Download Volume 6, Issue 3 - 2015 (3rd Quarter: Jul – Sep)

Quarterly Summary Report
Third Quarter – 2015 (Jul-Sep)
Volume 6; Issue Number 3; 2015
Communicable
Diseases Bulletin
www.haad.ae
Table 1: Notified cases in
Abu Dhabi Emirate by Region (Q3, 2015)
Quarter 2 2015
Cases
Table of Contents
Item
Content
I
Notified cases in Abu Dhabi Emirate by region
(Quarter 3, 2015)
3
Notified cases in Abu Dhabi Emirate by age
and gender (Quarter 3, 2015)
4
Monthly trends for selected notified diseases in
Abu Dhabi Emirate
(Q 3 /2015 Vs Q 3 /2014 and 2013)
5
Visa screening applicants in Abu Dhabi Emirate
(Q 3 /2015)
6
II
III
IV
V
VI
Page
7-10
Sharing Reports: HAAD Immunization
Information System (IIS)
11-13
VII
Activities
14
VIII
Flash news
15
IX
The volume: “Flash- on-an-Illness”: Leprosy
16-18
2015
TOTAL
2014
2013
Year Total
Q1
Q2
Q3
Q1+Q2
+Q3
Q1+Q2
+Q3
Q1+Q2
2014
2013
AFP *
2
0
0
2
1
2
5
6
8
7
10
Brucellosis
10
20
1
10
25
31
66
38
86
49
99
Chickenpox
705
103
52
1415
1312
860
3587
3575
3770
4660
4581
2
0
0
0
1
2
3
3
2
3
2
111
9
15
73
204
135
412
293
592
360
675
Haemophilus influenzae invasive
0
0
0
0
0
0
0
0
1
1
1
Hepatitis A
30
7
4
58
31
41
130
156
206
224
271
Hepatitis B
238
53
17
233
275
308
816
576
534
818
699
Hepatitis C
176
27
0
185
197
203
585
414
409
570
546
Influenza
103
35
4
772
341
142
1255
1089
257
1499
410
Malaria * ¶
521
328
82
159
383
931
1473
1863
1602
2415
2203
Measles *
6
5
0
36
54
11
101
112
53
117
122
Meningitis (bacterial)
11
1
0
20
11
12
43
32
28
38
33
Meningitis (viral)
14
1
3
14
11
18
43
39
46
56
59
Mumps
39
6
3
50
73
48
171
138
139
182
174
Pertussis
6
2
1
4
3
9
16
11
30
15
38
Rubella *
19
1
0
26
84
20
130
10
13
10
15
Scabies
243
51
5
554
372
299
1225
1123
707
1475
1001
Shigellosis
5
1
0
7
3
6
16
14
12
14
17
Tetanus
0
0
0
0
0
0
0
1
1
1
2
Tuberculosis (Pulmonary) *
41
17
6
112
85
64
261
249
329
338
311
Tuberculosis (Extra-Pulmonary)
36
18
2
52
57
56
165
146
130
205
169
Typhoid /Paratyphoid
54
13
10
67
67
77
211
160
198
222
248
Rotavirus
48
63
12
216
208
123
547
514
631
615
864
Other diseases
444
160
27
840
777
631
2248
1532
1320
2032
1607
Total
2864
921
244
4905
4575
4029
13509
12094 11104
15926
14157
Grand total including all ruled
out notifications
3352 1030
335
5755
5400
4717
15872
14455 12345
18705
16122
Cholera
Foodborne illnesses **
Topic of the volume: Sexually Transmitted
Infections (STIs)
Abu Eastern Western
Dhabi Region Region
Cumulative in Abu Dhabi Emirate
Illnesses covered by national control programs (only confirmed cases and cases that cannot be ruled out are included in the table)
Foodborne illnesses (FBI) other than those specified in the list
FBI includes: Salmonellosis, Campylobacteriosis, Adenovirus and Clostridium.
¶ All notified malaria cases are “imported”
Indicates increase or decrease in number of notified cases during the 3rd quarter of 2015 compared to previous quarters
Indicates increase or decrease in numbers of notified cases over Q1-Q3 2013 as compared to the previous two years
Page 2
Quarterly Summary Report: 3nd Quarter - 2015
Quarterly Summary Report: 3nd Quarter - 2015
Page 3
Chickenpox declined in 3rd quarter in consistence
with the previous two years. It could be due to
school vacation during this period of time.
