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WHO EMRO Weekly Epidemiological Monitor: Volume 13, Issue no 2; 12 January 2020

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Diphtheria situation update: Sudan

Federal Ministry of Health (FMOH) Sudan reported an upsurge of diphtheria cases, starting from epidemiologic week 33-2019. Till the reporting date (week 02-2020), a total of 98 suspected diphtheria cases with 13 associated deaths (CFR 13.27%) are reported from six states.

Editorial note

The Federal Expanded Programme of Immunization (FEPI) data shows that, between 5 February 2019 and 31 October 2019; 12 sporadic suspected cases reported from East Darfur, North Kordofan, Khartoum, Gezira and White Nile states. Since November 1st 2019 an upsurge of cases has been reported from seven states of the country (See graph).

The most affected state is South Darfur , and the joint field investigation by the joint WHO and MOH mission (late November 2019) showed that 99% of the cases within South Darfur were from one locality (Al Sunta) and it was found that the immunization coverage in the locality was estimated around 35% due to lack of mobile immunisation teams. Further, the cold chain system that has been dysfunctional since last three years, was only recently corrected during May 2019.

Since early November 2019 to 12 January 2020 the Al Sunta locality reported 91 cases with 10 deaths with a CFR of 10.9% and cases from other areas of Sudan reported during this period were 7 with 2 associated deaths (See table). Reports of diphtheria cases from multiple states within Sudan despite high national DPT3 coverage shows that multiple hotspots exist with low vaccination coverage with potential for future outbreaks and due to lack of proper data collection and analysis, those areas are masked during national coverage estimates.

To control the outbreak and provide treatment to the affected people, WHO provided assistance to the Government of Sudan for provision of adequate supplies of medicines (paracetamol, antibiotics etc.), diphtheria antitoxins (DAT) for the management of complicated cases, and for printing and distribution of IEC materials for public awareness. Targeted immunization campaign was launched within Al Sunta locality immediately and 1st round (November 25 - December 1) targeted 38 881 children aged < 15 years old; Penta vaccine for children under 7 years age and DT for 7-15 years old. The coverage during the campaign was high. Second round was administered from December 31 -January 6 with the same target population and vaccination coverage during this round was 80%. In addition to that, immunization drive through EPI was strengthened to vaccinate children less than 1 year old.

Although the outbreak is still on going but the number of new cases from the locality have reduced substantially since January 1, 2020. WHO is continuously monitoring the outbreak in coordination with MOH and is providing all possible support to control and eradicate the outbreak within the shortest possible time.

WHO recommends to develop a long-term strategy to enhance the immunization coverage in all areas and identification of hotspots through surveillance for taking timely corrective measures. Current diphtheria outbreak in Sudan can be used as a starting point to engage the state authorities to necessitate the sustained vaccination activities across the country to prevent such occurrences in future.