Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 8 th edition (2024), 17 April 2024. Reporting period: 1– 14 April

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 Indonesia: Dengue .................................................................................................................................................... 2 COVID-19............................................................................................................................................ 3 mpox .................................................................................................................................................. 7 Dengue ............................................................................................................................................... 8 Bangladesh ............................................................................................................................................................... 8 Maldives.................................................................................................................................................................... 9 Nepal ......................................................................................................................................................................... 9 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 8th edition (2024), 17 April 2024. Reporting period: 1– 14 April HEALTH programme EMERGENCIES 9 789290 211440 2 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Key events and updates Indonesia: Dengue Situation as of 8 April 2024 1 • Indonesia continues to experience a surge in dengue (dengue hemorrhagic fever) cases with a total of 60 296 cases including 455 deaths (case fatality rate (CFR) = 0.75%) reported nationally as of 8 April 2024. • For the whole year in 2023, a total of 114 720 dengue cases including 894 deaths were reported (CFR=0.78%) • The five districts/cities with the highest number of dengue cases this year include Tangerang Regency (2,540 cases), Bandung City (1,741 cases), West Bandung Regency (1,422 cases), Lebak Regency (1,326 cases) and Depok City (1,252 cases). • The districts/cities with the highest number of dengue deaths in 2024 include Bandung Regency (25 deaths), Jepara Regency (21 deaths), Subang Regency (18 deaths), Kendal Regency (16 deaths), and Bogor Regency (13 deaths). 1 Indonesia Ministry of Health Press Release. 8 April 2024. https://www.kemkes.go.id/eng/rilis-kesehatan/penyakit-tak-libur- saat-libur-lebaran-waspadai-demam-berdarah-dan-hfmd 3 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA COVID-19 Status as of 14 April 2024 • In the WHO South-East Asia Region, from 1 to 14 April 2024, 3 128 new COVID-19 cases and 31 deaths were reported which is a decrease of 11.4% and 24.4% compared to the previous 14 days, respectively (Table 1). o From 1 to 14 April 2024, Thailand (1 623 new cases, +19.5%) and Myanmar (62 new cases, +10.7%) reported an increase in the number of new cases while India (1 213 new cases, -28.9%), Bangladesh (209 new cases, -42.6%) and Indonesia (21 new cases, -63.8%), reported a decrease in the number of new cases compared to the previous 14 days. Sri Lanka reported 0 cases during the same period. o Data were not available from Bhutan, Maldives, Nepal and Timor-Leste for this period. • The Region has recorded a cumulative total of 61 276 960 COVID-19 cases, including 808 614 deaths (Table 1). • During week 14 in 2024, the proportion of respiratory samples collected at influenza sentinel surveillance sites in the selected countries that tested positive for COVID-19 ranged from 1% (Bangladesh) to 6% (Nepal) (Figure 2). • Please refer to the WHO SEARO COVID-19 dashboard for further information of COVID-19 in WHO South-East Asia Region. • Globally, 775 251 779 COVID-19 cases, including 7 043 660 deaths have been cumulatively reported, as of 31 March 2024 2. Please visit WHO COVID-19 dashboard for global situation of COVID-19. Table 1. COVID-19 cases, deaths, and the weekly change in countries in the WHO South-East Asia Region in the week from 1 to 14 April 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 and Indonesia data were for the period from 31 March to 13 April 2024 in comparison to the preceding 14 days. As for cumulative numbers, Maldives data are as of 5 August 2023, Timor-Leste data as of 11 August 2023, Bhutan data as of 8 October 2023, and Nepal data as of 20 October 2023. 2 Data as 31 March 2024 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 ten weeks (5 February to 14 April 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 eight weeks 5 February 2023 to 31 March 2024) in selected counties* (as of 14 April 2024) * Countries routinely conducting SARS-COV-2 testing of the samples collected through influenza sentinel surveillance sites (Bangladesh, Bhutan, Indonesia, Nepal and Timor-Leste). Timor-Leste data as of 24 March 2024. 5 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Global circulation of SARS-CoV-2 variants 3 • WHO is currently tracking several SARS-CoV-2 variants and their sub-lineages including: o Five variants of interest (VOIs): XBB.1.5; XBB.1.16; EG.5; BA.2.86 and JN.1 o Three variants under monitoring (VUMs): XBB, XBB.1.9.1, and XBB.2.3 have been de-escalated after having a prevalence of less than 1% for more than eight epidemiological weeks globally and across the WHO regions. o As of 12 April 2024, no variant is under monitoring. • Information on the current status of the global SARS-CoV-2 variants can be found from the WHO COVID-19 dashboard. SARS-CoV-2 variants in the South-East Asia Region • As of 11 April 2024, the sequence data submitted to GISAID4 by countries in the South-East Asia region in the last 60 days by date of collection are shown in Figures 3a and 3b. Only a small number of sequences have been submitted from countries and therefore