Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 1 st edition (2024), 10 January 2024. Reporting period: 25 December – 7 January 2024

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 assessments and responses. 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 and updates ...................................................................................................................... 2 Zika Virus Disease: Thailand ...................................................................................................................................... 2 Measles: Sri Lanka ..................................................................................................................................................... 2 COVID-19............................................................................................................................................ 3 mpox .................................................................................................................................................. 7 Dengue ............................................................................................................................................... 9 Bangladesh ............................................................................................................................................................... 9 Maldives.................................................................................................................................................................. 10 Nepal ....................................................................................................................................................................... 10 Sri Lanka .................................................................................................................................................................. 10 Thailand .................................................................................................................................................................. 11 Influenza .......................................................................................................................................... 12 WHO South-East Asia Region Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 1st edition (2024), 10 January 2024. Reporting period: 25 December – 7 January 2024 HEALTH programme EMERGENCIES 2 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Key events and updates Zika Virus Disease: Thailand 1 2 Situation Summary (As of 31 December 2023) • As of 31 December 2023, there have been 758 cases of Zika virus disease reported in 36 provinces of Thailand in 2023. Morbidity was 1.15 per 100,000 population. No fatalities reported. • Out of 758 cases, 33 pregnant women were identified with Zika virus infection. • The most commonly affected age groups are 25-34 years old (23%), followed by 35-44 years old (22%), and then 45-54 years old (16%). The male-to-female ratio is 1 to 1.41. • In 2023, the highest number of new cases has been reported from Bangkok (n=166), followed by Chanthaburi (n=142), Phetchabun (n=124) and Saraburi (n=39). Measles: Sri Lanka 3 4 Situation Summary (As of 10 January 2024) • An increasing number of laboratory-confirmed measles cases were reported from May to December 2023 in Sri Lanka. The first case was reported on 23 May 2023 through the routine disease surveillance system from the Colombo Municipality Area. • As of mid-November, there were 710 confirmed measles cases were reported across the country affecting 150 Medical Officer of Health (MOH) areas out of a total of 358 MOH areas. • Majority of the cases were reported from Colombo district (42%) and Gampaha district (18.6%) followed by Jaffna district (11.3%). • Out of the total positive cases, 17% were among less than 9 months old aged infants while nearly 35% of patients belonged to the 20 to 30 years age category (who were born after 1984, before introduction of the 2nd MCV). • Based on recommendation from the Advisory Committee on Communicable Diseases, a Supplementary Immunization Activity (SIA) with MMR vaccine was carried out on 6th January 2024 in a selected nine districts. During the period of SIA, a nationwide catch-up programme was launched to vaccinate children (9 months to 15 years) who have missed their due routine Measles Containing Vaccine/s (MCV). 