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

2. AFP Case Classification Afghanistan 08-09 Year 20082009 Reported AFP cases 1383395 Confirmed 316 Compatible 30 Discarded 1349312 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

3. Confirmed Polio cases & Compatibles Afghanistan 07-09 Province No. polio cases 2008 Date of Last Polio case 2008 No. polio cases 2009 Date of Last polio case 2009 P1P3P1P3P1P3P1P3 Farah1110-02-08 15-04-08 ---- Hirat1026-09-08---- Hilmand7001-12-082-02-03-09- Kandahar10215-10-0825-04-083-27-01-09- Uruzgan5014-10-08---- Zabul1002-09-08---- Nangarhar0327-11-08---- Nuristan001-30-03-09- 2007 NSL1=06 NSL3=11 Comp=02 NSL1=25 NSL3=06 Comp=3 2008 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

4. 2008 NSL1=25 NSL3=06 2004 NSL1= 2 NSL3= 2 1999 NSL1= 45 NSL3= 18 P1 & P3 Poliovirus Isolates Afghanistan 1999, 04, 07-09 2007 NSL1=06 NSL3= 11 NSL1=6 NSL3=0 2009 NSL1 NSL3 Data up to 18 Apr 09

5. Distribution of P1 & P3 by Month & District 07-09 Mar Feb JanAprMayJun 2007 2008 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=0 2009 NSL1 NSL3 NSL1=3 NSL3=0 NSL1=1 NSL3=0 NSL1=2 NSL3=0 Data up to 18 Apr 09 NSL1=0 NSL3=0

6. Distribution of P1 & P3 by Month & District 07-08 Sep Aug JulOctNovDec 2007 2008 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

7. List Of Confirmed Polio Cases Afghanistan 2008 *Confirmed by contact NoEpidProvinceDistrictDonsetPropFeverAsymSexAgeRoutineSIAs Dlast OPV Dstool 1Dstool2HcaseLabRCluster 1AFG/08/08/001HILMANDNAD ALI12-01-08YYNM280328-10-0715-01-0816-01-08YESNSL1 A-3A 2AFG/08/08/005HILMANDNAD ALI20-01-08YYNM110120-09-0725-01-0826-01-08NONSL1 A-3A 3AFG/08/08/012KANDAHARMAYWAND09-02-08YYYM84015Unknown14-02-0815-02-08NONSL3 B-1C 4AFG/03/08/012FARAHBALABULUK10-02-08YYNF260222-04-07 20-02-0821-02-08NONSL1A-3A 5AFG/08/08/027KANDAHARMAYWAND07-03-08YYYM1451209-03-08 13-03-0814-03-08YESNSL1A-3A 6AFG/03/08/041FARAHBALABULUK15-04-08YYYF1601213-04-08 18-04-0819-04-08YESNSL3B-1C 7AFG/08/08/045*KANDAHARSHAHWALIKOT25-04-08YYNM1200No dose 30-04-08DiedNONSL3B-1C 8AFG/06/08/070NANGARHARJALALABAD14-05-08YYNM84615-05-0816-05-08DiedNONSL3B-1C 9AFG/08/08/063KANDAHARGHORAK28-05-08YYYM3000No dose01-06-0802-06-08YESNSL1A-3A 10AFG/08/08/071KANDAHARMAYWAND03-06-08YYNF6605Unknown10-06-0814-06-08NoNSL1A-3A 11AFG/08/08/081UROZGANTARINKOT24-06-08YYYM1800No dose01-07-0802-07-08YESNSL1A-3A 12AFG/08/08/078UROZGANSHAHID HASSAS22-06-08YYNM104501-06-0827-06-0828-06-08NONSL1A-3A 13AFG/08/08/087KANDAHARSPIN BOLDAK03-07-08YYYF100229-06-0814-07-0815-07-08YESNSL1A-3A 14AFG/06/08/111NANGARHARJALALABAD24-07-08YYNF1421028-06-0824-07-0825-07-08NONSL3B-1C 15AFG/08/08/099UROZGANTARINKOT24-07-08YYNM2400No dose30-07-0831-07-08NONSL1A-3A 16AFG/08/08/111KANDAHARSPIN BOLDAK05-08-08YNNM1801229-06-0816-08-0817-08-08NONSL1A-3A 17AFG/08/08/117HILMANDMUSAQALA26-08-08YYNM220903-08-0830-08-0831-08-08NONSL1A-3A 18AFG/08/08/119ZABULSHAHJOY02-09-08YYYM141122-01-0804-09-0805-09-08YESNSL1A-3A 19AFG/08/08/120HILMANDSANGIN01-09-08YYNM180204-08-0808-09-0809-09-08NONSL1A-3A 20AFG/08/08/124KANDAHAR 10-09-08YYNM180602-06-0815-09-08DiedNONSL1A-3A 21AFG/08/08/122UROZGANTARINKOT11-09-08YYYF80010Unknown12-09-0813-09-08NONSL1A-3A 22AFG/08/08/138KANDAHARMAYWAND25-09-08YYYF2200No dose04-10-0805-10-08YESNSL1A-3A 23AFG/08/08/152KANDAHARSHAHWALIKOT09-10-08YYNF240117-06-0719-10-0820-10-08NONSL1A-3A 24AFG/08/08/153KANDAHARSHAHWALIKOT15-10-08YYNF2000No dose20-10-0821-10-08NONSL1A-3A 25AFG/03/08/129HERAT PASHTUM ZARGHUN 26-09-08YNNF9635Unknown29-09-0830-09-09NONSL1A-3A 26AFG/08/08/157UROZGANTARINKOT14-10-08YYYF2400No dose26-10-0827-10-08YESNSL1A-3A 27AFG/08/08/160HILMANDSANGIN27-10-08YYNM92121-10-0801-11-0802-11-08NONSL1A-3A 28AFG/08/08/164KANDAHARSPIN BOLDAK15-10-08YYYM240321-09-0806-11-0807-11-08YESNSL1A-3A 29AFG/08/08/167HILMANDNAHRI SARAJ30-10-08YYYF240819-10-089-11-0810-11-08YESNSL1A-3A 30AFG/06/08/168NANGARHARJALALABAD27-11-08YYYM1811224-11-0802-12-0803-12-08NONSL3B-1C 31AFG/06/08/188*HILMANDLASHKARGA01-12-08YYNM180624-11-0829-12-0830-12-08NONSL1A-3A Data up to 18 Apr 09

