Diphtheria resurgence in Sada'a-Yemen, 2017–2020

Background

Diphtheria is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children, especially in Yemen. As a consequence of war and collapse of the health system, a fatal epidemic occurred at the end of 2017. This study aims to describe the epidemiology of diphtheria by time, place, and person and vaccination status of affected children.

Methods

A study was conducted in Sada'a governorate by using accumulative line list of diphtheria from November 2017 to September 2020 at electronic Integrated Disease Early Warning System (eIDEWS). The case definition of WHO was adopted. Data was analyzed by Microsoft Excel and Epi info- version 7.2 and multivariable logistic analysis used for identifying significant associated factors.

Results

747 cases were met of WHO case definition. The annual peak of cases started during week 31 and weak 49. Males were slightly more than females (51% vs 49%) and about 35% of cases involved children aged 10 to < 15 years. The overall incidence of diphtheria and case fatality rate (CFR) were 69/ 100,000 and 6.4%, respectively. The highest CFR was among age groups under 5 years 11% (P < 0.001) and among females was 8%. Dysphagia and swollen lymph nodes were the predominant symptoms 98%, 92%, respectively. Based on the Vaccination status, the percentage of unvaccinated and unknown were 53% and 41% respectively, with CFR 11% among cases who received one dose. Furthermore, the most case were from Sahar 40% with case fatality rate 8% and the highest CFR was significantly higher among cases in border and ongoing conflict district (P < 0.05).

Conclusions

The findings highlight that diphtheria is still an ongoing cause of morbidity and mortality among under 5 children in Sada'a that is rising with the low diphtheria immunization coverage. Therefore, concomitant efforts should now focus on improving and monitoring routine immunization across all age groups and healthcare services, especially in borders and continuing conflict districts.

Public health workers' knowledge, attitude and practice regarding COVID-19: the impact of Field Epidemiology Training Program in the Eastern Mediterranean Region

BACKGROUND

This study aimed to compare knowledge, attitude and practice (KAP) regarding COVID-19 between public health workers (PHWs) attended field epidemiology training program (FETP-trained) and those who did not attend FETP (non-FETP trained).

METHODS

Multi-country cross-sectional survey was conducted among PHWs who participated in COVID-19 pandemic in 10 countries at EMR. Online questionnaire that included demographic information, KAP regarding COVID-19 pandemic was distributed among HCWs. Scoring system was used to quantify the answers, bivariate and Multivariate analysis performed to compare FETP-trained with non-FETP trained PHWs.

RESULTS

Overall, 1337 PHWs participated, with 835 (62.4%) < 40 years of age, and 851 (63.6%) males. Of them, 423 (31.6%) had FETP, including that 189 (44.7%) had advanced level, 155 (36.6%) intermediate and 79 (18.7%) basic level training. Compared with non-FETP trained, FETP trained were older, having higher KAP scores. FETP participation was low in infection control, and PH laboratories. KAP mean scores for intermediate level attendees are comparable to advanced level.

CONCLUSIONS

FETP-trained are having better KAP than non-FETP PHWs. Expanding the intermediate level, maintain the Rapid Response training and introduce the laboratory component are recommended to maximize the benefit from FETP. Infection control, antimicrobial resistance and coordination are areas where training should include.

Mental health impacts of COVID-19 on healthcare workers in the Eastern Mediterranean Region: a multi-country study

Background

Healthcare workers (HCWs) fighting against the COVID-19 pandemic are under incredible pressure, which puts them at risk of developing mental health problems. This study aimed to determine the prevalence of depression, anxiety, and stress among HCWs responding to COVID-19 and its associated factors.

Methods

A multi-country cross-sectional study was conducted during July–August 2020 among HCWs responding to COVID-19 in nine Eastern Mediterranean Region (EMR) countries. Data were collected using an online questionnaire administered using KoBo Toolbox. Mental problems were assessed using the Depression, Anxiety, and Stress Scale (DASS-21).

Results

A total of 1448 HCWs from nine EMR countries participated in this study. About 51.2% were male and 52.7% aged ≤ 30 years. Of all HCWs, 57.5% had depression, 42.0% had stress, and 59.1% had anxiety. Considering the severity, 19.2%, 16.1%, 26.6% of patients had severe to extremely severe depression, stress, and anxiety, respectively. Depression, stress, anxiety, and distress scores were significantly associated with participants’ residency, having children, preexisting psychiatric illness, and being isolated for COVID-19. Furthermore, females, those working in a teaching hospital, and specialists had significantly higher depression and stress scores. Married status, current smoking, diabetes mellitus, having a friend who died with COVID-19, and high COVID-19 worry scores were significantly associated with higher distress scores.

