Emerging and Reemerging Diseases in the World Health Organization (WHO) Eastern Mediterranean Region-Progress, Challenges, and WHO Initiatives

Exploring the National Nursing Research Priorities in the Eastern Mediterranean Region and Overcoming the Associated Challenges: An Expert Opinion

BACKGROUND

 Nurses play a significant role in contributing to various health priorities globally, including research. Identifying the status of national nursing research priorities in the Eastern Mediterranean Region is crucial to cultivating these priorities. This expert opinion paper highlights the existing status of national nursing research priorities in Eastern Mediterranean Region countries concerning their existence and publicity.

METHODS

 Experts from nine Eastern Mediterranean Region countries, including Egypt, Iran, Iraq, Jordan, Pakistan, Palestine, Qatar, Oman, and Saudi Arabia, contributed to this report. They participated by completing a cross-sectional survey and providing a narrative description of their opinions.

RESULTS

 The findings revealed that 58% of the participating countries have existing national nursing research priorities, while 25.8% do not, and 16% are under development. Governmental organizations developed the largest portion of the priorities (38%). Midwives were not considered in half of the published priorities. The vast majority of national nursing research priorities (65%) were developed by experts' opinions and consensus, and 33% only have an associated strategy, outcome measures, and/or funding opportunities. Generally, most published research priorities were not updated regularly.

CONCLUSION

 Eastern Mediterranean Region countries face a challenge with the need for more nurses, which may hinder their involvement in research projects or continued education. Despite this, all countries involved in this report emphasized the importance of developing nursing education and research as priorities for improving their current nursing workforce. Health policymakers, nurse practitioners, academic researchers, educators, and nursing leaders should collaborate to develop operational plans to foster national nursing education and research.

Drug-use disorders in the Eastern Mediterranean Region: a glance at GBD 2019 findings

PURPOSE

The aim of this study is to investigate drug use disorders which are a major cause of Disability Adjusted Life Years (DALYs) in the Eastern Mediterranean Region (EMR).

METHODS

This article is a part of the global burden of diseases (GBD), injuries, and risk factors 2019 study. The GBD modeling approach was used to estimate population-level prevalence of drug use disorders. We combined these estimates with disability weights to calculate years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 1990-2019.

RESULTS

It is estimated that in 2019 in EMR around 3.4 million people have drug use disorder which has increased by 137% compared to 1990. Also, in 2019, DALY number for drug use disorders was 1217.9 (95% UI: 940.4, 1528.9) thousand years and 7645 (95% UI: 6793.7, 8567.9) deaths occurred. The DALY rate increased 39.6% in the region since1990, whereas the global rate increased by 24.4%. United Arab Emirates, Libya, and Iran were most affected by drug use disorders with the highest rates of age-standardized DALY in EMR in 2019. The most prevalent drug use disorder in the region is opioid use which is accountable for 80% of all drug use disorders DALYs.

CONCLUSION

Despite many interventions, drug use disorders are still responsible for high rates of DALY in the region which has increased since 1990 in both males and females; more comprehensive policies, better control measures and proper education could reduce the adverse effects.

Assessment of the hematological profiles among COVID-19 patients during the first and second waves in Ethiopia: A multicenter retrospective cohort study

Background

The coronavirus disease 2019 is highly infectious and patients with coronavirus diseases demonstrated a series of clinical symptoms caused by severe acute respiratory syndrome coronavirus-2. Without a break of the wave's hematological profile of the patients is still ambiguous and differs from wave to wave.

Objective

This study aimed to assess the hematological profile among coronavirus disease 2019 patients during the first and the second waves in Ethiopia.

Methods

A multi-centered facility-based retrospective cohort study design was conducted at six coronavirus disease 2019 treatment centers. A total of 538 study participants were enrolled in the selected coronavirus disease 2019 treatment centers during the first and second waves of the pandemic. The demographic characteristics, underlying diseases, symptoms, and hematological parameters of patients were recorded. Data were entered into Epi-Data Manager 4.6 and analyzed using STATA 14.2. An independent sample t-test was used to assess the mean differences in hematological parameters across waves. Associations between categorical variables across waves were also determined using Chi-square and Fisher exact tests.

Results

Among the total study participants, 240 (44.6%) and 298 (55.4%) patients were taken from wave-1 and wave-2, respectively. The average age of the study participants was 56.44 ± 16.25 years. The most frequent comorbidities in this study were hypertension, diabetes mellitus, ischemic heart disease, and asthma. The most presenting symptoms of COVID-19 infection across the two waves were presented. In the first wave, dry cough 166 (69.2%), fatigue 153 (63.75%), shortness of breath 148 (61.67%), and fever accounted 116 (48.33%), while during the second wave, dry cough 242 (81.2%), fatigue 244 (81.88%) shortness of breath 204 (68.47%) and fever account 180 (60.40%). White blood cells (WBC), neutrophils, and lymphocytes had shown increment during the first wave. Platelet count and platelet distribution width (p < 0.001) had significant mean differences across the two waves, while the other had no significant mean difference.

Conclusion

In the present study, dry cough, fatigue, shortness of breath, and fever were found to be the most presenting symptoms of COVID-19 infection across the two waves. Only the platelet count and platelet distribution width had significant mean differences across the two waves, while the other had no significant mean difference across waves.

Driving factors of urban community epidemic prevention and control capability: QCA analysis based on typical cases of 20 anti-epidemic communities in China

Introduction

In the wake of the COVID-19 outbreak, urban communities have emerged as the frontline defenders in epidemic prevention and control, providing the most effective means of curbing the spread of virus both inward and outward. This study attempts to explain the underlying factors and mechanisms that shape the community epidemic prevention and control capacity (CEPCC).

Methods

We adopted a resilience-based perspective and drew on a sample of 20 exemplary anti-epidemic communities in China. By constructing an analytical framework and employing the fuzzy set qualitative comparative analysis method (fsQCA), we explored how four conditional variables-infrastructure completeness, community self-organizing ability, redundancy of community resources, and stability of regional economic development-and their various configurations impact the CEPCC.

Results

Our findings reveal that the four conditional variables, when considered in isolation, cannot effectively enhance the CEPCC. Instead, four configuration pathways with mixed conditional variables exist. Notably, community self-organizing ability emerges as a vital condition for effectively strengthening the CEPCC.

Discussion

This study identifies four pathways to improve the CEPCC and confirms the validity of the data results through case studies. Conclusions of this research contribute to a more nuanced understanding of the factors influencing the CEPCC, which can help communities to better plan and prepare for future epidemics and ensure better response and adaptation to the impacts of future emergencies.

Rapid response teams in the Eastern Mediterranean Region: Results from the baseline survey of country-level capacities, operations and outbreak response capabilities

The aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response.

