ACAPS Briefing Note: Yemen - Diphtheria Outbreak (22 December 2017)
312 suspected cases of diphtheria have been reported in Yemen between mid-August and 20 December. The outbreak has resulted in 35 deaths reported. At 11%, the case fatality rate (CFR) is high. 18 out of Yemen’s 22 governorates are affected, with Ibb having the majority of cases. Children aged 5-14 account for around 50% of suspected cases. About 90% of fatalities were reported in children aged less than 15.
Crisis impact 312 cases of suspected diphtheria were reported in Yemen between mid-August and 20 December. However, the exact number of cases might differ, as duplicate reporting can occur and many cases may go unreported as the disease continues to spread. 35 deaths were declared as of 20 December. Case fatality rate (CFR) has risen to 11.2% from 8,5% in November. (WHO December 2017 WHO 19/11/2017) 56% of all cases have been reported in Ibb governorate but the outbreak is widespread, with cases in 18 out of 22 governorates and 78 districts are affected in total. (For more detailed information, see map on page 5) Children aged 5-14 account for around 50% of suspected cases. About 90% of fatalities were reported in children aged less than 15. (WHO December 2017) Diphtheria is endemic in Yemen. However, this is the biggest outbreak since 1989. In recent years the cases have been sporadic, with 27 cases reported across the country in 2016. (WHO 19/11/2017)
Health: Yemen’s health system is severely affected by conflict, import restrictions on medicines and supplies, collapsing infrastructure, and critical shortages of health staff. It is heavily dependent on foreign aid. The quality of health services in treatment facilities is poor: infection prevention and control is poor, and partners have exhausted their capacities. Most health facilities do not have laboratory capacity to confirm the presence of C. diphtheriae, and therefore the diagnosis and treatment of the disease is difficult. Low vaccination rates and lack of access to medical care exacerbate the crisis. (Reuters 13/12/2017) Food: Most of the governorates affected by the outbreak currently face at least IPC 3 (Crisis) food security outcomes with Sa’ada, Hajjah, Taizz, and Abyan at risk of IPC 4 (Emergency) in 2018. (FEWSNET)
Nutrition: Areas affected by the outbreak – including Abyan, Al Hudaydah, Lahj, Hadramaut, and Taizz – face global acute malnutrition (GAM) rates above 15% (Nutrition Cluster 3/09/2017). 400,000 children in Yemen are suffering from severe acute malnutrition, particularly in Al Hudaydah. Children who are malnourished are nine times more likely to die. (UN 14/12/2017; UNICEF 2017)