Epidemiological Highlights

Transcription

1 W Highlights Epidemiological Highlights Week 14

2 W Highlights 155 health facilities are currently registered as EWARS sites. 111 reported were received for week 14. In 218, the cumulative completeness for reporting is 69%. 9 alerts were triggered through indicator-based surveillance (IBS) and 12 through event-based surveillance (EBS). All alerts were verified. Of the 9 IBS alerts, 75 (83.3%) were discarded and 13 (16.7%) are being monitored AWD cases, bringing total for AWD in 218 up to 68,628 cases. One field investigation was conducted in response to an AWD alert. The investigation and risk assessment was completed in less than 48 hours. Two suspected meningitis bringing total for suspected meningitis in 218 up to 42 cases. Three suspected hemorrhagic fever bringing total for suspected hemorrhagic fever in 218 up to 67 cases

3 W Highlights Diphtheria As of 7 April 218, a total of diphtheria case-patients were reported in EWARS, including 17 (+34) new case-patients in week 14, slightly higher than the previous three weeks. 27 case-patients have been laboratory confirmed. The last laboratory confirmed case was reported on 31 March. There have been (12 case-patients in week 14) probable, and 2 95 (22 case-patients in week 14) suspected case-patients reported up to week 14. A total of 52 (4 case-patient in week 14) diphtheria case-patients have been reported from the host community; 14 were laboratoryconfirmed; 3 probable and 8 suspected. A total of 41 (1 death in week 14) deaths (case-fatality proportion< 1%) were reported. No deaths have occurred in host community.

4 W Highlights Measles As of 7 April 218, a total of suspected measles case were reported in EWARS from 31 December 218, including 33 new case-patients in week 14, lower than the previous three week mean of 47 new case-patients (43 in week 13, 5 in week 12, 48 in week 11). Measles sampling strategy to confirm the outbreak and assess ongoing transmission is expected to begin on Sunday 15 April 218. Partners to receive information by 12 April 218.

5 W Highlights Acute Jaundice Syndrome (AJS) As of 7 April 218, a total of cases of AJS were reported in EWARS, including 96 new case-patients in week 14, lower than the previous week; 131 in week 13. Exhaustive sampling for cases of AJS was conducted between 26 February and 26 March 218. Three of four have been tested. Results from the final batch are pending. To date, serological testing of samples gave positive results for the following etiologies: Hepatitis A Virus (14/184, 56.2% positive); chronic Hepatitis B (HBSAg) (7/85, 8.2% positive), Hepatitis C Virus (14/1, 14% positive) and Leptospirosis (3/13, 2.9% positive). No sample was positive for Hepatitis E virus. A complete epidemiological analysis and report will be prepared for the national authorities and partners.

6 Bangladesh Rohingya Emergency Response Early Warning, Alert and Response System (EWARS) Annex W Ministry of Health and Family Welfare Bangladesh Printed: 11:16 Tuesday, 1 April 218 UTC

7 Proportional morbidity Figure 1 Proportional morbidity (W14 218) Disease W # cases % morbidity # cases % morbidity AWD 4, % 68, % Bloody diarrhoea 1,92 1.9% 26, % Other diarrhoea 2, % 26, % ARI 9, % 155, % Measles/Rubella 33.% 1,148.1% AFP.% 18.% Suspected meningitis 2.% 42.% AJS 96.1% 1,689.1% Susp. haem. fever 3.% 67.% Malaria (confirmed) Malaria (suspected) Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Bloody diarrhoea Other diarrhoea Unexplained fever Acute Jaundice Syndrome (AJS) Measles/Rubella Other Neonatal tetanus.% 3.% Adult tetanus.% 13.% Malaria (conf.) 4.% 44.% Malaria (susp.) 1,24 1.3% 1,851.9% Unexplained fever Severe Malnutrition 1, % 155, % 144.1% 2,679.2% Injuries/Wounds 1, % 19, % Other 65, % 65, % Total 98,761 1% 1,264,534 1% 1 W14 218

8 Trend in consultations and key diseases Figure 2 Trend in proportional morbidity for key diseases (W14) 1.% 8.% 6.% W W W W W W W1 218 W5 218 W9 218 W % morbidity 4.% 2.%.% Other consultations Acute Respiratory Infection (ARI) Unexplained fever Acute Watery Diarrhoea (AWD) Other diarrhoea Acute Jaundice Syndrome (AJS) 2 W14 218

