bangladesh - south-east asia regional officecox's bazar, bangladesh telephone: +88 018 1961...

BangladeshRohingya Emergency Response

Ministry of Health and Family WelfareBangladesh Printed: 12:18 Tuesday, 13 March 2018 UTC

Early Warning, Alert andResponse System (EWARS)

Annex W10 2018

Figure 1 | Proportional morbidity (W10 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 W10 2018

# cases % morbidity # cases % morbidity

AWD 4,852 4.8% 51,145 5.8%

Bloodydiarrhoea

1,679 1.6% 19,813 2.2%

Other diarrhoea 2,122 2.1% 18,414 2.1%

ARI 10,973 10.8% 113,017 12.8%

Measles/Rubella 56 0.1% 957 0.1%

AFP 1 0.0% 15 0.0%

Suspectedmeningitis

0 0.0% 29 0.0%

AJS 131 0.1% 1,261 0.1%

Susp. haem.fever

1 0.0% 39 0.0%

Neonataltetanus

0 0.0% 3 0.0%

Adult tetanus 0 0.0% 13 0.0%

Malaria (conf.) 2 0.0% 34 0.0%

Malaria (susp.) 742 0.7% 7,529 0.9%

Unexplainedfever

11,433 11.2% 113,876 12.9%

SevereMalnutrition

181 0.2% 1,715 0.2%

Injuries/Wounds 1,460 1.4% 13,435 1.5%

Other 68,348 67.0% 68,348 61.4%

Total 101,981 100% 884,517 100%

Proportional morbidity

1 W10 2018

Figure 2 | Trend in proportional morbidity for key diseases (W10)

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 W10 2018

% m

orbi

dity

W27

201

7

W29

201

7

W31

201

7

W33

201

7

W35

201

7

W37

201

7

W39

201

7

W41

201

7

W43

201

7

W45

201

7

W47

201

7

W49

201

7

W51

201

7

W01

201

8

W03

201

8

W05

201

8

W07

201

8

W09

201

8

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Acute Respiratory Infection | Trend

3 W10 2018

Total ARI cases - Cox's Bazar

W27

201

7

W29

201

7

W31

201

7

W33

201

7

W35

201

7

W37

201

7

W39

201

7

W41

201

7

W43

201

7

W45

201

7

W47

201

7

W49

201

7

W51

201

7

W01

201

8

W03

201

8

W05

201

8

W07

201

8

W09

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 - W10 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 (W10 2018)

4 W10 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 (W10 2018) Figure | % sex Figure | % age

Male Female > 5 < 5

Measles | Trend

5 W10 2018

Total suspected measles/rubella cases - Cox's Bazar

W27

201

7

W29

201

7

W31

201

7

W33

201

7

W35

201

7

W37

201

7

W39

201

7

W41

201

7

W43

201

7

W45

201

7

W47

201

7

W49

201

7

W51

201

7

W01

201

8

W03

201

8

W05

201

8

W07

201

8

W09

201

8

0

25

50

75

100

125

150

175

200

225

250

275

300

325

Figure 4 | Trend in number of suspected cases over time (W38 2017 - W10 2018)


Measles | Maps and Alert Management

Map 2 | Map of cases by site/zone (W10 2018)

6 W10 2018



Alert threshold1 case. Source: IEDCR

19Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Female Male > 5 < 5

Acute Jaundice Syndrome | Trend

7 W10 2018

Total suspected AJS cases - Bangladesh

W27

201

7

W29

201

7

W31

201

7

W33

201

7

W35

201

7

W37

201

7

W39

201

7

W41

201

7

W43

201

7

W45

201

7

W47

201

7

W49

201

7

W51

201

7

W01

201

8

W03

201

8

W05

201

8

W07

201

8

W09

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 - W10 2018)

8 W10 2018



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

10Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female > 5 < 5

Acute Watery Diarrhoea | Trends

9 W10 2018

Total AWD cases - Bangladesh

W27

201

7

W29

201

7

W31

201

7

W33

201

7

W35

201

7

W37

201

7

W39

201

7

W41

201

7

W43

201

7

W45

201

7

W47

201

7

W49

201

7

W51

201

7

W01

201

8

W03

201

8

W05

201

8

W07

201

8

W09

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 - W10 2018)

10 W10 2018



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

4Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female > 5 < 5

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 Uzzal RoySurveillance and Outbreak Response OfficerWorld Health OrganizationCox's Bazar, Bangladesh

