Bangladesh: Diphtheria Outbreak - Dec 2017Ongoing
Diphtheria is rapidly spreading among Rohingya refugees in Cox’s Bazar, Bangladesh, the WHO warned. More than 110 suspected cases, including 6 deaths, have been clinically diagnosed by health partners, including Médecins Sans Frontières (MSF) and IFRC. (WHO, 6 Dec 2017)
The Government of Bangladesh, with the support of UNICEF, WGO and GAVI, the Vaccine Alliance, launched a vaccination campaign against diphtheria and other preventable diseases for all Rohingya children aged six weeks to six years living in 12 camps and temporary settlements near the Myanmar border. Accelerated immunization will cover nearly 255,000 children in the Ukhiya and Teknaf sub-districts in Cox’s Bazar, while the Government and health partners continue to increase support for diphtheria treatment and prevention. (WHO, 12 Dec 2017)
From 3 November through 12 December 2017, a total of 804 suspected diphtheria cases including 15 deaths were reported among the displaced Rohingya population in Cox’s Bazar. The first suspected case was reported on 10 November by a MSF clinic in Cox’s Bazar.
Of the suspected cases, 73 per cent are younger than 15 years of age and 60 per cent are females (the sex for one percent of all cases was not reported). Fourteen of the 15 deaths reported among suspected diphtheria cases were children younger than 15 years of age. (WHO, 13 Dec 2017)
WHO has released US$1.5 million from its Contingency Fund for Emergencies to help finance scaling up of health operations in Cox’s Bazar over the next six months, in efforts to respond to an outbreak that has seen more than 1,500 probable cases, including 21 deaths. (W2HO, 19 Dec 2017)
As of 19 December, some 1,841 suspected cases of diphtheria have been reported, with 22 deaths. (WHO, 20 Dec 2017)
As of 26 December 2017, a total of 2,526 cases suspected with diphtheria have been reported with 27 deaths recorded. Over 220,000 children under the age of 15 has been vaccinated. (WHO, 27 Dec 2017)
As of 31 December, 28 deaths and 3,014 suspected cases of diphtheria have been reported from Cox’s Bazar. Nearly 10,594 contacts of these suspected cases have been put on diphtheria preventive medication. (WHO, 2 Jan 2018)
As of 6 January 2018, a total of 3,523 cases clinically suspected with diphtheria and 58 laboratory confirmed cases (out of 185 cases tested) have been reported. 104 clinically suspected cases were admitted at diphtheria treatment facilities on 6 January 2018. A total of 30 deaths have been recorded so far. The last reported death was on 2 January. (WHO, 6 Jan 2018)
WHO and UNICEF are working with Ministry of Health and Family Welfare to vaccinate over 350,000 children in the Rohingya camps and makeshift settlements with an additional dose of diphtheria vaccine. So far, 4,800 suspected cases of diphtheria and 35 deaths have been reported in Cox’s Bazar. Thirty-seven of the suspected cases were in host communities. (WHO & UNICEF, 28 Jan 2018).
As of 27 January 2018, a total of 4907 cases clinically suspected with diphtheria have been reported. Of these, laboratory specimen information was reported for 269 cases, 88 (32.7%) of which tested positive by PCR. A total of 35 deaths have been recorded as of 27 January. Reports of diphtheria have stabilized at 50-60 case-patients per day over the last 10 days which is consistent with diphtheria antitoxin use (WHO, 29 Jan 2018).
As of 10 February 2018, a total of 5,659 diphtheria case-patients were reported. A total of 38 deaths (case-fatality proportion <1%) were recorded as of 10 February. The last diphtheria related death occurred on 2 February. The second diphtheria vaccination campaign ended on 10 February, with 391 678 children up to 15 years immunized. (WHO, 15 Feb 2018).
As of 14 February 2018, a total of 5,710 suspected diphtheria cases have been reported, with 38 deaths. During the past seven days, 230 suspected cases were reported, compared to 298 cases in the previous week. This is showing a clear declining trend since the beginning of February. Among all the suspected diphtheria cases, more than 75 per cent are children below the age of 15 years and 14 per cent are under five years of age. Twelve per cent of cases have required diphtheria anti-toxin (DAT) (UNICEF, 18 Feb 2018).
