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September 24, 2012 DISEASES EARLY WARNING SYSTEM WER-38(6th

Yr)

REPORTS RECEIVED FROM REPORTING SITES:

As of September 21, 2012, 314 sentinel sites were functioning in eight epidemiological regions, in 34 provinces

of Afghanistan. In this reporting week, all 314 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-38,

2012

Cen

tra

l

East

Cen

tra

l

Wes

t

No

rth

No

rth

East

Wes

t

So

uth

East

So

uth

East

Tota

l No. of Expected

Reports from

Sentinel Sites

53 30 49 37 34 39 38 34 314

No. of Reports

Received in this

week 53 30 49 37 34 39 38 34 314

DEWS WEEKLY EPIDEMIOLOGICAL REPORT

EPREPORT SUMMARY:

This report includes surveillance data from 15th to 21

st September 2012.

Out of 314 functional Sentinel sites(SS), all 314 (100%) have sent their reports in Week-38 of 2012;

Out of total 287,519 Consultations recorded in week-38 of 2012, 91,189 (31.7%) consultations were reported due to

DEWS target diseases.

Main causes of consultations this week are Acute Respiratory Infections/ARI (17.1%) and Acute Diarrheal

Diseases/ADD (13.3%) from total clients in a continuing trend from the week before.

34 deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so that 15 deaths due to

pneumonia, 9 deaths due to diarrheal diseases and 10 deaths reported due to Meningitis and Severely Ill Children.

In this reporting week, one Measles outbreaks in Paktika and one Food poisoning outbreak in Laghman province were

reported.

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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 September 21,

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-38 of 2012 Ut of total 287,519 clients

recorded in week-38 of 2012, 14.9% (42764) of consultations were reported due to cough

and cold and 2.2% (6349) of consultations was

reported due to pneumonia. In the same reporting

period, 13.3% or 38,180 events were reported due to diarrheal illnesses (10.1% due to Acute Watery

Diarrhea, 2.2% due to Bloody Diarrhea and 1.0% due

to acute watery diarrhea with dehydration). In comparison with previous week (W37 of 2012) the

percentage of ARI diseases has increased by 0.7%

to17.1%, whereas the percentage of Acute Diarrheal diseases decreased by 1.1% to 13.3%. 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 age groups in week-38 of 2012.

Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in Week-38, 2012

Type of

SS

Cen

tr

al

East

Cen

tr

al

Wes

t N

ort

h

Nort

h

East

Wes

t

Sou

th

East

Sou

th

East

Tota

l

CHC/BHC 25 19 34 26 20 30 28 26 208

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 39 38 34 314

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

hospital, RH= Regional hospital, SH= specialized hospital

O

ARI C&C

ARI Pn

AwD

BDAwDw

Men/SI

C

AVHep

Measle

Pertussi

s

Diphth

Tet/NNT

AFPMalaria

TyphFe

v

U5% 21. 4.8 20. 3.4 2.0 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.7 0.4

O5% 11. 1.0 5.2 1.7 0.5 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.6 0.6

Tot% 14. 2.2 10. 2.2 1.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.6 0.6

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%Fig-2: Percentages of DEWS Target Diseases by

age Group in W38 of 2012

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Percentage of ARI by weeks and by Age Groups In the epidemiological week-38, a total of 49,113 events of ARI were reported.21.6 % of total clients less than 5 years of

age were cough & Cold patients and 11.8% among the age group 5 years and over. The percentage of C&C (<5 years)

consultations in week-28,in comparison with the percentage of C&C in week-38 of 2012, increased by 5.0%, whereas in

case of 5 years and above increased by 2.3% to 11.8% 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 increased by

0.6% in last 11 weeks, whereas the percentage of age group 5 years and over shows no considerable changes in last 11

weeks. n the reporting week-38 of 2012, the highest percentage of Cough & Cold has been recorded in Nuristan and Kapisa

provinces with 24% and 23% respectively, whereas the lowest percentages of C&C were reported from Uruzgan and

Farah provinces with 9% and 10% respectively. The highest percentages of Pneumonia cases reported from Jawzjan and Sar-pul provinces with 6.9% and 6.4% respectively, whereas the lowest percentage of Pneumonia cases was recorded

in Zabul and Uruzgan province with 0.3% and 0.4% respectively . (Fig-3)

Percentages of Diarrheal 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-28 to week-38 of 2012, from total clients. Acute watery diarrhea among children

less than five years of age has been decreased from 25.9% in week-28 to 20.5% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has been decreased by 1.8% to 5.2%.(Please refer to Table-4,

above).Bloody diarrhea, in age group less than 5 years decreased by 0.7% in last 11 weeks, while in case of age group 5

years and above decreased by 0.2%. Acute watery diarrhea with dehydration in age group less than 5 years decreased by 1.2% and in case of five years and above decreased by 0.3% in last 11 weeks.

