Community Foodborne of Salmonella Weltevreden Outbreak at Northern Governorate, Sultanate of Oman

OBJECTIVES

To investigate the course of a community gastroenteritis outbreak by Salmonella and implement interventional activities and roles to prevent occurring such an outbreak in the future.

METHODS

From August 27 to 2 September 2015, 101 individuals were reported among a local community. All affected individuals had a history of food consumption at a local restaurant. A rapid response team conducted active surveillance and interview with the affected individuals and workers of the restaurant. Food items and stools from food handlers and affected individuals were cultured and sent for genotyping. An environmental audit of the restaurant had been conducted.

RESULTS

The total majority of the affected individuals were male and more than 70% belonged to the young age group from 15 to 45 years. Out of the total, 97% had diarrhea, 70% fever, 56% abdominal cramps and 49% vomiting. All those affected were managed symptomatically except for 14 cases admitted for intravenous rehydration. Breakdown of food safety and basic personal hygiene were detected in the environment of the restaurant and among the workers. There are 39 out of 49 stool cultures of cases, six out of 18 food handlers, and five food samples were positive for Salmonella spp. The identical DNA fingerprinting pattern among S. Weltevreden strains originating from human cases and food was detected.

CONCLUSION

This is the first reported community foodborne of S. Weltevreden outbreak in Oman. The importance of food safety and rigors environmental safety is emphasized. Basic personal hygiene and training of food handlers in restaurants are recommended with public health measurements.

Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis

BACKGROUND

Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings.

METHODS AND FINDINGS

We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996-31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle-Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20-64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%-16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000-46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000-9,432,000) LRI hospitalizations occur each year among adults. While adults <65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000-5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000-44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265-612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources.

CONCLUSIONS

In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide.

Knowledge, Attitudes and Practices Related to HIV Stigma and Discrimination Among Healthcare Workers in Oman

Objectives

Stigma and discrimination undermine the quality of life of people with HIV and their access to health services. This study aimed to assess HIV-related knowledge, attitudes and practices among healthcare workers (HCWs) in Oman.

Methods

This cross-sectional study took place between July and November 2016. A questionnaire was distributed to 1,400 government HCWs to determine HIV-related knowledge, attitudes and practices.

Results

A total of 1,281 HCWs participated (response rate = 92%). Routine tasks, such as dressing wounds, drawing blood and touching clothes, were a cause of concern for 24-52% of HCWs. Only 69% correctly answered questions regarding the transmission of HIV via eating/drinking and mosquito bites. Compared to other HCWs, doctors had significantly higher knowledge (mean = 0.46, 95% confidence interval [CI]: 0.19 to 0.73; P <0.001), attitude (mean = 0.77, 95% CI: 0.31 to 1.24; P = 0.001) and practice (mean = 2.07, 95% CI: 1.59 to 2.55; P <0.001) scores. Expatriates also scored significantly higher in knowledge (mean = 1.08, 95% CI: 0.93 to 1.23; P <0.001), attitude (mean = 1.23, 95% CI: 0.98 to 1.48; P <0.001) and practice (mean = 1.08, 95% CI: 0.82 to 1.34; P <0.001) compared to Omani nationals. Finally, those with >15 years' work experience scored significantly higher on knowledge (mean = -0.60, 95% CI: -1.12 to -0.08; P = 0.025) and attitude (mean = -0.99, 95% CI: -1.87 to -0.10; P = 0.029) compared to those with less experience.

Conclusion

The high rate of HIV-related stigma among HCWs in Oman should be rectified in order to achieve the 90-90-90 target set by the Joint United Nations Programme on HIV/AIDS.

Incidence of Guillain–Barre's Syndrome in Children under 15 Years of Age in Oman

Objective Guillain–Barre's syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy seen in all ages but mostly in the adult population. We aim to report the incidence of GBS in children under 15 years of age in Oman, a Gulf country.

Materials and Methods All children with GBS under 15 years of age were included in the study from January 2002 to December 2016. The data were compiled in Microsoft Excel format and analysis was performed using SPSS, version 17.0. Population-based age- and sex-specific rates of GBS were calculated using the estimated population for each 5-year period based on 2004, 2009, and 2014 mid-year population, respectively. Relative risk and 95% confidence intervals of GBS at different age categories were calculated using the overall incidence of GBS in those under 15 years as reference.