9 Acute Respiratory Infection Trend Figure 3 Trend in number of cases over time (W W14 218) 16, 14, 12, 1, 8, 6, 4, 2, W W W W W W W1 218 W5 218 W9 218 W Total ARI cases - Cox's Bazar 3 W14 218

10 Acute Respiratory Infection Maps and Alert Management Map 1 Map of cases by site/zone (W14 218) a. Ukhia Number of cases b. Ukhia Number of alerts c. Teknaf Number of cases d. Teknaf Number of alerts Map legend Number of cases Number of alerts 1 1 Alert threshold Twice the average number of cases over the past 3 weeks. Source: IEDCR Alert management (W14 218) Figure % sex Figure % age Alerts % Verified Low Risk Moderate Risk High Risk Very High Risk Male Female > 5 < 5 4 W14 218

11 Measles Trend Figure 4 Trend in number of suspected cases over time (W W14 218) W W W W W W W1 218 W5 218 W9 218 W Total suspected measles/rubella cases - Cox's Bazar 5 W14 218

12 Measles Maps and Alert Management Map 2 Map of cases by site/zone (W14 218) a. Ukhia Number of cases b. Ukhia Number of alerts c. Teknaf Number of cases d. Teknaf Number of alerts Map legend Number of cases Number of alerts 1 1 Alert threshold 1 case. Source: IEDCR Alert management (W14 218) Figure % sex Figure % age 2 Alerts 1% Verified Low Risk Moderate Risk High Risk Very High Risk Male Female > 5 < 5 6 W14 218

13 Acute Jaundice Syndrome Trend Figure 5 Trend in number of cases over time (W W14 218) W W W W W W W1 218 W5 218 W9 218 W Total suspected AJS cases - Bangladesh 7 W14 218

14 Acute Jaundice Syndrome Maps and Alert Management Map 3 Map of cases by site/zone (W W14 218) a. Ukhia Number of cases b. Ukhia Number of alerts c. Teknaf Number of cases d. Teknaf Number of alerts Map legend Number of cases Number of alerts 1 1 Alert threshold A cluster of 3 or more cases seen in a health facility. Source: IEDCR Alert management (W14 218) Figure % sex Figure % age 1 Alerts 1% Verified Low Risk Moderate Risk High Risk Very High Risk Male Female > 5 < 5 8 W14 218

15 Acute Watery Diarrhoea Trends Figure 6 Trend in number of cases over time (W W14 218) 1, 9, 8, 7, 6, 5, 4, 3, 2, 1, W W W W W W W1 218 W5 218 W9 218 W Total AWD cases - Bangladesh 9 W14 218

16 Acute Watery Diarrhoea Maps and Alert Management Map 4 Map of cases by site/zone (W W14 218) a. Ukhia Number of cases b. Ukhia Number of alerts c. Teknaf Number of cases d. Teknaf Number of alerts Map legend Number of cases Number of alerts 1 1 Alert threshold Twice the average number of cases over the past 3 weeks. Source: IEDCR Alert management (W14 218) Figure % sex Figure % age 12 Alerts 1% Verified Low Risk Moderate Risk High Risk Very High Risk Male Female > 5 < 5 1 W14 218

17 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: Dr Uzzal Roy Surveillance and Outbreak Response Officer World Health Organization Cox's Bazar, Bangladesh Telephone: Notes WHO and the Ministry of Health and Family Welfare gratefully acknowledge all partners who have reported the data used in this bulletin. The data been collected with support from the EWARS project. This is an initiative to strengthen early warning, alert and response in emergencies. It includes an online, desktop and mobile application that can be rapidly configured and deployed in the field. It is designed with frontline users in mind, and built to work in difficult and remote operating environments. This bulletin has been automatically published from the EWARS application. More information can be found at Sign-up for an account with EWARS Bangladesh at Ministry of Health and Family Welfare Bangladesh

18 Bangladesh Rohingya Emergency Response Early Warning, Alert and Response System (EWARS) Epidemiological Bulletin W Ministry of Health and Family Welfare Bangladesh Printed: 11:15 Tuesday, 1 April 218 UTC

