London School of Hygiene & Tropical Medicine

London School of Hygiene & Tropical Medicine

Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger and Kate White Rohingya crisis August-December 2017, more than 600,000 Rohingya had fled a Myanmar military offensive into Bangladesh Between 10 Nov 2017 and 9 Dec 2017 440 suspected diphtheria cases were reported in the

refugee settlements, 168 of which were reported on 9 Dec 2017 MSF approached LSHTM to help forecast the expected scale of the diphtheria outbreak MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Timeline Dec 14 Decision on bed

capacity Dec 6 LSHTM involved Nov 10 1st case Early Dec rise in cases

seen Dec 12 1st forecast Jan 8 MSF treatme nt centre handed over

Dec 26 3rd forecast Dec 20 2nd forecast Dec 30 4th forecast

MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Model assumptions Population at risk: 608000 Incubation period: 2 days Infectious period: 4 days

3 age groups: 0-4, 5-14, 15+ Initial susceptibility of 80% in the 514 year age group Lower susceptibility in the 0-4 and 15+ year age groups Two separate geographical areas (Kutupalong and Balukhali) 15% hospitalisation MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Adjusting for delayed reporting MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in

Bangladesh Flavio Finger, Kate White Forecasting Final reported cases as of Jan 12th Decision for 100 hospital beds was made on Dec 14th

MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Forecasting Forecast Dec 12th MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Forecasting MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in

Bangladesh Flavio Finger, Kate White Forecasting Forecast Dec 12th Forecast Dec 20th MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Forecasting

MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Forecasting Previous forecasts Forecast Dec 26th MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White

Forecasting MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Forecasting Previous forecasts Forecast Dec 30th

MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Forecasting MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Forecasting Previous forecasts

Final model run MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Model conclusions The model was able to predict the correct scale of the outbreak starting on December 20th According to the model was between 5 and 10 Around 5% cases were reported

5-14 year olds sustained the epidemic Communication between field staff and modellers is key to success MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Impact on Operations Bed Capacity Division between critical and/or diphtheria anti-toxin (DAT) beds Decision to treat mild cases in

the community Division of bed capacity and severity between different MSF clinics Photo: Anna Surinyach MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Impact on Operations Diphtheria Antitoxin (DAT) Forecast amount needed

Decisions around prioritisation of use and treatment protocol Supply in General Forecast for urgent International Medical Order Photo: Sara Creta MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Impact on Operations Staffing

Employed a strategy of surge staffing for International Staff Expedited recruitment of National Staff doctors and nurses Photo: Sara Creta MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White Impact on Advocacy External Actors

Contributed to closer collaboration with WHO, GOARN and other actors Vaccination Strategy Initial advocacy centered on a much broader age group Highlighted previous lack of vaccination in Myanmar Photo: Sara Creta MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White

Acknowledgements LSHTM Adam Kucharski Sebastian Funk John Edmunds MSF Crystal Van Leuwan John Guzek Ruby Siddiqui Support Swiss National Science

Foundation Wellcome Trust Medical Research Council RECAP project by the Global Challenges Research Fund We confirm that we have obtained permission to use images from the patients included in this presentation. MSF Scientific Days 2018 London Real-time analysis of the diphtheria outbreak amongst forcibly displaced Myanmar nationals in Bangladesh Flavio Finger, Kate White

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