8. List Of Confirmed Polio Cases Afghanistan 2009 NoEpidProvinceDistrictDonsetProgFeverAsymSexAgeRoutineSIAs Dlast OPV Dstool 1Dstool2HcaseLabRCluster 1AFG/08/09/007KANDAHAR SHAH WALI KOT 16-01-09YYYM1800- 21-01-0922-01-09NNSL1A-3A 2AFG/08/09/010KANDAHARDaman27-01-09YYYM120324-11-0801-02-0902-02-09NNSL1A-3A 3AFG/08/09/017*KANDAHARPanjwai21-01-09YYNF80102-06-200814-02-0915-02-09NNSL1A-3A 4AFG/08/09/020HILMANDNadiali06-02-09YYYM110114-04-0817-02-0918-02-09YNSL1A-3A 5AFG/08/09/027HILMANDKajaki02-03-09YYYM90104-08-0811-03-0912-03-09YNSL1A-3A 6AFG/06/09/040NURISTANBARGI MATAL30-03-09YYYF2431515-03-0906-04-0907-04-09NNSL1PEND *Confirmed by contact Data up to 18 Apr 09

9. Polio Virus Isolates By Type & Month, Afghanistan 05-09 2005 tOPV mOPV1 mOPV3 sNID NID 2006 2007 Short interval additional dose NSL1 NSL3 2008 2009 Data up to 18 Apr 09

10. Afghanistan & Pakistan P1 isolates by genetic cluster 2008 Pakistan ProvinceA-3AA-3DB-4APEND Baluchistan11000 NWFP42140 Sindh9700 Islamabad0030 Punjab16240 Total2515410 Afghanistan ProvinceA-3AA-3DB-4APEND Helmand7000 Kandahar10000 Farah1000 Uruzgan5000 Zabul1000 Herat1000 Total25000 B-4A A-3D A-3A Data up to 18 Apr 09