Conclusions

Mental problems were prevalent among HCWs responding to COVID-19 in EMR. Therefore, special interventions to promote mental well-being among HCWs responding to COVID-19 need to be immediately implemented.

Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: A Multicountry Retrospective Study

BACKGROUND

The establishment of empirical evidence in the Eastern Mediterranean Region (EMR) necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of COVID-19 patients.

OBJECTIVE

This study aimed to assess the patterns of COVID-19 severity and mortality in seven countries and to determine the risk factors of COVID-19 severity and mortality.

METHODS

This multi-country study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study included data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.

RESULTS

A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (HT) (24.7%) and diabetes (22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.

CONCLUSIONS

The study confirmed the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.

First COVID-19 cases with high secondary infection among health workers, Sana'a capital, April 2020: Lessons learned and future opportunities

OBJECTIVES

Confirm existence of COVID-19 outbreak, conduct contact tracing, and recommend control measures.

METHODS

Two COVID-19 cases in Sana'a Capital met the WHO case definition. Data were collected from cases and contacts who were followed for 14 days. Nasopharyngeal swabs were taken for confirmation by Polymerase Chain Reaction (PCR).

RESULTS

Two confirmed Yemeni male patients aged 20 and 40 years who had no travel history were admitted to hospital on 24 April 2020. Regarding the first patient, symptoms started on April 18th, 2020 then the patient improved and was discharged on May 5th, while the second patient's symptoms started on April 22nd but the patient died on April 29th, 2020. Both patients had 54 contacts, 17 (32%) were health workers (HWs). Four contacts (7%) were confirmed, two of them were HWs that needed hospitalization. The secondary attack rate (sAR) was 12% among HWs compared to 5% among other contacts.

CONCLUSIONS

First COVID-19 outbreak was confirmed among Yemeni citizens with a high sAR among HWs. Strict infection control among HWs should be ensured. Physical distancing and mask-wearing with appropriate disinfecting measures should be promoted especially among contacts. There is a need to strengthen national capacities to assess, detect, and respond to public health emergencies.

1373Severe acute respiratory infection with high mortality rate in Sana'a city, 2018-2019 Yemen

Background

The burden of influenza and severe acute respiratory infection (SARI) in conflict countries such as Yemen is exacerbated due to limited resources and the collapse of the health system. The aims are to describe epidemiology of SARI, determine influenza detection and case fatality rates among SARI patients.

Methods

We used a descriptive analytical study design. All SARI patients who meet WHO case definition during 2018-2019 from Sana'a city were included. Nasopharyngeal samples were examined by polymerase chain reaction. A soft copy of data that collected by surveillance staff was obtained from the National Influenza Control Program (NICP). Case fatality rate and detection rate were calculated and P value &lt; 0.05 used for statistical significant.

Results

1447 SARI patients were reported: 73% males, 54% aged 15- &lt; 50 years. Comorbidity was among 27% (387) of them: (57% cardio-vascular diseases and 50% diabetes). Samples of 934 (64%) SARI patients were tested and influenza viruses were detected in 141 (15%) patients (13% type A and 2% type B). Higher influenza viruses were detected in winter months (November – February) (17% vs 9%, P &lt; 0.001). Overall SARI fatality rate was 19% (276), significantly higher among patients with comorbidity (26% vs 16%, P &lt; 0.001) confirmed influenza (30% Vs 15%, P value &lt; 0.001) and not receiving antiviral (51% vs 17%, P &lt; 0.001) than relevant groups.

Conclusions

SARI patients in Yemen had a high case-fatality rate particularly SARI patients with confirmed influenza. Introduce influenza vaccination for the risk group should be considered.

Key messages

Influenza and SARI cases are high in Yemen and progress to death.

1493Trends of Rotavirus Gastroenteritis during a Conflict Time, Yemen, 2014-2019

Background

The Rotavirus Gastroenteritis (RVG) is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children. In Yemen, Rotavirus Surveillance System (RVS) was launched in 2007 as sentinel surveillance and the vaccine was introduced in 2012. However, the current protracted conflict led to a significant breakdown of health services including immunization and water, sanitation and hygiene. The aim is to describe the pattern of RVG during the conflict time: 2014-2019.

Methods

2014-2019 RVS data that covers demographic variables, clinical symptoms, vaccination status and laboratory results were analyzed using Epi.info 7.2.

