Date: Mon 19 Nov 2018
Source: The New Nation [edited]
<http://m.thedailynewnation.com/news/196309/outbreak-of-hepatitis-e-virus-in-bangladesh>

[HEV is hepatitis E virus, which causes one of the 5 known viral hepatitis]. HEV spreads usually through faecal contamination of drinking water.

At least 4 people lost their lives due to HEV infection in the last few months and thousands have been infected by HEV in a large part of Chittagong city. This water-borne epidemic has challenged the capacity of supplying safe drinking water and maintaining sewerage system there, which is the second most important metropolis of Bangladesh with a population of more than 2.5 million people.

Hundreds of patients are being diagnosed with HEV infection in different parts of Chittagong. According to the office of the civil surgeon, Chittagong, from 1 May till 2 Jul 2018, the total number of patients infected by HEV was 848.
======================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Globally, 57 000 deaths and 3.4 million cases of acute hepatitis E are attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. More than 60 percent of all hepatitis E infections and 65 percent of all hepatitis E deaths occur in east and south Asia, where seroprevalence rates of 25 percent are common in some age-groups. In Egypt, half the population aged above 5 years is serologically positive for the hepatitis E virus (<http://www.who.int/mediacentre/factsheets/fs280/en/index.html>). - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Chittagong, Chittagong, Bangladesh:
<http://healthmap.org/promed/p/3449>]
Date: Sun, 21 Oct 2018 16:38:21 +0000
A ProMED-mail post
<http://www.promedmail.org>

- Dhaka. 13 Oct 2018. 39 new patients cases rise to 6694. Highest total in this country to date. According to sources at the Health Emergency and Control Room of Directorate General of Health Services (DGHS), 39 new patients were hospitalized in Dhaka on Thursday [11 Oct 2018], raising the total number of those infected by the mosquito-borne disease this year [2018] to 6694. The previous highest was 6232 cases confirmed in 2002.
<https://www.dhakatribune.com/health/2018/10/13/dengue-fever-death-toll-hits-highest-level-on-record>

- Dhaka. 6 Oct 2018. It's a record 6479 [patients] as of Wednesday [3 Oct 2018] since January 2018, with 3 more months of the year to go. "Look at last year [2018]. A much lower record," she said and pointed to the black line. Only 2769 patients took treatment at hospitals. And 2014, a blue line, looks so meek compared with the figure this year. Just 375 patients were admitted to hospitals that year. If this is not bad enough, then consider the fact that this year a new variety of dengue virus, called serotype 3, has appeared for the 1st time in Bangladesh. Such cross infections lead to haemorrhagic dengue, which means the patients will bleed from their organs.

As a new type has been added to the hordes of mosquitoes, chances of such cross infection have also increased. Another chilling fact is that the number of fatalities this year has dramatically increased to 16 in 9 months this year from last year's 8. But a doctor from the state-run IEDCR said the actual number of deaths could be much higher as many cases are not reported.
<https://www.thedailystar.net/frontpage/news/dengue-risk-rising-1643308>
Bangladesh
- Dhaka. Tue 28 Aug 2018. At least 1054 people admitted to hospitals in the 1st 26 days of August. Since January [2018], at least 2271 people have been admitted to different hospitals and 9 of them died of dengue in the capital.
<http://www.newagebd.net/article/49254/more-than-1000-infected-with-dengue-in-aug>

- Dhaka. Sun 2 Sep 2018. Dengue has so far claimed 10 lives, and 2718 others have been infected with the virus in Dhaka between 1 Jan and 1 Sep 2018, according to Directorate General of Health Services (DGHS). As of September 1, 123 patients were admitted into different hospitals, including 27 in Mitford Hospital, 11 in Holy Family Red Crescent Medical College Hospital, 17 in Bangladesh Institute of Research and Rehabilitation for Diabetes (Birdem), and 68 in different private hospitals. Since 2000, at least 270 people have died of dengue and 40,098 got infected in the capital, the official data revealed. The 1st officially recorded epidemic of dengue was in 2000, while the highest number of cases reported in a single year was 6132 back in 2002.
<https://www.dhakatribune.com/bangladesh/dhaka/2018/09/02/dengue-strikes-again-claims-10-lives-in-dhaka-since-jan-1>

[HealthMap/ProMED-mail map of Bangladesh:
<http://healthmap.org/promed/p/1987>]
Friday 24th August 2018
http://www.searo.who.int/mediacentre/releases/2018/1694/en/

In the past year concerted efforts by the Bangladesh Government, WHO and health partners have helped save thousands of lives, and prevented and rapidly curtailed deadly disease outbreaks among the nearly one million Rohingya refugees, who despite these efforts remain vulnerable even today with their evolving health needs, and severe funding crunch threatening continuity of life saving health services in their camps.

