Epidemiologic situation August 2013 Reported outbreaks since first
Epidemiologic situation August 2013
Reported outbreaks since first week of 2013 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis 10 ARI 3 1 2 SARI 2 2 Measles 28 1 27 Diarrhea 3 1 2 Cholera 11 1 10 Hepatitis 3 1 2 Typhoid 1 1 CCHF 23 Bloody Diarrhea 2 2 Chickenpox 7 7 Other 38 2 36 Total 131 6 125
30. 0 Percentages 25. 0 20. 0 15. 0 10. 0 5. 0 0. 0 ARI 32. 6 32. 4 32. 3 31. 6 31. 2 30. 5 ADD 29. 3 29. 4 29. 1 28. 7 28. 4 28. 3 27. 4 26. 1 25. 1 24. 9 24. 3 23. 4 23. 0 22. 5 22. 2 22. 0 18. 9 21. 821. 5 18. 7 20. 9 18. 1 20. 5 17. 7 17. 6 20. 0 19. 9 19. 8 17. 3 17. 0 16. 816. 8 19. 1 16. 6 19. 0 16. 5 18. 2 15. 7 17. 9 17. 7 15. 2 14. 7 17. 1 14. 5 14. 8 14. 4 14. 2 16. 5 16. 8 17. 2 16. 4 13. 3 15. 6 14. 5 17. 0 15. 4 15. 3 15. 2 12. 6 14. 5 12. 0 14. 3 14. 2 14. 0 13. 8 13. 9 13. 7 13. 6 13. 4 10. 9 10. 6 10. 3 10. 2 12. 6 9. 8 9. 0 8. 8 8. 3 8. 17. 8 7. 3 6. 9 6. 87. 2 6. 4 6. 1 6. 2 5. 55. 8 5. 45. 2 4. 94. 74. 64. 74. 74. 85. 2 W 25 W 27 W 29 W 31 W 33 W 35 W 37 W 39 W 41 W 43 W 45 W 47 W 49 W 51 W 3 W 5 W 7 W 9 W 11 W 13 W 15 W 17 W 19 W 21 W 23 W 25 W 27 W 29 W 31 W 33 35. 0 Trend of ARI/ADD as Proportion; Week-25/ 2012 to Week-3/ 2013 Weeks of the Year
Measles cases trend
AWD cases trend – DEWS reports
AWD outbreaks 2013 Outbreak cases by Investi Verification # Age group sex Rep # gation Date Cases Fema dead Date Clinic Lab <5 >5 Male Village le 6 -May 7 -May 10 -Jun yes 55 14 41 21 34 Location District Province Controll ed 0 Karargah Shorabak Kandahar Yes Payan-e. Bagh Kahmard Bamyan yes Chokar Kandahar 0 0 0 yes 33 6 27 15 18 0 17 Ju 17 -Jun yes 115 24 91 72 43 0 Qaram qul Khan abad Kunduz Yes 100 26 74 55 45 1 Shirabad Qarabagh Ghazni Yes 18 5 13 13 5 0 Yousufkhil Paktika Yes 1 Shahbash Mahmood khil Raqi Kapisa Yes 17 -Jun 18 -Jun 15 -Jun 16 -Jun 17 -Jun 18 -Jun 21 -Jun 22 -Jun yes 1 0 1 1 0 Daman Yes
cases by Investig Outbreak Rep # Age group cases by sex # Verification Date Cases dead Date Clinic Lab <5 >5 Male Femal 15 -Jul 16 -Jul Location Village District Province Controll ed yes 32 2 30 24 8 0 yes 12 0 12 3 9 0 yes 38 280 22 148 16 14 132 144 24 136 0 1 Sabzdara Yakowlang Bamyan Yes Segana Khairkot Paktika Yes yes 1680 2 Chapa Darayem Badakhsh yes 39 15 24 9 30 0 Asadkhil Achin Nangarha 1313 -Aug yes 283 0 Zairak Darayem Badakhsh yes 17 Au 18 -Aug yes 33 18 15 21 12 7 Kandring 2719 280 476 392 36415 37% 53% 52% 48%CFR 0. 55% Raghistan Badakhsh ongoing 23 -Jul 24 -Jul Yes 23 -Jul 24 -Jul 8 -Aug 10 Au 10 -Aug yes Mula wali Spinboldak Kandahar Yes Landay Achin Nangarha yes
Epidemiological events past 5 weeks • Cholera 2 outbreaks: Badakhshan (Drayem district 2 villages) and Nangarhar (Akim district) • Bloody Diarrhea; Bamyan Yakolang • Typhoid Fever: Badakhshan Shugnan • Antrax; Khost Tani • CCHF: Herat; Guzara 4 villages; Ghoroyan, Zanda Jan, Ingil, Obeh • Pertussis: Kandahar(spinboldak) Parwan (Sayed Kheil) • Food poisoning: Herat (Guzara), Kandahar (Daman)
Badakhshan cholera Darayem district Events: Chapa Village • Alert 7 Aug from Chapa village; investigation and response initiated on 8 Aug CAF, DEWS, Kinderberg, • Majority of cases reported on 8, 9, 10 Aug; around 450 -500 cases per day treated. • Few cases after 13 Aug: control achieved in Chapa on 25 th • Total cases 1690: two death – CFR 0. 12% Zairak Village • 13 Aug – cases reported in Zairak village 65 km away from Chapa; no HF in the village
