Communicable Diseases Bulletin

Quarterly Summary Report

Communicable Diseases Bulletin

www.doh.gov.aeSecond Quarter– 2019 (Apr-Jun)

Volume 10; Issue Number 2; 2019

2

Quarterly Summary Report - 2019

www.doh.gov.ae

Table of Contents

Section Content Page

I Distribution of Notified Cases in Abu Dhabi Emirate, by Region (Quarter 2, 2019)

3

II Distribution of Notified Cases in Abu Dhabi Emirate, by Age Group and Gender (Quarter 2, 2019)

4

VI Selected Annual Trends for Antimicrobial Resistance in Abu Dhabi Emirate

7-9

VII Visa Screening Applicants, Abu Dhabi Emirate (Quarter 2, 2019) 10

VIII Influenza Quarterly Report, Abu Dhabi Emirate (Quarter 2, 2019) 11

IX Topic of the Volume: Elimination of Hepatitis C by 2030 12 -14

X Sharing Reports: Cumulative Antibiogram, Abu Dhabi (2018) 15-19

XI Activities 20

XII

XIII

XIV

Flash News

Flash-on-an-Illness: Cryptosporidiosis

Applied Research in Communicable Diseases

21

22-25

26

III Distribution of Gastrointestinal Infections in Abu Dhabi Emirate, by Region (Quarter 2, 2019)

5

IV Distribution of Gastrointestinal Infections in Abu Dhabi Emirate, by Age Group and Gender (Quarter 2, 2019)

5

V Monthly Trends for Selected Notified Diseases, Abu Dhabi Emirate (Q2, 2019 vs. Q2, 2018 and 2017)

6

3


Volume 10 / Issue 2; 2019

Table 1: Distribution of Notified Cases in Abu Dhabi Emirate,by Region (Quarter 2, 2019)

* Illnesses covered by national control programs (only confirmed cases and cases that cannot be ruled out are included in the table).¶ All notified malaria cases are “imported”. @ Total number of notifications including gastrointestinal infections. For more details about gastrointestinal infections, refer to table 3. Indicates increase or decrease in number of notified cases.

Cases

AbuDhabi

Al Ain AlDhafra

Cumula�ve, Abu Dhabi EmirateYear Total

Quarter 2, 20192019 2018 2017

Q1 Q2 Q1+Q2 Q1+Q2 Q1+Q2 2018 2017

AFP/ Poliomyelitis * 0 0 0 3 0 3 5 7 8 9

Brucellosis 10 4 1 17 15 32 42 50 105 91

Chickenpox 1114 145 91 1299 1350 2649 2507 3024 4290 5254

Cholera 8 0 0 1 8 9 2 2 13 8Haemophilus influenzae(Invasive)

0 0 0 0 0 0 0 1 0 2

Hepatitis B 268 65 15 326 348 674 574 531 1244 1085

Hepatitis C 218 47 13 261 278 539 361 430 791 829Influenza (A, B, H1N1, & Unspecified)

3150 1184 102 7405 4436 11841 7557 4162 22447 15993

Malaria * ¶ 197 76 19 135 292 427 568 600 1429 1907

Measles (Rubeola) * 20 26 0 21 46 67 41 24 57 38

Meningitis (Bacterial) 11 3 0 12 14 26 17 21 47 45

Meningitis (Viral) 15 0 0 30 15 45 32 36 59 64

Mumps * 39 16 3 69 58 127 103 123 227 217

Pertussis (Whooping Cough) 11 2 0 10 13 23 22 27 65 50

Rubella (German Measles) * 33 0 0 14 33 47 3 12 7 23

Scabies 434 49 25 666 508 1174 1451 1175 2472 2111

Tetanus 0 0 0 1 0 1 3 0 4 1

Tuberculosis (Extra-Pulmonary) 84 14 2 98 100 198 149 149 314 275

Tuberculosis (Pulmonary) * 102 37 12 143 151 294 251 261 525 523

Typhoid /Paratyphoid Fever 31 11 6 37 48 85 68 84 178 188

Other Diseases 1118 476 82 1684 1676 3360 3409 2915 6933 6056

Total @ 6863 2155 371 12232 9389 21621 17165 13634 41215 34769Grand Total including ruledout notifications

7888 2292 442 13683 10622 24305 19875 15857 46965 41239

Cases

AbuDhabi

Al Ain AlDhafra

YearYear Total

Quarter 2, 20192019 2018 2017

Q1 Q2 Q1+Q2 Q1+Q2 Q1+Q2 2018 2017

11 0 0 4 11 9 15 22 21Campylobacter-Enteritis

*

Escherichia Coli(Enterohemorrhagic)

0 0 0 0 0 0 1 1 2

Giardiasis 35 11 4 44 50 84 56 176 128Hepatitis A 29 18 1 35 48 84 83 259 189

Rotavirus 200 125 24 365 349 666 528 1144 844Salmonellosis(non-typhoidal)

70 20 1 50 91 140 158 296 324

Shigellosis 1 5 0 7 6 12 13 45 23Foodborne illness(Not tested) 30 7 0 23 37 64 92 225 192

Foodborne illness(Tested-but no growth)

28 18 1 12 47 36 88 128 145

404 204 31 540 639 1095 1034 2296 1868TOTAL

15

0

9483

714

141

13

60

59

1179

4


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Table 2: Distribution of Notified Cases in Abu Dhabi Emirate,by Age Group and Gender (Quarter 2, 2019)

Cells with red numbers are indicative of the highest counts within the age/gender groups for the given illness.@ Total number of notifications including gastrointestinal infections. For more details about gastrointestinal infections, refer to table 4.Σ The grand total for Q2-2019 after including all ruled out notifications is 10622.

Cases< 1 y 1 - 4 y 5 - 14 y 15 -24 y 25 -34 y 35 -44 y 45 -54 y 55-64y 65+ y Total

TotalM F M F M F M F M F M MF F M F M F M F

AFP/ Poliomyelitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Brucellosis 0 0 0 0 1 0 2 0 3 1 2 3 2 0 1 0 0 0 11 4 15Chickenpox 15 8 33 32 87 66 225 22 511 86 184 21 45 5 8 2 0 0 1108 242 1350Cholera 0 0 0 0 0 0 1 0 3 0 0 0 2 0 1 0 0 1 7 1 8Haemophilusinfluenzae (Invasive) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Hepatitis B 0 0 0 0 1 1 22 4 110 25 87 18 41 5 22 7 4 1 287 61 348Hepatitis C 0 0 0 1 0 0 22 0 79 6 75 9 40 3 28 4 4 7 248 30 278Influenza(A, B H1N1 &unspecified)

102 99 576 510 581 464 230 118 617 296 391 157 132 44 53 33 20 13 2702 1734 4436

Malaria 0 0 2 2 0 0 76 2 99 2 59 2 32 1 14 0 0 0 282 10 292Measles 1 1 3 1 0 1 9 0 28 1 1 0 0 0 0 0 0 0 42 4 46Meningitis (Bacterial)

2 4 0 0 0 1 0 0 1 0 5 0 1 0 0 0 0 0 9 5 14

Meningitis (Viral) 2 3 1 0 2 0 0 0 3 1 1 2 0 0 0 0 0 0 9 6 15Mumps 0 1 8 6 10 7 2 1 11 1 6 3 2 0 0 0 0 0 39 19 58Pertussis 1 3 0 0 1 0 1 0 0 2 1 1 0 0 1 2 0 0 5 8 13Rubella 0 0 0 1 0 0 3 3 15 4 3 4 0 0 0 0 0 0 21 12 33Scabies 1 3 11 5 13 16 75 9 183 14 102 11 43 1 11 2 5 3 444 64 508Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Tuberculosis(Extra-Pulmonary) 1 0 0 0 1 0 14 2 33 18 17 5 4 1 3 0 1 0 74 26 100

Tuberculosis (Pulmonary) 0 0 0 1 0 0 16 11 43 19 23 4 16 3 8 4 2 1 108 43 151

Typhoid/Paratyphoid Fever

0 0 2 3 4 1 9 1 9 4 8 2 2 0 2 0 0 1 36 12 48

Other Diseases 45 44 158 150 107 94 107 41 258 207 155 116 80 53 26 27 10 5 946 737 1683170 166 794 712 808 651 814 214 2004 683 1120 357 442 116 175 77 49 37 6376 3013 9389

10622



Campylobacter-Enteritis

1 0 0 2 0 0 1 0 1 1 1 0 3 0 1 0 0 0 8 3 11

Escherichia Coli (Enterohemorrhagic)

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Giardiasis 1 0 0 0 1 0 8 3 21 0 13 2 1 0 0 0 0 0 45 5 50Hepatitis A 0 0 3 2 9 6 3 4 12 1 5 2 2 0 0 0 0 0 33 15 48Rota Virus GE 24 28 96 79 36 30 1 2 13 13 7 7 2 4 1 4 2 0 182 167 349Salmonellosis(non-typhoidal)

2 2 15 10 12 8 5 1 4 5 6 5 3 0 6 7 0 0 53 38 91

Shigellosis 0 0 1 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 5 1 6Foodborne illness (Not tested) 0 0 1 1 1 5 5 4 6 2 4 3 2 1 2 0 0 0 21 16 37

Foodborne illness (Tested-but nogrowth)

1 0 1 1 3 4 3 2 11 3 7 1 7 2 0 1 0 0 33 14 47

Total 29 30 117 96 66 53 26 16 67 25 43 20 20 7 7 7 5 5 380 259 639

TOTAL@

Grand Total

5



Table 4: Distribution of Gastrointestinal Infections in Abu Dhabi Emirate, by Age Group and Gender (Quarter 2, 2019)

Cells with red numbers are indicative of the highest counts within the age/gender groups for the given illness.

Table 3: Distribution of Gastrointestinal Infections in Abu Dhabi Emirate, by Region (Quarter 2, 2019)

* All cases are reported through electronic notification system of DoH. Indicates increase or decrease in numbers of notified cases.