Cholera prevention, control strategies, challenges and World Health Organization initiatives in the Eastern Mediterranean Region: A narrative review

The resurgence of cholera is presenting unusual challenges in the Eastern Mediterranean Region (EMR), where it is considered endemic in nine-member states. The risk of a cholera outbreak spreading to non-endemic countries remains high. We discuss the regional trends of cholera, regional burden, and challenges with a focus on World Health Organization (WHO) initiatives in the region that could be useful in preventing and controlling the disease in similar contexts. Despite significant progress in the control of cholera worldwide, the disease continues to be a major public health problem across the region, where it constitutes both an emerging and re-emerging threat. Recurring cholera outbreaks are an indication of deprived water and sanitation conditions as well as weak health systems, contributing to the transmission and spread of the cholera infection. We note that despite the challenges in eliminating cholera in the region, effective implementation of the proposed WHO EMR Strategic framework, among other measures, could sustain the region's cholera prevention, preparedness, and response needs.

Rodent-borne viruses in the region of Middle East

Rodents are one of the most abundant mammal species in the world. They form more than two-fifth of all mammal species and there are approximately 4600 existing rodent species. Rodents are capable of transmitting deadly diseases, especially those that are caused by viruses. Viruses and their consequences have plagued the world for the last two centuries, three pandemics occurred during the last century only. The Middle East is situated at the crossroads of Africa and Asia, along with the Mediterranean Sea and the Indian Ocean, its geographic importance is gained through the diversity of topographies, biosphere, as well as climate aspects that make the region vulnerable to host emerging diseases. Refugee crises also play a major role in expected epidemic outbreaks in the region. Public health has always been the most important priority, and our aim in this review is to raise awareness among public health organisations across the Middle East about the dangers of rodent borne diseases that have been reported or are suspected to be found in the region.

Vector-Borne and Zoonotic Diseases in the Eastern Mediterranean Region: A Systematic Review

BACKGROUND AND OBJECTIVE

World Health Organization Eastern Mediterranean Region (WHO EMR) has 40% people in the world in need of humanitarian assistance. This systematic review explores selected vector-borne and zoonotic diseases (VBZDs) of importance to EMR in terms of disease burden across countries and periods, disaggregated across sex, age groups, education levels, income status, and rural/urban areas, related vector or animal source reduction measures, and public health, social and economic impacts and related interventions.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and reviewed articles in PubMed, Embase, and WHO Global Index Medicus published between 1st of January 2011 and 27th of June 2022. Thirteen VBZDs with at least one reported outbreak in the last five years in the region or prioritized as per previous analysis at the WHO global and regional level and based on expert consultations, were included as part of the analysis.

RESULTS

The review included 295 studies-55% on leishmaniasis and dengue combined, and 75% studies from Pakistan, Kingdom of Saudi Arabia, and Iran combined. Hospital-based and nationally representative studies constituted 60% and 10% respectively. Males were predominantly affected in most diseases; children reported high burden of Leishmaniasis, whereas elderly had a higher burden of Dengue Fever and Middle East Respiratory Syndrome. Although very few studies reported on socioeconomic differences in burden, the ones that reported showed higher burden of diseases among the disadvantaged socioeconomic groups such as the poor and the less educated. More than 80% studies reported an increase in burden over the years.

CONCLUSION

The literature is scanty for most of the diseases reviewed and the number of studies from countries with humanitarian challenges is very low. The need for more nationally representative, population-based studies calls for prioritizing research investments.

Typhoid Fever in the Eastern Mediterranean Region: A Systematic Review, 1990-2021

The occurrence and antimicrobial resistance (AMR) of typhoid fever in the WHO Eastern Mediterranean Region (EMR) are poorly characterized. Robust surveillance data are needed to inform strategies for typhoid control and prevention in the region. We conducted a systematic review of typhoid fever occurrence, complications, and AMR patterns in EMR countries. We identified 70 studies published from 1990 to 2021, including a total of 44,541 cases with blood culture confirmed typhoid fever in 12 EMR countries, with 48 (69%) studies and 42,008 cases from Pakistan. Among 56 studies with AMR data, fluroquinolone (68% of 13,013 tested isolates), and multidrug resistance (40% of 15,765 tested isolates) were common. Forty (57%) of the 56 studies were from Pakistan, and all reports of extensively drug resistant Salmonella Typhi (48% of 9,578 tested isolates) were from studies in Pakistan. Our findings support the need for continued efforts to strengthen surveillance and laboratory capacity for blood-culture detection of typhoid fever in the region, including data from an ongoing collaboration among CDC, the American University of Beirut, and the WHO EMR office.

Compliance of Primary Healthcare Workers in Saudi Arabia With the National Surveillance System of Tropical and Non-tropical Dermatological Diseases

BACKGROUND

 Control and prevention of infectious diseases has been a primary health mandate. The reporting system is a vital step in preventing and controlling of these diseases. Most important, healthcare workers who have a responsibility to report must be aware of this responsibility. The present study aimed to improve the compliance of primary healthcare workers against reportable tropical and non-tropical dermatological diseases.

OBJECTIVE OF THE STUDY

The objective was to assess the knowledge, skills, and practice of primary healthcare workers in Saudi Arabia regarding the surveillance system of reportable tropical and non-tropical dermatological diseases using an assessment tool featuring closed-ended questions. As a secondary objective, this study assessed the satisfaction of primary healthcare workers with the surveillance system.

SUBJECTS AND METHODS

 Through a cross-sectional design, the study used an electronic self-administered questionnaire targeting the primary healthcare workers who met the inclusion criteria through a non-probability sampling technique.

RESULTS

By the end of the study period, data had been collected from 377 primary healthcare workers. Slightly more than half of them worked for the ministry of health facilities. In the last year, the vast majority (88%) of participants did not report any infectious diseases. Poor or low knowledge was reported by almost half of the participants concerning which dermatological diseases should be notified immediately on clinical suspicion or routinely on a weekly basis. Clinically and in response to the skills assessment, 57% of the participants had lower skills scores in detecting and identifying the skin ulcer of leishmania. Half of the participants were less satisfied with the feedback after their notification and considered the notification forms complicated and time-consuming, especially with the usual high workload in primary healthcare centers. Furthermore, the observed significant differences (p < 0.001) in knowledge and skill scores were demonstrated with female healthcare workers, older participants, employees from the Ministry of National Guard Health Affairs, and workers with more than ten years of experience.

CONCLUSION

The present study has shown the limitations of public health surveillance due to underreporting and lack of timeliness. The dissatisfaction of study participants with feedback after the notification step is another finding that demonstrates the need for collaboration among public health authorities and healthcare workers. Fortunately, health departments can implement measures to improve practitioners' awareness through continuous medical education and providing frequent feedback to overcome these hurdles.

A cross-tabulated analysis for the influence of climate conditions on the incidence of dengue fever in Jeddah City, Saudi Arabia during 2006-2009

OBJECTIVE

Increased temperature and humidity across the world and emergence of mosquito-borne diseases, notably dengue both continue to present public health problems, but their relationship is not clear as conflicting evidence abound on the association between climate conditions and risk of dengue fever. This characterization is important as mitigation of climate change-related variables will contribute toward efficient planning of health services. The purpose of this study was to determine whether humidity in addition to high temperatures increase the risk of dengue transmission.

METHODS

We have assessed the joint association between temperature and humidity with the incidence of dengue fever at Jeddah City in Saudi Arabia. We obtained weekly data from Jeddah City on temperature and humidity between 2006 and 2009 for 200 weeks starting week 1/2006 and ending week 53/2009. We also collected incident case data on dengue fever in Jeddah City.

