Afghanistan Polio Eradication Initiative Surveillance Update Week 18 ( Ending on Saturday 9 May 2009 ) National Surveillance Office May 12, 2009

AFP Case Classification Afghanistan 2009 Year 2009 Reported AFP cases 486 Confirmed 7 Compatible 1 Discarded 408 Pending 70 ^ Data up to 9 May 09 ^ 56 Adequate AFP cases pending lab results 11 Inadequate AFP case pending 60 days follow 3 Inadequate AFP case pending ERC

Confirmed Polio cases & Compatibles Afghanistan Province No. polio cases 2008 Date of Last Polio case 2008 No. polio cases 2009 Date of Last polio case 2009 P1P3P1P3P1P3P1P3 Farah Hirat Hilmand Kandahar Uruzgan Zabul Nangarhar Nuristan NSL1=06 NSL3=11 Comp=02 NSL1=25 NSL3=06 Comp= NSL1 NSL3 Compatible Polio cases are placed by village 2009 Recent NSL1 from Panjawai District of Kandahar Province, onset is 19 Apr, age 36m, 1 OPV dose NSL1=7 NSL3=0 Comp=1 Data up to 9 May 09

2008 NSL1=25 NSL3= NSL1= 2 NSL3= NSL1= 45 NSL3= 18 P1 & P3 Poliovirus Isolates Afghanistan 1999, 04, NSL1=06 NSL3= 11 NSL1=7 NSL3= NSL1 NSL3 Data up to 9 May 09

Distribution of P1 & P3 by Month & District Mar Feb JanAprMayJun NSL1=0 NSL3=0 NSL1=0 NSL3=0 NSL1=1 NSL3=0 NSL1=1 NSL3=1 NSL1=0 NSL3=0 NSL1=2 NSL3=0 NSL1=2 NSL3=0 NSL1=1 NSL3=1 NSL1=1 NSL3=0 NSL1=0 NSL3=2 NSL1=1 NSL3=1 NSL1=3 NSL3= NSL1 NSL3 NSL1=3 NSL3=0 NSL1=1 NSL3=0 NSL1=2 NSL3=0 Data up to 9 May 09 NSL1=1 NSL3=0 NSL1=0 NSL3=0

Distribution of P1 & P3 by Month & District Sep Aug JulOctNovDec NSL1=0 NSL3=3 NSL1=0 NSL3=1 NSL1=0 NSL3=1 NSL1=2 NSL3=1 NSL1=0 NSL3=3 NSL1=0 NSL3=1 NSL1=2 NSL3=1 NSL1=2 NSL3=0 NSL1=6 NSL3=0 NSL1=6 NSL3=0 NSL1=0 NSL3=1 NSL1=1 NSL3=0 NSL1 NSL3 Data up to 9 May 09

List Of Confirmed Polio Cases Afghanistan 2009 NoEpidProvinceDistrictDonsetProgFeverAsymSexAgeRoutineSIAs Dlast OPV Dstool 1Dstool2HcaseLabRCluster 1AFG/08/09/007KANDAHAR SHAH WALI KOT YYYM NNSL1A-3A 2AFG/08/09/010KANDAHARDaman YYYM NNSL1A-3A 3AFG/08/09/017*KANDAHARPanjwai YYNF NNSL1A-3A 4AFG/08/09/020HILMANDNadiali YYYM YNSL1A-3A 5AFG/08/09/027HILMANDKajaki YYYM YNSL1A-3A 6AFG/06/09/040NURISTANBARGI MATAL YYYF NNSL1B-4A 7AFG/08/09/063KANDAHARPANJWAYI YYYM YNSL1A-3A *Confirmed by contact Data up to 9 May 09

List Of Compatible Polio Cases Afghanistan 2009 No Epid Province District Donset Prog Fever Asym Sex Age Routine SIAs Dlast OPV Dstool 1 Dstool2 Hcase LabR 1AFG/08/09/023HILMAND NAWAI BARAK ZAI YYYM YNVI Data up to 9 May 09

Polio Virus Isolates By Type & Month, Afghanistan tOPV mOPV1 mOPV3 sNID NID Short interval additional dose NSL1 NSL Data up to 9 May 09

Afghanistan & Pakistan P1 isolates by genetic cluster 2009 Pakistan ProvinceA-3AA-3DB-4APEND Baluchistan000 NWFP012 Sindh100 Islamabad000 Punjab001 Total113 Afghanistan ProvinceA-3AA-3DB-4APEND Helmand200 Kandahar400 Farah000 Uruzgan000 Zabul000 Herat000 Nuristan010 Total610 A-3D A-3A Data up to 2 May 09 PEND B-4A

