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W30 2018 | Highlights

Epidemiological Highlights Week 30

Highlights:

• Diphtheria case-patients still reporting from the camps and confirmed

case-patients from host community.

• Overall, AWD trend showing decreasing trend.

• Number of Acute Respiratory Infection (ARI) & Acute Juandice

Syndrome (AJS) case-patients reporting decreases than previous

weeks but unexplained fever showing slightly increasing trend.

• No significant change in vector brone disease trend.

• Other diseases and clinical syndromes remain within the previous

level.


EWARS Reporting Updates:

• To date, 151 health facilities are registered as active Early Warning Alert

and Response System (EWARS) reporting sites.

• For week 30, 106/151 weekly reports (70%) were received by Tuesday

24 July 2018, resulting in a cumulative completeness of 77% in 2018.

• A total of 16 alerts were triggered in week 30, in which 1 is currently

being monitored by the WHO Epidemiology.


Diphtheria Updates

• 8 067 diphtheria case-patients reported through EWARS, including 264

case-patients tested positive and 931 tested negative on PCR.

• Last laboratory confirmed case-patients reported on 26 July 2018 from host

community.

• 36 new case-patients reported which is lower than previous week

-35 case-patients in week 29



• No death reported this week. Total number of deaths = 44(case-fatality

proportion <1.0%).

• Host community: 2 new diphtheria case-patients (1 probable and 1 lab-

negative) reported this week.

• Total case-patients (2018)= 171 (including 102 lab-negative case-patients)

-25 lab-confirmed

-29 probable

-15 suspected



Measles

• 10 new suspected case-patients reported via weekly reporting this week

which is slightly lower than previous weeks (15 case-patients in week 29

& 9 case-patients in week 28)

• Total number of cases (2018) = 1 457.

• Routine measles surveillance is ongoing in the FDMN population.

Acute Jaundice Syndrome (AJS)

• 25 new case-patients reported this week which is lower than previous

weeks (45 case-patients in week 29, 19 case-patients in week 28 & 36

case-patients in week 27)

• Total case-patients in EWARS (2018) = 2 548


Acute Watery Diarrhoea (AWD)

• 3 336 case-patients were reported from weekly report forms and an

additional 9 cases were reported from Diarrhoea Treatment Center (DTCs).

• A total 140 118 case-patients were reported from health facilities in 2018

and an additional 81 case-patients were reported from Diarrhoea treatment

Center (DTCs) from 1 June 2018.

Acute Respiratory Infection (ARI)

• 9 116 case-patients reported in EWARS via weekly report form lower than

previous week (12 173 in week 29 & 10 389 case-patients in week 28).

• Total reported case-patients = 299 289

• Proportional morbidity (2018) = 12.3%

BangladeshRohingya Emergency Response

Ministry of Health and FamilyWelfare Bangladesh Printed: 11:33 Tuesday, 31 July 2018 UTC

Early Warning, Alert and Response System (EWARS)Epidemiological Bulletin W30 2018

Highlights

Slide 1 Table 1 Coverage

Table 2 Early warning performance

Table 3 Alert performance

Early Warning

Slide 2 Map 1a Ukhia completeness by site/zone

Map 1b Teknaf completeness by site/zone

Slide 3 Table 4 Ukhia (Northern group) performance by site/zone

Map 2 Ukhia (Northern group) completeness by site/zone

Slide 4 Table 5 Ukhia (Southern group) performance by site/zone

Map 3 Ukhia (Southern group) completeness by site/zone

Slide 5 Table 6 Teknaf performance by site/zone

Map 4 Teknaf completeness by site/zone

Slide 6 Table 7 Performance by partner

Alert

Slide 7 Table 8 Ukhia (Northern group) alerts by site/zone

Map 5 Ukhia (Northern group) alerts site/zone

Slide 8 Table 9 Ukhia (Southern group) alerts by site/zone

Map 6 Ukhia (Southern group) alerts site/zone

Slide 9 Table 10 Teknaf alerts by site/zone

Map 7 Teknaf alerts site/zone

Slide 10 Table 11 Performance by type of alert

Table 12 Risk Assessment

Sources of data

1. Weekly EWARS Reporting Form 2. Mortality Case Report Form 3. Event-based Surveillance Form

Contents

W30 2018

Table 1 | Coverage

# %

918,936 - Estimated total Rohingya population

904,056 98% Total population under surveillance

270 - Total number of health facilities

151 56% Number of EWARS reporting sites

Table 2 | Early warning performance indicators

W30 Cumulative (2018)

106 3351 Number of weekly reports received

68% 77% Completeness

68% 76% Timeliness

Table 3 Alert performance indicators


16 1,745 Total alerts raised

100% 100% % verified

0% 0% % auto-discarded

0% 0% % undergoing risk assessment

0% 2% % completed risk assessment

Source: IOM. Bangladesh: Needs and Population Monitoring - NPM R11 Report. 14 June 2018.