Total
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
2
2
Brucellosis
0
0
0
0
3
1
2
2
11
1
5
1
3
0
0
2
0
0
24
7
31
700
860
600
30
35
42
46 138 18 343 52
95
10
21
0
5
2
0
0
Cholera
0
0
0
0
0
0
0
0
0
0
0
0
0
0
21
0
1
1
0
1
0
688 172
1
69
1
66
2
135
Food Borne Illness
2
Haemophilus influenzae
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Hepatitis A
0
0
3
1
9
7
5
3
8
1
1
1
0
0
1
0
1
0
28
13
41
Hepatitis B
1
2
0
0
1
0
26
5
79
42
54
19
40
7
17
8
2
5
220
88
308
Hepatitis C
1
0
0
0
1
0
12
1
52
11
46
4
35
5
21
10
2
2
170
33
203
7
11
5
9
7
6
33
13
5
7
5
3
0
0
Influenza
0
4
32
32
14
10
5
2
8
5
13
5
6
2
1
1
1
1
80
62
142
Malaria *
0
0
4
6
8
5
281
7
356
8
145
2
82
2
23
1
1
0
900
31
931
Measles *
0
2
2
2
0
0
0
1
1
2
1
0
0
0
0
0
0
0
4
7
11
Meningitis Bacterial
3
0
1
0
2
1
0
0
1
1
1
0
0
1
0
0
1
0
9
3
12
Meningitis Viral
2
4
1
0
1
0
1
0
1
1
4
1
2
0
0
0
0
0
12
6
18
Mumps
1
0
6
4
9
12
2
0
3
3
5
2
0
0
1
0
0
0
27
21
48
Pertussis
1
6
0
1
0
0
0
0
0
0
1
0
0
0
0
0
0
0
2
7
9
Rubella *
0
0
0
0
0
0
3
2
10
3
1
1
0
0
0
0
0
0
14
6
20
Scabies
2
11
7
62
3
106 15
45
6
18
4
7
1
6
4
2
0
0
257
42
0
0
0
0
0
0
1
1
0
1
2
1
0
0
0
0
0
0
3
3
6
Tetanus
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Tuberculosis (Pulmonary) *
1
0
0
0
0
0
7
4
17
4
9
6
5
2
4
2
1
2
44
20
64
Tuberculosis
(Extra-Pulmonary)
1
0
0
0
0
0
6
2
23
9
9
4
1
0
0
1
0
0
40
16
56
Typhoid /Paratyphoid
Fever
0
0
1
3
3
1
10
4
20
10
12
1
9
2
1
0
0
0
56
21
77
Rotavirus
10
14
33
28
7
5
1
3
9
3
3
2
3
0
0
2
0
0
66
57
123
Other Diseases
22
13
Total
61
62 170 160 151 139 601 95 1197 295 514 123 259 41 101 36
40
23
35
33
32
30 115 110 57
50
29
13
19
5
3
2
352 279
4717
Grand total
The highlighted cells (with red numbers) indicate the age/gender categories that had the largest numbers of reported cases for the given illness.
Σ The grand total for Q3 2015 after including all ruled out notifications will be 4717.
2014
500
2015
400
300
200
100
Foodborne Illnesses
(after excluding Rotavirus cases)
250
2013
2014
2015
200
150
100
50
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Pattern of Hepatitis A in Q3 is the same compared
to the previous two years. Increased number in
this quarter may be associated with the start of the
academic year and/or travel history.
Hepatitis A
50
45
Jul
Aug
Sep
Oct
Nov
Dec
Influenza notifications started to increase in Q3 following
the same pattern of the two previous years.
Influenza
500
2013
2014
2015
40
35
30
25
20
15
10
5
(Including influenza A and B only)
450
2013
2014
2015
400
350
300
250
200
150
100
50
0
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
MONTH
Jul
Aug
Sep
Oct
Nov
Dec
There is a decline in measles cases in Q3 following same pattern as of previous two years. This was
observed in summer time which may be due to school
vacation.
40
Malaria
450
Jun
MONTH
Malaria follows the same trend compared with previous years. All reported malaria cases are imported.
2013
2014
2015
400
Σ
Jun
MONTH
MONTH
631
12 12 3066 963 4029
300
2013
0
299
Shigellosis
Chickenpox
Number of notified cases
9
Number of notified cases
14
Number of notified cases
Chickenpox
Number of notified cases
AFP *
Food borne illness in 3rd quarter is still steady with
a minor outbreak reported in AD region.
Measles
35
2013
2014
30
350
Number of notified cases
Cases
Monthly Trends for Selected Notified
Diseases in Abu Dhabi Emirate (Q3/2015)
Number of notified cases
Table 2: Notified cases in
Abu Dhabi Emirate by Age & Gender (Q3, 2015)
2015
25
300
250
20
200
15
150
10
100
50
5
0
Jan
Feb Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
0
Jan
Feb
Mar
Apr
May Jun
MONTH
Page 4
Quarterly Summary Report: 3nd Quarter - 2015
Jul
Aug
Sep
Oct
Nov
Dec
MONTH
Quarterly Summary Report: 3nd Quarter - 2015
Page 5
Visa Screening in Abu Dhabi Emirate
(Q3-2015)
Visa screening is mandatory for all expatriates applying for work and/or residence in Abu
Dhabi Emirate. It consists mainly of screening for Human Immunodeficiency Virus (HIV),
pulmonary tuberculosis, and leprosy. Screening for Hepatitis B and syphilis are limited to a
few occupational categories. HAAD Visa Screening Standard is available online at: http://
www.haad.ae/HAAD/LinkClick.aspx?fileticket=rPUOPzw3_Gw%3D&tabid=820
Around quarter a million people or more apply for visa medical screening every three
months in Abu Dhabi Emirate. During the third quarter of 2015, a total of 424,899 applicants
were screened at all HAAD-licensed Screening Centers (a total of eleven centers in the three
regions of Abu Dhabi).