As of 17 February 2018, a total of 5,764 suspected diphtheria cases were reported, with 38 deaths. The number of reported suspected cases has remained stable with 219 new cases reported. The report of the second round of diphtheria vaccination shows that 397,375 children were vaccinated with a coverage 25 per cent higher than the first round. The third round of diphtheria vaccination will start on 10 March. (UNICEF, 25 Feb 2018).
As of 1 March 2018, 5,882 suspected diphtheria cases including 38 deaths have been reported, with 171 cases in the week of 23 February. This is a declining trend from 219 and 280 cases in the preceding two weeks. The third round of diphtheria vaccination will be held from 10 to 25 March with increased focus on communicating the importance of this campaign to the community. Independent monitoring in round two led to estimates that up to 60,000 children were missed. (UNICEF, 1 Mar 2018). On 10 March 2018, the number of suspected cases rose to 6,132 (WHO, 13 Mar 2018)
As of 24 April 2018, a total 6,780 suspected cases of diphtheria have been reported. Cases continue to be reported amongst children aged 5‐14 years. No deaths were reported in week 16. During the same week, seven cases were reported from the host community, bringing the total to 64 cases. (WHO, 26 Apr 2018)
As of 28 April 2018, 6,822 cases of diphtheria with 42 deaths, including 216 cases in the last two weeks, were reported. In host communities, a total of 56 cases were reported with no deaths. (UNICEF, 5 May 2018).
As of 12 May 2018, 6,887 diphtheria case-patients were reported through EWARS and an additional 617 case-patients tested negative on PCR. No new deaths were reported in last four weeks. (WHO, Gov't of Bangladesh, 12 May 2018)
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• Between 7 - 14 May, the ISCG reports that 10 landslides and 18 wind-storm related incidents occurred in the camps, affecting 1,560 households and 7,144 individuals. 37 UNICEF-supported learning centres were damaged after a few hours of rain and light gust of winds but quickly repaired.
In the face of the ethnic cleansing, some argue genocide, of the Rohingya by the Burmese authorities—and with a return to attacks against ethnic groups in the North East of Burma—it is time for the DFID once again to review its engagement with Burma.
Fifth Special Report
On 20 March 2018, the International Development Committee published its Third Report of Session 2017-19, on Bangladesh and Burma: the Rohingya crisis - monsoon preparedness in Cox’s Bazar. The response from the Government was received on 14 May 2018. The response is appended below.
Appendix: Government Response
USG provides more than $94 million in additional support to crisis-affected populations in Burma, Bangladesh
USAID Administrator conducts official visit to Burma, Bangladesh to observe ongoing relief efforts
Relief actors conduct preparedness activities ahead of cyclone, monsoon seasons in Burma, Bangladesh
Epidemiological Highlights Week 19
An estimated total FDMN population of 866 000 and 728 786 (84%) are under surveillance in Early Warning Alert and Response System (EWARS).
To date, 170 health facilities are currently registered as active EWARS reporting sites with one new facility registered this week.
In week 19, 125 weekly reports were received by Tuesday, resulting in a cumulative completeness of 70% for 2018.
From 8 November 2017, a total 6 887 suspected cases of diphtheria have been reported. A total of 42 deaths were reported in EWARS during this time.
The Oral Cholera Vaccination (OCV) campaign was successfully completed on 13 May, 2018. A total of 901 810 beneficiaries were vaccinated.
To date a total of 92 223 Acute Watery Diarrhea (AWD) case-patients have been notified through Indicator Based Surveillance in EWARS bringing. WHO and partners continue to prepare for likely outbreak.
New Rohingya arrivals since 25 August 2017 in Cox’s Bazar
Rohingya Population in Cox’s Bazar
People in Need in Cox’s Bazar
Strengthening government health services is a key part of the Joint Response Plan through support with equipment, training and institutional support. Cox’s Bazar District Hospital, and Teknaf and Ukhia upazila Health complexes will be supported including provision of laboratory capacity.
On 13 April, UNHCR and Bangladesh signed a MoU, which provides the framework for voluntary, safe, and dignified returns of refugees once conditions in Myanmar are conducive. UNHCR does not believe that current conditions in Rakhine State are currently conducive to returns.
