Afghanistan Polio Eradication Initiative Surveillance Update Week 14

Afghanistan Polio Eradication Initiative Surveillance Update Week 14 (Ending on Saturday 11 April 2009) National Surveillance Office April 14, 2009

AFP Case Classification Afghanistan 08 -09 Year 2008 2009 Reported AFP cases 1383 364 Confirmed 31 5 Compatible 3 0 1349 290 0 69 ^ Discarded Pending ^ 57 AFP cases pending lab results 8 Inadequate AFP case pending 60 days follow 4 Pending ERC Data up to 11 Apr 09

Confirmed Polio cases & Compatibles Afghanistan 07 -09 2007 2008 NSL 1=06 NSL 3=11 Comp=02 2009 NSL 1=25 NSL 3=06 Comp=3 NSL 1=5 NSL 3=0 Comp=0 NSL 1 NSL 3 Compatible Recent NSL 1 from Kajaki District of Helmand Province, onset is 2 Mar, age 9 m, 01 OPV doses Province No. polio cases 2008 P 1 P 3 Farah 1 1 Hirat 1 Hilmand Date of Last No. polio case Polio case 2008 cases 2009 P 1 P 3 10 -02 -08 15 -04 -08 - - 0 26 -09 -08 - - 7 0 01 -12 -08 2 - 02 -03 -09 - Kandahar 10 2 15 -10 -08 25 -04 -08 3 - 27 -01 -09 - Uruzgan 5 0 14 -10 -08 - - Zabul 1 0 02 -09 -08 - - Nangarhar 0 3 - - Polio cases are placed by village P 3 27 -11 -08 Data up to 11 Apr 09

P 1 & P 3 Poliovirus Isolates Afghanistan 1999, 04, 07 -09 1999 2004 NSL 1= 2 NSL 3= 2 NSL 1= 45 NSL 3= 18 NSL 1 NSL 3 2007 NSL 1=06 NSL 3= 11 2008 NSL 1=25 NSL 3=06 2009 NSL 1=5 NSL 3=0 Data up to 11 Apr 09

Distribution of P 1 & P 3 by Month & District 07 -09 2007 Jan Apr Mar Feb May Jun NSL 1=0 NSL 1=2 NSL 1=1 NSL 3=0 NSL 3=0 NSL 3=1 2008 NSL 1=2 NSL 1=1 NSL 1=0 NSL 1=1 NSL 1=3 NSL 1 NSL 3=0 NSL 3=2 NSL 3=1 NSL 3=0 NSL 3 2009 NSL 1=3 NSL 1=1 NSL 1=0 NSL 3=0 Data up to 11 Apr 09

Distribution of P 1 & P 3 by Month & District 07 -08 2007 Jul Oct Sep Aug Nov Dec NSL 1=0 NSL 1=0 NSL 1=2 NSL 3=3 NSL 3=1 NSL 1 NSL 3 2008 NSL 1=2 NSL 1=6 NSL 1=0 NSL 1=1 NSL 3=0 NSL 3=1 NSL 3=0 Data up to 11 Apr 09