Highlights W30 2018

1 W30 2018

1

1

Map 1a | Ukhia completeness by camp

Completeness 0 25% 50% 75% 100%

Map 1b | Teknaf completeness by camp

Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia and Teknaf

2 W30 2018

12

3 4

567

89 10 11 12

1314 15

16

17

18

19

20

21

22 2324

25

26

1 Camp 1W2 Camp 1E3 Camp 8W4 Camp 8E5 Camp 76 Camp 67 Camp 58 Camp 4 Ext9 Camp 410 Camp 311 Camp 2W12 Camp 2E13 Camp 914 Camp 20 Ext15 Camp 2016 Camp 1917 Camp 1818 Camp 1719 Camp 1620 Camp 1521 Camp 1422 Camp 1323 Camp 1224 Camp 1125 Camp 1026 Kutupalong RC

1

2

3

4

5

6

78

1 Camp 22 Unchiprang2 Nayapara RC3 Camp 23 Shamlapur4 Camp 21 Chakmarkul5 Camp 27 Jadimura6 Camp 26 Nayapara7 Camp 25 Ali Khali8 Camp 24 Leda

Northerngroup Reporting Performance

# healthfacilities

# reportsreceived Completeness Timeliness

Table 4 | Performance by camp (W30 2018) Map 2 | Completeness by camp

Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia (Northern Group)

3 W30 2018

Camp 1E 1 1 100% 100%

Camp 1W 3 2 67% 67%

Camp 2E 1 0 0% 0%

Camp 2W 4 4 75% 75%

Camp 3 6 5 83% 83%

Camp 4 5 3 60% 60%

Camp 4 Ext 1 1 100% 100%

Camp 5 2 0 0% 0%

Camp 6 1 1 100% 100%

Camp 7 5 4 80% 80%

Camp 8E 3 3 100% 100%

Camp 8W 4 4 100% 100%

KutupalongRC

2 2 100% 100%

12

3 4

567

89 10 11 12

13

1 Camp 1W2 Camp 1E3 Camp 8W4 Camp 8E5 Camp 76 Camp 67 Camp 58 Camp 4 Ext9 Camp 410 Camp 311 Camp 2W12 Camp 2E13 Kutupalong RC

Southerngroup Reporting Performance

# healthfacilities



Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia (Southern Group)

4 W30 2018

Camp 10 4 4 100% 100%

Camp 11 8 8 100% 100%

Camp 12 7 5 83% 83%

Camp 13 11 7 64% 64%

Camp 14 4 2 50% 50%

Camp 15 6 3 50% 50%

Camp 16 6 4 67% 67%

Camp 17 4 3 75% 75%

Camp 18 5 4 80% 80%

Camp 19 1 1 100% 100%

Camp 20 2 2 100% 100%

Camp 20 Ext 0 0 0% 100%

Camp 9 10 7 70% 70%

12 3

4

5

6

7

8

9

10 1112

13

1 Camp 92 Camp 20 Ext3 Camp 204 Camp 195 Camp 186 Camp 177 Camp 168 Camp 159 Camp 1410 Camp 1311 Camp 1212 Camp 1113 Camp 10

Teknaf Reporting Performance

# healthfacilities



Completeness 0 25% 50% 75% 100%

Early Warning | Teknaf

5 W30 2018

Camp 21Chakmarkul

4 3 75% 75%

Camp 22Unchiprang

6 3 50% 50%

Camp 23Shamlapur

3 2 67% 67%

Camp 24 Leda 1 1 100% 100%

Camp 25 AliKhali

2 2 100% 100%

Camp 26Nayapara

2 2 100% 100%

Camp 27Jadimura

1 1 100% 100%

Nayapara RC 2 1 50% 50%

1

2

3

4

5

6

78


Partner Performance Reporting

# sites # reportsreceived Completeness Timeliness

BDRCS 10 4 40% 40%

BRAC 11 11 100% 100%

CARE 4 4 100% 100%

FHM 1 0 0% 0%

FRNDS 5 5 100% 100%

GK 11 11 100% 100%

HMBDF 1 1 100% 100%

IHA 1 0 0% 0%

IOM 20 19 95% 95%

IRC 7 7 100% 100%

MOAS 2 2 100% 100%

MSF 19 7 37% 37%

MoH 13 1 8% 8%

Table 7 | Performance by partner (W30 2018)