More than 2000 families have been relocated for their safety due to risk of landslide or flooding, and relocations of new arrivals from the UNHCR Transit Centre moving to the main Kutupalong settlement.
A total of 34 IOM staff attended BBC Media Action Training on how to facilitate radio listening groups so that people listen to themed radio programs on issues that affect them, and then discuss the topic.
The two Oral Rehydration Points (ORP) at Kutupalong Primary Healthcare Centre and Leda PHCC have treated a total of 84 Acute Watery Diarrhoea (AWD) cases in the last week.
A total of 47,922 hygiene top-up kits have been distributed through six partners, reaching 239,610 beneficiaries.
From 8 November 2017, a total 6 860 suspected cases of diphtheria have been reported. Cases continue to be reported amongst children aged 5-14 years.
About 985 000 people are being targeted in the Oral Cholera Vaccine (OCV) campaign that commenced on 6 May 2018 including 135 000 from the host community. Over 464 000 people have been vaccinated by day four.
Epidemiological Highlights Week 18
An estimated total FDMN population of 866 000 and 728 786 (84%) are under surveillance in Early Warning Alert and Response System (EWARS).
To date, 169 health facilities are currently registered as active EWARS reporting sites including the twelve new MoH facilities.
In week 18, 110 weekly reports were received by Tuesday, resulting in a cumulative completeness of 69% for 2018.
Since 25th August 2017, Bangladesh has welcomed over 693,000 forcibly-displaced Rohingyas1 from Myanmar who require immediate, ongoing humanitarian services to address their basic needs. The concentration of displaced people in Cox’s Bazar district of Bangladesh is now among the densest in the world. Taking into account the pre-existing Rohingya population in the area, and affected members of the host community, roughly 1.3 million people are in need of comprehensive services and support.
During the reporting period, moderate rain and strong winds started affecting the land and the walkways in the camps; making them muddy and therefore risky for people to move around. Several temporary learning centres were damaged but quickly repaired to allow for continued learning.
From 6-13 May, the second round of Oral Cholera Vaccine (OCV) campaign will take place, targeting nearly one million people above one year of age from both refugee and host communities. Some 259 teams are deployed to support the campaign.
• From 8 November 2017, a total 6 822 suspected cases of diphtheria have been reported. Cases continue to be reported amongst children aged 5-14 years.
• According to Early Warning Alert and Response System (EWARS), in 2018, acute respiratory infections and AWD are the two leading syndromes with highest proportional morbidity of 11.8% and 5.3%, respectively. Both diseases and mosquito-borne diseases are at risk of causing severe outbreaks during monsoons and are being monitored by WHO team.
A Training of Trainers has been conducted for 35 Site Management field staff on Basic First Aid. These trained field staffs will conduct training for safety committees at the Camp level.
The Shelter/NFI unit is conducting random monitoring of shelter upgrades in KutupalongBalukhali Expansion (KBE) to assess the effectiveness of technical guidance and follow-up following recent high winds in the region.
Description of the disaster
Since 25 August 2017, 671,000 people, the majority of whom are women and children, have fled violence in Rakhine state, Myanmar and have crossed the border to seek shelter in Cox’s Bazar, Bangladesh. The newly displaced people is an addition to the 212,538 people who had already fled from Rakhine state, Myanmar to Cox’s Bazar, Bangladesh in successive displacement flows in the last few decades. In total, there are an estimated 884,000 people from Rakhine in Cox’s Bazar.
GENEVA, 1 May 2018 - This is a summary of what was said by Christophe Boulierac, UNICEF spokesperson in Geneva – to whom quoted text may be attributed – at today's press briefing at the Palais des Nations in Geneva.
The pre-monsoon rains have started in Cox’s Bazar, which is one of the most flood prone areas of Bangladesh. On the night of the 26th April, a storm damaged shelters and affected several families in refugee camps.
Weekly Situation Report # 23
Date of issue: 26 April 2018
Period covered: 17 April – 24 April
From 8 November 2017, a total 6,780 suspected cases of diphtheria have been reported. Cases continue to be reported amongst children aged 5‐14 years.
37 medical technologists and medical assistants participated in Laboratory diagnosis of malaria using Rapid diagnostics and Microscopy.