Diphtheria Outbreak Response Cox s Bazar Bangladesh
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1 Diphtheria Outbreak Response Cox s Bazar Bangladesh 1
2 Movement of population from Rakhine (Myanmar) to Cox s Bazar (Bangladesh) Cox s Bazar district Bangladesh Rakhine Province Myanmar Began on 25 Aug 17 Massive, sudden influx > 700,000 cross-over in a short time period Add to > 200,000 that had moved earlier Settled in make-shift camps Overcrowded and unstable settlements Priorities - shelter, food, life-saving health services Lack of sufficient resources Categorized Grade 3 emergency in October
3 Emergence of diphtheria in Cox s Bazar Suspected diphtheria cases reported through EWARS in November 2017 in camps Passive surveillance for diphtheria in Bangladesh No laboratory capacity for diphtheria diagnostics Spirals very rapidly into an outbreak Buthidaung (47%) DPT3 coverage, Myanmar 2017 Maungdaw (36%) Rakhine (62%) Sittwe (40%) <70% 70% - 79% 80% - 89% >90% 3
4 Diphtheria outbreak response Cox s Bazar Key elements Surveillance Case definition Case investigation and classification Sample collection and laboratory testing Immunization Case management & contact tracing Campaign planning & implementation Routine EPI strengthening Vaccination at the borders Vaccination of health workers and host community Vaccination of contacts of diphtheria cases Protocols for management Setting-up diphtheria treatment centres Availability of antibiotics and DAT Contact tracing & chemoprophylaxis 4
5 Diphtheria outbreak response Cox s Bazar Timeline of activities 1st vaccination campaign in camps 2nd vaccination campaign in camps 3rd vaccination campaign in camps Suspected cases of diphtheria among migrants SIA preparations: Vaccine, logistics, micro plans, training, soc mob; HR surge (nat l & int l) Vaccination campaign in host community micro plans refined, training, soc mob intensified; addl HR surge (nat l & int l) micro plans adjusted, training, addl HR surge (nat l & int l) November December January February March April Establishing Surveillance: case detection & investigation protocols & tools, training of concerned individuals Contact tracing & chemoprophylaxis Diphtheria treatment centres established, protocols, training, DAT and antibiotic availability; infection prevention & control Suspected cases of diphtheria in host community First samples shipped to Dhaka lab for testing Field lab set-up in Cox s Bazar 5
6 Diphtheria outbreak in Cox s Bazar - Observations/lessons learnt Diphtheria outbreak response rapidly initiated strong govt leadership, support from partners & NGOs (WHO, UNICEF, Gavi, CDC, MSF, others) Significant human and financial resources required to control outbreak Sub-national immunity gaps in Rakhine in Myanmar lead to the diphtheria outbreak among migrants in Cox s Bazar Passive surveillance for diphtheria, with no laboratory support, in Bangladesh confirmation of cases is a significant challenge Policy barriers in Bangladesh No boosters of diphtheria toxoid containing vaccine in EPI schedule of Bangladesh TT (and not Td) vaccine used in programme (Td only for pregnant women in camps) Challenges in timely availability of diphtheria anti-toxin 6
7 Diphtheria outbreak in Cox s Bazar - Actions being taken Intensification of routine immunization increased session sites & number of days for RI; strengthening of community mobilization efforts systematic registration of entire cohort; vaccination cards distribution Immunization of new arrivals at borders & in make-shift camps Vaccination of contacts of suspected cases with pentavalent/td Policy changes replace TT vaccine with Td vaccine introduce boosters of diphtheria toxoid containing vaccine Strengthen surveillance revise case definitions and protocols for investigation (as per WHO global and regional guidelines) laboratory capacity strengthening 7
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