Epidemic outbreaks, diagnostics, and control measures of the H5N1 highly pathogenic avian influenza in the Kingdom of Saudi Arabia, 2007-08

Community Engagement Within the Evaluation of Public Policies for Zoonotic Spillover Prevention: A Secondary Matrix Analysis

Despite the overall health, economic, and social costs of zoonotic spillover, its impacts are not felt equally around the globe. Engaging local communities in primary spillover prevention may help to better ensure equity is considered in research and policy-making activities. Our study aimed to gain an understanding of how and at what level community engagement (CE) has been incorporated into the evaluation of public policies for zoonotic spillover prevention. We conducted a secondary analysis on an existing dataset from a systematic review, beginning with a structured deductive content analysis. A secondary matrix of analysis was engaged using an adapted CE tool for screening the included articles based on their level of CE. We then characterized relevant themes based on the CE elements within the included articles. Of the 95 articles included, 55 had no level of CE reported. Among the included articles that had some level of CE, elements included the platforming of community consultation, community training for involvement in spillover prevention research, cultural and language considerations being engaged, community protection and awareness programmes for public health and biosecurity, and community-centered data collection processes being engaged. Our findings highlight the persistent equity gaps in appropriately engaging affected communities within the evaluation of public policies for spillover prevention.

Evaluation of the immune status of birds and domestic and companion animals for the influenza A virus in Eastern Saudi Arabia

Background and Aim:

Influenza type A virus infections are still one of the major concerns for the health of humans and various species of domestic and companion animals. Wild birds play an essential role in the transmission cycle of the virus. Regularly monitoring the spread of the virus is a significant step in its mitigation. Highly pathogenic avian influenza viruses, including H5N1 and H5N8, have been reported in birds in the Arabian Peninsula, including Saudi Arabia, in recent decades. This study aimed to evaluate the immune status of birds, domestic and companion animals for Influenza type A virus in Eastern Province of Saudi Arabia.

Materials and Methods:

We collected 195 serum samples from dromedary camels, sheep, goats, native breed chickens, doves, dogs, and cats. We tested these sera for the presence of specific antibodies against influenza type A virus using a commercially available enzyme-linked immunosorbent assay.

Results:

Our results show that 4% of the tested samples had antibodies in sera, including some doves, chickens, and dogs. These data suggest exposure and seroconversion of these animals or birds to the influenza type A virus.

Conclusion:

The presence of antibodies against influenza type A virus in sera of some animals and birds without a previous vaccination history against the virus indicates a natural exposure history regarding this virus and seroconversion. Further large-scale molecular and epidemiological studies are needed to obtain a better understanding of the dynamics of influenza type A virus among various species of animals and birds.

Questionnaire-based analysis of infection prevention and control in healthcare facilities in Saudi Arabia in regards to Middle East Respiratory Syndrome

Effective implementation of infection prevention and control in healthcare facilities depends on training, awareness and compliance of healthcare workers. In Saudi Arabia recent significant hospital outbreaks, including Middle East Respiratory Syndrome Coronavirus (MERS-CoV), have resulted from lack of, or breakdown in, infection prevention and control procedures. This study was designed to assess attitudes to, and awareness of, infection prevention and control policies and guidelines among healthcare workers of different professions and institution types in Saudi Arabia. A questionnaire was administered to 607 healthcare workers including physicians (n=133), nurses (n=162), laboratory staff (n=233) and other staff (n=79) in government hospitals, private hospitals and poly clinics. Results were compared using Chi square analysis according to profession type, institution type, age group and nationality (Saudi or non-Saudi) to assess variability. Responses suggested that there are relatively high levels of uncertainty among healthcare workers across a range of infection prevention and control issues, including institution-specific issues, surveillance and reporting standards, and readiness and competence to implement policies and respond to outbreaks. There was evidence to suggest that staff in private hospitals and nurses were more confident than other staff types. Carelessness of healthcare workers was the top-cited factor contributing to causes of outbreaks (65.07% of total group), and hospital infrastructure and design was the top-cited factor contributing to spread of infection in the hospital (54.20%), followed closely by lack and shortage of staff (53.71%) and no infection control training program (51.73%). An electronic surveillance system was considered the most effective by staff (81.22%). We have identified areas of concern among healthcare workers in Saudi Arabia on infection prevention and control which vary between institutions and among different professions. This merits urgent multi-factorial actions to try to ensure outbreaks such as MERS-CoV can be minimized and contained.