11. 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

12. 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

13. 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

14. 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 Jan11900892118%100%27 Feb10800901312%100%14 Mar 390031615%100%11 Week 1 Mar 300026413%100%00 Week 2 Mar 271020519%96%01 Week 3 Mar 35712026%80%14 Week 4 Mar total13181971713%94%26 Apr 33 ------- Week 1 Apr 99 ------- Week 2 Apr total42 0000% 00 Total AFP cases4005012765113%88%517 (4.25 %) Contacts2081501492914%93%*114 (6.73 %) * Index case AFG/08/09/017 is EV, while it’s contact is NSL1

15. 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/03/09/05804-04-09OBEHIRATM18915-03-09Right leg09-04-09YES Meningitis AFG/03/09/05907-04-09BAKWAFARAHM5115-03-09Right leg13-04-09YES Traumatic Neuritis AFG/01/09/07126-03-09 KHOST WA FIRING BAGHLHANM12416-03-09Left leg07-04-09YES - AFG/07/09/02408-04-09MATA KHANPAKTIKAF14 12-04-09 14-04-09YES - AFG/08/09/05204-04-09DISHUHILMANDF14213-01-09 Right leg 08-04-09YES Hemiplegia due to infection Right arm AFG/08/09/05305-04-09KANDAHAR F22213-01-09Left arm08-04-09YES Infective Hemiplegia AFG/08/09/05604-04-09 NAHRI SARRAJ HILMANDM361815-03-09Right leg10-04-09YES Acute Transverse Myelitis

16. Reported AFP Cases, Comparison By Month, Afghanistan 0 6 -09 @ of 2/100,0000 <15 year @ of 1/100,0000 <15 year 2006 2007 2008 Data up to 18 Apr 09 2009

17. 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 6789101112131415 Expect “2” Reported Good AFP 14-Feb21-Feb28-Feb 01-Mar14-Mar21-Mar22-Mar 04-Apr 11-Apr 18-Apr Badakhshan 10 112 0010112100 Central 63 6927 6567614650 Eastern 30 449 5124242330 Northeastern 39 7320 1096 244620 Northern 47 5821 4347644320 South East 34 246 0033322110 Southern 58 5627 3233597320 Western 55 6034 21033623411 Afghanistan 336 395146 30 283731272827161

18. AFP Cases Pending ERC, Afghanistan 2009 Data up to 18 Apr 09 EPIDDONSETDistrictProvinceSexAgeDoses Dstool2 (or 1) AsymProgressFeverLab result 60d follow-up result AFG/08/09/02309-01-09 NAWAY_I_BA RAKZAYI HILMANDM8124-02-09YES NVIRES WEAK AFG/08/09/01519-01-09 NAHRI SARRAJ HILMANDM72005-02-09NOYES NVIRES WEAK AFG/01/09/04224-01-09NAHRINBAGHLHANM144406-03-09NOYES NVIRES WEAK AFG/05/09/03525-01-09GHORBANDPARWANF144004-03-09YES NOEVDIED AFG/03/09/02414-02-09SHAHRAKGHORM5918.YES NO STOOLS DIED

19. 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/08/09/02309-01-09 NAWAY_I_B ARAKZAYI HILMANDM8124-02-09YES NVI94 Pending ERC

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

21. Non-Polio AFP Rate by Province, Afghanistan per 100,000 under 15 years (Annualized) 2009 2008 2007 0-0.99 1-2.99 3-4.99 5+ Data up to 4 Apr 09

22. % of AFP cases reported within 7 days of paralysis onset by region Afghanistan 07-09 Data up to 18 Apr 09

23. Proportion of Adequate Stools By Region Afghanistan 07-09 Data up to 18 Apr 09

24. AFP Cases with Stool Specimen Reaching The RRL Within 3 and 7 Days of 2 nd Specimen Collection By Region, Afghanistan 07-09 Within 3 days Within 7 days Data up to 18 Apr 09

25. Percentage of Entero -Virus and SL isolation Afghanistan 07-09 Entero Virus SL Percentage EV % by month 07-09 Data up to 18 Apr 09