Quarterly Summary Report
Second Quarter – 2012 (Apr – Jun)
Volume 3; Issue Number 2
Communicable
Diseases Bulletin
www.haad.ae
Foreword
As part of HAAD mission to ensure reliable excellence in health care for the
community, prevention is the best approach to healthy community. Vaccination is
one of the most effective strategies to eliminate and control infectious diseases.
The introduction of exuded program of immunization in UAE, helped to eradicate
polio and today UAE is certified as polio free country. In addition, vaccines helped
to decrease the presence of several childhood illnesses such as measles
and rubella, which is clearly seen in our notified list of illnesses with very minimal
numbers reported for these diseases.
The advancements in vaccine programs to target vaccine preventable illnesses
are ongoing and based on the available evidence and best practices. In this
respect, we are proud to introduce the full spectrum adult vaccination program.
This includes adults with high risk groups, and occupational groups at high risk of
exposure to infections like health care workers. In addition, the program is also
reemphasizing on the existing vaccination of close contacts, and travelers to high
risk areas.
Introducing adult vaccines is a new concept in our community that is expected
to be very challenging. Gathering our efforts at different levels is very important to
increase the awareness of the community and ensure success of the program.
Dr. Farida Al Hosani, Manager
Communicable Diseases Department- HAAD
Tel: 02 4193245
Fax: 02 4496966
Email: [email protected]
Page 2
Quarterly Summary Report: 2nd Quarter - 2012
Table of Contents
Item
Content
I
Foreword
2
II
Table of contents
3
III
Notified illnesses in Abu Dhabi Emirate by region
(Quarter 2, 2012)
4
IV
Notified illnesses in Abu Dhabi Emirate by age &
gender (Q2, 2012)
5
V
Monthly trends for selected notified diseases in Abu
Dhabi Emirate (Q1-Q2/2012 Vs 2010 and 2011)
6
VI
Visa screening applicants in Abu Dhabi Emirate
(Q2 /2012)
7
VII
Topic of the volume: Adult Vaccination Program
8-10
VIII
Sharing Reports: Figures from Premarital screening
11
IX
Contribution: Judicious use of antibiotics
12
X
Activities
13-14
XI
Flash news
15-16
XII
The volume “Flash- on-an-Illness”: Typhoid/Paratyphoid fever
17-18
Quarterly Summary Report: 2nd Quarter - 2012
Page
Page 3
Table 1: Notified Illnesses in
Abu Dhabi Emirate by Region (Quarter 2, 2012)
Abu
Dhabi
Cases
Eastern Western
Region Region
Quarter 2
Total Cumulative in Abu Dhabi Emirate
(Q1-Q2)
Q1
2012
Q2
TOTAL
2011
2010
13
8
4
58
78
37
18
7426
8635
5195
AFP *
4
1
1
Brucellosis
40
12
6
20
Chickenpox
2794
1371
470
2791
1
0
0
0
1
1
4
1
172
179
23
253
374
627
420
288
Haemophilus influenzae (invasive)
0
0
0
0
0
0
23
0
Hepatitis A
30
14
7
53
51
104
66
47
Hepatitis B
136
44
14
131
194
325
397
377
Hepatitis C
138
30
1
107
169
276
323
341
Influenza
23
3
5
79
31
110
172
142
Malaria *
383
202
107
265
692
957
967
439
Measles *
1
1
0
14
2
16
31
31
Meningitis (bacterial)
9
1
1
9
11
20
18
25
Meningitis (viral)
11
1
2
6
14
20
24
21
Mumps
46
20
3
37
69
106
123
125
Pertussis
18
9
0
9
27
36
19
38
Rubella *
5
0
1
2
6
8
36
11
Scabies
146
27
3
195
176
371
352
361
Shigellosis
8
1
0
7
9
16
14
33
Tetanus
0
0
0
1
0
1
3
1
Tuberculosis (Pulmonary) *
69
19
5
89
93
182
255
198
Tuberculosis (Extra-Pulmonary)
37
13
5
43
55
98
112
94
Typhoid /Paratyphoid
105
17
7
130
129
259
160
136
Other diseases
258
68
47
327
373
700
749
451
Total
4434
2033
708
4575
7175
11750
12948
8377
12411
13506
8544
Cholera
Foodborne illnesses **
7
6
4635
Grand total including ruled out notifications
Illnesses covered by national control programs
Foodborne illnesses other than those specified in the list
All notified malaria cases are “imported”
$ None of the reported Haemophilus influenzae cases was found meeting the case definition criteria.
Grand total with all ruled out notifications for Q1-Q2 over the three years
Indicates increase or decrease in number of notified cases during the 2nd quarter of 2012 compared to first quarter
Indicates increase or decrease in numbers of notified cases over Q1-Q2 2012 as compared to the previous two years
The number of whooping cough is increasing elsewhere as well, like in the US.
