epidemiological highlightsorigin.searo.who.int/entity/bangladesh/ewars-w20-2020.pdf ·...

Epidemiological HighlightsWeek 20, 2020

1 |

Epidemiological Highlights

Week 20 (11-17 May 2020)


2 |

Highlights:

▪ In FDMN 5 confirmed COVID-19 patientshas been identified during this period. Thefirst case was identified on 14 May 2020. Allconfirmed cases were identified throughARI/ILI sentinel surveillance. Out of 5patients, 3 are male, 3 above 18 years of age.

▪ In Cox’s Bazar district, 98 patients testedpositive for COVID-19 in week 20. TotalCOVID-19 patients in district is 191. Thefirst COVID-19 patient was detected on 23March.


3 |

Highlights:


4 |

Highlights:5 12

29

26

16

8 50

5

10

15

20

25

30

35

0-1

0 y

ears

11

-20 y

ears

21

-30 y

ears

31

-40 y

ears

41

-50 y

ears

51

-60 y

ears

>6

0 y

ears

Age Group (%) (n=191)COVID-19 update of Laboratory

Confirmed Cases in Cox’s Bazar (n=191)

The average age of patients is 33.9 years (median 31, range 2-90).

75% are male

6 Health Care Workers and 3 support staffs from health facilities and 5 staffs from agencies (UN/INGO/NGO)


5 |

Highlights:

▪ Currently 14 sentinel sites (Isolation Units) in camps have beentrained to collect sample using SARI/Suspected COVID-19 casedefinition.

▪ Rapid Investigation Team (comprised of IUs and CHWSupervisors) is functional in camps for case investigation andcontact tracing.

▪ Go.Data apps is being using for data collection along withpreliminary notification receiving through EWRAS hotline.


6 |

Highlights:

▪ Acute Respiratory Infection (16.0%), Diarrheal Diseases (7.7%) &Unexplained Fever (1.7%) are the diseases with highest proportionalmorbidity in week 20. Injury/wounds shows increasing trend (3.3%)over last couple of months.

▪ Total consultation is significantly dropped over 50% in last 2 months.Out of total consultation, ARI contributed 16.0% in week 20 decreasedfrom 26.4% in week 12.

▪ Two third reduction of total ARI consultation indicates changes inspecific health seeking behavior of population.

▪ Community-based mortality surveillance has included SARI death inweekly reporting. One (01) SARI death has been reported so far.


7 |

EWARS Reporting Updates

▪ Total 139/166 (84%) health facilities registered in EWARS

▪ Only 109/139 weekly reports received in week 20.

▪ Completeness and Timeliness for this week is 74%.

▪ In 2020 cumulative completeness and timeliness of reporting is 90% and80% respectively

▪ Total 40 alerts were triggered in week 20. All alerts were reviewed andverified by WHO EWARS team which is more than as of previous week(28).


8 |

Diphtheria

8 suspected diphtheria case reported in go.data in week 20

A total of 10 007 case-patients were reported since 2017 to till date

• Confirmed = 329

• Probable = 2785

• Suspected = 6001

Total Case reported in 2020 = 151

• Confirmed = 7

• Probable = 7

• Suspected = 137

Last confirmed case was reported in Week 13 (24 March 2020)

Total deaths reported is 47. Last death was reported on 25 October 2019


9 |

0

2

4

6

8

10

12

14

16

18

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Nu

mb

er

of

case

re

po

rte

d

Epidemiological week

Total number of diphtheria case reported in EWARS from week 1-20, 2020

Confirm Probable Suspected


10 |

Measles

▪ Total 14 suspected measles cases were reported throughaggregated weekly reporting in EWARS in week 20

▪ In last two month number of cases showed a decreasingtrend

▪ 2,439 (56%) individual case report forms (CRF) werereceived out of total 4,354 cases reported throughaggregated weekly report in EWARS in 2020


11 |

Measles

0

100

200

300

400

500

600

700

36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Nu

mb

er

of

rep

ort

ed

case

Epidemiological week

Total number of Measles case reported in EWARS from week 36, 2019 to week 20, 2020


12 |

Diarrhoeal Disease

▪ A total 3 012 cases of diarrhoeal diseases reported in EWARS inweek 20

▪ Among which 2063 cases (5.3%) reported as acute waterydiarrhoea (AWD), 740 (1.9%) and 209 (0.5%) cases as otherdiarrhea and bloody diarrhea respectively.

