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Emergency Operations Center Situation Report, issue no. 25
Diphtheria and Cholera Response
As of 10 March 2018, the local health authorities reported a
total of 1,294 suspected diphtheria cases including 73
associated deaths (CFR=5.6%).
The diphtheria outbreak has affected 179 districts from 20
governorates. Ibb and Al Hudaydah governorates are the most
affected governorates.
Children (<5 years of age) represent 20 % of probable
diphtheria cases and 40% of associated deaths.
A total of 4,984 diphtheria contacts had been traced and given
prophylactic antibiotics up to 10 March 2018, 640 of them
were during week 9.
The vaccination campaign started on the 10th of March 2018.
The campaign will cover 39 districts from 11 governorates for
the target groups (6 weeks to 15 years from 10-15 March
2018).
The cumulative total of suspected cholera cases reported since
April 2017 to 10 March 2018 is 1,076,472 with 2,265
associated deaths across the country. At governorate level, the
trend from W7-W9 decrease or was stable in all governorates
expect (Al Mahweet, Raymah, Al Jawf, and Taiz).
The overall case fatality ratio is 0.21% and the national attack
rate is 385 per 10,000 people. Children (< 5 years of age)
represent 28.8 % of the total suspected cases.
Yemen: Diphtheria & Cholera Response
Report No.25 As of 10 March 2018 Situation
EOC YEMEN: Emergency
Operations Center
Cholera
Diphtheria
1. Highlights
5.6 % Case Fatality Ratio
1,294 Suspected cases
73 Deaths
0.21 % Case Fatality Ratio
1,076,472 Suspected cases
2,265 Deaths
Emergency Operations Center Situation Report, issue no. 25
Diphtheria and Cholera Response
2. Diphtheria Outbreak Response
2.1 Surveillance and Response
There is a total of 1,294 probable diphtheria cases including 73 associated deaths (CFR=5.6%); with most cases reported from Ibb (441 cases) and Al Hudaydah (151 cases) governorates.
Standardized case definitions are used by all facilities.
A total of 4,984 contacts have been traced by district rapid response teams (RRTs) in 10 governorates since the beginning of the outbreak.
Sustainable Development Foundation (SFD) and WHO will conduct training for health partners on Diphtheria case management and response.
The curriculum and a plan for ‘train the trainers’ for clinicians in the management of diphtheria cases has been developed but is yet to be implemented awaiting local authorities' approval.
700 Vials of DAT were distributed last week. An additional 1000 vials of DAT will arrive on 18 March.
There are 32 prioritized DIUs with DICUs (map1). Currently, there are 10 functioning DIUs.
Map 1:
Emergency Operations Center Situation Report, issue no. 25
Diphtheria and Cholera Response
2.2 Vaccination Campaign
UNICEF, WHO and local authorities launched the vaccination campaign on the 10th March 2018. The campaign was launched at Sana'a level in Ibn Majid School of Al Wahdah District by Dr. Mohammed Salem Bin Hafiz, Minister of Public Health and Population, Mr. Nabil Al Wazir, Minister of Water and Environment.
The campaign will cover 39 districts from 11 governorates for the target population 6 weeks to 15 years from 10-15 March 2018 using 964 mobile teams and 1,310 fixed terms. A total of 2,666,839 people will be targeted that includes 1,390,279 children 6 weeks to 7 years of age with Penta vaccine and 1,276,560 aged 7-15 years of age with Td vaccine.
2.3 Laboratory
Laboratory reagents and transport media were procured by WHO for the Central Public Health Laboratories (CPHLs) in Sana’a and Aden to enable the diagnosis and laboratory confirmation of diphtheria cases. Further supplies have been ordered.
13 cases for C. diphtheria has been confirmed by culture at CPHL-Sana'a, recently 4 new cases were diagnosed from: Bait Al Jalal, Maen and Al Sabeen (Amanat Al Asimah governorate), and Wadi Rejam (Sana'a governorate).
3. Cholera Outbreak Response
3.1 Surveillance and Response
A total of 1,076,472 suspected cases and 2,265 associated deaths (CFR .21%) have been reported.
The weekly proportion of severe cases has significantly decreased representing now 11 % of the admitted cases since week 27.
The outbreak has affected 22 out of 23 governorates (96%) and 305 out of 333 districts (92%). At national level, the trend W6 –W9 decreased or was stable, however four governorates, Al Jawf (31%), Raymeh (28%), Taiz (17%) and Al Mahweet (11%), report increasing trends week (9).
Map2: showing Governorates included in Diphtheria campaign
Not included
Included
Emergency Operations Center Situation Report, issue no. 25
Diphtheria and Cholera Response
Health surveillance officers and Rapid Response Teams (RRTs) are conducting field investigations, active case finding and rapid reporting of deaths from severe dehydration, referral, providing health education, sample transportation and collection of water supplies (district and governorate level).
Emergency operations centres (EOCs) are supported and functional in eight governorates. A further 17 EOCs are planned for completion in late March 2018 (Annex 1).
Figure 1. Epi curve of suspected cholera cases (n=1,073,082), April 2017 to 3 March 2018.
3.2 Health Cluster Response
Health Cluster partners are maintaining 2,531 beds in 54 Diarrhoea treatment centres DTCs
and 489 Oral Rehydration Corners (ORCs) found across 109 affected districts in 17
governorates .
The Health Cluster has produced SOPs for integrating cholera treatment facilities into the
health system to ensure availability of resources in the event that the 3rd wave of cholera
starts in 2018 .
The EOC will work with the Health Cluster and WASH Cluster to conduct a joint cholera lessons
learnt workshop to ensure allocation and utilization of cholera response resources to
strengthen the health system .