BDS BALBAM

DAY

FYBGHA

HELHER

JOW

KAN

KHO

KDZLOG

NAN

PKA PIAPAR

SAM

SAR TAKWA

RZAB

KAB

BGLBDG

FRAGHO

KAPPAN

NIM

URU

KNR

LAGNUR

Pneumonia 2. 3. 3. 1. 2. 1. 1. 0. 6. 1. 1. 1. 1. 1. 1. 1. 2. 2. 6. 2. 3. 0. 2. 5. 0. 0. 1. 2. 1. 0. 0. 2. 3. 3.

Cough&Cold 17 17 16 19 19 13 10 15 14 10 19 20 19 19 16 15 11 15 13 15 18 10 12 16 13 10 8% 23 16 13 9% 19 13 24

0%

10%

20%

30%Fig-3: Percentages of ARI from Total Clients in week-38 of 2012

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

Disease Age Week

28-12

(%)

Week

29-12

(%)

Week

30-12

(%)

Week

31-12

(%)

Week

32-12

(%)

Week

33-12

(%)

Week

34-12

(%)

Week

35-12

(%)

Week

36-12

(%)

Week

37-12

(%)

Week

38-12

(%)

ARI- C&C <5 Yr. 16.6 16.5 16.8 17.3 16.4 16.9 16.2 18.3 18.4 21.5 21.6

5+ 9.5 9.6 10.0 9.7 9.7 10.2 7.5 10.1 11.0 10.9 11.8

ARI-

Pneumonia

<5 Yr. 4.2 4.0 3.9 3.9 3.7 3.8 4.6 4.0 4.3 4.7 4.8

>=5 Yr 1.0 1.0 0.9 0.9 0.8 1.0 1.1 0.9 1.0 1.1 1.0

I

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

Disease Age Week

28-12

(%)

Week

29-12

(%)

Week

30-12

(%)

Week

31-12

(%)

Week

32-12

(%)

Week

33-12

(%)

Week

34-12

(%)

Week

35-12

(%)

Week

36-12

(%)

Week

37-12

(%)

Week

38-12

(%)

Acute Watery

Diarrhea

<5 Years 25.9 25.0 27.5 27.1 27.2 25.0 28.9 24.0 21.6 20.9 20.5

>= 5 Years 7.0 6.7 7.4 7.0 6.9 6.8 8.4 6.6 6.3 6.4 5.2

Bloody Diarrhea <5 Years 4.1 3.9 4.1 4.1 4.1 4.1 2.9 3.8 3.8 3.7 3.4

>=5 Years 1.9 2.0 2.0 2.0 2.0 1.9 1.8 1.9 1.8 1.9 1.7

Acute W. Diarrhea

with Dehydration

<5 Years 3.2 3.1 2.8 2.9 3.1 3.1 3.4 2.5 2.3 2.1 2.0

≥5 Years 0.8 0.7 0.7 0.6 0.8 0.7 1.0 0.6 0.6 0.6 0.5

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Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: n the epidemiologic week-38 of 2012, a total of 134

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 1865 consultations were reported by Sentinel Sites to be malaria and the highest

percentages of Malaria cases were reported from East

and South East regions with 2.1% and 1.5%

respectively. Out of the total clients, 1270 cases or 0.6% in national level were reported to be suspected Typhoid

Fever and the highest percentage of Typhoid Fever was

reported from South east and South regions with 1.0%each.

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 134 cases in country

level, 47 cases have been reported from

Central East region and 28 cases from

North and 14 cases were reported from

North East region.

In general the highest number of cases of

Acute viral hepatitis being reported from

East and south East regions, so that in the

reporting week out of total 192 cases, 75

cases reported from Central-East, 34 from

East, and 25 cases from South East region

were reported. From total 88 Measles cases

reported in the reporting week 40 cases

were recorded in East and 29 cases were

reported from Central East region.

