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


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


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


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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(((

(((

(

( ((((

((((

((

(


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


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

0

210

2

193

3

180

0

132

3

88

1

42

0

37

4

35

2

141

30

50

100

150

200

250

300

350

400

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

Business

Afp surveillance Quality