Page 4
Quarterly Summary Report: 2nd Quarter - 2012
Table 2: Notified Illnesses in
Abu Dhabi Emirate by Age & Gender (Q2, 2012)
Cases
Total
AFP *
1
Brucellosis
1
Chickenpox
3
3
2
5
6
3
8
1
7
6
80 110 520 550 886 931 162 276 244 541 49 215
3
3
3
1
4
51
4
9
1
1
3
31
38
62
76
33
27
10
14
20
32
6
10
4
5
4
1
1
Haemophilus influenzae
4
2
7
11
2
6
23
35
58
1949 2686 4635
1
1
Cholera
Foodborne Illness
6
4
167
0
1
207 374
0
0
0
16
35
51
2
7
3
11
Hepatitis B
16
11
45
38
14
22
3
23
4
13
2
3
84
110 194
Hepatitis C
2
1
14
27
12
37
5
44
4
18
3
2
40
129 169
2
5
1
5
1
2
1
14
17
4
261
129
65
2
29
663 692
Hepatitis A
Influenza
1
2
Malaria
3
4
1
1
2
2
2
7
6
11 167
1
Measles
Meningitis bacterial
2
1
Meningitis viral
1
1
8
Mumps
Pertussis
10
12
2
14
7
15
2
3
2
1
1
1
1
1
2
11
1
4
1
Rubella
4
Scabies
1
5
4
3
Shigellosis
6
4
2
31
1
2
2
33
5
1
1
2
4
1
56
4
4
2
2
5
6
11
2
6
8
14
3
18
51
69
13
14
27
1
5
6
36
1
1
1
1
14
1
4
1
1
1
1
Tuberculosis
(Extra-Pulmonary)
Typhoid /Paratyphoid
Fever
Other Diseases
Total
7
2
6
14
10
29
1
15
2
6
10
16
2
7
1
8
1
7
17
159 176
2
7
9
0
0
0
22
71
93
2
17
38
55
20
109 129
148
225 373
1
Tetanus
Tuberculosis (Pulmonary)
31
0
1
1
2
2
4
1
1
1
1
4
5
21
5
54
4
16
3
8
1
4
8
43
61
17
25
16
27
38
48
18
31
5
14
4
9
3
0
2
132 177 648 724 978 1039 240 595 407 1139 125 537 30 249 24 103 12 16 2596 4579 7175
* The highlighted cells (with red numbers) indicate the age/gender categories that had the largest numbers of reported cases for the given illness.
The grand total after including all ruled out notifications will be 7522
Quarterly Summary Report: 2nd Quarter - 2012
Page 5
Monthly Trends for Selected Notified Diseases
in Abu Dhabi Emirate
(Q1-Q2/2012 Vs 2010 and 2011)
The decrease in reported chickenpox during
Q2 2012 is largely attributed to the introduction of varicella vaccine in Oct 2010. Especially
that the vaccinated cohort is now at the age
group 1-4 years, which used to be among the
most reported cases in previous years.
The peak in April and May was
largely due to Rotavirus infections
that dropped during June, and this
goes with Rotavirus seasonality.
However, acquisition of rotavirus
is not always foodborne, and this
should be considered when interpreting the apparent trend.
Chickenpox
2010
2011
2000
1500
1000
500
31
215
126
2
374
Foodborne Illnesses
160
2012
Number of notified cases
Number of notified cases
2500
Salmonella
Rotavirus
Unspecified
Other
Total
140
2010
120
2011
2012
100
80
60
40
20
0
Jan
0
Feb
Mar
Apr May
Jun
Jul
Aug
Sep
Oct
MONTH
Close to half the cases reported travel history,
and only five had epidemiologic link to another
case. As appear in table 2 (page 5), close to
half aged less than 14 y, and more than two
thirds were males.
Hepatitis A
Number of notified cases
50
Feb
Mar Apr May
2011
40
2012
35
30
25
20
Aug
Sep Oct Nov
Dec
Typhoid/Paratyphoid
2010
80
2011
70
2012
60
50
40
30
20
10
15
0
10
Jan
Feb
Mar Apr May
Jun
Jul
Aug
Sep
Oct Nov
Dec
MONTH
5
0
Jul
The number of reported cases started to decrease
in May, as reporters were informed to refer to the
case definition for reporting (which requires positive culture or epidemiologic link in addition to the
clinical picture).
2010
45
Jun
MONTH
Nov Dec
Number of notified cases
Jan
Jan
Feb
Mar Apr May Jun
Jul
Aug
Sep Oct Nov
Dec
MONTH
All reported malaria cases are imported, and the
majority of them diagnosed after returning from
their holidays in malaria endemic countries.
Influenza
Malaria
500
2010
50
2011
40
2012
30
20
10
0
2010
450
Number of notified cases
Number of notified cases
60
2011
400
2012
350
300
250
200
150
100
50
Jan
Feb
Mar Apr May Jun
Jul Aug
MONTH
Sep Oct Nov
Dec
0
Jan
Feb
Mar Apr May Jun
Jul
Aug
Sep Oct Nov
Dec
MONTH
Note: HAAD surveillance officers investigate individual cases, assess for outbreaks, and take action whenever indicated.