RESULTS

The cross-tabulated analysis showed an association between temperature or humidity conditions and incident cases of dengue. Our data found that hot and dry conditions were associated with a high risk of dengue incidence in Jeddah City.

CONCLUSION

Hot and dry conditions are risk factors for dengue fever.

Emerging and Re-emerging Infectious Diseases in the WHO Eastern Mediterranean Region, 2001-2018

BACKGROUND

Countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) are predisposed to highly contagious, severe and fatal, emerging infectious diseases (EIDs), and re-emerging infectious diseases (RIDs). This paper reviews the epidemiological situation of EIDs and RIDs of global concern in the EMR between 2001 and 2018.

METHODS

To do a narrative review, a complete list of studies in the field was we prepared following a systematic search approach. Studies that were purposively reviewed were identified to summarize the epidemiological situation of each targeted disease. A comprehensive search of all published studies on EIDs and RIDs between 2001 and 2018 was carried out through search engines including Medline, Web of Science, Scopus, Google Scholar, and ScienceDirect.

RESULTS

Leishmaniasis, hepatitis A virus (HAV) and hepatitis E virus (HEV) are reported from all countries in the region. Chikungunya, Crimean Congo hemorrhagic fever (CCHF), dengue fever, and H5N1 have been increasing in number, frequency, and expanding in their geographic distribution. Middle East respiratory syndrome (MERS), which was reported in this region in 2012 is still a public health concern. There are challenges to control cholera, diphtheria, leishmaniasis, measles, and poliomyelitis in some of the countries. Moreover, Alkhurma hemorrhagic fever (AHF), and Rift Valley fever (RVF) are limited to some countries in the region. Also, there is little information about the real situation of the plague, Q fever, and tularemia.

CONCLUSION

EIDs and RIDs are prevalent in most countries in the region and could further spread within the region. It is crucial to improve regional capacities and capabilities in preventing and responding to disease outbreaks with adequate resources and expertise.

Epidemiology of Mosquito-Borne Viruses in Egypt: A Systematic Review

There are at least five common mosquito-borne viruses (MBVs) recorded in Egypt, including dengue virus (DENV), Rift Valley fever virus (RVFV), West Nile virus (WNV), Chikungunya virus, and Sindbis virus. Unexpected outbreaks caused by MBVs reflect the deficiencies of the MBV surveillance system in Egypt. This systematic review characterized the epidemiology of MBV prevalence in Egypt. Human, animal, and vector prevalence studies on MBVs in Egypt were retrieved from Web of Science, PubMed, and Bing Scholar, and 33 eligible studies were included for further analyses. The monophyletic characterization of the RVFV and WNV strains found in Egypt, which spans about half a century, suggests that both RVFV and WNV are widely transmitted in this nation. Moreover, the seropositive rates of DENV and WNV in hosts were on the rise in recent years, and spillover events of DENV and WNV to other countries from Egypt have been recorded. The common drawback for surveillance of MBVs in Egypt is the lack of seroprevalence studies on MBVs, especially in this century. It is necessary to evaluate endemic transmission risk, establish an early warning system for MBVs, and develop a sound joint system for medical care and public health for managing MBVs in Egypt.

Reviewing the Past, Present, and Future Risks of Pathogens in Ghana and What This Means for Rethinking Infectious Disease Surveillance for Sub-Saharan Africa

The current epidemiological transition makes us wonder how the parallel of infectious diseases (IDs) might be at the end of each passing year. Yet, the surveillance of these IDs continues to focus on high-profile diseases of public health importance without keeping track of the broad spectrum of the IDs we face. Here, we presented the prevalence of the broad spectrum of IDs in Ghana. Data from the annual reports on Gold Coast now Ghana, Global Infectious Diseases and Epidemiology Network (GIDEON), and the District Health Information Management System II (DHIMS2) databases were examined for records of ID prevalence in Ghana. Using the IDs from these databases, the paper assessed the epidemiological transition, pathogen-host interactions, spatiotemporal distribution, transmission routes, and their potential areas of impact in Ghana. The topmost ID recorded in health facilities in Ghana transitioned from yaws in the 1890s to malaria in the 1950s through 2020. We then presented the hosts of a pathogen and the pathogens of a host, the administrative districts where a pathogen was found, and the pathogens found in each district of Ghana. The highest modes of transmission routes were through direct contact for bacteria and airborne or droplet-borne for viral pathogens. From GIDEON, 226 IDs were identified as endemic or potentially endemic in Ghana, with 42% cited in peer-reviewed articles from 2000 to 2020. From the extent of risk of endemic or potentially endemic IDs, Ghana faces a high risk of ID burden that we should be mindful of their changing patterns and should keep track of the state of each of them.

Organizational learning, resilience and psychological empowerment as antecedents of work engagement during COVID-19

Purpose

This paper aims to explore the relationship between organizational learning (OL) and work engagement (WE) in the Middle East region amid the COVID-19 pandemic and to test the mediating role of employee resilience (ER) and psychological empowerment (PE) on this relationship.

Design/methodology/approach

The sample size was 208 respondents working in the Middle East area during COVID-19. Hypotheses were tested using regression analysis with bootstrapping.

Findings

The findings indicate a significant positive impact of OL on WE. Moreover, both constructs – ER and WE – were identified as mediators for this relationship.

Practical implications

Practical implications within this study call for organizations to focus on promoting a learning culture in order to adapt and respond effectively to unprecedented external challenges.

Originality/value

The current study extends previous research and strengthens the antecedents of WE, namely, OL, ER and PE in the Middle East region while controlling for COVID-19 perceptions.

Field Epidemiology and Public Health Research Priorities in the Eastern Mediterranean Region: Delphi Technique

Research is essential for evidence-based decision making. This study aimed to identify research priorities in the areas of field epidemiology and public health in the Eastern Mediterranean Region (EMR) from the perspectives of public health professionals. A Delphi technique, using online survey, was employed to reach 168 public health professionals who have experience in the EMR countries. The study took place between November 2019 and January 2020. Consensus on the research priorities was reached after two-round online questionnaires. A list of top 10 field epidemiology and public health research priorities in the EMR was developed. Of those priorities, four fell under health in emergency, war and armed conflict, two under communicable diseases, two under immunization, one under digital health, and one under sexual, reproductive, and adolescent health. Availability, adequacy, and quality of health services in crisis settings were scored as a top priority (mean = 4.4, rank 1), followed by use of technology to improve the collection, documentation, and analysis of health data (mean = 4.28, rank 2), and capacity of countries in the region to respond to emergencies (mean = 4.25, rank 3). This study was conducted prior to COVID-19 pandemic and, thus, it did not capture COVID-19 research as a priority area. Nevertheless, identified priorities under communicable diseases including outbreak investigation of infectious diseases, epidemics and challenges related to communicable diseases in the EMR were still notable. In conclusion, the field epidemiology and public health research priorities identified in this study through a systematic inclusive process could be useful to make informed decisions and gear the research efforts to improve the health of people in the EMR.

