1 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA This epidemiological bulletin aims to provide the situation of key infectious diseases in the WHO South-East Asia region to inform risk assessment and response by countries. The bulletin uses information from publicly available sources and will be published every two weeks. For feedback or suggestions, please write to seoutbreak@who.int. Table of Contents Key events .......................................................................................................................................... 2 Dengue in the WHO South-East Asia Region ............................................................................................................ 2 Standing recommendations for COVID-19 ............................................................................................................... 3 COVID-19............................................................................................................................................ 4 mpox .................................................................................................................................................. 9 Dengue ............................................................................................................................................. 10 Bangladesh ............................................................................................................................................................. 10 Maldives.................................................................................................................................................................. 10 Nepal ....................................................................................................................................................................... 11 Sri Lanka .................................................................................................................................................................. 12 Thailand .................................................................................................................................................................. 13 Influenza .......................................................................................................................................... 14 WHO South-East Asia Region Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 8th edition, 7 August 2023. Reporting period: 24 July – 6 August 2023 HEALTH programme EMERGENCIES 2 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Key events Dengue in the WHO South-East Asia Region • Bangladesh: The increase in the number of new cases of dengue has started earlier in 2023 compared to previous years. A total of 66 732 dengue cases including 313 deaths have been reported between 1 January and 6 August 2023 with a case fatality rate of 0.47%. The overall CFR was higher in females than in males (0.73% v 0.32%), and the older age group recorded the higher CFR compared to younger age group (0.34% in those aged ≤ 40 vs 0.98% in those aged >40) (Figure 1).1 2 Figure 1. Number of dengue cases, deaths & case fatality rate by age & gender in Bangladesh in 2023 as of 6 August 2 • Nepal: Between 1 January and 7 August 2023, 9 411 cases of dengue have been reported from 74 districts in Nepal. Cases from Koshi province account for 73.7% of the cases (n=6 934) with Sunsari district reporting the highest number of cases in the province (72.7%, n=5 041). This is 18.1 times higher than the 519 cases reported between 3 January and 7 August 2022. 3 4 Interventions for dengue prevention and control are actively implemented, including: the dissemination of an Action Plan on Dengue Prevention and Control to all provinces and districts; routine surveillance using Early Warning and Reporting System; clinical case management orientation sessions in Kathmandu, Sunsari and Dhading; sensitization meetings with stakeholders to raise awareness about prevention and control and distribution messages via online and social media channels; and supply for dengue test kits to provinces and districts as needed3 • Thailand: A total of 54 119 dengue cases and 44 dengue deaths were reported in Thailand from January to July 2023, which were 1.5 and 1.1 times higher than the mean number of cases (n=36 771) and deaths (n=40), respectively, reported during the same months between 2018 and 2022.5 6 7 8 1 https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report 2 https://old.dghs.gov.bd/images/docs/vpr/20230806_dengue_all.pdf 