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RKI epidemiologists support refugee aid in Bangladesh

Four employees from the Department of Infectious Disease Epidemiology at the Robert Koch Institute worked in Bangladesh between March and June 2018. During their four to eight-week missions, they supported tohelped monitoring and controlling infectious diseases in the Rohingya refugee camps and to contain an ongoing outbreak of diphtheria.

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View of the Jamtoli refugee camp in Ukhia on the way to interviewing a suspected cholera case. (Source: Stefanie Böhm/RKI) View of the Jamtoli refugee camp in Ukhia on the way to interviewing a suspected cholera case. Source: Stefanie Böhm/RKI

Since August 2017, over 600,000 Rohingyas have fled violence and persecution in Myanmar across the border into Bangladesh in the district Cox's Bazar. About 300,000 Rohingyas were living there, they had fled Myanmar in earlier waves of expulsion. Existing settlements and camps have expanded with the new influx and formed new spontaneous settlements that are now growing rapidly. Some of the newcomers were accepted into the local host communities. In this context, an outbreak of diphtheria began in November 2017. Geographically, the outbreak, which now comprises of more than 7,000 suspected cases, has increasingly spread to the various refugee camps south of the city of Cox's Bazar and has also led to diphtheria cases among the local population.

The World Health Organization (WHO) and other organizations are working together to stop the outbreak of diphtheria and prevent future outbreaks of infectious diseases. With the beginning of the monsoon season in June, there were concerns of an increasing incidence of infectious diseases.

In December 2017, the Global Outbreak Alert and Response Network (GOARN) of WHO called experts to support the activities in Cox's Bazar, followed by a second call in March 2018. The RKI then sent four colleagues from the Department of Infectious Disease Epidemiology (Dept. 3) to Bangladesh: Stefanie Böhm, Nadine Zeitlmann, Andreas Reich and Gerhard Falkenhorst.

The main tasks of the RKI scientists on-site were to coordinate contact tracing of diphtheria cases and to supervise and further develop the monitoring of infectious diseases, using a web-based Early Warning, Alert and Response System (EWARS). This included the regular analysis of collected data, including the verification and evaluation of occurring alerts. Other areas of work composed of the preparation of a preparedness plan for cholera and the coordination of mortality surveillance in the refugee camps. In addition, two of the RKI colleagues were in charge of managing the activities of the Epidemiology Team within the WHO District Office in Cox's Bazar.

Through their efforts, the RKI staff members have made a successful contribution to further contain the outbreak of diphtheria and to prepare for the increased risks of outbreaks of infectious diseases during and after the monsoon season.

Date: 31.07.2018

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