Cox s Bazar, Bangladesh Volume No 2: 22 October 2017

Transcription

1 Mortality and Morbidity Weekly Bulletin (MMWB) Cox s Bazar, Bangladesh Volume No 2: 22 October 2017 Population OCV Consultations ARI AWD Death 702, , ,509 21,967 12, Photo Credit: WHO Bangladesh, Dr. Hammam EL Sakka This document is built on the Early Warning and Response System (EWARS), daily data received through MOHWF and WHO from the service providers in settlements of the Unregistered Myanmar Nationals (UMNs) and from health facilities in Cox s Bazar. As such, it can only be considered a snapshot of conditions in those reporting facilities. The presented information may hardly be viewed as representative of the overall health situation in Cox s Bazar; nonetheless we believe that it gives all actors in the field a stepping stone for building a true picture of morbidity and mortality in the UMNs. We thank all partners contributing to the EWARS. The EWARS itself and the resulting reports can only be a work in progress. We welcome all comments, feedback and further inputs that can help to improve the system and our joint understanding of the prevailing epidemiological situation, and ultimately - to avert spread of diseases. Contact Information Dr. Edwin Salvador, Deputy WHO Representative / Incident Manager, salvadore@who.int Dr. Hammam El Sakka, Team Leader, Health Emergency Programms, elsakkam@who.int WHO Bangladesh: 1

2 1. Population under Surveillance and Reporting Units The total number of reporting sites trained for EWARS in Cox s Bazar increased from 23 to 39; 90% (192/212) sent their filled EWARS data form on time during the epidemiological week 42 (15-21 October 2017). The EWARS is expected to be expanded to involve all camps/settlements in Cox s Bazar. The number of reports per camp/settlement from the past 7 days is shown in table 1. Table 1: Number of EWARS reports by camp/settlement, Cox s Bazar, Bangladesh, October Camp/Settlement Population EWARS Reports / Days October /10 16/10 17/10 18/10 19/10 20/10 21/10 Hakimpara 55, Jamtoli 31, Kutupalong Makeshift 424, Kutupalong Registered camp 32, Leda Makeshift 22, Moynarghona 21, Nayapara Registered camp 34, Shamlapur Settlement 22, Thangkhali 28, Unchiprang Makeshift 30, Mobile NA MoHFW NA Total 702, The total number of EWARS reports increased by 32% compared to the previous week (from 161 to 212 reports). Accordingly, the total number of consultations reported throughout EWARS increased by 92% compared to the previous week (21,301 vs 40,968). The weekly trend of reporting units participating in the EWARS and the number of consultations is shown in Figure 1. Figure 1: Number of EWRAS reports by camp/settlement, Cox s Bazar, Bangladesh, 15 to 21 October

3 2. Proportion of Primary Causes for Cases and Deaths During the period of 25 August-21 October 2017, a total of 96, 509 consultations were reported through EWARS. Of these, 52,475 were diseases under surveillance. Forty-two percent (21,967) of all consultations for diseases under surveillance were due to acute respiratory infections (ARI), 21% (11,141) due to unexplained fever (UNFEV), 19% (9,758) due to acute watery diarrhoea (AWD), 10% (5,547) due to skin diseases (SKD), 5% (2,422) due to injury (INJ) and 2% due to eye infections (EIN). The rest of the consultations included severe malnutrition, bloody diarrhoea, suspected measles/rubella, jaundice, and malaria. During the same period, there were 77 reported deaths: 40% (31) of deaths were due to ARI, 13% (10) to neonatal diseases, 13% (10) injury, 9% (7) AWD, 3% (2) malaria, 3% (2) meningitis and the remaining 19% (15) were due to other causes. The proportion of primary causes for the reported cases and related deaths is shown in Figure2. Figure 2: Proportion of primary causes for all reported cases and deaths, Cox s Bazar, Bangladesh, 25 August -21 October (ARI: Acute Respiratory Infection, AWD: Acute Water Diarrhoea, BD: Bloody Diarrhoea, INJ: Injuries, MEN: Meningitis like Disease, MAL: Malaria, ND: Neonatal Diseases, OTH: Other diseases, SKN: Skin Disease, UNFEV: Fever of unexplained origin, EIN: Eye Infections and UNK: Unknown Causes) For the under-5 year age group, a total number of 20,911 health events were reported through EWARS, constituting 37% of the total consultations. 18% (9,664) of these cases were attributed to ARI while 9% (4,695) were due to AWD. There were 31 reported deaths in the children under 5, representing 40% of total deaths. Forty-two percent (13) were ARI-related, 32% (10) due to neonatal diseases, 10% (3) due to AWD and 6% (2) due to injury and the remaining 10% were due to other causes. For the over-5 year age group, a total number of 31,564 health events were reported through EWARS, constituting 56% of the total consultations. 39% (12,303) of these cases were attributed to ARI while 16% (5,063) were due to AWD. There were 46 reported deaths in the age group over 5 years, representing 60% of total deaths reported. Of these, 39% (18) were due to ARI, 17% due to injury, 9% due to AWD and 4% due to suspected malaria. The proportion of primary causes of reported cases and deaths in both age groups are shown in figures 3 and 4. 3

