Epidemiological Bulletin: WHO Health Emergencies Programme: WHO Regional Office for South-East Asia: 3 rd edition, 31 May 2023; Reporting period: 15 – 28 May 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 Tropical Cyclone MOCHA – Myanmar ...................................................................................................................... 2 COVID-19............................................................................................................................................ 3 mpox .................................................................................................................................................. 8 Dengue ............................................................................................................................................... 8 Influenza .......................................................................................................................................... 11 WHO South-East Asia Region Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 3rd edition, 31 May 2023; Reporting period: 15 – 28 May 2023 HEALTH programme EMERGENCIES 2 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Key events Tropical Cyclone MOCHA – Myanmar 1, 2, 3 , 4, 5, 6 Status as of 29 May 2023 Situation Overview • One of the strongest cyclones ever recorded in Myanmar, cyclone Mocha, made landfall between Cox’s Bazaar and Kyaukpyu township on 14 May, approaching the coast with maximum sustained winds of around 250 km/h and wind gusts of up to 305 km/h. • Over two weeks after Cyclone Mocha hit western Myanmar, safe shelter remains a key priority for cyclone- affected people who have been left without a roof over their head as the monsoon approaches. • Number of affected people, injuries, missing persons and damaged health facilities are expected to rise as data collection continues as communications are restored. • Increased cases of acute watery diarrhea are reported in affected communities. Hundreds of latrines and wells are either damaged or destroyed, severely compromising access to safe drinking water and hygiene practices. • In Rakhine State, early field observations demonstrate large variation in the building condition of health facilities and in health service provision across the affected townships. About 50% of township hospitals have experienced some damage to the building; nevertheless, they are fully functioning since the second week of the cyclone Mocha with availability of electricity and water. In Sittwe, 10 Clinics at the camps for internally displaced persons (IDPs) are damaged (9 Camp Clinics fully damaged and 1 Camp Clinic severely damaged). • In Northwest (Chin, Magway & Sagaing), the situation remains complex in Northwest with increased reports of damaged rural health centres. • The situation in Kachin is unchanged in the second week of cyclone Mocha with one camp clinic in Waingmaw and one community clinic in Mansi townships partially damaged while health services provision is ongoing. The communities are proceeding with the repairs. Health response • A total of 15 health cluster partners are operating in Rakhine, 12 in Northwest Myanmar (Chin, Magway and Sagaing) and 28 in Kachin. • A total of USD 4.5 million have been committed for the health sector to target 279 000 beneficiaries. • Health partners who have access to the affected population have been scaling-up the response including the provision of 30 mobile clinics in Rakhine (seven under emergency approval and 23 under routine approval) which provide primary health services including maternal and child healthcare, non-communicable disease care and the treatment of minor injuries. • As of 26 May, a total of 1736 health consultations, 933 surgeries and two assisted deliveries have been performed. A total of 220 interagency Emergency Health Kits, 3200 Clean Delivery Kits and 17 million water purification tablets have been distributed. • Training in cholera readiness and the 3W/4W (who, what, where and when) cyclone Mocha reporting have been provided. . 