Page 6
Quarterly Summary Report: 2nd Quarter - 2012
Visa Screening in Abu Dhabi Emirate
(Q2-2012)
Visa screening is mandatory for all expatriates applying for work and/or residence in Abu
Dhabi Emirate. It consists mainly of screening for Human Immunodeficiency Virus (HIV), pulmonary tuberculosis, and leprosy. Screening for Hepatitis B and syphilis are limited to a few
occupational categories. HAAD Visa Screening Standard is available at: http://www.haad.
ae/HAAD/LinkClick.aspx?fileticket=DDCVCmde9R0%3d&tabid=819
Around quarter a million people or more apply for visa medical screening every three months
in Abu Dhabi Emirate. During the second quarter of 2012, a total of 279,720 applicants were
screened in all HAAD-licensed Screening Centers (a total of nine centers in the three regions
of Abu Dhabi).
.
Visa screening applicants during first quarter 2012
300000
279720
250000
217114
No. of Applicants
200000
153704
150000
126016
100000
62606
50000
0
Male
Female
New
Gender
Renew
Total
Visa Status
The table below shows the number and prevalence of positive cases among new and renewal visa applicants during the second quarter of 2012.
Hepatitis B*** Tuberculosis**
HIV
Number
Prevalence
Overall Prevalence
Leprosy
Syphilis***
New
Renew
New
Renew
New
Renew
New
30
4
287
10
86
44
0
0
289
0
19.5
3.2
834.8
54.4
55.95
34.9
0
0
840.6
0
12.2
563.1
46.5
Renew
0
New
Renew
547.9
* Prevalence: the number of positive cases per 100,000 visa screened applicant
** This refers to active TB cases only
*** Applies to tested occupational categories
Quarterly Summary Report: 2nd Quarter - 2012
Page 7
TOPIC OF THE VOLUME
Adult Vaccination Program
Official launch of Adult Vaccination Campaign
The Health Authority of Abu Dhabi (HAAD) officially announced on 30 July, 2012 through its Communicable
Diseases Department the launch of Adult Vaccination
Campaign. This campaign is a part of HAAD Vaccination
Campaign that was previously announced on May 2012 under the theme “Protect Your Health
with Vaccination”.
The announcement event took place in HAAD building in the presence of a diverse group of
attendees from the media, healthcare facilities in Abu Dhabi, and HAAD employees. The event
addressed the importance of adult vaccines in preventing morbidity, especially among adults
who are at high risk of contracting infections and developing related complications.
Inspite of the wide success achieved by HAAD Immunization Programs, the announcement
pointed out to the challenges that “Adults Vaccination” might face as a new concept to the community. However, given the importance of adults’ vaccinations, and to ensure good compliance
and acceptability, HAAD adjoined the announcement with issuing a circular to all health facilities in the Emirate of Abu Dhabi, and produced brochures and video for the public on adults’
vaccines. This would be followed by training workshops and forums for health providers, and a
number of media messages for the public over the coming months.
Why to vaccinate adults?
Given the large burden of some infectious diseases among certain high risk groups of adults (like
old people, people with debilitating medical conditions, travelers, and people in close contact
with or have frequent exposure to infections), the Health Authority of Abu Dhabi identified vaccines to be given to those high risk groups of adults as per best international practices and
WHO recommendations. The aim is to reduce preventable infections and related morbidity and
mortality and to enhance human’s health.
Based on the developed regulations:
“Adult high risk groups”
to be vaccinated
People aged > 65 years
Adults < 65 years at high risk include:
Adults with certain health conditions
•
•
•
Adults with certain non healthy practices
Travelers to high risk areas
Contacts of cases with certain infections
High risk occupational groups
Other special conditions
•
•
•
•
•
immunocompromising conditions
Diabetes
Chronic cardiovascular disease(except
hypertension)
Chronic lung disease(including Asthma)
Chronic alcoholism
Asplenia
Chronic liver disease
Kidney failure, end stage renal diseases,
hemodialysis
The whole list is shown in page 10!
Page 8
Quarterly Summary Report: 2nd Quarter - 2012
What vaccines you would need?
To make it easy for adults to decide what vaccines they need to take, the Communicable
Diseases Department at HAAD developed a simple questionnaire/quiz of 16 questions that
can be simply completed by ticking on the correct statements that pertain to your case.
Once completing all answers, you would click on “My Results” button to get what kind of
vaccines you need to have.
Fill a short quiz to know what vaccines you need to have!
The survey is available at HAAD website on:
http://emqubeweb.com/haad/survey.php
Are you a healthcare professional?
Below is an example of the survey rsult you might get if your answers indicated that you are
working in any healthcare setting (Healthcare Professional).
Vaccine
Suggested if
Number of doses
Tdap Vaccine and Td
booster
You are a healthcare worker and you may not have immunity
to diphtheria, tetanus, or pertussis.
Tdap single dose
Td booster, once every 10 years after
receiving Tdap vaccine
Varicella Vaccine
You are a healthcare worker and you may not have immunity
to chickenpox.
2 doses, 4 to 8 weeks apart
Hepatitis B Vaccine
You are a healthcare worker and may not have
immunity against Hepatitis B.
