Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 11 th edition, 20 September 2023. Reporting period: 4 – 17 September 2023

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 Nipah Virus Disease in India ..................................................................................................................................... 2 COVID-19............................................................................................................................................ 3 mpox .................................................................................................................................................. 8 Dengue ............................................................................................................................................... 9 Bangladesh ............................................................................................................................................................... 9 Maldives.................................................................................................................................................................. 11 Nepal ....................................................................................................................................................................... 12 Sri Lanka .................................................................................................................................................................. 13 Thailand .................................................................................................................................................................. 14 Influenza .......................................................................................................................................... 15 Situation of influenza in WHO South-East Asia Region .......................................................................................... 15 Global situation of influenza ................................................................................................................................... 17 WHO South-East Asia Region Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 11th edition, 20 September 2023. Reporting period: 4 – 17 September 2023 HEALTH programme EMERGENCIES 2 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Key events Nipah Virus Disease in India 1 2 3 4 5 6 7 8 9 10 11 12 13 Situation overview • According to the official press releases by the Government of Kerala, India, between 12 and 18 September, a total of six laboratory-confirmed cases of Nipah virus infection (NiV) including two deaths (case fatality rate = 33.3%) have been reported in Kozhikode district, Kerala, India. The cases included five male adults (of which one was reported to be a healthcare worker) and one child. o A 47-year-old male was treated in a private hospital and died on 30 August. His laboratory test results were positive for NiV. o His family contacts (a 9-year-old son and a 25-year-old brother-in-law) were reported as confirmed NiV cases on 12 September. The 9-year-old child was initially in a critical condition and required ventilatory support. However, his condition improved, and he was extubated. o On 12 September, an additional NiV-confirmed death was reported in a 40-year-old male who died on 11 September. o On 13 and 15 September, two further cases were confirmed, one of whom was reported to be a healthcare worker. o All four cases who are alive are reported to be clinically stable and under monitoring. • As of 19 September, a total of 1 286 contacts have been identified. All who came in contact with the first case of NiV have tested negative. The health workers who were in the contact list of the last positive person have been admitted to isolation at the medical college with mild symptoms. Public health response • After the 2018 NiV outbreak in Kerala, the state and central governments developed guidelines on multiple aspects of the response including surveillance, case management, infection prevention and control, laboratory sample collection and transport among others. • A control room was activated, and 18 core committees were created to oversee the response • A call center with hotline numbers is available for public guidance. • Nine Kozhikode villages are containment zones with strict restrictions; major events limited until 24 September 2023. • Alerts have been issued to neighboring districts and states for enhanced surveillance. • Contact tracing and isolation is ongoing; all high-risk contacts are being tested. • A fever survey in affected areas has covered 22 000 houses as of 17 September. • RT-PCR/Truenat testing for NiV is operational at multiple sites, including a mobile BSL3 laboratory for on-the- spot confirmations. • Advocacy measures for healthcare workers and the public are being disseminated, and actions are being taken against fake news. • Samples from bats, animal droppings and half-eaten fruits were collected on 15 September from Maruthonkara forest which is where the first case resided. All 14 samples collected from bats tested negative. 