Telephone: +88 017 0120 8837

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)

Epidemiological Bulletin W10 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

W10 2018

Table 1 | Coverage

# %

866,000 - Estimated total Rohingya population

728,786 84% Total population under surveillance

158 - Total number of health facilities

153 97% Number of EWARS reporting sites

Table 2 | Early warning performance indicators

W10 Cumulative (2018)

111 1049 Number of weekly reports received

71% 68% Completeness

71% 67% Timeliness

Table 3 Alert performance indicators


82 886 Total alerts raised

100% 99% % verified

0% 0% % auto-discarded

0% 1% % undergoing risk assessment

0% 3% % completed risk assessment

Source: IOM. Bangladesh: Needs and Population Monitoring - NPM R7 Report. 15 December 2017

Source: REACH. Health Facility Mapping Exercise. 12 December 2017Excluding non-operational health facilities; and excluding specialised services (DTCs, SRH clinics) and mobile clinics (which report under fixedsites)

Highlights W10 2018

1 W10 2018

1

2

1

2

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 W10 2018

1

23

4

5

6

7

8

9

10

11

12

13

14 15

161718

19

202122

23

242526

27

28

29

30

31

32

33

34

123456789101112131415161718192021222324252627

28293031323334

Zone ZZZone ZAZone YYZone XXZone WWZone UUZone TTZone SSZone RRZone QQZone PPZone OOZone NNZone MMZone LLZone KKZone JJZone IIZone HHZone GGZone FFZone EEZone DDZone CCZone BBZone AAThangkhali / Burmapara /

TasnimarkholaKutupalong RCKutupalong MSJamtoliHakimparaBalukhali MSZone VVMoynarghona / Bagghona

1

2

3

4

5

6

1

23

4

5

6

NayaparaRC

Leda MS

Chakmarkul

Unchiprang

ShamlapurJadimura

Northerngroup Reporting Performance

# healthfacilities

# reportsreceived Completeness Timeliness

Table 4 | Performance by site/zone (W10 2018) Map 2 | Completeness by site/zone

Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia (Northern Group)

3 W10 2018

Balukhali MS 11 7 64% 64%

KutupalongMS

6 5 83% 83%

KutupalongRC

4 3 75% 75%

Zone AA 4 3 75% 75%

Zone BB 2 2 50% 50%

Zone CC 2 1 50% 50%

Zone DD 6 4 67% 67%

Zone EE 3 3 100% 100%

Zone FF 4 3 75% 75%

Zone GG 3 1 33% 33%

Zone HH 2 1 50% 50%

Zone II 0 0 0% 100%

Zone JJ 3 1 33% 33%

Zone KK 2 4 200% 200%

Zone LL 0 0 0% 100%

Zone MM 1 1 100% 100%

Zone NN 11 7 64% 64%

Zone OO 1 1 100% 100%

1

2

3 4

567

8

91011

12

131415 16

17

18

12345678910111213141516

17

18

Zone OOZone NNZone MMZone LLZone KKZone JJZone IIZone HHZone GGZone FFZone EEZone DDZone CCZone BBZone AAKutupalong

RCKutupalong

MSBalukhali

MS

Southerngroup Reporting Performance

# healthfacilities



Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia (Southern Group)

4 W10 2018

EastPalongkhali

1 1 100% 100%

Hakimpara 8 6 75% 75%

Jamtoli 8 6 75% 75%

Moynarghona /Bagghona

9 5 56% 56%

Thangkhali /Burmapara /Tasnimarkhola

10 6 60% 60%

Zone PP 2 2 100% 100%

Zone QQ 0 0 0% 100%

Zone RR 2 2 100% 100%

Zone SS 5 4 80% 80%

Zone TT 9 5 56% 56%

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 2 100% 100%

Zone ZA 2 0 0% 0%

Zone ZZ 1 0 0% 0%

1

23

4

5

6

7

8

9

10

11

12

13

14

15

16

123456789101112

13141516

Zone ZZZone ZAZone YYZone XXZone WWZone UUZone TTZone SSZone RRZone QQZone PPThangkhali / Burmapara /