1 https://reliefweb.int/report/myanmar/iom-myanmar-flash-appeal-cyclone-mocha-response 2 https://reliefweb.int/report/myanmar/myanmar-cyclone-mocha-situation-report-no1-1400-25-may-2023 3 https://reliefweb.int/report/myanmar/myanmar-cyclone-mocha-situation-report-no2-1400-29-may-2023 4https://themimu.info/sites/themimu.info/files/documents/Sitrep_Report_2_on_Tropical_Cyclone_Mocha_Health_Cluster_ 26May2023.pdf 5 https://healthcluster.who.int/newsroom/news/item/26-05-2023-humanitarian-appeal-launched-for-cyclone-mocha-in- myanmar 6 https://www.who.int/myanmar/emergencies 3 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA COVID-19 Status as of 28 May 2023 The WHO South-East Asia Region has recorded a cumulative total of 61 161 195 COVID-19 cases, including 805 971 deaths. In the WHO South-East Asia Region, during the week from 22 to 28 May 2023, 8 598 new cases and 102 new deaths were reported (a decrease of 39.9% and 49.5% in new cases and deaths respectively, compared to the previous week). During the week from 22 to 28 May 2023, two countries reported an increase in the number of new cases - Bangladesh (345 new cases, +133.1%), and Timor-Leste (5 new cases, +400.0%), whereas Indonesia (4 198, -11.7%), India (3 283 new cases, -43.3%), Myanmar (634 new cases, -19.2%), Maldives (26 new cases, -27.8%) and Bhutan (1 new case, -50.0%) reported a decline, compared to the previous seven days. Data are not available from Thailand for the reporting period. For the same period, Indonesia reported 65 new deaths (no change compared to previous week) while two countries, India (32 new deaths, -48.4%) and Sri Lanka (5 new deaths, -50%), reported a decrease in the number of new deaths compared to the previous week. The remaining countries reported no new death. 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 22 to 28 May 2023. *Percent change in the number of newly confirmed cases/deaths in past seven days, compared to previous week. NA = data not available. The data of Maldives are for the period from 21 to 27 May 2023 in comparison to the preceding week. No data available from Thailand for the period from 22 to 28 May 2023. 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 (3 April – 28 May 2023) in the WHO South-East Asia Region Figure 2: Weekly number of samples tested for SARS-COV2 and SARS-CoV-2 test positivity at integrated influenza- SARS-COV-2 sentinel surveillance systems in the previous seven weeks (3 April – 21 May 2023) in selected counties* (as of 28 May 2023) * Countries conducting SARS-COV2 testing at their influenza sentinel surveillance sites (Bangladesh, Bhutan, 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 (3 April – 28 May 2023) in countries in the WHO South-East Asia Region * * No data available from Thailand for the period from 22 to 28 May 2023. DPR Korea has reported no confirmed COVID-19 cases. 6 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 4a. Number of Omicron sub-lineages submitted to GISAID within the past 30 and 31-60 days as of 23 May 2023 by date of collection for countries with recent submissions. XBB.X excludes XBB.1.X, XBB.1.11.X. XBB.1.16.X, XBB.1.16.1, XBB.1.22.X, XBB.1.5.X, XBB.1.9.1 and XBB.2.3.X. XBB.1.X excludes XBB.1.11.X, XBB.1.16.X, XBB.1.16.1, XBB.1.22.X, XBB.1.5.X and XBB.1.9.1 XBB.1.16.X excludes XBB.1.16.1 Figure 4b. Proportion of Omicron sub-lineages submitted to GISAID within the past 30 and 31-60 days as of 23 May 2023 by date of collection for countries with recent submissions. Source: GISAID (https://gisaid.org/) 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 23 May 2023, based on data downloaded from GISAID on 22 May (Figures 4a and 4b): o In India, XBB.1.16 and its sub-lineage XBB.1.16.1, remain predominant accounting for 87.8% (n=353) of the sequences submitted in the last 30 days. XBB.2.3 and its sub-lineages (XBB.2.3.X) accounted for 10% (n=40). o In Indonesia, 69.7% (n=299) of the sequences submitted in the last 30 days were XBB.1.9 and its sub- lineages of which, 70.2% (n=210) were XBB.1.9.2 and 19.1% (n=82). XBB.1.16.1 accounted for 5.1% (n=22) of the sequences. o In Thailand, in the last 30 days, the most prevalent sequences submitted were: XBB.1.5.X (25.4% (n=68), XBB.1.9.1 (21.3% (n=57)) and XBB.1.16 (19.8% (n=53)). o In the last 60 days, Nepal submitted 11 sequences, the most prevalent of which were XBB.1.16 (n=5). Myanmar submitted 12 