The Integrated Cholera Strategy 2018 has been drafted jointly by Health and WASH clusters
with input from UNICEF and WHO. Various Health, WASH, Nutrition and Protection Clusters
Partners and the Ministry of Health and relevant Ministries have shared their input into the
strategy. The Strategy be finalized in the coming days and will be endorsed upon presentation
of the final document.
3.3 WASH Cluster Response ( Information for the month of February 2018)
WASH Cluster partners are reporting cholera response activities in 16 governorates in 87 districts throughout the reporting period. Project owners reporting are ACF, ACTED, ADO, All Girls Foundation, CARE, DRC, IMC, IYCY, NFDHR, OXFAM, SCI, UNICEF and YFCA. Partners are
Emergency Operations Center Situation Report, issue no. 25
Diphtheria and Cholera Response
working closely with local authorities including GARWSP EU, GHOs and DHOs and community volunteer networks.
In the reporting period, monitoring of free residual chlorine continued in 2 districts in Al Mahwit. More than 29,000 people received safe water through water trucking in 2 districts in 2 governorates. More than 110,000 people have received chlorine tablets for household water treatment in 54 districts in 10 governorates. Furthermore, water storage container distribution is ongoing in 49 districts in 8 governorates.
An estimated 243,000 people were reached by partners with cholera key messages through household visits, and community events in 54 districts in 12 governorates. WASH partners reached over 65,000 people with basic or consumable hygiene kits in 64 districts in 13 governorates.
3.4 Laboratory
Support is ongoing to strengthen laboratory sampling and diagnostics in-country and availability of supplies and reagents.
Cumulatively, A total of 32,794 rapid diagnostic tests (RDT) have been performed which represents 30 % coverage as of week 9. The last positive culture was on 26 Feb 2018 from Amant Al Asimah. In week 9, a total of 1,127 RDTs were performed, 179 were positive.
Since the beginning of January up to 8 March 2018, 606 laboratory cultures have been carried out by CPHL. A total of 6 cases were positive results for V.cholera.
4. Challenges
Restricted access remains a major challenge to reaching those most in need.
Training for clinicians is urgently required to increase the usage of DAT.
Vaccination of HCWs is needed in diphtheria DIUs and ICUs.
Blockage of borders and the halt of delivery of humanitarian aid into Yemen have devastating effects on the response to disease outbreaks within the country impacting on the delivery of life-saving medical supplies.
5. Recommendations
Continue to strengthen early warning, alert and response activities, including full utilization of EOCs.
Support, monitor and supervise the district Rapid Response Teams (RRTs) to conduct contact tracing of diphtheria cases through daily contact, investigation of reported cholera cases from newly affected areas and other relevant activities.
Ensure monitoring and evaluation of communications and social mobilization activities to gauge uptake and presence of communities at vaccination points. Percentages of those vaccinated should increase in 2nd and 3rd rounds.
Enhance health facilities to enable electronic data entry focusing on surveillance of diphtheria and cholera and other epidemic-prone diseases.
Increase the capacity of laboratories for testing of epidemic-prone diseases trough procurement of relevant supplies and training.
Continue to procure, distribute and stockpile supplies such as DAT, antibiotics, cholera kits, medical and laboratory supplies.
Strengthen community-based WASH activities and improve the collection of water samples using epidemiological data.
Emergency Operations Center Situation Report, issue no. 25
Diphtheria and Cholera Response
ConstructionRenovation pre-
requisit
EOC site
assessmentFurniture
IT
Outsourcing
Electrical &
Network
infrastructure
setup
Interent
connectivityPAPX
IT
setup/installation
Handover
documentation
Recurring
Sop/Contract
Expected
Delivering
date to WHO
MoPH (Central
EOC)100% 100% 100% NA
(2) 100% 100% 100% 100% 100% 100% Delivered
Aden national 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% Delivered
WHO CO. NA(2) 100% 100% 100% 100% Delivered
Amran 100% 100% 100% 100% 0% 100% 100% (1) 100% 100% 100% 100% Delivered
Sana'a Gov 100% 100% 100% 100% NA(2) 100% 100% 100% 100% 100% 100% Delivered
Ibb 100% 100% 100% 100% NA(2) 100% 100%
(1) 100% 100% 100% 100% Delivered
Hodaydah 100% 100% 100% 100% NA(2) 100% 100% 100% 100% 100% 100% Delivered
Hajjah 100% 100% 100% 100% 0% 100% 100% (1) 100% 100% 100% 100% Delivered
Aden Gov. 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 04-10-18
Abyan 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 04-10-18
Al Dalea 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 04-10-18
Lahj 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 04-10-18
Shabwah 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 0% 20/4/2018
AlMukallah 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 20/4/2018
Al Mahara 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 0% 05-07-18
Amanat
AlAsema100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 29/3/2018
Taiz Enclave 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 20/4/2018
Marib 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 0% 20/4/2018
Al Jawf 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 29/4/2018
Dhamar 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 29/3/2018
Al Mahweet 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 29/3/2018
Al Bayda 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 20/4/2018
Sa'da 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 05-07-18
Raymah 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 05-07-18
Sayoun 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 0% 05-07-18
Governorates
EOC dashboard progressing report 12.03.2018Annex 1:
Mrs. Muneerah Al Mahdli Communication Consultant-EOC
Mrs. Jennie Musto Incident Manager, WHO
Dr. Mohammed Al Hajjer EOC Manager, MoPHP
Ms. Christine "Tiff" Cool Emergency Communication Lead, WHO
FOR FURTHER INFORMATION: please contact:
Mrs. Jennie Musto Incident Manager, WHO
Mrs. Muneerah Al Mahdli Communication Consultant-EOC