TasnimarkholaJamtoliHakimparaZone VVMoynarghona / Bagghona

Teknaf Reporting Performance

# healthfacilities



Completeness 0 25% 50% 75% 100%

Early Warning | Teknaf

5 W10 2018

Baharchora 2 2 100% 100%

Chakmarkul 2 2 100% 100%

Leda MS 4 4 100% 100%

MoH CC 1 1 100% 100%

Nayapara RC 3 3 100% 100%

Sabrang 1 1 100% 100%

Shamlapur 1 1 100% 100%

Teknaf UHC 0 0 0% 100%

Unchiprang 5 4 80% 80%

1

2

3

4

5

6

1

23

4

5

6

NayaparaRC

Leda MS

Chakmarkul

Unchiprang

ShamlapurJadimura

Partner Performance Reporting

# sites # reportsreceived Completeness Timeliness

AIDOCT 0 0

BDRCS 16 9 56% 56%

BRAC 10 10 100% 100%

CARE 4 4 100% 100%

FHM 1 0 0% 0%

FRNDS 5 0 0% 0%

GK 7 5 71% 71%

HMBDF 1 1 100% 100%

IHA 2 1 50% 50%

IOM 26 20 77% 77%

IRC 7 7 100% 100%

MERCY 2 1 50% 50%

MOAS 2 2 100% 100%

MSF 27 14 52% 52%

Table 7 | Performance by partner (W10 2018)

Partner Performance Reporting

# sites # reportsreceived Completeness Timeliness

MTI 1 1 100% 100%

OBAT 1 0 0% 0%

PHD 8 8 100% 100%

Prottyashi 3 3 100% 100%

PWJ 1 0 0% 0%

RHU 2 2 71% 71%

RI 5 5 100% 100%

RTMI 2 0 0% 0%

SCI 9 9 100% 100%

TdH 1 0 0% 0%

Early Warning | Partner performance

6 W10 2018

Northerngroup W10 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 W10 2018

Balukhali MS 5 100% 71 99%

KutupalongMS

5 100% 19 100%

KutupalongRC

3 100% 30 100%

Zone AA 2 100% 28 100%

Zone BB 0 0% 4 100%

Zone CC 0 0% 1 100%

Zone DD 5 100% 30 100%

Zone EE 6 100% 73 100%

Zone FF 1 100% 9 100%

Zone GG 1 100% 8 100%

Zone HH 0 0% 20 100%

Zone II 0 0% 0 0%

Zone JJ 1 100% 4 100%

Zone KK 2 100% 16 94%

Zone LL 0 0% 0 0%

Zone MM 0 0% 1 100%

Zone NN 2 100% 31 94%

Zone OO 0 0% 2 100%

1

2

3 4

567

8

91011

12

131415 16

17

18

12345678910111213141516

17

18

Zone OOZone NNZone MMZone LLZone KKZone JJZone IIZone HHZone GGZone FFZone EEZone DDZone CCZone BBZone AAKutupalong

RCKutupalong

MSBalukhali

MS

Southerngroup W10 Cumulative (2018)




Alert | Ukhia (Southern Group)

8 W10 2018

EastPalongkhali

0 0% 0 0%

Hakimpara 4 100% 56 100%

Jamtoli 6 100% 48 98%


3 100% 35 97%


3 100% 56 100%

Zone PP 2 100% 25 100%

Zone QQ 0 0% 0 0%

Zone RR 0 0% 10 100%

Zone SS 1 100% 32 94%

Zone TT 5 100% 65 100%

Zone UU 0 0% 0 0%

Zone VV 0 0% 0 0%

Zone WW 2 100% 15 93%

Zone XX 1 100% 16 94%

Zone YY 3 100% 40 100%

Zone ZA 0 0% 0 0%

Zone ZZ 0 0% 0 0%

1

23

4

5

6

7

8

9

10

11

12

13

14

15

16

123456789101112

13141516

Zone ZZZone ZAZone YYZone XXZone WWZone UUZone TTZone SSZone RRZone QQZone PPThangkhali / Burmapara /

TasnimarkholaJamtoliHakimparaZone VVMoynarghona / Bagghona

Teknaf W10 Cumulative (2018)




Alert | Teknaf

9 W10 2018

Baharchora 0 0% 1 100%

Chakmarkul 4 100% 21 100%

Leda MS 4 100% 25 100%

MoH CC 1 100% 3 100%

Nayapara RC 4 100% 30 100%

Sabrang 0 0% 3 100%

Shamlapur 0 0% 4 100%

Teknaf UHC 0 0% 3 100%

Unchiprang 5 100% 39 97%

1

2

3

4

5

6

1

23

4

5

6

NayaparaRC

Leda MS

Chakmarkul

Unchiprang

ShamlapurJadimura

Event W10 Cumulative (2018)


Indicator-based surveillance

Malaria 0 0% 0 0%

Measles/Rubella 19 100% 280 99%

Bloody Diarr. 0 0% 0 0%

AFP 2 100% 11 91%

Meningitis 0 0% 5 100%

Haem. fever(susp.)