19 Contents 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 1 Teknaf alerts by site/zone Map 7 Teknaf alerts site/zone Slide 1 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 W14 218

20 Highlights W Table 1 Coverage # % Table 3 Alert performance indicators W14 Cumulative (218) 866, - Estimated total Rohingya population 1 9 1,222 Total alerts raised 728,786 84% Total population under surveillance 1% 99% % verified Total number of health facilities 2 % % % auto-discarded % Number of EWARS reporting sites % % % undergoing risk assessment Table 2 Early warning performance indicators % 2% % completed risk assessment W14 Cumulative (218) Number of weekly reports received 71% 68% Completeness 71% 67% Timeliness 1 2 Source: IOM. Bangladesh: Needs and Population Monitoring - NPM R7 Report. 15 December 217 Source: REACH. Health Facility Mapping Exercise. 12 December 217 Excluding non-operational health facilities; and excluding specialised services (DTCs, SRH clinics) and mobile clinics (which report under fixed sites) 1 W14 218

21 Early Warning Ukhia and Teknaf Map 1a Ukhia completeness by site/zone Map 1b Teknaf completeness by site/zone Zone ZZ Zone ZA Zone YY Zone XX Zone WW Zone UU Zone TT Zone SS Zone RR Zone QQ Zone PP Zone OO Zone NN Zone MM Zone LL Zone KK Zone JJ Zone II Zone HH Zone GG Zone FF Zone EE Zone DD Zone CC Zone BB Zone AA Thangkhali / Burmapara / Tasnimarkhola Kutupalong RC Kutupalong MS Jamtoli Hakimpara Balukhali MS Zone VV Moynarghona / Bagghona Nayapara RC 2 Leda MS 3 Chakmarkul 4 Unchiprang 5 Shamlapur 6 Jadimura Completeness Completeness 25% 5% 75% 1% 25% 5% 75% 1% 2 W14 218

22 Early Warning Ukhia (Northern Group) Table 4 Performance by site/zone (W14 218) Map 2 Completeness by site/zone Northern group Reporting # health facilities # reports received Performance Completeness Balukhali MS % 73% Kutupalong MS Kutupalong RC % 83% % 75% Timeliness Zone AA 4 4 1% 1% Zone BB 2 3 1% 1% Zone CC 2 2 1% 1% Zone DD 6 3 5% 5% 1 Zone OO 2 Zone NN 3 Zone MM 4 Zone LL 5 Zone KK 6 Zone JJ 7 Zone II 8 Zone HH 9 Zone GG 1 Zone FF 11 Zone EE 12 Zone DD 13 Zone CC 14 Zone BB 15 Zone AA 16 Kutupalong RC 17 Kutupalong MS 18 Balukhali MS Zone EE 3 3 1% 1% Zone FF % 75% Zone GG 3 3 1% 1% Zone HH 2 1 5% 5% Zone II % 1% Zone JJ % 33% Zone KK 2 2 1% 1% Zone LL 1 % % Zone MM 1 1 1% 1% Zone NN % 73% Zone OO 1 1 1% 1% Completeness 25% 5% 75% 1% 3 W14 218

23 Early Warning Ukhia (Southern Group) Table 5 Performance by site/zone (W14 218) Map 3 Completeness by site/zone Southern group East Palongkhali Reporting # health facilities # reports received Performance Completeness Timeliness 1 1 1% 1% Hakimpara % 63% Jamtoli % 75% Moynarghona / Bagghona Thangkhali / Burmapara / Tasnimarkhola % 56% 1 5 5% 5% Zone ZZ Zone ZA Zone YY Zone XX Zone WW Zone UU Zone TT Zone SS Zone RR Zone QQ Zone PP Thangkhali / Burmapara / Tasnimarkhola Jamtoli Hakimpara Zone VV Moynarghona / Bagghona Zone PP 2 2 1% 1% Zone QQ % 1% Zone RR 2 2 1% 1% Zone SS 5 4 8% 8% Zone TT % 56% Zone UU 1 1 1% 1% Zone VV % 1% Zone WW % 67% Zone XX % 67% Zone YY 2 1 5% 5% Zone ZA 1 % % Zone ZZ 1 % % Completeness 25% 5% 75% 1% 4 W14 218

