD

Table-5: Suspected Cases of Vaccine Preventable Diseases in W-18

of 2013 by Region

Regions Men/SIC AVH Meas Pert Diphth Tetanus AFP

SR 21 21 29 0 0 2 1

CER 58 36 3 0 0 0 0

CWR 6 1 3 1 0 0 1

WR 5 20 0 0 0 0 0

ER 2 9 11 2 0 0 0

NR 26 4 12 0 0 0 0

NER 16 17 0 0 0 0 0

SER 6 26 0 0 0 0 0

Total 140 134 58 3 0 2 2

A

14

13.9

12.8

12.1

11.3

10.7 10.9

10.6

10.8 10.9 10.7

10.7

11.2 11.2

11.8

12.2 13.5

13.7 13

14.9

14.2

15.3 16.2

16.4

16.7

16.4

16.9

16.8

16.6

16.3

16.5

16.1

14.8

14.4

13.6 13.3

0

2

4

6

8

10

12

14

16

18

Perc

en

tag

es

Reporting Weeks

ARI Dis & ADD from Week-21 to Week-38 of 2008

ARIDisADD

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

27 (14 Male, 13 Female) deaths reported from all regions, 12 deaths (8 Male, 4 Female) caused by Pneumonia, 4 deaths (2 Male, 2

Female) caused by diarrheal diseases and 11 deaths (4 Male, 7 Female) were caused by Meningitis/severely ill children. (Table-6)

Table-6: Deaths by Main Causes of Mortality and by Region in W18 of 2013

G.

Total

Main

Causes of

Deaths Sou

th

Reg

ion

Cen

tral

Reg

ion

Cen

tral

Wes

t

Reg

ion

Wes

t

Reg

ion

East

Reg

ion

Nort

h

Reg

ion

Nort

h

East

Reg

ion

Sou

th

East

Reg

ion

Tota

l

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

Pneumonia

0 0 0 1 2 0 2 1 1 1 2 1 1 0 0 0 8 4 12

Diarrheal

Diseases 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0 2 2 4

Meningitis

2 1 0 0 1 0 0 2 0 0 1 2 0 2 0 0 4 7 11

Total 2 1 0 1 3 0 2 3 1 1 5 5 1 2 0 0 14 13 27

M: Male F: Female

Number of Outbreaks investigated in 2013 with details of W17/W18

Epidemiological week- 17

Suspected Measles Outbreak: reported from Khandi khil and Seendghara villages of Sawki district ,

Kunar province on April 22/2013, the team investigated the area on April 23/2013 , the population of

the affected area is around 700 ,and it is under coverage of Sawkay CHC, It has fair vaccination

coverage which is around 80%. During the investigation there were 6 suspected measles cases with no

death cases, it was clinical confirm outbreak, there was 5 case of over five year old and one cases were

under five year old and base on sex 3 female and 3 male cases the team collected lab samples and send

them to CPHL and 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 poisoning : reported from Bibi Maryam high school of Taloqan city of Takhar province

on April 21 /2012 and the team investigated the area on the same day, and during investigation there

were 54 cases of suspected poisoning with following sign and symptoms excessive crying , headach,

abdominal pain and dizziness with no deaths case and lab sample collected and send it to CPHL, the

patients treated and health education and hygiene session conducted for students, outbreak is under

control.

Suspected CCHF outbreak: reported from Chapa village of Burka district of Baghlan province

on April 21 /2013, 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

Suspected Scabies outbreak: reported from Baba –e –Barg area of district 3 of Herat province on April

23/2012, the team investigated on the same day and during the investigation there were 11 suspected

Reported outbreaks since first week of 2013 to date

Type of outbreak Investigated Rumor Clinic-ally/lab

Pertussis 4 4

Avian/Swine Flu

ARI 3 1 2

Measles 2 2

Diarrhea 20 1 19

Meningitis

Hepatitis

Malaria 1 1

Typhoid

CCHF

Bl. Diarrhea 3 3

Chickenpox

Other 3 3

Total 19 19

55 2 53

scabies cases, the cases treated and the health education was given to them, the team is investigating for

further cases.

Suspected Measles Outbreak: reported from Astewi villages of Parun district , Nuristan province

on April 21/2013, the team investigated the area on April 22/2013 , the population of the affected area

is around 1400 ,and it is under coverage of Parun BHC, It has poor vaccination coverage which is

around 60%. During the investigation there were 13 suspected measles cases, it was clinical confirm

outbreak, there were one case of over five year old and 12 cases were under five year old and base on

sex 7 female and 6 male cases, In addition to this there were 8 death cases and all of the death cases

were under five which were 5 male and 3 female the team collected lab samples and send them to CPHL

and 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- 18

Suspected poisoning : reported from Sultan Razia girl high school of Kabul city of Kabul province

on May01 /2012 and the team investigated the area on the same day, and during investigation there

were 262 cases of suspected poisoning with following sign and symptoms excessive crying , weakness

, dizziness and nervous with no deaths case and lab sample collected and send it to CPHL, the patients

treated and health education and hygiene session conducted for students, outbreak is under control.

Suspected viral hepatitis Outbreak: reported from Tishi palak and Malek ata villages of Adraskan

district , Herat province on April 27/2013, the team investigated the area on April 28/2013 , the

population of the affected area is around 1500 ,and it is under coverage of Shirad BHC. During the

investigation there were 18 suspected hepatitis cases with following clinical manifestation

weakness/weight loss, dark urine, nausea, RUQ pain, Jaundice/Icter, lose of appetites and fever it was

clinical confirm outbreak, there were 18 cases of over five year old but no case of under five year old

and base on sex 6 female and 12 male cases ,In addition to this there were 4 death cases and one of the

death cases were under five and 3 cases of over five which were 2 male and 2 female the team collected

lab samples and send them to CPHL and the cases treated . Susceptible individual were vaccinated and

health education session conducted in surrounding villages, the active surveillance has been established

for investigation of further cases.

Suspected Measles Outbreak: reported from Kochiai Kariz villages of Shahwali kot district ,

Kandahar province on April 29/2013, the team investigated the area on April 30/2013 , the population of

the affected area is around 420 ,and it is under coverage of Shahwali kot CHC, It has poor vaccination

coverage which is around zero %. During the investigation there were 8 suspected measles cases, it was

clinical confirm outbreak, there were 5 cases of over five year old and 3 cases were under five year old

and base on sex 6 female and 2 male cases , the team collected lab samples and send them to CPHL and

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 Janikhil village of Khairkot district , Paktika province

on April 30/2013, the team investigated the area on May 01/2013 , the population of the affected area is

around 600 ,and it is under coverage of Khairkot BHC, It has poor vaccination coverage . During the

investigation there were 6 suspected measles cases, it was clinical confirm outbreak, there were one case

of over five year old and 5 cases were under five year old and base on sex 2 female and 4 male cases ,

the team collected lab samples and send them to CPHL and 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 Janikhil village of Khairkot district , Paktika province

on April 29/2013, the team investigated the area on April 30/2013 , the population of the affected area is

around 2600 ,and it is under coverage of Sarobi BHC, It has poor vaccination coverage . During the

investigation there were 8 suspected measles cases, it was clinical confirm outbreak, there were 3 cases

of over five year old and 5 cases were under five year old and base on sex 3 female and 5 male cases ,

the team collected lab samples and send them to CPHL and 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.

ANNEX: Mapping of Percentages/Cases of Selected Diseases in Week-18 of 2013 by Province