1 100% 16 88%

NNT 0 0% 2 50%

Unexp. fever 5 100% 39 100%

AWD 4 100% 49 100%

ARI 9 100% 56 98%

AJS 10 100% 121 99%

Event-based surveillance

EBS total 9 100% 206 100%

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


0 3 Low risk

0 3 Moderate risk

0 23 High risk

0 1 Very high risk

Alert | Event risk assessment

10 W10 2018



Telephone: +88 018 1961 4952

Dr Uzzal RoySurveillance and Outbreak Response OfficerWorld Health OrganizationCox's Bazar, Bangladesh

Telephone: +88 017 0120 8837









Diphtheria Outbreak

Update 2018-03-10

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 2018-03-10

Indicator Cumulative Last 7 days Last 24hours

Epidemiology

1. Total number of cases 6,132 165 30

Confirmed 3.0% (n= 182 ) 3.0% (n= 5 ) 0.0% (n= 0 )

Probable 53.1% (n= 3,255 ) 56.4% (n= 93 ) 56.7% (n= 17 )

Suspected 43.9% (n= 2,695 ) 40.6% (n= 67 ) 43.3% (n= 13 )

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

2. Laboratory testing

Positive 33.0% (n= 182 ) 33.3% (n= 5 ) 0.0% (n= 0 )

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

Negative (excluded) 67.0% (n= 369 ) 66.7% (n= 10 ) 0.0% (n= 0 )

3. Total number of deaths 38 0 0

4. Attack rate / 10,000 population 88.84 2.40

Clinical presentation

5. % with pseudomembrane 36.6% (n= 2,381 ) 34.9% (n= 61 ) 50.0% (n= 15 )

6. % with complications 1.1% (n= 74 ) 2.3% (n= 4 ) 0.0% (n= 0 )

Case management

7. % patients given antibiotics 57.2% (n= 3,723 ) 100.0% (n= 175 ) 100.0% (n= 30 )

8. % patients treated with DAT 14.3% (n= 932 ) 40.0% (n= 70 ) 36.7% (n= 11 )

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 2018-03-10

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 - W10 2018)

Suspected Probable

Confirmed Indeterminate

Diphtheria | Epidemic curve

3 2018-03-10

Num

ber

13. N

ov

20. N

ov

27. N

ov

4. D

ec

11. D

ec

18. D

ec

25. D

ec

1. J

an

8. J

an

15. J

an

22. J

an

29. J

an

5. F

eb

12. F

eb

19. F

eb

26. F

eb

5. M

ar

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 2018-03-10

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 6,132 38 0.6% 932 165 0 70 30 0 11

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 2018-03-10

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 203 0 0.0% 11 18 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 1,424 3 0.2% 305 93 0 44 14 0 0

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

SPP1TT 750 2 0.3% 290 54 0 26 16 0 0

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

1

2

< 5 ( 13.9% ; n = 903 ) 5-14 ( 58.1% ; n = 3,782 ) 15-44 ( 25.8% ; n = 1,680 ) > 45 ( 2.0% ; n = 129 )

Figure 3a | Sex

Male ( 45.2% ; n = 2,944 ) Female ( 54.6% ; n = 3,557 )

Figure 3b | Age

Figure 3c | Nationality

FDMN ( 93.2% ; n = 6,072 ) National ( 0.9% ; n = 58 )

Figure 3d | Vaccination status

Vaccinated ( 15.8% ; n = 1,028 ) Not vaccinated ( 24.8% ; n = 1,614 ) Unknown vaccination status ( 57.3% ; n = 3,733 )