Afghanistan & Pakistan P3 isolates by genetic cluster 2009 Cluster B-1C PAK DistrictDonset Sialkot11 Jan Charsada11 Jan Charsada19 Jan Khi Baldia11 Feb Khi Baldia25 Feb Kambar09 Apr Cluster B-1C AFG DistrictDonset Data up to 2 May 09

Regional Reference Lab Update Afghanistan 2009 Data up to 9 May 09 *AFG/08/09/017 (Index case EV but 1 contact is NSL1) Month of onsetCases Cases under process Negative cases NPEV positive (excl PV/NPEV) NPEV % Within 28 days Positive cases CultureITD Wild (incl W/V) Vaccine (excl W/V) Jan %100%27 Feb %100%14 Mar %100%29 Apr %95%05 Week 1 Apr %97%02 Week 2 Apr %55%11 Week 3 Apr % 00 Week 4 Apr total %73%18 May Week 1 Total AFP cases %92%628 ( 5.70 %) Contacts %90%1*17 ( 6.51 %)

AFP Cases Labeled As Hot & Pending in Lab, Afghanistan 2009 Hot by criteria=AFP cases have (Fever + rapid progress+ Asymmetric paralysis + Age <48 month) Data up to 9 May 09 EPIDDONSETDistrictProvinceSexAgeDoses Date of last OPV Site of paralysis Dstool2 (or 1) Hot by field Hot by criteria Provincial diagnoses AFG/06/09/ BATI KOTNANGARHARF Right leg YES Viral Neuropathy AFG/07/09/ SAROBIPAKTIKAM Right arm Right leg YES Hemiplegia due infection. AFG/08/09/ MUSA QALAHILMANDM Right leg YES Traumatic Neuritis AFG/08/09/ KANDAHAR F Left arm Left leg YES Hemiplegia due to infection AFG/08/09/ DAMANKANDAHARM Right leg YES Infective Monoplegia AFG/08/09/ KANDAHAR F Right arm Right leg YES Hemiplegia due to Infection AFG/08/09/ ARGHISTANKANDAHARM Left leg YES Traumatic Neuritis

AFP Cases Pending ERC, Afghanistan EPIDDONSETDistrictProvinceSexAgeDoses Dstool2 (or 1) AsymProgreFever Lab result 60d follow up result AFG/01/09/ TALUQANTAKHARM NOYESNONVIRES WEAK AFG/06/09/ JALAL ABADNANGARHARF YES NVIRES WEAK AFG/03/09/ KUSHKHIRATM NOYESNONVIRES WEAK Data up to 9 May 09

AFP Cases Pending Classification >90 days, Afghanistan EPIDDONSETDistrictProvinceSexAgeDoses Dstool2 (or 1) AsymProgressFever Lab result Days since onset Reason for not being classified AFG/01/09/ TALUQANTAKHARM NOYESNONVI108PEND ERC Data up to 9 May 09

Reported AFP Cases, Comparison By Month, Afghanistan 0 6 of 2/100,0000 <15 of 1/100,0000 <15 year Data up to 9 May

AFP Cases By Week Of Onset Afghanistan 2009 Week (Sun-Sat) Expected 2= Two cases/100,000 <15 yrs Good AFP= GBS or T. Myelitis, T. Neuritis Data up to 9 May 09 Region AFP Cases 2009 Week Number Expect “2” Reported Good AFP 01-Mar14-Mar21-Mar22-Mar 04-Apr 11-Apr 18-Apr25-Apr26-Apr27-Apr Badakhshan Central Eastern Northeastern Northern South East Southern Western Afghanistan

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

Non-Polio AFP Rate by Province, Afghanistan per 100,000 under 15 years (Annualized) Data up to 2 May 09

% of AFP cases reported within 7 days of paralysis onset by region Afghanistan Data up to 9 May 09

Proportion of Adequate Stools By Region Afghanistan Data up to 9 May 09

AFP Cases with Stool Specimen Reaching The RRL Within 3 and 7 Days of 2 nd Specimen Collection By Region, Afghanistan Within 3 days Within 7 days Data up to 9 May 09

Percentage of Entero -Virus and SL isolation Afghanistan Entero Virus SL Percentage EV % by month Data up to 9 May 09