Partner Performance Reporting

# sites # reportsreceived Completeness Timeliness

MTI 1 0 0% 0%

OBAT 1 0 0% 0%

PHD 8 8 100% 100%

Prottyashi 3 1 33% 33%

PWJ 1 0 0% 0%

RHU 2 2 100% 100%

RI 5 5 100% 100%

RTMI 3 2 67% 67%

SCI 10 10 100% 100%

TdH 1 0 0% 0%

Early Warning | Partner performance

6 W30 2018

Northerngroup W30 Cumulative (2018)

# alerts % verif. # alerts % verif.

Northerngroup W30 Cumulative (2018)


Table 8 | Performance by camp Map 5 | Number of alerts by camp

# of alerts 0 2 5 10

Alert | Ukhia (Northern Group)

7 W30 2018

Camp 1E 0 0% 5 100%

Camp 1W 0 0% 14 100%

Camp 2E 0 0% 57 100%

Camp 2W 1 100% 36 100%

Camp 3 0 0% 92 100%

Camp 4 0 0% 41 100%

Camp 4 Ext 0 0% 0 0%

Camp 5 0 0% 61 100%

Camp 6 0 0% 6 100%

Camp 7 1 100% 73 100%

Camp 8E 0 0% 64 100%

Camp 8W 0 0% 47 100%

KutupalongRC

0 0% 22 100%

12

3 4

567

89 10 11 12

13

1 Camp 1W2 Camp 1E3 Camp 8W4 Camp 8E5 Camp 76 Camp 67 Camp 58 Camp 4 Ext9 Camp 410 Camp 311 Camp 2W12 Camp 2E13 Kutupalong RC

Southerngroup W30 Cumulative (2018)




Alert | Ukhia (Southern Group)

8 W30 2018

Camp 10 0 0% 30 100%

Camp 11 2 100% 59 100%

Camp 12 2 100% 81 100%

Camp 13 1 100% 99 100%

Camp 14 0 0% 66 100%

Camp 15 0 0% 97 100%

Camp 16 1 100% 76 100%

Camp 17 0 0% 52 100%

Camp 18 0 0% 46 100%

Camp 19 1 100% 5 100%

Camp 20 0 0% 18 100%

Camp 20 Ext 0 0% 0 0%

Camp 9 4 100% 163 100%

12 3

4

5

6

7

8

9

10 1112

13

1 Camp 92 Camp 20 Ext3 Camp 204 Camp 195 Camp 186 Camp 177 Camp 168 Camp 159 Camp 1410 Camp 1311 Camp 1212 Camp 1113 Camp 10

Teknaf W30 Cumulative (2018)




Alert | Teknaf

9 W30 2018

Camp 21Chakmarkul

0 0% 22 100%

Camp 22Unchiprang

0 0% 85 100%

Camp 23Shamlapur

0 0% 18 100%

Camp 24 Leda 0 0% 38 100%

Camp 25 AliKhali

1 100% 21 100%

Camp 26Nayapara

2 100% 53 100%

Camp 27Jadimura

0 0% 12 100%

Nayapara RC 0 0% 11 100%

1

2

3

4

5

6

78


Event W30 Cumulative (2018)


Indicator-based surveillance

Malaria 1 100% 1 100%

Measles/Rubella 5 100% 532 100%

Bloody Diarr. 0 0% 0 0%

AFP 0 0% 18 100%

Meningitis 0 0% 12 100%

Haem. fever(susp.)