Public health education in Saudi Arabia: Needs and challenges

In the last decade, public health (PH) has come to the frontlines in Saudi Arabia. The recent outbreak of a novel corona virus (MERS-CoV) highlighted the importance of PH services and the need for a competent PH workforce. The urgency and panic induced by infectious disease outbreaks explain the heightened interest. Decision makers' interest in public health was observed through a series of decisions, including creating a position for Deputy Minister for Public Health, changing the name of "Directorate of Primary Healthcare Centers" to "Directorate of Public Health" in all health regions and initiating a special scholarship program to prepare health administration professionals in collaboration with US-based universities. A distinguished group of PH leaders in Saudi Arabia was gathered in a structured workshop that was organized by the Al Imam Mohammad Ibn Saud Islamic University, college of medicine to discuss the current status and future needs of PH education in the Kingdom of Saudi Arabia. The workshop highlighted the need for PH education development and outlined the challenges ahead. The main challenges laid out by participants in the workshop were the development of an appropriate PH curriculum, appropriate training spots for practical placement, the development of research priorities for PH to satisfy the needs of PH programs and agencies, attracting the most qualified academic staff, the enrolment of highly motivated students and finally, the establishment of a quality assurance program to ensure the quality of PH education programs. The development of a framework for graduate competencies in PH was perceived to be a top priority. Moreover, setting a PH workforce surveillance system, building partnership between PH academic institutions and PH services providers, implementing national campaigns to explain what PH is about and illuminating the role of PH workers were also of utmost importance.

Epidemic protection zones: centred on cases or based on connectivity?

When an exotic infectious disease invades a susceptible environment, protection zones are enforced. Historically, such zones have been shaped as circles of equal radius (ER), centred on the location of infected premises. Because the ER policy seems to assume that epidemic dissemination is driven by a similar number of secondary cases generated per primary case, it does not consider whether local features, such as connectivity, influence epidemic dispersal. Here we explored the efficacy of ER protection zones. By generating a geographically explicit scenario that mimicked an actual epidemic, we created protection zones of different geometry, comparing the cost-benefit estimates of ER protection zones to a set of alternatives, which considered a pre-existing connecting network (CN) - the road network. The hypothesis of similar number of cases per ER circle was not substantiated: the number of units at risk per circle differed up to four times among ER circles. Findings also showed that even a small area (of <115 km(2) ) revealed network properties. Because the CN policy required 20% less area to be protected than the ER policy, and the CN-based protection zone included a 23.8% greater density of units at risk/km(2) than the ER-based alternative, findings supported the view that protection zones are likely to be less costly and more effective if they consider connecting structures, such as road, railroad and/or river networks. The analysis of local geographical factors (contacts, vectors and connectivity) may optimize the efficacy of control measures against epidemics.

Towards universal influenza vaccines?

Vaccination is the most cost-effective way to reduce the considerable disease burden of seasonal influenza. Although seasonal influenza vaccines are effective, their performance in the elderly and immunocompromised individuals would benefit from improvement. Major problems related to the development and production of pandemic influenza vaccines are response time and production capacity as well as vaccine efficacy and safety. Several improvements can be envisaged. Vaccine production technologies based on embryonated chicken eggs may be replaced by cell culture techniques. Reverse genetics techniques can speed up the generation of seed viruses and new mathematical modelling methods improve vaccine strain selection. Better understanding of the correlates of immune-mediated protection may lead to new vaccine targets besides the viral haemagglutinin, like the neuraminidase and M2 proteins. In addition, the role of cell-mediated immunity could be better exploited. New adjuvants have recently been shown to increase the breadth and the duration of influenza vaccine-induced protection. Other studies have shown that influenza vaccines based on different viral vector systems may also induce broad protection. It is to be expected that these developments may lead to more universal influenza vaccines that elicit broader and longer protection, and can be produced more efficiently.

Spatio-temporal epidemiology of highly pathogenic avian influenza (H5N1) outbreaks in Nigeria, 2006-2008

From 2006 to 2008, outbreaks of highly pathogenic avian influenza A (HPAI) virus of the H5N1 subtype occurred among poultry in Nigeria. We described the spatio-temporal patterns of the HPAI H5N1 outbreaks in Nigeria. Data of suspected and laboratory confirmed outbreaks maintained at the National Veterinary Research Institute Vom was analyzed using descriptive and exploratory analyses, GIS mapping, global and local spatial statistical analyses using the Cuzick-Edwards' (C-E) test and SaTScan Space-Time Scan Statistic. A total of 1654 suspected outbreaks were reported from 32 of the 36 States and the Federal Capital Territory (FCT), 299 were confirmed HPAI H5N1 positive from 27 states and FCT. The outbreaks occurred as three distinct epidemic waves with peak periods of January-March mainly in the North-West, North-Central and North-East regions during 2006 and 2007 and July-September in the South-West and South-South regions in 2007. Three spatio-temporal clusters were identified extending across States and international borders, consistent with disease transmission occurring through local and long-distance spread. This calls for enhanced strategies by the states and regional authorities to improve surveillance, prevention and control measures at the states, national and international levels.