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