0 0% 32 100%

NNT 0 0% 2 100%

Unexp. fever 2 100% 148 100%

AWD 1 100% 183 100%

ARI 2 100% 189 100%

AJS 5 100% 247 100%

Event-based surveillance

EBS total 0 0% 23 100%

Table 11 | Performance by type of alert Table 12 | Risk assessment


0 13 Low risk

0 2 Moderate risk

0 17 High risk

0 1 Very high risk

Alert | Event risk assessment

10 W30 2018

For more help and support, please contact:

Dr. Md. Alamgir Medical Officer Civil Surgeon Office Ministry of Health and Family Welfare Cox's Bazar, Bangladesh

Telephone: +88 018 1961 4952

Dr. Md Khadimul Anam Mazhar Surveillance and Outbreak Response Officer World Health Organization Cox's Bazar, Bangladesh

Telephone: +88 017 0120 8845

Email: [email protected]

NotesWHO and the Ministry of Health and Family Welfare gratefully acknowledge all partners who havereported the data used in this bulletin. The data been collected with support from the EWARS project. This is an initiative to strengthen earlywarning, alert and response in emergencies. It includes an online, desktop and mobile application thatcan be rapidly configured and deployed in the field. It is designed with frontline users in mind, and builtto work in difficult and remote operating environments. This bulletin has been automatically publishedfrom the EWARS application. More information can be found at http://ewars-project.org Sign-up for an account with EWARS Bangladesh at http://bd.ewars.ws

Ministry ofHealth andFamilyWelfare Bangladesh



Early Warning, Alert and Response System (EWARS)Annex W30 2018

Figure 1 | Proportional morbidity (W30 2018)

Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Bloody diarrhoea Other diarrhoea Unexplained fever

Acute Jaundice Syndrome (AJS) Measles/Rubella Other Vector-borne disease Combines malaria and dengue cases (suspected and confirmed)

Disease W30 2018

# cases % morbidity # cases % morbidity

AWD 3,336 5.4% 140,118 5.7%

Bloody diarr. 182 0.3% 35,078 1.4%

Other diarr. 1,861 3.0% 69,923 2.9%

ARI 9,116 14.6% 299,289 12.3%

Measles/Rub. 10 0.0% 1,457 0.1%

AFP 0 0.0% 24 0.0%

Susp. menin. 0 0.0% 54 0.0%

AJS 25 0.0% 2,548 0.1%

Susp. HF 0 0.0% 87 0.0%

Neo. tetanus 0 0.0% 3 0.0%

Adult tetanus 0 0.0% 15 0.0%

Malaria (conf.) 1 0.0% 57 0.0%

Malaria (susp.) 1,541 2.5% 25,810 1.1%

Dengue (conf.) 0 0.0% 0 0.0%

Dengue (susp.) 0 0.0% 3 0.0%

Unexpl. fever 7,981 12.8% 283,279 11.6%

Sev. Malnut. 77 0.1% 4,542 0.2%

Inj./Wounds 1,149 1.8% 43,645 1.8%

Other 37,001 59.4% 1,534,808 62.9%

Total 62,280 100% 2,440,740 100%

Proportional morbidity

1 W30 2018

*

*

Figure 2 | Trend in proportional morbidity for key diseases (W30)

Other consultations Acute Respiratory Infection (ARI) Unexplained fever Acute Jaundice Syndrome (AJS)

Acute Watery Diarrhoea (AWD) Other diarrhoea Vector-borne disease Combines malaria and dengue cases (suspected and confirmed)

Trend in consultations and key diseases

2 W30 2018

% m

orbi

dity

W26

201

7

W31

201

7

W35

201

7

W39

201

7

W44

201

7

W48

201

7

W01

201

8

W05

201

8

W09

201

8

W13

201

8

W18

201

8

W22

201

8

W26

201

8

W31

201

8

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

*

*

Acute Respiratory Infection | Trend

3 W30 2018

Total ARI cases - Cox's Bazar

W26

201

7

W31

201

7

W35

201

7

W39

201

7

W44

201

7

W48

201

7

W01

201

8

W05

201

8

W09

201

8

W13

201

8

W18

201

8

W22

201

8

W26

201

8

W31

201

8

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000

Figure 3 | Trend in number of cases over time (W38 2017 - W30 2018)

a. Ukhia | Number of cases b. Ukhia | Number of alerts c. Teknaf | Number of cases d. Teknaf | Number of alerts

Acute Respiratory Infection | Maps and Alert Management

Map 1 | Map of cases by camp (W30 2018)

4 W30 2018

Map legendNumber of cases 0 1 100 200 500

Number of alerts 0 1 10

Alert thresholdTwice the average number of casesover the past 3 weeks. Source: IEDCR

1Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk

Alert management (W30 2018) Figure | % sex Figure | % age

Male Female >=5 < 5

Measles | Trend

5 W30 2018

Total suspected measles/rubella cases - Cox's Bazar

W26

201

7

W31

201

7

W35

201

7

W39

201

7

W44

201

7

W48

201

7

W01

201

8

W05

201

8

W09

201

8

W13

201

8

W18

201

8

W22

201

8

W26

201

8

W31

201

8

0

20

40

60

80

100

120

140

160

180

200

Figure 4 | Trend in number of suspected cases over time (W38 2017 - W30 2018)


