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Rohingya crisis Diphtheria Short note – 11 December 2017

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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. An emergency vaccination campaign targeting 250,000 children is to begin on December 10. Difficult terrain and lack of access to some areas in expansion sites are likely to hamper health services provision. Awareness raising will be important to ensure as many children as possible access immunisations.

Crisis impact

110 clinically diagnosed cases of diphtheria, including six deaths as of 6 December – this figure may have increased (WHO 06/12/2017). A first suspected case was identified on 10 November, but health workers were unable to trace the patient. Another suspected case was found on 19 November.

Diphtheria is a respiratory tract illness, which spreads through air droplets (i.e. sneezing or coughing), or hand-to-hand and hand-to-mouth contact (WHO, WHO 06/12/2017). First symptoms include a sore throat, fever, and a loss of appetite. Membrane may form on the throat and tonsils. Diphtheria is endemic in Bangladesh. The likelihood of dying from a case of diphtheria, the Case Fatality Rate (CFR), is generally 5-10%, but it can go up to 20% among children under five and adults over 40 years old (CDC; WHO, WHO 06/12/2017).

Vaccination coverage: The best way to reduce transmission of the disease is to maintain a high level of immunisation in the community. The Rohingya population generally has low vaccination coverage, as they have limited accessed to health services in Myanmar. Diphtheria vaccines have to be given in various stages to ensure immunity. Immunity to diphtheria fades overtime, and a booster vaccine should ideally be given every ten years (CDC).