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W21 2018 | Highlights

Epidemiological Highlights Week 21

• An estimated total FDMN population of 866 000, of which 728 786

(84%) are under surveillance in the Early Warning Alert and Response

System (EWARS).

• 170 health facilities are currently registered as active EWARS

reporting sites and no new facilities registered this week.

• For week 21, 119 weekly reports were received by Tuesday of the

following week, resulting in a cumulative completeness of 71% for

2018.

• A total of 47 alerts were triggered this week. All alerts went through

initial verification within 72 hours of being triggered. Of the 47 alerts,

22 alerts are currently being monitored.


Diphtheria

• As of 26 May 2018, there were 7 630 diphtheria case-patients reported

through EWARS, including 681 case-patients who were tested negative

by PCR.

• This week 47 new case-patients were reported which is slightly lower

than previous week (58 case-patients in week 20).

• Total of 42 deaths were reported in EWARS (case-fatality proportion

<1.0%), no new deaths were reported this week and the last death was

recorded on 9 April 2018.

• Of all diphtheria cases, 238 case-patients have been laboratory confirmed.

The last laboratory confirmed case-patient was reported on 18 May 2018.

• In week 21, three (1 probable and 2 suspected) case-patient were reported

from the host community, bringing the total to 60 case-patients.

• 20 case-patients were laboratory confirmed, 29 were probable and 13

were suspected. No deaths have been reported within the host community.



Measles

• In week 21, there were 20 new suspected measles case-patients reported via weekly reporting, bringing the total number of cases reported in 2018 to 1 319.

Acute Jaundice Syndrome (AJS)

• In week 21, there were 55 cases of Acute Jaundice Syndrome (AJS), the same as in the previous week. Since January 2018, there has been a total of 2 146 reported cases.

Malaria

• 9 confirmed malaria case-patient were reported in week 21. The number of confirmed malaria case-patients in 2018 is 61.


Acute Watery Diarrhoea (AWD)

• In week 21, 5 019 Acute Watery Diarrhea (AWD) case-patients were reported in EWARS, bringing the total number to 103 824 in 2018.

• AWD Preparedness and Response Plan with case report form (CRF), case investigation form (CIF) and outbreak line list was finalized with the partners.

• AWD and EWARS refresher training for partners was planned for upcoming week.

• In week 21, unexplained fever, acute respiratory infections (ARI) and AWD are the three leading syndromes with highest proportional morbidity of 11.3%, 11.2% and 7.1%, respectively. These are syndromes at risk of causing severe outbreaks during monsoons and are being monitored by WHO Team.

BangladeshRohingya Emergency Response

Ministry of Health and Family WelfareBangladesh Printed: 14:05 Tuesday, 29 May 2018 UTC

Early Warning, Alert andResponse System (EWARS)

Epidemiological Bulletin W21 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

W21 2018

Table 1 | Coverage

# %

866,000 - Estimated total Rohingya population

728,786 84% Total population under surveillance

270 - Total number of health facilities

170 63% Number of EWARS reporting sites

Table 2 | Early warning performance indicators

W21 Cumulative (2018)

119 2367 Number of weekly reports received

69% 71% Completeness

69% 70% Timeliness

Table 3 Alert performance indicators


47 1,683 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 R7 Report. 15 December 2017

Highlights W21 2018

1 W21 2018

1

1

Map 1a | Ukhia completeness by site/zone

Completeness 0 25% 50% 75% 100%

Map 1b | Teknaf completeness by site/zone

Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia and Teknaf

2 W21 2018

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1213

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20 21

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1234567891011

1213141516171819202122232425262728293031323334

Zone ZZZone ZAHakimparaMoynarghona / BagghonaZone VVBalukhali MSKutupalong RCJamtoliKutupalong MSZone AAThangkhali / Burmapara /

TasnimarkholaZone BBZone CCZone DDZone FFZone EEZone IIZone GGZone HHZone JJZone KKZone MMZone LLZone NNZone OOZone TTZone PPZone QQZone RRZone SSZone YYZone UUZone WWZone XX

1

2

3

4

5

6

12

3

4

56

Jadimura

Chakmarkul

Shamlapur

UnchiprangLeda MSNayapara

RC

Northerngroup Reporting Performance

# healthfacilities

# reportsreceived Completeness Timeliness

Table 4 | Performance by site/zone (W21 2018) Map 2 | Completeness by site/zone

Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia (Northern Group)