1 https://www.prd.kerala.gov.in/index.php/ml/node/231325 2 https://www.prd.kerala.gov.in/index.php/ml/node/231120 3 https://www.prd.kerala.gov.in/ml/node/230904 4 https://www.prd.kerala.gov.in/ml/node/230672 5 https://www.prd.kerala.gov.in/ml/node/231585 6 https://www.prd.kerala.gov.in/en/node/231067 7 https://www.prd.kerala.gov.in/ml/node/230905 8 https://www.prd.kerala.gov.in/en/node/230799 9 https://www.prd.kerala.gov.in/ml/node/230670 10 https://www.prd.kerala.gov.in/ml/node/231778 11https://www.prd.kerala.gov.in/ml/node/231836 12 https://www.prd.kerala.gov.in/ml/node/231782 13 https://www.prd.kerala.gov.in/ml/node/231957 3 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA COVID-19 Status as of 17 September 2023 • The WHO South-East Asia Region has recorded a cumulative total of 61 204 332 COVID-19 cases, including 806 778 deaths. In the WHO South-East Asia Region, from 11 to 17 September 2023, 771 new cases (an increase of 0.7%) and six new deaths (a decrease of 14.3%) reported as compared to the previous week. • Between 11 to 17 September 2023, India (452 new cases, +17.7%), Nepal (seven new cases, +133.3%) and Sri Lanka (four new cases, +100.0%) reported an increase in the number of new cases while Thailand (212 new cases, -13.1%), Bangladesh (85 new cases, -22.0%) and Myanmar (11 new cases, -57.7%) reported a decrease in the number of new cases compared to the previous week. Bhutan has not reported new cases during the same period. Data were not available from Indonesia, Maldives, and Timor-Leste for this period. • For the same period, only Thailand and India reported three new COVID-19 deaths each. The remaining countries reported no new deaths. Data from Indonesia, Maldives and Timor-Leste were not available for this period. • Globally, 770 563 467 COVID-19 cases, including 6 957 216 deaths have been cumulatively reported, as of 13 September 2023 14. From 4 to 10 September 2023, a total of 189 331 new cases including 338 new deaths were reported, representing a decrease of 41.3% and 4.2% respectively, as compared to the previous week 15. • Please refer to the WHO SEARO COVID-19 dashboard for further information of COVID-19 in WHO South-East Asia Region. Table 1. COVID-19 cases, deaths, and the weekly change in countries in the WHO South-East Asia Region in the week from 11 to 17 September 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 10 to 16 September 2023 in comparison to the preceding week. DPR Korea has not reported confirmed COVID-19 cases. 14 Data as of 7:25 pm CEST, 13 September 2023, link: https://covid19.who.int/ 15 Starting from the week of 7 August 2023, the Region of the Americas has stopped sharing the COVID-19 cases and deaths updates. For more information regarding COVID-19 in the Americas, please access the link: https://www.paho.org/en/topics/influenza-and-other-respiratory-viruses. 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 (24 July to 17 September 2023) in the WHO South-East Asia Region 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 (24 July to 10 September 2023) in selected counties* (as of 17 September 2023) * 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 weekly new COVID-19 cases per 100 000 population in the previous eight weeks (24 July - 17 September 2023) in countries in the WHO South-East Asia Region * *DPR Korea has reported no confirmed COVID-19 case. Indonesia data as of 13 September 2023. Timor-Leste data as of 11 August 2023 6 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Circulation of SARS-CoV-2 variants globally 16 • Currently, WHO is closely tracking three variants of interest (VOI) and seven variants under monitoring (VUMs) and their descendent lineages (* includes their descendant lineages). o The VOIs are XBB.1.5, XBB.1.16 and EG.5*. o The VUMs are BA.2.75*, BA.2.86*, 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* and XBB.2.3*. • Globally, EG.5 is now the most prevalent VOI, increasing from 14.8% in epidemiological week 28 (10 to 16 July 2023) to 33.2% in epidemiological week 36 (3 to 9 August 2023). Among the other VOIs, XBB.1.16 decreased from 23.3% to 16.1% and XBB.1.5 from 16.9% to 10.5%. • Among the VUMs, the prevalence of CH.1.1* remained stable (0.2% in week 28 to 0.1% in week 36), XBB* remained stable (2.5% to 1.1%), XBB.1.9.1* decreased (11.5% to 8.4%), XBB.1.9.2* (1.4% to 8.6%), and XBB.2.3* remained stable (10.1% to 9.9%). The prevalence of BA.2.75* and BA.2.86 could not be calculated due to the very small numbers of sequences; however, as of 18 September 2023, 135 sequences of BA.2.86* have been reported