3 doses at 0, 1 and 6 months
Meningococcal Vaccine
If a microbiologist and routinely exposed to isolates of N.
meningitides.
Single dose every 3 years
MMR Vaccine
You are a healthcare worker and if you may not have immunity
to measles, mumps or rubella.
You are a healthcare worker and need to be vaccinated against
seasonal influenza once every year.
2 doses, 4 weeks apart
Seasonal Influenza
Vaccine
Single dose every year
Travelers to certain places shall receive the recommended adults vaccines!
Travelers
Meningococcal vaccine ACWY135 for travelers to
countries in meningitis belt.
Yellow Fever vaccine for travelers to countries
in the endemic zone.
Rabies vaccine to travelers to high risk areas who
are likely to get in contact with rabies
The following page shows required adults vaccines and indicated groups (the list with detailed scheduled doses is included in HAAD circular to all facilities, available at HAAD website
(Healthcare Facilities - Circulars): http://www.haad.ae/haad/tabid/183/Default.aspx
Quarterly Summary Report: 2nd Quarter - 2012
Page 9
Adults Vaccinations indicated for
High Risk Groups
Vaccine
Indication
• Hajj and Umrah pilgrims
• All healthcare professionals
• All Adults ≥ 65years
• < 65 years Adults at high risk which
include the following :
Seasonal Influenza
(Flu)
immunocompromising conditions
Diabetes
Chronic cardiovascular disease(except
hypertension)
Chronic lung disease(including Asthma)
Chronic alcoholism
Asplenia (including elective splenectomy
and persistent complement component
deficiencies)
Chronic liver disease
Kidney failure ,end stage renal disease,
recipients of hemodialysis
All vaccines will be given through Primary
Health Care Centers in Abu Dhabi, while
contacts of cases will be vaccinated at
Disease Prevention and Screening Centers.
Places for Haj and Umra vaccines are
announced annually.
Vaccine
• People with following conditions (if
did not receive Hib vaccine
Haemophilus influenzae previously)
sickle cell disease
type b (Hib)
leukemia
HIV infection
Splenectomy
• Contacts of a case
Hepatitis A
• Patients with Chronic liver disease
• Persons who receive clotting factor
concentrates
• Outbreak control
• Contacts of a case.
Varicella
• All unvaccinated healthcare
professionals who have no serologic
proof of immunity, prior vaccination, or
history of varicella disease or herpes
zoster
• Contacts of a case
• All Adults ≥ 65years without a history of
Pneumococcal polysaccharide 23 Valent
vaccination
• Adults < 65 years at high risk which include
the following :
Pneumococcal
polysaccharide
23 Valent
Rabies
• Persons with rabies-prone animal bite
• Persons in high-risk occupational groups, such
as veterinarians and their staff, animal handlers,
rabies researchers, and certain laboratory workers
• Travelers to high risk area (traveler who likely to
get in contact with domestic animals particularly
dogs and other rabies vectors)
Hepatitis B
• All unvaccinated healthcare
professionals
• IV Drug user
• Household contacts of Hepatitis
B cases/chronic carries
• Post exposure immunoprophylaxis
• Patients with chronic liver disease
• Person beginning hemodialysis
• Diabetes Mellitus type 1 and 2 up
to age of 59Years
• Contacts of a case include:
Household members
Sexual contacts
Medical staff exposed to
oral or respiratory secretions
Meningococcal
ACWY135
• Hajj and Umrah pilgrims
• Travelers to countries in meningitis
belt
• Asplenia (including elective
splenectomy and persistent
complement component deficiencies)
• Microbiologists who are routinely
exposed to isolates of N. meningitidis.
• Close contacts
Measles, mumps,
rubella (MMR)
• All unvaccinated healthcare professionals
• Premarital Program in case of unavailability of
Rubella vaccine
Contacts of a case
Rubella
• Unvaccinated postpartum
mothers
• Premarital screening program for
unvaccinated female applicant
• Contacts of a case
Tetanus, diphtheria,
pertussis (Tdap)
• All unvaccinated healthcare professionals
Tetanus Toxoid (TT)
• Post tetanus-prone wound
Yellow Fever
• Travelers to countries in the
Yellow Fever endemic zone
Typhoid
Page 10
immunocompromising conditions
Diabetes
Chronic Cardiovascular disease(except
hypertension)
Sickle cell anemia
Cochlear implants
Chronic lung disease include asthma
Chronic alcoholism
Asplenia (including elective splenectomy
and persistent complement component
deficiencies)
Chronic liver disease
Kidney failure ,end stage renal disease,
recipients of hemodialysis
Indication
Contacts of a case
Quarterly Summary Report: 2nd Quarter - 2012
Sharing Reports
Figures from HAAD Premarital Screening Report, 2011
Consanguinity
Marriage Consanguinity Rate by Nationality, Abu Dhabi, 2011
(Premarital Screening Applicants n=2341)
50.0%
Nationals
45.0%
Premarital screening applicants during
2011 revealed that 1130 (20%) of UAE
nationals married their 1st cousin, 294 (5%)
second cousins, and 494 (7%) married
distance cousins. The overall consanguinity was higher among UAE nationals 1838
(32.3%) when compared to expatriates 503
(13.3%).
