Situation Report No - HumanitarianResponse
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Yemen: Cholera Response and Diphtheria Update Emergency Operations Center Situation Report No.16 Week 49 ( 4 – 10 ) December 2017 2,225 Deaths of Cholera 983,484 Suspected Cholera Cases Cholera Update: • There were 6,552 suspected cholera cases and 1 associated deaths in week 49. No governorate reported a CFR higher than 1%. • Cumulative (27 April to 10 December 2017) total of 983,484 suspected cholera cases 2,225 associated deaths, and CFR of 0.23 %. • The national attack rate is 357.10 per 10,000. The five governorates with the highest cumulative attack rates per 10,000 are Amran, Al Mahwit , Al Dhale’e , Abyan , and Hajjah . • Children under 5 years old represent 28 % of total suspected cases. • Trend between weeks 46 and 48 was stable or decreased among all governorates except in Abyan (+20%). • Use of RDTs has significantly increased since week 40. Out of 458 RDTs performed, 92 were positive. • The weekly number of cases has been decreasing for 13 consecutive weeks. • The weekly proportion of severe cases has significantly decreased representing 10% of admitted cases. Epidemic curve at country level Emergency Operations Center- Situation Report. Issue.16
Transcript of Situation Report No - HumanitarianResponse
Yemen: Cholera Response and Diphtheria Update Emergency Operations Center
Situation Report No.16 Week 49 ( 4 – 10 ) December 2017
2,225
Deaths of Cholera
983,484
Suspected Cholera Cases
Cholera Update:
• There were 6,552 suspected cholera cases and 1
associated deaths in week 49. No governorate
reported a CFR higher than 1%.
• Cumulative (27 April to 10 December 2017) total of
983,484 suspected cholera cases 2,225 associated
deaths, and CFR of 0.23 %.
• The national attack rate is 357.10 per 10,000. The
five governorates with the highest cumulative
attack rates per 10,000 are Amran, Al Mahwit , Al
Dhale’e , Abyan , and Hajjah .
• Children under 5 years old represent 28 % of total suspected cases.
• Trend between weeks 46 and 48 was stable or decreased among all governorates except in Abyan (+20%).
• Use of RDTs has significantly increased since week 40. Out of 458 RDTs performed, 92 were positive.
• The weekly number of cases has been decreasing for 13 consecutive weeks.
• The weekly proportion of severe cases has significantly decreased representing 10% of admitted cases.
Epidemic curve at country level
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Health Cluster Response: Cholera
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• Health Cluster partners are maintaining 4,151 beds in 226
Diarrhoea treatment centres DTCs and 946 Oral Rehydration
Corners (ORCs) found across 236 affected districts in 20
governorates.
• During the past week, 293 cholera treatment facilities with
1,161 beds (70 DTCs and 223 ORCs) were closed, including those
in Hajjah (70), Taiz (34), Amran (45), Sana’a (33), Al Mahwit (22)
Al Hudayda (15) and Dhammar (26).
• Still some partners plan to set up 115 ORCs, and 11 DTCs with 54
beds capacity in total.
• Health cluster has discussed and is developing
recommendations to integrate cholera treatment facilities into
health system in Yemen. The 16 recommendations developed
covered ORCs, DTCs and funding for cholera and aims to best
utilize of available resources. These should be considered as part
of preparedness in the event of new wave of cholera.
• Health cluster is working with other clusters through the ICCM to conduct a workshop to identify lessons learnt from the cholera epidemic and
better prepare for a new wave if it happens. The date of the activity has yet to be finalized.
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20
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60
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Status of different Cholera Treatement Facilities (DTCS and ORCs) by Governroate - 26 Nov 2017
Closed Functional Planned
WASH Cluster Response: Cholera
• WASH Cluster partners are reporting cholera response activities in 17
governorates in 100 districts throughout the reporting period.
• Chlorine for disinfection of water supply networks were provided in 44
districts in 12 governorates, with an estimated 3.6 million people
connected to these networks.
• More than 150,000 people received safe water through water trucking in
29 districts in 9 governorates.
• More than 70,000 people have received chlorine tablets for household
water treatment in 12 districts in Amanat Al Asimah, Hajjah, and Sana’a
governorates.
• Campaigns on disinfection of water storage containers are ongoing in 3
districts in Aden and Amanat Al Asimah.
• An estimated 96,000 people were reached by partners with cholera key
messages through household visits, and community events in 37 districts
in 9 governorates.
• WASH partners reached over 78,000 people with consumable hygiene
kits in 13 districts in 4 governorates.
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UNICEF is still working to support Yemen's water and sanitation
system to prevent cholera from emerging again. More than
23,000 houses in Aden benefited from disinfecting water
tanks. Photo: UNICEF
• Support to solid Waste management is ongoing in Kuhlan Ash Sharaf district in Hajjah governorate. Waste water treatment plants are
supported in Aden, Al Hudaydah and Amanat Al Asimah, Dhamar and Hajjah with approximately 3.3 million people connected. Desludging
of cesspits is ongoing in Bani Al Harith district in Sana’a city.
• DTCs are supported with distribution of consumable hygiene kits in Al Hali district in Al Hudaydah. Partners provided handwashing facilities
in DTCs in 1 district in Hajjah.