from 16 countries (nine in the WHO European Region, three in the Western Pacific Region, two in the Region of the Americas, one in the African Region and one in the South-East Asia Region) and uploaded on GISAID. • Due to the lag between the date of sample collection and submission of the sequences to GISAID, there was a decline in the number of sequences by date of samples collection from 10 278 in epidemiological week 28 to 1 515 in week 36 and therefore trends to be interpreted appropriately. Figure 4. Proportion and number of SARS-CoV-2 sequences submitted globally from epidemiological weeks 28 to 36 by date of sample collection 16https://gisaid.org/hcov19-variants/ 7 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 16 September 2023, the sequence data submitted to GISAID in the last 60 days by date of collection are as follows (Figures 5a and 5b). Only small number of sequences have been submitted from the Region and therefore the data should be interpreted with caution. • In Bhutan, four sequences were submitted all of which were XBB.1.16*. • In India, XBB.2.3* now accounts for the highest percentage of the 165 sequences submitted (54.5%, n=90) followed by XBB.1.16* (37.0%, n=61). Four sequences of EG.5* (2.4%) were submitted. • In Thailand, XBB.1.16* accounted for 43.5% (n=128) of the 294 sequences submitted, with XBB.1.9.1* accounting for 15.6% (n=46) and XBB.2.3* for 15.3% (n=45). A total of 16 (5.4%) sequences of EG.5* were submitted and five sequences of BA.2.86* (1.7%) • Other countries have not submitted sequences recently to GISAID. Figure 5a. Number of Omicron sub-lineage sequences submitted to GISAID within the past 30 and 31-60 days as of 16 September 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 16 September 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 submitted to GISAID. XBB* excludes XBB.1.16*, XBB.1.5*, XBB.1.9.1, XBB.1.9.2 and XBB.2.3* EG.5* is a sub-lineage of XBB.1.9.2 Sources: GISAID (https://gisaid.org/), as of 16 September 2023. 8 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA mpox Status as of 17 September 2023 • In the WHO South-East Asia Region, a total of 344 laboratory-confirmed mpox cases, including two deaths, 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 – 17 September 2023) * Notification - The date on which the case is notified to the public health authority. Table 2. Profile of the 353 confirmed mpox cases reported in WHO South-East Asia Region since July 2022 (as of 17 September 2023) Country India 22 (6.2%) Indonesia 1 (0.3%) Nepal 1 (0.3%) Sri Lanka 4 (1.1%) Thailand 325 (92.1%) Gender Male 329 (93.2%) Female 23 (6.5%) Transgender 1 (0.3%) Age group Less than 18 2 (0.6%) 18-29 102 (28.9%) 30-39 166 (47.0%) 40-49 67 (19.0%) 50 and over 16 (4.5%) Sexual orientation Heterosexual 31 (8.8%) Men who have sex with men (MSM) 284 (80.5%) Bisexual 2 (0.6%) Other 3 (0.8%) Unknown 33 (9.3%) For more information on the global situation of mpox outbreak, please visit the global dashboard. 9 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Dengue Bangladesh 17 18 19 20 • During August 2023, a total of 71 976 cases and 342 deaths have been reported. This is the highest number of monthly cases and deaths, compared with the available historical data from 2019 to 2023. Between 1 and 17 September, 43 876 new cases and 229 new deaths were reported compared to 9 911 new cases and 22 new deaths for entirety of September 2022 (Figure 7). • A total of 19 356 cases of dengue were reported in Bangladesh during week 37 (11 to 17 September 2023), an 7.4% increase compared to the number of cases reported in during week 36 (4 to 10 September 2023) (n=18 026). The number of new deaths decreased by 4.2% (n=92 in week 37 compared to n=96 in week 36) (Figure 6). • A total of 167 684 dengue cases including 822 deaths have been cumulatively reported between 1 January and 17 September 2023 with a case fatality rate (CFR) of 0.49%. Of the 130 302 cases: o 73 233 (43.7%) were reported in Dhaka city and 94 451 (56.3%) from outside Dhaka city however, during epidemiological week 35 (28 August to 3 September), the highest number of new cases was reported in Dhaka division (8 601, a 5.8% increase compared to week 34 (21 to 27 September)) and Chattogram (2 421, a 6.1% increase compared to week 34). o 61.2% (n=102 648) were male; however, females accounted for 58.2% (n=478) of the deaths and the overall CFR was higher in females compared to males (0.73% vs 0.34%); and o mortality also differed by age with those aged over 60 years having the highest CFR (1.84%) followed by those aged 41 to 60 years (0.82%), 21 to 40 years (0.36%) and 20 years and younger (0.29%). Response • The Directorate General of Health (DGHS), Ministry of Health, provided orientation sessions in Dhaka, Chattogram and Barisal on for 300 doctors on the updated case management of dengue