0%

5%

10%

15%

20%

25%

BD

S

BA

L

BA

M

DA

Y

FYB

GH

A

HEL

HER

JOW

KA

N

KH

O

KD

Z

LOG

NA

N

PK

A

PIA

PA

R

SAM

SAR

TAK

WA

R

ZAB

KA

B

BG

L

BD

G

FRA

GH

O

KA

P

PA

N

NIM

UR

U

KN

R

LAG

NU

R

Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-38 of 2012 AWDwD BD AWD

I

Table-5: Suspected Cases of Vaccine Preventable

Diseases in W38 of 2012 by Region

Regions

Men

ingit

is/

Sev

er I

ll

Ch

ild

Vir

al

Hep

ati

tis

Mea

sles

Per

tuss

is

Dip

hth

eria

Tet

an

us

/New

Nata

l

Tet

an

us

Acu

te

Fla

ccid

Para

lysi

s

North East 14 13 0 0 0 2 3

North 28 7 5 5 0 0 4

Central West 5 4 1 0 0 0 1

West 13 19 1 0 0 0 1

Central East 47 75 29 0 0 0 1

South 13 15 7 0 0 0 2

East 7 34 40 0 0 0 2

South East 7 25 5 0 0 0 1

Total 134 192 88 5 0 2 15

NER NR CWR WR CER SR ER SER

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

Malaria 0.2% 0.3% 0.2% 0.0% 0.1% 0.5% 2.1% 1.5%

Typhoid Fev 0.4% 0.5% 0.6% 0.3% 0.2% 1.0% 0.8% 1.0%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%Fig -5: Percentages of Men/SIC Malaria & Typhoid Fever from Total Clients in Week-38 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 W38 of 2012) 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-22 of 2011 to week-38 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 in 2011, these 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-37, ARI increased by 0.7% to17.1%, while the percentage of ADD decreased by 1.1% to 13.3%. As the line-chart shows in week-36 once again the ARI and ADD curves crossed each other

and it is expected to continue their courses at least to end of December of current year i.e. the percentages of ADD will decrease, while the percentage of ARI

increases further.

13.41313.6

14.9

13.212.913.8

12.812.413.4

12.811.5

12.8

14.315.4

16.317.617.9

2020.7

21.8

18.8

2223.2

26.125.7

28.128

29.529.930.5

31.231.530.8

30.529.929.328.9

26.926.8

25.324.4

22.522.4

21.521.7

20.920.119.919.5

18.117.1

16.3

15.2

14.6

14.013.613.714.013.913.614.3

12.6

14.5

15.3

16.417.115.516.215.816.1

16.81615.916.215.816.115.8

17.1

1514.1

13.312.4

11.110.110.1

9.28.5 8.2

7 7.36.6 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 4.95.5 5.6

6.37.2

8.5 8.6 9.0

10.610.711.4

12.913.5

14.7 15.715.7

16.8 16.816.517.717.317.6

16.8

18.9

15.7

14.7

14.413.3

0

5

10

15

20

25

30

35

P

e

r

c

e

n

t

a

g

e

s

Weeks of the Year

Fig.-6: Trend of ARI/ADD as Propotion of Total Clients From Week-22 of 2011 to Week-38 of 2012

ARI

ADD

A

14

13.9

12.8

12.1

11.3

10.710.9

10.6

10.810.910.7

10.7

11.211.2

11.8

12.213.5

13.713

14.9

14.2

15.316.2

16.4

16.7

16.4

16.9

16.8

16.6

16.3

16.5

16.1

14.8

14.4

13.613.3

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

ARI DisADD

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]

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 34 deaths reported from all regions, 15 deaths caused

by Pneumonia, 9 deaths caused by diarrheal diseases and 10 deaths were caused by

Meningitis/severely ill children.(Table-6). In this reporting week the highest number of deaths was

reported from sentinel sites of North region.

Number of Outbreaks investigated in 2012 with details of W37/W38

Epidemiological week-37 In this reporting week NO OUTBREAKS have been reported from all sentinel sites.

Epidemiological week-38 Suspected Measles Outbreak: reported from Zawl village of Sharana district of Paktika

province on September 17 /2012, the team investigated the area on the following day and

during the investigation there were 8 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.

Table-6: Deaths by Main Causes of Mortality and by Region in W38 of 2012

Main Causes

of Deaths

Nort

h

East

Nort

h

Cen

tral

Wes

t

Wes

t

Cen

tral

East

Sou

th

East

Sou

th

East

Tota

l

Pneumonia 2 4 3 0 0 3 0 3 15

Diarrheal

Diseases 1 2 0 3 2 0 1 0 9

Meningitis/SIC 0 3 3 0 1 2 1 0 10

Total 3 9 6 3 3 5 2 3 34

Reported outbreaks since first week of 2012 to date

Type of outbreak Investigated Rumor Clinic-ally/lab

Pertussis 24 3 21

Avian/Swine Flu 1 1

ARI 7 7

Measles 183 7 176

Diarrhea 5 1 4

Meningitis

Hepatitis 2 2

Malaria

Typhoid 1 1

CCHF 17 17

Bl. Diarrhea 2 2

Chickenpox 1 1

Other 47 2 45

Total 291 14 277





Suspected food poisoning Outbreak: reported from Odarmok and Kail villages of Dawlat shah

district of Laghman province on September 17 /2012, the team investigated the area on the

following day and during the investigation there were 123 suspected food poisoning cases with

no deaths , the team collected the specimens and send it to CPHL , the cases treated and the

health education campaign conducted in surrounding villages, the outbreak is controlled .





ANNEX: Mapping of Percentages/Cases of Selected Diseases in Week-38 of 2012 by Province

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