Cross-sectional seasonal prevalence and relative risk of ectoparasitic infestations of rodents in North Sinai, Egypt

Background and Aim:

Rodents are ubiquitous animals that host ectoparasites and transmit zoonotic diseases. We conducted a cross-sectional study on the seasonal variation, period prevalence (Pp), and relative risk of ectoparasitic infestations in rodents collected in North Sinai, Egypt, from September 2019 to August 2020.

Materials and Methods:

We captured 380 rodents during the study period. Rodents were euthanized to perform species identification, and 2930 external parasites were collected and identified using light microscopic examination with systemic keys depending on morphological characters.

Results:

Rattus norvegicus (brown rat), Rattus rattus frugivorus (white-bellied rat), Rattus rattus alexandrines (gray-bellied rat), and Mus musculusdomesticus (house mouse) were captured at the highest frequencies during summer (n=186), followed by spring (n=84), fall (n=71), and winter (n=39), with a higher proportion of males captured in all seasons. Analysis of the infestation Pp revealed highly significant increases (p<0.01) in ectoparasites during the winter. Temperature, humidity, and dew point were significantly (p<0.01) correlated with the numbers of captured and infested rodents. Parasitological examinations showed the higher risks of flea (Echidnophaga gallinacea, Xenopsylla cheopis, and Leptopsylla segnis) and lice (Hoplopleura hirsuta, Hoplopleura ocanthopus, Hoplopleura oenomydis, and Polyplax spinulosa) infestations during winter and mite (Laelaps nuttalli, Dermanyssus gallinae, Ornithonyssus bacoti, and Myobia musculi) infestations during summer.

Conclusion:

We conclude that ectoparasitic infestation prevalence and risk varies with predominating macroclimatic conditions. Strict preventive and biosecurity measures should be applied to combat rodent-related problems.

Main Factors Affecting the Readiness and Responsiveness of Healthcare Systems during Epidemic Crises: A Scoping Review on Cases of SARS, MERS, and COVID-19

Background:

Given the significance of the preparedness and responsiveness of healthcare systems in relation to epidemics, this study aimed to determine their influencing factors during epidemic crises with a view to utilizing the findings in the battle against the coronavirus disease 2019 (COVID-19) outbreak.

Methods:

This scoping study was conducted in 2020 via the Arksey and O’Malley approach. A systematic search was conducted on five online databases from January 2000 to June 15, 2020. Initially, 1926 English articles were retrieved based on their abstracts. After the screening process, 60 articles were considered for the final analysis. Data were charted by applying Microsoft Office Excel 2013 and were synthesized via thematic analysis.

Results:

Five main factors have affected the responsiveness and preparedness of countries during the epidemics of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19: community-related interventions, managerial interventions, socioeconomic factors, the readiness of hospitals and health centers, and environmental factors. These themes are associated with 38 related sub-themes. The thematic framework shows that interactions between these five determinantes can affect the preparedness and responsiveness of healthcare systems during pandemics/epidemics.

Conclusion:

According to the results, healthcare systems need to pay attention to their internal capacities, managerial interventions, and health centers to overcome the current pandemic. They should also consider such external factors as socioeconomic and environmental determinants that can affect their potential preparedness against pandemic/epidemic crises. Community-related interventions such as improvement of the community health literacy, teamwork, and social responsibility can enhance the readiness of healthcare systems against the COVID-19 outbreak.

Global Research Activity on Health System Preparedness Against Viral Infectious Disease Outbreaks

OBJECTIVE

The present study aimed to give an overview of research publications on health system preparedness against viral infectious disease outbreaks.

METHODS

A bibliometric method was implemented from 2001 to 2020. The studied pathogens were dengue, Ebola, influenza, Zika, Middle East respiratory syndrome (MERS), Severe acute respiratory syndrome (SARS), and coronavirus disease 2019 (COVID-19).

RESULTS

The search query returned 501 documents. The growth of publications showed a sharp peak in 2020 for COVID-19 and 3 small peaks in 2006, 2009, and 2015 for SARS, influenza, and Ebola, respectively. Of the retrieved documents, 208 (41.5%) were on influenza, 164 (32.7%) were on COVID-19, and 83 (16.6%) were on Ebola. Countries in the region of the Americas (n = 221; 44.1%) returned the majority of the documents, while countries in Latin America and the African region returned the least. The United States (n = 197; 39.3%) had a leading role in this field. The US Centers for Disease Control and Prevention (n = 51; 10.2%) ranked first, followed by the Johns Hopkins University (n = 16; 3.2%). The Disaster Medicine and Public Health Preparedness journal (n = 21; 4.2%) ranked first. International research collaboration was relatively inadequate.

CONCLUSIONS

Research on preparedness against infectious diseases was episodic. Research collaboration needs to be prioritized for countries with a history of fatal outbreaks.

Identifying the research gap of zoonotic disease in displacement: a systematic review

Background

Outbreaks of zoonotic diseases that transmit between animals and humans, against a backdrop of increasing levels of forced migration, present a major challenge to global public health. This review provides an overview of the currently available evidence of how displacement may affect zoonotic disease and pathogen transmission, with the aim to better understand how to protect health and resilience of displaced and host populations.

Methods

A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Between December 2019 - February 2020, PubMed, Web of Science, PLoS, ProQuest, Science Direct and JSTOR were searched for literature. Studies were included based on a focus on zoonotic disease risks in displacement and/or humanitarian emergencies, and relevance in terms of livestock dependency of the displaced populations. Evidence was synthesised in form of a table and thematic analysis.

Results

Of all records, 78 papers were selected for inclusion. Among the included studies, the majority were based on secondary data, including literature reviews (n=43) and case studies (n=5), while the majority of papers covered wide geographical areas such as the Global South (n=17) and Africa (n=20). The review shows significant gaps in the literature, which is specifically lacking primary data on zoonotic diseases in displacement. Risk factors for the transmission of zoonoses in displacement are based on generic infectious disease risks, which include the loss of health services, increased population density, changes in environment, reduced quality of living conditions and socio-economic factors. Regardless of the presence of these disease drivers during forced migration however, there is little evidence of large-scale zoonotic disease outbreaks linked directly to livestock in displacement.

Conclusion

Due to the lack of primary research, the complex interlinkages of factors affecting zoonotic pathogen transmission in displacement remain unclear. While the presence of animals may increase the burden of zoonotic pathogens, maintaining access to livestock may improve livelihoods, nutrition and mental health, with the potential to reduce people’s vulnerability to disease. Further primary interdisciplinary and multi-sectoral research is urgently required to address the evidence gaps identified in this review to support policy and program development.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-021-00205-3.