Results

6,663 suspected RVG cases were reported. The most affected age group was 9-12 months and cases were higher among males (59%). RVG shows a seasonal pattern where RVG was predominantly reported in the cold season. Only 24% needed admission due to severe dehydration. Only 65% of cases were vaccinated, of them 85% received two doses. The case fatality rate was 1.1%, and was significantly higher among unvaccinated (1.8 vs. 0.6%, P &lt; 0.0001). Of the 5,875 samples collected, only one third found positive to Rotavirus where the predominant genotypes were G12 P [8] and G 2 P [4].

Conclusions

The findings highlight that RVG is still an ongoing cause of morbidity among under 5 children in Yemen that upsurges with the low Rotavirus immunization coverage. Therefore, boosting immunization coverage together with other diarrhea prevention strategies are required. Furthermore, ongoing surveillance is important to monitor the RVG epidemiology and to evaluate vaccine effectiveness against the currently circulating genotypes.

Key messages

It is First research about rota that done in Yemen during conflict so it gives opportunity for future increased scientific rigor, outcomes-focused research, and health informatics.

It provides policy makers by recommendation for improving public health and surveillance system during crisis.

1513Foodborne Outbreak in the Central Prison, Amanat Al-Asimah, Yemen-October, 2020

Background

Foodborne diseases continuous to be one of important health problem in Yemen. On October 9, 2020, the surveillance officer in Amanat Al-Asimah reported increased number of diarrhea cases in the prison. On October 10, 2020, team from Y-FETP was sent to determine the magnitude of the outbreak, identify risk factors and recommend control measures.

Methods

Descriptive and case control study with a ratio of (1: 1) was conducted. Case defined as any person in prison developed of diarrhea or vomiting/nausea or abdominal cramps from 1st-15th October. Control defined as: any person in prison not developed of diarrhea or vomiting or any symptoms. Data was collected by using prepared line list and multivariable logistic analysis used for identifying risk factors.

Results

A total of fifty-one cases met the case definition. All cases were males with the mean of age (31.3±3.06). Al-Qala’ah ward was the most affected area (AR 5.7/100) and none of the cases died. The implicated food items were: tomato sauce (OR 4.92: CI 2.11-11.49) and potato sauce (OR 5.68: CI 2.29-14.07). Tanks were open and in bad condition and handling of food were poor. Laboratory results of examined food and water samples revealed Shigella flxneri sero type II and coliform growth and Staph. aurous were isolated from nasal of 3 cookers.

Conclusions

The foodborne outbreak in prison was associated with eating contaminated food in main restaurants. Monitoring of food consumed, rigorous implementation of food handling instructions and health education of handlers, and periodic inspection of water tanks in prisons are recommended.

Key messages

Highlight the importance of foodborne illness which leads to a negative impact on affected people loss of work, medical costs, long-term disability, and even death.in addition to bad impact on the economy especially in a poor country such as Yemen which has lacked awareness of the foodborne illness and doesn't have any surveillance system and regulation

Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study (Preprint).. [DOI: 10.2196/preprints.32831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19.

OBJECTIVE

This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality.

METHODS

This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.

RESULTS

A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.

CONCLUSIONS

The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.

The impact of COVID-19 pandemic on blood supplies and transfusion services in Eastern Mediterranean Region

Background

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spurred a global health crisis. The safety and supply of blood during this pandemic has been a concern of blood banks and transfusion services as it is expected to adversely affect blood system activities. We aim to assess the situation in the Eastern Mediterranean Region (EMR) during the first months of the pandemic.

Materials and methods

A survey was designed to address blood supply, transfusion demand, and donor management during the coronavirus disease-19 (COVID-19) pandemic. Medical directors of different blood banks were invited to participate.

Results

A total of 16 centers participated with representation from 15/19 countries in the region. In total, 75% were from national blood banks. Most centres had a decrease in the blood supply, ranging from 26–50%. Representatives from 14 countries (93.3%) believed that public fear has contributed to a decrease in donations. Most centres (n = 12, 75%) had a reduction in transfusion demand, while those who did not, reported heavy involvement in treating patients with underlying haemoglobinopathies and haematological malignancies. Half of the centres activated their contingency plans. Four centres had to alter the blood donor eligibility criteria to meet demands. All centres implemented donor deferral criteria in relation to SARS-CoV-2, but were variable in measures to mitigate the risk of donor and staff exposure.

Conclusion

Blood services in the region faced variable degrees of blood shortages. We summarize lessons learnt during this pandemic for the blood banks to consider to plan, assess, and respond proportionately to future similar pandemics.