Epidemiological Bulletin: WHO Health Emergencies Programme: WHO Regional Office for South-East Asia: 2 nd edition, 17 May 2023; Reporting period: 1 – 14 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 Statement on the fifteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic ....................................................................................... 2 Statement on the fifth meeting of the International Health Regulations (2005) Emergency Committee on the Multi-Country Outbreak of monkeypox (mpox) ....................................................................................................... 2 Tropical Cyclone MOCHA - Myanmar and Bangladesh ............................................................................................ 3 COVID-19............................................................................................................................................ 4 mpox .................................................................................................................................................. 7 Dengue ............................................................................................................................................... 9 Influenza .......................................................................................................................................... 12 WHO South-East Asia Region Epidemiological Bulletin WHO Health Emergencies Programme WHO Regional Office for South-East Asia 2nd edition, 17 May 2023; Reporting period: 1 – 14 May 2023 HEALTH programme EMERGENCIES 2 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Key events Statement on the fifteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health- regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic During the 15th meeting of the International Health Regulations (2005) (IHR) Emergency Committee meeting for the COVID-19 pandemic held on 4 May 2023, members highlighted the decreasing trend in COVID-19 deaths, the decline in COVID-19 related hospitalizations and intensive care unit admissions, and the high levels of population immunity to SARS-CoV-2. While acknowledging the remaining uncertainties posted by potential evolution of SARS- CoV-2, they advised that it is time to transition to long-term management of the COVID-19 pandemic. The WHO Director-General concurred with the advice offered and determined that COVID-19 is now an established and ongoing health issue which no longer constitutes a public health emergency of international concern (PHEIC). During this transition, States Parties are advised to continue implementing Temporary Recommendations issued by the WHO Director-General. Statement on the fifth meeting of the International Health Regulations (2005) Emergency Committee on the Multi-Country Outbreak of monkeypox (mpox) https://www.who.int/news/item/11-05-2023-fifth-meeting-of-the-international-health- regulations-%282005%29-%28ihr%29-emergency-committee-on-the-multi-country-outbreak-of- monkeypox-%28mpox%29 During the fifth meeting of the IHR (2005) Emergency Committee on the multi-country outbreak of mpox, members noted a significant decline in the number of reported cases compared to the previous reporting period and no changes in the severity and clinical manifestation of the disease. The Committee acknowledged remaining uncertainties about the disease, regarding modes of transmission in some countries, poor quality of some reported data, and continued lack of effective countermeasures in the African countries, where mpox occurs regularly. The Committee considered, however, that these are long-term challenges that would be better addressed through sustained efforts in a transition towards a long-term strategy to manage the public health risks posed by mpox such as integration of mpox prevention, preparedness and response within national surveillance and control programmes, including for HIV and other sexually transmissible infections, rather than the emergency measures inherent to a public health emergency of international concern (PHEIC). The WHO Director-General concurred with this advice that the event no longer constitutes a public health emergency of international concern (PHEIC), and issued revised Temporary Recommendations for the transition period. 