Results The average annual incidence in those under 15 years was 3.1/100,000. Age-specific incidence was 4.0/100,000 in the age group 0 to 9 years and 4.7/100,000 in age group 0 to 4 years. Sixty percent had evidence of preceding infections, and the male to female ratio was 1.8:1. Fifty percent had cranial nerve involvement and 18% needed mechanical ventilation. Five percent had residual weakness. Intravenous immunoglobulins (IVIGs) were used in all, and 3.3% required plasmapheresis when they did not improve with IVIG. Clinical profile of the GBS was not different from the rest reported in the literature.

Conclusion The incidence of GBS in Oman was 3.1/100,000 (range: 2.7–3.5 cases/100,000) in children under 15 years of age. The GBS is a smaller proportion among the total acute flaccid paralysis cases.

Epidemiology of Meningitis in Oman-Implications for Future Surveillance

Objectives:

This study aimed to understand the epidemiology of meningitis cases admitted to hospitals in Oman and to identify any changing microbial patterns from the introduction of the new vaccines.

Methods:

A retrospective analysis of all cases of meningitis reported through a national surveillance system. Meningitis is a notifiable disease.

Results:

Of a total of 581 cases of meningitis from the period between January 1, 2005 and December 31, 2013, 15% (88) were confirmed to be bacterial in origin and 7.2% (42/581) viral. In 50.9% (296) of patients with suspected pyogenic meningitis, no specific bacterial pathogen were identified, and in 26% of cases (151) a cerebrospinal fluid study could not be undertaken. Among 88 cases with confirmed bacterial pathogens the organisms identified were Streptococcus pneumoniae (65.9%), Neisseria meningitides (18.2%), Haemophilus influenzae (6.8%), and other organisms (9.1%). The peak incidence was in children <2 years of age (39.4%). It showed notable decline in H. influenzae cases as well as pneumococcal meningitis cases, possibly indicative of the successful immunization program.

Conclusion:

A drop in H. Influenzae and pneumococcal meningitis cases was possibly the effect of the introduction of vaccines. It shows the need for improving diagnostic accuracy, laboratory capacities, and quality of surveillance reporting.

Clinical and molecular epidemiology of Crimean-Congo hemorrhagic fever in Oman

BACKGROUND

Crimean-Congo hemorrhagic fever (CCHF) is a serious disease with a high fatality rate reported in many countries. The first case of CCHF in Oman was detected in 1995 and serosurveys have suggested widespread infection of humans and livestock throughout the country.

METHODOLOGY

Cases of CCHF reported to the Ministry of Health (MoH) of Oman between 1995 and 2017 were retrospectively reviewed. Diagnosis was confirmed by serology and/or molecular tests in Oman. Stored RNA from recent cases was studied by sequencing the complete open reading frame (ORF) of the viral S segment at Public Health England, enabling phylogenetic comparisons to be made with other S segments of strains obtained from the region.

FINDINGS

Of 88 cases of CCHF, 4 were sporadic in 1995 and 1996, then none were detected until 2011. From 2011-2017, incidence has steadily increased and 19 (23.8%) of 80 cases clustered around Eid Al Adha. The median (range) age was 33 (15-68) years and 79 (90%) were male. The major risk for infection was contact with animals and/or butchering in 73/88 (83%) and only one case was related to tick bites alone. Severe cases were over-represented: 64 (72.7%) had a platelet count < 50 x 109/L and 32 (36.4%) died. There was no intrafamilial spread or healthcare-associated infection. The viral S segments from 11 patients presenting in 2013 and 2014 were all grouped in Asia 1 (IV) lineage.

CONCLUSIONS

CCHF is well-established throughout Oman, with a single strain of virus present for at least 20 years. Most patients are men involved in animal husbandry and butchery. The high mortality suggests that there is substantial under-diagnosis of milder cases. Preventive measures have been introduced to reduce risks of transmission to animal handlers and butchers and to maintain safety in healthcare settings.

HIV viral suppression in Oman: Encouraging progress toward achieving the United Nations 'third 90'

OBJECTIVE

To assess the impact of capacity-building interventions introduced by the Oman National AIDS Programme on the quality of HIV care in the country.