Spatiotemporal variability of COVID-19 pandemic in relation to air pollution, climate and socioeconomic factors in Pakistan

Information on the spatiotemporal variability of respirable suspended particulate pollutant matter concentrations, especially of particles having size of 2.5 μm and climate are the important factors in relation to emerging COVID-19 cases around the world. This study aims at examining the association between COVID-19 cases, air pollution, climatic and socioeconomic factors using geospatial techniques in three provincial capital cities and the federal capital city of Pakistan. A series of relevant data was acquired from 3 out of 4 provinces of Pakistan (Punjab, Sindh, Khyber Pakhtunkhwa (KPK) including the daily numbers of COVID-19 cases, PM2.5 concentration (μgm-3), a climatic factors including temperature (°F), wind speed (m/s), humidity (%), dew point (%), and pressure (Hg) from June 1 2020, to July 31 2020. Further, the possible relationships between population density and COVID-19 cases was determined. The generalized linear model (GLM) was employed to quantify the effect of PM2.5, temperature, dew point, humidity, wind speed, and pressure range on the daily COVID-19 cases. The grey relational analysis (GRA) was also implemented to examine the changes in COVID-19 cases with PM2.5 concentrations for the provincial city Lahore. About 1,92, 819 COVID-19 cases were reported in Punjab, Sindh, KPK, and Islamabad during the study period. Results indicated a significant relationship between COVID-19 cases and PM2.5 and climatic factors at p < 0.05 except for Lahore in case of humidity (r = 0.175). However, mixed correlations existed across Lahore, Karachi, Peshawar, and Islamabad. The R2 value indicates a moderate relationship between COVID-19 and population density. Findings of this study, although are preliminary, offers the first line of evidence for epidemiologists and may assist the local community to expedient for the growth of effective COVID-19 infection and health risk management guidelines. This remains to be seen.

Prioritizing zoonotic diseases utilizing the One Health approach: Jordan's experience

Background

Zoonotic diseases constitute a threat to humans and animals. The Middle East Region is a hotspot for such a threat; given its geographic location under migratory birds' flight paths, mass gatherings, political conflicts, and refugee crises. Thus, prioritizing zoonotic diseases of national significance is critical for preventing and controlling such threats and optimizing limited resources. Using a multi-sectoral One Health (OH) approach, this study aimed at prioritizing zoonotic diseases of national significance to Jordan and identifying future recommendations and action plans.

Methods

Zoonotic diseases of national significance to Jordan were initially identified (n = 27 diseases). In December 2019, national staff from governmental and non-state sectors were invited to develop ranking criteria, including questions and answers choices, and to weigh each criterion. Then, the national staff were asked to assess zoonotic diseases' priority using the developed criteria and provide recommendations and action plans to strengthen multi-sectoral collaboration.

Results

Seven zoonotic diseases were identified as being of great significance. Rabies was ranked as the number one priority disease, followed by middle east respiratory syndrome, avian influenza, brucellosis, leishmaniasis, rickettsiosis, and salmonellosis. The highest weighted criteria used to rank diseases were disease severity, outbreaks profile, and potential human-to-human transmission. Establishing a one-health platform, surveillance, laboratory, preparedness planning, outbreak response, and workforce were suggested as recommendations for approaching the priority diseases. Respondents identified data sharing, coordination, event-based surveillance, and effective communication channels as vital areas to enhance prevention and control strategies, conduct joint outbreak investigations, and improve multi-sectoral collaboration.

Conclusions

This study represents the first attempt to prioritize zoonotic diseases of national significance in Jordan using the OH approach and a semi-qualitative, transparent, and comparative method. Study results can be used as a decision-making guide for policymakers and stakeholders and a cornerstone for combating zoonotic disease threats.

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This is the first regional report to prioritize zoonotic diseases using the One Health (OH) approach.

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A list of country relevant zoonotic diseases was identified, prioritized, and approved using the OH Zoonotic Disease Prioritization (OHZDP) tool.

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Relevant surveillance systems in Jordan should adopt a standardized data sharing mechanism and an event-based method for zoonotic events.

Screening of ZIKA virus infection among dengue-like illness patients with negative RT-PCR for dengue virus in Punjab - Pakistan

Objective

To detect ZIKV using reverse transcription-polymerase chain reaction (RT-PCR) among clinical samples tested negative for Dengue virus (DENV) by RT-PCR in Punjab, 2016.

Methods

A descriptive cross-sectional study was carried out for duration of two months. Total of 506 samples were collected within seven days from onset of illness from all over hospitals of Punjab, Pakistan of which 350 were selected simply randomly to test for presence of ZIKV by using "Trioplex Real-Time RT-PCR Assay (Trioplex)". Cohen's kappa coefficient (κ) and 95% confidence interval (CI) were used to assess the degree of concordance between DENV positive results of non-structural protein 1 (NS1) and IgM solid-phase enzyme immunoassay (ELISA).

Results

No samples were positive for any ZIKV, DENV or Chikungunya virus (CHIKV) by Trioplex. Among the 350 samples, 26 samples were positive concordant and the degree of concordance between NS1- and IgM-ELISA was 13% and κ coefficient was -0.71 (95% CI -0.79, -0.63).

Conclusion

At study time, no samples were positive for ZIKV. Strengthening laboratory capacity to confirm arboviruses for Punjab's laboratories is warranted. Trioplex RT-PCR has 100% sensitivity so there are nominal chances of false negative results. Establishing syndromic surveillance for Zika and conducting a sero-surveillance survey for Zika in areas with high human and Aedes mosquito density are recommended in Punjab.

Rodent Ectoparasites in the Middle East: A Systematic Review and Meta-Analysis

Rodents carry many ectoparasites, such as ticks, lice, fleas, and mites, which have potential public health importance. Middle Eastern countries are hotspots for many emerging and re-emerging infectious diseases, such as plague, leishmaniasis, Crimean Congo hemorrhagic fever, and Q fever, due to their ecological, socioeconomic, and political diversity. Rodent ectoparasites can act as vectors for many of these pathogens. Knowledge of rodent ectoparasites is of prime importance in controlling rodent ectoparasite-borne zoonotic diseases in this region. The current systematic review and meta-analysis performs a comprehensive synthesis of the available knowledge, providing an evidence-based overview of the ectoparasites detected on rodents in Middle Eastern countries. Following a systematic search in Pubmed, Scopus, and Web of Science, a total of 113 published articles on rodent ectoparasites were studied and analyzed. A total of 87 rodent species were documented, from which Mus musculus, Rattus norvegicus, and Rattus rattus were found to be the most common. Fleas were the most reported ectoparasites (87 articles), followed by mites (53), ticks (44), and lice (25). Xenopsylla cheopis, Polyplax spinulosa, Ornithonyssus bacoti, and Hyalomma rhipicephaloides were the most commonly described fleas, lice, mites, and ticks, respectively. Based on the reviewed articles, the median flea, louse, mite, and tick indices were highest in Israel (4.15), Egypt (1.39), Egypt (1.27), and Saudi Arabia (1.17), respectively. Quantitative meta-analysis, using a random-effects model, determined the overall pooled flea prevalence in the Middle East as 40% (95% CI: 25-55, I2 = 100%, p < 0.00001), ranging between 13% (95% CI: 0-30, I2 = 95%, p < 0.00001) in Iran and 59% (95% CI: 42-77, I2 = 75%, p < 0.00001) in Israel. The overall pooled louse prevalence was found to be 30% (95% CI: 13-47, I2 = 100%, p < 0.00001), ranging between 25% in Iran (95% CI: 1-50, I2 = 99%) and 38% in Egypt (95% CI: 7-68, I2 = 100%). In the case of mites, the pooled prevalence in this region was 33% (95% CI: 11-55, I2 = 100%, p < 0.00001), where the country-specific prevalence estimates were 30% in Iran (95% CI: 4-56, I2 = 99%) and 32% in Egypt (95% CI: 0-76, I2 = 100%). For ticks, the overall prevalence was found to be 25% (95% CI: 2-47, I2 = 100%, p < 0.00001), ranging from 16% in Iran (95% CI: 7-25, I2 = 74%) to 42% in Egypt (95% CI: 1-85, I2 = 100%). The control of rodent ectoparasites should be considered to reduce their adverse effects. Using the One Health strategy, rodent control, and precisely control of the most common rodent species, i.e., Mus musculus, Rattus norvegicus, and Rattus rattus, should be considered to control the rodent-borne ectoparasites in this region.

