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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To date, there are nearly 860,000 Rohingya refugees in Cox’s Bazar – of whom 646,000 have arrived since 25 August. Not only has the pace of new arrivals since 25 August made this the fastest growing refugee crisis in the world, the concentration of refugees in Cox’s Bazar is now amongst the densest in the world.
1. Population under Epidemiological Surveillance and Reporting Units
During epidemiological week 48 (26 November-2 December 2017), there was a 0.1% decrease in the population1 under EWARS compared to the previous epidemiological week (from 827,609 to 827,181). Overall, the settlement populations remained more or less stable.
The number of suspected diphtheria cases among the Rohingya refugees in Cox's Bazaar has increased to 549, with nine confirmed deaths as of 11 December. The extremely congested conditions in the camps, low immunization coverage of the refugees, the lack of clean water and proper sanitation facilities are conducive to a rapid spread of the epidemic, with the number of cases expected to double every three to five days.
As of 6 December, 110 clinically diagnosed cases of diphtheria, including six deaths have been reported, with most cases in the Balukhali makeshift settlement (BMS), located in the larger Kutupalong–Balukhali expansion site. Other cases have been detected in Jamtoli and Thangkhali settlements. Low vaccination coverage amongst the camp population increases their vulnerability to the disease, which is particularly deadly for children. Congestion in sites, unevenly distributed health facilities and poor WASH infrastructure facilitate the spread of the disease, particularly during winter.
The number of displaced people in the Eastern Region reached nearly 110,000, including more than 93,000 people in Nangarhar Province. Of those displaced in Nangarhar, 56,000 arrived since mid-October from Khogyani due to fighting between armed groups. In total, more than 390,000 people in Afghanistan have been displaced this year.
390,000 people displaced
What you need to know today
A total of 646,000 forcibly-displaced Myanmar nationals have entered Bangladesh since 25 August (Source: ISCG report, 7 December)
BRAC's total coverage (based on sanitation) is 498,680 people with installation of 12,467 latrines (181 today). BRAC ensures access to safe water for 320,956 people through 1,201 shallow tube wells, 24 deep tube wells, three ring wells. 2,578 bathing cubicles were set up (88 today) especially for women and adolescent girls.
6 DECEMBER 2017 | GENEVA - Diphtheria is rapidly spreading among Rohingya refugees in Cox’s Bazar, Bangladesh, WHO warned today.
More than 110 suspected cases, including 6 deaths, have been clinically diagnosed by health partners, including Médecins Sans Frontières (MSF) and the International Federation of the Red Cross (IFRC).
As of 6 December 2017, the cumulative number of new arrivals in all sites was 626,000. This number includes over 343,000 arrivals in Kutupalong Balukhali expansion site, 237,000 in other camps and settlements, and 46 000 arrivals in host communities.
As of 6 December, 354,982 adolescents and children received measles and rubella vaccination. Rapid convenience assessments are being carried out in parallel to the campaign, and based on their results corrective actions will be taken.
According to a WHO statement on 6 December, diphtheria is rapidly spreading in the refugee camps in Cox's Bazaar, with the epicentre of the outbreak being located in Kutupalong, Balukali and Jamtoli refugee camps. As of 8 December, over 110 people have contracted the disease, including six fatalities. The majority of people affected are between 5 and 15 years old. This airborne disease is highly contagious in congested environments. Immediate relocation of populations and additional sites and land are required to limit the spread of the outbreak.
1. Overview of the Early Warning and Response System (EWARS)
The World Health Organization (WHO) in collaboration with the Ministry of Health and Family Welfare (MOHWF) established a disease early warning and response system (EWARS) in Cox’s Bazar district, Chittagong division in Bangladesh as a response to the influx of Forcibly Displaced Myanmar Nationals (FDMN) in early September 2017.