Cases

AbuDhabi

Al Ain AlDhafra

Cumula�ve, Abu Dhabi EmirateYear Total

Quarter 2, 20192019 2018 2017

Q1 Q2 Q1+Q2 Q1+Q2 Q1+Q2 2018 2017

AFP/ Poliomyelitis * 0 0 0 3 0 3 5 7 8 9

Brucellosis 10 4 1 17 15 32 42 50 105 91

Chickenpox 1114 145 91 1299 1350 2649 2507 3024 4290 5254

Cholera 8 0 0 1 8 9 2 2 13 8Haemophilus influenzae(Invasive)

0 0 0 0 0 0 0 1 0 2

Hepatitis B 268 65 15 326 348 674 574 531 1244 1085

Hepatitis C 218 47 13 261 278 539 361 430 791 829Influenza (A, B, H1N1, & Unspecified)

3150 1184 102 7405 4436 11841 7557 4162 22447 15993

Malaria * ¶ 197 76 19 135 292 427 568 600 1429 1907

Measles (Rubeola) * 20 26 0 21 46 67 41 24 57 38

Meningitis (Bacterial) 11 3 0 12 14 26 17 21 47 45

Meningitis (Viral) 15 0 0 30 15 45 32 36 59 64

Mumps * 39 16 3 69 58 127 103 123 227 217

Pertussis (Whooping Cough) 11 2 0 10 13 23 22 27 65 50

Rubella (German Measles) * 33 0 0 14 33 47 3 12 7 23

Scabies 434 49 25 666 508 1174 1451 1175 2472 2111

Tetanus 0 0 0 1 0 1 3 0 4 1

Tuberculosis (Extra-Pulmonary) 84 14 2 98 100 198 149 149 314 275

Tuberculosis (Pulmonary) * 102 37 12 143 151 294 251 261 525 523

Typhoid /Paratyphoid Fever 31 11 6 37 48 85 68 84 178 188

Other Diseases 1118 476 82 1684 1676 3360 3409 2915 6933 6056

Total @ 6863 2155 371 12232 9389 21621 17165 13634 41215 34769Grand Total including ruledout notifications

7888 2292 442 13683 10622 24305 19875 15857 46965 41239

Cases

AbuDhabi

Al Ain AlDhafra

YearYear Total

Quarter 2, 20192019 2018 2017

Q1 Q2 Q1+Q2 Q1+Q2 Q1+Q2 2018 2017

11 0 0 4 11 9 15 22 21Campylobacter-Enteritis

*

Escherichia Coli(Enterohemorrhagic)

0 0 0 0 0 0 1 1 2

Giardiasis 35 11 4 44 50 84 56 176 128Hepatitis A 29 18 1 35 48 84 83 259 189

Rotavirus 200 125 24 365 349 666 528 1144 844Salmonellosis(non-typhoidal)

70 20 1 50 91 140 158 296 324

Shigellosis 1 5 0 7 6 12 13 45 23Foodborne illness(Not tested) 30 7 0 23 37 64 92 225 192

Foodborne illness(Tested-but no growth)

28 18 1 12 47 36 88 128 145

404 204 31 540 639 1095 1034 2296 1868TOTAL

15

0

9483

714

141

13

60

59

1179



AFP/ Poliomyelitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Brucellosis 0 0 0 0 1 0 2 0 3 1 2 3 2 0 1 0 0 0 11 4 15Chickenpox 15 8 33 32 87 66 225 22 511 86 184 21 45 5 8 2 0 0 1108 242 1350Cholera 0 0 0 0 0 0 1 0 3 0 0 0 2 0 1 0 0 1 7 1 8Haemophilusinfluenzae (Invasive) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Hepatitis B 0 0 0 0 1 1 22 4 110 25 87 18 41 5 22 7 4 1 287 61 348Hepatitis C 0 0 0 1 0 0 22 0 79 6 75 9 40 3 28 4 4 7 248 30 278Influenza(A, B H1N1 &unspecified)

102 99 576 510 581 464 230 118 617 296 391 157 132 44 53 33 20 13 2702 1734 4436

Malaria 0 0 2 2 0 0 76 2 99 2 59 2 32 1 14 0 0 0 282 10 292Measles 1 1 3 1 0 1 9 0 28 1 1 0 0 0 0 0 0 0 42 4 46Meningitis (Bacterial)

2 4 0 0 0 1 0 0 1 0 5 0 1 0 0 0 0 0 9 5 14

Meningitis (Viral) 2 3 1 0 2 0 0 0 3 1 1 2 0 0 0 0 0 0 9 6 15Mumps 0 1 8 6 10 7 2 1 11 1 6 3 2 0 0 0 0 0 39 19 58Pertussis 1 3 0 0 1 0 1 0 0 2 1 1 0 0 1 2 0 0 5 8 13Rubella 0 0 0 1 0 0 3 3 15 4 3 4 0 0 0 0 0 0 21 12 33Scabies 1 3 11 5 13 16 75 9 183 14 102 11 43 1 11 2 5 3 444 64 508Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Tuberculosis(Extra-Pulmonary) 1 0 0 0 1 0 14 2 33 18 17 5 4 1 3 0 1 0 74 26 100

Tuberculosis (Pulmonary) 0 0 0 1 0 0 16 11 43 19 23 4 16 3 8 4 2 1 108 43 151

Typhoid/Paratyphoid Fever

0 0 2 3 4 1 9 1 9 4 8 2 2 0 2 0 0 1 36 12 48

Other Diseases 45 44 158 150 107 94 107 41 258 207 155 116 80 53 26 27 10 5 946 737 1683170 166 794 712 808 651 814 214 2004 683 1120 357 442 116 175 77 49 37 6376 3013 9389

10622



Campylobacter-Enteritis

1 0 0 2 0 0 1 0 1 1 1 0 3 0 1 0 0 0 8 3 11

Escherichia Coli (Enterohemorrhagic)

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Giardiasis 1 0 0 0 1 0 8 3 21 0 13 2 1 0 0 0 0 0 45 5 50Hepatitis A 0 0 3 2 9 6 3 4 12 1 5 2 2 0 0 0 0 0 33 15 48Rota Virus GE 24 28 96 79 36 30 1 2 13 13 7 7 2 4 1 4 2 0 182 167 349Salmonellosis(non-typhoidal)

2 2 15 10 12 8 5 1 4 5 6 5 3 0 6 7 0 0 53 38 91

Shigellosis 0 0 1 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 5 1 6Foodborne illness (Not tested) 0 0 1 1 1 5 5 4 6 2 4 3 2 1 2 0 0 0 21 16 37

Foodborne illness (Tested-but nogrowth)

1 0 1 1 3 4 3 2 11 3 7 1 7 2 0 1 0 0 33 14 47

Total 29 30 117 96 66 53 26 16 67 25 43 20 20 7 7 7 5 5 380 259 639

TOTAL@

Grand Total

6


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Monthly Trends for Selected Notified Diseases, Abu Dhabi Emirate(Q2, 2019 vs. Q2, 2018 and 2017)

Figure 2: Foodborne illness (FBI) cases reported from 2017 to Q2, 2019.

Figure 3: Hepatitis A cases reported from 2017 to Q2, 2019. Figure 4: Brucellosis cases reported from 2017 to Q2, 2019.

Figure 5: Rubella cases reported from 2017 to Q2, 2019. Figure 6: Measles cases reported from 2017 to Q2, 2019.

Figure 1: Chickenpox cases reported from 2017 to Q2, 2019.

There was an increase in number of reported cases in Q2, 2019 compared to Q1, 2019 due to clusters of cases in labor camps and few schools in June. Almost all of the cases were unvaccinated against varicella.

There was an increase in number of reported FBI cases in Q2, 2019 compared to Q2, 2018 with few outbreak. Salmonella was detected in 48% of reported cases.

Number of reported hepatitis A cases in Q2, 2019 is close to number of reported cases in Q2 of previous two years. Around 40% of reported cases had recent travel history. Slight increase in the number of cases in June is due to a cluster in one family.

Number of reported brucellosis cases in Q2, 2019 is less by 50% compared to cases reported in Q2 of previous 2 years. 35% of cases exposed to risk factors outside UAE, 28% had history of consuming raw milk and 20% of the cases had history of animal contact.

There was an increase in number of reported cases in Q2, 2019. Around 70% of the cases related to an outbreak in a camp and 11% had recent travel history. Mass vaccination was conducted in the camp.

There was a marked increase in number of reported cases in Q2, 2019 compared to Q2 of previous two years. The peak caused by an outbreak in two labor camps. Almost all of the cases were adults with unknown MMR vaccination history and no travel history. Mass vaccination was conducted for the labors in the affected camps.

7



Selected Annual Trends for Antimicrobial Resistance inAbu Dhabi EmirateAntimicrobial resistance (AMR) has become a serious threat to public health, leading to increased length of stay at hospital, increased costs, treatment failures, and death. Global and UAE commitments have led to the strengthening of AMR surveillance systems. In this section, selected AMR levels and trends are reported from Abu Dhabi Emirate AMR surveillance system.

Figure 7 Table 5

An�bio�c % of resistant isolates (%R), by year Trend

2010-2018 2010 2012 2014 2016 2018 2019 Q1+2

AMP 67.4 63.2 65.3 65.7 65.2 64.4 No trend AMC 13.6 8.8 12.6 11.8 12.6 12.1 No trend CAZ 14.0 11.4 15.7 16.4 18.0 16.6 CTX 23.3 20.6 26.8 30.0 31.7 31.2 FEP 5.0 8.3 7.7 7.8 10.1 9.4 ETP – 0 0.6 0.7 1.0 1.1 No trend IPM 0.3 0.2 0.2 0.7 0.5 0.5 MEM 0.1 0 0.2 1.9 0.5 0.6 CIP 29.8 33.4 32.9 34.8 37.9 35.5 SXT 46.2 42.7 42.6 42.6 42.0 41.2 FOS – – 0.5 0.8 0.3 0.8 No trend NIT 1.8 2.3 2.7 2.0 1.6 1.6 No trend CTX+CIP 16.5 14.1 17.2 19.1 19.0 23.4 ESBL – 38.0 28.9 29.7 27.9 25.5 No trend N 2,354 5,869 6,300 6,130 5,192 4,298 56,040

E. coli: Increasing trends of resistance for 3rd-generation (CAZ ↑, CTX ↑↑) and 4th-generation (FEP ↑) cephalosporins, carbapenems (IPM ↑, MEM ↑), and fluoroquinolones (CIP ↑). High resistance to trimethoprim/sulfamethoxazole (SXT).