3 https://edcd.gov.np/uploads/news/pdf/64d20dadc7061.pdf 4 https://edcd.gov.np/resources/newsletter 5 http://doe.moph.go.th/surdata/y66/mcd_DF_66.rtf 6 http://doe.moph.go.th/surdata/disease.php?dcontent=old&ds=66 7 http://doe.moph.go.th/surdata/disease.php?ds=26 8 http://doe.moph.go.th/surdata/disease.php?ds=27 3 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Standing recommendations for COVID-19 During the public health emergency of international concern (PHEIC) associated with the COVID-19 pandemic, from January 2020 to May 2023, countries’ response efforts were guided by temporary recommendations issued under the International Health Regulations (IHR) (2005). In the current transitional phase, countries’ preparedness and response actions can be guided by standing recommendations, issued under the IHR(2005). The WHO Director-General of the World Health Organization (WHO) convened a Review Committee to provide the stranding recommendations, which he accepted on 9 August 2023. These standing recommendations are issued by the Director-General in accordance with provisions of Articles 16 to 18, and 50 to 53 of the IHR (2005). These standing recommendations are in effect for all States Parties from 9 August 2023 until 30 April 2025. The COVID19 recommendations cover 7 major areas. All countries should: 1. Update their national COVID-19 programmes using the WHO Strategic Preparedness and Response Plan, to move towards longer term sustained management of COVID-19. 2. Sustain collaborative surveillance for COVID-19, to detect significant changes in the virus, and trends in disease severity and population immunity. 3. Continue to report COVID-19 data to WHO or in open sources, especially on death and severe disease, genetic sequences, & data on vaccine effectiveness. 4. Continue to offer COVID-19 vaccination especially for the high priority groups, based on both, the recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and on national prioritization. 5. Continue to initiate, support, and collaborate on research to generate evidence for COVID-19 prevention & control. 6. Deliver optimal clinical care for COVID-19 patients, including access to proven treatments and measures to protect health workers and caregivers. 7. Continue to work towards ensuring equitable access to safe, effective and quality-assured vaccines, tests & treatments for COVID-19. For more information, please visit: https://www.who.int/publications/m/item/standing-recommendations-for-covid-19-issued-by-the-director- general-of-the-world-health-organization-(who)-in-accordance-with-the-international-health-regulations-(2005)- (ihr) https://www.who.int/publications/m/item/report-of-the-review-committee-regarding-standing- recommendations-for-covid-19 https://twitter.com/WHO/status/1689278628729614337 4 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA COVID-19 Status as of 6 August 2023 The WHO South-East Asia Region has recorded a cumulative total of 61 199 192 COVID-19 cases, including 806 627 deaths. In the WHO South-East Asia Region, from 31 July to 6 August 2023, 1 199 new cases (a decrease of 14.4%) while 20 new deaths (a decrease 13.0%) were reported compared to the previous week. Between 31 July and 6 August 2023, only India (392 new cases, +21.0%) reported an increase in the number of new cases, while Bangladesh (369 new cases, -15.9%), Thailand (268 new cases, -31.5%), Indonesia (129 new cases, - 12.8%) Myanmar (34 cases, -57.0%), Nepal (six new cases, -53.8%) and Sri Lanka (one new case, -80.0%) reported a decrease in the number of new cases compared to the previous week. Bhutan and Timor-Leste have reported no new case in the same period. Data of Maldives were not available for this period. For the same period, India (two new deaths, +100%), Thailand (12 new deaths, +71.4%) and Sri Lanka (two new deaths, +100%) reported an increase in the number of new deaths while Bangladesh (two new deaths, -50.0%) and Indonesia (two new deaths, -81.8%) reported a decrease in the number of new deaths compared to the previous week. The remaining countries reported no new death. Data of Maldives were not available for this period. Please refer to the WHO SEARO COVID-19 dashboard for further information. Table 1. COVID-19 cases, deaths, and the weekly change in countries in the WHO South-East Asia Region in the week from 31 July to 6 August 2023 *Percent change in the number of newly confirmed cases/deaths in past seven days, compared to previous week. NA = data not available. Thailand data were for the period from 30 July to 5 August 2023 in comparison to the preceding week. Maldives data were as of 1 July 2023. 