4 Figure 3: Proportion of primary causes for the reported cases and deaths in the under-5 year age group, Cox s Bazar, Bangladesh, 25 August -21 October Proportion of primary causes for the reported cases and deaths in the under-5 year age group, Cox s Bazar, Bangladesh, 25 August -21 October

5 3. Acute Respiratory Infection Between 25 August and 21 October 2017 (epidemiological weeks 34-42), a total of 21,967 ARI cases of them; 46% (9,664/21,967) were under 5 years old. There were 31 ARI related deaths (CFR 0.14%). The weekly distribution of ARI cases is shown in Figure 5. Figure 5: Weekly Distribution of Reported ARI Case by age groups, Cox s Bazar, Bangladesh, 25 August -21 October Ukhia reported 76% (16,788/21,967) of the total ARI reported cases followed by Teknaf and Cox s Bazar 23% and 1% respectively. The weekly distribution of ARI cases by district is shown in Figure 6. Figure 6: Weekly distribution of reported ARI cases by district, Cox s Bazar, Bangladesh, 25 August -21 October

6 4. Measles Between 18 September and 21 October 2017, a total of 67 suspected measles cases were reported through EWARS: 70% (47) from Ukhia, 16% (11) from Teknaf, 10% (7) from Cox s Bazar, 1% (1) from Ramu and 1% (1) from Kutuidbia. Sixty-three percent (42/67) were >=1 and less than 5 years old. The mean age of the reported cases was 4.6 years [SD, 7.70] ranging from 36 days to 30 years. The age distribution of reported cases is shown is figure 7. Figure 7: Reported Measles cases by age group, Cox s Bazar, Bangladesh, 18 September - 21 October Only 10% (7/67) of the reported cases were from the host community. On 16 September 2017, a mass measles vaccination campaign was carried out in Cox s Bazar for 14 days. Activities included vaccination using a combination of fixed posts and outreach immunization teams, the use of checklists to monitor vaccination sessions, social mobilization activities, and surveillance for adverse events following immunization. Although the campaign targeted 122,580 children <15 years old in the 2 upazilas of Cox s Bazar (Tekaf, Ukhia) and Naikhongchhari upazila in Bandarban district, the total number of vaccinated children was 135,519. Case investigations and were conducted for only 47 suspected cases and their samples were collected for laboratory confirmation; only 11% (5/47) reported history of 1 dose of measles vaccination (4 from the host community and 1 from UMNs), the remaining 87% (42/47) reported no history of previous measles vaccination. 6

7 Figure 8: Daily distribution of reported measles cases by age group, Cox s Bazar, Bangladesh, 18 September - 21 October Laboratory results showed that 31% (21) were positive for measles specific IgM, 10% (5) were negative for measles specific IgM and 61% (41) are pending the laboratory results. Figure 9: Daily distribution of reported measles cases by laboratory results, Cox s Bazar, Bangladesh, 18 September - 21 October