Figure 8 Table 6


2010-2018 2010 2012 2014 2016 2018 2019 Q1+2 AMC 8.3 7.7 13.7 14.9 15.5 14.4 CAZ 9.5 10.0 16.4 19.8 18.4 17.2 CTX 12.0 15.8 20.7 26.8 25.1 23.8 FEP 2.0 5.4 7.0 10.2 10.5 11.0 ETP – 0 3.9 5.2 3.7 3.3 No trend IPM 0.4 1.6 3.0 3.7 2.6 2.9 MEM 0.6 1.0 3.6 5.4 3.2 3.5 CIP 11.1 16.5 18.9 21.3 25.6 24.5 SXT 18.2 20.3 21.9 25.0 24.6 22.4 NIT 21.7 35.3 32.3 20.7 23.0 17.7 No trend ESBL – 24.4 21.8 25.0 21.9 20.6 No trend N 816 2,170 2,255 2,454 2,969 1,753 21,918

K. pneumoniae: Increasing trends of resistance for all beta-lactams (↑↑), including 3rd- and 4th-generation cephalosporins (CAZ, CTX, FEP: ↑↑) and carbapenems (IPM↑, MEM ↑), as well as for fluoroquinolones (CIP ↑), and trimethoprim/sulfamethoxazole (SXT ↑).

0

10

20

30

40

50

% r

esis

tant

isol

ates

Year

CTX CIPSXT FOS

Escherichia coli

0

10

20

30

% r

esis

tant

isol

ates

Year

CTX FEP MEM CIP

Klebsiella pneumoniae

2019/Q1+2

2019/Q1+2

Figure 9 Table 7


2010-2018 2010 2012 2014 2016 2018 2019 Q1+2 TZP 9.6 10.9 9.9 10.0 2.7 3.7 CAZ 7.9 6.9 8.1 8.3 8.7 10.8 FEP 6.1 5.4 5.6 5.8 6.1 7.6 No trend IPM 13.0 10.1 16.2 18.0 17.4 21.3 MEM 14.0 9.3 12.0 13.6 12.8 15.5 GEN 8.0 6.3 5.4 5.8 5.0 5.2 No trend CIP 10.0 9.8 11.7 12.2 12.2 14.1 IPM/MEM 16.7 11.6 16.8 18.8 18.1 22.4 N 757 1,881 1,815 1,962 2,310 1,384 17,888

P. aeruginosa: Increasing trends of resistance for 3rd-generation cephalosporins (CAZ ↑), carbapenems (IPM ↑↑, MEM ↑), and fluoroquinolones (ciprofloxacin, CIP ↑). Decreasing trend for resistance for piperacillin/tazobactam (TZP ↓).

22.4

0

10

20

30

% re

sist

ant i

sola

tes

Year

IPM or MEMPseudomonas aeruginosa

8


www.doh.gov.ae

Figure 11 Table 9


2010-2018 2010 2012 2014 2016 2018 2019 Q1+2

OXA (MRSA) 25.7 27.5 33.0 37.7 39.3 42.5 GEN 4.9 3.5 4.5 5.8 5.0 5.2 CIP 10.6 27.4 26.2 30.3 32.8 30.1 SXT 16.6 19.5 18.9 19.5 22.4 20.6 CLI 1.5 2.9 11.3 11.1 13.1 13.3 ERY 16.2 18.6 22.1 24.2 26.4 27.9 N 1,384 3,323 3,277 3,678 4,503 2,485 32,777

S. aureus: Increasing trends of resistance across all antibiotic classes, including beta-lactam antibiotics (OXA ↑↑), aminoglycosides (GEN ↑), fluoroquinolones (CIP ↑↑), trimethoprim/sulfamethoxazole (SXT ↑), lincosamides (CLI ↑↑), and macrolides (ERY ↑↑).

Figure 12 Table 10


2010-2018 2010 2012 2014 2016 2018 2019 Q1+2

PEN-G (oral BP) 19.8 12.8 10.3 7.2 8.5 9.5

PEN-G (NM BP) 0 0 0 0.4 0.4 0.8 No trend

PEN-G (M BP) 61.7 61.0 59.5 60.5 58.0 57.5 No trend

CRO NM 1.2 1.4 0.4 0.9 0.7 0.7 No trend

CTX NM 2.4 1.5 0 0 0.7 0 No trend

SXT 22.2 17.7 21.0 22.8 23.8 29.1 No trend

ERY 43.5 41.0 45.2 49.8 47.3 48.2 No trend

PEN-G + ERY 35.9 33.9 33.6 39.0 37.1 34.7 No trend

01020304050

% re

sist

ant i

sola

tes

Year

OXA (% MRSA)

Staphylococcus aureus

0

20

40

60

% re

sist

ant i

sola

tes

Year

PEN-G (oral BP) ERY PEN-G + ERYStreptococcus pneumoniae

N 204 438 384 471 604 303 4,331

S. pneumoniae: Decreasing trend of resistance for penicillin G (oral breakpoints), ↓↓). High level of resistance for macrolides (ERY), and for penicillin G and macrolides, combined (PEN-G + ERY).

2019/Q1+2

2019/Q1+2

Figure 10 Table 8


2010-2018 2010 2012 2014 2016 2018 2019 Q1+2

IPM 39.3 46.6 40.5 33.7 28.7 38.3

MEM 46.3 53.7 41.8 34.6 29.1 37.8

AMK 13.5 21.8 13.0 6.1 5.6 11.5

GEN 33.0 37.2 28.6 28.5 24.9 30.5

CIP 41.2 45.9 41.4 33.7 30.0 39.9

MNO – 19.1 14.1 12.1 6.1 9.8

TCY 36.2 42.9 43.6 34.3 20.6 26.1 IPM/MEM 46.3 53.7 41.7 34.5 29.1 38.7

N 189 523 432 420 506 273 4,395

A. baumannii: Overall decreasing trends of resistance across all classes of antibiotics, however, resistance to carbapenems (IPM, MEM, IPM or MEM) remains high.

0

20

40

60

80

% re

sist

ant i

sola

tes

Year

IPM or MEM

Acinetobacter baumannii

9



• Results shown represent a selection of key trends relevant for surveillance of antimicrobial resistance. Antibiotics included in this report are important for antimicrobial resistance surveillance purposes. They may not be first-line options for testing or treatment, and should not be interpreted as such. Trend figures and data in tables represent the percentage of isolates tested resistant (%R), by year and antimicrobial agent. AMR data represents average rates across all patients/location types (inpatient and outpatient), and all specimen types. First isolate per patient only (non-duplicate isolates).

• Data was generated by routine clinical antimicrobial susceptibility testing (AST), conducted on VITEK®-2 platform (BioMérieux), (minimal inhibitory concentrations data only, MIC, except for M. tuberculosis data which represents growth interpretation data, generated on BD BACTEC™ MGIT™ (BD Diagnostics). Data represents average resistance rates for all specimen/all patient types.

• AMC=Amoxicillin/clavulanic acid, AMK=Amikacin, AMP=Ampicillin, CAZ=Ceftazidime, CIP=Ciprofloxacin, CLI=Clindamycin, CRO=Ceftriaxone, CTX=Cefotaxime, CXM=Cefuroxime, EMB=Ethambutol, ERY=Erythromycin, ESBL=extended-spectrum β-lac-tamase-producing Enterobacteriaceae, ETP=Ertapenem, FEP=Cefepime, GEN=Gentamicin, INH=Isoniazid, IPM=Imipenem, MEM=Meropenem, MNO=Minocycline, NIT=Nitrofurantoin, OXA=Oxacillin, PEN V=Penicillin V (oral), PEN G M/NM=Penicillin G (i.v., meningitis/non-meningitis breakpoints), PZA=Pyrazinamide, RIF=Rifampin, STR=Streptomycin, SXT=Trimethoprim/sulfame-thoxazole, TCY=Tetracycline, TZP=Piperacillin/tazobactam.

• ABX : Antibiotic,

• %R : percentage resistant.

• N : Number of non-duplicate isolates tested for antimicrobial susceptibility by MIC (minimal inhibitory concentration).

• - : no data available.

• No trend: means no statistically significant trend was identified (p>0.05).

• Trend indicators / : Trend for percent of resistant isolates (%R) is increasing ( ) or decreasing ( ), statistically significant, (p≤0.05). / : Trend for percent of resistant isolates (%R) is increasing ( ) or decreasing ( ) by ≥1.0 percentage points per year (on average) (p≤0.05). Trends are long-term trends (2010-2019 Q2).

Data source: Abu Dhabi Antimicrobial Resistance Surveillance System. Data shown is from Abu Dhabi public healthcare facilities (SEHA), 2010-2019 Q2.

Figure 13 Table 11


2010-2018 2010 2012 2014 2016 2018 2019 Q1+2

PEN 50.0 45.5 62.1 42.9 43.5 35.7 No trend

CRO 0 0 0 0 0 0 No trend

CTX 0 0 0 0 0 0 No trend

CIP 69.2 66.7 77.1 78.0 76.9 94.3 No trend

TCY 92.9 71.9 67.3 71.9 62.5 77.1 No trend

N 14 33 50 71 74 40 465

N. gonorrhoeae: High level of resistance for penicillin, fluoroquinolones (ciprofloxacin) and tetracycline. No trend observed. No data available for cefixime, azithromycin, spectinomycin, and gentamicin. Note: small sample size, potential selection bias.