5 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 2. Weekly number of new COVID-19 cases reported during the previous eight weeks (12 June – 6 August 2023) in the WHO South-East Asia Region * Data of Maldives were available up to 1 July 2023. Figure 3. Weekly number of SARS-CoV-2 positive samples and test positivity from integrated influenza-SARS-CoV- 2 sentinel surveillance systems in the previous seven weeks (12 June – 30 July 2023) in selected counties* (as of 6 August 2023) * Countries routinely conducting SARS-COV-2 testing of the samples collected through influenza sentinel surveillance sites (Bangladesh, Bhutan, Nepal and Timor-Leste). 6 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 4. Number of weekly new COVID-19 cases per 100 000 population in the previous eight weeks (12 June – 6 August 2023) in countries in the WHO South-East Asia Region * *DPR Korea has reported no confirmed COVID-19 case. 7 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Circulation of SARS-CoV-2 variants globally9 Currently, WHO is closely tracking two variants of interest (VOI) and seven variants under monitoring (VUMs) and their descendent lineages (* includes their descendant lineages). • The VOIs are XBB.1.5 and XBB.1.16. • The VUMs are BA.2.75*, CH.1.1*, XBB* (excluding XBB.1.5*, XBB.1.16*, XBB.1.9.1*, XBB.1.9.2* and XBB.2.3*), XBB.1.9.1*, XBB.1.9.2*, XBB.2.3* and EG.5. • XBB.1.16 is the most prevalent VOI, reported from a total of 100 countries. In epidemiological week 28 (10 to 16 July 2023) it accounted for 18.4% of sequences but declined from 20.9% in week 24 (12 to 18 June 2023). • From epidemiological weeks 24 to 28 the prevalence of EG.5* increased from 6.2% to 11.6%. The prevalence of the other VOIs and VUMs either remained stable or decreased in prevalence. SARS-CoV-2 variants in the South-East Asia Region The number of sequences submitted to GISAID from the Region has continued to decline in recent weeks. As of 5 August 2023, based on data downloaded from GISAID (Figures 5a and 5b): • In Bangladesh, in the last 60 days, the most prevalent sequences submitted were XBB.2.3 and its sub-lineages (XBB.2.3*) (73.3%, n=30) and XBB.1.16 and its sub-lineages (XBB.1.16*) (23.3%, n=7). • In India, XBB.1.16* accounted for 50.9% (n=29) of the sequences submitted in the last 60 days. XBB.2.3* accounted for 35.1% (n=20). • In Indonesia, EG and its sub-lineages (EG* and EG.5*) accounted for 42.2% (n=27) of sequences submitted in the last 60 days of which the majority (81.5%, n=22) were EG.2*. Two sequences of EG.5* were submitted. . XBB.1.9.1 and its sub-lineages (XBB.1.9.1*) accounted for 20.3% (n=13) and XBB.1.16* for 17.2% (n=11) of the sequences submitted. • In Thailand, in the last 60 days, XBB.1.16* remained predominant accounting for 46.5% (n=219) of sequences with XBB.1.9.1* accounting for 16.1% (n=76) and XBB.2.3* for 11.5% (n=54). A total of 24 sequences of EG* (including EG.5*) were submitted of which 11 were EG.1*, six were EG.4*, four were EG.5.1 and three were EG.2*. • Other countries have not submitted sequences recently to GISAID. 9 https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---3-august-2023 8 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 5a. Number of Omicron sub-lineage sequences submitted to GISAID within the past 30 and 31-60 days as of 5 August 2023 by date of collection (countries with recent submissions) ⱡ Figure 5b. Proportion of Omicron sub-lineage sequences submitted to GISAID within the past 30 and 31-60 days as of 5 August 2023 by date of collection (countries with recent submissions) ⱡ *indicates the sub-lineage of each variant ⱡ The date next to the country name indicates the latest date of sample collection for sequence submission to GISAID. XBB* excludes XBB.1.16*, XBB.1.5*, XBB.1.9.1, XBB.1.9.2 and XBB.2.3* EG* is a sub-lineage of XBB.1.9.2 and excludes EG.5* Sources: GISAID (https://gisaid.org/), as of 5 August 2023. 