1 http://doe.moph.go.th/surdata/506wk/y66/d87_5266.pdf 2https://ddc.moph.go.th/brc/news.php?news=39794&deptcode=brc&fbclid=IwAR0OJ2tieTLNyvapCKjolvynwx9O0I50oywmy0 HtSV_26QZ9mUcMba6Z_A4 3 https://www.epid.gov.lk/storage/post/pdfs/en_658d8c4b9214b_Measles%20SIA%20guidelines.pdf 4 https://www.epid.gov.lk/storage/post/pdfs/en_658d8b7f34cd6_SIA%20Circular.pdf 3 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA COVID-19 Status as of 7 January 2024 • In the WHO South-East Asia Region, from 25 December 2023 to 7 January 2024, 15 026 new COVID-19 cases and 70 deaths have been reported, a 31.3% and 62.8% increase compared to the previous 14 days, respectively. o Between 25 December 2023 to 7 January 2024, India (9 514 new cases, +71.0%), Thailand (1 258 new cases, +17.7%), Bangladesh (202 new cases, +173.0%), Sri Lanka (42 new cases, +68.0%) and Myanmar (74 new cases, +105.6%) reported an increase in the number of new cases, while Indonesia (3 936 new cases, - 15.8%) reported decrease in the number of new cases compared to previous 14 days. o Data were not available from Bhutan, Maldives, Nepal and Timor-Leste for this period. • General bed occupancy rates remain low in Delhi, India (0.14% as of 7 January 2024)5 and Indonesia (2.08% as of 7 January 2024); however, a small rise has been reported in the latter from 0.62% as of 1 December.6 • The Region has recorded a cumulative total of 61 241 866 COVID-19 cases, including 808 278 deaths. • Please refer to the WHO SEARO COVID-19 dashboard for further information of COVID-19 in WHO South-East Asia Region. • Globally, 773 819 856 COVID-19 cases, including 7 010 568 deaths have been cumulatively reported, as of 31 December 2023 7. Table 1. COVID-19 cases, deaths, and the weekly change in countries in the WHO South-East Asia Region in the week from 25 December 2023 to 7 January 2024 Percent change in the number of newly confirmed cases/deaths in past 14 days, compared to the previous 14 days. NA = data not available. DPR Korea has not reported confirmed COVID-19 cases. Thailand data were for the period from 24 December 2023 to 6 January 2024 in comparison to the preceding 14 days. As for cumulative numbers, Maldives data are as of 5 August, Timor-Leste data as of 11 August, Bhutan data as of 8 October and Nepal data as of 20 October 2023. 5 https://coronabeds.jantasamvad.org/ 6 https://vaksin.kemkes.go.id/#/scprovinsi 7 Data as 31 December 2023 link: https://data.who.int/dashboards/covid19/cases 4 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 1. Weekly number of new COVID-19 cases reported during the previous eight weeks (13 November 2023 to 7 January 2024) in the WHO South-East Asia Region * * Data of Maldives, Bhutan, Nepal and Timor-Leste are not available. Figure 2. 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 (13 November to 31 December 2023) in selected counties* (as of 7 January 2024) * Countries routinely conducting SARS-COV-2 testing of the samples collected through influenza sentinel surveillance sites (Bangladesh, Bhutan, Indonesia, Nepal and Timor-Leste). 5 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 3. Number of new daily COVID-19 cases and deaths in India from 1 November 2023 to 7 January 2024 Figure 4. Number of new daily COVID-19 cases and deaths in Indonesia from 1 November 2023 to 7 January 2024 6 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA SARS-CoV-2 variants in the South-East Asia Region • As of 8 January 2024, the sequence data submitted to GISAID by countries in the South-East Asia region in the last 60 days by date of collection are shown in the Table 2. Only a small number of sequences has been submitted from the Region and therefore the data should be interpreted with caution. o In India, 135 sequences were submitted, with JN.1* accounting for the highest percentage (83.7%, n=113). As per the Indian SARS-CoV-2 Genomics Consortium, as of 10 January 2024, a total of 688 sequences of JN.1* have been reported in India, of which 170 were from Maharashtra, 154 from Kerala and 105 from Andhra Pradesh.8 o In Indonesia, 399 sequences were submitted with JN.1* accounting for the highest percentage (54.9%, n=219). A total of 61 sequences of XBB.1.16* were submitted accounting for 15.3% of all sequences. o Sri Lanka submitted three sequences which were unassigned. o In Thailand, 19 sequences were submitted with EG.5 and its sub-lineages accounting for the highest percentage (52.8%) of which 11 sequences were HK.3*. o Other countries have not submitted sequences recently to GISAID. Table 2. Percentage and number of variants of interest (VOIs) and variants under monitoring (VUMs) submitted to GISAID within the past 30 and 31-60 days as of 8 January 2024 (by date of sample collection) *indicates the sub-lineage of each variant. XBB* excludes XBB.1.16*, XBB.1.5*, XBB.1.9.1, XBB.1.9.2 and XBB.2.3* XBB.1.9.2* excludes the EG.5 and its sub-lineage (EG.5*) The number and % for EG.5* are not inclusive of those of HK.3* and HV.1*; the denominator for the percentage of HK.3* and HV.1* is the total number of all variants. Sources: GISAID (https://gisaid.org/), as of 8 January 2024. 