Figure 14 Table 12


2010-2018 2010 2012 2014 2016 2018 2019 Q1+2

STR 0 5.1 3.3 – – – No trend

RIF 2.3 1.1 1.5 4.0 1.6 2.8 No trend

EMB 0 0 0.4 1.9 0.5 1.2 No trend

INH 4.7 6.5 6.4 7.7 6.5 6.5 No trend

PZA 9.5 9.4 6.5 8.9 10.9 4.9 No trend

RIF+INH (MDR) 2.3 0.9 1.3 3.4 1.6 2.4 No trend

N 91 360 456 473 434 248 3,612

M. tuberculosis: Low level of resistance to first-line antimicrobials, and low rate of multidrug-resistant TB (MDR-TB).

0

25

50

75

100

% re

sist

ant i

sola

tes

Year

CIPNeisseria gonorrhoeae

0

2

4

6

8

10

% re

sist

ant i

sola

tes

Year

RIF+INH (MDR-TB)Mycobacterium tuberculosis

2019/Q1+2

10


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Visa Screening Applicants, Abu Dhabi Emirate (Quarter 2, 2019)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 (TB), and leprosy. Screening for Hepatitis B and syphilis is limited to a few occupational categories.

The Department of Health (DoH) Visa Screening Standard is available online at:https://www.haad.ae/HAAD/LinkClick.aspx?fileticket=taXl6j6Q6I4%3d&tabid=820

Average of 250,000 people or more apply for visa medical screening every quarter in Abu Dhabi Emirate. During the second quarter of 2019, a total of 366,958 applicants were screened at all DoH-licensed Screening Centers.

Figure 15: Visa screening applicants during Q2, 2019.

* Rate: the number of positive cases per 100,000 visa screened applicants.** Applied to certain occupational categories only (New= 27216; Renew= 21762).*** This refers to active TB cases only confirmed by PCR or culture.

Figure 16: Active TB cases detected by visa screening in Abu Dhabi Emirate (Q2, 2019).

Table 13: Number and rate of positive cases among new and renewal visa applicants during Q2, 2019.

Disease HIV Hepatitis B** Tuberculosis*** Leprosy Syphilis**

Visa Status New Renew New Renew New Renew New Renew New Renew

Number of Cases 65 11 155 17 86 42 0 0 239 144

Rate * 42.9 5.1 569.5 78.1 56.8 19.5 0 0 878.2 661.7

Overall Rate 20.7 351.2 34.9 0 782.0

283218

83740

151341

215617

366958

0

50000

100000

150000

200000

250000

300000

350000

400000

M F New Renew TOTAL

No.

of A

pplic

ants

Gender Visa Status

51

35

22 20

0

10

20

30

40

50

60

PCR+ve PCR-ve & Culture+ve

No.

of C

ases

Lab result

NewRenewal

11



Influenza Quarterly Report, Abu Dhabi Emirate (Quarter 2, 2019)Monitoring influenza trends through the surveillance systems enables the decision makers to evaluate the current situation of influenza epidemiology in Abu Dhabi Emirate. Influenza surveillance reports and activity updates are derived from a number of data sources that include passive infectious disease surveillance through DoH electronic notification system. Furthermore active influenza surveillance that includes both sentinel influenza-like illness (ILI) and severe acute respiratory illness (SARI) reporting from selected healthcare facilities.

A total of 4436 influenza cases were reported to DoH in Q2, 2019 through the electronic infectious disease notification system. In figure 17, influenza cases presented in monthly distribution compared to the previous two years. Distribution of influenza cases by weeks during quarter 2, in addition to virus types shown in figure 18.

Only 67 ILI cases in Q2, 2019 were reported through the active surveillance system. 16 (24%) of the cases were influenza positive and figure 19 showed distribution of virus types by percentage. Another source of influenza surveillance is SARI in which 425 cases were reported from two selected health care facilities (368 cases from Mafraq Hospital and 57 cases from Al Ain Hospital). Out of 388 tested SARI cases, 67 cases (17%) were found to be positive for respiratory organisms as shown in figure 20.

Figure 17: Q2, 2019 influenza cases decreased compared to Q1, 2019, but still higher than same period in 2017 and 2018.

Figure 19: Distribution of influenza viruses in ILI cases by percentage (n = 16).

Figure 20: Distribution of respiratory organisms among SARI cases by percentage (n = 67).

Figure 18: Distribution of influenza types by weeks. Influenza B cases are higher compared to influenza A in Q2/2019.

13 13

75 71

29

0 0 0

100

27

35

128

19 20

30 30

15

5

19

510

19

48

Influenza A (H1N1)Influenza A (H3N2)Influenza BRespiratory Syncytial Virus (RSV)Others

April May June

Months

WeekMonths

Months

60

40

20

0

Perc

enta

ge o

f Cas

esN

o. o

f Cas

es

No.

of N

otif

ied

Case

s

April May June

120

100

80

60

40

20

0

Perc

enta

ge o

f Cas

es

Influenza A (H1N1)Influenza A (H3N2)Influenza B

Influenza AInfluenza BInfluenza A (H1N1)Influenza A/BUnspecified

April May June

week week week week week week week week week week week week week

350

300

250

200

150

100

50

0

14 15 16 17 18 19 20 21 22 23 24 25 26

201720182019

6000

5000

4000

3000

2000

1000

0

12


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Topic of the Volume

Elimination of Hepatitis C by 2030

RotavirusAuthor: Dr. Mahra Alhosani, Medical resident, Ambulatory Health Service (AHS) - SEHA, Community Medicine.

Introduction Hepatitis C is a liver disease caused by Hepatitis C Virus (HCV) that can cause both acute and chronic hepatitis, ranging in severity from a mild illness lasting for few weeks to a serious lifelong illness with severe complications. HCV is a blood-borne virus and the most common modes of transmission is the exposure to infected blood or body fluids. This may happen through injection drug use, unsafe injection practices, unsafe practice in health care setting, and the transfusion of unscreened blood and blood products. HCV is recognized as a major cause of liver cirrhosis, end-stage liver disease, and hepatocellular cancer. Viral hepatitis represents a considerable public health challenge as many people are either misdiagnosed or do not come forward for testing. Individuals can easily avoid the health and economic burden and complications of advanced liver disease through early detection.

This report highlights the challenges and proposed suggestions in the World Health Organization (WHO) Framework to achieve HCV elimination in addition to addressing the local efforts toward this public health priority.

Health BurdenAccording to the WHO, the current worldwide health burden of HCV is estimated at 71 million people and considered as the 7th leading cause of mortality. Only 30% of people living with HCV are aware of their condition. The Middle East and North Africa region (MENA) has the highest prevalence of HCV infection in the world, affecting more than 20 million people in Arab countries (Figure 21). Although prevalence of HCV in the UAE in 2018 is less than 1%, only 30 to 50% of people are diagnosed either accidently or after having HCV-related liver complications. Therefore, screening and early detection for such disease is crucial in the treatment plan. In the previous 6 years from 1st Jan 2013 till 31st Dec 2018, the total number of reported HCV cases in Abu Dhabi Emirate alone was 4352 cases.

Figure 21: Worldwide HCV prevalence, 2015.

13



RecommendationsWHO focused on the theme: "Test. Treat. Hepatitis" for World Hepatitis Day 2018 events. WHO aims to achieve the following objectives globally:

1. To support scale-up of hepatitis prevention, testing, treatment and care services, with specific focus on promoting WHO testing and treatment recommendations

2. To showcase best practices and promote universal health coverage of hepatitis services3. To improve partnerships and funding in the fight against viral hepatitis

The WHO considers HCV a public health threat that can be eliminated by 2030 through two key recommendations:

1 - Decrease HCV-related liver mortality rate by 65%.2 - Decrease transmission of new infections by 90%

In addition to raising HCV risk awareness, it is also important that screening programs are optimized. To date there is limited data on the effectiveness of various testing programs among key populations. Currently HCV testing programs lack coverage, are often costly, with some countries reporting higher prices for testing than for treatment. Furthermore, development of diagnostic and treatment monitoring with point-of-care testing, and novel cheaper tests should be encouraged. There are successful testing programs that can be used as examples for other countries and different settings. One of them is ‘network-based testing’ among People Who Inject Drugs (PWID). This ensures timely diagnosis and when combined with treatment, also acts as treatment as prevention.

Testing for HCV alone without a high proportion of diagnosis being linked to care will limit progress towards elimination. To date, not all individuals diagnosed with HCV have access to care or receive treatment. The HCV care continuum can be very complex and people fall out of the care plan process. There is a need to simplify testing for improved compliance to care. Reflex testing by immediately performing an HCV-RNA assay on the same sample after a positive hepatitis C antibody test could help to provide a timely diagnosis. Furthermore, the HCV core antigen assay can represent both a cheaper and faster alternative for diagnosing HCV infection.

It will be important to monitor key populations at high risk of reinfection like PWID group and to ensure the availability of high-quality harm-reduction programs. Similarly, in some jurisdictions, it will be vital to strengthen healthcare systems, to prevent onward transmission of HCV. Therefore, innovative surveillance models and identifying reinfection are needed for at-risk populations.

Local Efforts A new public awareness campaign to help eradicate Hepatitis C Virus (HCV) in the UAE by 2030 was launched on Wednesday 21st of March 2018, along with a new treatment that provides patients with 95% chance of being cured. The campaign, ‘Ready to be Hepatitis C Cured’, is being organized by the Ministry of Health and Prevention (MOHAP) in partnership with the Emirates Gastroenterology and Hepatology Society (EGHS), with the aim of raising awareness about diagnosis and early detection among residents. The campaign encourages testing for people who fall under specific categories, including individuals who inject drugs, have a tattoo, have received care in countries of high HCV prevalence, hemodialysis patients, and individuals born between 1945 and 1965.

HCV treatment options have undergone major transformation with the introduction of direct-acting antivirals (DAA), which are highly effective and well tolerated with minimal side effects. These pills were recently introduced in the UAE. The medication, which consists of pills that are taken for a period of 8 to 12 weeks, have proven to have a sustained viral response, reversing the effects of early stage fibrosis, and slowing down the progression of cirrhosis into decompensation. Unlike other chronic conditions such as

14


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Figure 22: Major gaps in viral Hepatitis care.