Challenges and Concerns: Cholera
• Limited availability of WASH supplies in the local market impedes blanket distributions.
• Some WASH partners face access issues in most affected communities due to security risks or the bureaucratic procedures entailed to grant
access. Visa constraints also hinder WASH experts from coming into the country.
• The cholera response of WASH partners competes with other WASH emergency response priorities, such as the provision of clean water and sanitation for displaced populations and the response to malnutrition. The health system has been weakened by the ongoing conflict. More than 55% of all facilities are closed or are only partially functional. Water and sanitation systems have been disrupted and continued funding is required for the operation and maintenance of these systems to control outbreaks such as cholera and AWD.
• Blockage of borders and stopping delivery of humanitarian aid into Yemen may have devastating effects on cholera situation. With possible lack of medical supplies to respond to the epidemic in the coming few weeks. While health cluster has enough medical supplies to respond to the epidemic for 6-8 weeks, lack of medical supplies may result in higher case fatality that is currently is around 0.24% with more deaths of cholera.
• The health system has been weakened by the ongoing conflict. More than 55% of all facilities are closed or are only partially functional. Water and sanitation systems have been disrupted and continued funding is required for the operation and maintenance of these systems to control outbreaks such as cholera and AWD.
• Misreporting of suspected cholera cases in many health facilities accounts for a misleading increased case load observed in some governorates and districts. There is a lack of capacity and resources of some partners to conduct regular supervisory visits to DTCs and ORPs. Health partners need some time to adjust their projects to the new endorsed modality of work for health partners in health facilities.
• Collecting stool samples for laboratory testing, transporting the samples to laboratory and provision of operational cost, and availability of supplies and reagents.
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Diphtheria Outbreak
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Diphtheria Update:
• As of week 49, a total of 283 suspected diphtheria cases and 34 associated deaths (CFR 12 %) were reported from 62 districts in 15 governorates.
• 67 % of the suspected cases were from Ibb governorate
(Assadah, Yareem and Rural Ibb districts), followed by Al
Hudaydah (8.8%), Dhamar (6.6%) and Aden (5%).
• A total of 28 new cases were reported from Ibb districts:
(Assadah 9), (Yareem 4), (Ar Radmah 3), and Al Hudaydah
districts: (Alhali 4), and (Bayt Al Faqiah 8).
• Most of deaths were reported from Ibb governorate (12) followed by Al Hudaydah governorate (8).
• Children under 5 accounts for 19 % of cases and 39% of deaths.
34
Deaths of Diphtheria
283
Suspected Diphtheria Cases
19%
27%
34%
15%
5%
Probable Diphtheria cases by age group
<5
5--10
11--20
21--40
>40
Response, Challenges and Concerns: Diphtheria
Diphtheria Response:
• EPI task force meetings with the participation of MOPHP, WHO and UNICEF.
• Regular communication and coordination between the MOPHP and other
international organizations (WHO, UNICEF, MSF, others).
• A sub-committee to develop the response plan has been formed.
• The governorate rapid response teams (RRTs) in the most affected districts were
deployed for active search, provide medications among suspected cases, and
conduct health education sessions.
• WHO mission was conducted in most affected districts of Ibb governorate to
coordinate the response efforts, collect samples from the suspected patients and
train the district rapid response team particularly on proper investigation, contact
tracing, chemoprophylaxis for the contacts and health education to prevent
further transmission of the disease.
• WHO continue the support to deploy the rapid response teams in 30 of the priority
districts to ensure their functionality and active participation in the response
efforts
• Urgent orders placed for Lab supplies especially for transport/culture media and
Lab reagents that are not locally available as per the MOH request submitted to
WHO
• Urgent orders placed to procure medicine for the patients and contacts from the
local market
Diphtheria is an infectious disease caused by the
bacterium Corynebacterium diphtheria, which
primarily infects the throat and upper airways, and
produces a toxin affecting other organs. The illness
has an acute onset and the main characteristics are
sore throat, low fever and swollen glands in the
neck, and the toxin may, in severe cases, cause
myocarditis or peripheral neuropathy: WHO
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Ms. Muneerah Al Mahdli
Communication Consultant-EOC
Dr. Veronique Urbaniak
Cholera Incident Manager
Dr. Ali Sariah
Emergency Operations Center Manager
FOR FURTHER INFORMATION, please contact with:
Dr. Alaa Abou Zeid
Health Cluster Coordinator
Ms. Marije Broekhuijsen
WASH Cluster Coordinator
Response, Challenges and Concerns: Diphtheria
Challenges and Concerns:
• The lack of recent clinical experience with Diphtheria in the country and the low vaccination coverage in affected areas can be challenging for
health care workers, in terms of both clinical management and laboratory diagnosis. The provision of diphtheria vaccines and anti-serum, and
laboratory supplies were delayed due to the recent blockade.
• Deteriorating security situation due to armed clashes in Sana’a and other Governorates.
• Dysfunctional health system and limited access to healthcare facilities.
• Low vaccination coverage especially in the affected areas.
• Difficulties in the timely availability of Penta and Td vaccine, as well as medications and medical supplies.
• Reporting challenges particularly in terms of data discrepancies/incompleteness and lack of timely recording and reporting.
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