A. Situation analysis
Description of the disaster
On 15 January 2019, due to the outbreak of Influenza A (H1N1) virus in Mongolia, the State Emergency Commission meeting was called. The Ministry of Health stated that Influenza A cases were confirmed to be H1N1 in the end of December 2018 and since then it had rapidly spread within a short period of time. By January 2019, 9 districts of Ulaanbaatar city and 11 provinces have been spread to outbreak, ranging from 11-23.5 per cent with a national average of 10.6 per cent of total outpatient examinations. From the total number of Influenza cases, 30.9 per cent are children aged 0-1 year, 26.5 per cent children aged 2-4 years and 14.1 per cent children aged 5-9 years. As of 3 January, the outbreak became higher than three years’ average and four deaths have been registered in January.
The situation has worsened, and the risk of outbreak rapid increase is high in urban areas due to several factors including air pollution, high population density, extremely cold temperatures dropping lower than -40oC and socioeconomic situation of households. It must be emphasized that due to poor air conditions in Ulaanbaatar2, the infants and children in the city are most exposed and vulnerable to the outbreak3. The air pollution is mainly caused by coal combustion of individual households which mainly emits PM10, PM2.5 pollution that increases during the cold season that continues from October to April. The fatality risk is high due to the Ulaanbaatar City air quality is 133 times worse than WHO standard level. For the last 10 years, incidences of respiratory diseases increased 2.7-fold in respiratory infections per 10,000 population. Children aged 0-5 years are the most vulnerable, pneumonia becoming the second leading cause of death of children aged 0-5 years. In 2018, the pneumonia death among children increased by 40 per cent and the total ambulatory screening of children increased by 76.8 per cent compared to the previous year.
According to the Ministry of Health (MoH), the outbreak is expected to rise over the coming weeks as Influenza is dominantly (40 per cent) caused by Influenza A (H1N1) virus. Hospitals of Ulaanbaatar City are capacitated to hospitalize 977 children, which now has exceeded by 53.2 per cent. In the hospitals, 423 beds are transferred from adult floor and 354 portable beds are being used additionally to handle the situation. According to the MoH, on average about 139 new patients are hospitalized every day, therefore at least 500 more portable beds are needed urgently. According to the MoH contingency plan, if influenza is detected in more than 15 per cent of the total outpatient examinations, local and national authorities will take measures to discourage public gathering.
The Ministry of Health is concerned about the speed and scale of the outbreak. There is a high risk that it may spread at a national scale during the Lunar New Year (5-7 February) as the population movement becomes highest during the year, because population moves from Ulaanbaatar City to more remote areas to meet and greet their families. In Mongolia, the peak of the outbreak has not come yet as the country is in the midst of winter which will continue for another two months. The MoH has sent an official request to Mongolian Red Cross Society to support the health facilities and to organize public awareness campaigns to prevent from the further spread of the outbreak.