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Mongolia

Mongolia: Influenza A Outbreak - Information Bulletin

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The Situation

On 15 January 2019, due to the outbreak of Influenza A (H1N1) virus in Mongolia, the State Emergency Commission meeting was called. The Ministry of Health stated that Influenza A cases were confirmed to be H1N1 in the end of December 2018 and since then it had rapidly spread within a short period of time. Starting from 3 January, the outbreak became higher than three years average and two deaths have been registered among children within the first week of January 2019. By January 2019, 9 districts of Ulaanbaatar city and 11 provinces are spread to epidemics, ranging from 11-17 per cent with a national average of 9.3 per cent of total outpatient examinations. According to the Ministry of Health contingency plan, if influenza is detected in more than 15 per cent of the total outpatient examinations, there will be local and national quarantine. The outbreak is expected to rise over the coming weeks as Influenza is dominantly (40 per cent) caused by Influenza A (H1N1) virus. The same outbreak was registered in 2009 in Mongolia and state of emergency had been called.

From the total registered cases, 67.4 per cent is children from 0-4 ages. 86.3 per cent of the hospitalized patients are children from 0-4. Hospitals of Ulaanbaatar city is capacitated to hospitalize 977 children, which is now exceeded by 53.2 per cent. In Ulaanbaatar city hospitals, 423 beds are transferred from adult floor and 354 portable beds are being used additionally to handle the situation. According to the Ministry of Health, on average about 139 new patients are hospitalized every day, at least 500 more portable beds are needed urgently.

The situation has worsened, and the risk of outbreak rapid increase is high in urban areas due to several factors including air pollution, high population density, extremely cold temperatures dropping lower than -40oC and socioeconomic situation of households. It must be emphasized that due to poor air conditions in Ulaanbaatar, the infants and children in the city are most exposed and vulnerable to the outbreak3. The fatality risk is high due to the Ulaanbaatar city air quality is 133 times worse than what the WHO deems safe, placing pneumonia to become the 2nd leading cause of death of child aged 0-5 years. The following tables provide more comparative details on pneumonia cases, ambulatory screening children mortality for 2017-2018.

The Ministry of Health is concerned about the speed and scale of the epidemic. There is a high risk that it may spread at a national scale during the Lunar New Year (5-7 February) as the population movement becomes highest during the year, because population moves from Ulaanbaatar city to more remote areas to meet and greet their families. In Mongolia, the peak of the outbreak has not come yet as the country is in the midst of winter which will continue for another two months. The Ministry of Health has sent an official request to Mongolian Red Cross Society to support the health facilities and to organize public awareness campaigns to prevent further spread of the outbreak.