HCV in PediatricsThere is a significant lack of available data in the pediatric field as well as awareness regarding the infection. Despite, nearly 11 million children below 15 years old around the world are living with HCV, they are rarely tested. Diagnosis of HCV infection among children remains a challenge due to the asymptomatic nature of the disease and lack of liver enzyme elevations. Currently, no DAA treatment is approved for children under the age of 12 years old, despite the fact that they could derive considerable benefit from treatment as they will achieve a high gain in quality-adjusted life years (QALYs). Furthermore, if left untreated, there is the possibility of onward HCV transmission due to high-risk behavior during adolescence. Therefore, appropriate epidemiological data and awareness of the infection must be improved in order to allow children access to DAAs.

Challenges for HCV Elimination

diabetes and hypertension, which can be controlled, HCV can be cured. Patients who are cured of their HCV infection experience numerous health benefits including “decrease in liver inflammation, halting liver fibrosis progression, and reducing the chance of hepatocellular carcinoma”.

However, various gaps and challenges have arisen in the WHO strategic framework. Therefore, the International Viral Hepatitis Elimination Meeting (IVHEM), held on 17–18 November 2017 in Amsterdam has established an expert panel made of public health professionals, epidemiologists, virologists, and clinicians to discuss the key gaps and figure out solutions for these challenges (figure 22).

TESTING GAP2020

TARGETS2015

BASELINE

2020TARGETS

2030 TARGETSFOR ELIMINATION


2015BASELINE

TREATMENT GAP

HEPATITIS B

HEPATITIS C

(% OF PEOPLE DIAGNOSED)

HEPATITIS B(% OF DIAGNOSED PEOPLEON TREATMENT)

(% OF PEOPLE DIAGNOSED)

HEPATITIS C(% OF DIAGNOSED PEOPLEON CURE)



2015BASELINE

2015BASELINE

9%

8%

7%

90%

90%

80%

80%

20%

20% 30%

15



Figure 23: Abu Dhabi Emirate Surveillance System for AMR (2019).

Sharing Reports

Cumulative Antibiogram, Abu Dhabi (2018)

Cumulative Antibiograms (CA) are a periodic (usually annual) summary of antimicrobial susceptibility of clinically relevant bacterial and fungal isolates from clinical samples. They are used to:

• inform clinicians on local levels and trends of antimicrobial susceptibilities,

• guide clinicians for making decisions on initial empirical chemotherapy for infections,

• participate in, and inform antibiotic stewardship programs (ASP),

• reveal and document trends in emerging resistance, and

• compare susceptibility rates, within and across different facilities, and benchmark to national and international data.

The data presented in this report has been collected as part of the Abu Dhabi Emirate Surveillance System for Antimicrobial Resistance (AMR), which has been established by Health Authority – Abu Dhabi (now: Department of Health) in 2010, and is currently operated by the Abu Dhabi Public Health Center (ADPHC). Selected annual and quarterly trends of antimicrobial resistance for key AMR priority pathogens have been published in this bulletin since Q1/2017 (see section VI).

The following section is shedding the light on further data from the Abu Dhabi Emirate Surveillance System for Antimicrobial Resistance, in form of an annual cumulative antibiogram for the year 2018. This report includes summary antimicrobial susceptibility test results for Gram-positive and Gram-negative bacteria, Fungi (Candida spp.), and Mycobacterium tuberculosis. Isolates represent diagnostic samples that have been isolated during routine patient care at participating private and public healthcare facilities in Abu Dhabi Emirate during the reporting period 2018. Data shown represents the percentage of isolates tested susceptible (%S).

Figures 23 and 24 provide an overview of the Abu Dhabi antimicrobial resistance surveillance system and network of participating facilities and microbiology labs (by sector, facility type and region):

16


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Figure 24: Abu Dhabi Emirate Surveillance System for Antimicrobial Resistance, Surveillance sites – by facility type and region (2019).

AAH = Al Ain hospital, ASP = Antibiotic Stewardship program, CA = Cumulative antibiogram, AMR = Antimicrobial Resistance, BWH = Brightpoint Women’s hospital, CCA = Cleveland Clinic Abu Dhabi hospital, COH = Corniche hospital, DAE = Danat Al Emarat hospital, DEL = Delma hospital, EIH = Emirates International hospital, GYH = Gayathi hospital, LIW = Liwa hospital, MAA = Mediclinic Al Ain hospital, MAJ = Mediclinic Al Jowhara hospital, MAN = Mediclinic Al Noor hospital, MAR = Mediclinic Airport Road hospital, MIR = Mirfa hospital, MQH = Mafraq hospital, MZH = Madinat Zayed hospital, NRY = NMC Royal hospital Khalifa City A, NSA = NMC Specialty hospital Al Ain, NSD = NMC Specialty hospital Abu Dhabi, RAH = Rahba hospital, SIL = Silla hospital, SKM = Sheikh Khalifa Medical City (SKMC), sp. = species, TAW = Tawam hospital, UAA = Universal hospital Al Ain, UND = Universal hospital Abu Dhabi, WAG = Al Wagan Hospital.

17



Tabl

e 14

: Cum

ulat

ive

Antim

icro

bial

Sus

cept

ibili

ty R

epor

t – G

ram

-neg

ativ

e Ba

cter

ia

Abu

Dhab

i Em

irate

, 1 Ja

nuar

y to

31

Dece

mbe

r 201

8, P

erce

nt su

scep

tible

isol

ates

(%S1 ),

isola

tes f

rom

all

sour

ces3 (N

=34,

932)

Gram

-neg

ativ

e Ba

cter

ia

Isol

ates

β-

Lact

ams

Peni

cilli

ns

Ce

phal

ospo

rins

Ca

rbap

enem

s Am

inog

lyco

side

s FQ

O

ther

N

AMP

AMC

TZP

CZO

b CX

M

CTX

CAZ

FEP

IPM

M

EM

ETP

AMK

GEN

TO

B CI

P AT

M

SXT

NIT

c G

ram

-neg

ativ

e ba

cter

ia (a

ll)

34,7

55

‒ 69

89

‒

‒ 73

‒

83

92

95

96

95

88

85

68

69

68

75c

H

aem

ophi

lus i

nflu

enza

ed 79

8 86

94

‒

‒ 97

‒

‒ ‒

‒ ‒

‒ ‒

‒ ‒

96

‒ 93

‒

M

orax

ella

(Bra

nh.)

cata

rrha

lise

179

‒ 97

‒

‒ 10

0g ‒

‒ ‒

‒ ‒

‒ ‒

‒ ‒

91g

‒ 99

‒

Enteroba

cteriaceae

27

,944

28

70

92

60

‒

75

‒84

95

99

98

98

89

87

67

79

68

‒

C

itrob

acte

r kos

eri (

dive

rsus

) 54

9 R

95

97

90

79

95

‒98

98

99

99

10

0 99

99

95

91

98

87

c

Ent

erob

acte

r clo

acae

80

6 R

R 86

R

50

79

‒92

91

98

94

99

93

93

86

87

89

47

c

Ent

erob

acte

r aer

ogen

es

539

R R

85

R R

82

‒ 95

65

98

98

10

0 95

94

85

88

92

26

c

Esc

heric

hia

coli

f 16

,805

36

74

93

59

65

70

‒

81

99

99

99

99

89

86

62

76

60

94c

K

lebs

iella

pne

umon

iae

5,70

5 R

79

87

61

70

76

‒85

97

97

97

98

91

86

73

79

77

32

c

Kle

bsie

lla o

xyto

ca

236

R 91

93

‒

73

88

‒ 91

98

98

99

98

95

88

84

85

88

85

c

Mor

gane

lla m

orga

nii

303

R R

96

R R

68

‒92

53

99

99

10

0 79

79

44

83

62

R

P

rote

us m

irabi

lis

877

66

93

99

84

91

92

‒94

22

98

96

97

82

87

65

91

62

R

P

rote

us v

ulga

ris

26

R 76

g 10

0g R

R 88

g ‒

91g

17g

92g

84g

100g

84g

‒ 56

g ‒

36g

R

Pro

vide

ncia

spp.

11

1 R

R 95

R

‒ 92

‒

98

58

95

90

100

79

71

69

‒ 84

R

S

alm

onel

la sp

p. (n

on-t

ypho

id)

687

86

92

99

‒ ‒

97

‒99

‒

‒ ‒

‒‒

‒74

h ‒

96

‒

Sal

mon

ella

Typ

hi/P

arat

yphi

26

72

g 80

g 92

g ‒

‒ 81

h ‒

69 h

‒

‒ ‒

‒‒

‒16

h ‒

72h

‒

Ser

ratia

mar

cesc

ens

649

R R

95

R R

91

‒97

81

98

98

10

0 98

89

87

98

98

R

S

hige

lla sp

p.

