YEMEN: Diphtheria Outbreak Weekly epidemiology bulletin Week 52 -2017 Highlights: The cumulative total of probable diphtheria from week 33 to 29 December 2017 is 429 and 42 associated deaths. During week 52 (from week 33 to 29 December 2017), 16 probable diphtheria and 0 deaths were reported in Yemen. The national attack rate is 0.16 per 10,000 and CFR is 10%. The governorates with the highest cumulative of probable cases are Ibb (53% of the cases) and Al Hudeydah. 18 governorates and 90 districts are affected. Ibb is the most affected governorate. 50% of the probable case were between 5-14 years old 63% were not vaccinated at all. 17 tests were positive for Gram stain and Albert stain Probable Diphtheria Cases and CFR % 67% 80 70% 70 60% 50% 60 50% 50 40% 40 22% 30% CFR, % 30 21% 17% 14% 13% 20% 20 10% 7% 9% 8% 3% 4% 10% Numberof probablecases 10 0% 0% 0% 0% 0% 0 0% W34 W37 W38 W39 W40 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W33 Cases CFR% Figure 1: number of probable diphtheria cases per epiweek, and CFR, Yemen, 2017 Geographical distribution of cases and deaths The most affected governorates are Ibb (53.9%) and Al hudaydah . Ibb has the highest attak rate (0,75 per 10 000), followed by Aden (0.30 per 10000). The highest cumulative number of deaths is in Ibb. Governorate Cases Population AR/10000 Death CFR% Ibb 226 3017004 0.75 13 6% Al Hudaydah 50 3315812 0.15 11 22% Aden 29 955022 0.30 2 7% Amran 24 1173542 0.20 3 13% Sana'a 23 1497466 0.15 0 0% Dhamar 20 2064534 0.10 2 10% Taizz 13 3056222 0.04 4 31% Hajjah 12 2442558 0.05 2 17% Amanat Al Asimah 10 2964094 0.03 0 0% Al Mahwit 4 749974 0.05 1 25% Sa'ada 4 959746 0.04 1 25% Abyan 4 583242 0.07 2 50% Lahj 3 1028118 0.03 0 0% Al Bayda 2 770358 0.03 0 0% Marib 2 368613 0.05 0 0% Hadramaut 1 1468311 0.01 0 0% Raymah 1 622106 0.02 0 0% Al Jawf 1 589320 0.02 1 100% Total 429 27626042 0.16 42 10% Table 1: Number of probable diphtheria cases and deaths, AR and CFR, per governorate, Yemen, week 33- 52, 2017 In Ibb governorates, As saddah and Yareem districts are the most affected. In Al Hudeydah, the districts of Al Hali and bayt el faquiah are more affected. Probable Diphtheria Cases by District in Yemen 140 120 100 80 60 Suspected Diphtheria Cases by Districts 40 In total 90 districts are affected Numberof probablecases 20 0 (Ibb) Ibb (Ibb) Jiblah (Ibb) Al Qafr (Lahj) Tuban (Marib) Harib (Aden) Craiter (Ibb) Al Dhihar (Hajjah)Kushar (Sanaa) Sanhan (Ibb) SaddahAs (Sanaa) Al Husn (Abyan)Khanfir (Al Bayda) Rada (Amran) Dhi Bin (Saada) As Safra (Amran)Raydah (Ibb) Ar Radmah (Sanaa) Hamdan (Ibb) (Ibb) An Nadirah (Dhamar)Jahran (Aden) Al Mualla (Lahj) Al Maflahy (Ibb) Al Makhadir (Hajjah)Wadhrah (Dhamar)Al Hada (Taizz) At Taiziyah (Amran) Al Qaflah (Amran) Al Madan (Sanaa) Bani Matar (Aden) Khur Maksar (Taizz)Al Mudhaffar (Al Hudaydah) Zabid (Hadramaut) Rumah (Amran) Harf Sufyan (Al Hudaydah) Hali Al (Dhamar)Dhamar City (Dhamar)Mayfaat Anss (Amran) Jabal Yazid Iyal (Al Hudaydah) HawakAl (Taizz)Ash