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 19 May 2018, there were 6,918 diphtheria case-patients reported through EWARS and an additional 653 case-patients were tested negative on PCR. No new deaths were reported in last four weeks. (WHO, Gov't of Bangladesh, 22 May 2018)
As of 26 May 2018, there have been 6,949 diphtheria case-patients reported through EWARS, and an additional 681 case-patients were tested negative on PCR. A total of 47 new case-patients were reported, which is slightly lower compared to previous week. Total of 42 diphtheria deaths have reported, no new death was reported this week. (WHO, 31 May 2018)
As of 2 June 2018, there were 7,682 diphtheria case-patients reported through EWARS, including 686 case-patients who were tested negative by PCR. This week 51 new case-patients (updated counts as of 5 June 2018) were reported which is slightly lower than previous week (57 case-patients in week 21). (WHO, Gov't of Bangladesh, 5 June 2018)
As of 12 June, a total 7,748 diphtheria case-patients were reported through EWARS, including 240 case-patients who were tested positive on PCR. This week 39 new case-patients were reported which is slightly lower than previous week (57 case-patients in week 21). (WHO, Gov't of Bangladesh, 12 June 2018)
As of 17 June, a total 7,772 diphtheria case-patients were reported through EWARS, including 241 case-patients who were tested positive on PCR. Last laboratory confirmed case-patients were reported on 11 June 2018. This week 25 new case-patients were reported which is slightly lower than previous week (38 case-patients in week 23, 52 case-patients in week 22 & 59 case-patients in week 21). (WHO, Gov't of Bangladesh, 17 June 2018)
As of 30 June, a total of 7,888 diphtheria case-patients were reported through EWARS, including 245 case-patients tested positive and 778 tested negative on PCR. 65 new case-patients reported which is higher than previous week. One death reported this week. Total number of deaths = 44. (WHO, Gov't of Bangladesh, 30 June 2018)
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In October 2016, Haiti was hit by its strongest hurricane for more than half a century. Hurricane Matthew caused enormous damage, killing more than 470 people, leaving more than 175 000 homeless and decimating what little infrastructure the country had.
Despite the devastation, within five days of receiving a request for help, WHO medical supplies – including cholera and malaria diagnosis and treatment kits – were being delivered to affected areas.
SITUATION OVERVIEW as of 21 March
Close to 700 000 Rohingya refugees have entered Bangladesh since 25 August 2017 (at least 90% of the total Rohingya population of northern Rakhine).
The vast majority of new arrivals are located in the densely populated Kutupalong-Balukali agglomeration, known as the “Mega Camp”. There is a serious risk of flooding and landslides, due to the fast approaching cyclone and monsoon season.
The third round of diphtheria vaccination campaign is ongoing; in the first five days, 62,658 children aged 6 months to 7 years were vaccinated with pentavalent vaccine while 89,005 children from 7 to 15 years were vaccinated with tetanus-diphtheria vaccine.
The UK is stepping up its efforts to help Rohingya men, women and children living in Cox’s Bazar, Bangladesh.
This is ahead of the fast-approaching annual cyclone and monsoon season which has the potential to cause significant devastation and loss of life.
Almost a million persecuted Rohingya people, who have fled neighbouring Burma, live in the fragile and cramped camps.
The UN estimates 102,000 of them are living in areas at risk of flooding and 12,000 people are at risk from landslides.
We travelled to Bangladesh in early March 2018 as part of our inquiry into DFID’s work in Bangladesh and Burma1 commenced in October 2017.2
The rainy season is expected to have a serious impact on life-saving services and ongoing humanitarian aid in Cox’s Bazar. The pre-monsoon and monsoon will cause access constraints to sites in both Ukhia and Teknaf, as mud roads become impassable, footpaths slippery and earthen stairs and slopes become dangerous and potentially collapse. Shelters and facilities will be damaged and flooded. The overall impact is likely to be an increase in needs for the 671,000 refugees and a more challenging response environment.
PART I: CRISIS AND NEEDS OVERVIEW
OVERVIEW OF THE CRISIS
Since 25 August 2017, targeted violence against Rohingya communities in Rakhine State, Myanmar, has forced 671,000 people - mostly women and children - to flee their homes. This exodus has become one of the fastest growing refugee crises in the world.
Funds will meet the urgent needs of nearly 900,000 refugees and more than 330,000 vulnerable Bangladeshis in the communities hosting them.
By Tim Gaynor in Kutupalong Refugee Settlement, Bangladesh | 16 March 2018
When they fled Myanmar violence six months ago, Mohammad Islam and his family had nothing to eat and were sleeping in the open lashed by monsoon rains.
Joint UNHCR/IOM Press Release
16 March 2018
United Nations agencies and NGO partners today released the 2018 Joint Response Plan (JRP) for the Rohingya Humanitarian Crisis, a US$951 million appeal to meet the urgent needs of nearly 900,000 Rohingya refugees and more than 330,000 vulnerable Bangladeshis in the communities hosting them.
671,000 new arrivals are reported as of 15 February, according to IOM Needs and Population Monitoring (NPM) Round 8 site assessment. The full dataset can be found here. The decrease is not a result of population return, but rather the use of a more detailed and accurate methodology to estimate total population figures.
As of 10 March 2018, a total of 6 132 suspected cases of diphtheria have been reported.
The third round of 13-day Diphtheria campaign started on 10 March.
There is an increase in the number of reported cases of acute jaundice syndrome relative to previous weeks.
Funding required: $23.18 B
Funding received: $936.6 M
Funding percentage: 3.8%
People in need: 128.8 M
People to receive aid: 93.6 M Countries affected: 35
UNICEF is stepping up its monsoon preparedness in Rohingya camps. Facilities at risk of floods and landslides are being reinforced, decommissioned or relocated. Five diarrhoea treatment centres are being constructed, and contingency stock (e.g. hygiene kits, aquatabs, chlorine, soap and buckets) is being prepositioned. Meanwhile, a network of 1,000 community mobilization volunteers are proactively engaging the community on how they can protect themselves during the upcoming monsoon/cyclones.
Since July 2014 it has been my privilege to hold the position of Executive Director with MSF in the UAE. As I reach the end of my tenure, I find myself reflecting on our work in recent months and years – on the projects that may come to define us as a medical humanitarian movement.
As of 3 March 2018, a total of 6 025 suspected cases of diphtheria have been reported.
There is a decline in the reported numbers of acute jaundice syndrome in week 9 relative to the previous weeks.
• The third round of the diphtheria vaccination campaign will run from 10 to 25 March 2018. Meanwhile, a declining trend is noted in Acute Jaundice Syndrome, with 87 cases reported in past week compared to 169 cases in the previous week. The total number of cases is now 921. For the first time since the crisis began, routine immunization has started in 19 fixed health posts.
Within the Rohingya refugee camps situated outside of Cox’s Bazar, Bangladesh, the lanes are crowded, thick with people in motion. Turning your head in any direction, you are swallowed by the deep sense of humanity and are carried along in the sea of movement. The mass movement of people seeking survival, relief and better lives.
More than 700,000 of these refugees have fled Myanmar into Bangladesh, and the latest threat to their survival comes not only from food insecurity, unsafe housing and disease, but the weather.