Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 20th edition (2024), 02 October 2024. Reporting period: 16 September to 29 September 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 ...................................................................................................................... 3 India: mpox ............................................................................................................................................................... 3 Global situation: mpox .............................................................................................................................................. 3 India: Nipah virus ...................................................................................................................................................... 4 Multiple countries: Flood .......................................................................................................................................... 5 Nepal ..................................................................................................................................................................... 5 Myanmar .............................................................................................................................................................. 5 India ...................................................................................................................................................................... 6 Multiple countries: Acute Watery Diarrhea / cholera ............................................................................................... 7 Cox’s Bazar, Bangladesh ....................................................................................................................................... 7 India ...................................................................................................................................................................... 7 Myanmar .............................................................................................................................................................. 7 Nepal ..................................................................................................................................................................... 9 COVID-19.......................................................................................................................................... 10 Situation overview as of 29 September 2024 ..................................................................................................... 10 Global circulation of SARS-CoV-2 variants .......................................................................................................... 11 SARS-CoV-2 variants in the South-East Asia Region ........................................................................................... 11 mpox ................................................................................................................................................ 13 Dengue ............................................................................................................................................. 15 Bangladesh ............................................................................................................................................................. 15 India ........................................................................................................................................................................ 16 Indonesia ................................................................................................................................................................. 17 Maldives.................................................................................................................................................................. 17 Nepal ....................................................................................................................................................................... 18 Sri Lanka .................................................................................................................................................................. 18 WHO South-East Asia Region Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 20th edition (2024), 02 October 2024. Reporting period: 16 September to 29 September 2024 HEALTH programme EMERGENCIES 2 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Thailand .................................................................................................................................................................. 19 Annex ............................................................................................................................................... 