▪ Diarrhoeal diseases are the second highest contributor ofproportional morbidity after acute respiratory infection (ARI).


13 |

Community-based surveillance

▪ In week 20 total of 11 deaths were recorded due to 9 causesclassified as “Others” , 1 neonatal death and 1death due to severeacute malnutrition.

▪ 1 mortality alert raised for women of reproductive age (12-49 years).

▪ 9 of deaths reported are at the home and 2 from health facility

▪ We would like to urge donor agencies to inform their partners toreport all mortalities into EWARS using the “Community-basedmortality surveillance” form.


14 |

Community-based Surveillance Update

1

6

1

3

ACUTE MALNUTRITION

INFECTIOUS DISEASE

INJURY

MATERNAL DEATH

NEONATAL (<28 DAYS OLD)

OTHER

STILL BIRTH (BORN DEAD)

SEVERE ACUTE RESPIRATORY INFECTION

FEMALE MALE

BangladeshRohingya Emergency Response

Ministry of Health and FamilyWelfare Bangladesh Printed: 11:57 Tuesday, 19 May 2020 UTC

Early Warning, Alert and Response System (EWARS)Epidemiological Bulletin W20 2020

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

W20 2020

Table 1 | Coverage

# %

854,704 - Estimated total Rohingya population

854,704 100% Total population under surveillance

166 - Total number of health facilities

139 84% Number of EWARS reporting sites

Table 2 | Early warning performance indicators

W20 Cumulative (2020)

109 2724 Number of weekly reports received

74% 90% Completeness

74% 83% Timeliness

Table 3 Alert performance indicators


40 1,300 Total alerts raised

100% 99% % verified

0% 0% % auto-discarded

0% 0% % undergoing risk assessment

0% 1% % completed risk assessment

Source: UNHCR. Bangladesh: Joint Goverment of Bangladesh- UNHCR Population Factsheet. 31 December 2019.

Highlights W20 2020

1 W20 2020

1

1

Map 1a | Ukhia completeness by camp

Completeness 0 25% 50% 75% 100%

Map 1b | Teknaf completeness by camp

Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia and Teknaf

2 W20 2020

1

2

3

4

5

6

7

8

9

10

11

12

13

14

1516

17

18

19

20

21

22 23

24

25

26

1 Camp 122 Camp 1E3 Camp 144 Camp 1W5 Camp 76 Camp 47 Camp 58 Camp 2E9 Camp 8E10 Kutupalong RC11 Camp 1112 Camp 613 Camp 2W14 Camp 1015 Camp 8W16 Camp 1717 Camp 2018 Camp 1919 Camp 1520 Camp 20 Ext21 Camp 4 Ext22 Camp 1823 Camp 924 Camp 325 Camp 1326 Camp 16

1

2

3

4

5

6

7

8

1 Nayapara RC2 Camp 27 Jadimura3 Camp 24 Leda4 Camp 21 Chakmarkul5 Camp 25 Ali Khali6 Camp 23 Shamlapur7 Camp 26 Nayapara8 Camp 22 Unchiprang

Northerngroup Reporting Performance

# healthfacilities

# reportsreceived Completeness Timeliness

Table 4 | Performance by camp (W20 2020) Map 2 | Completeness by camp

Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia (Northern Group)

3 W20 2020

Camp 1E 4 3 75% 75%

Camp 1W 3 2 67% 67%

Camp 2E 1 0 0% 0%

Camp 2W 2 2 100% 100%

Camp 3 6 5 83% 83%

Camp 4 6 4 60% 60%

Camp 4 Ext 1 1 100% 100%

Camp 5 4 3 75% 75%

Camp 6 2 2 100% 100%

Camp 7 5 5 100% 100%

Camp 8E 7 4 67% 67%

Camp 8W 7 6 86% 86%

KutupalongRC

1 2 100% 100%

12

3

4

5

6

7

8

9

10

11

1213

1 Camp 1E2 Camp 1W3 Camp 74 Camp 45 Camp 56 Camp 2E7 Camp 8E8 Kutupalong RC9 Camp 610 Camp 2W11 Camp 8W12 Camp 4 Ext13 Camp 3