Cox’s Bazar, Bangladesh, 24 August 2018: In the past year concerted efforts by the Bangladesh Government, WHO and health partners have helped save thousands of lives, and prevented and rapidly curtailed deadly disease outbreaks among the nearly one million Rohingya refugees, who despite these efforts remain vulnerable even today with their evolving health needs, and severe funding crunch threatening continuity of life saving health services in their camps.

“Unprecedented efforts have been made in the last year and in the most challenging conditions. Deadly diseases such as cholera have been prevented, and measles and diphtheria curtailed rapidly with quick roll-out and scale-up of health services and mass vaccination campaigns. It is remarkable that not only has the mortality rate among the Rohingyas remained lower than expected in an emergency of such a scale, it has also reduced significantly in the last six months”, said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, commending the Government of Bangladesh and health partners’ work on the ground.

The arrival of nearly 700,000 Rohingyas in Cox’s Bazar beginning 25 August 2017 was one of the largest ever population influxes over such a short span of time. Women, children and the elderly arrived with injuries, low immunization coverage, high rates of malnutrition, in need of reproductive health care and psycho-social support, and at risk of deadly disease outbreaks. In response, WHO, with the Ministry of Health and Family Welfare, coordinated emergency health services provided by the nearly 107 health partners on the ground, to ensure access to essential services for the Rohingyas across the area they settled - in mega and small camps, and many with their host communities.

In the last year, 155 health posts have been established, each catering to around 7700 people. In addition, 60 primary health care facilities covering 20,000 people each, and 11 secondary care facilities being accessed by nearly 115,000 people each have also been established. With generous support from KSrelief, 86 staff has been added to the workforce of the Cox’s Bazar district hospital, the only facility providing referral services to the vulnerable population and the host community.

“We have done things that collectively we can be proud of. However, we need to continue to support the health needs of this vulnerable population and remain vigilant against the spread of diseases. This is still a very fragile situation,” said Dr Peter Salama, WHO’s Deputy Director-General for Emergency Preparedness and Response, who recently visited the Rohingya camps in Cox’s Bazar.

Four million doses of vaccines against cholera, polio, measles and rubella and diphtheria and tetanus have been administered to children, adolescents and adults through multiple mass vaccination campaigns, preventing major disease outbreaks and saving thousands of lives. Childhood immunization has been established with 94 sites delivering lifesaving vaccines to children across the Rohingya camps.

WHO helped establish and strengthen disease surveillance to enable early detection and timely response to outbreaks, as the Rohingyas settled in crowded camps with suboptimal water and sanitation conditions, prone to water and vector borne diseases such as cholera, polio, measles, malaria, chikungunya etc. At least 152 health facilities covering 98% of the population are now implementing disease surveillance through the Early Warning Alert and Response System.

Laboratory capacity has been strengthened in Dhaka and established in Cox’s Bazar, while field health facility staff continues to be trained in the use of diagnostics for diseases such as malaria.

Coordinating monsoon contingency plan, preparedness and response for acute watery diarrhoea, and diphtheria outbreak, WHO has delivered nearly 175 tons of medicines and supplies and pre-positioned emergency supplies in three locations for the monsoon and cyclone season. WHO has distributed water filters prioritizing health posts and centres and households with pregnant women.

WHO continues to build the capacity of health workers to provide mental health and psychosocial support services to the Rohingya refugees.

Despite these efforts, challenges remain. Floods and landslides in the ongoing monsoon season continue to displace people and affect the functioning of health facilities. The Rohingya population is reluctant to access sexual and reproductive health services, and as a result 70% of births are still taking place outside of health facilities.

The biggest challenge is the need to further scale up services to meet the complex, evolving and long term health needs of this highly vulnerable population amidst a funding shortfall that also threatens to undo the gains and progress made so far.

WHO has appealed for US$ 16.5 million for its continued support to the Rohingya response, which is part of the US$ 113.1 million being sought by all health partners together under the Joint Response Plan until March 2019.

Thanking all partners who have contributed to health response in Cox’s Bazar, Dr Bardan Jang Rana, WHO Representative to Bangladesh, said, “We need generous and continued support of our partners. It is important that the Rohingya people do not suffer anymore. We need to find sustainable ways of meeting their needs for health, water, sanitation, education, and livelihood.” 

5th August 2018

- National. 29 Jul 2018. About 1000 cases of dengue have been reported so far this year [2018] in Bangladesh, resulting in the deaths of 8 people in the capital Dhaka. Abdur Rahim, an official at the control room of the Directorate General of Health Services (DGHS) under the Ministry of Health, told Xinhua Sunday [29 Jul 2018] that "22 fresh cases of dengue were reported from Dhaka in the 24 hours as of 12:00 pm local time Saturday [28 Jul 2018], bringing the total number of confirmed cases till July 28 this year [2018] in the capital city to 992."
<http://www.xinhuanet.com/english/2018-07/29/c_137355773.htm>

[HealthMap/ProMED-mail map of Bangladesh:
<http://healthmap.org/r/1VpI>]
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