20 WHO resources on mpox ........................................................................................................................................ 20 3 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Key events and updates India: mpox Situation overview (as of 1 October 2024) • On 26 September, Health Secretary issued an advisory to the States and Union Territories regarding key public health actions that are required to prevent and minimise the risk of further spread of mpox in India. The advisory mentioned that India became the third country outside of Africa to detect a case with clade Ib monkeypox virus (MPXV) infection, following Sweden and Thailand 1. • On 1 October, Ministry of Health and Family Welfare of India notified to WHO the mpox cases recently detected in India. o In September 2024, India detected three mpox cases. All three cases were male and reported recent travel history, returning from aboard. o Out of the three cases, one case was infected with clade Ib MPXV, as confirmed at the National Institute of Virology. The case was 38 year-old male, having symptom onset on 8 September, arriving in a Southern state of India from abroad on 13 September, and admitted to hospital and isolated on 16 September. Public health measures, including contact tracing, were actively implemented by the authorities in India. Global situation: mpox Situation overview (as of 22 September 2024) 2 • In Africa, in 2024, as of 22 September 2024: o A total of 6 603 confirmed mpox cases, including 32 deaths, have been reported across 15 African countries. The Democratic Republic of the Congo (DRC) accounts for most cases (5621 cases, 25 deaths), followed by Burundi (696 cases, no deaths) and Nigeria (78 cases, no deaths). o A total of 31 427 suspected mpox cases, including 844 deaths (CFR 2.7%) have been reported. o Guinea reported its first mpox case in the past month. • DRC and Burundi have been most affected by the clade Ib MPXV: o DRC has reported 5 621 confirmed cases, including 25 deaths (case fatality rate at 0.4%), and 27 103 suspected cases, including 838 deaths (case fatality rate at 3.1%). Based on disease surveillance data reported from the South Kivu province, which is believed to be affected primarily by clade Ib MPXV, from 1 January – 15 September 2024, the case fatality ratio of clade Ib is estimated at 0.5% 2. o Burundi has reported 696 confirmed cases and 1879 suspected cases, with no deaths; 35 of 49 (71%) districts are affected, with children under 5 years of age comprising about 30% of confirmed cases. • Although genomic sequencing capacity is limited, clade Ib appears to be the predominant clade in the North and South Kivu provinces of the DRC, Burundi, Rwanda, Kenya, and Uganda, and has been confirmed in travel- related cases in Sweden, Thailand, and India. • For further information on global epidemiological situation of mpox, please see: o WHO multi-country outbreak of mpox, External situation report #38 - 28 September 2024 o WHO mpox surveillance dashboard 1 ANI on X 2 WHO multi-country outbreak of mpox, External situation report #38 - 28 September 2024 4 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 1. The number of confirmed and suspected mpox cases in Africa (as of 29 September 2024) India: Nipah virus Situation overview (as of 24 September 2024) • On 15 September, Kerala State Government issued a press release3 on a man who died due to Nipah virus infection in Malappuram district, Kerala, India. The case was a 24-year-old man (a student in Bangalore) who had shown symptoms of encephalitis, and died on Monday 9 September 2024, after attending four private hospitals. • According to a press release issued by the Kerala State Government on 24 September 2024 4: o There are 267 individuals were in the contact list, of which 104 have tested negative. o The quarantine of 94 people on the contact list ended on 25 September, which is the end of one incubation period. o The containment zone control, including the disease-affected area, will be lifted. o On 24 September, a person was admitted to Manjeri Medical College Hospital with symptoms. o 281 people were given psychological support through the call center. 