DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) Weekly Epidemiological Report 33

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1 DISEASE EARLY WARNING SYSTEM -Plus (DEWS-Plus) Weekly Epidemiological Report August 2015 Summary: o Out of 469 functional sentinel sites, 466 (99.3%) have submitted reports this week. o Out of a total of 386,553 new consultations (164,658 male, 221,895 female) this week, 36.8% or 142,073 (68,434 male, 73,639 female) consultations were reported due to DEWS targeted diseases. o Main causes of consultations in this week were Diarrheal Diseases, 69,216 cases (18% out of total new consultations) and Pneumonia, 8,005 cases (2.1% out of total new consultations). o A total of 222 deaths were reported this week, of which 53 were due to DEWS targeted diseases, which includes 20 Pneumonia deaths, 15 Diarrheal Diseases deaths, 10 Meningitis/SIC deaths, 2 Malaria deaths, 2 Typhoid Fever deaths, 2 Hemorrhagic fever deaths, 1 Viral Hepatitis death and 1 Neonatal tetanus death. o Total of 8 outbreaks reported this week; of which 6 were CCHF outbreaks reported from Herat, and Ghor provinces, 1 Pertussis outbreak reported from Kandahar province and 1 Dog bite /suspected Rabies/ outbreak reported from Kapisa. Figure1: Surveillance/DEWS-Plus Sentinel Sites with GPS location by type of Health Facility Table 1: Coverage of DEWS-Plus Surveillance System Type of Health Facility Total Health Facilities (HF) HF covered by DEWS-Plus RH/PH DH CHC/BHC Polyclinic Private Hospital Special Hospital Total , ,

2 Disease Number of cases Disease % out of total consultations Indicator based Surveillance The Indicator-based surveillance component of DEWS-plus reports on weekly bases on 15 priority infectious diseases from sentinel sites. The data is compared with previous weeks and corresponding week of previous years and the alert and epidemic threshold is checked to see if disease incidence has crossed these levels and necessary action is initiated. Figure 2: DEWS targeted diseases Percentage of Diseases out of total consultation during week 33 < 5 years 5 years Pneumo nia with Dehydra tion Bloody Diarrhea Meningi tis Viral Hepatiti s Measles Neonata l Tetanus Malaria Typhoid Fever < 5 years years Number of cases of diseases during week < 5 years 5 years Pneumo nia with Dehydra tion Bloody Diarrhea Meningi tis 2 Viral Hepatiti s Measles Neonata l Tetanus Malaria Typhoid Fever < 5 years years

3 Percentage Precentage Percentage Percentage Vaccine Preventable Diseases (VPDs): Table 2: Cases and deaths due to VPDs by age group during week 33, 2015 Diseases Cases Deaths <5 years 5 years Total <5 years 5 years Total CFR/100 Measles Pertussis Diphtheria Neonatal Tetanus Seasonal Diseases: Trend of Pneumonia in recent weeks Trend of with severe dehydration in recent weeks Trend of Measles in recent weeks Trend of Malaria in recent weeks

4 Event-Based Surveillance: During week 33 a total of 8 outbreaks detected, investigated and responded to by DEWS-plus. The details are as below: 1. CCHF Outbreaks 1.1 CCHF Outbreak: Suspected CCHF 17 th August The case is resident of Mahale Khajaha village of Guzara district, Herat province. The case is 17 years old young having continuous contact with the animals. Investigation team collected blood specimen and send it to CPHL for lab confirmation (the result is not yet received from lab and is pending). Treatment was started and health education session conducted to him and his family members. 1.2 CCHF Outbreak: Suspected CCHF 18 th August The case is resident of Mahale Bisha village of Guzara district, Herat province. The case is a 30 years old farmer having continuous contact with the domestic animals. Investigation team collected blood specimen and send it to CPHL for lab confirmation (the result is not yet received from lab and is pending). Treatment was started and health education session conducted to him and his family members. 1.3 CCHF Outbreak: Suspected CCHF 19 th August The case is resident of Chil Gaz village of Dolina district, Ghor province. The case is a 21 years old farmer having continuous contact with the domestic animals. Investigation team collected blood specimen and send it to CPHL for lab confirmation (the result is not yet received from lab and is pending). Treatment was started and health education session conducted to him and his caretaker. 1.4 CCHF Outbreak: Suspected CCHF 20 th August The case was resident of Eshaq Soliman village of Injil district, Herat province. The case was a 20 years old farmer having continuous contact with the domestic animals. Investigation team collected blood specimen and send it to CPHL for lab confirmation (the result is not yet received from lab and is pending). Treatment was started and health education session conducted to him and his caretaker. But unfortunately the case passed away in the hospital. 1.5 CCHF Outbreak: Suspected CCHF 22 th August The case is resident of Now Badam village of Injil district, Herat province. The case is a 70 years old butcher having continuous contact with the animals. Investigation team collected blood specimen and send it to CPHL for lab confirmation (the result is not yet received from lab and is pending). Treatment was started and health education session conducted to him and his caretaker. 1.6 CCHF Outbreak: Suspected CCHF 22 th August The case is resident of Kawarzan village of Injil district, Herat province. The case was a 16 years old boy having continuous contact with the animals. Investigation team collected blood specimen and send it to CPHL for lab confirmation (the result is not yet received from lab and is pending). Treatment was started and health education session conducted to him and his caretaker. 2. Pertussis Outbreaks. 4

5 2.1 Suspected Pertussis outbreak was reported on 15 th August 2015 from Sanzerai village of Zherai district, Kandahar province with 2 suspected cases (1 case in age group under five and 1 case in age group over five). The investigation team visited the area and collected specimens from 2 suspected cases and sent them to CPHL for lab confirmation. The vaccination coverage of the area was 49%. The team vaccinated 13 (45d-2Y) children and active surveillance has been established for detection and investigation of further cases. Health education sessions conducted in the affected area. 3. Dog Bite/ suspected rabies outbreaks 3.1 Dog Bite/suspected rabies outbreak was reported from Afghania village of Nijrab district of Kapisa province on 18 th August The team investigated the outbreak, during the investigation there were 6 dog bite cases (2 cases in age group under five and 4 cases in age group over five) that were bitten by the same stray dog. The cases were treated and vaccination was advised to them and health education conducted to them. Figure 3: Outbreaks investigated during the week 33, 2015 Table 2: Updates on the outbreaks reported during 2015 (01 Jan to 22 August) 5

6 Disease/event No. of outbreaks No. of lab confd. Outbreaks No. of cases No. of deaths Measles CCHF Pertussis Suspected Rabies/dog bites Mass psychogenic illness Mumps Scabies Viral Hepatitis Food poisoning Chickenpox Pneumonia Conjunctivitis Watery Diarrhea Total Laboratory surveillance: In this week a total of 35 different specimens/samples were received by CPHL, out of which 3 specimens were positive and 2 specimens were negative for Measles while the rest are under the process. Recommendations: o o o High number of cases (above alert threshold) and deaths due to acute diarrheal Diseases in the age group less than 5 years (31.5 % Diarrheal Diseases cases among total consultations and 15 deaths) is a cause of concern. This should be analyzed and discussed at provincial level among stakeholders to find out the reasons for high morbidity and mortality and take appropriate actions. The increase in the number of measles (as compared to the average of last three years) and malaria cases (as compared to the previous weeks) should looked into at field level and take appropriate response at field and national Levels. The increase in the outbreaks of Measles in South, South East and Central West is to be given serious consideration at the provincial level among stakeholders. Early reporting and hospitalization of CCHF cases, IEC and strong coordination with animal health department and actions to be taken by them to control the ticks on the animals 6