This document is built on the Early Warning and Response System (EWARS), daily data received through MOHWF and WHO from the service providers in settlements of the Unregistered Myanmar Nationals (UMNs) and from health facilities in Cox’s Bazar. As such, it can only be considered a snapshot of conditions in those reporting facilities. The presented information may hardly be viewed as representative of the overall health situation in Cox’s Bazar; nonetheless we believe that it gives all actors in the field a stepping stone for building a true picture of morbidity and mortality in the UMNs. We thank all partners contributing to the EWARS. The EWARS itself and the resulting reports can only be a work in progress. We welcome all comments, feedback and further inputs that can help to improve the system and our joint understanding of the prevailing epidemiological situation, and ultimately - to avert spread of diseases. Contact Information Dr. Edwin Salvador, Deputy WHO Representative / Incident Manager, [email protected]Dr. Hammam El Sakka, Team Leader, Health Emergency Programms, [email protected]WHO Bangladesh: http://www.searo.who.int/bangladesh ) Mortality and Morbidity Weekly Bulletin (MMWB Cox’s Bazar Volume N o 1: 15 October 2017 Photo Credit: WHO Bangladesh, Dr. Syed Mahfuzul Huq
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This document is built on the Early Warning and Response System (EWARS), daily data received through MOHWF and WHO from the service providers in settlements of the Unregistered Myanmar Nationals (UMNs) and from health facilities in Cox’s Bazar. As such, it can only be considered a snapshot of conditions in those reporting facilities. The presented information may hardly be viewed as representative of the overall health situation in Cox’s Bazar; nonetheless we believe that it gives all actors in the field a stepping stone for building a true picture of morbidity and mortality in the UMNs. We thank all partners contributing to the EWARS.
The EWARS itself and the resulting reports can only be a work in progress. We welcome all comments, feedback and further inputs that
can help to improve the system and our joint understanding of the prevailing epidemiological situation, and ultimately - to avert spread
of diseases.
Contact Information Dr. Edwin Salvador, Deputy WHO Representative / Incident Manager, [email protected] Dr. Hammam El Sakka, Team Leader, Health Emergency Programms, [email protected]
WHO Bangladesh: http://www.searo.who.int/bangladesh
)Mortality and Morbidity Weekly Bulletin (MMWB
Cox’s Bazar
Volume No 1: 15 October 2017
Photo Credit: WHO Bangladesh, Dr. Syed Mahfuzul Huq
Injuries, MEN: Meningitis like Disease, MAL: Malaria, NNT: Neonatal Diseases, OTH: Other diseases, SKN: Skin Disease, UNFEV:
Fever of unexplained origin and UNK: Unknown Causes).
For under-5 year age group, a total number of 14,015 cases of health events were reported through
EWARS constituting 37% of the total consultations. 39% (5,461) of these cases were attributed to ARI
while 16% (2,190) were due to AWD. There were 29 reported deaths in the children under-5
representing 41% of total deaths reported from Cox’s Bazar. Of these figures, 59% (17 deaths) were ARI-
related, 17% (5 deaths) were due to neonatal diseases and 10% (3 deaths) due to AWD. The proportion
of primary causes for the reported cases and deaths for the children under-5 year is shown in Figure 3.
Cases (n=38,209) Deaths (n=71)
MMWB Morbidity and Mortality Weekly Bulletin, Cox’s Bazar, Bangladesh 15 October 2017 / Vol. 1
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Figure 3: Proportion of primary causes for the reported cases and deaths in the under-5 year age group, Cox;s Bazar, Bangladesh, 25 August -10 October 2017.
For the over-5 year age group, a total number of 24,194 cases of health events were reported through
EWARS constituting 63% of the total number of consultations. 28% (6,704) of these cases were
attributed to ARI and 7% (1,686) to AWD. There were 42 reported deaths in this age group, representing
59% of total deaths reported from Cox’s Bazar. Of these, 29% (12 deaths) were due to ARI, 4% to injury,
10% to AWD and 5% to CVD. The proportion of primary causes for the reported cases and deaths for the
children under-5 year is shown in Figure 4.
Figure 4: Proportion of primary causes for the reported cases and deaths in the Over 5 year age group, Cox;s Bazar, Bangladesh,
25 August -10 October 2017.
3. Measles cases
Between 10 and 25 September 2017, a total of 22 suspected measles cases were reported from Cox’s
Bazar district: 55% (12/22) from Ukhia, 41% (9/12) from Teknaf and 4% (1/22) from Ramu upazila. No
cases were reported from Bandarban district. Case investigations were conducted for all suspected
cases and samples collected for laboratory confirmation. Laboratory results showed that 64% (14/22)
were positive for measles specific IgM, 18% (4/22) were negative for measles specific IgM and 18%
(4/22) are still pending the laboratory results. From all confirmed cases, 93% (13/14) were among UMNs
while one confirmed case was reported from the host community in Teknaf upazila.
3.1 Measles vaccination campaign in Cox’s Bazar
Measles vaccination is one of the most recommended priority health interventions during emergencies.
In 2016, a total of 945 confirmed measles cases were reported from Bangladesh, and Cox’s Bazar
reported the highest attack rate in the country (>120/100,000 population). Measles incidence rate by
district in Bangladesh (2016) is shown in the Figure 5.
MMWB Morbidity and Mortality Weekly Bulletin, Cox’s Bazar, Bangladesh 15 October 2017 / Vol. 1
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A recent (2017) needs assessment carried out by
WHO showed that measles vaccination coverage in
Cox’s Bazar was below 90%, which may explain
several reported outbreaks over the last few years.
On 16 September 2017, a mass measles vaccination
campaign was carried out in Cox’s Bazar for 14 days.
Activities included vaccination using a combination
of fixed posts and outreach immunization teams,
the use of checklists to monitor vaccination
sessions, social mobilization activities, and
surveillance for adverse events following
immunization. The campaign targeted 122,580
children <15 years old in the 2 upazilas of Cox’s
Bazar (Tekaf, Ukhia) and Naikhongchhari upazila in
Bandarban district. The total number of vaccinated
children is shown in table 2.
The Civil Surgeon’s Office in Cox’s Bazar was
responsible for planning, monitoring, coordinating
and implementing the campaign activities. The role
of the staff in the Control Room was to monitor
preparedness on a day-to-day basis, especially
mobilization of human and other resources like transport, inter-sectoral coordination and full utilization
of resources. In addition, the Control Room staff was providing regular updates on progress and
obstacles in implementing the campaign to the central level. The campaign faced several challenges,
including difficulty to correctly estimate the target population due to the continuing influx of UMNs into
the camps; heavy rains rendered most of the settlements inaccessible, forcing the vaccination teams to
turn around and return to the sites later.
Table2: Number of vaccinated children, Special Vaccination Campaign, 16 September –to 3 October 2017.
District Upazila Estimated Target Total Vaccinated/Vaccine Type
0-59 M 6M to <15 Y bOPV
(0-59 M) MR
(6 M to <15 Y) VIT A
Cox's Bazar Teknaf 14,450 29,410 20,826 36,116 21,265
Cox's Bazar Ukhia 28,800 84,000 48,713 93,634 47,676