3 W21 2018

Balukhali MS 11 8 73% 73%

KutupalongMS

6 4 80% 80%

KutupalongRC

4 3 75% 75%

Zone AA 4 4 100% 100%

Zone BB 3 4 100% 100%

Zone CC 3 3 100% 100%

Zone DD 6 3 50% 50%

Zone EE 4 2 50% 50%

Zone FF 4 4 100% 100%

Zone GG 4 3 100% 100%

Zone HH 2 1 50% 50%

Zone II 1 1 100% 100%

Zone JJ 3 1 33% 33%

Zone KK 3 2 67% 67%

Zone LL 1 0 0% 0%

Zone MM 1 1 100% 100%

Zone NN 12 10 83% 83%

Zone OO 1 1 100% 100%

1

2

3

4 56

7

89

10

11

12

13 14

15 16

17

18

1

2

3

456789101112131415161718

BalukhaliMS

KutupalongRC

KutupalongMS

Zone AAZone BBZone CCZone DDZone FFZone EEZone IIZone GGZone HHZone JJZone KKZone MMZone LLZone NNZone OO

Southerngroup Reporting Performance

# healthfacilities



Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia (Southern Group)

4 W21 2018

EastPalongkhali

1 1 100% 100%

Hakimpara 10 4 40% 40%

Jamtoli 9 4 44% 44%

Moynarghona /Bagghona

9 4 44% 44%

Thangkhali /Burmapara /Tasnimarkhola

11 7 64% 64%

Zone PP 2 2 100% 100%

Zone QQ 0 0 0% 100%

Zone RR 2 1 50% 50%

Zone SS 5 4 80% 80%

Zone TT 9 6 67% 67%

Zone UU 1 0 0% 0%

Zone VV 0 0 0% 100%

Zone WW 3 2 67% 67%

Zone XX 3 3 100% 100%

Zone YY 2 0 0% 0%

Zone ZA 1 1 100% 100%

Zone ZZ 2 2 100% 100%

1

2

3

4

5

6

7

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9

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1234567

8910111213141516

Zone ZZZone ZAHakimparaMoynarghona / BagghonaZone VVJamtoliThangkhali / Burmapara /

TasnimarkholaZone TTZone PPZone QQZone RRZone SSZone YYZone UUZone WWZone XX

Teknaf Reporting Performance

# healthfacilities



Completeness 0 25% 50% 75% 100%

Early Warning | Teknaf

5 W21 2018

Baharchora 2 2 100% 100%

Chakmarkul 3 3 100% 100%

Leda MS 4 4 100% 100%

MoH CC 1 1 100% 100%

Nayapara RC 4 4 100% 100%

Sabrang 1 1 100% 100%

Shamlapur 2 2 100% 100%

Teknaf UHC 1 0 0% 0%

Unchiprang 7 6 86% 86%

1

2

3

4

5

6

12

3

4

56

Jadimura

Chakmarkul

Shamlapur


RC

Partner Performance Reporting

# sites # reportsreceived Completeness Timeliness

AIDOCT 0 0

BDRCS 16 5 31% 31%

BRAC 11 11 100% 100%

CARE 4 4 100% 100%

FHM 1 0 0% 0%

FRNDS 5 3 60% 60%

GK 13 12 92% 92%

HMBDF 1 1 100% 100%

IHA 2 0 0% 0%

IOM 20 19 95% 95%

IRC 7 6 86% 86%

MERCY 2 2 100% 100%

MOAS 2 2 100% 100%

MSF 27 10 37% 37%

MoH 14 12 86% 86%

Table 7 | Performance by partner (W21 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 1 100% 100%

RHU 2 2 92% 92%

RI 5 5 100% 100%

RTMI 5 3 60% 60%

SCI 9 9 100% 100%

TdH 1 0 0% 0%

Early Warning | Partner performance

6 W21 2018

Northerngroup W21 Cumulative (2018)

# alerts % verif. # alerts % verif.

Table 8 | Performance by site/zone Map 5 | Number of alerts by site/zone

# of alerts 0 2 5 10

Alert | Ukhia (Northern Group)

