A. SITUATION ANALYSIS
Description of the disaster
Starting from mid of December 2018 (51st week of 2018), two cases of influenza A (H1N1) were detected. As of 3 January 2019, the outbreak had become higher than the three-year average, and four deaths had been registered in January. By the second week of January, the outbreak had spread to nine districts of Ulaanbaatar City and 11 provinces, ranging from 11 per cent to 23.5 per cent of total outpatient visits with influenza or influenza-like illnesses and a national average of 10.6 per cent. From the total number of influenza cases, 30.9 per cent were children aged zero to one year, 26.5 per cent children aged zero to four years, and 14.1 per cent children aged five to nine years, based on the report by Mongolian National Influenza Centre under the Mongolian Ministry of Health.
The risk of rapid increase of the outbreak was high in urban areas due to several factors including air pollution, high population density, extremely cold temperatures dropping lower than -40oC, and the socioeconomic situation of households. UNICEF reported that it must be emphasized that due to poor air quality in Ulaanbaatar, infants and children in the city are the most exposed and vulnerable to the outbreak. The poor air pollution is mainly caused by the use of coal combustion by individual households.
An increase in coal consumption during the cold season between October and April further exacerbates the situation due to elevated particulate matter (PM10 and PM2.5) emissions.
For the last 10 years, incidences of respiratory diseases have increased 2.7-fold in terms of respiratory infections per 10,000people. Children aged zero to five years are the most vulnerable, and pneumonia has become the second leading cause of death for children aged zero to five years. In 2018, pneumonia deaths among children increased by 40 per cent, and the total ambulatory screening of children for pneumonia increased by 76.8 per cent compared to the previous year. The hospital bed capacity had exceeded by 53.2 per cent according to Ministry of Health.
Due to the continued effects of severe air pollution and the Influenza outbreak, children aged zero to ten had been prohibited to attend public gatherings and service areas within Ulaanbaatar city until 1 March 2019. From its peak of 73 H1N1 influenza cases in every 10,000 population in January, it has decreased to 33 cases by the end of March, 2019.
As such during the operation timeframe, there have been no further requests from the State Emergency Commission or the Ministry of Health.