24 Early Warning Teknaf Table 6 Performance by site/zone (W14 218) Map 4 Completeness by site/zone Teknaf Reporting Performance # health facilities # reports received Completeness Timeliness Baharchora 2 2 1% 1% Chakmarkul 2 2 1% 1% Leda MS 4 4 1% 1% MoH CC 1 1 1% 1% 1 Nayapara RC 2 Leda MS 3 Chakmarkul 4 Unchiprang 5 Shamlapur 6 Jadimura Nayapara RC 3 3 1% 1% Sabrang 1 1 1% 1% Shamlapur 1 1 1% 1% Teknaf UHC 1 % % Unchiprang 5 5 1% 1% Completeness 25% 5% 75% 1% 5 W14 218

25 Early Warning Partner performance Table 7 Performance by partner (W14 218) Partner Performance Reporting Partner Performance Reporting # sites # reports received Completeness Timeliness # sites # reports received Completeness Timeliness AIDOCT BDRCS % 44% BRAC 1 1 1% 1% CARE 4 4 1% 1% FHM 1 % % FRNDS 5 % % GK % 1% HMBDF 1 1 1% 1% IHA 2 1 5% 5% IOM % 85% IRC 7 7 1% 1% MERCY 2 2 1% 1% MOAS 2 2 1% 1% MSF % 56% MTI 1 1 1% 1% OBAT 1 1 1% 1% PHD 8 8 1% 1% Prottyashi 3 3 1% 1% PWJ 1 1 1% 1% RHU 2 2 1% 1% RI 5 5 1% 1% RTMI 5 % % SCI 9 9 1% 1% TdH 1 % % 6 W14 218

26 Alert Ukhia (Northern Group) Table 8 Performance by site/zone Map 5 Number of alerts by site/zone Northern group W14 Cumulative (218) # alerts % verif. # alerts % verif. Balukhali MS 8 1% 13 99% Kutupalong MS Kutupalong RC 5 1% 31 1% 5 1% 42 1% Zone AA 5 1% 39 1% Zone BB % 4 1% Zone CC % 1 1% Zone DD 5 1% 42 1% 1 Zone OO 2 Zone NN 3 Zone MM 4 Zone LL 5 Zone KK 6 Zone JJ 7 Zone II 8 Zone HH 9 Zone GG 1 Zone FF 11 Zone EE 12 Zone DD 13 Zone CC 14 Zone BB 15 Zone AA 16 Kutupalong RC 17 Kutupalong MS 18 Balukhali MS Zone EE 3 1% 86 1% Zone FF % 13 1% Zone GG 4 1% 2 1% Zone HH 1 1% 23 1% Zone II % % Zone JJ % 5 1% Zone KK 3 1% 23 96% Zone LL % 6 1% Zone MM % 4 1% Zone NN 1 1% 43 98% Zone OO 1 1% 6 1% # of alerts W14 218

27 Alert Ukhia (Southern Group) Table 9 Performance by site/zone Map 6 Number of alerts by site/zone Southern group East Palongkhali W14 Cumulative (218) # alerts % verif. # alerts % verif. % % Hakimpara 5 1% 72 1% Jamtoli 5 1% 71 99% Moynarghona / Bagghona Thangkhali / Burmapara / Tasnimarkhola 5 1% 52 98% 7 1% 81 1% Zone ZZ Zone ZA Zone YY Zone XX Zone WW Zone UU Zone TT Zone SS Zone RR Zone QQ Zone PP Thangkhali / Burmapara / Tasnimarkhola Jamtoli Hakimpara Zone VV Moynarghona / Bagghona Zone PP 1 1% 34 1% Zone QQ % % Zone RR 1 1% 16 1% Zone SS 3 1% 44 98% Zone TT 4 1% 79 1% Zone UU % % Zone VV % % Zone WW 1 1% 19 95% Zone XX % 17 94% Zone YY 4 1% 48 1% Zone ZA % % Zone ZZ % % # of alerts W14 218

28 Alert Teknaf Table 1 Performance by site/zone Map 7 Number of alerts by site/zone Teknaf W14 Cumulative (218) # alerts % verif. # alerts % verif. Baharchora % 1 1% Chakmarkul 3 1% 3 1% Leda MS 3 1% 36 1% MoH CC % 4 1% 1 Nayapara RC 2 Leda MS 3 Chakmarkul 4 Unchiprang 5 Shamlapur 6 Jadimura Nayapara RC 2 1% 39 1% Sabrang % 3 1% Shamlapur 1 1% 7 1% Teknaf UHC % 3 1% Unchiprang 4 1% 6 1% # of alerts W14 218