8 Figure 10: Geographical distribution of reported measles cases, Cox s Bazar, Bangladesh, 18 September - 21 October

9 5. Acute Watery Diarrhoea Between 25 August and 21 October 2017 (epidemiological weeks 34-42), a total of 9,758 AWD cases were reported including 7 related deaths (CFR 0.07%). 48% (4,695) were under 5 years old. The weekly distribution of AWD cases by age group is shown in Figure 11. Figure 11 Weekly distribution of reported AWD cases by age group, Cox s Bazar, Bangladesh, 25 August -21 October Ukhia reported 75% (7,321/9,758) of the total AWD cases, followed by Teknaf and Cox s Bazar 24% and 1% respectively. The weekly distribution of AWD cases by district is shown in Figure 12. Figure 12: Weekly Distribution of Reported ARI Case by District, Cox s Bazar, Bangladesh, 25 August -21 October

10 5.1 Cholera vaccination campaign in Cox s Bazar and Bandarban Since August 2017, an influx of approximately 600,000 from Myanmar arrived in Bangladesh. Overcrowding, bad sanitation and malnutrition were prevalent and outbreaks of cholera resulting in thousands of cases anticipated. Considering lack of safe drinking water, proper sanitation facilities and poor personal hygiene practices, the UMN camps of two sub-districts, Teknaf and Ukhia, were at high risk of spreading cholera as experience from similar situations in other countries has shown. Moreover, it has been reported that a huge number of people are suffering from acute watery diarrhoea. Based on field assessments conducted by WHO in the newly established settlements and makeshift camps, the water and sanitation conductions are dire. Sanitation facilities range between 1 latrine per 1,000 to 5,000 people, open defecation is a widespread practice. Coupled with rainfall these pose serious public health threats. WHO estimates from regular visits in 11 settlements that there is limited soap available among new arrivals. Traditionally, Rohingya rarely boil drinking water before consumption. No boiling of water was observed, besides the limited access to wood for fire. Likewise, there is a severe shortage of clean drinking water, estimated at liter per person, per day. Accordingly, in several settlements and camps, people are resorting to use of surface water from streams and ditches, which is highly polluted. On 10 October 2017, the Government of Bangladesh launched an oral cholera vaccination (OCV) campaign with the support of WHO for 10 days, targeting over people in 11 camps/settlements in Cox s Bazar district, Chittagong division. It was the first OCV campaign to be conducted in the country, and comes at a critical time after UMNs influx to the country since August Because of the large numbers of UMNs living in the camps and within the host community and the limited supply of OCV, the vaccination campaign in Cox s Bazar Bangladesh was limited to UMN camps at full capacity or overcrowded and to all host community areas. The large influx of UMNs increased uncertainty about the size of the target population, data from the most recent measles vaccination campaign (2017) were used to estimate the population aged >1-year-old. The vaccination campaign was preceded by extensive social mobilization efforts to inform the community of the benefits, availability and necessity of the vaccine. The main message included that vaccination is a preventive measure against cholera that supplements, but does not replace, other traditional cholera control measures such as improving access to safe water and sanitation and hygiene measures/interventions. The vaccination strategy included a combination of fixed sites and mobile teams for door-to-door vaccine delivery. The vaccine cold chain was maintained, and vaccines were transported using a sufficient number of vaccine carriers and ice packs for a door-to-door strategy. 10

11 Experience from WHO s technical staff supported the implementation of this campaign during the public health emergency. As of October 18, 2017, a total of 700,487 persons were reported to have been vaccinated of them; 691,574 representing 105% % (691,574/658,372) of the target population (Table 2). An additional 8,913 (not included in the original micro-plan) were vaccination in 2 sites; Anjumanpara, and Sabrang Entry Point. Seventy-six percent (528,425/691,574) were from the total OCV vaccinated were from Ukhia, 21% (146,985/691,574) from Teknaf and the remaining 2% were from Bandarban district. The number of vaccinated per camp/settlement is shown in figure 13 and table 2. No AEFIs associated with cholera vaccination were reported during the campaign. However, because a monitoring system for adverse events was not fully established, some adverse events might have been missed. Figure 13: Number of vaccinated and vaccine coverage per camp/settlement, Chittagong division, Bangladesh, October