3 Kerala Government Press release – 15 September 2024 4 Kerala Government Press release – 24 September 2024 5 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Multiple countries: Flood Situation overview Nepal 5 • From 26 to 28 September 2024, continuous heavy rainfall has caused significant flooding and landslides affecting at least 20 districts in Nepal. The water flow in the Saptakoshi River has reached the highest level in 56 years, • According the Nepal Police, as of 1 October 2024, approximately 217 people have died, 143 have been injured, and 28 are missing 6. Informal media articles reported 241 deaths, while more than 4000 people were rescued 7. • According to WHO country office, as of 30 September, a total of 17 health facilities have been affected by the floods and landslides, including 16 in Bagmati Province and one in Madhesh Province. • Severe damage to infrastructure has been observed including disrupted roads, bridges, and powerplants. • Key needs: Temporary shelter for displaced families, tents with light and other utilities, emergency water and sanitation, and rescue and relief for those stranded on highways due to flash floods and landslides. • On 30 September 2024, the first Health Cluster Coordination Meeting was convened to update on the ongoing flood and landslide situation and to coordinate the health sector response. • WHO Nepal Country Office is supporting the response and coordinating with partners. Myanmar 8 9 • Heavy rains from Typhoon Yagi's remnants have resulted in significant flooding and damage in various parts of Myanmar. o As of 26 September 2024, around 1 million people across 70 of Myanmar’s 330 townships have been affected by flooding due to heavy monsoon rains and the remnants of Typhoon Yagi. This extensive flooding has caused significant damage in the Northwest, Southeast, and Rakhine State. o Over 360 deaths have been reported and at least 100 are missing. o Approximately 386,289 people will require health assistance, with an estimated $6.5 million needed for the health response. o In Rakhine State, delivering humanitarian supplies from Sittwe to other townships has been challenging due to access issues, insecurity, and landmines along routes and waterways, which have been displaced by floodwaters, further complicating relief efforts. • The ministerial authorities for health dispatched specialist medical teams to 49 flood-affected townships, offering healthcare services on weekends. 10 • Food, drinking water, medicine, clothes, dignity kits, and shelters have been reported as urgent needs. • Key challenges: Response efforts are impacted by physical constraints such as road blockages, damaged bridges, and ongoing clashes. Telecommunications and internet services are unstable, frequently interrupting humanitarian communications and operations. OCHA and the Humanitarian Coordinator (HC) are actively fundraising to mobilize additional resources to quickly scale-up ongoing flood response efforts. • WHO Myanmar country office is supporting the response, working with local partners to implement mobile clinics, facilitating disease reporting through the early warning system in flood-affected areas, and distribution of medical supplies. 5 Government of Nepal, Ministry of Home Affairs, National Disaster Risk Reduction and Management Authority – Situation report 1, 29 September 2024 6 https://x.com/NepalPoliceHQ/status/1840933413819428932 7 Media article 8 Myanmar: Flood Situation Report, 27 September 2024 9 UNHCR Flash Update on Flooding in Myanmar, 28 September 2024 10 Myanmar Ministerial authorities for health – Press release 30 September 2024 6 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA India 11 • Heavy rainfall in Nepal has resulted in severe flooding in 16 districts in Bihar state, India, which shares a border with Nepal. • As of 30 September 2024, a total of 990,376 individuals have been affected and 180,204 have been evacuated. Additionally, there are nearly 55,000 individuals in 71 relief camps. • No deaths have been reported thus far. • A total of 19 teams of National Disaster Response Force and 22 teams of State Disaster Response Team have been deployed to rescue flood affected population. 11 India Ministry of Home Affairs Disaster Management Division (National Emergency Response Centre) Situation report regarding Flood / Heavy rainfall in the country, 30 September 2024 7 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Multiple countries: Acute Watery Diarrhea / cholera Cox’s Bazar, Bangladesh Situation overview (as of 29 September 2024) 12 • From 23 June to 29 September, 231 cases were reported, including 203 culture-confirmed cases and 28 rapid diagnostic test positive acute watery diarrhea (AWD) cases. • 90% (183 of the 203) of culture-confirmed cholera cases were reported from Rohingya Refugee camps. o No confirmed cholera fatalities have been reported since the upsurge began in week 26 (23 June). o Confirmed cases among refugees were distributed in 26 out of 33 camps in Ukhiya and Teknaf. o Children aged 0-9 years old account for 72% of confirmed cases. • Plan to operationalize oral cholera vaccine (OCV) mass vaccination campaign is ongoing. • Monitor camps with zero cases for emerging transmission and limit outbreak spreading to unaffected camps. • The WASH sector sustained response interventions and coordinated Water