29 Alert Event risk assessment Table 11 Performance by type of alert Event W14 Cumulative (218) Table 12 Risk assessment W14 Cumulative (218) Indicator-based surveillance # alerts % verif. # alerts % verif. Malaria % % Measles/Rubella 2 1% % Bloody Diarr. % % AFP % 13 92% Meningitis % 6 1% Haem. fever (susp.) 1 1% 18 89% NNT % 2 5% Unexp. fever 3 1% 52 1% AWD 12 1% 79 1% ARI 5 1% 82 1% AJS 1 1% 156 1% 3 Low risk 3 Moderate risk 23 High risk 1 Very high risk Event-based surveillance EBS total 1 1% 247 1% 1 W14 218

30 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: Dr Uzzal Roy Surveillance and Outbreak Response Officer World Health Organization Cox's Bazar, Bangladesh Telephone: Notes WHO and the Ministry of Health and Family Welfare gratefully acknowledge all partners who have reported the data used in this bulletin. The data been collected with support from the EWARS project. This is an initiative to strengthen early warning, alert and response in emergencies. It includes an online, desktop and mobile application that can be rapidly configured and deployed in the field. It is designed with frontline users in mind, and built to work in difficult and remote operating environments. This bulletin has been automatically published from the EWARS application. More information can be found at Sign-up for an account with EWARS Bangladesh at Ministry of Health and Family Welfare Bangladesh

31 Bangladesh Rohingya Emergency Response Diphtheria Outbreak Update Ministry of Health and Family Welfare Bangladesh Printed: 12: Tuesday, 1 April 218 UTC

32 Disclaimer Disclaimer The information in this bulletin is gathered from partners in the field each 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 updated and validated, and therefore the figures may be subject to revisions as new data is received. Acknowledgements WHO and Ministry of Health and Family Welfare gratefully acknowledge the support of all partners involved in the Diphtheria Outbreak Response for their support in contributing the data to this bulletin. Sources of data 1. Diphtheria Case Report Form 2. Diphtheria Contact Tracing Report Form 3. Diphtheria Daily Operational Report Form

33 Diphtheria Summary of key indicators Table 1 Summary of key indicators Indicator Cumulative Last 7 days Epidemiology 1 Last 24 hours Notes November present based on date of presentation Case definition: 1. 2 Total number of cases 6, Confirmed 3.1% (n= 27 ) 1.2% (n= 2 ).% (n= ) Probable 52.7% (n= 3,466 ) 53.2% (n= 91 ) 37.1% (n= 13 ) Suspected 44.2% (n= 2,95 ) 45.6% (n= 78 ) 62.9% (n= 22 ) Indeterminate.% (n= ).% (n= ).% (n= ) 2. Laboratory testing Positive 29.4% (n= 27 ) 16.7% (n= 2 ).% (n= ) Indeterminate.% (n= ).% (n= ).% (n= ) Negative (excluded) 7.6% (n= 498 ) 83.3% (n= 1 ).% (n= ) 3. Total number of deaths Attack rate 3 / 1, population Clinical presentation 5. % with pseudomembrane 37.% (n= 2,63 ) 43.3% (n= 81 ) 34.3% (n= 12 ) 6. % with complications4 1.2% (n= 82 ) 1.1% (n= 2 ) 2.9% (n= 1 ) Case management 7. % patients given antibiotics 6.4% (n= 4,297 ) 96.8% (n= 181 ) 1.% (n= 35 ) 8. % patients treated with DAT5 17.3% (n= 1,23 ) 46.5% (n= 87 ).% (n= ) 3 Confirmed: case-patients reported as positive for toxigenic C. diphtheriae strain by a multiplex assay. Probable: case-patients with an upper respiratory tract illness with laryngitis or nasopharyngitis or tonsillitis AND sore throath or difficulty swallowing and an adherent membrane/pseudomembrane OR gross cervical lymphadenopathy. Suspected: any case with a clinical suspicion of diphtheria. Includes case-patients that are unclassified due to missing values. Indeterminate: case-patients reported as indeterminate for toxigenic C. diphtheriae strain by a multiplex assay. Excluded: case-patients reported as negative for toxigenic C. diphtheriae strain by a multiplex assay. Source of population data: IOM. Bangladesh: Needs and Population Monitoring - NPM R7 Report. 15 December Defined as one or more of the following: respiratory distress, shock, irregular heart rate, peripheral neuritis / neuropathy, kidney failure or cutaneous necrotic lesions. 5 Diphtheria anti-toxin. Data for number treated with DAT in last 24 hours comes from the Daily Operational Monitoring Report Form