8 https://inda.rcb.ac.in/insacog/lineagWiseGraph?lineage=JN.1 Lineage India (n=135) Indonesia (n=399) Sri Lanka (n=3) Thailand (n=36) <31 days (n=120) 31-60 days (n=15) <31 days (n=291) 31-60 days (n=108) <31 days (n=2) 31-60 days (n=1) <31 days (n=0) 31-60 days (n=36) Variants of interest XBB.1.5* 1 (6.7%) 3 (1.0%) 1 (0.9%) 2 (5.6%) XBB.1.16* 3 (2.5%) 36 (12.4%) 25 (23.1%) 5 (13.9%) EG.5* HK.3* HV.1* 1 (0.8%) 1 (0.8%) 5 (33.3%) 7 (2.4%) 5 (1.7%) 3 (2.8%) 11 (10.2%) 2 (1.9%) 5 (13.9%) 11 (30.6%) 3 (8.3%) BA.2.86* 5 (4.2%) 9 (3.1%) 4 (3.7%) 4 (11.1%) JN.1* 105 (87.5%) 8 (53.3%) 194 (66.7%) 25 (23.1%) Variants under monitoring DV.7* XBB* 13 (4.5%) 16 (14.8%) XBB.1.9.1* 6 (2.1%) 4 (3.7%) 2 (5.6%) XBB.1.9.2* 1 (0.3%) 1 (2.8%) XBB.2.3* 2 (1.7%) 1 (6.7%) 4 (1.4%) 7 (6.5%) 3 (8.3%) Other 3 (2.5%) 13 (4.5%) 10 (9.3%) 2 (100%) 1 (100%) 7 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA mpox Status as of 7 January 2024 • In epidemiological weeks 52 (25 to 31 December 2023) and 1 (1 to 7 January 2024), six new mpox cases were reported from Thailand and two from Indonesia. • In the WHO South-East Asia Region, a total of 794 laboratory-confirmed mpox cases (including two deaths) have been reported since 14 July 2022 (Figure 5). • Figure 6 shows the weekly number of cases reported in Indonesia and Thailand since 1 January 2023. • Table 3 summarizes the basic epidemiological profile of the mpox cases in the Region. • For more information on the global situation of mpox outbreak, please visit the global dashboard. Figure 5. Number of mpox cases reported in WHO South-East Asia Region by date of notification* (14 July 2022 – 7 January 2024) * Cases are plotted as per the week of notification (based on the date on which the case was notified to the public health authority). Where the date of notification is missing for 73 cases in Indonesia, this was replaced with the date of diagnosis. Figure 6. Weekly number of mpox cases reported in Indonesia (n=73) and Thailand (n=674) since 1 January 2023 by date of notification* (as of 7 January 2024) 8 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA * Cases are plotted as per the week of notification (based on the date on which the case is notified to the public health authority). Where the date of notification is missing for cases in Indonesia, this was replaced with the date of diagnosis. Table 3. Profile of the 781 confirmed mpox cases reported in WHO South-East Asia Region for which case-based information is available since July 2022 and since July 2023 (as of 7 January 2024)* Since July 2022 (n = 794) Since July 2023 (n = 661) Country India 27 (3.4%) 0 (0.0%) Indonesia 74 (9.3%) 73 (11.0%) Nepal 1 (0.1%) 0 (0.0%) Sri Lanka 4 (0.5%) 0 (0.0%) Thailand 688 (86.6%) 588 (89.0%) Gender Female 32 (4.0%) 10 (1.5%) Male 761 (95.8%) 651 (98.5%) Transgender 1 (0.1%) 0 (0.0%) Age group (years) Less than 18 4 (0.5%) 3 (0.5%) 18-29 268 (33.8%) 229 (34.6%) 30-39 340 (42.8%) 283 (42.8%) 40-49 152 (19.1%) 126 (19.1%) 50 and over 30 (3.8%) 20 (3.0%) Sexual orientation Heterosexual 58 (7.3%) 34 (5.1%) Men who have sex with men (MSM) 642 (80.9%) 556 (84.1%) Bisexual 13 (1.6%) 12 (1.8%) Other 23 (2.9%) 21 (3.2%) Unknown 58 (7.3%) 38 (5.7%) Recent travel Yes 45 (5.7%) 14 (2.1%) No 741 (93.3%) 645 (97.6%) Unknown 8 (1.0%) 2 (0.3%) 9 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Dengue Bangladesh 9 10 • During week 1 in 2024 (1 to 7 January 2024), a total of 378 new dengue cases were reported in Bangladesh, a 47.4% decrease compared to week 52 (25 to 31 December 2023) (n=719). The number of new deaths also decreased by 62.5% from 8 in week 52 to 3 in week 1 (2024). • Between 1 and 31 December 2023 a total of 9 288 cases including 83 deaths have been reported. This compares to 5 024 cases including 27 deaths during the entirety of December 2022 (Figure 7). • In the year 2023, a total of 321 179 dengue cases, including 1 705 deaths, were reported. This represents a case fatality rate (CFR) of 0.53%. Comparatively, in the previous year, 2022, there were 62 382 reported cases, with 281 associated deaths and CFR at 0.45%. This marks a significant increase of approximately 416% in the number of cases and a 506% increase in deaths compared to 2022. Figure 7. Number