79

37

72

98

‒ ‒

65

‒79

‒

‒ ‒

‒‒

‒52

‒

48

‒ N

on-fe

rmen

ting

Gra

m-n

eg. r

ods

5,59

6 R

R 77

‒

‒ ‒

82

80

76

76

R 82

82

80

73

55

72

‒

A

cinet

obac

ter b

aum

anni

i 74

8 R

R 72

‒

‒ ‒

70

70

78

76

R 90

77

77

73

R

82

‒

Pse

udom

onas

aer

ugin

osa

3,72

2 R

R 91

‒

R R

88

90

84

83

R 95

92

95

82

69

R

R

Ste

notr

opho

mon

as m

alto

phili

ai 47

9 R

R R

‒ ‒

R 66

‒

R R

R R

R R

‒ R

88

‒ a Th

e %

S fo

r eac

h or

gani

sm/a

ntim

icro

bial

com

bina

tion

was

gen

erat

ed b

y in

clud

ing

the

first

isol

ate

only

of t

hat o

rgan

ism e

ncou

nter

ed o

n a

give

n pa

tient

dur

ing

2018

(de-

dupl

icat

ed d

ata)

. b

CZO

(cef

azol

in):

data

is fr

om

two

hosp

itals

only

, i.e

. not

repr

esen

tativ

e fo

r UAE

. c

NIT

: Nitr

ofur

anto

in d

ata

from

test

ing

urin

e iso

late

s on

ly.

d H.

influ

enza

e: L

VX: 9

6 %

S, C

RO: 9

7 %

S, A

ZM: 9

9 %

S, C

LR: 9

4 %

S.

e M

. cat

arrh

alis:

CLR

92

%S,

ERY

100

%

S, A

ZM 9

6%, L

VX 1

00 %

S, T

CY 8

7 %

S.

f E. c

oli (

urin

ary

trac

t iso

late

s): F

OS:

99

%S.

g A

smal

l num

ber o

f iso

late

s w

ere

test

ed (N

<30)

, and

the

perc

enta

ge su

scep

tible

shou

ld b

e in

terp

rete

d w

ith c

autio

n. h

Cipr

oflo

xaci

n re

sults

for S

alm

onel

la sp

p. re

fer t

o ex

tra-

inte

stin

al (n

on-s

tool

) iso

late

s onl

y. i S

. mal

toph

ilia:

MN

O: 9

7 %

S, T

CC: 8

0 %

S.

AMC=

Amox

icill

in/C

lavu

lani

c ac

id,

AMK=

Amik

acin

, AM

P=Am

pici

llin,

AT

M=A

ztre

onam

, AZ

M=A

zithr

omyc

in,

CAZ=

Cefta

zidim

e,

CIP=

Cipr

oflo

xaci

n,

CLR=

Clar

ithro

myc

in,

CRO

=Cef

tria

xone

, CT

X=Ce

fota

xim

e,

CXM

=Cef

urox

ime,

CZ

O=C

efaz

olin

, ET

P=Er

tape

nem

, ER

Y=Er

ythr

omyc

in,

FEP=

Cefe

pim

e,

FOS=

Fosf

omyc

in,

GEN

=Gen

tam

icin

, IP

M=I

mip

enem

, LV

X=Le

voflo

xaci

n,

MEM

=Mer

open

em,

MN

O=M

inoc

yclin

e,

NIT

=Nitr

ofur

anto

in, S

XT=T

rimet

hopr

im/S

ulfa

met

hoxa

zole

, TCC

=Tic

arci

llin/

Clav

ulan

ic a

cid,

TCY

=Tet

racy

clin

e, T

OB=

Tobr

amyc

in, T

ZP=P

iper

acill

in/T

azob

acta

m.

%S=

Perc

ent o

f iso

late

s su

scep

tible

, FQ

=Flu

oroq

uino

lone

s, M

IC=M

inim

al in

hibi

tory

con

cent

ratio

n da

ta o

nly,

exc

ept f

or H

. inf

luen

zae

and

M. c

atar

rhal

is (d

isc d

iffus

ion

data

), N

=Num

ber,

spp.

=spe

cies

, R=i

ntrin

sical

ly

resis

tant

, (‒)

=N

o da

ta a

vaila

ble,

smal

l num

ber o

f iso

late

s tes

ted

(N<3

0), a

ntim

icro

bial

age

nt is

not

indi

cate

d, o

r not

effe

ctiv

e cl

inic

ally

. Int

erpr

etat

ion

stan

dard

: CLS

I M10

0 ED

29:2

019.

Pre

sent

atio

n st

anda

rd: C

LSI M

39-

A4:2

014.

Data

sou

rce:

Abu

Dha

bi A

ntim

icrob

ial R

esist

ance

Sur

veill

ance

Sys

tem

. Dat

a sh

own

is fro

m 8

6 su

rvei

llanc

e sit

es f

rom

pub

lic a

nd p

rivat

e se

ctor

, inc

ludi

ng 2

8 ho

spita

ls an

d 58

am

bula

tory

hea

lthca

re f

acili

ties.

Ve

rsio

n 1.

4 (2

6/09

/201

9)

18


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Table 15: Cumulative Antim

icrobial Susceptibility Report – Gram-positive Bacteria

Abu Dhabi Emirate, 1 January to 31 Decem

ber 2018, Percent susceptible Isolates (%S

1), isolates from all sources 2 (N

=17,268)

Gram-positive Bacteria

Isolates β-Lactam

s M

acrolides Am

inoglycosides FQ

G

lycopept. O

ther

N

AMP

PEN

AMC

OXA

CRO

CTX ERY

CLI G

EN

GEH

STH

LVX

MFX

VAN

TEC SXT

NIT

b LN

Z TCY

RIF Q

DA

Gram

-positive organisms (all)

17,268 ‒

‒ ‒

‒ ‒

‒ 54

78 ‒

‒ ‒

77 65

99 98

69 97

99 ‒

‒ ‒

Enterococcus spp. 2,167

92 ‒

‒ ‒

R R

‒ R

R 88

90 72

69 98

97 R

96 96

‒ ‒

‒

Enterococcus faecalis 1,874

99 ‒

‒ ‒

R R

‒ R

R 88

91 74

70 99

99 R

98 97

‒ ‒

R

Enterococcus faecium

179 24

‒ ‒

‒ R

R ‒

R R

85 77

33 ‒

87 86

R 52

98 ‒

‒ 89

Staphylococcus aureus 7,726

‒ ‒

643

64 ‒

‒ 72

87 93

‒ ‒

69 72

100 100

73 100

100 86

100 88

MSSA

5,181 ‒

‒ 100

100 ‒

‒ 78

90 97

‒ ‒

73 77

100 100

75 100

100 88

100 93

MRSA

2,567 ‒

‒ ‒

‒ ‒

‒ 60

80 83

‒ ‒

59 60

100 100

70 100

100 83

99 74

Coagulase-neg. staphylococci (CNS)

1,605 ‒

‒ 32

c 32

‒ ‒

32 69

81 ‒

‒ 74

68 99

89 82

98 99

81 95

90

Staphylococcus epidermidis

675 ‒

‒ 24

c 24

‒ ‒

27 65

72 ‒

‒ 47

54 99

85 71

100 99

78 95

87

Staphylococcus saprophyticus 228

‒ ‒

33c

33 ‒

‒ 33

78 100

‒ ‒

98 97

100 100

97 99

99 89

99 93

Staphylococcus lugdunensis 109

‒ ‒

83c

83 ‒

‒ 70

79 97

‒ ‒

99 99

100 100

100 100

100 94

99 94

Streptococcus pneumoniae

727 ‒

95d

‒ ‒

97e

94e

51 70

‒ ‒

‒ 96

97 100

‒ 62

‒ 100

58 100

98

Streptococcus pyogenes 1,415

100f

100 ‒

‒ 99

99 68

87 ‒

‒ ‒

89 ‒

100 ‒

‒ ‒

100 84

‒ ‒

Streptococcus agalactiae 2,333

99 95

‒ ‒

100 94

44 58

‒ ‒

‒ 88

‒ 97

‒ ‒

100 99

12 ‒

100

Streptococcus spp. (viridans group) 434

‒ 58

‒ ‒

88 91

46 75

‒ ‒

‒ 87

‒ 99

‒ ‒

‒ 99

64 ‒

‒

a The %S for each organism

/antimicrobial com

bination was generated by including the first isolate only of that organism

encountered on a given patient during 2018 (de-duplicated data). b NIT: Nitrofurantoin data

from testing urine isolates only. c Extrapolated, based on O

xacillin. d Data shown is based on non-m

eningitis breakpoints for Pen G. Pen G (meningitis breakpoints/oral breakpoints): 44 %

S. e CRO/CTX: Data show

n is based on non-m

eningitis breakpoints f Extrapolated, based on Penicillin G.

AMP=Am

picillin, AMC=Am

oxicillin/Clavulanic acid, CLI=Clindamycin, CRO

=Ceftriaxone, CTX=Cefotaxime, ERY=Erythrom

ycin, GEH=Gentam

icin, high-level, GEN

=Gentamicin, LN

Z=Linezolid, LVX=Levofloxacin, MFX=M

oxi-floxacin, N

IT=Nitrofurantoin, O

XA=Oxacillin, PEN

=Penicillin G, QDA=Q

uinupristin/Dalfopristin, RIF=Rifampin, STH=Streptom

ycin, high-level, SXT=Trimethoprim

/Sulfamethoxazole, TEC=Teicoplanin, TCY=Tetracycline,

VAN=Vancom

ycin. %

S=Percent of isolates susceptible, FQ=Fluoroquinolones, GAS=Group A streptococci, GBS=Group B streptococci, Glycopept.=Glycopeptides, M

IC=Minim

al inhibitory concentration data only, MRSA=O

xacillin-resistant S. aureus, M

SSA=Oxacillin-susceptible S. aureus, N

=Num

ber, spp.=species, R=intrinsically resistant, (‒) =No data available, or sm

all number of isolates tested (N

<30), or antimicrobial agent is not indicated or not

effective clinically. Interpretation standard: CLSI M100 ED29:2019. Presentation standard: CLSI M

39-A4:2014.