7 W21 2018

Balukhali MS 3 100% 157 99%

KutupalongMS

3 100% 57 100%

KutupalongRC

3 100% 67 100%

Zone AA 0 0% 62 100%

Zone BB 0 0% 8 100%

Zone CC 1 100% 6 100%

Zone DD 1 100% 50 100%

Zone EE 1 100% 111 100%

Zone FF 2 100% 26 100%

Zone GG 2 100% 42 100%

Zone HH 1 100% 31 100%

Zone II 0 0% 0 0%

Zone JJ 2 100% 7 100%

Zone KK 0 0% 26 96%

Zone LL 0 0% 14 100%

Zone MM 0 0% 8 100%

Zone NN 5 100% 61 100%

Zone OO 1 100% 7 100%

1

2

3

4 56

7

89

10

11

12

13 14

15 16

17

18

1

2

3

456789101112131415161718

BalukhaliMS

KutupalongRC

KutupalongMS

Zone AAZone BBZone CCZone DDZone FFZone EEZone IIZone GGZone HHZone JJZone KKZone MMZone LLZone NNZone OO

Southerngroup W21 Cumulative (2018)




Alert | Ukhia (Southern Group)

8 W21 2018

EastPalongkhali

1 100% 4 100%

Hakimpara 1 100% 89 100%

Jamtoli 1 100% 94 100%


1 100% 73 100%


3 100% 104 100%

Zone PP 0 0% 42 100%

Zone QQ 0 0% 0 0%

Zone RR 1 100% 20 100%

Zone SS 0 0% 50 98%

Zone TT 3 100% 97 100%

Zone UU 0 0% 3 100%

Zone VV 0 0% 0 0%

Zone WW 0 0% 24 100%

Zone XX 0 0% 20 95%

Zone YY 0 0% 48 100%

Zone ZA 0 0% 0 0%

Zone ZZ 0 0% 0 0%

1

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3

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6

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9

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12

13

14

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16

1234567

8910111213141516

Zone ZZZone ZAHakimparaMoynarghona / BagghonaZone VVJamtoliThangkhali / Burmapara /

TasnimarkholaZone TTZone PPZone QQZone RRZone SSZone YYZone UUZone WWZone XX

Teknaf W21 Cumulative (2018)




Alert | Teknaf

9 W21 2018

Baharchora 1 100% 4 100%

Chakmarkul 0 0% 36 100%

Leda MS 4 100% 63 100%

MoH CC 1 100% 9 100%

Nayapara RC 2 100% 53 100%

Sabrang 0 0% 3 100%

Shamlapur 1 100% 12 100%

Teknaf UHC 0 0% 3 100%

Unchiprang 2 100% 77 100%

1

2

3

4

5

6

12

3

4

56

Jadimura

Chakmarkul

Shamlapur


RC

Event W21 Cumulative (2018)


Indicator-based surveillance

Malaria 0 0% 0 0%

Measles/Rubella 13 100% 463 99%

Bloody Diarr. 0 0% 0 0%

AFP 0 0% 16 100%

Meningitis 0 0% 9 100%

Haem. fever(susp.)

1 100% 23 100%

NNT 0 0% 2 100%

Unexp. fever 3 100% 85 100%

AWD 10 100% 134 100%

ARI 12 100% 125 100%

AJS 7 100% 209 100%

Event-based surveillance

EBS total 0 0% 267 100%

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


0 9 Low risk

0 3 Moderate risk

0 23 High risk

0 1 Very high risk

Alert | Event risk assessment

10 W21 2018

For more help and support,please contact:

Dr. Md. AlamgirMedical OfficerCivil Surgeon OfficeMinistry of Health and Family WelfareCox's Bazar, Bangladesh

Telephone: +88 018 1961 4952

Dr. Md Khadimul Anam MazharSurveillance and Outbreak Response OfficerWorld Health OrganizationCox'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 of Healthand Family WelfareBangladesh



Early Warning, Alert andResponse System (EWARS)

Annex W21 2018

Figure 1 | Proportional morbidity (W21 2018)

Malaria (confirmed) Malaria (suspected) Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Bloody diarrhoea

Other diarrhoea Unexplained fever Acute Jaundice Syndrome (AJS) Measles/Rubella Other

