Pandemic Influenza AH1N1 situation in Afghanistan 2009

و ایاک نستعین : 

و ایاک نستعین بسم الله الرحمن الرحیم

H1N1 Epidemiology and surveillance in Afghanistan : 

H1N1 Epidemiology and surveillance in Afghanistan Dr. Jawad Mofleh Dr. Islam Saeed Fridon Oria(DVM) 24 October 2009 Presented by: Dr. Jawad Mofleh, Director DEWS/AI coordinator

Background : 

Background Poor country Animal husbandry is a main source of income Porous borders east-south, high IMR(129/1000), MMR(1600/100000) and <5MR(191/1000) Prevalence of ARI 19% in <5 (MICS 2003), Every child has chance to get ARI 5 times a year Treatment not seek for ARI (15 days period from survey) 72% national (MICS-2003)

Background Cont… : 

Background Cont… Low education -71% of people are illiterate Almost one million births per year Young population (15-45y)( approx 45%) BPHS coverage 86%( population based) Access to ICU facilities very poor Pneumonia is one of the top five killers of under 5y

1- Surveillance : 

1- Surveillance HMIS-Monthly- over 1700 health facilities DEWS weekly-175 Hospital based -daily 34 provincial and regional and 17 national hospitals AFP(ILI) surveillance- over 1200 sites Outbreak reporting-immediately

DEWS sites : 

DEWS sites On time reporting rate in the last QTR 99.8%

2- Rapid Response Teams : 

2- Rapid Response Teams 42 teams trained 34 provinces-2007. Each team consist of 4 people IEC & CDC officers, lab tech and vet Coordinated by DEWS regional coordinator 34 teams for 34 provinces 08 back teams at the regional levels 11 teams received refresher training in 2009 -

3-Development of Protocols and guideline( H1N1, H5N1) : 

3-Development of Protocols and guideline( H1N1, H5N1) Guidelines for surveillance, response and case management developed Guidelines translated in Dari and Pashto 4000 copies of the same printed

4- National Influenza Center : 

4- National Influenza Center Located in Central Public Health Lab in Kabul Established late 2006. Recognized by WHO as National Influenza Center-April 2009 Contributes isolate to Global influenza Network and WHO CC

5- Trainings and workshops : 

5- Trainings and workshops

7-Information Education and Communication : 

7-Information Education and Communication Broadcasting of Radio and TV spots through 6 TV and 7 Radio channels IEC campaigns for Kabul, Balkh, Kandhar, Nangarhar, Herat and Bamyan regions IEC Materials for Hajj and umra visitors Posters, brochures, announcements , flip charts and Bannahers on H1N1 produced

Slide 12: 

H1N1 IEC campaigns-2009 Herat Balkh kandahar Bamyan Nangarhar IRAN Pakistan

8- Case Investigations2009 : 

8- Case Investigations2009 Afghanistan has detected 50 cases of H1N1 so far 48 cases are in Bagram airfield in military staff 2 cases in civil people( both expatriates), cases are treated and discharged 48 US citizen 1 Philippines-UN workers 1- French- NGO workers No deaths reported/detected so far All H1N1 cases were none Afghan

H1N1 cases in Afghanistan- as of 23 October 2009 : 

H1N1 cases in Afghanistan- as of 23 October 2009 Bagram airfield- 48 cases Kabul city- 2 cases

9- Supplies : 

9- Supplies

10-Other activities : 

10-Other activities Command and Control Center activated MOPH Pandemic plan of action endorsed Surveillance enhanced Hospital based daily reporting system established Number of sentinel sites increased Lab capacity improved to confirm H1N1 Tamiflu stockpile increased to 55000 Antiviral medicine released to regions RRTs received refresher training(13 provinces)

Slide 18: 

MOPH is preparing for an increased number of influenza cases: Estimated 22% of population to be ill, half of that to attend a clinic or hospital

MOPH Command and Control Center0798660829 / 0798665085 / 0798684404 : 

MOPH Command and Control Center0798660829 / 0798665085 / 0798684404

Treatment plan for the cases : 

Treatment plan for the cases Home treatment of mild cases: Mild cases will be treated at home with rest, nutrition, and necessary treatment for fever and infection according to MOPH guidelines to be made public through mass media. Treatment at Fever Clinics: When the flow of influenza patients is too high for established facilities, fever clinics will be set up and managed by the Provincial Health Departments in collaboration with the NGOs. They will provide care for patients who need intravenous medication or other treatment beyond home care. Treatment at Hospitals: The role of established health facilities and hospitals is double fold: to maintain their essential health care to non-influenza patients and to attend to more severe cases of Influenza. Admission to hospital after declaration of pandemic by GoA will be strictly limited to cases with severe complications, in need for intensive care and in particular assisted ventilation.

Health services for Hajj : 

Health services for Hajj National Health committee for Hajj established Provincial Health Committees for Hajj Established All haj visitors screened, elderly people(>65y), pregnant ladies, children under 12 and people with chronic diseases excluded a team of 80 health staff will accompany hajji this year 600 Hajj guides trained on H1N1 to give the information to Hajj visitors

Hajj services-cont... : 

Hajj services-cont... All Hajji will receive: IEC package Seasonal influenza vaccine Polio vaccine Meningitis vaccine Enough medicine and other supplies will be available for hajji Mobile teams will be available during the hajj process 24/7

Slide 23: 

Questions?