1. Afghanistan Polio Eradication Initiative Surveillance Update Week 29 ( Ending on Saturday 19 July 2008 ) National Surveillance Office July 22, 2008

2. AFP Case Classification Afghanistan 2008 Data up to 19 July 08 Year 2008 Reported AFP cases 754 Confirmed 11 Compatible 0 Discarded 668 Pending 75* * 58 AFP cases pending lab results 12 Inadequate AFP cases pending 60 days follow up 05 AFP cases pending ERC

3. Recent NSL1 from, Trinkot District of Uruzgan Province, onset is 24 Jun, age 18m, 0 OPV doses Recent NSL3 from, Jalalabad District of Nangarghar Province, onset is 14 May, age 08m, 10 OPV doses NSL1=07 NSL3=04 Comp=0 2008 Confirmed Polio cases & Compatibles Afghanistan 06-08 NSL1 NSL3 Compatible 2006 NSL1=29 NSL3=02 Comp=06 NSL1=06 NSL3=11 Comp=02 2007 Data up to 19 July 08

4. 2007 NSL1=06 NSL3=11 2004 NSL1= 2 NSL3= 2 NSL1 NSL3 1999 NSL1= 45 NSL3= 18 P1 & P3 Poliovirus Isolates Afghanistan 1999, 04, 06-08 2006 NSL1=29 NSL3= 2 NSL1=07 NSL3=04 Data up to 19 July 08 2008

5. Afghanistan & Pakistan P1 isolates by genetic cluster Jan to June 08 Data up to 19 July 08 Cluster A-3D 01 Jan 08 Nawabsha 25 Feb Shikarpoor 06 Apr Nferoz 09 Apr Jacobabad Cluster B-4A 14 May Kohat 03 June Maywand 28 May Ghorak Unclassified 24 June Trinkot 03 July Swat Cluster A-3A 10 Feb Balab uluk 07 Mar Maywand 12 Jan Nadi Ali 20 Jan Nadali 05 April Mir pur khas 25 Jan Haidrabad 01 April Khinorth 23 Apr Dadu 12 May Sanghar 14 May Khisite 30 May Kabdullah 04 Jun Pishin

6. Afghanistan & Pakistan P3 isolates by genetic cluster Jan to June 08 Cluster B-1C Data up 19 July 08 09 Feb Maywand 15 Apr Balabuluk 15 Apr Shah Wali Kot 27 Apr Nowshera 14 May Jalalabad 14 May Nowshera

7. Polio Virus Isolates By Type & Month, Afghanistan 05-08 2005 tOPV mOPV1 mOPV3 sNID NID 2006 2007 2008 Short interval additional dose NSL1 NSL3 Data up to 19 July 08

8. List Of Confirmed Polio Cases Afghanistan 2008 Data up to 19 July 08 *Confirmed by contact NoEpidProvinceDistrictDonsetPropFeverAsymSexAgeRoutineSIAs Dlast OPV Dstool 1Dstool2HcaseLabRCluster 1AFG/08/08/001HILMANDNAD ALI12-01-08YYNM280328-10-0715-01-0816-01-08YESNSL1 A3A 2AFG/08/08/005HILMANDNAD ALI20-01-08YYNM110120-09-0725-01-0826-01-08NoNSL1 A-3A 3AFG/08/08/012KANDAHARMAYWAND09-02-08YYYM84015 No date 14-02-0815-02-08NoNSL3 B1C 4AFG/03/08/012FARAHBALABULUK10-02-08YYNF2602 22-04-07 20-02-0821-02-08NoNSL1A3A 5AFG/08/08/027KANDAHARMAYWAND07-03-08YYYM14512 09-03-08 13-03-0814-03-08YESNSL1A3A 6AFG/03/08/041FARAHBALABULUK15-04-08YYYF16012 13-04-08 18-04-0819-04-08YESNSL3B1C 7AFG/08/08/045*KANDAHARSHAHWALIKOT25-04-08YYNM1200 No date 30-04-08DiedNoNSL3B1C 8AFG/06/08/070NANGARHARJALALABAD14-05-08YYNM846 15-05-08 16-05-08DiedNoNSL3B1C 9AFG/08/08/063KANDAHARGHORAK28-05-08YYYM3000 No date 01-06-0802-06-08YESNSL1PEND 10AFG/08/08/071KANDAHARMAYWAND03-06-08YYNF6605 No date 10-06-0814-06-08NoNSL1PEND 11AFG/08/08/081UROZGANTARINKOT24-06-08YYYM1800 No date 01-07-0802-07-08YESNSL1PEND