Measles | Maps and Alert Management

Map 2 | Map of cases by camp (W30 2018)

6 W30 2018



Alert threshold1 case. Source: IEDCR

5Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female >= 5 < 5

Acute Jaundice Syndrome | Trend

7 W30 2018

Total suspected AJS cases - Bangladesh

W26

201

7

W31

201

7

W35

201

7

W39

201

7

W44

201

7

W48

201

7

W01

201

8

W05

201

8

W09

201

8

W13

201

8

W18

201

8

W22

201

8

W26

201

8

W31

201

8

0

20

40

60

80

100

120

140

160

180



Acute Jaundice Syndrome | Maps and Alert Management

Map 3 | Map of cases by camp (W37 2017 - W30 2018)

8 W30 2018



Alert thresholdA cluster of 3 or more cases seen in ahealth facility. Source: IEDCR

5Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Female Male >= 5 < 5

Acute Watery Diarrhoea | Trends

9 W30 2018

Total AWD cases - Bangladesh

W26

201

7

W31

201

7

W35

201

7

W39

201

7

W44

201

7

W48

201

7

W01

201

8

W05

201

8

W09

201

8

W13

201

8

W18

201

8

W22

201

8

W26

201

8

W31

201

8

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000



Acute Watery Diarrhoea | Maps and Alert Management


10 W30 2018




1Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female < 5 >= 5

Dengue | Trends

11 W30 2018

Total Dengue cases - suspected - BangladeshTotal Dengue cases - confirmed - Bangladesh

W26

201

7

W31

201

7

W35

201

7

W39

201

7

W44

201

7

W48

201

7

W01

201

8

W05

201

8

W09

201

8

W13

201

8

W18

201

8

W22

201

8

W26

201

8

W31

201

8

0

1

2

3

4



Dengue | Maps and Alert Management


12 W30 2018




0Alerts

0%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female >= 5 < 5



Telephone: +88 018 1961 4952

Dr. Md Khadimul Anam Mazhar Surveillance and Outbreak Response Officer World Health Organization Cox's Bazar, Bangladesh

Telephone: +88 017 0120 8845






Diphtheria OutbreakUpdate W30 2018 (Jul 23-Jul 29)

The information in this bulletin is gathered from partners in the fieldeach day. Whilst it attempts to reflect updated real time numbers,there maybe some delays in reporting and missing values.

The data is also subject to change as case information is updatedand validated, and therefore the figures may be subject to revisionsas new data is received.

WHO and Ministry of Health and Family Welfare gratefullyacknowledge the support of all partners involved in the DiphtheriaOutbreak Response for their support in contributing the data to thisbulletin.

1. Diphtheria Case Report Form

2. Diphtheria Contact Tracing Report Form

3. Diphtheria Daily Operational Report Form

Disclaimer

Acknowledgements

Sources of data

Disclaimer

1 W30 2018 (Jul 23-Jul 29)

Indicator Cumulative Last 7 days Last 24hours

Epidemiology

1. Total number of cases 7,079 36 11

Confirmed 3.7% (n= 264 ) 8.3% (n= 3 ) 0.0% (n= 0 )

Probable 51.5% (n= 3,649 ) 83.3% (n= 30 ) 90.9% (n= 10 )

Suspected 44.7% (n= 3,166 ) 8.3% (n= 3 ) 9.1% (n= 1 )

Indeterminate 0.0% (n= 0 ) 0.0% (n= 0 ) 0.0% (n= 0 )

2. Laboratory testing

Positive 22.1% (n= 264 ) 42.9% (n= 3 ) 0.0% (n= 0 )

Indeterminate 0.0% (n= 0 ) 0.0% (n= 0 ) 0.0% (n= 0 )

Negative (excluded) 77.9% (n= 931 ) 57.1% (n= 4 ) 0.0% (n= 0 )

3. Total number of deaths 44 0 0

4. Attack rate / 10,000 population 145.49 0.44

Clinical presentation

5. % with pseudomembrane 35.4% (n= 2,875 ) 30.0% (n= 12 ) 18.2% (n= 2 )

6. % with complications 1.0% (n= 83 ) 0.0% (n= 0 ) 0.0% (n= 0 )

Case management

7. % patients given antibiotics 64.5% (n= 5,231 ) 100.0% (n= 40 ) 100.0% (n= 11 )

8. % patients treated with DAT 18.0% (n= 1,464 ) 17.5% (n= 7 ) 9.1% (n= 1 )

Table 1 | Summary of key indicators

8 November 2017 - present based on date of presentation

Case definition:

Confirmed: case-patients reported as positive for toxigenicC. diphtheriae by PCR

Probable: case-patients with an upper respiratory tractillness with laryngitis or nasopharyngitis or tonsillitis AND atleast one of the following signs: adherentmembrane/pseudomembrane OR gross cervicallymphadenopathy.