List Of Confirmed Polio Cases Afghanistan 2008 No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epid Province AFG/08/08/001 HILMAND AFG/08/08/005 HILMAND AFG/08/08/012 KANDAHAR AFG/03/08/012 FARAH AFG/08/08/027 KANDAHAR AFG/03/08/041 FARAH AFG/08/08/045* KANDAHAR AFG/06/08/070 NANGARHAR AFG/08/08/063 KANDAHAR AFG/08/08/071 KANDAHAR AFG/08/08/081 UROZGAN AFG/08/08/078 UROZGAN AFG/08/08/087 KANDAHAR AFG/06/08/111 NANGARHAR AFG/08/08/099 UROZGAN AFG/08/08/111 KANDAHAR AFG/08/08/117 HILMAND AFG/08/08/119 ZABUL AFG/08/08/120 HILMAND AFG/08/08/124 KANDAHAR AFG/08/08/122 UROZGAN AFG/08/08/138 KANDAHAR AFG/08/08/152 KANDAHAR AFG/08/08/153 KANDAHAR District NAD ALI MAYWAND BALABULUK SHAHWALIKOT JALALABAD GHORAK MAYWAND TARINKOT SHAHID HASSAS SPIN BOLDAK JALALABAD TARINKOT SPIN BOLDAK MUSAQALA SHAHJOY SANGIN KANDAHAR TARINKOT MAYWAND SHAHWALIKOT PASHTUM 25 AFG/03/08/129 HERAT ZARGHUN 26 AFG/08/08/157 UROZGAN TARINKOT 27 AFG/08/08/160 HILMAND SANGIN 28 AFG/08/08/164 KANDAHAR SPIN BOLDAK 29 AFG/08/08/167 HILMAND NAHRI SARAJ 30 AFG/06/08/168 NANGARHAR JALALABAD 31 AFG/06/08/188* HILMAND LASHKARGA 12 -01 -08 20 -01 -08 09 -02 -08 10 -02 -08 07 -03 -08 15 -04 -08 25 -04 -08 14 -05 -08 28 -05 -08 03 -06 -08 24 -06 -08 22 -06 -08 03 -07 -08 24 -07 -08 05 -08 -08 26 -08 -08 02 -09 -08 01 -09 -08 10 -09 -08 11 -09 -08 25 -09 -08 09 -10 -08 15 -10 -08 Y Y Y Y Y Y Y Y Y Y N Y Y Y Y N N Y N Y N N Y Y N N M M M F F M M M F F 28 11 84 26 14 16 12 8 30 66 18 10 10 14 24 18 22 14 18 18 80 22 24 20 0 0 5 0 0 4 0 2 0 0 0 1 0 0 0 3 1 15 2 12 12 0 6 0 5 2 10 0 12 9 1 2 6 10 0 1 0 Dlast OPV 28 -10 -07 20 -09 -07 Unknown 22 -04 -07 09 -03 -08 13 -04 -08 No dose 15 -05 -08 No dose Unknown No dose 01 -06 -08 29 -06 -08 28 -06 -08 No dose 29 -06 -08 03 -08 -08 22 -01 -08 04 -08 -08 02 -06 -08 Unknown No dose 17 -06 -07 No dose 16 -01 -08 26 -01 -08 15 -02 -08 21 -02 -08 14 -03 -08 19 -04 -08 Died 02 -06 -08 14 -06 -08 02 -07 -08 28 -06 -08 15 -07 -08 25 -07 -08 31 -07 -08 17 -08 -08 31 -08 -08 05 -09 -08 09 -09 -08 Died 13 -09 -08 05 -10 -08 20 -10 -08 21 -10 -08 YES NO NO NO YES No YES NO NO YES NO NO NSL 1 NSL 3 NSL 1 NSL 1 NSL 3 NSL 1 NSL 1 NSL 1 26 -09 -08 Y N N F 96 3 5 Unknown 29 -09 -08 30 -09 -09 NO NSL 1 A-3 A 14 -10 -08 27 -10 -08 15 -10 -08 30 -10 -08 27 -11 -08 01 -12 -08 Y Y Y Y N Y Y Y N F M M 24 9 24 24 18 18 0 2 0 0 1 3 8 12 6 No dose 21 -10 -08 21 -09 -08 19 -10 -08 24 -11 -08 YES NO NO NSL 1 NSL 3 NSL 1 Donset Prop Fever Asym Sex Age Routine SIAs *Confirmed by contact Dstool 1 Dstool 2 Hcase Lab. R Cluster 15 -01 -08 25 -01 -08 14 -02 -08 20 -02 -08 13 -03 -08 18 -04 -08 30 -04 -08 16 -05 -08 01 -06 -08 10 -06 -08 01 -07 -08 27 -06 -08 14 -07 -08 24 -07 -08 30 -07 -08 16 -08 -08 30 -08 -08 04 -09 -08 08 -09 -08 15 -09 -08 12 -09 -08 04 -10 -08 19 -10 -08 20 -10 -08 26 -10 -08 01 -11 -08 06 -11 -08 9 -11 -08 02 -12 -08 29 -12 -08 27 -10 -08 02 -11 -08 07 -11 -08 10 -11 -08 03 -12 -08 30 -12 -08 A-3 A B-1 C B-1 C A-3 A A-3 A A-3 A A-3 A A-3 A B-1 C A-3 A Data up to 11 Apr 09

List Of Confirmed Polio Cases Afghanistan 2009 No Epid Province District Donset Prog Fever Asym Sex Age Routine SIAs 1 AFG/08/09/007 KANDAHAR SHAH WALI KOT 16 -01 -09 Y Y Y M 18 0 0 2 AFG/08/09/010 KANDAHAR Daman 27 -01 -09 Y Y Y M 12 0 3 AFG/08/09/017* KANDAHAR Panjwai 21 -01 -09 Y Y N F 8 4 AFG/08/09/020 HILMAND Nadiali 06 -02 -09 Y Y Y M 5 AFG/08/09/027 HILMAND Kajaki 02 -03 -09 Y Y Y M *Confirmed by contact Dlast OPV - Dstool 1 Dstool 2 Hcase Lab. R Cluster 21 -01 -09 22 -01 -09 N NSL 1 A-3 A 3 24 -11 -08 01 -02 -09 02 -02 -09 N NSL 1 A-3 A 0 1 02 -06 -2008 14 -02 -09 15 -02 -09 N NSL 1 A-3 A 11 0 1 14 -04 -08 17 -02 -09 18 -02 -09 Y NSL 1 A-3 A 9 0 1 04 -08 -08 11 -03 -09 12 -03 -09 Y NSL 1 A-3 A Data up to 11 Apr 09