sequences, of which eight were XBB.1.16.X (four were XBB.1.16 and four were XBB.1.16.1). o Other countries have not submitted sequences recently to GISAID. Circulation of SARS-CoV-2 variants globally7 • Currently, WHO is closely tracking two variants of interest (VOI), XBB.1.5 and XBB.1.16, and seven variants under monitoring (VUMs) and their descendent lineages (* includes their decedent lineages) o The VUMs are BA.2.75*, CH.1.1*, BQ.1*, XBB* (excluding XBB.1.5*, XBB.1.16* and XBB.1.9.1*), XBB.1.9.1*, XBB.1.9.2* and XBB.2.3*. o From epidemiological week 13 (26 March to 1 April 2023) to week 17 (23 to 29 April 2023), the prevalence of XBB.1.16 increased from 4.91% to 11.56%; XBB* from 5.78% to 9.85%; XBB.1.9.1* from 9.75 to 13.94%; XBB.1.9.2* from 2.73% to 4.11% and XBB.2.3* from 1.85% to 4.64%. The other VOIs and VUMs decreased in prevalence. 7 https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---25-may-2023 8 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA mpox Status as of 28 May 2023 In the WHO South-East Asia Region, a total of 51 laboratory-confirmed mpox cases including one death have been verified since 14 July 2022 (Figure 5). Table 2 summarizes the basic epidemiological profile of the 51 confirmed cases in the Region. No new cases were reported in the last two weeks. Figure 5. Number of mpox cases reported in WHO South-East Asia Region by date of notification* (14 July 2022 – 28 May 2023) * Notification - The date on which the case is notified to the public health authority. Table 2. Profile of 51 confirmed mpox cases reported in WHO South-East Asia Region since July 2022 (as of 28 May 2023) Country India 22 Indonesia 1 Sri Lanka 2 Thailand 26 Gender Male 34 Female 17 Age group 0-17 0 18-29 23 30-39 19 40 and over 9 Sexual orientation Heterosexual 21 MSM 15 Other 2 Unknown 13 For more information on the global situation of mpox outbreak, please visit the global dashboard. Dengue 9 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Status as of 16 May 2023 Bangladesh A total of 143 cases of dengue were reported in Bangladesh during April 2023, a 28.8% increase compared March 2023 (n = 111). From 1 to 29 May 2023, 857 cases have been reported compared to a total of 163 cases reported for the entirety of May, 2022 (Figure 6). Figure 6. Number of new cases of dengue by month in Bangladesh from 2019 to 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 * Note the log10 scale on the y axis. Maldives No new updates were available for Maldives. Please refer to previous versions of the South-East Asia Epidemiological Bulletin for prior epidemiological information. Nepal No new data have been uploaded since epidemiological week three (15-21 January 2023) in Nepal. Please refer to previous versions of the South-East Asia Epidemiological Bulletin for prior epidemiological information. 10 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Sri Lanka In 2023, a total of 1653 cases of dengue were reported in Sri Lanka in week 19 (6 to 12 May 2023), a 36.7% increase compared to week 18 (29 April to 5 May, n=1209). During week 19 in 2022, a total of 889 cases were reported (Figure 7). Figure 7. Number of new cases of dengue by week in Sri Lanka from 2018 to 2023 (Week 19) Source: Epidemiology Unit, Ministry of Health. https://www.epid.gov.lk/web/index.php?option=com_casesanddeaths&Itemid=448&lang=en *Data from week 1, 2023 onwards are taken from the Weekly Epidemiological Reports. Data prior to this, were compiled from the online dashboard. Thailand A total of 2731 cases of dengue were reported in Thailand in April 2023, a 6.2% increase compared to March (n=2571). From 1 to 29 May 2023, a total of 1159 news cases were reported compared to 1792 new cases for entirety of May 2022 (Figure 8). Figure 8. Number of new cases of dengue by month in Thailand from 2018 to 2023. Source: Bureau of Epidemiology, DDC, MPH. http://doe.moph.go.th/surdata/disease.php?ds=66 11 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Influenza Figure 9: Number of specimens positive for influenza by subtypes and the percentage positive in WHO South- East Asia Region (as of 28 May 2023) Data sources and information on influenza, please refer to the WHO SEARO Influenza dashboard.