Suspected: any case with a clinical suspicion of diphtheria.Includes case-patients that are unclassified due to missingvalues.

Excluded: case-patients reported as negative for toxigenicC. diphtheriae by PCR

Source of population data: IOM. Bangladesh: Needs andPopulation Monitoring - NPM R7 Report. 15 December 2017

Defined as one or more of the following: respiratory distress,shock, irregular heart rate, peripheral neuritis / neuropathy,kidney failure or cutaneous necrotic lesions.

Diphtheria anti-toxin. Data for number treated with DAT inlast 24 hours comes from the Daily Operational MonitoringReport Form.

Notes

Diphtheria | Summary of key indicators

2 W30 2018 (Jul 23-Jul 29)

1

2

3

4

5

1

2

3

4

5

Figure 1a Epidemic curve of diphtheria cases in Cox's Bazar, by date of admission (W44 2017 - W30 2018)

Suspected Probable

Confirmed Indeterminate

Diphtheria | Epidemic curve

3 W30 2018 (Jul 23-Jul 29)

Num

ber

W26

201

8

W48

201

7

W01

201

8

W05

201

8

W09

201

8

W13

201

8

W18

201

8

W22

201

8

W31

201

8

0

100

200

300

400

500

600

700

800

900

1000

1100

Figure 1b Epidemic curve of diphtheria cases in Cox's Bazar, by age group, by date of admission (W44 2017 - W30 2018)

< 5 5 - 14

15 - 44 > 45


3 W30 2018 (Jul 23-Jul 29)

Num

ber

W26

201

8

W48

201

7

W01

201

8

W05

201

8

W09

201

8

W13

201

8

W18

201

8

W22

201

8

W31

201

8

0

100

200

300

400

500

600

700

800

900

1000

1100

Figure Percentage of Lab-confirmed positive Diphtheria Cases by Age and Type Bangladesh, Cox’s Bazar (W1 2018 - W30 2018)

< 15 Suspected cases ≥ 15 Suspected cases

< 15 Probable cases ≥ 15 Probable cases


3 W30 2018 (Jul 23-Jul 29)

%

Dec

'17

Jan

'18

Feb

'18

Mar

'18

Apr '

18

May

'18

Jun

'18

Jul '

18

Aug

'18

0%

20%

40%

60%

80%

100%

Figure 1c Epidemic curve of diphtheria cases in Cox's Bazar, for Host Community, by date of admission (W44 2017 - W30 2018)

Suspected Probable

Confirmed Indeterminate


3 W30 2018 (Jul 23-Jul 29)

Num

ber

W46

201

7

W48

201

7

W50

201

7

W52

201

7

W02

201

8

W04

201

8

W06

201

8

W08

201

8

W10

201

8

W12

201

8

W14

201

8

W16

201

8

W18

201

8

W20

201

8

W22

201

8

W24

201

8

W26

201

8

W28

201

8

W30

201

8

0

2

4

6

8

10

12

14

16

18

Figure 2a | IOM1D4

Figure 2d | MSFBKL

Figure 2g | SPP1TT

Figure 2b | IOM2AA

Figure 2e | MSFJAM

Figure 2c | IOM3LD

Figure 2f | MSFRUB

Case definition

Suspected Probable Confirmed Indeterminate

Diphtheria | Epidemic curves for diphtheria outbreak in Cox's Bazar, by DTC

4 W30 2018 (Jul 23-Jul 29)

Num

ber

0

200

400

600

800

Num

ber

0

200

400

600

800

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DTC Cumulative Last 7 days Last 24 hours

Cases Deaths CFR DAT Cases Deaths DAT Cases Deaths DAT

DTC Cumulative Last 7 days Last 24 hours

Cases Deaths CFR DAT Cases Deaths DAT Cases Deaths DAT

Table 2 | Summary of cases, deaths and DAT use by DTC

Total 7,079 44 0.5% 1,464 36 0 7 11 0 1

Case fatality rate Number of cases treated with diphtheria anti-toxin (DAT). Data for number treated with DAT in last 24 hours comes from the Daily Operational Monitoring Report Form.