Polio Virus Isolates By Type & Month, Afghanistan 05 -09 2005 NSL 1 NSL 3 2006 t. OPV m. OPV 1 m. OPV 3 2007 2008 2009 Short interval Data up to 11 Apr 09 s. NID additional dose

Afghanistan & Pakistan P 1 isolates by genetic cluster 2008 A-3 A A-3 D B-4 A Afghanistan Province A-3 A A-3 D B-4 A PEND Helmand 7 0 0 0 Kandahar 10 0 Farah 1 0 0 0 Uruzgan 5 0 0 0 Zabul 1 0 0 0 Herat 1 0 0 0 Total 25 0 0 0 Pakistan Province A-3 A A-3 D B-4 A PEND Baluchistan 11 0 0 0 NWFP 4 2 14 0 Sindh 9 7 0 0 Islamabad 0 0 3 0 Punjab 1 6 24 0 Total 25 15 41 0 Data up to 11 Apr 09

Afghanistan & Pakistan P 1 isolates by genetic cluster 2009 A-3 A A-3 D B-4 A PEND Afghanistan Province A-3 A A-3 D B-4 A PEND Helmand 2 0 Kandahar 3 0 Farah 0 0 Uruzgan 0 0 Zabul 0 0 Herat 0 0 Total 5 0 Pakistan Province A-3 A A-3 D B-4 A PEND Baluchistan 0 0 NWFP 0 1 1 0 Sindh 1 0 0 0 Islamabad 0 0 Punjab 0 0 1 0 Total 1 1 2 0 Data up to 11 Apr 09

Afghanistan & Pakistan P 3 isolates by genetic cluster 2008 Cluster B-1 C AFG District Maywand Balabuluk Shah Wali Kot Jalalabad Donset 09 -Feb 15 -Apr 25 -Apr 14 -May 21 -Jul 27 - Nov* Cluster B-1 C PAK Data up to 11 Apr 09 District Nowshera Bajour Peshawar (2) Bajaour Peshawar (2) Islamabad Mohmand Khyber Peshawar (2) Peshawar Islamabad Peshawar Kohat Peshawar Charsada Khyber Peshawar Peshawar Haydarabad KHIGIqbad Donset 27 -Apr 14 -May 14 -Jul 19 -Jul 24 -Jul 10 Aug 12 -Aug 24 -Aug 01 -Sep 05 -Sep 16 -Sep 05 -Sep 12 -Sep 15 -Sep 16 -Sep 27 -Sep 3 -Oct 6 - Oct 11 -Oct 22 -Oct 28 –Oct 30 -Oct 13 -Oct 1 -Nov 19 -Nov 22 -Nov 1 -Dec 03 -Dec 11 -Dec 29 -Nov 06 -Dec

Afghanistan & Pakistan P 3 isolates by genetic cluster 2009 Cluster B-1 C AFG District Donset Cluster B-1 C PAK District Donset Sialkot Charsada Khi Baldia 11 Jan 19 Jan 11 Feb Data up to 11 Apr 09

Regional Reference Lab Update Afghanistan 2009 Cases under process Month of onset Cases Culture ITD Negative cases NPEV positive Within 14 NPEV % days Positive cases Wild Vaccine Jan 119 0 0 89 21 18% 100% 2 7 Feb 108 1 0 89 13 12% 99% 1 4 39 0 0 31 6 15% 100% 1 1 30 1 0 25 4 13% 97% 0 0 26 6 0 17 2 8% 77% 0 1 33 24 1 5 0 0% 27% 0 3 Mar total 128 31 1 78 12 9% 76% 1 5 Apr 9 9 - - - - Total AFP cases 364 41 1 256 46 13% 89% 4 16 (4. 39 %) Contacts 198 10 1 146 28 14% 95% 1 12 (6. 06 %) Mar Week 1 Mar Week 2 Mar Week 3 Mar Week 4 Data up to 11 Apr 09