34 Diphtheria Epidemic curve Figure 1 Epidemic curve of diphtheria cases in Cox's Bazar, by date of admission (W W14 218) Number Nov 2. Nov 4. Dec 18. Dec 1. Jan 15. Jan 29. Jan 12. Feb 26. Feb 12. Mar 26. Mar 9. Apr Suspected Probable Confirmed Indeterminate

35 Diphtheria Epidemic curves for diphtheria outbreak in Cox's Bazar, by DTC Figure 2a IOM1D4 2 Figure 2b IOM2AA 2 Figure 2c IOM3LD Number 1 Number 1 Number Figure 2d MSFBKL 2 Figure 2e MSFJAM 2 Figure 2f MSFRUB Number 1 Number 1 Number Figure 2g SPP1TT Number Case definition Suspected Probable Confirmed Indeterminate

36 Diphtheria Summary by DTC Table 2 Summary of cases, deaths and DAT use by DTC DTC Cumulative Last 7 days Last 24 hours Cases Deaths CFR DAT Cases Deaths DAT Cases Deaths DAT BRC1HK 48.% BRC2II 12.% IOM1D4 19.% 37 IOM2AA 147.% 23 IOM3LD 215.% 11 2 IRC1YY.% JRC1TT.% MSFBKL 2, % 15 MSFJAM % 161 MSFRUB 1, % OBT1UU.% SPP1TT % Unknown % Total 6, % 1, Case fatality rate 2 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

37 Diphtheria Demographic breakdown, vaccination status and signs and symptoms Figure 3a Sex Male ( 44.4% ; n = 3,155 ) Female ( 55.1% ; n = 3,92 ) Figure 3c Nationality FDMN 1 ( 91.7% ; n = 6,523 ) National (.7% ; n = 53 ) 1Forcibly-Displaced Myanmar National Figure 3b Age < 5 ( 13.7% ; n = 971 ) 5-14 ( 57.1% ; n = 4,58 ) ( 26.7% ; n = 1,897 ) > 45 ( 2.% ; n = 143 ) Figure 3d Vaccination status Vaccinated ( 2.1% ; n = 1,433 ) Not vaccinated ( 24.9% ; n = 1,774 ) Unknown vaccination status ( 52.6% ; n = 3,744 ) Table 3a Symptoms # % Fever 6, % Sore throat 6, % Difficulty swallowing 2, % Difficulty breathing % Nasal regurgitation % Bloody nasal discharge % Ear discharge 4.1% Drooling of saliva.% Change in voice 26.4% Swollen neck % Skin ulcers 28.4% Other % Table 3b Signs # % Pseudomembrane 2,63 37.% Gross cervical lymphadenopathy 2, % Chest indrawing 9.1% Fast breathing rate 16.2% Stridor 33.5% Central cyanosis 4.1% Fast heart rate 29.4% Decreased capillary refill 2.% Weakness 24.3% Lethargy 9 1.3% Restlessness 9.1% Other %

38 Diphtheria Trend in DAT use Figure 3 Trend in DAT use over time ( ) Jan 15. Jan 22. Jan 29. Jan 5. Feb 12. Feb 19. Feb 26. Feb 5. Mar 12. Mar 19. Mar 26. Mar 2. Apr Total patients treated with DAT - Cox's Bazar 7 W14 218

