Afghanistan Polio Eradication Initiative Surveillance Update Week 15 ( Ending on Saturday 18 April 2009 ) National Surveillance Office April 21, 2009

AFP Case Classification Afghanistan Year Reported AFP cases Confirmed 316 Compatible 30 Discarded Pending 077 ^ Data up to 18 Apr 09 ^ 64 AFP cases pending lab results 8 Inadequate AFP case pending 60 days follow 5 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 Bargi Matal District of Nuristan Province, onset is 30 Mar, age 24m, 18 OPV doses NSL1=6 NSL3=0 Comp=0 Data up to 18 Apr 09

2008 NSL1=25 NSL3= NSL1= 2 NSL3= NSL1= 45 NSL3= 18 P1 & P3 Poliovirus Isolates Afghanistan 1999, 04, NSL1=06 NSL3= 11 NSL1=6 NSL3= NSL1 NSL3 Data up to 18 Apr 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 18 Apr 09 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 18 Apr 09

List Of Confirmed Polio Cases Afghanistan 2008 *Confirmed by contact NoEpidProvinceDistrictDonsetPropFeverAsymSexAgeRoutineSIAs Dlast OPV Dstool 1Dstool2HcaseLabRCluster 1AFG/08/08/001HILMANDNAD ALI YYNM YESNSL1 A-3A 2AFG/08/08/005HILMANDNAD ALI YYNM NONSL1 A-3A 3AFG/08/08/012KANDAHARMAYWAND YYYM84015Unknown NONSL3 B-1C 4AFG/03/08/012FARAHBALABULUK YYNF NONSL1A-3A 5AFG/08/08/027KANDAHARMAYWAND YYYM YESNSL1A-3A 6AFG/03/08/041FARAHBALABULUK YYYF YESNSL3B-1C 7AFG/08/08/045*KANDAHARSHAHWALIKOT YYNM1200No dose DiedNONSL3B-1C 8AFG/06/08/070NANGARHARJALALABAD YYNM DiedNONSL3B-1C 9AFG/08/08/063KANDAHARGHORAK YYYM3000No dose YESNSL1A-3A 10AFG/08/08/071KANDAHARMAYWAND YYNF6605Unknown NoNSL1A-3A 11AFG/08/08/081UROZGANTARINKOT YYYM1800No dose YESNSL1A-3A 12AFG/08/08/078UROZGANSHAHID HASSAS YYNM NONSL1A-3A 13AFG/08/08/087KANDAHARSPIN BOLDAK YYYF YESNSL1A-3A 14AFG/06/08/111NANGARHARJALALABAD YYNF NONSL3B-1C 15AFG/08/08/099UROZGANTARINKOT YYNM2400No dose NONSL1A-3A 16AFG/08/08/111KANDAHARSPIN BOLDAK YNNM NONSL1A-3A 17AFG/08/08/117HILMANDMUSAQALA YYNM NONSL1A-3A 18AFG/08/08/119ZABULSHAHJOY YYYM YESNSL1A-3A 19AFG/08/08/120HILMANDSANGIN YYNM NONSL1A-3A 20AFG/08/08/124KANDAHAR YYNM DiedNONSL1A-3A 21AFG/08/08/122UROZGANTARINKOT YYYF80010Unknown NONSL1A-3A 22AFG/08/08/138KANDAHARMAYWAND YYYF2200No dose YESNSL1A-3A 23AFG/08/08/152KANDAHARSHAHWALIKOT YYNF NONSL1A-3A 24AFG/08/08/153KANDAHARSHAHWALIKOT YYNF2000No dose NONSL1A-3A 25AFG/03/08/129HERAT PASHTUM ZARGHUN YNNF9635Unknown NONSL1A-3A 26AFG/08/08/157UROZGANTARINKOT YYYF2400No dose YESNSL1A-3A 27AFG/08/08/160HILMANDSANGIN YYNM NONSL1A-3A 28AFG/08/08/164KANDAHARSPIN BOLDAK YYYM YESNSL1A-3A 29AFG/08/08/167HILMANDNAHRI SARAJ YYYF YESNSL1A-3A 30AFG/06/08/168NANGARHARJALALABAD YYYM NONSL3B-1C 31AFG/06/08/188*HILMANDLASHKARGA YYNM NONSL1A-3A Data up to 18 Apr 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 NNSL1PEND *Confirmed by contact Data up to 18 Apr 09

Polio Virus Isolates By Type & Month, Afghanistan tOPV mOPV1 mOPV3 sNID NID Short interval additional dose NSL1 NSL Data up to 18 Apr 09

Afghanistan & Pakistan P1 isolates by genetic cluster 2008 Pakistan ProvinceA-3AA-3DB-4APEND Baluchistan11000 NWFP42140 Sindh9700 Islamabad0030 Punjab16240 Total Afghanistan ProvinceA-3AA-3DB-4APEND Helmand7000 Kandahar10000 Farah1000 Uruzgan5000 Zabul1000 Herat1000 Total25000 B-4A A-3D A-3A Data up to 18 Apr 09