Disease W21 2018

# cases % morbidity # cases % morbidity

AWD 5,019 7.1% 103,824 5.6%

Bloodydiarrhoea

331 0.5% 32,576 1.8%

Other diarrhoea 2,897 4.1% 45,532 2.5%

ARI 7,934 11.2% 213,851 11.6%

Measles/Rubella 20 0.0% 1,339 0.1%

AFP 0 0.0% 22 0.0%

Suspectedmeningitis

0 0.0% 48 0.0%

AJS 55 0.1% 2,210 0.1%

Susp. haem.fever

3 0.0% 72 0.0%

Neonataltetanus

0 0.0% 3 0.0%

Adult tetanus 0 0.0% 22 0.0%

Malaria (conf.) 9 0.0% 61 0.0%

Malaria (susp.) 1,001 1.4% 18,936 1.0%

Unexplainedfever

8,020 11.3% 218,705 11.9%

SevereMalnutrition

100 0.1% 3,542 0.2%

Injuries/Wounds 1,390 2.0% 31,564 1.7%

Other 44,255 62.3% 1,169,465 63.5%

Total 71,034 100% 1,841,772 100%

Proportional morbidity

1 W21 2018

Figure 2 | Trend in proportional morbidity for key diseases (W21)

Other consultations Acute Respiratory Infection (ARI) Unexplained fever

Acute Watery Diarrhoea (AWD) Other diarrhoea Acute Jaundice Syndrome (AJS)

Trend in consultations and key diseases

2 W21 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

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Acute Respiratory Infection | Trend

3 W21 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

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Figure 3 | Trend in number of cases over time (W38 2017 - W21 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 site/zone (W21 2018)

4 W21 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

0Alerts

0%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk

Alert management (W21 2018) Figure | % sex Figure | % age

Male Female > 5 < 5

Measles | Trend

5 W21 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

0

25

50

75

100

125

150

175

200

225

250

275

300

325

350

Figure 4 | Trend in number of suspected cases over time (W38 2017 - W21 2018)


Measles | Maps and Alert Management

Map 2 | Map of cases by site/zone (W21 2018)

6 W21 2018



Alert threshold1 case. Source: IEDCR

13Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female < 5 > 5

Acute Jaundice Syndrome | Trend

7 W21 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

0

20

40

60

80

100

120

140

160

180



Acute Jaundice Syndrome | Maps and Alert Management

Map 3 | Map of cases by site/zone (W37 2017 - W21 2018)

8 W21 2018



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

7Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female > 5 < 5

Acute Watery Diarrhoea | Trends

9 W21 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

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000



Acute Watery Diarrhoea | Maps and Alert Management

Map 4 | Map of cases by site/zone (W37 2017 - W21 2018)

10 W21 2018



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

10Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female < 5 > 5



Telephone: +88 018 1961 4952

Dr. Md Khadimul Anam MazharSurveillance and Outbreak Response OfficerWorld Health OrganizationCox's Bazar, Bangladesh

Telephone: +88 017 0120 8845






Ministry ofHealth andFamily WelfareBangladesh



Diphtheria Outbreak

Update 2018-05-26

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 2018-05-26

Indicator Cumulative Last 7 days Last 24hours

Epidemiology

1. Total number of cases 6,949 47 7

Confirmed 3.4% (n= 238 ) 0.0% (n= 0 ) 0.0% (n= 0 )

Probable 51.7% (n= 3,592 ) 4.3% (n= 2 ) 28.6% (n= 2 )

Suspected 44.9% (n= 3,119 ) 95.7% (n= 45 ) 71.4% (n= 5 )

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

2. Laboratory testing

Positive 25.9% (n= 238 ) 0.0% (n= 0 ) 0.0% (n= 0 )

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

Negative (excluded) 74.1% (n= 681 ) 100.0% (n= 25 ) 100.0% (n= 2 )

3. Total number of deaths 42 0 0

4. Attack rate / 10,000 population 104.81 0.99

Clinical presentation

5. % with pseudomembrane 36.8% (n= 2,818 ) 16.7% (n= 12 ) 33.3% (n= 3 )

6. % with complications 1.1% (n= 85 ) 0.0% (n= 0 ) 0.0% (n= 0 )

Case management

7. % patients given antibiotics 63.3% (n= 4,851 ) 100.0% (n= 72 ) 100.0% (n= 9 )

8. % patients treated with DAT 18.4% (n= 1,408 ) 25.0% (n= 18 ) 22.2% (n= 2 )

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 strain by a multiplex assay.