Expatriates
40.0%
35.0%
32.3%
Rate
30.0%
25.0%
20.0%
19.9%
13.3%
15.0%
10.0%
7.3%
8.2%
5.2%
5.0%
2.6%
2.5%
0.0%
1st Degree
2nd Degree
3rd Degree
Total
Consanguinity
Smoking and types
Adult Smoking Prevalence by Type, Abu Dhabi 2011
(Premarital Screening Program applicants n=2309)
40.0%
35.0%
30.0%
24.7%
Rate
25.0%
20.0%
15.0%
11.5%
10.0%
5.9%
5.0%
4.8%
0.0%
Cigarette
Medwakh
Waterpipe Overall Smoking
• Close to one quarter of premarital screening applicants during 2011 were current
smokers, with men were more than
women to be current cigarette smokers
(19.2% Vs 3.5%).
• Women were much less likely to smoke
medwakh than men ((0.1% Vs 11.5%),
with male UAE Nationals had the highest
prevalence (16.1%).
• The prevalence of waterpipe smoking
was 6.8% among men and 2.8% among
women, with the highest prevalence was
among Arab expatriate men (10.2%)
• Such variations in prevalence reflect
preferences for different modes of tobacco consumption by nationality, age
group, and gender.
• Enforcement of tobacco control laws
and targeted health education programs are required to reduce tobacco
consumption and related morbidity and
mortality.
Quarterly Summary Report: 2nd Quarter - 2012
Page 11
Contributions!
Judicious use of antibiotics
By: Kholoud Jamal, Infectious Diseases Clinical Pharmacist, Tawam Hospital; Aqeel Saleem, Infectious Diseases Consultant, Tawam Hospital.
Since their introduction in 1940s, antimicrobial agents have significantly reduced morbidity and
mortality associated with infectious diseases. Antibiotics are relatively so effective, non-toxic, generally inexpensive, and so easy to use; that they are prone to abuse. Studies suggest that overall, up
to 50% of antibiotic usage is inappropriate. The widespread use of antibiotics in hospitalized and
non-hospitalized patients has been associated with increase in bacterial strains and species that no
longer respond to treatment with most antibiotics. The world is facing a major public health threat
with the spread of antibiotic-resistant bacteria running ahead of production of new antibiotics to fight
them, leading to increased mortality due to multi-drug resistant microorganisms, increased length of
hospital stay, increased C. difficile & other ecological consequences and increased healthcare costs.
Achieving more judicious prescribing of antibiotics requires an understanding of the factors that
promote overuse and the barriers to change, and implementation of effective strategies for changing behavior. Among providers, most physicians are aware that antibiotics misuse/overuse is a major
risk factor for the development of antibiotic resistance; despite this recognition, unnecessary antibiotic prescriptions remain common. The majority of this abuse occurs in treatment of upper respiratory infections, for example, pharyngitis, acute otitis media, and acute bronchitis, for which antibiotic
use is not proven to be beneficial. Particularly worrisome is the overuse of fluoroquinolones and
cephalosporins as first-line agents for the treatment of respiratory tract infections. On the other
hand, patients’ lack of knowledge and past experience contribute to increased misuse of antibiotics. Many patients have received antibiotics for viral respiratory illness, and these treatments were
perceived as effective because the infections were generally self-limiting.
Overcoming barriers to more judicious prescribing needs the development of materials to support
change, implementation of effective strategies, and development of supportive structures in healthcare organizations. Those efforts should take into consideration the two sides of this issue, the
patients and prescribers.
Implementation of an antimicrobial stewardship program is the recommended strategy to help
improving the proper use of antibiotics. These antimicrobial stewardship programs are interventions
designed to ensure that patients receive the right antibiotic, at the right dose, at the right time, and
for the right duration. Hospitals are adopting various stewardship strategies to minimize the misuse
of antimicrobials and decreasing the burden of resistance, an example is the formulary restriction
and preauthorization requirements for certain classes of antibiotics. From a provider’s perspective,
education at an individual level or small group level is one effective strategy. Another effective strategy is the adoption of clinical practice guidelines, which has to be accompanied by other educational activities. Patients should also be involved in this educational process, in order to increase the
awareness of common infections and diseases among patients.
Page 12
Quarterly Summary Report: 2nd Quarter - 2012
Activities
The Communicable Diseases Department conducted several activities during the second quarter of
2012. Below are briefs on the main activities took place during that period.
1) Meetings and Workshops with Police Social Support Centers
Abu Dhabi workshop for Police Social Support
Western Region workshop for Police Social Support
HAAD communicable diseases team arranged three workshops in coordination with Abu Dhabi Social Support Centers in the three regions of Abu Dhabi Emirate (Abu Dhabi
city, Al Ain, and the Western Region). During the meetings
HAAD team discussed the importance of collaboration
between the two authorities; mainly in follow up of defaulters
from disease control programs. The workshops targeted all
staff working in those centers, to increase their awareness
about communicable diseases and their burdens, and the
different programs run by HAAD Communicable Diseases
Department to prevent and control the spread of those illnesses in the community. The workshop focused mainly on
illnesses like tuberculosis and HIV infections, and how social
support can help combating the stigma surrounding those
illnesses and encourage infected people to seek medical
care and abide by recommended treatment protocols. A
total of 70 participants attended the three workshops in the
three regions of Abu Dhabi.