12 Table 2: Number of OCV vaccinated per camp/settlement, Cox s Bazar and Bandarban districts, Bangladesh, October Camp/Area Name Estimated Pop Target Pop (>=1 year) Total vaccinated % Coverage Shafiullah Kata 40,000 37,200 38, % Bag Gona Jamtoli 37,095 34,498 35, % Hakimpara 51,437 47,836 45,281 95% Taznirmar khola 27,557 25,628 22,036 86% Moinergona 70,764 65,810 60,253 92% Balukhali 45,470 42,287 64, % Kutupalong unregistered camp 194, , , % Kutupalong registered camp 33,901 31,527 32, % Total Ukhia Upazila 500, , , % Chakmarkul 14,980 14,000 11,498 82% Baharchara 10,700 10,000 8,256 83% Unchiprong 41,195 38,500 25,178 65% Leda camp 26,978 25,214 25, % Nayapara camp 36,626 34,230 35, % Nilha 53,500 50,000 41,198 82% Total Teknaf Upazila 183, , ,985 85% Uttorpara (Gundhum Uni) 4,163 3,872 2,356 61% Konarpara (Gundhum Uni) 9,000 8,370 5,094 61% Bahirmat (Naikhoyongchari Uni) % Sapmarijhil (Naikhoyongchari Uni) 2,000 1,860 1,826 98% Bara Sonkhola (Naikhoyongchari Uni) 7,042 6,549 6, % Total Naikanchari Upazila 22,581 21,000 16,164 77% Grand Total 707, , ,574* 105% *Additional 8,913 were vaccinated in Anjumanpara, and Sabrang Entry Point (N=700,487) 12

13 5.2 Drinking water testing results Between 18 September and 21 October 2017, a total of 150 water samples from different water sources were collected from the Cox s Bazar UMNs settlements. Using membrane filtration technique, only 35% (52) of the samples were found negative for E. Coli -meeting the Bangladesh Standard and WHO guideline value (0 cfu/100ml). The remaining 65% (98) tested positive for faecal contamination (E. Coli); 38% (37/98) of all the positive samples were very highly contaminated (>100 cfu/100ml), 18% (18) highly contaminated (>50 and <100 cfu/100ml) and intermediate contamination (<50 cfu/100ml) was found in 43% (43) of the samples. Out of all contaminated samples, 61% (61/98) were collected from water stored at household level, 18% (18) from tube-wells, 4% (4) from stream water (Chhora), and the remaining 11% were collected from other sources including water supplied by tankers and water bladders. Teknaf represented 84% (84) of all the contaminated samples followed by Ukhia and Banderband with 14% and 5%, respectively. Locationwise, the highest contamination level was detected in Unchiprang (3/3) followed by Kutupalong settlement (36/44). The E Coli water testing results by camp/settlement is showed in Figure 14. Figure14: E Coli water testing results, UMNs settlements, Cox s Bazar and Bandarban districts, Bangladesh, 18 September -21 October 2017 WHO is strengthening the water quality surveillance activity in collaboration with the Department of Public Heath Engineering (DPHE), Ministry of the LGRD and Cooperatives. A field water quality testing laboratory has been established in DPHE Cox's Bazar Sadar upazila office. WHO supported DPHE in deploying manpower for collecting drinking water samples from different sources and household UMN 13

14 settlements. On 20 October two days training programme was organized by WHO for DPHE personnel with the objectives of increasing the capacity for recording the GPS location of the sampling points; sample collection techniques; transportation; and E. Coli testing. A total of 18 participants comprising 12 sample collectors, 2 data entry operators and 4 chemists participated in the training programme. The surveillance data to identify the high-risk settlement to enable the WASH sector actors to take immediate measures to reduce the health risk arising from consuming the contaminated water. 14