AFP Cases Labeled As Hot & Pending in Lab, Afghanistan 2009 EPID DONSET Sex Age Doses Date of Site of Dstool 2 last OPV paralysis (or 1) Hot by field criteria Provincial Diagnoses District Province AFG/08/09/048 20 -03 -09 LASHKAR GAH HILMAND F 18 5 15 -03 -09 Left leg 30 -03 -09 YES Hypokalemic Hypotonia AFG/08/09/049 20 -03 -09 MIZAN ZABUL M 10 1 12 -01 -09 Left leg 02 -04 -09 YES Monoplegia AFG/08/09/050 25 -03 -09 MAYWAND KANDAHAR M 13 12 16 -03 -09 Left leg 02 -04 -09 YES GBS AFG/03/09/054 28 -03 -09 GUZARA HIRAT M 5 6 15 -03 -09 Right leg 31 -03 -09 YES Traumatic Neuritis AFG/03/09/053 27 -03 -09 KOHSAN HIRAT M 48 20 15 -03 -09 Right leg 30 -03 -09 YES NO Traumatic Neuritis AFG/07/09/022 25 -03 -09 ZURMAT PAKTYA M 12 12 16 -03 -09 Left arm 02 -04 -09 YES NO Hot by criteria=AFP cases have (Fever + rapid progress+ Asymmetric paralysis + Age <48 month) Data up to 11 Apr 09

Reported AFP Cases, Comparison By Month, Afghanistan 06 -09 @ of 2/100, 0000 <15 year @ of 1/100, 0000 <15 year 2006 2007 2008 2009 Data up to 11 Apr 09

AFP Cases By Week Of Onset Afghanistan 2009 Week Number 5 6 7 8 9 10 11 12 13 14 Expect “ 2” Reported Good AFP 07 -Feb 14 -Feb 21 -Feb 28 -Feb 01 -Mar 14 -Mar 21 -Mar 22 -Mar 04 -Apr 11 -Apr Region AFP Cases 2009 Badakhshan 10 11 2 0 0 0 1 1 2 1 0 Central 63 62 23 3 6 5 6 7 6 1 4 4 0 Eastern 30 40 9 3 5 1 2 4 2 2 0 Northeastern 39 67 18 3 10 9 6 10 2 4 3 3 0 Northern 47 54 19 2 4 3 4 7 6 3 4 2 0 South East 34 22 6 2 0 0 3 3 3 2 2 0 0 Southern 58 51 20 2 3 3 5 9 7 0 0 Western 55 57 32 6 2 10 3 3 6 2 3 3 0 Afghanistan 336 364 129 21 30 30 28 37 31 26 27 15 0 Expected 2= Two cases/100, 000 <15 yrs Good AFP= GBS or T. Myelitis, T. Neuritis Week (Sun-Sat) Data up to 11 Apr 09

AFP Cases Pending ERC, Afghanistan 2009 EPID DONSET District Province Sex Age Doses Dstool 2 (or 1) Asym Progress Fever Lab result 60 d follow-up result NAWAY_I_BAR HILMAND AKZAYI M 8 1 24 -02 -09 YES YES NVI RES WEAK AFG/08/09/015 19 -01 -09 NAHRI SARRAJ HILMAND M 72 0 05 -02 -09 NO YES NVI RES WEAK AFG/05/09/035 25 -01 -09 GHORBAND PARWAN F 144 0 04 -03 -09 YES NO EV DIED AFG/03/09/024 14 -02 -09 SHAHRAK GHOR M 59 18 . YES YES NO STOOLS DIED AFG/08/09/023 09 -01 -09 Data up to 11 Apr 09

AFP Cases Pending Classification > 90 Days, Afghanistan 2009 EPID DONSET AFG/08/09/023 09 -01 -09 District Dstool 2 Lab Province Sex Age Doses Asym Progress Fever (or 1) result NAWAY_I_B HILMAND M ARAKZAYI 8 1 24 -02 -09 YES YES NVI Days since onset Reason for not being classified 94 94 Data up to 11 Apr 09

Population Density Map Afghanistan 2009 Tajikistan Uzbakistan China Turkmanistan Iran Pakistan Dot=10 Persons/Sq Km

Non-Polio AFP Rate by Province, Afghanistan per 100, 000 under 15 years (Annualized) 2007 2008 2009 0 -0. 99 1 -2. 99 3 -4. 99 5+ Data up to 4 Apr 09

% of AFP cases reported within 7 days of paralysis onset by region Afghanistan 07 -09 Data up to 11 Apr 09

Proportion of Adequate Stools By Region Afghanistan 07 -09 Data up to 11 Apr 09

AFP Cases with Stool Specimen Reaching The RRL Within 3 and 7 Days of 2 nd Specimen Collection By Region, Afghanistan 07 -09 Within 3 days Within 7 days Data up to 11 Apr 09

Percentage of Entero -Virus and SL isolation Afghanistan 07 -09 Entero Virus SL Percentage EV % by month 07 -09 Data up to 11 Apr 09