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Transcript of Afp surveillance Quality
Polio Eradication Initiative Afghanistan
Quality AFP Surveillance
TAG Meeting IslamabadMarch 24-25, 2011
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Distribution of AFP cases by population density and by districts Afghanistan 2010-2011 (March)
2010
1400-56,00056,001-144,000144,001-381,000381,001-1,225,000
Pop <15 years
Data up to 20 Mar 2011
2011
12%
2%
4%6%
7%
60%5%
3%
1%
Paed/Phys Nurse PharmacistVaccinator Physitherapy Traditional HealerMullah/shrine CHW NIDOther
Distribution of AFP cases by reporting source 2010-2011Community Based Surveillance System Afghansitan
2010
13%
1%
2%
5%4% 6%
61%4%
4%
2011
Data up to 20 Mar 2011
23 % of AFP cases are reported by various categories of community based reporting sites, including Mullah, Shrine Keepers, Pharmacists, CHWs. AFP cases from Nomads (03
cases in 2010) also reported
Surveillance system is reporting from each age group and Gender Overall Immunization status of NP AFP cases is improving
2010
2009
0-0.991-1.992-4.99
5+
Non Polio AFP Rate by ProvinceStool Adequacy Rate by Region
Detection within 7 days by Region
Major AFP Surveillance Indicators 2009-2011 Afghanistan
2011
Badak
hshan
Centra
lEas
t
Northea
st
North
Southea
st
Souther
nW
est
National
0102030405060708090
100
2009 2010 2011
Perc
enta
ge
Badak
hshan
Centra
lEas
t
Northea
st
North
Southea
st
SouthW
est
National
0102030405060708090
100
2009 2010 2011
Perc
enta
ge
AFP Cases with Stool Specimen Reaching RRL Within 3, 7 or 8+ days & % of SL, EV isolated in each period, AFG 2010
0
5
10
15
20
25
30
Same
day D1 D2 D3 D4 D5 D6 D7 D8 D9D10 D11 D12 D13 D14 D15 D16 D17 D18 D19 D20 D22
% o
f c
as
es
60% of Specimens Reaching
within 3 days
Days
0
5
10
15
20
25
30
Within 3 Days 4-7 Days 8+ days
% of SL
% of EV
94% of Specimens Reaching
within 7 days
Data up to 20 Mar 2011
Hirat
Farah
Sari Pul
Balkh
Samangan
KunduzTakhar
Badakhshan
NangarharLaghman
Parwan
KabulKapisa
• 8 team members with polio field experience from Pakistan (6), WHO/EMRO (1)and WHO/HQ (1)
• visit to 14 provinces in 5 Regions• Southern and S.-Eastern Region
not visited for security reasons
Afghanistan international AFP surveillance review, 2010Mission members and provinces visited,
Overall strong and good quality AFP system in reviewed areas:
High level awareness, timely case detection, investigation and documentation
Good coverage of population through community networks, Active Surveillance and ZERO-reporting
Tajikistan outbreak initiated rapid and effective measures to increase surveillance sensitivity
Practice of exclusion of non-AFP cases need improvement with tendency of inclusion
Based on these findings, the review team concludes that ongoing transmission of wild poliovirus in the reviewed areas is very unlikely to be missed
AFP Surveillance in insecure areas
AFP Surveillance Key Indicators, by Province Southern region Afghanistan 2010- Mar 2011
ProvinceExp @ 2
NP AFP rate
Stool ADEQ
%
Detection with 7 days of onset %
No of M/F
Median OPV <60 M
Median Age and range
EV % SL %
10 11 10 11 10 11 10 11 10 11 10 11 10 11
HILMAND 22 6 85 100 60 79 45/28 9/5 4 424
(1-179) 36
(1-132) 29 7 8 7
KANDAHAR 18 10 76 79 67 58 52/49 11/8 7 818
(4-168) 30
(1-168) 21 11 10 5
NIMROZ 3 12 100 100 63 67 9/7 2/1 7 531
(8-108)72
(12-84) 19 0 6 0
URUZGAN 12 2 81 100 68 100 30/7 1/1 6 630
(4-160)64
(8-120) 22 0 3 0
ZABUL 5 5 96 100 88 100 13/11 3/ 8 860
(11-144)20
(18-42) 25 33 0 0
Farah 7 12 96 100 81 100 28/20 3/5 13 1334
(1-156)33
(7-96) 23 8 4 25
Data up to 12 Mar 2011
Roll On Mapping of Southern Region AFP cases 2010
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<100,000100,000-<200,000200,000-370,000
Pop < 15 years
AFP Case Data up to 20 Mar 2011
JulCum=123New=28
AugCum=177New=26
SepCum=188New=11
OctCum=213New=25
NovCum=230New=17
DecCum=251New=21
Managing AFP Surveillance in Difficult to access and insecure areas, Afghanistan 2010-Mar 2011
• Identified 1-2 members of community from each district like DSTs, are trained on surveillance. Conduct household survey and facilitate specimen collection and transportation. Also visit reporting volunteers
• Orientation sessions for reporting volunteers in Helmand
• Provision of Transportation cost to bring the AFP case to health facility for investigation and specimen collection
• Collection of Samples from contacts of AFP cases in Ghor and Farah
• Training sessions focus on search for AFP cases during house to house campaign
2010 Discarded Confirmed
Other Dist 98 2
HR Dist 121 17
2011 Discarded Confirmed
Other Dist 9 1
HR Dist 22 0
During 2010, 58% AFP cases of Southern Region reported from 13 HR district.