Probable: case-patients with an upper respiratory tractillness with laryngitis or nasopharyngitis or tonsillitis ANDsore throath or difficulty swallowing and an adherentmembrane/pseudomembrane OR gross cervicallymphadenopathy.

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

Indeterminate: case-patients reported as indeterminate fortoxigenic C. diphtheriae strain by a multiplex assay.

Excluded: case-patients reported as negative for toxigenicC. diphtheriae strain by a multiplex assay.

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 2018-05-26

1

2

3

4

5

1

2

3

4

5

Figure 1 Epidemic curve of diphtheria cases in Cox's Bazar, by date of admission (W44 2017 - W21 2018)

Suspected Probable

Confirmed Indeterminate

Diphtheria | Epidemic curve

3 2018-05-26

Num

ber

6. N

ov

20. N

ov

4. D

ec

18. D

ec

1. J

an

15. J

an

29. J

an

12. F

eb

26. F

eb

12. M

ar

26. M

ar

9. A

pr

23. A

pr

7. M

ay

21. M

ay

0

20

40

60

80

100

120

140

160

180

200

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 2018-05-26

Num

ber

0

50

100

150

200

Num

ber

0

50

100

150

200

Num

ber

0

50

100

150

200

Num

ber

0

50

100

150

200

Num

ber

0

50

100

150

200

Num

ber

0

50

100

150

200

Num

ber

0

50

100

150

200

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 6,949 42 0.5% 1,408 47 0 18 7 0 2

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 2018-05-26

1 2 2 2

BRC1HK 48 0 0.0% 0 0 0 0 0 0 0

BRC2II 12 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 219 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 2,008 6 0.3% 588 44 0 9 7 0 0

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

SPP1TT 967 3 0.3% 483 3 0 9 0 0 0

Unknown 1 1 100.0% 0 0 0 0 0 0 0

1

2

< 5 ( 13.3% ; n = 1,017 ) 5-14 ( 56.1% ; n = 4,302 ) 15-44 ( 28.1% ; n = 2,151 ) > 45 ( 2.0% ; n = 153 )

Figure 3a | Sex

Male ( 43.8% ; n = 3,355 ) Female ( 55.8% ; n = 4,274 )

Figure 3b | Age

Figure 3c | Nationality

FDMN ( 89.8% ; n = 6,884 ) National ( 0.8% ; n = 63 )

Figure 3d | Vaccination status

Vaccinated ( 24.0% ; n = 1,840 ) Not vaccinated ( 25.0% ; n = 1,915 ) Unknown vaccination status ( 48.9% ; n = 3,750 )

Forcibly-Displaced Myanmar National

Table 3a | Symptoms # %

Fever 6,566 85.7%

Sore throat 7,157 93.4%

Difficulty swallowing 2,746 35.8%

Difficulty breathing 128 1.7%

Nasal regurgitation 394 5.1%

Bloody nasal discharge 104 1.4%

Ear discharge 4 0.1%

Drooling of saliva 0 0.0%

Change in voice 59 0.8%

Swollen neck 511 6.7%

Skin ulcers 31 0.4%

Other 490 6.4%

Table 3b | Signs # %

Pseudomembrane 2,818 36.8%

Gross cervical lymphadenopathy 2,312 30.2%

Chest indrawing 10 0.1%

Fast breathing rate 16 0.2%

Stridor 33 0.4%

Central cyanosis 4 0.1%

Fast heart rate 33 0.4%

Decreased capillary refill 2 0.0%

Weakness 39 0.5%

Lethargy 105 1.4%

Restlessness 12 0.2%

Other 390 5.1%

Diphtheria | Demographic breakdown, vaccination status and signs and symptoms

6 2018-05-26

1

1

Diphtheria | Trend in DAT use

7 W21 2018

Total patients treated with DAT - Cox's Bazar

15. J

an

29. J

an

12. F

eb

26. F

eb

12. M

ar

26. M

ar

9. A

pr

23. A

pr

7. M

ay

21. M

ay

0

5

10

15

20

25

30

35

Figure 3 | Trend in DAT use over time (2018-01-05 - 2018-05-26)

