Afghanistan Polio Eradication Initiative Surveillance Update Week 13 ( Ending on Saturday 4 April 2009 ) National Surveillance Office April 07, 2009

AFP Case Classification Afghanistan Year Reported AFP cases Confirmed 315 Compatible 30 Discarded Pending 070 ^ Data up to 4 Apr 09 ^ 58 AFP cases pending lab results 8 Inadequate AFP case pending 60 days follow 4 Pending ERC

Confirmed Polio cases & Compatibles Afghanistan Province No. polio cases 2008 Date of Last case 2008 No. polio cases 2009 Date of Last case 2009 P1P3P1P3P1P3P1P3 Farah Hirat Hilmand Kandahar Uruzgan Zabul Nangarhar NSL1=06 NSL3=11 Comp=02 NSL1=25 NSL3=06 Comp= NSL1 NSL3 Compatible Polio cases are placed by village 2009 Recent NSL1 from Kajaki District of Helmand Province, onset is 2 Mar, age 9m, 01 OPV doses NSL1=5 NSL3=0 Comp=0 Data up to 4 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=5 NSL3= NSL1 NSL3 Data up to 4 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=1 NSL3=0 Data up to 4 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 4 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 4 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 *Confirmed by contact Data up to 4 Apr 09

Polio Virus Isolates By Type & Month, Afghanistan tOPV mOPV1 mOPV3 sNID NID Short interval additional dose NSL1 NSL Data up to 4 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 4 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 Helmand11 Kandahar30 Farah00 Uruzgan00 Zabul00 Herat00 Total41 A-3D A-3A B-4A PEND Data up to 4 Apr 09

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 Peshawar (2)17-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 4 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 4 Apr 09

Regional Reference Lab Update Afghanistan 2009 Data up to 4 Apr 09 Month of onset Cases Cases under process Negative cases NPEV positive NPEV % Within 28 days Positive cases CultureITDWildVaccine Jan %100%27 Feb %100%14 Mar %97%11 Week 1 Mar %80%00 Week 2 Mar %45%00 Week 3 Mar Week 4 Mar total %66%11 Total AFP cases %89%412 ( 3.58 %) Contacts %84%18 ( 4.25 %)

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 4 Apr 09 EPIDDONSETDistrictProvinceSexAgeDoses Date of last OPV Site of Paralysis Dstool2 (or 1) Hot by field Hot by criteria Provincial Diagnoses AFG/08/09/ KANDAHAR M Right leg YES AFG/08/09/ KANDAHAR M Left leg YES AFG/08/09/ MUSA QALAHILMANDF Right leg YES AFG/08/09/ SPIN BOLDAKKANDAHARM Right leg YES AFG/08/09/ CHORAURUZGANM Left leg Right leg YES Inf Monopegia AFG/08/09/ QALATZABULM Left leg Right leg Right arm YES Hypokalemic Hypotonia AFG/08/09/ MUSA QALAHILMANDM Left leg Left arm YES Hemiplegia AFG/03/09/ HIRAT F Right leg Right arm YES Hemiplegia AFG/03/09/ ZINDA JANHIRATF Left leg YES Traumatic Neuritis AFG/03/09/ PUR CHAMANFARAHF Right arm YES AFG/03/09/ KOHSANHIRATM Right leg YESNO Traumatic Neuritis

Reported AFP Cases, Comparison By Month, Afghanistan 0 6 of 2/100,0000 <15 of 1/100,0000 <15 year Data up to 4 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 4 Apr 09 Region AFP Cases 2009 Week Number Expect “2” Reported Good AFP 31-Jan 07-Feb14-Feb21-Feb28-Feb 01-Mar14-Mar21-Mar22-Mar23-Mar Badakhshan Central Eastern Northeastern Northern South East Southern Western Afghanistan

AFP Cases Pending ERC, Afghanistan 2009 Data up to 4 Apr 09 EPIDDONSETDistrictProvinceSexAgeDoses Dstool2 (or 1) AsymProgressFeverLab result 60d follow-up result AFG/08/09/ NAWAY_I_BAR AKZAYI HILMANDM YES NVIRES WEAK AFG/08/09/ NAHRI SARRAJHILMANDM NOYES NVIRES WEAK AFG/05/09/ GHORBANDPARWANF YES NOEVDIED AFG/03/09/ SHAHRAKGHORM5918.YES NO STOOLS DIED

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 4 Apr 09

Proportion Of Adequate Stools By Region Afghanistan Data up to 4 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 4 Apr 09

Percentage of Entero -Virus and SL isolation Afghanistan Entero Virus SL Percentage EV % by month Data up to 4 Apr 09