Southerngroup Reporting Performance

# healthfacilities



Completeness 0 25% 50% 75% 100%

Early Warning | Ukhia (Southern Group)

4 W20 2020

Camp 10 4 4 100% 100%

Camp 11 9 6 67% 67%

Camp 12 7 7 100% 100%

Camp 13 8 7 86% 86%

Camp 14 6 6 100% 100%

Camp 15 11 7 78% 78%

Camp 16 6 4 67% 67%

Camp 17 5 2 40% 40%

Camp 18 5 3 60% 60%

Camp 19 5 4 80% 80%

Camp 20 3 2 67% 67%

Camp 20 Ext 1 0 0% 0%

Camp 9 7 4 60% 60%

1

2

3

4

5

6

7

8

9 10 11

12

13

1 Camp 122 Camp 143 Camp 114 Camp 105 Camp 176 Camp 207 Camp 198 Camp 159 Camp 20 Ext10 Camp 1811 Camp 912 Camp 1313 Camp 16

Teknaf Reporting Performance

# healthfacilities



Completeness 0 25% 50% 75% 100%

Early Warning | Teknaf

5 W20 2020

Camp 21Chakmarkul

4 2 33% 33%

Camp 22Unchiprang

4 2 67% 67%

Camp 23Shamlapur

4 3 100% 100%

Camp 24 Leda 1 1 100% 100%

Camp 25 AliKhali

3 2 67% 67%

Camp 26Nayapara

1 1 100% 100%

Camp 27Jadimura

1 0 0% 0%

Nayapara RC 2 2 100% 100%

1

2

3

4

5

6

7

8


Partner Performance Reporting

# sites # reportsreceived Completeness Timeliness

BDRCS 4 3 75% 75%

BRAC 11 11 100% 100%

CARE 4 4 100% 100%

FHM 1 0 0% 0%

FRNDS 12 12 100% 100%

GK 9 9 100% 100%

HMBDF 1 1 100% 100%

IOM 15 14 93% 93%

IRC 2 2 100% 100%

MSF 8 5 63% 63%

MoH 0 1 0% 0%

Hope 2 2 100% 100%

Medair 1 0 0% 0%

Table 7 | Performance by partner (W20 2020)

Partner Performance Reporting

# sites # reportsreceived Completeness Timeliness

FH/MTI 3 2 67% 67%

PHD 9 9 100% 100%

PWJ 1 1 100% 100%

RHU 3 3 100% 100%

RI 3 3 100% 100%

RTMI 9 5 56% 56%

SCI 9 0 0% 0%

TdH 1 1 100% 100%

Early Warning | Partner performance

6 W20 2020

Northerngroup W20 Cumulative (2020)

# alerts % verif. # alerts % verif.

Table 8 | Performance by camp Map 5 | Number of alerts by camp

# of alerts 0 2 5 10

Alert | Ukhia (Northern Group)

7 W20 2020

Camp 1E 2 100% 34 100%

Camp 1W 1 100% 14 100%

Camp 2E 0 0% 30 100%

Camp 2W 2 100% 34 100%

Camp 3 2 100% 100 100%

Camp 4 4 100% 92 100%

Camp 4 Ext 1 100% 11 100%

Camp 5 2 50% 66 98%

Camp 6 1 100% 14 100%

Camp 7 1 100% 22 100%

Camp 8E 0 0% 18 100%

Camp 8W 4 50% 59 95%

KutupalongRC

0 0% 8 100%

12

3

4

5

6

7

8

9

10

11

1213

1 Camp 1E2 Camp 1W3 Camp 74 Camp 45 Camp 56 Camp 2E7 Camp 8E8 Kutupalong RC9 Camp 610 Camp 2W11 Camp 8W12 Camp 4 Ext13 Camp 3

Southerngroup W20 Cumulative (2020)




Alert | Ukhia (Southern Group)

8 W20 2020

Camp 10 2 100% 36 100%

Camp 11 1 100% 46 100%

Camp 12 3 100% 75 100%

Camp 13 1 100% 46 100%

Camp 14 1 100% 48 100%

Camp 15 2 50% 71 99%

Camp 16 1 100% 75 96%

Camp 17 2 100% 35 100%

Camp 18 2 100% 38 100%

Camp 19 1 100% 45 100%

Camp 20 0 0% 35 100%

Camp 20 Ext 0 0% 6 100%

Camp 9 1 100% 64 100%

1

2

3

4

5

6

7

8

9 10 11

12

13

1 Camp 122 Camp 143 Camp 114 Camp 105 Camp 176 Camp 207 Camp 198 Camp 159 Camp 20 Ext10 Camp 1811 Camp 912 Camp 1313 Camp 16