9 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA mpox Status as of 6 August 2023 In the WHO South-East Asia Region, a total of 147 laboratory-confirmed mpox cases, including one death, have been verified since 14 July 2022 (Figure 6). Table 2 summarizes the basic epidemiological profile of the reported mpox cases in the Region. Figure 6. Number of mpox cases reported in WHO South-East Asia Region by date of notification* (14 July 2022 – 6 August 2023) * Notification - The date on which the case is notified to the public health authority. Table 2. Profile of the 147 confirmed mpox cases reported in WHO South-East Asia Region since July 2022 (as of 6 August 2023) Country India 22 (15.0%) Indonesia 1 (0.7%) Nepal 1 (0.7%) Sri Lanka 4 (27%) Thailand 119 (81.0%) Gender Male 125 (85.0%) Female 21 (14.3%) Transgender 1 (0.7%) Age group 0-17 1 (0.7%) 18-29 43 (29.3%) 30-39 64 (43.5%) 40 and over 39 (26.5%) Sexual orientation Heterosexual 25 (17.0%) Men who have sex with men (MSM) 102 (69.4%) Bisexual 2 (1.4%) Other 2 (1.4%) Unknown 16 (10.9%) For more information on the global situation of mpox outbreak, please visit the global dashboard. 10 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Dengue Bangladesh A total of 17 561 cases of dengue were reported in Bangladesh during epidemiological week (EW) 31 (30 July to 5 August 2023), an 11.7% increase compared to the number of cases reported in during EW 30 (n=15 722) and 34 times higher than the number of cases reported in EW 31 in 2022 (n=517). A total of 204 deaths were reported during July 2023, six times higher than the 34 deaths reported in June 2023 and 22.7 times higher than the nine deaths reported in July 2022 (Figure 7). Figure 7. Number of new cases of (A) and deaths (B) from dengue by month in Bangladesh from January 2019 to 31 July 2023 Source: Health Emergency Operation Center and Control Room, DGHS Reported Monthly Dengue cases & Dengue Deaths in Bangladesh. https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report Maldives No new data have been uploaded since the Monthly Communicable Disease report for May 2023 in Maldives. Please refer to previous versions of the South-East Asia Epidemiological Bulletin for prior epidemiological information. 11 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Nepal In 2023, a total of 275 cases of dengue were reported in Nepal in week 28 (17 to 23 July), a 36.1% increase compared to week 27 (10 to 16 July, n=202) and 12 times higher than the mean number of cases reported during week 28 from 2018 to 2022 (n=23) (Figure 8). Figure 8. Number of new cases of dengue by week (1 to 53 (A) and 18 to 34 (B)) in Nepal from January 2018 to 23 July 2023 Source: Government of Nepal, Ministry of Health and Population, Department of Health Services, Epidemiology and Disease Control Division. EWARS Weekly Bulletin. https://edcd.gov.np/resources/newsletter 12 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Sri Lanka In 2023, a total of 1 718 cases of dengue were reported in Sri Lanka in week 27 (3 to 9 July 2023), a 5.4% decrease compared to week 26 (26 June to 2 July, n=1 816) and 38.2% lower than the mean number of cases reported during week 27 from 2017 to 2022 (n=2 782) (Figure 9. Figure 9. Number of new cases of dengue by week in Sri Lanka from January 2018 to 9 July 2023 (week 27)* Sources: Epidemiology Unit and National Dengue Control Unit, Ministry of Health. https://www.epid.gov.lk/epid/public/index.php/weekly-epidemiological-report/weekly-epidemiological-report (2017 to 2021) https://www.dengue.health.gov.lk/web/index.php/en/publication-and-resources/publications/category/20-weekly-dengue-update (2022 and 2023) 13 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Thailand A total of 19 673 cases of dengue (inclusive of dengue fever, dengue haemorrhagic fever and dengue haemorrhagic fever shock syndrome) were reported in Thailand in July 2023, a 44.3% increase compared to June (n=13 633) and 1.6 times higher than the mean number of cases in July between 2018 and 2022 (n=12 150) (Figure 10). A total of nine deaths due to dengue (inclusive of dengue fever, dengue haemorrhagic fever and dengue shock syndrome) were reported in July 2023, a decrease of 35.7% from the number reported in June (n=9) and 0.8 times lower than the mean number of deaths reported in July between 2018 and 2022 (n=11) (Figure 10). Figure 10. Number of new dengue cases (A) and dengue deaths (B) by month in Thailand from January 2018 to July 2023. Sources: Bureau of Epidemiology, DDC, MPH. http://doe.moph.go.th/surdata/disease.php?ds=66; http://doe.moph.go.th/surdata/disease.php?ds=26 and http://doe.moph.go.th/surdata/disease.php?ds=27 14 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Influenza Figure 11. Number of specimens positive for influenza by subtypes and the influenza test positivity in WHO South-East Asia Region (as of 8 August 2023) Data sources and information on influenza, please refer to the WHO SEARO Influenza dashboard.
