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)
As of 17 July, a total of 7,986 diphtheria case-patients were reported through EWARS, including 260 case-patients tested positive and 884 tested negative on PCR. During week 28, 38 new case-patients reported which is higher than previous week. (WHO, Gov't of Bangladesh, 17 Jul 2018)
Most read (last 30 days)
- ISCG Situation Report: Rohingya Refugee Crisis, Cox’s Bazar | 05 July 2018
- WHO EMRO Weekly Epidemiological Monitor: Volume 11, Issue 26 (1 July 2018)
- Bangladesh: Humanitarian Situation report No.35 (Rohingya influx) 17 June – 04 July 2018
- ISCG Monsoon Emergency Response Update - Rohingya Refugee Crisis, Cox's Bazar, Bangladesh (4 - 10 July 2018)
- ISCG Situation Report: Rohingya Refugee Crisis, Cox’s Bazar | 19 July 2018
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.
As of 28 February 2018, a total of 5 882 suspected cases of diphtheria have been reported.
The Diphtheria vaccination campaign in the host community in Teknaf upazila, vaccinated 39 222 children (97% coverage) from 17 February to 22 February with pentavalent vaccine in the age group of 1 to 5 years.
There is a decline in the reported numbers of suspected measles/rubella cases as well as acute watery diarrhea in week 8 relative to the previous week
An estimated 688 000 Rohingya have crossed over to Bangladesh following violence in Myanmar’s Rakhine state on 25 August 2017.
The ongoing challenges in safe water, sanitation and hygiene raise, together with the upcoming rainy season, risk of outbreaks of waterborne and diseases transmitted through the fecal-oral route, as well as vectorborne diseases among others.
The second round of vaccination campaign against diphtheria concluded on 10 February with 391 678 children (109% of estimated target) immunized.
• UNICEF has released a Child Alert to commemorate the six-month mark of the beginning of the crisis on 25 August 2017.
• During the past seven days, 219 suspected diphtheria cases were reported indicating a declining and stable trend. The third round of diphtheria vaccination will start from 10 March.
• 290,700 people now have access to safe drinking water and 391,090 people have access to sanitation facilities.
• UNICEF is providing non-formal education to 82,006 children and psychosocial support to 141,227 children.
• 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.
Humanitarian access to northern Rakhine remains constrained, limiting relief actors’ ability to conduct needs assessments and implement activities.
Preparations for refugee repatriation are ongoing, despite continued insecurity.
Relief actors prepare for upcoming cyclone and monsoon seasons in Cox’s Bazar.
KEY DEVELOPMENTS ￼￼￼￼￼
Cox’s Bazar – It will be six months, this Sunday (25/02), since almost 700,000 Rohingya refugees fleeing violence in Myanmar started arriving in Bangladesh.
In one of the world’s biggest forced migrations in recent years, around half a million people crossed the border in just two months after 25 August. Early images of tens of thousands of frightened and exhausted families filing through muddy paddy fields or crammed into rickety boats during their flight shocked the world.
As of 17th February 2018, a total of 5 764 suspected cases have been reported
The second round of vaccination campaign against diphtheria along with sweep activity concluded on 14th February 2018 397,375 children up to 15 years immunized.
With the last major outbreak happening decades ago, most MSF staff had only ever seen diphtheria in textbooks. MSF medical team leader Carla Pla describes the challenges of treating the disease amongst the refugee settlements of southeastern Bangladesh.
More than 2,000 Bangladeshi and international staff members—from doctors, nurses, and mental health counselors to logisticians, translators, and social workers—are working with Doctors Without Borders/Médecins Sans Frontières (MSF) to respond to the Rohingya refugee crisis in Bangladesh. MSF operations here have rapidly scaled up since late August 2017.