and an assessment of dengue case management was conducted at major public hospitals in Dhaka by the United States Centers for Disease Control (US CDC), WHO and the Ministry of Health, Bangladesh. • Additional dengue test kits have been procured by the United States Agency for International Development (USAID) through UNICEF and RT-PCR assay kits have been provided by US CDC for dengue serotyping. A dengue laboratory expert from US CDC has been providing technical support on PCR testing, serotyping and sequencing. • WHO and UNICEF will be developing key educational messages targeted at eliminating the breeding sources of Aedes mosquitoes and environmental cleaning. • Between 28th August and 7th September, WHO facilitated a series of virtual training sessions on dengue outbreak management for all relevant stakeholders. • Two clinical management specialists are being deployed by WHO to assist the Ministry of Health (MoH). • An entomologist has been deployed by WHO to enhance vector-control initiatives, and a systematic deployment of medical epidemiologists has commenced to support surveillance efforts. • WHO is amplifying Risk Communication and Community Engagement by supporting the country in crafting more contextually relevant communication materials. These primarily emphasize the warning signs of dengue and the crucial moments to seek medical attention. 17 https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report 18 https://old.dghs.gov.bd/images/docs/vpr/20230903_dengue_all.pdf 19 https://www.who.int/bangladesh/news/detail/13-09-2023-who-response-to-dengue-upsurge-in-rohingya-camps 20 https://cdn.who.int/media/docs/default-source/searo/bangladesh/dengue-sitrep/dengue-sitrep_issue- 2.pdf?sfvrsn=1ee053fd_1&download=true 10 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 7. Number of new cases of, and deaths from dengue by month in Bangladesh from January 2019 to 31 August 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 11 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Maldives • Between January and August 2023, a total of 2 357 cases of dengue have been reported in Maldives compared to 1 288 cases reported during the same period in 2022. • A total of 323 new cases of dengue were reported in August 2023, a 19.1% increase compared to July 2023 (n=271) and 1.3 times higher than the number reported during August 2022 (n=250) (Figure 8). Figure 8. Number of new cases of dengue by month in Maldives from January 2022 to May 2023 Source: Ministry of Health, Republic of Maldives: https://health.gov.mv/en/publications?search=Monthly&category=&department= 12 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Nepal • Between 1 January and 8 September 2023, 24 842 cases of dengue including 14 confirmed deaths (CFR=0.06%) have been reported from 75 districts in Nepal. • The highest cumulative number of cases and case incidence have been reported from Sunsari district, Koshi province (14 228 cases (57.3% of the total), 1 601 cases per 100 000). The second highest number of cumulative cases has been reported from Morang district, Koshi province (2 254 cases (9.1% of the total), 210 cases per 100 000) and the second highest incidence of cases from Dhading district, Bagmati province (2 197 cases (8.8% of the total), 625 per 100 000 population). • Nationally, the number of cases reported in August 2023 (n= 15 284) was 4.1 times higher than the 3 708 cases reported in August 2022. In 2022, the number of new cases peaked in September (n=27 529). • A total of 1 386 cases of dengue were reported in Nepal during week 35 (27 August to 2 September 2023), a 5.9% decrease compared to week 34 (20 to 26 August, n= 1 304) and 3.9 times higher than the mean number of cases reported during week 35 from 2018 to 2022 (n=355) (Figure 9). Figure 9. Number of new cases of dengue by week (1 to 53 (A) and 21 to 38 (B)) in Nepal from January 2018 to 2 September 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 13 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Sri Lanka • As of 25 August, a total of 61 361 cases of dengue have been reported in Sri Lanka in 2023. This compares with 53 181 cases reported until the end of week 34 in 2022 (26 August). • In 2023, a total of 1 219 cases of dengue were reported in Sri Lanka in week 34 (19 to 25 August 2023), a 4.5% increase compared to week 33 (12 to 18 August, n=1 166) and 96.1% of the mean number of cases reported during week 34 from 2017 to 2022 (n=1 268) (Figure 10). Figure 10. Number of new cases of dengue by week in Sri Lanka from January 2018 to 25 August 2023 (week 34) 4 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 and weeks 28-34) https://www.dengue.health.gov.lk/web/index.php/en/publication-and-resources/publications/category/20-weekly-dengue-update (2022 and 2023 (excluding weeks 28-34 in 2023) 14 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Thailand • As of 14 September, a total of 91 979 dengue cases and 81 dengue deaths (CFR=0.09%) were reported in Thailand in 2023. • A total of 27 196 cases of dengue (inclusive of dengue fever, dengue haemorrhagic fever and dengue haemorrhagic fever shock syndrome) were reported in Thailand in August 2023, a 1.3% increase compared to July (n=26 850) and 2.7 times higher than the mean number of cases reported in August between 2018 and 2022 (n=10128) (Figure 11). • A total of 23 deaths due to dengue (inclusive of dengue fever, dengue haemorrhagic fever and dengue shock syndrome) the same number as reported in July (n=23) (Figure 11). Figure 11. Number of new dengue cases and deaths by month in Thailand from January 2018 to August 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 15 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Influenza Situation of influenza in WHO South-East Asia Region • From the week starting on 26 June 2023, WHO’s South-East Asia (SE Asia) Region has been witnessing an increase in transmission of seasonal influenza. This increasing trend is corroborated by the percentage of specimens positive for influenza that increased from 18% to 25% in the region during the period from 24 July to 17 September 2023. However, the proportion of influenza positive laboratory specimens demonstrated a decreasing trend from 29% on week of 21 August to 25% on week starting on 11 September 2023. • Increases in WHO SE Asia Region were primarily driven by Bangladesh and Thailand. In Bangladesh, from the week starting on 17 July to the week starting on 11 September 2023, the percentage of specimens positive for influenza ranged from 40% (n=179) to 32% (n=65) (Figure 11). However, since the week starting on 7 August 2023 (46%), the percentage of positive influenza specimens have shown a declining trend. The corresponding figure on the week starting from 4 September was 32%. In Thailand, from the week starting from 12 June to the week starting on 17 September 2023, overall, the trend of percentage positive specimens for influenza was increasing. The rise started from 2% (12 June) and continued to rise steeply till 29% (14 August) and from there onwards it fluctuated between 21% (21 August) -32% (28 August). Continuing this variation at a high level, the specimen positivity proportion for influenza remained high at 27% on 11 September (Figure 12). • The most frequently circulating strains overall in the WHO SE Asia region were influenza A/H3, A/H1N1pdm09 and influenza B Victoria (Figure 10). In Bangladesh, the transmission was primarily driven by influenza subtype B Victoria followed by influenza A/H3 and A/H1N1 pdm09 (Figure 11), while in Thailand, it was due to influenza subtype A/H1N1 pdm09 followed by A/H3 and a significant number of un-subtyped influenza B (Figure 12). • From the week starting on 24 July to the week starting on 11 September 2023, the proportion of respiratory samples collected at influenza sentinel surveillance systems in these countries that tested positive for COVID- 19 varied from 2.5% to 1.2% (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 12. Number of specimens positive for influenza by subtypes and the influenza test positivity in WHO South-East Asia Region (as of 17 September 2023) 16 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 13. Number of specimens positive for influenza by subtypes and the influenza test positivity in Bangladesh 2023 (as of 17 September 2023) Figure 14. Number of specimens positive for influenza by subtypes and the influenza test positivity in Thailand 2023 (as of 17 September 2023) 17 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Global situation of influenza Status as of 19 September 2023 • Globally, influenza detections remained low as per data reported till 10 September 2023 with activity in many countries in the southern hemisphere now decreasing after having peaked in previous weeks. o The global situation of low detection continued. The percentage of specimens positive for influenza changed from 2.7% (n=3 466 /129 413) in the week 29 (the week starting on 17 July 2023) to 3.2% (n=2 021/63 863) in the week 36 (the week starting on 4 September 2023) (Figure 13). • The WHO GISRS laboratories tested 63 863 specimens during the period from 4 to 10 September 2023 (Week 36). Total 2 021 specimens were positive for influenza viruses, of which 1 454 (72%) were typed as influenza A and 567 (22%) as influenza B. o Of the sub-typed influenza, A viruses, 382 (26%) were influenza A/H1N1pdm09 and 794 (55%) were influenza A/H3N2. Of the type B viruses for which lineage was determined, 315 (56%) belonged to the B/Victoria lineage and 325 (57%) were unsub-typed. Figure 15. Number of specimens positive for influenza by subtypes and the influenza test positivity globally (as of 10 September 2023) 29 30 31 32 33 34 35 36