• Mobile team established Kinderberg; 280 cases • Control achieved on 25 th CFR: 0% Actions: Additional stock – WHO/ Health cluster Surveillance DEWS daily – WHO, MOPH, NGOs. Prompt treatment of cases; existing HFs and establishment of temporary CTC in Chapa village; CAF, Merlin, WHO/Health Cluster funding • Health Education – NGOs, Mo. PH, WHO • Chlorination of water sources ; Mo. PH, UNICEF • Plan to improve water sources in district: Mo. RRD &UNICEF • •
date 1 25 -08 -13 2 24 -08 -13 5 23 -08 -13 6 22 -08 -13 18 21 -08 -13 14 20 -08 -13 4 19 -08 -13 3 18 -08 -13 4 17 -08 -13 4 16 -08 -13 5 15 -08 -13 36 14 -08 -13 35 13 -08 -13 25 12 -08 -13 11 -08 -13 1 10 -08 -13 0 09 -08 -13 500 08 -08 -13 600 07 -08 -13 Number of cases and death Darayem district Cholera outbreak Chapa village , Darayem August 2013 No=1680 1. 2 534 456 464 1 400 0. 8 300 0. 6 200 0. 4 100 0. 2 0 0 0 Deaths Cholera cases
Cholera outbreak: Zairak, Darayem distric; Badakhshan August 2013; cases 283 90 82 80 70 Number 60 53 50 50 49 40 31 30 20 8 -1 3 0 25 - 08 -1 3 24 - 08 -1 3 23 - 08 22 - -1 3 08 -1 3 date 21 - 08 08 -1 3 20 - 18 - 0 19 - -1 3 0 08 08 -1 3 16 - 08 -1 3 15 - 08 -1 3 14 - 08 13 - -1 3 0 0 8 4 17 - 10
Report on Helmand No 1 2 3 4 5 6 7 8 9 10 11 12 Outpatients injuries (war related) reported by BRAC and ACTD # of treated wounded patients Name & type of HF District (April. 2013 May (2013) June (2013) Total Musakalala DH 55 87 121 263 Musakala Landi Nawa CHC 34 65 69 168 Kani Mandah BHC 26 29 58 113 Sangeen CHC 125 149 219 493 Puza CHC 9 21 42 72 Sangeen Malmand BHC 0 0 Nasozi BHC 80 238 160 478 Katozi SHC 28 15 49 92 Mermindab BHC 34 49 96 179 Shoraki BHC 473 610 750 Nah-e-seraj 1833 Nahr-e-seraj MHT 0 10 89 99 Kajaki 80 80 TOTAL 3870 EMERGENCY four First Aid Trauma Post reported out patients injuries 2485 Total reported outpatient injuries treated Total reported hospitalised injuries past 3 months (until end June) Number of war casualty referred by FATP to Lashkargar trauma hospital 6355 492
Action taken • CERF support for 2 mobile team – very timely • WHO health cluster supported – 24/7 services 2 ACTD clinics, 2 additional ambulances and • Training on the first aid for CHW in high risk areas • Waiting feed back from ACTD on community level intervention– is proved added value we can expand
Ghor contingency plan • “Dryness” – stressed food security –can go to crisis • WFP- 180, 000 people at high risk the Government 780, 000 • Most affected: Charsada, Chigcharan, Pasaband, and Duleena • Second most affected: Taywara, Tulak, Saghar, Shahrak • Potential health impacts 1. Cholera 2. > communicable diseases (>pop vulnerability) during winter 3. Micronutrient and. Risk acute malnutrition
Outcome 1. Prevention and preparedness Cholera outbreak Activities Mitigation Plan Respons Support ible ACTD, WHO Mo. PH Mo. RRD UNICEF Stock: medicines, tents, equipment Chlorine powder and tablets HP materials distributed Mo. PH to HF and schools Systematic Water Quality t Mo. PH/ Mo. RRD Early Warning community ACTD/M level linked with DEWS: o. PH CHW, Mullas 2. Prevention Five months + emergency ACTD and stock in high risk districts preparedness and HF+ mobile services Early warning community ACTD to increase communicabl level during winter Mass media campaign ACTD, e diseases prevention ARI Mo. PH and ARI Deworming + Vit A ACTD, Target districts/villages Provincial center WHO, UNICEF WHO/ DEWS Districts at risk (XX Timeline Qty/ cost 30 Aug $ 7000 30 Aug 5 Sept 1 o Sept Food insecurity 30 Sept &isolation winter WHO/ UNICEF 1 st Nov $ 6000 WHO/ DEWS WHO Province 3 WHO Risk district Oct
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