1 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA This epidemiological bulletin aims to provide the situation of key infectious diseases in the WHO South-East Asia region to inform risk assessment and response by countries. The bulletin uses information from publicly available sources and will be published every two weeks. For feedback or suggestions, please write to seoutbreak@who.int. Table of Contents Key events .......................................................................................................................................... 2 Dengue in the WHO South-East Asia Region ............................................................................................................ 2 Standing recommendations for COVID-19 ............................................................................................................... 3 COVID-19............................................................................................................................................ 4 mpox .................................................................................................................................................. 9 Dengue ............................................................................................................................................. 10 Bangladesh ............................................................................................................................................................. 10 Maldives.................................................................................................................................................................. 10 Nepal ....................................................................................................................................................................... 11 Sri Lanka .................................................................................................................................................................. 12 Thailand .................................................................................................................................................................. 13 Influenza .......................................................................................................................................... 14 WHO South-East Asia Region Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 8th edition, 7 August 2023. Reporting period: 24 July – 6 August 2023 HEALTH programme EMERGENCIES 2 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Key events Dengue in the WHO South-East Asia Region • Bangladesh: The increase in the number of new cases of dengue has started earlier in 2023 compared to previous years. A total of 66 732 dengue cases including 313 deaths have been reported between 1 January and 6 August 2023 with a case fatality rate of 0.47%. The overall CFR was higher in females than in males (0.73% v 0.32%), and the older age group recorded the higher CFR compared to younger age group (0.34% in those aged ≤ 40 vs 0.98% in those aged >40) (Figure 1).1 2 Figure 1. Number of dengue cases, deaths & case fatality rate by age & gender in Bangladesh in 2023 as of 6 August 2 • Nepal: Between 1 January and 7 August 2023, 9 411 cases of dengue have been reported from 74 districts in Nepal. Cases from Koshi province account for 73.7% of the cases (n=6 934) with Sunsari district reporting the highest number of cases in the province (72.7%, n=5 041). This is 18.1 times higher than the 519 cases reported between 3 January and 7 August 2022. 3 4 Interventions for dengue prevention and control are actively implemented, including: the dissemination of an Action Plan on Dengue Prevention and Control to all provinces and districts; routine surveillance using Early Warning and Reporting System; clinical case management orientation sessions in Kathmandu, Sunsari and Dhading; sensitization meetings with stakeholders to raise awareness about prevention and control and distribution messages via online and social media channels; and supply for dengue test kits to provinces and districts as needed3 • Thailand: A total of 54 119 dengue cases and 44 dengue deaths were reported in Thailand from January to July 2023, which were 1.5 and 1.1 times higher than the mean number of cases (n=36 771) and deaths (n=40), respectively, reported during the same months between 2018 and 2022.5 6 7 8 1 https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report 2 https://old.dghs.gov.bd/images/docs/vpr/20230806_dengue_all.pdf 