Helminth Parasites among Rodents in the Middle East Countries: A Systematic Review and Meta-Analysis

Rodents can be a source of zoonotic helminths in the Middle East and also in other parts of the world. The current systematic review aimed to provide baseline data on rodent helminths to recognize the threats of helminth parasites on public health in the Middle East region. Following a systematic search on PubMed, Scopus, and Web of Science, a total of 65 research studies on rodent cestodes, nematodes, and trematodes, which were conducted in the countries of the Middle East, were analyzed. The study identified 44 rodent species from which Mus musculus, Rattus norvegicus, and Rattus rattus were most common (63%) and recognized as the primary rodent hosts for helminth infestation in this region. Cestodes were the most frequently reported (n = 50), followed by nematodes (49), and trematodes (14). The random effect meta-analysis showed that the pooled prevalence of cestode (57.66%, 95%CI: 34.63-80.70, l2% = 85.6, p < 0.001) was higher in Saudi Arabia, followed by nematode (56.24%, 95%CI: 11.40-101.1, l2% = 96.7, p < 0.001) in Turkey, and trematode (15.83%, 95%CI: 6.25-25.1, l2% = 98.5, p < 0.001) in Egypt. According to the overall prevalence estimates of individual studies, nematodes were higher (32.71%, 95%CI: 24.89-40.54, l2% = 98.6, p < 0.001) followed by cestodes (24.88%, 95%CI: 19.99-29.77, l2% = 94.9, p < 0.001) and trematodes (10.17%, 95%CI: 6.7-13.65, l2% = 98.3, p < 0.001) in the rodents of the Middle East countries. The review detected 22 species of helminths, which have zoonotic importance. The most frequent helminths were Capillaria hepatica, Hymenolepis diminuta, Hymenolepis nana, and Cysticercus fasciolaris. There was no report of rodent-helminths from Bahrain, Jordan, Lebanon, Oman, United Arab Emirates, and Yemen. Furthermore, there is an information gap on rodent helminths at the humans-animal interface level in Middle East countries. Through the One Health approach and countrywide detailed studies on rodent-related helminths along with their impact on public health, the rodent control program should be conducted in this region.

Public health response to COVID-19 in selected countries - Hits and misses

Background

Lack of a cure or vaccine of COVID-19 forced us to rely on public health interventions (PHIs) for combating the pandemic. The main objective of the study to assess the PHI in selected countries and relate the various factors related to the intervention with the case load of the country.

Methods

An ecological analysis was conducted using secondary data on PHIs and disease burden extracted from official documents and press releases of the respective countries. Disease transmission was described based on calculated doubling time. PHIs were classified into 14 categories within three domains. An intervention score was calculated to reflect the number and stringency of the PHIs. Correlations between intervention scores, daily new cases and doubling time were presented.

Results

Brazil and the USA had the lowest intervention scores while South Korea had the highest scores. The median doubling time was negatively correlated with the rapidity of the escalation of the PHIs.

Conclusion

Dynamic government policies and timely PHIs, which are locally relevant and ably supported by the public are key to successful containment of the COVID-19 pandemic.

Association Between Socioeconomic Factors and the COVID-19 Outbreak in the 39 Well-Developed Cities of China

Background: Socioeconomic factors play an indispensable role in the spread of emerging infectious diseases. Few studies have investigated the role of socioeconomic factors in the spread of COVID-19.

Methods: The number of COVID-19 cases in the 39 well-developed cities of China was aggregated by searching the publicly available sources. Socioeconomic indicators (e.g., population, population density, gross domestic product, rural-to-urban migrants, urbanization rate, per-person disposable income, and level of health care) in these cities were also aggregated from the Bureau of Statistics. The data referring to travelers from Wuhan were collected from the Baidu Migration database. A multiple stepwise linear regression model was performed to identify the independent risk factors of the number of cases.

Results: As of Mar 19, 2020, a total of 5,939 cases were reported in the 39 well-developed cities with almost half of total cases in China outside of Hubei. The number of cases ranged 20–576, and the median number of cases was 93 (IQR 54–180) in these cities. Nine socioeconomic variables including the number of travelers from Wuhan, population, native population, gross domestic product, Per-person GDP, the number of hospitals, the number of rural-to-urban migrants, traffic capacity, and person-disposable income were recognized as potential contributors of the number of cases. Results of multiple linear regression showed a statistically significant association between the number of cases and the number of travelers from Wuhan (t = 6.746, P = 0.000) and the number of rural-to-urban migrants (t = 3.776, P = 0.001) in these cities. However, other seven potential contributors were not associated with the number of cases. Moreover, a well-fitted multiple regression model was built in this study, and a regression equation was as follows: Y = 0.007X_t + 0.200X_m (adjusted R² = 0.833).

Conclusions: Travelers from Wuhan and rural-to-urban migrants were independently associated with the COVID-19 outbreak in the 39 well-developed cities of China. These findings suggested that travelers from an epicenter and rural-to-urban migrants should be paid more attention in the early stage of the COVID-19 outbreak in the well-developed cities.

Is BCG associated with reduced incidence of COVID-19? A meta-regression of global data from 160 countries

Background

Global research is running towards to find a vaccine to stop the threat of the COVID-19. The Bacillus Calmette–Guérin (BCG) vaccine that prevents severe forms of tuberculosis is getting more attention in this scenario. The objective of our study was to determine the association between BCG vaccine coverage and incidence of COVID-19 at a national-level across the Globe.

Methods

The data of 160 countries were included in the study. Meta-regression was done to estimate the difference in the incidence of COVID-19 cases between countries with BCG vaccination coverage. BCG coverage was categorized as ≤70%, >70% and no vaccination. The analyses were carried out by adjusting for factors such as population density, income group, latitude, and percentage of the total population under age groups 15–64 and above 65 years of each country.

Results

The countries that had ≤70% coverage of BCG vaccine reported 6.5 (95% CI: −8.4 to −4.5) less COVID-19 infections per 10,000 population as compared to countries that reported no coverage. Those that had >70% coverage reported 10.1 (95% CI: −11.4 to −8.7) less infections per 10,000 population compared to those with no BCG countries.

