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).
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).
Most read (last 30 days)
- Over 350,000 children to get additional dose of diphtheria vaccine in Cox's Bazar
- Bangladesh: Rohingya Emergency Response EWARS Epidemiological Bulletin W4 2018, 30 January 2018
- Restoration of rights key to Myanmar refugee return, UNHCR’s Grandi says
- Bangladesh: Humanitarian Situation report No.21 (Rohingya influx) 4 February 2018
- Bangladesh: Humanitarian Situation report No.19 (Rohingya influx) 21 January 2018
What you need to know today
• A total of 655,000 forcibly-displaced Myanmar nationals have entered Bangladesh since 25 August (Source: ISCG report, 31 December)
Doctors Without Borders/Médecins Sans Frontières doctor Nina Goldman is currently in Bangladesh, where MSF provides medical care to hundreds of thousands of Rohingya refugees who fled violence in neighboring Myanmar. Here, she describes the diphtheria outbreak that is currently affecting the makeshift camps where refugees have settled.
What you need to know today
• A total of 655,000 forcibly-displaced Myanmar nationals have entered Bangladesh since 25 August (Source: ISCG report, 26 December)
Since 25 August, more than 656,000 Rohingya refugees have fled violence in Myanmar and crossed into Cox’s Bazar, Bangladesh. Not only has the pace of new arrivals made this the fastest growing refugee crisis, the concentration of refugees in Cox’s Bazar is now amongst the densest in the world.
212,000 Rohingya estimated to be in Cox’s Bazar before the August influx
656,000 New arrivals as of 31 December 2017
868,000 Total number of Rohingya refugees estimated to be in Cox’s Bazar.
Cox’s Bazar, Bangladesh, 2 January 2018 - As schools reopened on 1st January after the winter break, children in Ukhia sub-district of Cox’s Bazar, Bangladesh, lined up to not only receive new books, but also a dose of diphtheria tetanus (DT) vaccine.
Children were vaccinated by WHO and UNICEF mobilized vaccinators and military nurses, as all health system staff remained on country-wide strike.
This article was first published in The National, UAE Edition.
655,500 new arrivals (Since 25th August) are reported as of 31 December (IOM Needs and Population Monitoring).
Since the latest weekly situation report on 17 December, there have been 628 new arrivals.
Kindly note that due to the holiday period, not all sectors are represented in this situation report.
The next full situation report will be issued on 14th January.
655,500 Cumulative arrivals since 25 Aug
548,000 Arrivals in Kutupalong Expansion Site
As of 26 December 2017, a total of 2 526 cases suspected with diphtheria have been reported, of whom 96 presented at the treating health facilities on 26 December 2017. A total of 27 deaths have been recorded so far.
As of 26 December, 109 487 children 6 weeks to under 7 years were vaccinated with Penta,
PCV, and bOPV and 102 383 children aged 7-15 years were vaccinated with Td vaccine.
In the past week, some 700 Rohingya refugees crossed into Bangladesh through Teknaf. They were assisted by UNHCR and partners and transfer to Nayapara settlement.
The Governments of Bangladesh and of Myanmar established a Joint Working Group (JWG), which is tasked to develop a specific instrument for repatriation.
A referral pathway for “persons at heightened risks” has been rolled out. It aims to ensure that identified refugees in need are linked to specialized services and care.
Rohingya Population in Cox’s Bazar
New Arrivals since 25 August 2017 in Cox’s Bazar
People in Need in Cox’s Bazar
As of 28 December, IOM has distributed over 124,000 tarpaulins, 9,000 bamboo bundles, 200,000 blankets, 125,000 floor mats and 35,000 kitchen sets as key emergency shelter materials.
More than 40 British doctors, nurses and firefighters from the UK’s Emergency Medical Team are going to Bangladesh to treat the disease.
More than 40 British doctors, nurses and firefighters from the UK’s Emergency Medical Team (EMT) are making their way to Cox’s Bazar, Bangladesh to save thousands of lives at risk from a rapid and deadly outbreak of diphtheria.
The humanitarian situation for Rohingya refugees in Bangladesh remains dire, with some 655,000 refugees newly arrived since 25 August 2017. At least 58% of them are children. Even if the pace of arrivals has slowed down, thousands of refugees continue to arrive every week, adding pressure on already heavily stretched resources on the ground.
Further disease outbreaks are likely if the refugees’ living conditions don’t improve.
Diphtheria, a disease long forgotten in most parts of the world thanks to increasing rates of vaccination, is re-emerging in Bangladesh, where more than 655,000 Rohingya have sought refuge since 25 August, following increased violence in Myanmar. As of 21 December, Médecins Sans Frontières (MSF) has seen more than 2,000 suspected cases in its health facilities and the number is rising daily. The majority of patients are between five and 14 years old.
A total of 2248 cases suspected of diphtheria, of whom 26 died, have been reported from 8 November – 23 December 2017. The District Core Committee for Diphtheria Outbreak, chaired by the Civil Surgeon of Cox’s Bazar, has been formalized with WHO and partners to contain the spread of diphtheria through effective treatment, vaccination, and contact tracing activities.
Over the 8 week period, from October 16 to December 10, the 5 most frequently reported diseases/syndromes were: unexplained fever (98 523 cases, 15.9%), acute respiratory infection (68 769 cases, 11.1%, with higher incidence rate among children less than 5 years old), acute watery diarrhoea (65 092 cases, 10.5%), and skin diseases (28 693 cases, 4.6%, with similar numbers of reported cases among both children aged under 5 and individuals aged 5 years and older).
Epidemiological overview as of 25 Dec 2017
Between 8 Nov 2017 and 25 Dec 2017, 2440 suspected case-patients with diphtheria were reported in the settlements of forcibly displaced Myanmar nationals, Cox’s Bazar (Figure 1), 80 of which were reported on 25 Dec 2017 (Figure 2). Date of onset information is missing for 111 (4.5%) case-patients.
PHILIPPINES / VIET NAM
Since 25 August, MSF has massively scaled up its operations in Cox's Bazar, Bangladesh.
Number of MSF health facilities: 19 health posts, three primary health centres and four inpatient health facilities
Number of staff: 2,258 national and international staff as of the end of November
What you need to know today
A total of 655,000 forcibly-displaced Myanmar nationals have entered Bangladesh since 25 August (Source: ISCG report, 21 December)
SITUATION OVERVIEW as of 20 Dec
Diphtheria cases tot. number: 1 841 (8 Nov.-20 Dec., reported in the camps for forcibly displaced Myanmar nationals south of Cox’s Bazar)
22 confirmed deaths among Rohingya
Overall living conditions in camps are poor and with extreme overcrowded situation, with lack of medical/health facilities