the data should be interpreted with caution; however, JN.1* continues to dominate in most countries in the Region. • In the last 60 days: o In India, 202 sequences were submitted, with JN.1* accounting for 55%. o In Indonesia, 48 sequences were submitted, with JN.1* also continuing to account for the large majority (87.5%, n=42). o In Thailand, 138 sequences were submitted with JN.1* accounting for 86.2% (n=119) followed by BA.2.86* (8%, n=11). o Other countries have not submitted sequences recently to GISAID. Figure 3a. Number of SARS-CoV-2 variants of interest and other selected variants sequences submitted to GISAID within the past 30 and 31-60 days as of 11 April 2024 by date of collection (countries with recent submissions) ⱡ 3 https://www.who.int/publications/m/item/covid-19-epidemiological-update-edition-166 4 https://gisaid.org/ 6 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 3b. Proportion of SARS-CoV-2 variants of interest and other selected variants sequences submitted to GISAID within the past 30 and 31-60 days as of 11 April 2024 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*, and XBB.2.3*. Source: GISAID (https://gisaid.org/), as of 11 April 2024. 7 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA mpox Status as of 14 April 2024 • In epidemiological weeks 14 (1 April to 7 April 2024) and 15 (8 April to 14 April 2024), no new mpox cases were reported. • In the WHO South-East Asia Region, a total of 868 laboratory-confirmed mpox cases (including two deaths) have been reported since 14 July 2022. • Details on the demographics and previous cases can be found in prior versions of the Epidemiological bulletin. • For more information on the global situation of mpox outbreak, please visit the global dashboard. 8 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Dengue Bangladesh 5 6 • During week 15 (08 April 2024 to 14 April 2024), a total of 62 new dengue cases were reported in Bangladesh, a 3.1% decrease compared to 64 cases reported during week 14 (01 April 2024 to 07 April 2024). • During week 15, one new dengue deaths was reported in Bangladesh while there were zero deaths reported during week 14. • During 2024 (as of 14 April 2024), a total of 1831 dengue cases and 23 dengue related deaths have been reported. This compares to 2.1 times the number of cases(n=867) and 2.3 the number of deaths (n=10) reported during the same period in 2023. Figure 4. Number of new cases of, and deaths from dengue by month in Bangladesh from January 2019 to 14 April 2024 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 5 https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report 6 https://old.dghs.gov.bd/images/docs/vpr/20240414_dengue_all.pdf 9 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Maldives7 • No new data are available. Please refer to previous versions of the South-East Asia Epidemiological Bulletin for prior epidemiological information. Nepal 8 • During week 13 (25 March 2024 to 31 March 2024), a total of 40 new dengue cases were reported via the Early Warning and Reporting System (EWARS) in Nepal, a 2.6% increase compared to 39 cases reported during week 12 (18 March 2024 to 24 March 2024). • Between weeks one and 13 in 2024, a total of 507 dengue cases were reported via EWARS compared to 454 and 24 during the same period in 2023 and 2022, respectively. Figure 5. Number of new cases of dengue by week reported by the Early Warning and Reporting System (EWARS) in Nepal from epidemiological week (EW) 1 of 2018 to EW 13 of 2024 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 7 https://health.gov.mv/en/publications/roagaage-gothugai-fethuremundhaa-balithah-feburuaree-2024 8 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 10 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Sri Lanka 9 • During week 14 (01 April 2024 to 07 April 2024), a total of 544 new dengue cases were reported in Sri Lanka, a 13.4% decrease compared to 628 cases reported during week 13 (25 to 31 March 2024). • Between weeks one and 14 in 2024, a total of 20 586 cases were reported compared to 24 107 and 14 578 during the same period in 2023 and 2022, respectively. Figure 6. Number of new suspected cases of dengue by week in Sri Lanka from epidemiological week (EW) 1 of 2017 to EW 12 of 2024 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 2024) 9 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 • During April (as of 12 April 2024), a total of 488 dengue cases (inclusive of dengue (n=369, 75.6%)), dengue hemorrhagic fever (DH) (n=118, 24.2%) and dengue shock syndrome (DSS) (n=1, 0.2%) and nil dengue death was reported in Thailand. • During 2024, (as of 12 April) a total of 24 619 cases including 21 deaths (CFR=0.09%) have been reported. This compares to 15 630 cases reported between January and March in 2023. Figure 7. Number of new dengue cases and deaths by month in Thailand from January 2018 to 12 April 2024 Source: Ministry of Public Health, Thailand http://doe.moph.go.th/surdata/index.php 10 http://doe.moph.go.th/surdata/disease.php?ds=66 11 http://doe.moph.go.th/surdata/disease.php?ds=26 12 http://doe.moph.go.th/surdata/disease.php?ds=27 Thailand10 11 12 12 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Influenza Situation as of 14 April 2024 • According to the data submitted to the FluMart of the Global Influenza Surveillance and Response system (GISRS), in the WHO South-East Asia Region, in epidemiological week 14 in 2024 (1 to 7 April), the weekly test positivity was at 11.54% and the most frequently reported strains were influenza B (Victoria lineage), influenza A/H3 and A/H1N1pdm09 (Figure 8). • 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 and WHO SEARO monthly updates. Figure 8. Number of specimens positive for influenza by subtypes and the influenza test positivity in WHO South-East Asia Region during 2023 and 2024 (as of week 1 – 7 April 2024)