3 https://edcd.gov.np/uploads/news/pdf/64d20dadc7061.pdf 4 https://edcd.gov.np/resources/newsletter 5 http://doe.moph.go.th/surdata/y66/mcd_DF_66.rtf 6 http://doe.moph.go.th/surdata/disease.php?dcontent=old&ds=66 7 http://doe.moph.go.th/surdata/disease.php?ds=26 8 http://doe.moph.go.th/surdata/disease.php?ds=27 3 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Standing recommendations for COVID-19 During the public health emergency of international concern (PHEIC) associated with the COVID-19 pandemic, from January 2020 to May 2023, countries’ response efforts were guided by temporary recommendations issued under the International Health Regulations (IHR) (2005). In the current transitional phase, countries’ preparedness and response actions can be guided by standing recommendations, issued under the IHR(2005). The WHO Director-General of the World Health Organization (WHO) convened a Review Committee to provide the stranding recommendations, which he accepted on 9 August 2023. These standing recommendations are issued by the Director-General in accordance with provisions of Articles 16 to 18, and 50 to 53 of the IHR (2005). These standing recommendations are in effect for all States Parties from 9 August 2023 until 30 April 2025. The COVID19 recommendations cover 7 major areas. All countries should: 1. Update their national COVID-19 programmes using the WHO Strategic Preparedness and Response Plan, to move towards longer term sustained management of COVID-19. 2. Sustain collaborative surveillance for COVID-19, to detect significant changes in the virus, and trends in disease severity and population immunity. 3. Continue to report COVID-19 data to WHO or in open sources, especially on death and severe disease, genetic sequences, & data on vaccine effectiveness. 4. Continue to offer COVID-19 vaccination especially for the high priority groups, based on both, the recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and on national prioritization. 5. Continue to initiate, support, and collaborate on research to generate evidence for COVID-19 prevention & control. 6. Deliver optimal clinical care for COVID-19 patients, including access to proven treatments and measures to protect health workers and caregivers. 7. Continue to work towards ensuring equitable access to safe, effective and quality-assured vaccines, tests & treatments for COVID-19. For more information, please visit: https://www.who.int/publications/m/item/standing-recommendations-for-covid-19-issued-by-the-director- general-of-the-world-health-organization-(who)-in-accordance-with-the-international-health-regulations-(2005)- (ihr) https://www.who.int/publications/m/item/report-of-the-review-committee-regarding-standing- recommendations-for-covid-19 https://twitter.com/WHO/status/1689278628729614337 4 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA COVID-19 Status as of 6 August 2023 The WHO South-East Asia Region has recorded a cumulative total of 61 199 192 COVID-19 cases, including 806 627 deaths. In the WHO South-East Asia Region, from 31 July to 6 August 2023, 1 199 new cases (a decrease of 14.4%) while 20 new deaths (a decrease 13.0%) were reported compared to the previous week. Between 31 July and 6 August 2023, only India (392 new cases, +21.0%) reported an increase in the number of new cases, while Bangladesh (369 new cases, -15.9%), Thailand (268 new cases, -31.5%), Indonesia (129 new cases, - 12.8%) Myanmar (34 cases, -57.0%), Nepal (six new cases, -53.8%) and Sri Lanka (one new case, -80.0%) reported a decrease in the number of new cases compared to the previous week. Bhutan and Timor-Leste have reported no new case in the same period. Data of Maldives were not available for this period. For the same period, India (two new deaths, +100%), Thailand (12 new deaths, +71.4%) and Sri Lanka (two new deaths, +100%) reported an increase in the number of new deaths while Bangladesh (two new deaths, -50.0%) and Indonesia (two new deaths, -81.8%) reported a decrease in the number of new deaths compared to the previous week. The remaining countries reported no new death. Data of Maldives were not available for this period. Please refer to the WHO SEARO COVID-19 dashboard for further information. Table 1. COVID-19 cases, deaths, and the weekly change in countries in the WHO South-East Asia Region in the week from 31 July to 6 August 2023 *Percent change in the number of newly confirmed cases/deaths in past seven days, compared to previous week. NA = data not available. Thailand data were for the period from 30 July to 5 August 2023 in comparison to the preceding week. Maldives data were as of 1 July 2023. 