:: WHO Event Information for IHR National Focal Points ::

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Afghanistan / Q fever
Hazard Infectious Places Not Available Verification Status WHO-NFP risk assessment ongoing Date Information First Received by WHO 2011-07-11 IHR Status Public Health Risk (PHR) Laboratory Confirmed WHO IHR Contact Point WHO IHR Contact EMRO Phone: +201 0006 9722 Email: ihr@emro.who.int Fax: +202 2276 5456 Attachments Current Risk Assessment Serious Public Health Impact Unusual or Unexpected International disease spread Interference with international travel or trade Risk Assessment Comments Serious Public Health impact: Intercurrent outbreaks of Q fever and brucellosis has been confirmed in blood samples from 28 cases from Punjab and Yakawlang districts of Bamyan province. This finding have substantial public health implications in the immediate and longer term at national, and potentially at regional levels, as these outbreaks are associated with a high economic and health burden due to loss of livestock and productivity and the need for prolonged treatment of cases. The implementation of control measures, including sustained enhanced surveillance and the required case management activities, is expected to pose a challenge to the national public health system. Unusual or unexpected: Afghanistan has several zoonotic diseases which occasionally cause disease outbreaks in humans. However, this is the first time that the Ministry of Public Health has detected Q fever in the population of Afghanistan. Furthermore the occurrence of intercurrent Q fever and brucellosis is an unusual and unexpected event which requires action in the immediate and longer terms. These findings may also have implications for the international public health community, especially through the cross-border movement of animals. In Afghanistan, there is also a risk of new sporadic cases due to the level of environmental contamination and a mobile animal population. International disease spread: Intercurrent outbreaks of brucellosis and Q fever have been detected in which all cases have been in contact with animals and their products. Although neither disease is spread by human-to-human transmission, illegal movement of animals is common between Afghanistan and its neighbouring countries with the risk of some cross-border Interference with international travel or trade: In response to outbreaks of Q fever and brucellosis with long-term health and economic impact detected in Afghanistan, there is a need to strengthen public health measures including enhanced surveillance to be in place at borders to watch over animal movement. Currently, there is no evidence to support any restrictions on animal movement in Afghanistan.

Event

Update - Intercurrent Q fever and brucellosis outbreaks in Bamyan Province as at 2011-08-18

2011-08-23 On 10 July 2011, the IHR National Focal Point of the Islamic Republic of Afghanistan reported to WHO outbreaks of brucellosis and Q fever in Yakawlang and Panjab districts of Bamyan province affecting 147 individuals. Currently, there are also reports of other cases in the area. The laboratory findings on 28 patients are presented in this report. All 28 samples tested positive for brucellosis using the Rose Bengal agglutination slide test and 27 were also positive for Q fever by PCR. The results of testing carried out at the Central Veterinary Diagnostic and Research Laboratory (CVDRL) of Afghanistan were confirmed by the UN Food and Agriculture Organization (FAO). In Afghanistan, three outbreaks of brucellosis have been reported countrywide from 2007 to 18 August 2011 by the Disease Early Warning System (DEWS), Ministry of Public Health (MOPH). Outbreaks were reported in the Punjab district, Bamyan province in 2007 (35 cases) and 2008 (10 cases). No outbreaks were reported nationally in 2009 and 2010. Although seroprevalence studies since 2007 have confirmed Q fever in small ruminants in Afghanistan, and sporadic laboratory-confirmed cases have been reported in foreign troops returning from Afghanistan, this is the first reported outbreak of human Q fever. Overall, the average age of the reported cases is 30 years, with an age range from 5 years - 70 years. Public health actions Brucellosis and Q fever are commonly spread through airborne transmission (dust in environments contaminated by placental tissues, birth fluids and excreta of infected animals), direct contact with infected animals and their body fluids and tissues, and through the ingestion of raw milk. The following acute care and public health measures are being carried out by the MOPH: 1. Physicians are being trained on the case management and treatment protocols of brucellosis and Q fever. Treatment guidelines are being distributed to each health facility in the affected region. 2. Disease Guidelines for brucellosis and Q fever have been adopted and sent to field officers. The MOPH is translating the guidelines into Persian and Pashto. 3. The MOPH is coordinating access to medicines with support from implementing NGOs for provision of treatment in the affected areas. 4. In collaboration with the MOPH Health Promotion Department, health education campaigns on diseases and their prevention are being conducted based on the existing cultural practices regarding farm practices and animal product use. MOPH is working on a large health education campaign which WHO is supporting financially and with the provision of technical materials.

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5. The MOPH and WHO have started enhanced surveillance activities in Bamyan province to collect more details about these diseases. 6. Laboratory specimens (18) from the same 28 positive are being sent to the WHO Collaborating Centre for Rickettsioses and other Arthropod Borne Bacterial Diseases, Marseilles, France, for reference and further investigations. Animal control measures This first reported outbreak of human Q fever in Afghanistan against a background of brucellosis activity highlights the need to strengthen public health measures for the prevention and control of endemic zoonotic diseases, including implementing enhanced surveillance at Afghan borders jointly by Afghanistan health authorities and their counterparts in neighbouring countries to check animal movement. The following steps are taken with Ministry of Agriculture, Irrigation and Livestock (MAIL) and FAO for the prevention and control purposes. 1. Agreement on the establishment of zoonotic diseases task force. The task force main members are relevant representatives of MoPH, MAIL, WHO, FAO and NGOs. The TOR for the task force is developed. 2. Joint health education campaign and animal vaccination (15 000 animals) in the affected area is planned.

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