Quality Assessment. • WHO Sub Office, Cox’s Bazar, continues supporting the response. India Situation overview (as of 14 July 2024) 13 • According to the Integrated Disease Surveillance Programme, between January 2024 and 14 July 2024, there have been 6 244 suspected cholera cases including 262 confirmed cases and 34 deaths reported from 14 states. Myanmar Situation overview (as of 28 September 2024) Yangon • After 25 August 2024, no official data on AWD cases and deaths were shared publicly. WHO also has not received the relevant data. • A total of 3 421 hospitalized cases of acute watery diarrhea (AWD) including 160 cases with severe dehydration were reported in Yangon Region from 24 June to 25 August 2024, by the ministerial authorities for health. Rakhine • According to the ministerial authorities for health, from week 27 to 39 of 2024, a total of 2 389 hospitalized AWD cases including 243 cases with severe dehydration were reported in Sittwe, Rakhine. • According to the early warning and response systems (EWARS) supported by the Health Cluster in Myanmar, in the epidemiological week 39 (22-28 September 2024), a total of 26 AWD cases were recorded. The AWD cases with severe dehydration increased to seven in the week 39. 12 Cox’s Bazar sub-office, WCO Bangladesh 13 IDSP India 8 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 2. Weekly Trend of AWD cases in Rakhine state, Myanmar from 30 June to 28 September 2024 Source: Health Cluster in Myanmar Public Health Response Vaccination • 2.4 million doses of oral cholera vaccines (OCVs) have arrived in Myanmar, and the reactive vaccination campaign has started in Yangon Region on 22 September 2024 and will continue until 3 October 2024 14. • The campaign is being implemented in densely populated areas with sub-optimal sanitation and hygrine, monasteries, religious schools, charitable organizations, orphanages, schools, nursing homes, prisons, mental health hospitals, factories, schools, boarding schools, markets, and street food shops of 34 townships with high case load. • The vaccine will be administered to the individuals above one years of age. • The authorities are planning to provide OCV to other States/Regions which are at high risk of severe AWD. Risk communication and community engagement (RCCE) • The OCV campaign’s key messages along with questions and answers is uploaded on the WHO channels, mainly Facebook and Viber which are active in Myanmar. • Social listening exercise will be conducted to monitor the online conversations, any misinformation related to OCV. • WHO continues sharing the cholera RCCE materials to stakeholders, targeting communities in Yangon through various communication channels and platforms. Challenges • Lack of access to the real-time disaggregated data for the ongoing cholera situation has been a challenge for effective planning of response actions and mobilization of resources. WHO has requested the Ministerial authorities to continue communicating detailed public health information on AWD and cholera to WHO as per the requirements under the International Health Regulations (2005). • The reactive OCV campaign can support the containment efforts; however, effective and efficient public health measures are required in the longer-term, along with more sustained investments, both in health and water, sanitation and hygiene (WASH). • AWD/cholera cases continue to be reported, indicating that the transmission chain remains active. This highlights the need to further intensify community engagement efforts to stop the transmission. For more information: • Myanmar Acute Watery Diarrhea/Cholera Outbreak External Situation Report – the fourth edition was published on 25 September 2024. 14 https://www.mohs.gov.mm/page/19895 9 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Nepal Situation overview (as of 24 September 2024) 15 • According to an official situation report from the Nepal Ministry of Health and Population, clusters of cholera cases have been reported in several districts across the country since 19 July 2024. • Vibrio cholerae O1 Ogawa serotype has been confirmed in stool samples. All confirmed cholera cases have been confirmed by culture. • As of 24 September 2024, there are 95 cases in 9 districts: Lalitpur (54), Kathmandu (12), Kailali (8), Pyuthan (2), Makawanpur (1), Rolpa (4), and Sidhupalchowk (1), Accham (1), Rautahat (12). With the exception of recent sporadic cases that may have an epidemiological link in two districts of Kathmandu Valley, no epidemiological link has been established between the districts. No deaths have been reported. Public health response • EDCD is coordinating with provincial health directorates, public health emergency operations centers, district administrative offices, national and provincial laboratories, and health facilities daily for enhanced responses. • EDCD is coordinating with the rapid response focal person from districts and local municipalities for active case finding and testing for laboratory conformation. Alerts are investigated within 48 hours. • Active management, case finding and testing ongoing with support from Health Directorate, Province Public Health Laboratory and Rautahat District. • Water, sanitation and hygiene (WASH) response are being implemented, including decontamination of probable sources, handwash activities, chlorination of drinking water sources. Dissemination of WASH and cholera-related messages through social media platforms such as Facebook and Instagram. 