3 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Tropical Cyclone MOCHA - Myanmar and Bangladesh 1,2,3,4 On Sunday 14 May 2023, tropical cyclone MOCHA made landfall between Cox’s Bazar in Bangladesh and Kyaukphyu near Sittwe, the state capital of Rakhine, Myanmar as an extremely severe cyclonic storm with maximum sustained winds of 250 km/h and wind gusts of up to 305 km/h (the equivalent of a category four hurricane on the Saffir- Simpson scale). The storm then moved north-northeast towards Chin State and Sagaing Region Myanmar MOCHA was one of the strongest cyclones recorded in Myanmar causing a storm surge of approximately 3-3.5 m which has flooded low lying areas in Rakhine particularly in and around Sittwe. Almost 5.4 million people are estimated to have been in the path of the cyclone, enduring winds in excess of 90 kmph across Rakhine and the Northwest. Of these, nearly 3.2 million are considered to be most vulnerable to the cyclone impact based on analysis of shelter quality, food insecurity and coping capacity. This group is highly likely to have humanitarian needs in the wake of the cyclone. Significant information gaps still exist. However, extensive damage was reported in camps of internally displaced people (IDP) in Rakhine. Based on field observations in the Sittwe camps, most of the shelters are heavily damaged. There are local reports of possible deaths and of people being missing, including IDPs. The UN and its partners are working to start rapid needs assessments as soon as access is granted to better understand the impact of the disaster. Negotiations for access are ongoing. According to health partners, several hospitals were damaged. Temporary clinics or shelters for temporary clinics are being considered. Extensive damage to the telecommunications tower has limited communications although this was partially restored on 15 May and some roads remain inaccessible due to fallen trees and debris. Due to this, information on the full impact of the cyclone is unavailable and is still being collected. Bangladesh Cyclone Mocha affected 4 districts, 26 upazilas (subdistricts), 99 unions, and 429,337 Bangladeshi nationals. The cyclone fully damaged 2,052 houses and partially damaged 10,692. Over 750 000 people were evacuated in Cox’s Bazar and other areas to cyclone centers and shelters in advance of MOCHA making landfall. Rohingya refugees in the camps in Teknaf and neighbouring Bangladeshi communities were most affected, with thousands of shelters and service facilities destroyed, putting families at greater risk for the upcoming monsoon season. On Bhasan Char, no casualties or damage were reported following the precautionary evacuation of around 30,000 refugees to 53 cyclone shelters. Most refugees returned home after the cyclone. Over 3,500 household assessments were completed out of an estimated 6,200 households that suffered major and partial shelter damage, affecting around 30,000 Rohingya refugees. Rapid assessments started on 15 May and are ongoing. 1 https://unocha.us4.list-manage.com/track/click?u=b438b7d9f4bff43c0ebb7a4a0&id=6061072cb6&e=b7ab7d9dbf 2 https://unocha.us4.list-manage.com/track/click?u=b438b7d9f4bff43c0ebb7a4a0&id=00114d9d49&e=b7ab7d9dbf 3 https://reliefweb.int/report/bangladesh/bangladesh-cyclone-mocha-humanitarian-response-situation-report-14-may-2023 4 https://rohingyaresponse.org/wp-content/uploads/2023/05/SitRep-2-Bangladesh-Cyclone-Mocha-Humanitarian- Response_15-May-2023-1.pdf 4 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA COVID-19 Status as of 14 May 2023 The WHO South-East Asia Region has recorded a cumulative total of 61 138 284 COVID-19 cases, including 805 666 deaths. In the WHO South-East Asia Region, during the week from 8 to 14 May 2023, 25 001 new cases and 271 new deaths were reported (a decrease of 37.7% and 20.1% in new cases and deaths respectively, compared to the previous week). During this reporting period, six countries reported an increase in the number of new cases - Thailand (2 356new cases, +38.7%), Myanmar (1 218 new cases, +5.5%), Bangladesh (140 new cases, +32.1%), Nepal (132 new cases, +3.9%), Sri Lanka (55 new cases, +7.8%), and Timor-Leste (11 new cases, +266.7%), whereas India (11 044 new cases, -54.4%), Indonesia (9 982 new cases, -21.0%) and Maldives (63 new cases, -30.8%) reported a decline, compared to the previous seven days. Bhutan reported no new case during this week. For the same period, three countries reported an increase in the number of new deaths compared to the previous week – Thailand (22 new deaths, +120%), Myanmar (one new death, +100%) and Sri Lanka (eight new deaths, +60.0%) – while India (90 new deaths, -38.8%) and Indonesia (150 new deaths, -14.3%) reported a decrease in deaths and 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 8 to 14 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 and Thailand are for the period from 7 to 13 May 2023 in comparison to the preceding week. 5 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 1. Daily number of new COVID-19 cases reported during the previous six weeks (3 April – 14 May 2023) in the WHO South-East Asia Region Figure 2: Weekly number and the percentage of samples taken from cases of influenza-like-illness (ILI) and severe acute respiratory infection (SARI) (mostly at sentinel surveillance sites) which were positive for SARS COV-2 in the previous five weeks (3 April – 7 May 2023) in selected counties* (as of 14 May 2023) * Countries conducting SARS-COV2 testing at their influenza sentinel surveillance sites (Bangladesh, Bhutan, Nepal and Timor-Leste). 