Al Ain workshop for Police Social Support
2) CME on Malaria Prevention in Travelers from UAE
An educational session on malaria prevention among travelers from UAE was conducted on 30th of
June 2012. The CME activity targeted physicians working in primary health care and Disease Prevention and Screening Centers. The importance of this CME activity comes from the fact that the majority
of imported malaria cases are diagnosed in patients returning from their holidays in malaria endemic
countries. Taking malaria prophylaxis medication, in addition to mosquitoe bite prevention, will minimize the possibility of being infected by malaria.
The CME covered the epidemiology of malaria and malaria endemic countries, products used to prevent mosquito bite, medications used for malaria prophylaxis, and prophylaxis in special groups mainly
children and pregnant women.
Quarterly Summary Report: 2nd Quarter - 2012
Page 13
3) Training Workshop on Malaria
Laboratory Diagnosis with Ministry of
Health Oman
The Communicable Diseases Department at HAAD organized through its Malaria Control Program a training workshop
on Malaria Laboratory Diagnosis during the period from 25
to 27 June, 2012.The workshop was arranged in collaboration between HAAD and the Ministry of Health in Sultanate
of Oman. It targeted laboratory technicians from the main
public and private hospitals diagnosing malaria in UAE. The
aim was to enable laboratory technicians to acquire up to
date technical knowledge on malaria microscopic diagnosis, so they can confidently diagnose the different types of
malaria parasites, which is the corner stone for physicians
to treat malaria appropriately and as per the internationally
recommended guidelines.
Malaria has been eliminated from UAE and reintroduction is
a threat that should be prevented through effective laboratory diagnosis, treatment, epidemiological investigation, and
vector control.
4) Continuation of e-Infectious
Diseases Notifications Workshops
HAAD communicable diseases team conducted two additional workshops on e-notification of infectious diseases during April 2012, targeting Zayed Military and Al Rahba Hospitals in Abu Dhabi. The workshops introduced attendees
to the benefits of the electronic notification system for both
HAAD and the reporting facility in terms of confidentiality,
record keeping, search options, and timeliness of reporting.
It included an enhanced training on the different parts of the
notification process; stressed on the importance of filling the
investigation subforms; and openly discussed noticed gaps.
Page 14
Quarterly Summary Report: 2nd Quarter - 2012
Flash News
Measles and rubella eradication-Meetings and new resolutions
The GCC Committee of infectious diseases conducted a meeting in Dubai during the period 1-2
April 2012, to discuss the regional and international efforts in the eradication of measles and rubella. The meeting was attended by representatives from all member states of the GCC for health
affairs, in additions to representatives from the Executive Council of the GCC Ministers of Health
and the WHO. After discussing the updated reports presented by countries, a set of recommendations were raised to allow achieving the goals of eradication in the GCC region. Consequently,
the GCC Ministers of Health released on May 2012 the Resolution No. 8 for Conference (73), with
the following main points:
•
•
•
Circulation to all GCC approved Home Screening Centers to assess the vaccination status of applicants for
measles and rubella, and to give additional dose of measles and rubella vaccine before issuing a Fitness
Certificate.
Asking for vaccination records certificates from all newcomers less than 18 years old (especially to assess for
measles, German measles, and polio vaccines), and to give children necessary doses in case of non completion of the required schedules.
Assess the possibility of giving the second dose of MMR during the second year of age, and ensure completion of the second dose before school entry.
Acceptance of the UAE report by the certification committee of polio eradication!
The UAE hosted the 26th meeting of the Regional Commission of Certification (RCC) of polio
eradication for countries of the Eastern Mediterranean Region of the WHO (EMRO). This is an
annual meeting to discuss the abridged annual update reports on the performance of polio eradication programs and polio situation in all member states of EMRO. The UAE Abridged Annual Update Report for 2011 , which is a national documentation submitted annually by the UAE National
Certification Committee, was among the accepted reports that were considered adequate by the
WHO/EMRO, and hence UAE maintained the WHO certification of polio eradication.
Expansion of “Home Screening “ to include Ethiopia
The Home Screening Program has been expanded to include Ethiopia as the third country after
Indonesia and Sri Lanka. This came by a ministerial decree that is to be effective starting from July
2012. Hence, similar to previous two countries, all applicants coming from Ethiopia for residency
or work in UAE have to do medical screening in their home country, and this should only be done
in any of the GCC approved centers there. Medically fit newcomers from all three countries will be
subjected to re-testing once arriving UAE, and therefore must show the original and copy of the
home-issued fitness certificates at any of the designated screening centers in UAE.