Conclusion

Our analysis suggests that BCG is associated with reduced COVID-19 infections if the BCG vaccine coverage is over 70%. The region-wise analyses also suggested similar findings, except the Middle East and North African region.

Hospital Preparedness Measures for Biological Hazards: A Systematic Review and Meta-Synthesis

BACKGROUND

Biological hazards are one of the most important and common types of hazards in emergencies and disasters. Hospital preparedness measures for biological hazards are essential for a proper response and mitigation of its effects. The aim of this systematic review is to investigate hospital preparedness measures for biological hazards.

METHODS

For this research, electronic databases including Web of Science, PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, and Cochrane Library from March 1950 to June 2019 were searched. Key words such as hospital, emergency department, preparedness, plan, management, and biological hazards were used in combination with the Boolean operators OR and AND. A thematic synthesis approach through the use of MAXQDA software was applied to analyze the data.

RESULTS

In total, 5257 articles were identified, in which 23 articles meet the inclusion criteria for entering the process of final analysis. The findings showed three main administrative, specialized, and logistical issues regarding preparedness measures for biological hazards in hospitals.

CONCLUSION

Hospital preparedness for biological hazards is one of the most important hospital disaster plans. Results of this systematic review present valuable advice for policy-makers and hospital managers to prepare and enhance hospital performance against biological hazards.

Bibliometric analysis of peer-reviewed literature on climate change and human health with an emphasis on infectious diseases

Background

Assessing research activity is important for planning future protective and adaptive policies. The objective of the current study was to assess research activity on climate change and health with an emphasis on infectious diseases.

Method

A bibliometric method was applied using SciVerse Scopus. Documents on climate change and human health were called “health-related literature” while documents on climate change and infectious diseases were called “infection-related literature”. The study period was from 1980 to 2019.

Results

The search query found 4247 documents in the health-related literature and 1207 in the infection-related literature. The growth of publications showed a steep increase after 2007. There were four research themes in the health-related literature: (1) climate change and infectious diseases; (2) climate change, public health and food security; (3) heat waves, mortality, and non-communicable diseases; and (4) climate change, air pollution, allergy, and respiratory health. The most frequently encountered pathogens/infectious diseases in the infection-related literature were malaria and dengue. Documents in infection-related literature had a higher h-index than documents in the health-related literature. The top-cited documents in the health-related literature focused on food security, public health, and infectious diseases while those in infection-related literature focused on water-, vector-, and mosquito-borne diseases. The European region had the highest contribution in health-related literature (n = 1626; 38.3%) and infection-related literature (n = 497; 41.2%). The USA led with 1235 (29.1%) documents in health-related literature and 365 (30.2%) documents in infection-related literature. The Australian National University ranked first in the health-related literature while the London School of Hygiene & Tropical Medicine ranked first in the infection-related literature. International research collaboration was inadequate. Documents published in the Environmental Health Perspectives journal received the highest citations per document. A total of 1416 (33.3%) documents in the health-related literature were funded while 419 (34.7%) documents in the infection-related literature were funded.

Conclusion

Research on climate change and human health is on the rise with research on infection-related issues making a good share. International research collaboration should be funded and supported. Future research needs to focus on the impact of climate change on psychosocial, mental, innovations, policies, and preparedness of health systems.

Vaccine confidence: the keys to restoring trust

During the 20th century, the discovery of modern vaccines and ensuing mass vaccination dramatically decreased the incidence of many infectious diseases and in some cases eliminated them. Despite this, we are now witnessing a decrease in vaccine confidence that threatens to reverse the progress made. Considering the different extents of low vaccine confidence in different countries of the world, both developed and developing, we aim to contribute to the discussion of the reasons for this, and to propose some viable scientific solutions to build or help restore vaccine confidence worldwide.

Increased Susceptibility of Cattle to Intranasal RVFV Infection

Rift Valley Fever virus (RVFV) is a zoonotic mosquito-borne virus that belongs to the Phenuiviridae family. Infections in animal herds cause abortion storms, high mortality rates in neonates, and mild to severe symptoms. Infected animals can also transmit the virus to people, particularly people who live or work in close contact with livestock. There is currently an ongoing effort to produce safe and efficacious veterinary vaccines against RVFV in livestock to protect against both primary infection in animals and zoonotic infections in people. To test the efficacy of these vaccines it is essential to have a reliable challenge model in relevant target species, including ruminants. In this study we evaluated three routes of inoculation (intranasal, intradermal and a combination of routes) in Holstein cattle using an infectious dose of 10⁷ pfu/ml and a virus strain from the 2006-2007 outbreak in Kenya and Sudan. Our results demonstrated that all routes of inoculation were effective at producing viremia in all animals; however, the intranasal route induced the highest levels and longest duration of viremia, the most noticeable clinical signs, and the most widespread infection of tissues. We therefore recommend using the intranasal inoculation for future vaccine and challenge studies.

The Middle East Respiratory Syndrome Coronavirus: An Emerging Virus of Global Threat

Middle East respiratory syndrome (MERS) is a viral respiratory illness caused by a coronavirus (CoV), first identified in Saudi Arabia in 2012. Since then, almost 2000 cases have been reported from 27 countries, with Saudi Arabia being the epicenter. This newly emerging virus is highly pathogenic and has a case mortality rate of 35%. It is similar to the CoV causing severe acute respiratory syndrome CoV (SARS-CoV) in that both belong to the genus beta CoVs that are of zoonotic origin and cause lower respiratory infection. The natural reservoir for MERS-CoV remains unknown. Serological studies indicate that most dromedary camels in the Middle East have been infected with this virus, and they maybe the potential intermediate host. However, the mode of transmission from camels to humans is poorly understood. The majority of confirmed human cases have resulted from human-to-human transmission, most probably via respiratory route. Patients most at risk of developing severe MERS-CoV infection appear to be those with underlying conditions such as diabetes, hypertension, obesity, cardiac diseases, chronic respiratory diseases, and cancer. Unlike SARS-CoV, MERS-CoV is considered an ongoing public health problem, particularly for the Middle East region. In this chapter, we outline the prevailing information regarding the emergence and epidemiology of this virus, its mode of transmission and pathogenicity, its clinical features, and the potential strategies for prevention.

A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences

As a World Health Organization Research and Development Blueprint priority pathogen, there is a need to better understand the geographic distribution of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and its potential to infect mammals and humans. This database documents cases of MERS-CoV globally, with specific attention paid to zoonotic transmission. An initial literature search was conducted in PubMed, Web of Science, and Scopus; after screening articles according to the inclusion/exclusion criteria, a total of 208 sources were selected for extraction and geo-positioning. Each MERS-CoV occurrence was assigned one of the following classifications based upon published contextual information: index, unspecified, secondary, mammal, environmental, or imported. In total, this database is comprised of 861 unique geo-positioned MERS-CoV occurrences. The purpose of this article is to share a collated MERS-CoV database and extraction protocol that can be utilized in future mapping efforts for both MERS-CoV and other infectious diseases. More broadly, it may also provide useful data for the development of targeted MERS-CoV surveillance, which would prove invaluable in preventing future zoonotic spillover.