Data source: Abu Dhabi Antimicrobial Resistance Surveillance System

. Data shown is from

86 surveillance sites from public and private sector, including 28 hospitals and 58 am

bulatory healthcare facilities. Version 1.4 (26/09/2019)

Table 17: Cumulative Antimicrobial Susceptibility Report – Candida spp. Abu Dhabi Emirate, 1 January to 31 December 2018, Percent susceptible Isolates (%S1), isolates from all sources (N=536)

Isolates (N)

Isolates (%)

Triazoles Polyenes Echinocandins Other

FLU VOR AMB2 CAS3 MIF FCT

Candida spp. 536 100 75 70 95 83 98 94

Candida albicans 193 36 96 98 96 92 92 99

Candida spp. (non-albicans) 343 64 63 ‒ 94 79 100 91

Candida tropicalis 122 23 96 97 98 ‒ ‒ 100

Candida parapsilosis 77 14 46 62 99 100 ‒ 100

Candida glabrata 63 12 ‒ ‒4 100 67 100 100

Other (non-albicans) 81 15 71 ‒ 82 ‒ ‒ 67 1The %S for each organism/antimicrobial combination was generated by including the first isolate of that organism encountered on a given patient (de-duplicated data). 2AMB: EUCAST breakpoints (S≤1, R>2). 3CAS: Caspofungin susceptibility testing in vitro has been associated with significant inter-laboratory variability. 4For C. glabrata and Voriconazole, current data are insufficient to demonstrate a correlation between in vitro susceptibility testing and clinical outcome. AMB=Amphotericin B, CAS=Caspofungin, FCT=5-Fluorocytosine, FLU=Fluconazole, MIF=Micafungin, VOR=Voriconazole. %S=Percent of isolates susceptible, MIC=Minimal inhibitory concentration data only, N=Number, spp.=species, R=intrinsically resistant, (‒) =No data available, or small number of isolates tested (N<30), or antimicrobial agent is not indicated or not effective clinically. Interpretation standard: CLSI M60 ED1:2017. For AMB: EUCAST v9.0:2019 (for AMB). Presentation standard: CLSI M39-A4:2014. Data source: Abu Dhabi Antimicrobial Resistance Surveillance System. Data shown is from 86 surveillance sites from public and private sector, including 28 hospitals and 58 ambulatory healthcare facilities. Version 1.4 (26/09/2019)

Table 18: Cumulative Antimicrobial Susceptibility Report – Mycobacterium tuberculosis Abu Dhabi Emirate, 1 January to 31 December 2018, Percent susceptible Isolates (%S1), isolates from all sources (N=434)

Isolates (N) Rifampin Ethambutol Isoniazid Pyrazinamide

Mycobacterium tuberculosis complex 434 98 99 91 89

1The %S for each organism/antimicrobial combination was generated by including the first isolate of that organism encountered on a given patient (de-duplicated data). %S=Percent of isolates susceptible, N=Number.

Data source: Abu Dhabi Antimicrobial Resistance Surveillance System. Data shown is from 86 surveillance sites from public and private sector, including 28 hospitals and 58 ambulatory healthcare facilities. Version 1.4 (26/09/2019)


Isolates (N)

Isolates (%)



Candida spp. 536 100 75 70 95 83 98 94












19




Isolates (N)

Isolates (%)



Candida spp. 536 100 75 70 95 83 98 94













Isolates (N)

Isolates (%)



Candida spp. 536 100 75 70 95 83 98 94












20


www.doh.gov.ae

1. Training sessions on Personal Protective Equipment (PPE) • Communicable diseases department (CDD) at DoH conducted 3 training sessions on the

importance of using the PPE when handling or dealing with dead bodies. The target audience are non-medical staff who deal with dead bodies, municipality and Tadweer companies, in the three regions of Abu Dhabi emirate. The objectives of these sessions were to provide practical and theoretical training on the proper donning and doffing of PPE while dealing with dead bodies.

• 80 employees attended these sessions.2. Infectious Diseases Notification (IDN) Training sessions • Two training sessions on Infectious Disease Notification (IDN) were conducted to train HCWs

at the Heart medical center in Al Ain and Etihad airways medical center in Abu Dhabi. These sessions aim to enhance awareness of HCWs on importance of reporting infectious diseases and actions taken by CDD team to prevent transmission of infections in the community.

• The total number of attendees to these sessions was 27 HCWs from different categories.3. Malaria microscopy training workshops • Malaria control team at the communicable diseases department in coordination with SEHA

laboratories conducted six training workshops in the three regions of Abu Dhabi emirate targeting physicians and laboratory technicians. The aim of these workshops were to enhance the skills of the trainees about proper methods for blood samples collection, staining and diagnosis of malaria parasites microscopically as per the updated WHO standards.

• 97 HCPs working at different SEHA and private HCFs attended these workshops.4. Immunization scientific program • An immunization scientific program was conducted in April 2019 in Abu Dhabi. The aims of the

program were to promote the use of vaccines as a tool to protect all age groups of people against infectious diseases, to explore the DoH vaccination programs with special emphasis on adult vaccination, and to address concerns related to vaccination. It targets mainly family physicians, pediatricians, general practitioners, nurses involved in vaccination services in the Emirate of Abu Dhabi. Other targeted audience include Healthcare professionals (HCPs) working in Internal Medicine, Endocrinology, Infectious Diseases, Pulmonary Diseases, Cardiovascular Diseases, and Renal Diseases departments.

• 142 HCPs attended the program from SEHA and private healthcare facilities.5. TB awareness session • As part of TB awareness sessions to the community sectors, an awareness session was conducted

at Etihad airways engineering department. The aim of the session was to raise the awareness of the employees about TB mode of transmission and preventive measures and other infectious respiratory diseases.

• 170 employees and management staff attended the awareness session.

Activities

21



Flash News

1- Outbreaks of Salmonella Infections Linked to Backyard PoultrytJune 13, 2019

A total of 279 people infected with the outbreak strains of Salmonella have been reported from 41 states in United States. 40 (26%) people have been hospitalized and no deaths have been reported. 70 (30%) people are children younger than 5 years.

Epidemiologic and laboratory evidence indicate that contact with backyard poultry, such as chicks and ducklings, from multiple hatcheries is the likely source of these outbreaks. In interviews, 118 (77%) of 153 ill people reported contact with chicks or ducklings.

People reported obtaining chicks and ducklings from several sources, including agricultural stores, websites, and hatcheries.

One of the outbreak strains making people sick has been identified in samples collected from backyard poultry in Ohio.

https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/index.html

2- Chickenpox vaccination lowers risk of pediatric shinglesJune 10, 2019

Children who receive the chickenpox (varicella) vaccine are significantly less likely to contract shingles, according to a new study led by researchers at the Kaiser Permanente Center for Health Research published in the journal Pediatrics.

The study, funded by the CDC, looked at the electronic health records of more than 6.3 million children between 2003 and 2014, using data from 6 integrated health care organizations. Approximately 50% of the children were vaccinated for some or all of the study period. Researchers found that, overall, shingles risk is much lower in vaccinated than unvaccinated children. Specifically, they concluded the following:

Over the 12-year period of the study, the rate of pediatric shingles declined by 72% overall as the number of vaccinated children rose. Incidence of shingles was 78% lower in vaccinated children than in unvaccinated children. Rates for immunosuppressed children, who were unable to receive the vaccination, were 5- to 6-times higher than for those who were not immunosuppressed.

https://www.sciencedaily.com/releases/2019/06/190610090105.htm

3- Transmission of Nipah Virus — 14 Years of Investigations in Bangladesh May 9, 2019

The investigators used data from all Nipah virus cases identified during outbreak investigations in Bangladesh from April 2001 through April 2014 to investigate case-patient characteristics associated with onward transmission and factors associated with the risk of infection among patient contacts.

Out of 248 Nipah virus cases identified, 82 were caused by person-to-person transmission. The predicted reproduction number increased with the patient’s age and was highest among patients 45 years of age or older who had difficulty breathing. Serologic testing of 1863 asymptomatic contacts revealed no infections. Spouses of patients were more often infected (8 of 56 [14%]) than other close family members The risk of infection increased with increased duration of exposure of the contacts and with exposure to body fluids.

In conclusion, increasing age and respiratory symptoms were indicators of infectivity of Nipah virus. Interventions to control person-to-person transmission should aim to reduce exposure to body fluids.

https://www.nejm.org/doi/full/10.1056/NEJMoa1805376

22


www.doh.gov.ae

Figure 26: number of imported malaria cases to the Emirate of Abu Dhabi (2013 – 2017).

Flash-on-an-Illness

Cryptosporidiosis

Cryptosporidiosis is an illness caused by Cryptosporidium spp. which are oocysts-forming apicomplexan protozoa that can cause enteric infection both in humans and in animals.Infection with Cryptosporidium spp. is now recognized globally as an important cause of diarrhea in both children and adults. Clinical manifestations can be wide ranging, from asymptomatic infections to severe, life-threatening illness especially in severely immunocompromised patients.While the small intestine is the site most commonly affected, symptomatic Cryptosporidium infections have also been found in other organs including other digestive tract organs, the lungs, and possibly conjunctiva.Cryptosporidiosis has great public health importance as it also poses occupational risks to the human population. For example, asymptomatic food workers infected with Cryptosporidium spp. can be the source of transmissions in the outbreaks.

History of Cryptosporidiosis

1907 Cryptosporidiosis was first recognized in by Edward Tyzzer (a distinguished medical parasitologist at Harvard University in Boston who published numerous papers). For nearly 50 years after Tyzzer's initial discovery the protozoan was regarded as an infrequent and insignificant infection that occurred in the intestines of vertebrates and caused little or no disease.

1955 Cryptosporidiosis was discovered in fowl with fatal enteritis that the protozoan was considered a parasite.

1970s Cryptosporidiosis has been identified in the gastrointestinal or respiratory tract of most species of animals, including mammals, reptiles, birds and fish.

1980s Its association with gastrointestinal illness in humans and animals was recognized only in the early1980s

1993 There was an outbreak in the municipal water supply in Milwaukee, Wisconsin in the United States, causing about 40,000 illnesses

1997 Another outbreak occurred at the Minnesota Zoo, associated with a large decorative water fountain where children were allowed to play. There were 369 cases of Cryptosporidium infection, most occurring in children under the age of 10 years. Many other outbreaks have occurred since then and most of them associated with recreational water venues (from CDC website).

Over the next 25 years, information was generated on the disease's epidemiology, biology, cultivation, taxonomy and development of molecular tools. Cryptosporidiosis has now entered the forefront of public attention, as it has become a lethal threat to immunocompromised individuals. In the case of HIV, cryptosporidiosis plays the role of an opportunistic infection as it may cause severe dehydration and malnutrition, which may be fatal to the HIV positive patient.