Shamayatayn (Taizz)Sabir Al Mawadim (Al Hudaydah) MunirahAl (Al Hudaydah) SukhnahAs (AmanatAl Asimah)Shuaub (AmanatAl Asimah)Assafiyah Figure 2: Number of probable diphteria cases per district, Yemen, week(Governorate) 33-52, 2017 District Figure 3: map of number of probable cases per district, Yemen, week 33-52, 2017 Epi curves in the most affected Districts In total there were 226 cases in Ibb governorate, 71 in Yareem and 123 in As Saddah. Probable Diphtheria Cases and Death by Epi Week of Onset (Ibb Governorate) 35 30 1 25 1 20 1 15 2 1 10 2 1 1 5 2 1 0 W33 W34 W37 W38 W39 W40 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 Cases Death Figure 4: epicurve of probable diphteria cases and deaths in Ibb governorate, Yemen, week 33- 52, 2017 Yareem District (Ibb) Probable Diphtheria Cases and Death And CFR% by Epi Week of Onset (Yareem District) 25 120% 100% 100% 20 67% 80% 15 50% 60% 10 33% 40% 5 2 1 1 20% 0% 0% 1 0% 0% 0% 0% 0% 0% 0% 0 0% W49 W39 W40 W41 W42 W43 W44 W46 W47 W48 W50 W51 W38 Cases Death CFR% Figure 5: Epicurve of probable diphteria cases and deaths, Yareem district, Yemen, week 33-52, 2017 As Sadah District (Ibb) Suspected Diphtheria Cases and Death And CFR% by Epi Week of Onset (As Saddah District) 30 14% 14% 16% 1 14% 25 12% 20 10% 2 15 8% 6% 10 4% 1 4% 5 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 2% 0 0% W51 W33 W34 W37 W38 W39 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 Cases Death CFR% Figure 6: Epicurve of probable diphteria cases and deaths, As Saddah district, Yemen, week 33-52, 2017 Sex and age distribution The male/female sex ratio was 0.9. The highest proportion of cases was seen in the 5- 14 year age group (i.e. 50%). The proportion of under-five y.o. cases was 17% and this age group was was more at risk of dying (CFR: 17%). Table 2: Distribution of probable cases and deaths by age and sex, Yemen, week 33-52, 2017 Cases Death Age Group Female Male Total % of cases Female Male Total Specific CFR % 0-4 29 43 72 17% 6 6 12 17% 5-14 94 116 210 50% 12 13 25 12% 15 - 24 38 34 72 17% 3 1 4 6% 25 - 44 30 20 50 12% 0 0 0 0% 45- 64 14 3 17 4% 0 1 1 6% >65 0 2 2 0% 0 0 0 0% Total 205 218 423 100% 21 21 42 10% 6 Missing values Vaccination Status Among the 419 cases, 268 (63%) were not vaccinated with diphtheria vaccine, 27% received 3 doses. Probable Diphtheria Cases by Vaccination Status 300 268 250 200 150 100 74 50 32 40 15 0 Zero dose 1 dose 2 doses 3 doses Unkwnon Figure 7: Vaccination status of probable diphteria cases, Yemen, week 33-52 Laboratory In total, 47 samples were taken for Albert stain and Gram stain test in Ibb, Al hudeydah and Sanaa. In total, 17 were positive for Albert stain and gran stain: Ibb (11/40), Al Hudaydah (4/5), Sanaa (2/2). For further information: Bouhenia Malika WHO country office Epidemiologist, Yemen Phone: +967 739 888 893 E-mail: [email protected] Christine (Tiff) COOL Emergency Communications Lead WHO Country Office, Yemen Phone +967 739 888 959 Email: [email protected] .