1. Epidemiologic situation August 2013

2. Reported outbreaks since first week of 2013 to date Type of outbreakInvestigatedRumorClinic-ally/lab Pertussis10 ARI312 SARI2 2 Measles28127 Diarrhea312 Cholera11110 Hepatitis312 Typhoid1 1 CCHF23 Bloody Diarrhea2 2 Chickenpox7 7 Other38236 Total1316125

4. Measles cases trend

5. AWD cases trend – DEWS reports

6. AWD outbreaks 2013 Rep Date Investi gation Date Outbreak Verification # Cases cases by Age group cases by sex # dead Location Controll ed ClinicLab<5>5Male Fema le VillageDistrictProvince 6-May7-May yes 55144121340KarargahShorabakKandaharYes 10-Jun 000000 Payan-e- BaghKahmardBamyanyes 17-Jun18-Jun yes 3362715180 ChokarDamanKandahar Yes 17Ju17-Jun yes 115249172430Qaram qulKhan abadKunduzYes 15-Jun16-Jun Yes100267455451ShirabadQarabaghGhazniYes 17-Jun18-Jun Yes18513 50Yousufkhil PaktikaYes 21-Jun22-Jun yes 101101 Shahbash khil Mahmood RaqiKapisaYes

7. Rep Date Investig ation Date Outbreak Verification # Cases cases by Age group cases by sex # dead Location Controll ed ClinicLab<5>5MaleFemalVillageDistrictProvince 15-Jul16-Jul yes 322302480Mula waliSpinboldakKandaharYes 23-Jul24-Jul yes 120 390 LandayAchinNangarha yes 23-Jul24-Jul Yes 38221614240SabzdaraYakowlangBamyanYes 23-Jul24-Jul yes2801481321441361SeganaKhairkotPaktikaYes 8-Aug yes1680 2ChapaDarayemBadakhshyes 10Au10-Aug yes 3915249300 AsadkhilAchinNangarha yes 13- Aug yes283 0ZairakDarayemBadakhshyes 17Au18-Aug yes 33181521127KandringRaghistanBadakhshongoing 271928047639236415 37%53%52%48%CFR 0.55%

8. Epidemiological events past 5 weeks Cholera 2 outbreaks: Badakhshan (Drayem district 2 villages) and Nangarhar (Akim district) Bloody Diarrhea; Bamyan Yakolang Typhoid Fever: Badakhshan Shugnan Antrax; Khost Tani CCHF: Herat; Guzara 4 villages; Ghoroyan, Zanda Jan, Ingil, Obeh Pertussis: Kandahar(spinboldak) Parwan (Sayed Kheil) Food poisoning: Herat (Guzara), Kandahar (Daman)

9. Badakhshan cholera Darayem district Events: Chapa Village Alert 7 Aug from Chapa village; investigation and response initiated on 8 Aug CAF, DEWS, Kinderberg, Majority of cases reported on 8,9,10 Aug; around 450-500 cases per day treated. Few cases after 13 Aug: control achieved in Chapa on 25 th Total cases 1690: two death – CFR 0.12% Zairak Village 13 Aug – cases reported in Zairak village 65 km away from Chapa; no HF in the village

10. Mobile team established Kinderberg; 280 cases Control achieved on 25 th CFR: 0% Actions: Additional stock – WHO/ Health cluster Surveillance DEWS daily – WHO, MOPH, NGOs. Prompt treatment of cases; existing HFs and establishment of temporary CTC in Chapa village; CAF, Merlin, WHO/Health Cluster funding Health Education – NGOs, MoPH, WHO Chlorination of water sources ; MoPH, UNICEF Plan to improve water sources in district: MoRRD &UNICEF

11. Darayem district

13. Report on Helmand Outpatients injuries (war related) reported by BRAC and ACTD NoName & type of HFDistrict # of treated wounded patients (April.2013May (2013)June (2013)Total 1Musakalala DH Musakala 5587121 263 2Landi Nawa CHC346569 168 3Kani Mandah BHC262958 113 4Sangeen CHC Sangeen 125149219 493 5Puza CHC92142 72 6Malmand BHC000 0 7Nasozi BHC80238160 478 8Katozi SHC281549 92 9Mermindab BHC Nah-e-seraj 344996 179 10Shoraki BHC473610750 1833 11Nahr-e-seraj MHT01089 99 12Kajaki 80 TOTAL 3870 EMERGENCY four First Aid Trauma Post reported out patients injuries2485 Total reported outpatient injuries treated 6355 Total reported hospitalised injuries past 3 months (until end June) Number of war casualty referred by FATP to Lashkargar trauma hospital492 Inpatients brought by family116

14. Action taken CERF support for 2 mobile team – very timely WHO health cluster supported – 24/7 services 2 ACTD clinics, 2 additional ambulances and Training on the first aid for CHW in high risk areas Waiting feed back from ACTD on community level intervention– is proved added value we can expand

15. Ghor contingency plan “Dryness” – stressed food security –can go to crisis WFP- 180,000 people at high risk the Government 780,000 Most affected: Charsada, Chigcharan, Pasaband, and Duleena Second most affected: Taywara, Tulak, Saghar, Shahrak Potential health impacts 1.Cholera 2.> communicable diseases (>pop vulnerability) during winter 3.Micronutrient and. Risk acute malnutrition

16. Mitigation Plan OutcomeActivities Respons ible Support Target districts/villages Timeline Qty/ cost 1.Prevention and preparedness Cholera outbreak Stock: medicines, tents, equipment ACTD, MoPH WHOProvincial center30 Aug $ 7000 Chlorine powder and tablets MoRRDUNICEFProvincial center30 Aug HP materials distributed to HF and schools MoPH WHO, UNICEF Districts at risk (XX 5 Sept Systematic Water Quality t MoPH/ MoRRD WHO, UNICEF 1o Sept Early Warning community level linked with DEWS: CHW, Mullas ACTD/M oPH WHO/ DEWS Food insecurity &isolation winter 30 Sept 2.Prevention and preparedness to increase communicabl e diseases and ARI Five months + emergency stock in high risk districts and HF+ mobile services ACTD WHO/ UNICEF 1 st Nov $ 6000 Early warning community level during winter ACTD WHO/ DEWS Mass media campaign prevention ARI ACTD, MoPH WHOProvince3 Deworming + Vit A preschool children ACTD, MoPH WHORisk districtOct 3.Monitor nutrition situation