15 EDCD Nepal – Cholera and dengue situation update 31, 25 September 2024 10 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA COVID-19 Situation overview as of 29 September 2024 • In the WHO South-East Asia Region, from 16 September to 29 September 2024, 1 009 new COVID-19 cases, a decrease of 15.7% and 12 deaths, an increase of 140%, were reported, compared to the previous 14 days (Table 1). o From 16 September to 29 September 2024, all countries, Thailand (525 new cases, -14.8%), India (378 new cases, -11.1%), Bangladesh (17 new cases, -15%), Myanmar (62 new cases, -39.8%) and Indonesia (27 new cases, -28.9%) reported a decrease in the number of new cases, compared to the previous 14 days. o Data were not available from Bhutan, Maldives, Nepal, Sri Lanka and Timor-Leste for this period. • The Region has recorded a cumulative total of 61 318 984 COVID-19 cases, including 808 839 deaths (Table 1). • Please refer to the WHO SEARO COVID-19 dashboard for further information of COVID-19 in WHO South-East Asia Region. • Globally, 776 281 230 COVID-19 cases, including 7 065 880 deaths have been cumulatively reported, as of 15 September 16. Please visit the WHO COVID-19 dashboard for the 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 16 to 29 September 2024. Notes: 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. Indonesia Thailand data were for the period from 8 to 21 September 2024 and Thailand data were for the period from 15 to 28 September 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, Nepal data as of 20 October 2023 and Sri Lanka data as of 2 September 2024. 16 Global Dashboard Data as 15 September 2024 11 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 3. Weekly number of new COVID-19 cases reported during the previous ten weeks (as of 29 September 2024) in the WHO South-East Asia Region*. * Data for Maldives, Bhutan, Nepal, and Timor-Leste are not available. Sri Lanka data were as of 2 September and Indonesia data were as of 21 September 2024. Global circulation of SARS-CoV-2 variants • WHO is currently tracking several SARS-CoV-2 variants and their sub-lineages including 17: o Two variants of interest (VOIs): BA.2.86 and JN.1 o Seven variants under monitoring (VUMs): JN.1.7; KP.2; KP.3; KP.3.1.1; JN.1.18, LB.1 and XEC • 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 • The genomic sequence data submitted to GISAID 18 by countries in the South-East Asia region in the past 60 days by date of collection are shown in Figure 4 (as of 28 September 2024). Only a small number of genomic sequences have been submitted from countries and therefore the data should be interpreted with caution. • In the last 60 days: o In India, 20 genomic sequences were submitted with KP.2* accounting for 20% (n=4) followed by JN.1* (10%, n=2). One genomic sequence each with JN.1.18* and KP.3.1.1* were also submitted. o In Thailand, 25 genomic sequences were submitted with JN.1* accounting for 80% (n=20). One sample each with KP.2* and LB.1* were also submitted. o Other countries have not submitted genomic sequences recently to GISAID. 17 https://www.who.int/publications/m/item/covid-19-epidemiological-update-edition-171 18 https://gisaid.org/ 12 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA A. Number B. Proportion Other countries in the region have not submitted genomic sequences to GISAID in the past 60 days. * 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 28 September 2024. Figure 4. Number (A) and proportion (B) of SARS-CoV-2 VOI and VUM sequences submitted to GISAID within the past 30 days and 31-60 days as of 28 September by date of collection (countries in South-East Asia Region, with recent submissions) ⱡ: 13 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA mpox Situation overview as of 29 September 2024 • In the WHO South-East Asia Region, a total of 971 laboratory-confirmed mpox cases, including 11 deaths, have been reported since 14 July 2022 (Figure 4). • In 2024, a total of 178 mpox cases, 158 from Thailand, 15 from Indonesia and 5 from India have been reported. One death was also reported from Thailand. • In