HAAD and Dubai Health Authority share experiences!
The two health authorities of Abu Dhabi and Dubai met early in April 2012 to discuss all possible
collaborations especially with respect to reporting of infectious diseases. HAAD and DHA shared
their experiences in e-notifications and all documentations and standards related to communicable diseases surveillance. Such kind of collaboration is expected to grow given the sincere intentions of both authorities to make better investment for resources available at their institutes.
Quarterly Summary Report: 2nd Quarter - 2012
Page 15
Complicated hand, foot and mouth disease claimed dozens of Cambodian children
The World Health Organization helped the Cambodian Ministry of health investigating an illness that
was initially considered mysterious. The unknown illness was described as a severe respiratory disease with neurologic symptoms affecting children, mostly under 3 years of age, and generally starts
with high fever. Initially it was announced that 61 of the 62 children admitted in hospitals have died from
the disease, but further investigation showed that 57 out of the 78 cases meeting the case definition
died of the illness.
The investigations into the cases and deaths have lastly concluded that a severe form of hand, foot
and mouth disease (HFMD) was the cause in the majority of cases, where most of the tested samples
were positive for Enterovirus 71 (EV-71) that causes HFMD. It was found that a significant number
of cases had been treated with steroids at some point during their illness, which has been shown to
worsen the condition of patients with EV-71.
Enhanced surveillance for neuro-respiratory syndrome was established, and it is therefore expected
to identify occasional new cases in the coming months. Additionally, the authorities trained the staff on
proper management, and raised public awareness on prevention, identification, and care.
Bone marrow transplants and hopes for HIV cure!
Infection with the human immunodeficiency virus type 1 (HIV-1) requires the presence of a CD4
receptor and a chemokine receptor, principally chemokine receptor 5 (CCR5). Homozygosity for a
32-bp deletion in the CCR5 allele provides resistance against HIV-1 infection. So far, only one person who was infected with HIV-1 and had bone marrow transplant to treat acute myeloid leukemia
has been considered cured of HIV. In his case, the bone marrow donor was not only HIV-negative,
but was homozygous for CCR5 delta32 (i.e. had a rare genetic mutation that blocks HIV from
entering cells).
Recently, researchers at the International AIDS Conference in Washington made presentations on two
HIV-positive men who developed lymphoma. In both cases, their treatment included a bone marrow
transplant, which results in a new immune system. The bone marrow donors did not have HIV, but
did not have the rare genetic variant like in the reported cured case a couple of years back. However,
researchers could not detect any HIV genetic material in the patients’ blood until seventeen months
after the transplants. They say this can be due to the antiretroviral drugs the patients are taking, and
only when they can successfully stop their medication can they be considered cured of HIV. However,
marrow transplantation is not currently considered as a treatment option for HIV.
Promising malaria vaccine from algae!
The difficulty to develop a vaccine against malaria is that it requires producing complex three-dimensional proteins similar to those made by the parasite. Biologists at the University of California, in collaboration with a professor of medicine who is a leading expert in tropical diseases, have succeeded in
engineering algal proteins that are structurally similar to the native malaria proteins and elicit antibodies
that recognize Pfs25 and Pfs28 from P. falciparum. When injected into laboratory mice, such proteins
made antibodies that bind the surface of in-vitro cultured P. falciparum sexual stage parasites and
therefore blocked malaria transmission from mosquitoes. Thus, algae are promising organisms for
producing malaria vaccine.
Page 16
Quarterly Summary Report: 2nd Quarter - 2012
The volume “Flash- on-an-Illness”:
Typhoid/Paratyphoid fever
Illness and cause: Typhoid fever is a life-threatening illness caused by the bacterium Salmonella
Typhi (Salmonella enterica serotype Typhi). Paratyphoid fever is a similar illness caused by S. Paratyphi A, B, or C. These bacteria live only in humans, and infected people carry the bacteria in their
blood stream and intestinal tract, and shed them in their stool and urine (with about 1-3% of cases
continue carrying the bacteria and shedding them for more than a year after recovery “chronic carriers”). The illness is common in most parts of the world, but mainly in developing countries. Cases in
industrial countries are mostly acquired while traveling internationally.
Source of infection: People get infected through contaminated drinking water or food (i.e. eating
food or drinking beverages that have been handled by a person who is shedding the bacteria, or if
sewage contaminated with the bacteria gets into the water you use for drinking or washing food).
Large epidemics are most often related to fecal contamination of water supplies or street vended
foods.
Clinical picture: The illness has an insidious onset characterized by fever (usually sustained fever as
high as 39°-40° C), headache, constipation, malaise, chills, myalgia, loss of appetite, and may have
abdominal pain, diarrhea and vomiting. The serious complications of typhoid fever generally occur after
2–3 weeks. Confusion, delirium, intestinal perforation, and death may occur in severe cases. Case-fatality
rates of 10% in Typhoid fever can be reduced to less than 1% with appropriate antibiotic therapy.