of new cases of, and deaths from dengue by month in Bangladesh from January 2019 to 31 December 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 9 https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report 10 https://old.dghs.gov.bd/images/docs/vpr/20231224_dengue_all.pdf 10 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Maldives • No new data have been uploaded. Please refer to previous versions of the South-East Asia Epidemiological Bulletin for prior epidemiological information. Nepal • No new data have been uploaded. Please refer to previous versions of the South-East Asia Epidemiological Bulletin for prior epidemiological information. Sri Lanka 11 • Between 1 and 8 January 2024, 2 866 suspected cases were reported in Sri Lanka. • A total of 2 770 suspected dengue cases were reported in Sri Lanka in week 52 (25 to 31 December), a 21.8% decrease compared to the previous week (Figure 8). • Between week 1 and 52 in 2023, a total of 88 658 cases of dengue have been reported in Sri Lanka. This compares to 76 255 cases reported between week 1 and 52 in 2022. Figure 8. Number of new cases of dengue by week in Sri Lanka from January 2018 to 31 December2023 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 2020) https://lookerstudio.google.com/reporting/95b978f1-5c1a-44fb-a436-e19819e939c0/page/XRtTB (2021 to 2023) 11 https://lookerstudio.google.com/reporting/95b978f1-5c1a-44fb-a436-e19819e939c0/page/XRtTB 11 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA • In the year 2023, a total of 156 097 dengue cases (inclusive of dengue (n=117 548, 75.3%), dengue hemorrhagic fever (DHF) (n=37 291, 23.9%) and dengue shock syndrome (DSS) (n=1 258, 0.8%)) and 167 dengue deaths (inclusive of dengue (n=12, 7.2%), DHF (n=47, 28.1%) and DSS (n=108, 64.7%)) (CFR=0.1%) were reported in Thailand (Figure 9). • In 2023, the reported cases and deaths were the highest since 2018, surpassing the numbers seen in 2019 when 131 157 cases and 142 deaths were reported. Figure 9. Number of new dengue cases and deaths by month in Thailand from January 2018 to December 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 12 Bureau of Epidemiology, DDC, MPH. http://doe.moph.go.th/surdata/disease.php?ds=66 13 Bureau of Epidemiology, DDC, MPH. http://doe.moph.go.th/surdata/disease.php?ds=26 14 Bureau of Epidemiology, DDC, MPH. http://doe.moph.go.th/surdata/disease.php?ds=27 15 https://lookerstudio.google.com/reporting/dfa7d4e2-b7f5-48ed-b40a-54f1cd4cbdfb/page/p_ortuohurpc Thailand 12 13 14 15 12 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Influenza Status as of 31 December 2023 • According to the data submitted to the FluMart of the Global Influenza Surveillance and Response system (GISRS), in the WHO South-East Asia Region, an increase in transmission of seasonal influenza has been observed since late June 2023 (the weekly test positivity was at 7%). The transmission peaked on the week starting from 11 September (weekly test positivity at 33%) and then started displaying a decreasing trend. • In the week starting from 25th December 2023, the weekly test positivity was at 12% and the most frequently reported strains were influenza B Victoria, followed by A/H1N1pdm09 and A/H3 (Figure 10). • Though a decreasing trend is observed in the region, the transmission still high in Thailand. The trend measured by the percentage of specimens positive for influenza indicated that seasonal influenza transmission increased from 13% in the week starting on 31 July to 38% in the week starting on 25 September. Since then, the test positivity for influenza has fluctuated between 26% and 36%. The test positivity was 34% in the week starting on 25 December 2023. In the past month, the majority of reported influenza strains has been the influenza B Victoria linage and influenza A/H3 (Figure 11). • During the week starting on 25 December, the proportion of respiratory samples collected at influenza sentinel surveillance sites in the selected countries that tested positive for COVID-19 was 6.9% (Figure 2). • Data sources and information on influenza, including updates of integrated surveillance of SARS-CoV-2 using influenza sentinel surveillance systems, are available at WHO SEARO Influenza dashboard. Figure 10. Number of specimens positive for influenza by subtypes and the influenza test positivity in WHO South-East Asia Region (as of 25 December 2023) 13 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 11. Number of specimens positive for influenza by subtypes and the influenza test positivity in Thailand 2023 (as of 31 December 2023)