Forcibly-Displaced Myanmar National

Table 3a | Symptoms # %

Fever 5,474 84.1%

Sore throat 6,040 92.8%

Difficulty swallowing 1,709 26.2%

Difficulty breathing 91 1.4%

Nasal regurgitation 340 5.2%

Bloody nasal discharge 97 1.5%

Ear discharge 3 0.0%

Drooling of saliva 0 0.0%

Change in voice 12 0.2%

Swollen neck 369 5.7%

Skin ulcers 25 0.4%

Other 378 5.8%

Table 3b | Signs # %

Pseudomembrane 2,381 36.6%

Gross cervical lymphadenopathy 2,055 31.6%

Chest indrawing 6 0.1%

Fast breathing rate 11 0.2%

Stridor 31 0.5%

Central cyanosis 4 0.1%

Fast heart rate 19 0.3%

Decreased capillary refill 1 0.0%

Weakness 13 0.2%

Lethargy 79 1.2%

Restlessness 6 0.1%

Other 229 3.5%

Diphtheria | Demographic breakdown, vaccination status and signs and symptoms

6 2018-03-10

1

1

Diphtheria | Trend in DAT use

7 W10 2018

Total patients treated with DAT - Cox's Bazar

8. J

an

15. J

an

22. J

an

29. J

an

5. F

eb

12. F

eb

19. F

eb

26. F

eb

5. M

ar

0

5

10

15

20

25

30

35

Figure 3 | Trend in DAT use over time (2018-01-05 - 2018-03-10)

Indicator Cumulative Previous cycle Current cycle

Number of case-patients notified 3,193 175 150

Number of case-patients whose households were successfully traced 2259 102 69

% of case-patients who were traced 64.6% 58.6% 46.9%

Total # of close contacts 16,276 653 475

Average # close contacts per case household traced 7.2 6.4 6.9

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 2018-03-10)

Diphtheria | Contact tracing indicators

8 2018-03-10

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 2012 1416 71.8% 71 32 41.6% 87 32 36.8%

Diphtheria | Contact tracing by site/zone

9 2018-03-10

Balukhali MS 357 232 65% 7 2 29% 3 2 67%

KutupalongMS

189 141 75% 2 1 50% 11 5 45%

KutupalongRC

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

Zone AA 109 92 84% 0 0 0% 1 1 100%

Zone BB 20 15 75% 2 1 50% 3 3 100%

Zone CC 24 19 79% 4 4 100% 8 6 75%

Zone DD 51 35 69% 2 1 50% 10 3 30%

Zone EE 41 22 54% 0 0 0% 5 0 0%

Zone FF 10 4 40% 1 0 0% 2 1 50%

Zone GG 21 12 57% 1 1 100% 4 0 0%

Zone HH 175 123 70% 8 2 25% 10 1 10%

Zone II 110 82 75% 4 3 75% 1 0 0%

Zone JJ 211 152 72% 12 4 33% 5 0 0%

Zone KK 139 79 57% 2 0 0% 4 0 0%

Zone LL 173 122 71% 6 1 17% 2 0 0%

Zone MM 207 155 75% 8 2 25% 6 3 50%

Zone NN 135 100 74% 12 10 83% 10 7 70%

Zone OO 19 16 84% 0 0 0% 2 0 0%



# case-patientstraced








Table 6 | Ukhia Southern Zones

Total 606 443 34.8% 60 44 61.1% 37 20 50.0%


10 2018-03-10

EastPalongkhali

4 0 0% 1 0 0% 0 0 0%

Hakimpara 67 58 87% 13 11 85% 9 6 67%

Jamtoli 42 38 90% 8 7 88% 4 2 50%


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


168 106 63% 27 19 70% 10 5 50%

Zone PP 12 4 33% 1 0 0% 1 1 100%

Zone QQ 7 3 43% 1 0 0% 0 0 0%

Zone RR 39 21 54% 1 0 0% 3 0 0%

Zone SS 80 66 83% 1 1 100% 0 0 0%

Zone TT 59 44 75% 5 4 80% 6 5 83%

Zone UU 5 5 100% 0 0 0% 0 0 0%

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

Zone WW 5 4 80% 0 0 0% 0 0 0%

Zone XX 79 64 81% 2 2 100% 2 0 0%

Zone YY 6 1 17% 0 0 0% 1 0 0%

Zone ZA 1 1 100% 0 0 0% 1 1 100%

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 2018-03-10











Table 7 | Teknaf

Total 237 196 78.4% 23 18 72.0% 15 9 45.0%


12 2018-03-10

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

Chakmarkul 17 15 88% 0 0 0% 1 0 0%

Leda MS 147 123 84% 21 18 86% 12 9 75%

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

Nayapara RC 32 25 78% 0 0 0% 1 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 39 32 82% 2 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 2018-03-10



Telephone: +88 018 1961 4952

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

Telephone: +88 017 0120 8845







bangladesh - south-east asia regional officecox's bazar, bangladesh telephone: +88 018 1961...

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