Bangladesh: Diphtheria Outbreak - Dec 2017Ongoing
Diphtheria is rapidly spreading among Rohingya refugees in Cox’s Bazar, Bangladesh, WHO warned on 6 December 2017. More than 110 suspected cases, including 6 deaths, have been clinically diagnosed by health partners, including [MSF] and [IFRC]. (WHO, 6 Dec 2017)
The Government of Bangladesh, with the support of UNICEF, [WGO] and GAVI, the Vaccine Alliance, today launched a vaccination campaign against diphtheria and other preventable diseases for all Rohingya children aged 6 weeks to 6 years living in 12 camps and temporary settlements near the Myanmar border. Accelerated immunization will cover nearly 255 000 children in 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 2017 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 2017 by a clinic of Médecins Sans Frontières (MSF) in Cox’s Bazar.
Of the suspected cases, 73% are younger than 15 years of age and 60% females (the sex for one percent cases was not reported). Fourteen of 15 deaths reported among suspected diphtheria cases were children younger than 15 years of age. To date, no cases of diphtheria have been reported from local communities. (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. (WHO, 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).
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I was shocked by the stories I heard from Rohingya children on my recent visit to Bangladesh + to see the work of UNICEF and its partners to help 680,000 Rohingya refugees, 58% of which are children.
As of 27January 2018, a total of 4 907 cases clinically suspected with diphtheria have been reported.
A second diphtheria vaccination campaign started, targeting 363 537 Rohingya refugees aged 6 weeks to 15 years.
A joint health and WASH sector survey of health facilities started to inform implementation of priority WASH and IPC interventions.
SITUATION OVERVIEW as of 30 Jan.
688 000 refugees into Bangladesh (of which 585 000 in Kutupalong and Bulukhali camps)
4 865 clinically suspected Diphtheria cases and 31 deaths (reported in refugee camps)
In parallel, an increase in mumps cases has been reported.
Total population of 728,786 (84%) persons under surveillance. 147 (93%) of 158 health facilities enrolled in EWARS.
Completeness of reporting in W4 was 69% (101/147 health facilities).
Total of 95 alerts were triggered, of which 100% were verified; 3% are undergoing risk assessment, and 3% completed risk assessment.
Situation in Numbers
720,000 Children in need of humanitarian assistance.
1.2 million People in need (HRP 2017 - 18)
399,040 Children (arrived since 25 August 2017) in need of humanitarian assistance
688,000 New arrivals since 25 August (ISCG SitRep, as of January 27, 2018 )
As of 13 January 2018, a total of 4 119 cases clinically suspected with diphtheria have been reported. Of these, laboratory specimen information was reported for 228 cases, 61 (27%) of which tested positive by PCR. 108 clinically suspected cases were admitted at diphtheria treatment facilities on 13 January 2018. A total of 32 deaths have been recorded so far.
A diphtheria outbreak is raging in the refugee camps in the Cox’s Bazar area of Bangladesh, where nearly 700,000 Rohingya people have settled after fleeing violence and persecution across the border in Myanmar. Doctors Without Borders/Médecins Sans Frontières (MSF) doctor Rosie Burton recently returned from Bangladesh, where she spent one month working in a diphtheria treatment center run by the organization. Here, she describes the situation.
A. SITUATION ANALYSIS
Since 25 August 2017, 655,000 people4 , 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 (People from Rakhine) add to the 212,538 people who had already fled from Rakhine state, Myanmar to Cox’s Bazar, Bangladesh in successive displacement flows - most recently in October 2016. In total, there are 832,112 People from Rakhine in Cox’s Bazar.
More than 17,000 people have reportedly been displaced in Afghanistan in the past week. This includes more than 10,000 people who fled military operations in Chardarah district, Kunduz Province, and arrived in Kunduz City, according to initial information. Following an attack on the office of Save the Children in Jalalabad, Kandahar Province, that killed four staff members, the international NGO suspended activities across the country.
17,000 people displaced
Cox’s Bazar, 28 January 2018 – Stepping up efforts to curtail the ongoing diphtheria outbreak in Cox’s Bazar, 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.
• Humanitarian access to northern Rakhine remains limited; insecurity and intercommunal tensions persist
• Approximately 900,500 people displaced from Burma to Bangladesh need assistance
• FFP contributes $18.4 million to WFP to support vulnerable populations in Bangladesh
Number of health facilities: 15 health posts, three primary health centres and five inpatient health facilities
Number of staff: More than 2,000 national and international staff as of the end of November
Number of patients: More than 200,000 patients have been treated at MSF outpatient facilities and 4,938 patients in inpatient facilities between the end of August and the end of December
Main morbidities: respiratory infections, diarrhoeal diseases, diphtheria
900,000 Rohingya Population in Cox’s Bazar District
688,000 New Rohingya Arrivals since 25 August 2017 in Cox’s Bazar
1.2 Million People in Need in Cox’s Bazar
A Shelter/NFI Common Pipeline has been established, including an application system and supply numbers. Agreements with pipeline partners will be signed from next week aiming to release the Upgrade Shelter Kits (USKs) from the beginning of February 2018.
What you need to know today:
A total of 655,500 forcibly-displaced Myanmar nationals have entered Bangladesh since 25 August (Source: ISCG report, 14 January 2018)
Nearly 688,000 refugees have arrived since 25 August 2017, of which 399,040 are children.
As of mid-January, 41 suspected diphtheria cases have been identified in the host community. The campaign in host community schools for Pentavalent and Tetanus-Diphtheria (Td) vaccination was finalized and reached 168,842 children (97%) of the total target of 174,403 children; 293 cases of measles have been reported during the first two weeks of January 2018.
The alert level for the Mayon Volcano has been raised to Level-4 due to increased seismic unrest, lava fountaining and explosions. The volcano spewed a 10-kilometer high ash column on 22 January, with authorities warning of an imminent hazardous eruption, possibly within days. The eruption resulted in moderate to heavy ash fall, with low-visibility reported in the towns of Guinobatan, Camalig, and Ligao located to the southwest of the volcano.
Total population of 766,460 (89%) under surveillance. 145 (92%) of health facilities enrolled.
Completeness of reporting in W2 was 63% (92/145 health facilities).
Total of 70 alerts were triggered, of which 92% were verified and 14% are undergoing risk assessment.
Total of 53 indicator based alerts:
The first meeting of the Bangladesh/Myanmar Joint Working Group was held on 15 January in Naypiydaw, Myanmar. Discussions reportedly focused on the modalities for the return of refugees.
The right of refugees to return voluntarily should continue to be at the core of the dialogue between the Governments of Bangladesh and Myanmar. In addition to voluntary returns must be safe, dignified and sustainable.
The relocation of 9,400 refugees from Bandarban, near the border with Myanmar, to Kutupalong settlement began on 14 January 2018. It will continue in the next weeks.
Nearly 656,000 refugees have arrived since 25 August 2017, among them 380,190 are children.
As of 11 January 2018, over 4,000 cases of suspected diphtheria were reported, with 32 deaths registered. Over 54 per cent of these deaths occurred among children under five years.