23



Cryptosporidia live in the intestine of infected humans or animals. The infection is transmitted by fecal-oral route and results from the ingestion of oocysts through the consumption of fecally contaminated food or water or through contact with an infected person or animal.

Incubation period: The incubation period is 1-12 days, usually 5-7 days

Confirmed: Evidence of Cryptosporidium organisms or DNA in stool, intestinal fluid, tissue samples, biopsy specimens, or other biological sample by certain laboratory methods with a high positive predictive value (PPV) like: • Direct fluorescent antibody [DFA] test, • Polymerase chain reaction [PCR], • Enzyme immunoassay [EIA], OR • Light microscopy of stained specimen.Probable: The detection of Cryptosporidium antigen by a screening test method, such as immunochromatographic card/rapid card test; or a laboratory test of unknown method.

Clinical DescriptionCryptosporidiosis is a gastrointestinal illness characterized by watery diarrhea that can be accompanied by abdominal cramps, fatigue, fever, vomiting, anorexia, and weight loss.

Management and treatmentThe infection is usually self-limiting in healthy people and they usually recover after 2 to 4 days. Treatment is supportive to relieve the symptoms. Increased oral fluid intake is recommended to prevent dehydration. Supplementation with intravenous fluids may be necessary to prevent dehydration if the patient is unable to maintain oral intake.

Probable• A case with supportive laboratory test results for Cryptosporidia spp. infection using a method listed

in the probable laboratory criteria. When the diagnostic test method on a laboratory test result for cryptosporidiosis cannot be determined, the case can only be classified as probable, OR

• A case that meets the clinical criteria and is epidemiologically linked to a confirmed case.

ConfirmedA case that is diagnosed with Cryptosporidium spp. infection based on laboratory testing using a method listed in the confirmed criteria.

Laboratory Criteria for Diagnosis

Case Classification

24


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EpidemiologyC. hominis and C. parvum are the major causing agents of human cryptosporidiosis both in immunocompetent and in immunocompromised individuals but their prevalence varies in different regions of the world. Epidemiological studies showed that C. hominis is more prevalent in North and South America, Australia, and Africa, whereas C. parvum causes more human infections in Europe, especially in the UK.A seasonal incidence of infection is sometimes present, possibly corresponding to rainfall peaks, increased pollution from farm waste, or calving and lambing activities.Outbreaks have been reported in hospitals, day-care centres, within households, among bathers (affecting participants in water sports in lakes and swimming pools), and in municipalities with contaminated public water supplies. Water distribution systems are particularly vulnerable to contamination with Cryptosporidium, which can survive most disinfection procedures such as chlorination.

Cryptosporidiosis in the UAEThere is little epidemiological data on Cryptosporidium infections in the United Arab Emirates. A study was conducted in 2018 to determine the prevalence of Cryptosporidium species among a community of expatriates in Sharjah working in different sectors, including the food industry, housemaids and other domestic occupations.

Figure 25: Major worldwide occurrence of human cryptosporidiosis outbreaks and sporadic cases

25



One hundred and thirty four stool samples were collected from asymptomatic individuals presenting to the Sharjah Municipality Public Health Clinic (SMPHC) for screening of intestinal parasites for work permission purposes between 2009 and 2011. Infection by Cryptosporidium sp. was common in the study group (Twenty-six individuals (19.4%) were positive for Cryptosporidium sp. by PCR). Another study was conducted in 2014 to assess the presence of Cryptosporidium and Giardia in the water of school swimming pools in Dubai. The study concluded that Cryptosporidium and Giardia were found to be present in the tested schools' swimming pool water and recommended monitoring of both parasites to enhance the swimming pool water quality and ensure the public health safety.Further studies are needed in the UAE to understand the prevalence of the cryptosporidiosis in the population in addition to disease transmission and possible sources of infection.

Cryptosporidiosis in Abu DhabiCryptosporidiosis is not a reportable disease but outbreaks of cryptosporidiosis affecting many people that are related to water and food, should be reported to DoH through the electronic notification system so that appropriate public health responses can be taken to control the spread of this disease.Department of health received 9 notifications of Cryptosporidium in 2018. All cases were ≤10 years old and required admission to the hospital and discharged in a good condition. Almost all cases didn’t have known source of infection. Few had travel history before developing symptoms. Health education provided to the patients and families on the nature of disease transmission and prevention.

PreventionContact with human and animal feces should be entirely avoided and if such interaction is necessary as in diaper changing, litter box cleaning, the individual should wear protective gloves. If contact occurs the individual should immediately wash and disinfect exposed area. Ingestion of water from rivers, lakes, swimming pools or other such open bodies of water should be avoided.

26


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AbstractSince the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, there have been a number of clusters of human-to-human transmission. These cases of human-to-human transmission involve close contact and have occurred primarily in healthcare settings, and they are suspected to result from repeated zoonotic introductions. In this study, we sequenced whole MERS-CoV genomes directly from respiratory samples collected from 23 confirmed MERS cases in the United Arab Emirates (UAE). These samples included cases from three nosocomial and three household clusters. The sequences were analysed for changes and relatedness with regard to the collected epidemiological data and other available MERS-CoV genomic data. Sequence analysis supports the epidemiological data within the clusters, and further, suggests that these clusters emerged independently. To understand how and when these clusters emerged, respiratory samples were taken from dromedary camels, a known host of MERS-CoV, in the same geographic regions as the human clusters. Middle East respiratory syndrome coronavirus genomes from six virus-positive animals were sequenced, and these genomes were nearly identical to those found in human patients from corresponding regions. These data demonstrate a genetic link for each of these clusters to a camel and support the hypothesis that human MERS-CoV diversity results from multiple zoonotic introductions.

KEYWORDS:

dromedary camel; epidemiology; genomics; middle east respiratory syndrome; viral pathogens; zoonoses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893383/pdf/nihms939333.pdf

Applied Researches in Communicable DiseasesZoonotic origin and transmission of Middle East respiratory

syndrome coronavirus in the UAE

Paden CR, Yusof MFBM, Al Hammadi ZM, Queen K, Tao Y, Eltahir YM, Elsayed EA, Marzoug BA, Bensalah OKA, Khalafalla AI, Al Mulla M, Khudhair A, Elkheir KA, Issa ZB, Pradeep K, Elsaleh FN, Imambaccus H, Sasse J, Weber S, Shi M, Zhang J, Li Y, Pham H, Kim L, Hall

AJ, Gerber SI, Al Hosani FI, Tong S, Al Muhairi SSM.

27



Editorial Board- Dr. Farida Al Hosani (Manager / Communicable Diseases Department, DoH)- Dr. Mariam Al Mulla (Section Head, Communicable Diseases Department, DoH)- Dr. Badreyya Al Shehhi (Section Head, Communicable Diseases Department, DoH)- Dr. Ahmed Khudhair (Senior Officer, Communicable Diseases Department, DoH)- Dr. Tahera Al Ameri (Senior Officer, Communicable Diseases Department, DoH)- Mrs. Wafa Aldhaheri (Senior Officer, Communicable Diseases Department, DoH)- Dr. Salwa Mohammed (Officer, Communicable Diseases Department, DoH)- Mrs. Feda El Saleh (Officer, Communicable Diseases Department, DoH)- Dr. Bashir Aden (Advisor, Healthcare Quality, DoH)- Dr. Faiza Ahmed (Senior Analyst, Healthcare Quality, DoH)- Dr. Jens Thomsen (Section Head, Environmental Health, DoH)- Dr. Budoor Al Shehhi (Section Head, Community Health and Surveillance Department, DoH)

Scientific Board - Dr. Farida Al Hosani, Chair of the committee (Manager / Communicable Diseases Department, DoH)- Prof. Tibor Pal (Professor, Department of Medical Microbiology, UAEU)- Dr. Ahmed Al Suwaidi (Consultant Pediatric Infectious Diseases, Assistant Professor, UAEU)- Dr. Rayhan Hashmey (Consultant Infectious Diseases, Tawam Hospital)- Dr. Bashir Aden (Advisor, Healthcare Quality, DoH)- Dr. Jamal Al Mutawa (Manager, Community Health and Surveillance Department, DoH)- Dr. Stefan Weber (Consultant Microbiologist / SKMC)- Dr. Zahir Babiker (Consultant Infectious Diseases Physician and Assistant Professor in UAEU)- Dr. Huda Imam (Consultant Physician / Al Ain Hospital)- Mrs. Wafa Aldhaheri, Secretary (Senior Officer, Communicable Diseases Department, DoH)

We are glad to invite you to participate in this bulletin. Please contact:

Mrs. Wafa Aldhaheri Communicable Diseases DepartmentDepartment of HealthTel: +971 (3) 7165020E-Mail: [email protected]

LIST OF INFECTIOUS DISEASES TO BE NOTIFIED

AnthraxBotulismBrucellosis

ChikungunyaCholeraCorona virus (MERS COV)Dengue Fever

Pertussis (Whooping Cough)

Diphtheria

Escherichia coli (Enterohemorrhagic):Foodborne Illness Specify: ..............

ShigellosisSmallpox (Variola)

Tuberculosis (Pulmonary)

Typhoid/Paratyphoid FeverTyphus FeverViral Hemorrhagic FeverYellow FeverZika VirusOccurrence of any unusual diseasesspecify ...........................................

ViralBacterial

UnspecifiedFungal

PlagueRabiesRelapsing Fever

Rubella (German Measles)Rubella Syndrome, Congenital

ViralBacterial

1

1

1

1

1

1

1

1

1

1

1

1

11

Influenza - Avian (Human)

Haemophilus influenza invasive disease

Human Immunodeficiency Virus(HIV)/AIDS

Influenza – H1N1

LegionellosisLeprosy (Hansen Disease)

Malaria

11

1

11

11Measles (Rubeola)

Unspecified

All notifications (suspected and confirmed) should be submitted via: https://bpmweb.haad.ae/UserManagement/Login.aspx

http://www.haad.ae/haad/

Communicable Diseases Bulletin

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