6 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Figure 3. Number of new COVID-19 cases per 100 000 population in the previous six weeks (3 April – 14 May 2023) in countries in the WHO South-East Asia Region * * For countries reporting cases on a weekly basis (Bhutan, Maldives and Thailand), the number is divided by seven to give the average of the daily new cases. For other countries, the values are shown as the 7-day moving average. DPR Korea has reported no confirmed COVID-19 cases. 7 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA mpox Status as of 14 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. Of these, 22 cases have been reported in India, 26 in Thailand, two in Sri Lanka and one in Indonesia (Figure 4). Figure 4. Number of mpox cases reported in WHO South-East Asia Region by date of notification* (14 July 2022 – 14 May 2023) * Notification - The date on which the case is notified to the public health authority. Of the 51 verified cases with available information: o 34 (66.7%) are male compared to 96.2% (n= 77 834) globally. o The majority (42, 84%) are aged between 18 and 39 years with a median age of 30 years. o 18 cases were imported with the majority (n=15, 83.3%) from the Eastern Mediterranean Region (11 from the United Arab Emirates and four from Qatar). In 24 cases, the infection was likely acquired locally. Of the 18 who travelled, 14 (77.8%) were male. o Of those in whom the sexual orientation was known, the majority (56.8%, n=21) were reported as heterosexual compared to the majority identifying as MSM globally (84.1%, n=25 871). It appears that there are different characteristics between the cases reported in India and those reported in Thailand (Table 2): o Of the 26 cases reported in Thailand, 13 (53.8%) reported as MSM compared to none of the 22 cases in India. o Six of the cases reported in Thailand (23.1%) were living with HIV compared to none of the cases reported in India. o 88.5% of the cases in Thailand (n=23) reported sexual exposure compared to one case in India. 8 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Table 2. Profile of verified mpox cases in India and Thailand 23 July 2022 – 16 May 2023 Frequency (n=48) Total India (n=22) Thailand (n=26) Gender Male 31 12 19 Female 17 10 7 Age group (years) 0-17 0 0 0 18-29 21 10 11 30-39 19 12 7 40-49 5 0 5 50 and over 3 0 3 Sexual orientation Heterosexual 19 7 12 MSM 14 0 14 Other 2 2 0 Unknown 13 13 0 HIV status Positive 6 0 6 Negative 16 6 10 Unknown 26 16 10 Recent international travel Yes 15 7 8 No 31 13 18 Unknown 2 2 0 Exposure type Sexual encounter 24 1 23 Unknown 24 21 3 Clade Clade I 0 0 0 Clade II 25 0 25 Unknown 22 22 0 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 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 16 May 2023, 306 cases have been reported compared to a total of 163 cases reported for the entirety of May, 2022 (figure 5). Figure 5. Number of new cases of dengue by month in Bangladesh from 2019 to 2023* https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report * Note the log10 scale on the y axis. 10 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Maldives A total of 320 cases of dengue were reported in Maldives during April 2023, a 40.4% increase compared March 2023 (n = 228). During April 2022, a total of 95 cases were reported (Figure 6). Figure 6. Number of dengue cases per month in Maldives from 2018 to 2023 excluding 2020 and 2021. Source: Monthly Communicable Disease report (April 2023), 15 May 2023, Ministry of Health Maldives. https://health.gov.mv/en/publications/roagaage-gothugai-fethuremundhaa-balithah-mei-2023 Nepal No new data have been uploaded since epidemiological week three (15-21 January 2023) in Nepal. A total of 21 cases of dengue were reported in Nepal in epidemiological week three, a 12.5% decrease compared to week two (n=24). During week three in 2022, a total of two cases were reported (Figure 7). Figure 7. Number of new cases of dengue by epidemiological week in 2018 to 2023 in Nepal. 11 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Sri Lanka In 2023, a total of 1198 cases of dengue were reported in Sri Lanka in week 17 (22 to 28 April 2023), a 17% decrease compared to week 16 (15 to 21 April, n=1443)). During week 17 in 2022, a total of 1020 cases were reported (Figure 8). Figure 8. Number of new cases of dengue by week in Sri Lanka from 2018 to 2023 (Week 17) * 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 2396 cases of dengue were reported in Thailand in April 2023, a 6.9% decrease compared to March (n=2561). During April 2022, a total of 550 cases were reported. From 1 to 16 May 2023, a total of 485 news cases were reported compared to 1792 new cases for entirety of May 2022 (Figure 9). Figure 9. Number of new cases of dengue by month in Thailand from 2018 to 2023. 12 BIWEEKLY EPIDEMIOLOGICAL BULLETIN WHO HEALTH EMERGENCIES PROGRAMME WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA Influenza Figure 10: Number of specimens positive for influenza by subtypes and the percentage positive in WHO South- East Asia Region (as of 14 May 2023) Data sources and information on influenza, please refer to the WHO SEARO Influenza dashboard.