epidemiological weeks 38 (16 to 22 September 2024) and 39 (23 to 29 September 2024), 2 new mpox cases were reported from India, 6 from Thailand 19 and none from Indonesia 20 (Figures 5 and 6). o Please see the “Key events and update” section for the cases reported in India. • 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 – 29 September 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). For 87 cases in Indonesia for which the date of notification is missing, the date of diagnosis was used. 19 Thailand Mpox 20 Indonesia Mpox 14 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 6. Weekly number of mpox cases reported in Indonesia (n=87) and Thailand (n=831) since 1 January 2023 by date of notification* (as of 29 September 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 cases in Indonesia, this was replaced with the date of diagnosis. Table 2. Profile of the confirmed mpox cases reported in WHO South-East Asia Region in 2024 for which case- based information is available (as of 29 September 2024) Total (n = 923) 2024 (n=131) Country India 27 (2.9%) 0 (0.0%) Indonesia 88 (9.5%) 15 (11.5%) Nepal 1 (0.1%) 0 (0.0%) Sri Lanka 4 (0.4%) 0 (0.0%) Thailand 803 (87.0%) 116 (88.5%) Gender Female 36 (3.9%) 2 (1.5%) Male 886 (96.0%) 129 (98.5%) Transgender 1 (0.1%) 0 (0.0%) Age group (years) Less than 18 4 (0.4%) 0 (0.0%) 18-29 315 (34.1%) 48 (36.6%) 30-39 389 (42.1%) 49 (37.4%) 40-49 179 (19.4%) 28 (21.4%) 50 and over 36 (3.9%) 6 (4.6%) Sexual orientation Heterosexual 64 (6.9%) 7 (5.3%) Men who have sex with men (MSM) 751 (81.4%) 110 (84.0%) Bisexual 21 (2.3%) 8 (6.1%) Other 26 (2.8%) 3 (2.3%) Unknown 61 (6.6%) 3 (2.3%) Recent travel Yes 45 (4.9%) 0 (0.0%) No 870 (94.3%) 131 (100.0%) Unknown 8 (0.9%) 0 (0.0%) 15 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Dengue Bangladesh 1 2 • During week 39 of 2024 (23 September 2024 to 29 September 2024), a total of 5 752 new dengue cases were reported in Bangladesh, a 16% increase compared to 4 959 cases reported during week 38 of 2024 (16 September 2024 to 22 September 2024). • During week 39, a total of 27 new dengue deaths were reported in Bangladesh, a 12.5% increase compared to 24 deaths reported during week 38. • In 2024, as of week 39, a total of 29 786 dengue cases and 158 dengue related deaths have been reported. This is 14% of the number of cases (n=206 247) and 16% of the number of deaths (n=1 006) reported at the same time (week 39) in 2023. Figure 7. Number of new cases and deaths from dengue by week in Bangladesh from week 1 of 2020 to week 39 of 2024. Source: Health Emergency Operation Center and Control Room, DGHS Reported Monthly Dengue cases & Dengue Deaths in Bangladesh. Available at: https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report 1 Bangladesh Dengue press releases 2 Bangladesh daily Dengue press release 29 September 2024 16 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA India 3 Kerala 4 • During week 39 of 2024 (23 September to 29 September 2024), a total of 505 new dengue cases were reported in Kerala, a 17.7% increase compared to 429 cases reported during week 38 (16 September to 22 September 2024). • From the week one to week 39 in 2024, a total of 17 093 cases were reported. • A total of 17 426 dengue cases were reported in the entirety of 2023. Karnataka 5 • During week 38 of 2024 (16 September 2024 to 22 September 2024), a total of 836 new dengue cases were reported in Karnataka, a 8.3% decrease compared to 912 cases reported during week 37 (9 September to 15 September 2024). • From the week one to week 36 in 2024, a total of 28 071 cases were reported. • A total of 19 300 dengue cases were reported in the entirety of 2023. 3 NCVBDC 4 Kerala 5 Karnataka Figure 9. Number of new dengue cases by week in Karnataka from week 1 to week 38 of 2024. Figure 8. Number of new dengue cases by week in Kerala from week 1 to week 39 of 2024. 17 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Indonesia 6 7 • As of week 35 (as of 4 September), 549 501 suspected cases were reported including 186 324 confirmed cases and 1 120 deaths. Figure 10. Number of new confirmed cases and deaths of dengue by month as of 4 September Maldives 8 • No further update. During August 2024, a total of 393 cases of dengue were reported in Maldives, a 31.9% decrease compared to July 2024 (n=577). • During 2024, a total of 3 089 cases of dengue have been reported compared to 2 419 cases during the same period in 2023. A total of 3 417 cases were reported in the entirety of 2023. Figure 11. Number of new cases of dengue by month in Maldives from January 2022 to August 2024. 