39 Diphtheria Contact tracing indicators Table 4 Contact tracing reporting cycles ( to ) Indicator Cumulative Previous cycle Current cycle 5 Number of case-patients notified 3, Number of case-patients whose households were successfully traced % of case-patients who were traced 64.9% 44.9% 35.1% Total # of close contacts 18, Average # close contacts per case household traced Notes 1 Reporting cycle denotes a retrospective 7-day reporting period, from present back to 1 January 218. The current cycle start -2 days from current date to provide time to locate the case-household 2 1 January present 3 Current date -16 days to current date -9 days 4 Current date -8 days to current date -2 days 5 Number of case-patients notified denotes diphtheria case-patients who were admitted at a diphtheria treatment centre (DTC) and their details were entered in the EWARS reporting platform 6 Traced denotes that a case-patient's household is identified in community, and all contacts are enumerated and placed on chemoprophylaxis and referred for vaccination

40 Diphtheria Contact tracing by site/zone Table 5 Ukhia Northern Zones Indicator Cumulative Previous cycle Current cycle # casespatients notified # case-patients successfully traced % casepatients traced # casespatients notified # case-patients successfully traced % casepatients traced # casespatients notified # case-patients successfully traced % casepatients traced Balukhali MS % 1 % 5 % Kutupalong MS Kutupalong RC % % % % % % Zone AA % 2 1 5% % Zone BB % % % Zone CC % 4 4 1% 5 % Zone DD % % 3 % Zone EE % % 2 2 1% Zone FF % 7 % 3 % Zone GG % 11 % 15 % Zone HH % 8 % 5 % Zone II % 1 % 5 3 6% Zone JJ % 9 % 11 % Zone KK % 4 % 3 % Zone LL % 3 % 2 % Zone MM % 6 % 3 % Zone NN % % % Zone OO % % 1 % Total % % %

41 Diphtheria Contact tracing by site/zone Table 6 Ukhia Southern Zones Indicator Cumulative Previous cycle Current cycle # casespatients notified # case-patients traced % casepatients traced # casespatients notified # case-patients traced % casepatients traced # casespatients notified # case-patients traced % casepatients traced East Palongkhali 5 % % 1 % Hakimpara % % % Jamtoli % 6 6 1% 5 3 6% Moynarghona / Bagghona Thangkhali / Burmapara / Tasnimarkhola % % % % % % Zone PP % % 1 1 1% Zone QQ % % % Zone RR % 4 % 3 % Zone SS % % % Zone TT % % 5 5 1% Zone UU % 6 % % Zone VV % % % Zone WW % 1 % % Zone XX % % % Zone YY % % 1 % Zone ZA % % % Zone ZZ 1 % % % Total % % %

42 Diphtheria Contact tracing percentage of case-patients who were traced Map 1a Ukhia (Cumulative) Map 1b Ukhia (Current cycle) Map 1c Ukhia (Previous cycle) % case-patients who were traced 25% 5% 75% 1% % case-patients who were traced 25% 5% 75% 1% % case-patients who were traced 25% 5% 75% 1%

43 Diphtheria Contact tracing by site/zone Table 7 Teknaf Indicator Cumulative Previous cycle Current cycle # casespatients notified # case-patients traced % casepatients traced # casespatients notified # case-patients traced % casepatients traced # casespatients notified # case-patients traced % casepatients traced Baharchora 2 1 5% % % Chakmarkul % 2 2 1% % Leda MS % % 2 % MoH CC % % % Nayapara RC % % 1 % Sabrang % % % Shamlapur % % % Teknaf UHC % % % Unchiprang % % 2 % Total % 2 2.% 5.%

44 Diphtheria Contact tracing percentage of case-patients who were traced Map 2a Teknaf (Cumulative) Map 2b Teknaf (Current cycle) Map 2c Teknaf (Previous cycle) % case-patients who were traced 25% 5% 75% 1% % case-patients who were traced 25% 5% 75% 1% % case-patients who were traced 25% 5% 75% 1%

45 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: Dr. Md Khadimul Anam Mazhar Surveillance and Outbreak Officer World Health Organization Cox's Bazar, Bangladesh Telephone: Notes WHO and the Ministry of Health and Family Welfare gratefully acknowledge all partners who have reported the data used in this bulletin. The data been collected with support from the EWARS project. This is an initiative to strengthen early warning, alert and response in emergencies. It includes an online, desktop and mobile application that can be rapidly configured and deployed in the field. It is designed with frontline users in mind, and built to work in difficult and remote operating environments. This bulletin has been automatically published from the EWARS application. More information can be found at Sign-up for an account with EWARS Bangladesh at Ministry of Health and Family Welfare Bangladesh