Myanmar: Acute Watery Diarrhoea (AWD) Outbreak - May 2024

The military-controlled Ministry of Health has confirmed the presence of cholera in Yangon in an official statement. As of 17 July, there are 77 confirmed cases of hospitalisation. According to other reports, cholera cases have also been identified in Rakhine, Chin and East Bago regions, with local media reporting over 240 hospitalisations. The World Health Organization (WHO) is providing training to local health workers, while the in-country water, sanitation and hygiene (WASH) humanitarian cluster has a response plan that includes a rapid response team, capacity building, water supply and provision of non-food items (NFIs). Rapid assessment is partially hindered by ongoing conflict and access restrictions across the country. DG ECHO is assessing the situation and possible response together with humanitarian partners. (ECHO, 17 Jul 2024)

Since late June, severe diarrhea cases have been admitted to hospitals in some townships in the eastern district of Yangon, including Thaketa Township. As of 23 July 2024, a total of 1,645 cases were hospitalized with Acute Watery Diarrhea (AWD), of which 269 had severe dehydration. WHO is supporting the response to the outbreak in collaboration with partners. (WHO, 07 Aug 2024)

[...] According to the SAC ministerial authorities for health, a total of 2,261 hospitalized cases of acute watery diarrhoea (AWD) and 161 hospitalized cases of AWD with severe dehydration were reported from 44 townships in Yangon Region, as of 8 August. Among them, 15 cases died and the cause of the deaths is unknown. The most affected townships were Botahtaung, Dawbon, Hlaingtharyar, Thaketa and Thingangyun. [...] During the last week of July, more than 40 severe diarrhoea cases including suspected cases of cholera were identified in IDP camps and villages in Sittwe Township in Rakhine State. (OCHA, 16 Aug 2024)

According to the ministerial authorities for health, as of 18 August 2024, a total of 2 957 hospitalized cases of acute watery diarrhea (AWD) including 160 cases with severe dehydration were reported in Yangon Region, since 24 June 2024. [...] As per information from open sources, it has been reported that cases are on the rise again in some townships. According to the early warning and response systems (EWARS) supported by the Health Cluster in Myanmar, an increase of AWD cases has been observed in Sittwe in Rakhine State. A notable surge of cases, including those with severe dehydration, has been observed since late July. Cholera infection is confirmed in some of those AWD cases. During the most recent epidemiological week (week 34, from18 to 24 August), a total of 364 new AWD cases were reported, including 22 AWD cases with severe dehydration. This represents an increase compared to the 197 AWD cases reported in the previous week (week 33, from 11 to 17 August). The AWD cases were reported from both camps and residential areas in Sittwe. (WHO, 28 Aug 2024)

According to the ministerial authorities, 154 severe cases and 15 deaths were reported in Yangon among 3,421 cases between 24 June and 8 August (causes of 15 deaths were uncertain and may not be linked to severe AWD/cholera), while there were no reports of severe case and death after 8 August. According to the ministerial authorities for health, from 4 to 25 August 2024, a total of 235 hospitalized AWD cases including 63 cases with severe dehydration were reported in Sittwe, Rakhine. (WHO, 9 Sep 2024)

A cluster of AWD cases including cases with severe outcomes were observed around Kyaikkhami Township, Mon State. With the severe flooding caused by the remnants of the Typhoon Yagi in the context of ongoing monsoon, the risk of AWD, including potential transmission of cholera, is heightened in flood-affected areas. 2.4 million doses of oral cholera vaccines (OCVs) arrived in Myanmar for the vaccination campaign, which started in Yangon Region on 22 September 2024. After 25 August 2024, no official data on AWD cases and deaths were shared publicly. In Yangon, in the epidemiological week 38 (15-21 September 2024), a total of 5 AWD cases were recorded, 72% decrease compared the week 37 (8-14 September 2024); the reasons for sudden decrease of AWD cases are not well understood. (WHO, 25 Sep 2024)

According to the ministerial authorities for health, in Yangon Region, a total of 576 hospitalized cases of acute watery diarrhea were reported from 9 September to 6 October 2024. Reactive vaccination campaign using oral cholera vaccine (OCV) was carried out in Yangon Region, where a total of 2,451,847 doses of were received to cover 34 townships. A total of 70,243 OCV doses of OCV were re-allocated to three townships in Mon State, with approval from the International Coordinating Group (ICG) for vaccine provision. As of 15 October, 32,309 people have received the vaccine. (WHO, 16 Oct 2024)