Indicator Cumulative Previous cycle Current cycle

Number of case-patients notified 4,298 70 70

Number of case-patients whose households were successfully traced 3349 63 23

% of case-patients who were traced 72.0% 90.0% 33.3%

Total # of close contacts 27,535 287 71

Average # close contacts per case household traced 8.2 4.6 3.1

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 2018-05-26)

Diphtheria | Contact tracing indicators

8 2018-05-26

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 2700 2136 78.6% 46 42 97.7% 44 9 17.3%

Diphtheria | Contact tracing by site/zone

9 2018-05-26

Balukhali MS 385 277 72% 4 3 75% 2 0 0%

KutupalongMS

268 217 81% 7 7 100% 5 4 80%

KutupalongRC

21 15 71% 0 0 0% 0 0 0%

Zone AA 120 104 87% 1 1 100% 0 0 0%

Zone BB 71 58 82% 3 3 100% 3 1 33%

Zone CC 62 49 79% 1 1 100% 0 0 0%

Zone DD 70 52 74% 0 0 0% 0 0 0%

Zone EE 57 34 60% 1 0 0% 4 0 0%

Zone FF 69 56 81% 10 9 90% 5 0 0%

Zone GG 109 95 87% 5 5 100% 5 0 0%

Zone HH 217 181 83% 3 3 100% 2 0 0%

Zone II 140 105 75% 0 0 0% 1 0 0%

Zone JJ 261 222 85% 2 2 100% 5 0 0%

Zone KK 164 106 65% 0 0 0% 4 0 0%

Zone LL 194 157 81% 2 2 100% 1 0 0%

Zone MM 245 199 81% 2 1 50% 2 0 0%

Zone NN 221 187 85% 5 5 100% 4 4 100%

Zone OO 26 22 85% 0 0 0% 1 0 0%



# case-patientstraced








Table 6 | Ukhia Southern Zones

Total 922 718 43.4% 19 16 59.3% 20 13 76.5%


10 2018-05-26

EastPalongkhali

5 0 0% 0 0 0% 0 0 0%

Hakimpara 123 114 93% 6 6 100% 6 5 83%

Jamtoli 75 69 92% 1 1 100% 0 0 0%


31 28 90% 0 0 0% 0 0 0%


273 202 74% 4 4 100% 5 3 60%

Zone PP 16 7 44% 0 0 0% 0 0 0%

Zone QQ 10 4 40% 1 1 100% 1 0 0%

Zone RR 48 29 60% 0 0 0% 0 0 0%

Zone SS 98 79 81% 0 0 0% 2 0 0%

Zone TT 113 86 76% 6 4 67% 4 3 75%

Zone UU 12 7 58% 0 0 0% 0 0 0%

Zone VV 0 0 0% 0 0 0% 0 0 0%

Zone WW 9 8 89% 0 0 0% 0 0 0%

Zone XX 92 77 84% 1 0 0% 0 0 0%

Zone YY 13 5 38% 0 0 0% 2 2 100%

Zone ZA 3 3 100% 0 0 0% 0 0 0%

Zone ZZ 1 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 2018-05-26











Table 7 | Teknaf

Total 272 226 80.7% 0 0 0.0% 1 0 0.0%


12 2018-05-26

Baharchora 2 1 50% 0 0 0% 0 0 0%

Chakmarkul 25 25 100% 0 0 0% 0 0 0%

Leda MS 165 139 84% 0 0 0% 0 0 0%

MoH CC 0 0 0% 0 0 0% 0 0 0%

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

Sabrang 0 0 0% 0 0 0% 0 0 0%

Shamlapur 0 0 0% 0 0 0% 0 0 0%

Teknaf UHC 0 0 0% 0 0 0% 0 0 0%

Unchiprang 42 32 76% 0 0 0% 1 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 2018-05-26



Telephone: +88 018 1961 4952

Dr. Md Khadimul Anam MazharSurveillance and Outbreak OfficerWorld Health OrganizationCox's Bazar, Bangladesh

Telephone: +88 017 0120 8845






Ministry ofHealth andFamilyWelfareBangladesh

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