Diphtheria | Summary by DTC

5 W30 2018 (Jul 23-Jul 29)

1 2 2 2

BRC1HK 0 0 0.0% 0 0 0 0 0 0 0

BRC2II 0 0 0.0% 0 0 0 0 0 0 0

IOM1D4 190 0 0.0% 37 0 0 0 0 0 0

IOM2AA 147 0 0.0% 23 0 0 0 0 0 0

IOM3LD 218 0 0.0% 11 0 0 0 0 0 0

IRC1YY 0 0 0.0% 0 0 0 0 0 0 0

JRC1TT 0 0 0.0% 0 0 0 0 0 0 0

MSFBKL 2,485 29 1.1% 105 0 0 0 0 0 0

MSFJAM 872 3 0.3% 161 0 0 0 0 0 0

MSFRUB 2,200 9 0.3% 638 36 0 7 11 0 0

OBT1UU 0 0 0.0% 0 0 0 0 0 0 0

SPP1TT 967 3 0.3% 489 0 0 0 0 0 0

Unknown 0 0 0.0% 0 0 0 0 0 0 0

1

2

Table 3a | Symptoms # %

Fever 6,995 86.2%

Sore throat 7,595 93.6%

Difficulty swallowing 3,164 39.0%

Difficulty breathing 149 1.8%

Nasal regurgitation 440 5.4%

Bloody nasal discharge 104 1.3%

Ear discharge 5 0.1%

Drooling of saliva 0 0.0%

Change in voice 63 0.8%

Swollen neck 516 6.4%

Skin ulcers 33 0.4%

Other 512 6.3%

Table 3b | Signs # %

Pseudomembrane 2,875 35.4%

Gross cervical lymphadenopathy 2,543 31.4%

Chest indrawing 10 0.1%

Fast breathing rate 16 0.2%

Stridor 33 0.4%

Central cyanosis 4 0.0%

Fast heart rate 33 0.4%

Decreased capillary refill 2 0.0%

Weakness 38 0.5%

Lethargy 103 1.3%

Restlessness 11 0.1%

Other 393 4.8%

< 5 ( 12.6% ; n = 1,022 ) 5-14 ( 54.8% ; n = 4,441 ) 15-44 ( 29.3% ; n = 2,380 ) > 45 ( 2.0% ; n = 160 )

Figure 3a | Sex

Male ( 42.5% ; n = 3,444 ) Female ( 56.3% ; n = 4,565 )

Figure 3b | Age

Figure 3c | Nationality

FDMN ( 86.4% ; n = 7,007 ) National ( 0.9% ; n = 70 )

Figure 3d | Vaccination status

Vaccinated ( 26.5% ; n = 2,148 ) Not vaccinated ( 25.2% ; n = 2,042 ) Unknown vaccination status ( 45.6% ; n = 3,695 )

Forcibly-Displaced Myanmar National

Diphtheria | Demographic breakdown, vaccination status and signs and symptoms

6 W30 2018 (Jul 23-Jul 29)

1

1

Diphtheria | Trend in DAT use

7 W30 2018

Total patients treated with DAT - Cox's Bazar

W02

201

8

W04

201

8

W06

201

8

W08

201

8

W10

201

8

W12

201

8

W14

201

8

W16

201

8

W18

201

8

W20

201

8

W22

201

8

W24

201

8

W26

201

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W28

201

8

W30

201

8

0

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40

60

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Figure 3 | Trend in DAT use over time (2018-01-05 - W30 2018 (Jul 23-Jul 29))

Indicator Cumulative Previous cycle Current cycle

Number of case-patients notified 536 12 13

Number of case-patients whose households were successfully traced 326 0 0

% of case-patients who were traced 6.4% 0.0% 0.0%

Total # of close contacts 5,024 0 0

Average # close contacts per case household traced 15.4 0.0 0.0

Notes

Reporting cycle denotes a retrospective 7-day reporting period, from present back to 1 January 2018. The current cycle start -2 days from current date to provide timeto locate the case-household

1 January 2018 - present

Current date -16 days to current date -9 days

Current date -8 days to current date -2 days

Number of case-patients notified denotes diphtheria case-patients who were admitted at a diphtheria treatment centre (DTC) and their details were entered in theEWARS reporting platform