According to the ministerial authorities for health, in Yangon Region, a total of 250 hospitalized cases of acute watery diarrhea (AWD) were reported in the week 43 (20 to 27 October 2024). No severe cases have been reported. In Rakhine, the weekly number of AWD cases rose again to 137 in week 43 (20 to 26 October), from 18 cases in week 42 (13 to 19 October). In week 43, a total of 44 severe dehydration cases were reported. Among these 44 cases, 18 were reported in children under 5 years of age. According to the ministerial authorities for health, a total of 5 hospitalized cases of AWD, including two severe cases, were reported in week 43 (20 to 27 October) in Mon State. According to the ministerial authorities for health, in some townships of Mandalay Region, a total of 370 hospitalized cases of AWD including 218 severe cases were reported in week 43 (20 to 27 October). According to the ministerial authorities for health, in some townships of Ayeyarwady Region, a total of 28 hospitalized AWD cases, including seven severe cases, were reported in week 43 (20 to 27 October). (WHO, 6 Nov 2024)

The ministerial authorities for health publicly shared the following data on acute watery diarrhea (AWD) cases on 11 November 2024. In Yangon Region, a total of 205 hospitalized cases of AWD were reported from 3 to 10 November 2024. No severe cases have been reported. The weekly numbers of hospitalized AWD cases in the last few weeks are lower compared to the level observed in August (fewer than 300 cases in recent weeks, while over 400 cases in the weeks in August). However, the data indicates that pathogens causing AWD continues to circulate in Yangon. In Mon State, a total of 26 hospitalized cases of AWD were reported from 3 to 10 November 2024. No severe cases have been reported. In Mandalay Region, a total of 344 hospitalized cases of AWD including 167 cases with severe dehydration were reported from 3 to 10 November 2024. In Ayeyarwady Region, no new cases were reported between 03 to 10 November 2024 (28 hospitalized AWD cases, including seven severe cases, were reported from 20 to 27 October 2). [...] In Rakhine State, an increase of cases (135 cases in a week), including both mild and severe cases, was observed in week 43. In week 46 (10 to 16 November), a total of 60 AWD cases, including one case with severe dehydration, were reported. From week 25 to week 46 (16 June to 16 November), a total of 2,753 AWD cases were recorded. (WHO, 20 Nov 2024)

On 22 December 2024, the Thailand Ministry of Public Health published a press release, summarizing actions taken to manage the risks related to acute watery diarrhea/cholera along the border with Myanmar. According to the press release, Shwe Kokko, Myawaddy Township, Kayin State in Myanmar, which borders with Thailand, has reported 300 patients and 2 deaths, with 56 individuals being treated at Shwe Kokko Hospital. (WHO, 25 Dec 2024)

Multi-source surveillance in Myanmar estimates over 700 AWD cases including 2 deaths in Shwe Kokko. Thanks to rapid response from health partners, effective health and WASH interventions have been implemented, reporting with a drastic reduction in cases as of 30 December 2024. (WHO & Health Cluster, 31 Dec 2024)

In Thailand, two patients are admitted for treatment, one at Mae Sot Hospital and another at Mae Ramat Hospital, and awaiting laboratory results. An emergency operations center (EOC) was established in Tak province in Thailand to manage the event, highlighting that Mae Ramat and Mae Sot districts in Tak Province are high-risk areas. Proactive surveillance will be implemented in high-risk areas such as border communities, factories, and temporary border shelters, facilitating early notification of people with diarrhea to public health officials. (WHO, 3 Jan 2025)

By January 2025, acute watery diarrhoea (AWD) cases were reported from 9 of 15 states in Myanmar, after the first cases were reported in Yangon in June 2024. A confirmed AWD outbreak in neighbouring Thailand during December 2024 was reportedly linked with cases originating from Myanmar, showing the high risk of cross-border transmission. (OCHA, 19 Feb 2025)

According to the Ministerial authorities for health, a total of 90 hospitalized AWD cases were reported from 2 (6 pm) to 9 (6 pm) March 2025, consisting of 89 mild/moderate cases and one severe case. Out of 90 cases, 51 cases were in Yangon, 20 cases in Bago, 10 cases in Kayin, five cases in Mandalay, three cases in Tanintharyi, and one case in Ayeyarwady. A 58% increase in the number of weekly cases was observed compared to the previous week (23 February 6 pm to 2 March 6 pm), in which 57 cases were reported. (WHO, 14 Mar 2025)

A total of 73 mild/moderate hospitalized AWD cases were reported from 16 (6 pm) to 23 (6 pm) March 2025. None of the cases had severe dehydration. Out of 73 cases, 40 cases were in Yangon, 23 cases in Bago, and 10 cases in Mandalay. A 13% decrease in the number of weekly cases was observed compared to the previous week (9 March 6 pm to 16 March 6 pm), in which 84 cases were reported. (WHO, 26 Mar 2025)

There has been widespread destruction of water systems, including broken boreholes and damaged piped networks, along with the collapse of over 76,000 latrines. There is a growing concern among communities about the risk of infectious diseases due to improperly managed corpses and the lack of access to safe water and sanitation facilities. A cluster of mild to moderate acute watery diarrhoea (AWD) cases has been reported in Sagaing township and urban areas of Mandalay, though no cases of cholera have been confirmed to date. (UNICEF, 16 Apr 2025)