Teknaf W20 Cumulative (2020)




Alert | Teknaf

9 W20 2020

Camp 21Chakmarkul

0 0% 31 100%

Camp 22Unchiprang

2 100% 12 100%

Camp 23Shamlapur

0 0% 13 100%

Camp 24 Leda 0 0% 16 100%

Camp 25 AliKhali

0 0% 12 100%

Camp 26Nayapara

0 0% 42 100%

Camp 27Jadimura

0 0% 12 100%

Nayapara RC 0 0% 10 100%

1

2

3

4

5

6

7

8


Event W20 Cumulative (2020)


Indicator-based surveillance

Malaria 0 0% 0 0%

Measles 7 100% 641 100%

Bloody Diarr. 0 0% 0 0%

AFP 0 0% 5 100%

Meningitis 0 0% 10 100%

Haem. fever(susp.)

0 0% 8 100%

NNT 0 0% 1 100%

Unexp. fever 2 100% 77 100%

AWD 7 100% 91 100%

ARI 3 100% 78 100%

AJS 3 100% 52 100%

Varicella (Susp.) 0 0% 10 100%

SuspectedCOVID-19

0 0% 0 0%

Event-based surveillance

EBS total 4 0% 70 94%

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


0 16 Low risk

0 0 Moderate risk

0 0 High risk

0 0 Very high risk

Alert | Event risk assessment

10 W20 2020

For more help and support, please contact:

Dr. Shownam Barua Medical Officer - Civil Surgeon Office (MO-CS) Ministry of Health and Family Welfare Cox's Bazar, Bangladesh

Telephone: +88 01723350483

Email: [email protected]

Dr. Md. Sabbir Hossain Surveillance & Outbreak Officer World Health Organization Cox's Bazar, Bangladesh

Telephone: +88 017 1355 9987

Email: [email protected] 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 ofHealth andFamilyWelfare Bangladesh

BangladeshRohingya Emergency Response

Ministry of Health and FamilyWelfare Bangladesh Printed: 11:55 Tuesday, 19 May 2020 UTC

Early Warning, Alert and Response System (EWARS)Annex W20 2020

Figure 1 | Proportional morbidity (W20 2020)

0.0% Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Bloody diarrhoea Other diarrhoea Varicella (susp.)

Unexplained fever Acute Jaundice Syndrome (AJS) Measles/Rubella Other Vector-borne disease Combines malaria and dengue cases (suspected and confirmed)

Disease W20 2020

# cases % morbidity # cases % morbidity

AWD 2,063 5.3% 48,950 4.3%

Bloody diarr. 209 0.5% 6,660 0.6%

Other diarr. 740 1.9% 20,667 1.8%

Susp. Varicella 18 0.0% 1,287 0.1%

ARI 6,216 16.0% 271,773 23.8%

Measles/Rub. 14 0.0% 4,354 0.4%

AFP 0 0.0% 5 0.0%

Susp. menin. 0 0.0% 33 0.0%

AJS 20 0.1% 428 0.0%

Susp. HF 0 0.0% 12 0.0%

Neo. tetanus 0 0.0% 1 0.0%

Adult tetanus 0 0.0% 1 0.0%

Malaria (conf.) 0 0.0% 6 0.0%

Malaria (susp.) 0 0.0% 573 0.1%

Dengue (conf.) 0 0.0% 2 0.0%

Dengue (susp.) 2 0.0% 6 0.0%

Unexpl. fever 681 1.7% 21,844 1.9%

Sev. Malnut. 3 0.0% 544 0.0%

Inj./Wounds 1,272 3.3% 30,556 2.7%

Other 27,687 71.1% 733,518 64.2%

Total 38,261 100% 1,141,663 100%

Proportional morbidity

1 W20 2020

*

*

Figure 2 | Trend in proportional morbidity for key diseases (W20)

Other consultations Acute Respiratory Infection (ARI) Unexplained fever Acute Jaundice Syndrome (AJS)