Afghanistan & Pakistan P1 isolates by genetic cluster 2009 Pakistan ProvinceA-3AA-3DB-4APEND Baluchistan0000 NWFP0110 Sindh1000 Islamabad0000 Punjab0010 Total1120 Afghanistan ProvinceA-3AA-3DB-4APEND Helmand20 Kandahar30 Farah00 Uruzgan00 Zabul00 Herat00 Nuristan01 Total51 A-3D B-4A A-3A Data up to 18 Apr 09 PEND

Afghanistan & Pakistan P3 isolates by genetic cluster 2008 Cluster B-1C PAK DistrictDonset Nowshera27-Apr Nowshera14 -May Bajour14-Jul Bajour19-Jul Peshawar (2)24-Jul Bajaour10 Aug Peshawar12-Aug Peshawar (2)24-Aug Islamabad01-Sep Mohmand05-Sep Khyber16-Sep Peshawar05-Sep Peshawar (2)12-Sep Peshawar15-Sep Peshawar16-Sep Islamabad27-Sep Peshawar3-Oct Peshawar6- Oct Peshawar11-Oct Peshawar22-Oct Kohat28 –Oct Peshawar30-Oct Charsada13-Oct Khyber1-Nov Peshawar19-Nov Peshawar22-Nov Khyber1-Dec Peshawar1-Dec Peshawar03-Dec Peshawar11-Dec Haydarabad29-Nov KHIGIqbad06-Dec Cluster B-1C AFG DistrictDonset Maywand09-Feb Balabuluk15-Apr Shah Wali Kot25-Apr Jalalabad14-May Jalalabad21-Jul Jalalabad27- Nov* Data up to 15 Apr 09

Afghanistan & Pakistan P3 isolates by genetic cluster 2009 Cluster B-1C PAK DistrictDonset Sialkot11 Jan Charsada11 Jan Charsada19 Jan Khi Baldia11 Feb Cluster B-1C AFG DistrictDonset Data up to 15 Apr 09

Regional Reference Lab Update Afghanistan 2009 Data up to 18 Apr 09 Month of onsetCases Cases under process Negative cases NPEV positive NPEV % Within 28 days Positive cases CultureITDWildVaccine Jan %100%27 Feb %100%14 Mar %100%11 Week 1 Mar %100%00 Week 2 Mar %96%01 Week 3 Mar %80%14 Week 4 Mar total %94%26 Apr Week 1 Apr Week 2 Apr total % 00 Total AFP cases %88%517 (4.25 %) Contacts %93%*114 (6.73 %) * Index case AFG/08/09/017 is EV, while it’s contact is NSL1

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 18 Apr 09 EPIDDONSETDistrictProvinceSexAgeDoses Date of last OPV Site of Paralysis Dstool2 (or 1) Hot by field Hot by criteria Provincial Diagnoses AFG/03/09/ OBEHIRATM Right leg YES Meningitis AFG/03/09/ BAKWAFARAHM Right leg YES Traumatic Neuritis AFG/01/09/ KHOST WA FIRING BAGHLHANM Left leg YES - AFG/07/09/ MATA KHANPAKTIKAF YES - AFG/08/09/ DISHUHILMANDF Right leg YES Hemiplegia due to infection Right arm AFG/08/09/ KANDAHAR F Left arm YES Infective Hemiplegia AFG/08/09/ NAHRI SARRAJ HILMANDM Right leg YES Acute Transverse Myelitis

Reported AFP Cases, Comparison By Month, Afghanistan 0 6 of 2/100,0000 <15 of 1/100,0000 <15 year Data up to 18 Apr

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 18 Apr 09 Region AFP Cases 2009 Week Number Expect “2” Reported Good AFP 14-Feb21-Feb28-Feb 01-Mar14-Mar21-Mar22-Mar 04-Apr 11-Apr 18-Apr Badakhshan Central Eastern Northeastern Northern South East Southern Western Afghanistan

AFP Cases Pending ERC, Afghanistan 2009 Data up to 18 Apr 09 EPIDDONSETDistrictProvinceSexAgeDoses Dstool2 (or 1) AsymProgressFeverLab result 60d follow-up result AFG/08/09/ NAWAY_I_BA RAKZAYI HILMANDM YES NVIRES WEAK AFG/08/09/ NAHRI SARRAJ HILMANDM NOYES NVIRES WEAK AFG/01/09/ NAHRINBAGHLHANM NOYES NVIRES WEAK AFG/05/09/ GHORBANDPARWANF YES NOEVDIED AFG/03/09/ SHAHRAKGHORM5918.YES NO STOOLS DIED

AFP Cases Pending Classification > 90 Days, Afghanistan 2009 Data up to 18 Apr 09 EPIDDONSETDistrictProvinceSexAgeDoses Dstool2 (or 1) AsymProgressFever Lab result Days since onset Reason for not being classified AFG/08/09/ NAWAY_I_B ARAKZAYI HILMANDM YES NVI94 Pending ERC

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 4 Apr 09

% of AFP cases reported within 7 days of paralysis onset by region Afghanistan Data up to 18 Apr 09

Proportion of Adequate Stools By Region Afghanistan Data up to 18 Apr 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 18 Apr 09

Percentage of Entero -Virus and SL isolation Afghanistan Entero Virus SL Percentage EV % by month Data up to 18 Apr 09