9. Regional Reference Lab Update Afghanistan-2008 Data up to 19 July 2008 Month of onsetCases Cases under process Negative cases NPEV positive (excl PV/NPEV) NPEV % Within 28 days Positive cases CultureITDWild (incl W/V) Vaccine (excl W/V) Jan9700791010%100%27 Feb11200881413%100%28 Mar11500741412%100%126 Apr12500833024%100%114 May13200834131%100%27 Jun 371028719%97%10 Week 1 Jun 260018831%100%00 Week 2 Jun 3100201135%100%00 Week 3 Jun 4471231125%84%11 Week 4 Jun total13881893727%94%21 Jul 29240413%17%00 Week 1 Jul 66 ------- Week 2 Jul total35300413%14%00 Total AFP cases75438150014719%95%1063 (8.35%) Contacts4032702638321%93%3*27 (6.69%) * Index case as well as its 2 Contacts are NSL3 – AFG/03/08/041 Index case is EV & its one contact is NSL1 - AFG/08/08/045)

10. AFP Cases Pending ERC, Afghanistan 2008 Data up to 19 July 08 EPIDDONSETDistrictProvinceSexAgeDoses Dstool2 (or 1) AsymProgressFever Lab result 60d follow- up result AFG/01/08/09513-04-08TALUQANTAKHARM132704-06-08YES NVIRES WEAK AFG/08/08/04717-04-08QALATZABULM481406-05-08YES NVIRES WEAK AFG/02/08/07720-04-08BILCHIRAGHFARYABF144212-06-08NOYES NVIRES WEAK AFG/06/08/08228-04-08SHINWARNANGARHARM361612-06-08YES EVRES WEAK AFG/08/08/08027-06-08ARGHANDABZABULF6128-06-08NOYES EVDIED

11. AFP Cases Pending Classification >90 days, Afghanistan 2008 Data up to 19 July 08 EPIDDONSETDistrictProvinceSexAgeDoses Dstool2 (or 1) AsymProgFever Lab result Days since onset Reason for not being classified AFG/01/08/09513-04-08TALUQANTAKHARM132704-06-08YES NVI98PEND ERC AFG/01/08/08414-04-08ARCHIKUNDUZM842015-05-08NOYES EV97PEND FUP AFG/08/08/04717-04-08QALATZABULM481406-05-08YES NVI94PEND ERC AFG/02/08/07720-04-08BILCHIRAGHFARYABF144212-06-08NOYES NVI91PEND ERC

12. AFP Cases Labeled As Hot & Pending in Lab, Afghanistan 2008 Hot by criteria=AFP cases have (Fever + rapid progress+ Asymmetric paralysis + Age <48 month) * UP= Under Process in the Lab Data up to 19 July 08 ^ Pending contacts lab result Lab No EPIDDONSETDistrictProvinceSexAgeDoses Date of last OPV Dstool2 (or 1) Hot by field Hot by criteria Lab result 1130AFG/03/08/08705-07-08INJILHIRATF241013-04-0808-07-08YES UP 1153AFG/08/08/08703-07-08 SPIN BOLDAK KANDAHARF10229-06-0815-07-08NOYESUP 981AFG/01/08/11118-06-08 IMAM SAHIB KUNDUZF481613-04-0821-06-08YESNOUP^

13. Reported AFP Cases, Comparison By Month, Afghanistan 0 6 -08 @ of 2/100,0000 <15 year @ of 1/100,0000 <15 year 2006 2007 2008 Data up to 19 July 08

14. AFP Cases By Week Of Onset Afghanistan 2008 Week (Sun-Sat) Expected 2= Two cases/100,000 <15 yrs Good AFP= GBS or T. Myelitis, T. Neuritis Data up to 19 July 08 Region AFP Cases 2008 Week Number 181920212223242526272829 Expect 2 Reported Good AFP 03-May10-May17-May24-May31-May 07-Jun14-Jun21-Jun28-Jun 05-Jul12-Jul19-Jul Badakhshan10214 101112010010 Central6217565 6799788614610 Eastern2910534 459353343640 Kunduz3813339 5235456117610 Northern469627 322325442700 South East344916 422031101130 Southern578729 075239125400 Western548837 573614322110 Afghanistan329754251 28323429263626303431110

15. Population Density Map Afghanistan 2008 Pakistan Uzbakistan Turkmanistan Iran Tajikistan China Dot=10 Persons/Sq Km

16. Non-Polio AFP Rate by Province, Afghanistan per 100,000 under 15 years 2008 2007 2006 0-0.99 1-2.99 3-4.99 5+ Data up to 05 July 2008 2.96 2.30

17. % of AFP cases reported within 7 days of paralysis onset by region Afghanistan 06-08 Data up to 19 July 08

18. Proportion Of Adequate Stools By Region Afghanistan 06-08 Data up to 19 July 08

19. AFP Cases with Stool Specimen Reaching The RRL Within 3 and 7 Days of 2 nd Specimen Collection By Region, Afghanistan 06-08 Within 3 days Within 7 days Data up to 19 July 08

20. Percentage of Entero -Virus and SL isolation Afghanistan 06-08 Entero Virus SL Percentage EV % by month 06-08 Data up to 19 July 08