Measurement(s)	Middle East Respiratory Syndrome • geographic location
Technology Type(s)	digital curation
Factor Type(s)	geographic distribution of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) • year
Sample Characteristic - Organism	Middle East respiratory syndrome-related coronavirus
Sample Characteristic - Location	Earth (planet)

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.11108801

EpiExploreR: A Shiny Web Application for the Analysis of Animal Disease Data

Emerging and re-emerging infectious diseases are a significant public and animal health threat. In some zoonosis, the early detection of virus spread in animals is a crucial early warning for humans. The analyses of animal surveillance data are therefore of paramount importance for public health authorities to identify the appropriate control measure and intervention strategies in case of epidemics. The interaction among host, vectors, pathogen and environment require the analysis of more complex and diverse data coming from different sources. There is a wide range of spatiotemporal methods that can be applied as a surveillance tool for cluster detection, identification of risk areas and risk factors and disease transmission pattern evaluation. However, despite the growing effort, most of the recent integrated applications still lack of managing simultaneously different datasets and at the same time making available an analytical tool for a complete epidemiological assessment. In this paper, we present EpiExploreR, a user-friendly, flexible, R-Shiny web application. EpiExploreR provides tools integrating common approaches to analyze spatiotemporal data on animal diseases in Italy, including notified outbreaks, surveillance of vectors, animal movements data and remotely sensed data. Data exploration and analysis results are displayed through an interactive map, tables and graphs. EpiExploreR is addressed to scientists and researchers, including public and animal health professionals wishing to test hypotheses and explore data on surveillance activities.

Epidemiological and genetic characterization of pH1N1 and H3N2 influenza viruses circulated in MENA region during 2009-2017

BACKGROUND

Influenza surveillance is necessary for detection of emerging variants of epidemiologic and clinical significance. This study describes the epidemiology of influenza types A and B, and molecular characteristics of surface glycoproteins (hemagglutinin [HA] and neuraminidase [NA]) of influenza A subtypes: pH1N1 and H3N2 circulated in Arabian Gulf, Levant and North Africa regions during 2009-2017.

METHODS

Analysis of phylogenetics and evolution of HA and NA genes was done using full HA and NA sequences (n = 1229) downloaded from Influenza Research Database (IRD).

RESULTS

In total, 130,354 influenza positive cases were reported to WHO during study period. Of these, 50.8% were pH1N1 positive, 15.9% were H3N2 positives and 17.2% were influenza B positive. With few exceptions, all three regions were showing the typical seasonal influenza peak similar to that reported in Northern hemisphere (December-March). However, influenza activity started earlier (October) in both Gulf and North Africa while commenced later during November in Levant countries. The molecular analysis of the HA genes (influenza A subtypes) revealed similar mutations to those reported worldwide. Generally, amino acid substitutions were most frequently found in head domain in H1N1 pandemic viruses, while localized mainly in the stem region in H3N2 viruses. Expectedly, seasons with high pH1N1 influenza activity was associated with a relatively higher number of substitutions in the head domain of the HA in pH1N1 subtype. Furthermore, nucleotide variations were lower at the antigenic sites of pH1N1 viruses compared to H3N2 viruses, which experienced higher variability at the antigenic sites, reflecting the increased immunological pressure because of longer circulation and continuous vaccine changes. Analysis of NA gene of pH1N1 viruses revealed sporadic detections of oseltamivir-resistance mutation, H275Y, in 4% of reported sequences, however, none of NAI resistance mutations were found in the NA of H3N2 viruses.

CONCLUSIONS

Molecular characterization of H1N1 and H3N2 viruses over 9 years revealed significant differences with regard to position and function of characterized substitutions. While pH1N1 virus substitutions were mainly found in HA head domain, H3N2 virus substitutions were mostly found in HA stem domain. Additionally, more fixed substitutions were encountered in H3N2 virus compared to larger number of non-fixed substitutions in pH1N1.

An Overview of the Most Significant Zoonotic Viral Pathogens Transmitted from Animal to Human in Saudi Arabia

Currently, there has been an increasing socioeconomic impact of zoonotic pathogens transmitted from animals to humans worldwide. Recently, in the Arabian Peninsula, including in Saudi Arabia, epidemiological data indicated an actual increase in the number of emerging and/or reemerging cases of several viral zoonotic diseases. Data presented in this review are very relevant because Saudi Arabia is considered the largest country in the Peninsula. We believe that zoonotic pathogens in Saudi Arabia remain an important public health problem; however, more than 10 million Muslim pilgrims from around 184 Islamic countries arrive yearly at Makkah for the Hajj season and/or for the Umrah. Therefore, for health reasons, several countries recommend vaccinations for various zoonotic diseases among preventive protocols that should be complied with before traveling to Saudi Arabia. However, there is a shortage of epidemiological data focusing on the emerging and reemerging of zoonotic pathogens transmitted from animal to humans in different densely populated cities and/or localities in Saudi Arabia. Therefore, further efforts might be needed to control the increasing impacts of zoonotic viral disease. Also, there is a need for a high collaboration to enhance the detection and determination of the prevalence, diagnosis, control, and prevention as well as intervention and reduction in outbreaks of these diseases in Saudi Arabia, particularly those from other countries. Persons in the health field including physicians and veterinarians, pet owners, pet store owners, exporters, border guards, and people involved in businesses related to animal products have adopted various preventive strategies. Some of these measures might pave the way to highly successful prevention and control results on the different transmission routes of these viral zoonotic diseases from or to Saudi Arabia. Moreover, the prevention of these viral pathogens depends on socioeconomic impacts, available data, improved diagnosis, and highly effective therapeutics or prophylaxis.

The European Respiratory Society course on acute respiratory pandemics: how to plan for and manage them

Learn about the @ERStalk course on acute respiratory pandemics http://ow.ly/XGe430i7743.

Current views and challenges on clinical cholera

Cholera, an acute diarrheal infection has become a major global threat. Vibrio cholerae the causative agent of cholera has been responsible for six previous pandemics since 1817 that spanned four continents and Australia with the seventh pandemic ongoing since 1961. Two serogroups of V. cholerae O1 and O139 have the ability to secrete the enterotoxin with potential to cause epidemics. The prior six pandemics were caused by the classical biotype of the O1 serogroup. However, the emergence of the El Tor biotype and subsequent variants of El Tor with classical traits are the main isolates in the seventh pandemic. Cholera outbreaks have increased among vulnerable communities affected by war, earthquakes, conflicts and famines. Annually, 2.9 million cases of cholera occur globally in 69 endemic countries with 95,000 deaths. Early detection followed by prompt fluid and electrolyte replacement can reduce the case fatality ratio significantly. Improvements in water systems, sanitation and hygiene have effectively eliminated the transmission of cholera in high-income countries and reduced transmission in some developing nations. However, an estimated 1.8 billion are still at risk for cholera due to lack of potable water, inadequate sanitation and hygiene. Interventions focusing on hygiene in conjunction with proper disposal and treatment of sewage and provision of safe drinking water are likely to be effective in preventing the recurrence of cholera. Lastly, the use of current oral vaccines in endemic settings in combination with WASH interventions may be an effective approach to prevent and reduce the spread of cholera infection.