METHODS

HIV viral load (VL) suppression and loss to follow-up (LTFU) rates were calculated for the period before (in December 2015; n=1098) and after (in June 2017; n=1185) the introduction of the interventions: training, support, and care pathway development. Three HIV VL cuts-offs at last measurement in the year of interest were used to define VL suppression.

RESULTS

In the intention-to-treat (ITT) analysis, rates of VL <200 copies/ml and <1000 copies/ml increased from 51.9% in 2015 to 65.5% in 2017 (relative risk (RR) 1.26, 95% confidence interval (CI) 1.17-1.36) and from 58.1% in 2015 to 70.9% in 2017 (RR 1.22, 95% CI 1.14-1.30), respectively; p<0.0001 for both. Similarly, in the on-treatment analysis, rates of VL <200 copies/ml and <1000copies/ml increased from 64.2% in 2015 to 76.9% in 2017 (RR 1.20, 95% CI 1.12-1.28) and from 71.9% in 2015 to 83.2% in 2017 (RR 1.16, 95% CI 1.10-1.22), respectively. Fewer patients were LTFU in 2017 than in 2015 (14.7% (157/1061) vs. 19.2% (188/981); RR 0.77, 95% CI 0.64-0.94).

CONCLUSIONS

Achieving the UNAIDS target of 90% of HIV patients on treatment having VL suppression by 2020 is feasible in Oman.

Effective vaccine management and Oman's healthcare system's challenge to maintain high global standards

The prevention of infection through vaccination has been among the most successful public health interventions. Nearly 2.5 million deaths per year globally are saved by immunization against vaccine-preventable disease (VPD) (WHO, 2013) [1]. Oman has experienced a sharp decline in VPDs over the last 40 years due to the introduction of new vaccines and the maintenance of high vaccination coverage of over 99%. The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) launched the effective vaccine management (EVM) framework to assist countries to gauge the performance of their immunization supply chains. Oman underwent the assessment in 2016 and scored the best score to date. This report looks at the process of EVM and the challenges for the Oman healthcare system to maintain high global standards.

Surveillance of adverse events following immunization in Oman, 2006-2015

BACKGROUND

In 1996, Oman launched its surveillance programme for adverse events following immunization (AEFI) to address vaccine safety concerns. In 2010, an analysis of surveillance activities for AEFI was done for 10 years (1996-2005).

OBJECTIVES

The main objective of the study was to describe the trend of AEFI over the 10-year period, 2006-2015, and compare the findings with a previous report in Oman and reports from other countries.

METHODS

A descriptive record-based review of AEFI was carried out using the national AEFI surveillance database for the study period, 2006-2015.

RESULTS

A total of 890 adverse event reports were received, giving an annual rate during the review period of 21.4 per 100 000 population or 8.3 per 100 000 doses administered. The most frequently reported AEFI were BCG adenitis and local reactions - 31.1 and 4.1 per 100 000 doses respectively. There were no reported deaths. Pentavalent vaccine was responsible for the greatest proportion of adverse events (30%). Local reaction was the most common adverse event among all vaccines administered. The Hexa vaccine caused fewer adverse events compared with the pentavalent vaccine, probably due to the acellular pertussis component - 0.8 versus 1.5 per 100 000 doses administered respectively.

CONCLUSION

The overall rate of AEFI (8.3 per 100 000 doses administered) is comparable to the rate (10.8/100 000 doses) in the previous decade (1996-2005) in Oman. The reported rates for individual vaccines are similar to or below international rates.

Acute Renal Failure in a Patient with both Leptospirosis and Dengue Fever

The spectrum of tropical nephropathies includes Acute Renal Failure (ARF) or Acute Kidney Injury (AKI) due to infective agents that are endemic in the tropics which include Leptospira (LS) and Dengue Viruses (DV). The major histological feature is Acute Tubular Necrosis (ATN).(1, 2)We report the case of a patient who presented ARF with co-infection with both agents. The clinical manifestations were consistent with both diseases. A renal treatment was supportive and the outcome was positive.We conclude that co-infection with these two tropical agents was possible. It may have been overlooked when the diagnosis of one agent was confirmed, especially that aware of the possibility of co-infection, as the management may be different. Spontaneous full recovery in these circumstances is still possible with supportive treatment.