5 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 2. Weekly number of new COVID-19 cases reported during the previous eight weeks (12 June – 6 August 2023) in the WHO South-East Asia Region * Data of Maldives were available up to 1 July 2023. Figure 3. Weekly number of SARS-CoV-2 positive samples and test positivity from integrated influenza-SARS-CoV- 2 sentinel surveillance systems in the previous seven weeks (12 June – 30 July 2023) in selected counties* (as of 6 August 2023) * Countries routinely conducting SARS-COV-2 testing of the samples collected through influenza sentinel surveillance sites (Bangladesh, Bhutan, Nepal and Timor-Leste). 6 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 4. Number of weekly new COVID-19 cases per 100 000 population in the previous eight weeks (12 June – 6 August 2023) in countries in the WHO South-East Asia Region * *DPR Korea has reported no confirmed COVID-19 case. 7 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Circulation of SARS-CoV-2 variants globally9 Currently, WHO is closely tracking two variants of interest (VOI) and seven variants under monitoring (VUMs) and their descendent lineages (* includes their descendant lineages). • The VOIs are XBB.1.5 and XBB.1.16. • The VUMs are BA.2.75*, CH.1.1*, XBB* (excluding XBB.1.5*, XBB.1.16*, XBB.1.9.1*, XBB.1.9.2* and XBB.2.3*), XBB.1.9.1*, XBB.1.9.2*, XBB.2.3* and EG.5. • XBB.1.16 is the most prevalent VOI, reported from a total of 100 countries. In epidemiological week 28 (10 to 16 July 2023) it accounted for 18.4% of sequences but declined from 20.9% in week 24 (12 to 18 June 2023). • From epidemiological weeks 24 to 28 the prevalence of EG.5* increased from 6.2% to 11.6%. The prevalence of the other VOIs and VUMs either remained stable or decreased in prevalence. SARS-CoV-2 variants in the South-East Asia Region The number of sequences submitted to GISAID from the Region has continued to decline in recent weeks. As of 5 August 2023, based on data downloaded from GISAID (Figures 5a and 5b): • In Bangladesh, in the last 60 days, the most prevalent sequences submitted were XBB.2.3 and its sub-lineages (XBB.2.3*) (73.3%, n=30) and XBB.1.16 and its sub-lineages (XBB.1.16*) (23.3%, n=7). • In India, XBB.1.16* accounted for 50.9% (n=29) of the sequences submitted in the last 60 days. XBB.2.3* accounted for 35.1% (n=20). • In Indonesia, EG and its sub-lineages (EG* and EG.5*) accounted for 42.2% (n=27) of sequences submitted in the last 60 days of which the majority (81.5%, n=22) were EG.2*. Two sequences of EG.5* were submitted. . XBB.1.9.1 and its sub-lineages (XBB.1.9.1*) accounted for 20.3% (n=13) and XBB.1.16* for 17.2% (n=11) of the sequences submitted. • In Thailand, in the last 60 days, XBB.1.16* remained predominant accounting for 46.5% (n=219) of sequences with XBB.1.9.1* accounting for 16.1% (n=76) and XBB.2.3* for 11.5% (n=54). A total of 24 sequences of EG* (including EG.5*) were submitted of which 11 were EG.1*, six were EG.4*, four were EG.5.1 and three were EG.2*. • Other countries have not submitted sequences recently to GISAID. 9 https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---3-august-2023 8 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 5a. Number of Omicron sub-lineage sequences submitted to GISAID within the past 30 and 31-60 days as of 5 August 2023 by date of collection (countries with recent submissions) ⱡ Figure 5b. Proportion of Omicron sub-lineage sequences submitted to GISAID within the past 30 and 31-60 days as of 5 August 2023 by date of collection (countries with recent submissions) ⱡ *indicates the sub-lineage of each variant ⱡ The date next to the country name indicates the latest date of sample collection for sequence submission to GISAID. XBB* excludes XBB.1.16*, XBB.1.5*, XBB.1.9.1, XBB.1.9.2 and XBB.2.3* EG* is a sub-lineage of XBB.1.9.2 and excludes EG.5* Sources: GISAID (https://gisaid.org/), as of 5 August 2023. 