6 WHO Global Dengue Surveillance 7 Dengue Data Update – Directorate General of P2P (kemkes.go.id) 8 Maldives Monthly Communicable Diseases Report (August 2024) 18 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Nepal 9 • During week 38 (16 September 2024 to 22 September 2024), a total of 2 323 new dengue cases were reported via the Early Warning and Reporting System (EWARS) in Nepal, a 15.6% increase compared to 2 010 cases reported during week 37 (09 September 2024 to 15 September 2024). • In 2024 as of week 38, a total of 11 139 dengue cases have been reported via EWARS compared to 12 163 and 11 385 during the same period in 2023 and 2022, respectively. Figure 12. Number of new cases of dengue by week reported by the Early Warning and Reporting System (EWARS) in Nepal from week 1 to week 38 of 2024. Sri Lanka 10 • During week 38 (16 September 2024 to 22 September 2024), a total of 590 new dengue cases were reported in Sri Lanka, a 17% decrease compared to 711 cases reported during week 37 (09 September 2024 to 15 September 2024). • From the week one to the week 38 in 2024, a total of 38 681 cases were reported compared to 63 816 and 57 004 during the same period in 2023 and 2022, respectively. Figure 13. Number of new dengue cases by week in Sri Lanka from week 1 of 2017 to week 38 of 2024. Sources: Epidemiology Unit and National Dengue Control Unit, Ministry of Health - 2017 to 2020; 2021 to 2024 9 EWARS Weekly Bulletin 10 Sri Lanka National Dengue Control Unit 19 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA • During week 38 (16 September to 22 September 2024), a total of 1 761 new dengue cases were reported in Thailand, a 27.2% decrease compared to 2 420 cases reported during week 37 (09 September to 15 September 2024). • During week 38, one new dengue death was reported in Thailand, a decrease of 50% while two new dengue deaths were reported during week 33. • In 2024, (as of week 38) a total of 82 016 cases including 66 deaths (CFR=0.08%) have been reported. This compares to 108 251 cases reported between week 1 and week 38 of 2023 including 112 deaths (CFR=0.10%). Figure 14. Number of new dengue cases and deaths by week in Thailand from 2019 to week 38 of 2024. Source: Ministry of Public Health, Thailand 11 Thailand Ministry of Public Health 12 Thailand Ministry of Public Health 13 Thailand Ministry of Public Health Thailand 11 12 13 20 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Annex WHO resources on mpox All current WHO interim technical guidance can be accessed on this page of the WHO website. WHO evidence- based guidance has been and will continue to be updated in line with the evolving situation and updated scientific evidence. The selected publications are listed below for easy reference, together with other relevant resources. • IHR Emergency Committee, Temporary Recommendations and Standing Recommendations o First meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024 o Standing recommendations for mpox issued by the Director-General of the World Health Organization (WHO) in accordance with the International Health Regulations (2005) (IHR) • Strategic framework o Mpox global strategic preparedness and response plan (26 August 2024, updated on 6 September 2024) • General information on mpox o Mpox fact sheet: o Monkeypox outbreak page (2022) o Mpox (monkeypox) health topic page o Mpox (monkeypox) Q&A • Epidemiological situation o Dashboard: https://worldhealthorg.shinyapps.io/mpx_global/ o Multi-country outbreak of mpox, External situation report #38 - 28 September 2024 (who.int) o Genomic epidemiology of monkeypox virus (Nextstrain) • Technical documents o Technical Brief (interim) and Priority Actions: Enhancing Readiness for mpox in WHO South-East Asia Region (13 September 2024) o Diagnostic testing for the monkeypox virus (MPXV): interim guidance (10 May 2024) o Risk communication and community engagement readiness and response toolkit: mpox (23 April 2024) o Surveillance, case investigation and contact tracing for mpox (monkeypox): Interim guidance (20 March 2024) o Clinical characterization of mpox including monitoring the use of therapeutic interventions: statistical analysis plan (13 October 2023) o Vaccine position paper: https://iris.who.int/bitstream/handle/10665/378522/WER9934-eng-fre.pdf o Monkeypox vaccines technical documents o SAGE on mpox vaccines (page 16): https://iris.who.int/bitstream/handle/10665/376936/WER9922-285- 306.pdf?sequence=1 • Data collection tools o Case report form: Word o Case investigation form: PDF • Mass gathering o Public health advice for gatherings during the current monkeypox outbreak o Interim advice for public health authorities on summer events during the monkeypox outbreak in Europe, 2022 o Holding mass and large gathering events during the multi-country mpox outbreak in the WHO European Region: Lessons identified for future mass gathering preparedness (22 February 2023) o Catalogue of resources on mpox mass and large gathering event preparedness