Traced denotes that a case-patient's household is identified in community, and all contacts are enumerated and placed on chemoprophylaxis and referred forvaccination

Table 4 | Contact tracing reporting cycles (2018-01-01 to W30 2018 (Jul 23-Jul 29))

Diphtheria | Contact tracing indicators

8 W30 2018 (Jul 23-Jul 29)

1

2 3 4

5

6

1

2

3

4

5

6


# cases-patientsnotified

# case-patientssuccessfullytraced

% case-patients traced







Table 5 | Ukhia Northern Zones

Total 22 15 0.0% 0 0 0.0% 0 0 0.0%

Diphtheria | Contact tracing by camp

9 W30 2018 (Jul 23-Jul 29)

Camp 1E 0 0 0% 0 0 0% 0 0 0%

Camp 1W 0 0 0% 0 0 0% 0 0 0%

Camp 2E 0 0 0% 0 0 0% 0 0 0%

Camp 2W 0 0 0% 0 0 0% 0 0 0%

Camp 3 0 0 0% 0 0 0% 0 0 0%

Camp 4 0 0 0% 0 0 0% 0 0 0%

Camp 4 Ext 0 0 0% 0 0 0% 0 0 0%

Camp 5 0 0 0% 0 0 0% 0 0 0%

Camp 6 0 0 0% 0 0 0% 0 0 0%

Camp 7 0 0 0% 0 0 0% 0 0 0%

Camp 8E 0 0 0% 0 0 0% 0 0 0%

Camp 8W 0 0 0% 0 0 0% 0 0 0%

KutupalongRC

22 15 68% 0 0 0% 0 0 0%



# case-patientstraced








Table 6 | Ukhia Southern Zones

Total 6 0 0.0% 0 0 0.0% 0 0 0.0%


10 W30 2018 (Jul 23-Jul 29)

Camp 10 0 0 0% 0 0 0% 0 0 0%

Camp 11 4 0 0% 0 0 0% 0 0 0%

Camp 12 0 0 0% 0 0 0% 0 0 0%

Camp 13 0 0 0% 0 0 0% 0 0 0%

Camp 14 2 0 0% 0 0 0% 0 0 0%

Camp 15 0 0 0% 0 0 0% 0 0 0%

Camp 16 0 0 0% 0 0 0% 0 0 0%

Camp 17 0 0 0% 0 0 0% 0 0 0%

Camp 18 0 0 0% 0 0 0% 0 0 0%

Camp 19 0 0 0% 0 0 0% 0 0 0%

Camp 20 0 0 0% 0 0 0% 0 0 0%

Camp 20 Ext 0 0 0% 0 0 0% 0 0 0%

Camp 9 0 0 0% 0 0 0% 0 0 0%

Map 1a | Ukhia (Cumulative)

% case-patients who were traced 0 25% 50% 75% 100%

Map 1b | Ukhia (Current cycle)


Map 1c | Ukhia (Previous cycle)


Diphtheria | Contact tracing percentage of case-patients who were traced

11 W30 2018 (Jul 23-Jul 29)











Table 7 | Teknaf

Total 41 29 0.0% 0 0 0.0% 0 0 0.0%


12 W30 2018 (Jul 23-Jul 29)

Camp 21Chakmarkul

0 0 0% 0 0 0% 0 0 0%

Camp 22Unchiprang

2 0 0% 0 0 0% 0 0 0%

Camp 23Shamlapur

0 0 0% 0 0 0% 0 0 0%

Camp 24 Leda 0 0 0% 0 0 0% 0 0 0%

Camp 25 AliKhali

0 0 0% 0 0 0% 0 0 0%

Camp 26Nayapara

0 0 0% 0 0 0% 0 0 0%

Camp 27Jadimura

1 0 0% 0 0 0% 0 0 0%

Nayapara RC 38 29 76% 0 0 0% 0 0 0%

Map 2a | Teknaf (Cumulative)


Map 2b | Teknaf (Current cycle)


Map 2c | Teknaf (Previous cycle)


Diphtheria | Contact tracing percentage of case-patients who were traced

13 W30 2018 (Jul 23-Jul 29)



Telephone: +88 018 1961 4952

Dr. Md Khadimul Anam Mazhar Surveillance and Outbreak Officer World Health Organization Cox's Bazar, Bangladesh

Telephone: +88 017 0120 8845




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