Acute Watery Diarrhoea (AWD) Other diarrhoea Vector-borne disease Combines malaria and dengue cases (suspected and confirmed)

Trend in consultations and key diseases

2 W20 2020

% m

orbi

dity

W01

201

9

W05

201

9

W09

201

9

W14

201

9

W18

201

9

W22

201

9

W27

201

9

W31

201

9

W35

201

9

W40

201

9

W44

201

9

W48

201

9

W01

202

0

W05

202

0

W09

202

0

W14

202

0

W18

202

0

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

*

*

Acute Respiratory Infection | Trend

3 W20 2020

Total ARI cases - Cox's Bazar

W26

201

7

W39

201

7

W01

201

8

W13

201

8

W26

201

8

W40

201

8

W01

201

9

W14

201

9

W27

201

9

W40

201

9

W01

202

0

W14

202

0

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

Figure 3 | Trend in number of cases over time (W38 2017 - W20 2020)

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 camp (W20 2020)

4 W20 2020

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 (W20 2020) Figure | % sex Figure | % age

Male Female >=5 < 5

Measles | Trend

5 W20 2020

Total suspected measles/rubella cases - Cox's Bazar

W26

201

7

W39

201

7

W01

201

8

W13

201

8

W26

201

8

W40

201

8

W01

201

9

W14

201

9

W27

201

9

W40

201

9

W01

202

0

W14

202

0

0

50

100

150

200

250

300

350

400

450

500

550

600

650

700

Figure 4 | Trend in number of suspected cases over time (W38 2017 - W20 2020)


Measles | Maps and Alert Management

Map 2 | Map of cases by camp (W20 2020)

6 W20 2020



Alert threshold1 case. Source: IEDCR

7Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk


Male Female >= 5 < 5

Acute Jaundice Syndrome | Trend

7 W20 2020

Total suspected AJS cases - Bangladesh

W26

201

7

W39

201

7

W01

201

8

W13

201

8

W26

201

8

W40

201

8

W01

201

9

W14

201

9

W27

201

9

W40

201

9

W01

202

0

W14

202

0

0

20

40

60

80

100

120

140

160



Acute Jaundice Syndrome | Maps and Alert Management

Map 3 | Map of cases by camp (W37 2017 - W20 2020)

8 W20 2020



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

3Alerts

100%Verified

0Low Risk

0Moderate

Risk

0High Risk

0Very High

Risk



Acute Watery Diarrhoea | Trends

9 W20 2020

Total AWD cases - Bangladesh

W26

201

7

W39

201

7

W01

201

8

W13

201

8

W26

201

8

W40

201

8

W01

201

9

W14

201

9

W27

201

9

W40

201

9

W01

202

0

W14

202

0

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

5,500


Dengue | Trends

11 W20 2020

Total Dengue Cases - Confirmed - BangladeshTotal Dengue Cases - Suspected - Bangladesh

W01

201

8

W09

201

8

W18

201

8

W26

201

8

W35

201

8

W44

201

8

W01

201

9

W09

201

9

W18

201

9

W27

201

9

W35

201

9

W44

201

9

W01

202

0

W09

202

0

W18

202

0

0

1

2

3

4

5

6

7

8

9



Dengue | Maps and Alert Management


12 W20 2020



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



Varicella (Susp.) | Trends

13 W20 2020

Total Varicella Cases - Suspected - Bangladesh

W01

201

8

W09

201

8

W18

201

8

W26

201

8

W35

201

8

W44

201

8

W01

201

9

W09

201

9

W18

201

9

W27

201

9

W35

201

9

W44

201

9

W01

202

0

W09

202

0

W18

202

0

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000


For more help and support, please contact:

Dr. Shownam Barua Medical Officer - Civil Surgeon Office (MO-CS) Ministry of Health and Family Welfare Cox's Bazar, Bangladesh

Telephone: +88 01723350483

Email: [email protected]

Dr. Md. Sabbir Hossain Surveillance & Outbreak Officer World Health Organization Cox's Bazar, Bangladesh

Telephone: +88 017 1355 9987

Email: [email protected] 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 ofHealth andFamilyWelfare Bangladesh

epidemiological highlightsorigin.searo.who.int/entity/bangladesh/ewars-w20-2020.pdf ·...

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