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(((
(((
(
( ((((
((((
((
(
Data up to 20 Mar 2011
Contacts having Polio Virus Isolates with their Index Cases, Afghanistan 2010
S/NEpid Donset Province District Sex Age Prog Fever Asym Doses Dstool2 Hcase
LabResult
RelationWith Index
child
1
AFG/03/10/003 08-01-10 Farah BalablukF 144 Y N N 6 10-01-10N NVI
AFG/03/10/003-C5 . Farah Balabluk F 36 7+ 10-01-10 NSL1Cousin living in the same
house
2
AFG/06/10/044 08-04-10 Nangarhar Surkh RodM 18 Y N Y 7+ 13-04-10N NSL3
AFG/06/10/044-C3 Nangarhar Surkh Rod M 36 7+ 20-04-10 NSL3 Cousin
AFG/06/10/044 –C4 . Nangarhar Surkh Rod M 20 20-04-10 NSL3 Cousin
3
AFG/03/10/102 08-05-10 Farah Khaki Safid M 96 Y Y N 7+ 03-06-10 NVI
AFG/03/10/102 –C2 Farah Khaki Safid F 48 06-06-10 NSL1 Nephew
AFG/03/10/102–C3 . Farah Khaki Safid M 12 06-06-10 NSL1 Nephew
4AFG/08/10/184 10-10-10 Kandahar Maywand M 24 Y Y N 0 12-10-10 N NVI
AFG/08/10/184-C4 Kandahar Maywand M 36 0 24-10-10 NSL1 Cousin
5AFG/08/10/201 19-10-10 Kandahar Kandahar F 8 Y Y Y 9 04-11-10 Y EV
AFG/08/10/201-C2 Kandahar Kandahar M 59 7+ 04-10-10 NSL1 Brother
Data up to 12 Mar 2011
Surveillance Indicators: Selected insecure difficult to access Districts, Afghanistan 2010-Mar 2011
District Expected NP AFP “Rate 2”
2010 Reported 2011 Reported
NP AFP Conf % Adeq NP AFP Conf % Adeq
Bust 3 13 2 87 4 - 100
MusaQala 2 2 - 100 - - -
Nawzad 2 - 0 - - -
Nadali 3 20 3 87 3 - 100
Sangin 2 1 1 50 1 - 100
Kandahar 8 40 2 72 6 - 70
Shawalikot 2 5 3 75 - - 0
Maywand 1 7 5 75 2 - 100
Panjwai 2 3 - 33 1 - 100
Boldak 1 20 1 90 4 - 100
Trinkot 1 9 - 80 1 - 100
Shahidihassas 1 - - - -
Dihrawud 1 2 - 100 - - -
Data up to 20 Mar 2011The case of 2011 is from Daman Non-HRD
% %
%
%%
Compatible High Risk Districts
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Managing AFP Surveillance in Difficult to access insecure areas, Afghanistan: Areas of Surveillance Concern
Long arm NSL DISTRICT EPID PV TYPE Cluster Homologous isolates
DAMAN AFG/08/09/010 NSL1 A3 98.23% with AFG09-84 AFG/08/09/007 Kandhar
PANJWAYI ** AFG/08/09/017 NSL1 A3 98.32% with AFG09-84 AFG/08/09/007 Kandhar
KAJAKI AFG/08/09/027 NSL1 A3 97.52% with AFG08-069 AFG/08/08/005 Helmand
MAYWAND AFG/08/09/125 NSL1 A3 98.2% with PAK08-6583 PAK/BN/11/08/029 Quetta
Bala Baluk AFG/03/10/003 C5 NSL1 A3-D297.3% with PAK08-5350 PAK/PB/31/08/090 Lahore97.3% with PAK08-3806 PAK/PB/34/08/052 Okara
NAD ALI AFG/08/10/041 NSL3B1-C6A 97.6 % with AFG07-934 AFG/08/07/689 Helmand
KANDAHAR AFG/08/10/201-C2 NSL1 A3-A1A 98.4% with AFG10-1634 AFG/08/10/169 Kandahar98.2% with AFG10-1630 AFG/08/10/164 Shah Wali Kot
Lashkar Gah AFG/08/10/243 NSL1 A3-A1A3 98.4% with PAK10-ENV133E2PAK/BN/QTA/JT-1/10/003 Jatak Killi & Takhthani Quetta
AFP Surveillance: Benefits beyond Polio Eradication
393
4
289
1
240
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2
193
3
180
0
132
3
88
1
42
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Jan
Feb
March Ap
ril
May Jun Jul
Aug
Sep
Oct
Nov
Dec
M NNT
Total Measles Cases Reported = 2446
Total specimens collected for lab = 1978
Total Lab confirmed = 1526 Supported Surveillance for influenza A/H1N1 in 2009
Reporting of other VPDs Measles and NNT
Strengthen Routine EPI by assisting mapping, district micro-planning, supervision during active surveillance and feed-back
Reporting and responding to epidemics/outbreak in coordination with DEWs
Summary AFP Surveillance Afghanistan, 2010
• AFP cases are being reported by various sources, particularly the community-based, most of the surveillance indicators are meeting the desired level at regional and provincial levels except in Kandahar, Helmand and Uruzgan provinces of Southern Region
• International Surveillance Review held in 5 regions of the country concluded that transmission of poliovirus in reviewed areas is very unlikely to be missed.
• Although AFP surveillance in selected security affected areas is constantly providing evidence of poliovirus circulation but needs extra efforts to achieve and maintain required standards
AFP Surveillance Afghanistan: Goals 2011
• Improving surveillance in insecure or difficult to access areas and maintaining standard surveillance
• Internal Surveillance Reviews ( Southern Regions)
• Strengthening the linkage between Focal Point & Reporting Sites.
• Training of AFP Focal Points and Seminars for Reporting volunteers
• Continue using AFP surveillance for other VPDs
Thank You