9 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA mpox Status as of 6 August 2023 In the WHO South-East Asia Region, a total of 147 laboratory-confirmed mpox cases, including one death, have been verified since 14 July 2022 (Figure 6). Table 2 summarizes the basic epidemiological profile of the reported mpox cases in the Region. Figure 6. Number of mpox cases reported in WHO South-East Asia Region by date of notification* (14 July 2022 – 6 August 2023) * Notification - The date on which the case is notified to the public health authority. Table 2. Profile of the 147 confirmed mpox cases reported in WHO South-East Asia Region since July 2022 (as of 6 August 2023) Country India 22 (15.0%) Indonesia 1 (0.7%) Nepal 1 (0.7%) Sri Lanka 4 (27%) Thailand 119 (81.0%) Gender Male 125 (85.0%) Female 21 (14.3%) Transgender 1 (0.7%) Age group 0-17 1 (0.7%) 18-29 43 (29.3%) 30-39 64 (43.5%) 40 and over 39 (26.5%) Sexual orientation Heterosexual 25 (17.0%) Men who have sex with men (MSM) 102 (69.4%) Bisexual 2 (1.4%) Other 2 (1.4%) Unknown 16 (10.9%) For more information on the global situation of mpox outbreak, please visit the global dashboard. 10 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Dengue Bangladesh A total of 17 561 cases of dengue were reported in Bangladesh during epidemiological week (EW) 31 (30 July to 5 August 2023), an 11.7% increase compared to the number of cases reported in during EW 30 (n=15 722) and 34 times higher than the number of cases reported in EW 31 in 2022 (n=517). A total of 204 deaths were reported during July 2023, six times higher than the 34 deaths reported in June 2023 and 22.7 times higher than the nine deaths reported in July 2022 (Figure 7). Figure 7. Number of new cases of (A) and deaths (B) from dengue by month in Bangladesh from January 2019 to 31 July 2023 Source: Health Emergency Operation Center and Control Room, DGHS Reported Monthly Dengue cases & Dengue Deaths in Bangladesh. https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report Maldives No new data have been uploaded since the Monthly Communicable Disease report for May 2023 in Maldives. Please refer to previous versions of the South-East Asia Epidemiological Bulletin for prior epidemiological information. 11 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Nepal In 2023, a total of 275 cases of dengue were reported in Nepal in week 28 (17 to 23 July), a 36.1% increase compared to week 27 (10 to 16 July, n=202) and 12 times higher than the mean number of cases reported during week 28 from 2018 to 2022 (n=23) (Figure 8). Figure 8. Number of new cases of dengue by week (1 to 53 (A) and 18 to 34 (B)) in Nepal from January 2018 to 23 July 2023 Source: Government of Nepal, Ministry of Health and Population, Department of Health Services, Epidemiology and Disease Control Division. EWARS Weekly Bulletin. https://edcd.gov.np/resources/newsletter 12 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Sri Lanka In 2023, a total of 1 718 cases of dengue were reported in Sri Lanka in week 27 (3 to 9 July 2023), a 5.4% decrease compared to week 26 (26 June to 2 July, n=1 816) and 38.2% lower than the mean number of cases reported during week 27 from 2017 to 2022 (n=2 782) (Figure 9. Figure 9. Number of new cases of dengue by week in Sri Lanka from January 2018 to 9 July 2023 (week 27)* Sources: Epidemiology Unit and National Dengue Control Unit, Ministry of Health. https://www.epid.gov.lk/epid/public/index.php/weekly-epidemiological-report/weekly-epidemiological-report (2017 to 2021) https://www.dengue.health.gov.lk/web/index.php/en/publication-and-resources/publications/category/20-weekly-dengue-update (2022 and 2023) 13 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Thailand A total of 19 673 cases of dengue (inclusive of dengue fever, dengue haemorrhagic fever and dengue haemorrhagic fever shock syndrome) were reported in Thailand in July 2023, a 44.3% increase compared to June (n=13 633) and 1.6 times higher than the mean number of cases in July between 2018 and 2022 (n=12 150) (Figure 10). A total of nine deaths due to dengue (inclusive of dengue fever, dengue haemorrhagic fever and dengue shock syndrome) were reported in July 2023, a decrease of 35.7% from the number reported in June (n=9) and 0.8 times lower than the mean number of deaths reported in July between 2018 and 2022 (n=11) (Figure 10). Figure 10. Number of new dengue cases (A) and dengue deaths (B) by month in Thailand from January 2018 to July 2023. Sources: Bureau of Epidemiology, DDC, MPH. http://doe.moph.go.th/surdata/disease.php?ds=66; http://doe.moph.go.th/surdata/disease.php?ds=26 and http://doe.moph.go.th/surdata/disease.php?ds=27 14 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Influenza Figure 11. Number of specimens positive for influenza by subtypes and the influenza test positivity in WHO South-East Asia Region (as of 8 August 2023) Data sources and information on influenza, please refer to the WHO SEARO Influenza dashboard.