Diagnosis: The etiologic agent may be recovered from the bloodstream or bone marrow, and occasionally from the stool or urine. Therefore, diagnosis depends on isolation of S. Typhi from blood,
stool, or other clinical specimen. Widal test alone is not sufficient for diagnosis.
Treatment: Three commonly prescribed antibiotics are ampicillin, trimethoprim-sulfamethoxazole, and
ciprofloxacin. Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely
occur. However, in recent years, development of antibiotic resistance has resulted in more challenges.
Occurrence: Typhoid/paratyphoid fever is most prevalent in poor areas that are overcrowded and
have poor access to sanitation. South-Central Asia, Southeast Asia, and Southern Africa are regions with high incidence. Worldwide, there are about 21 million cases of typhoid fever and 200,000
deaths occur every year. An additional 6 million cases of paratyphoid fever are estimated to occur
annually.
In Abu Dhabi Emirate, brucellosis is a reportable infectious disease that needs to be notified
within one calendar day
The incidence of typhoid/paratyphoid during 2011 was 17 per 100,000 population. However, about
three quarters of the cases were reported based on positive serological testing, which is not sufficient
for diagnosis.
HAAD Case Definition for Reporting
Probable
A clinically compatible
case that is epidemiologically linked to
a confirmed case in an
outbreak.
Confirmed
A clinically compatible case that
is lab confirmed by isolation of
the bacteria from blood, stool, or
other specimen.
Below are some figures that show the epidemiology of typhoid/paratyphoid fever during 2011 in the
Emirate of Abu Dhabi, and sources of infection.
Quarterly Summary Report: 2nd Quarter - 2012
Page 17
Epidemiology of Typhoid/Paratyphoid fever in Abu Dhabi Emirate, 2011
Notified Typhoid/Paratyphoid in AD Emirate by
Region, 2011
Most of the
cases were
reported from
Abu Dhabi city,
but in the vast
majority it was
based on
serological
testing only, and
in absence of
any epidemiological link to a
confirmed case.
350
303
No. of Cases
300
Notified Typhoid/Paratyphoid in AD
Emirate by Nationality, 2011
250
Abu Dhabi
200
Eastern
150
9%
Western
68
100
50
91%
23
0
Abu Dhabi
Eastern
Western
Region
Notified Typhoid/Paratyphoid in AD Emirate
by Age and Gender, 2011
Notified Typhoid/Paratyphoid in AD Emirate
by Risk Factors 2011
140
120
2%
100
Unknown
Male
80
Travel History
21%
Suspected Food
60
Others
64%
40
20
The increase in number of reported cases
during the last two years coincide with the
implementation of the e-notification and
improvement in reporting. However, the
majority were not confirmed.
65
+
4
4
55
-6
4
45
-5
34
35
-4
-2
4
25
-
4
14
15
5-
1-
y
0
<1
Age in years
Only culture
positive cases
are considered
confirmed.
Widal test is not
enough for
diagnosis.
Reported Typhoid/Paratyphod by testing
results in AD Emirate, 2011
Widal test
Culture
500
Not tested
No. of Cases
No. of Cases
13%
Female
Of those with
travel history,
the majority of
cases (86%)
were coming
back from
South Asia.
6%
20%
74%
Typhoid / Paratyphoid in Abu Dhabi Emirate
(2005-2011)
394
400
347
300
200
100
129
57
81
82
2006
2007
163
0
2005
2008
Year
Page 18
Quarterly Summary Report: 2nd Quarter - 2012
2009
2010
2011
Editorial Board
- Dr. Farida Al Hosani (Manager, Communicable Diseases Department, HAAD)
- Dr. Mariam Al Mulla (Senior Officer, Communicable Diseases Department, HAAD)
- Dr. Ahmed Abdulla (Senior Officer, Communicable Diseases Department, HAAD)
- Dr. Badreyya Al Shehhi (Senior Officer Vaccines, Communicable Diseases Department, HAAD)
- Dr. Kamal Jaafar (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Ahmed Khudhair (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Lamees Abu Haliqa (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Bashir Aden (Senior Officer, Surveillance Section, HAAD)
- Dr. Ghada Yahia (Senior Regional Officer, Communicable Diseases Section, HAAD)
Scientific Board
- Dr. Iain Blair (Associate Professor, Community Medicine, UAEU)
- Prof. Tibor Pal (Professor, Department of Medical Microbiology, UAEU)
- Dr. Agnes Sonnevend (Assistant Professor, Department of Medical Microbiology, UAEU)
- Dr. Rayhan Hashmey (Consultant Infectious Diseases, Tawam Hospital)
- Dr. Ahmed Al Suwaidi (Consultant Pediatric Infectious Diseases, Assistant Professor, UAEU)
- Dr. Bashir Aden (Senior Officer, Surveillance Section, HAAD)
- Dr. Jamal Al Mutawa (Manager, External Services Department, HAAD)
We are glad to invite your participation in this bulletin,
please contact:
Dr. Ghada Yahia
Communicable Diseases Department, HAAD
Tel: 03 7041130
Fax: 03 7679556
Email: [email protected]
Quarterly Summary Report: 2nd Quarter - 2012
Page 19