Figure 1: Visa screening applicants during the third quarter. 2015
450000
No. of Applicants
252876
250000
172023
200000
Introduction
Sexually transmitted infections (STIs) are a major global cause of acute illness, infertility, longterm disability and death with serious medical and psychological consequences for millions of
men, women and infants.
The Health Authority Abu Dhabi (HAAD) estimates that nearly 1500 new sexually transmitted
infections occur every year in the Emirate of Abu Dhabi. The most widely known are syphilis,
gonorrhoea, chlamydia and human immunodeficiency virus (HIV). Many of these are curable with
effective treatment, but they continue to be a major public health concern in both industrialized and
developing countries. The World Health Organization (WHO) estimates that, globally, more than
340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occur every year in
men and women aged between 15–49 years.
• More than 1 million people acquire sexually transmitted infection every day.
• Each year, an estimated 500 million people become ill with one of 4 STIs: chlamydia,
gonorrhoea, syphilis and trichomoniasis.
• More than 530 million people have the virus that causes genital herpes (HSV2).
• More than 290 million women have a human papillomavirus (HPV) infection.
• In pregnancy, untreated early syphilis will result in a stillbirth rate of 25% and be responsible
for 14% of neonatal deaths – an overall perinatal mortality of about 40%.
347292
300000
Sexually Transmitted Infections (STIs)
Global Figures
424899
400000
350000
TOPIC OF THE VOLUME
150000
77607
100000
50000
0
M
Gender
F
New
TOTAL
Renewal
Visa Status
Table 3: Number and prevalence rate of positive cases among new and renewal visa
applicants during the third quarter of 2015.
Disease
Hepatitis B*** Tuberculosis**
HIV
Leprosy
Syphilis***
New
Renew
New
Renew
New
Renew
New
Number of Cases
102
9
235
14
119
73
0
0
336
0
Prevalence*
59.3
3.6
709.9
52.3
69.2
28.9
0
0
1105.7
0
Visa Status
Overall Prevalence*
26.1
416.0
45.2
Renew
New
0
Renew
611.6
* Prevalence: the number of positive cases per 100,000 visa screened applicants
** This refers to active TB cases only
*** Applies to tested occupational categories only.
Figure 2: Estimated cases of curable sexually transmitted infections (gonorrhoea, chlamydia, syphilis and trichomoniasis) by WHO regions, 2008.
Page 6
Quarterly Summary Report: 3nd Quarter - 2015
Quarterly Summary Report: 3nd Quarter - 2015
Page 7
Causative agents and mode of transmission
STIs are infections that are spread primarily through sexual contact with an infected
person. There are more than 30 different sexually transmissible bacteria, viruses and
parasites.
The most common conditions they cause are gonorrhoea, chlamydial infection, syphilis,
trichomoniasis, chancroid, genital herpes, genital warts, and human immunodeficiency virus
(HIV) infection.
Several infections, in particular HIV and syphilis, can also be transmitted from mother to
child during pregnancy and childbirth, and through blood products and tissue transfer.
Treatment of STIs
In addition, category of “Others” was added to report any other STIs which are not listed in HAAD
electronic system.
Health professionals are ethically obligated to protect patient confidentiality. On the other hand CDD
should contact the case and make sure he/she is aware of the diagnosis. As well, the case should be
educated with regard to mode of transmission and prevention methods of STIs.
Both suspected and confirmed STIs should be reported to HAAD through
electronic notification system:
http://bpmweb.haad.ae//Usermanagement/login.aspx
Effective treatment is currently available for several STIs. The infection is easily treated
Resistance of STIs—in particular gonorrhoea—to antibiotics has increased rapidly in recent
years and has reduced treatment options. The emergence of decreased susceptibility of
gonorrhoea to the “last line” treatment option (oral and injectable cephalosporins) together with
antimicrobial resistance already shown to penicillins, sulphonamides, tetracyclines, quinolones
and macrolides makes gonorrhoea a multidrug-resistant organism. Antimicrobial resistance for
other STIs, though less common, making prevention and prompt treatment critical.
For more information about common STIs, please refer to CDC/STIs Fact Sheets available at:
http://www.cdc.gov/std/healthcomm/fact_sheets.htm.
STIs notification in the Health Authority - Abu Dhabi (HAAD)
According to the federal law No. 27 of 1981 (and the updated law No. 14 of 2014), STIs are
among notifiable diseases which should be reported to communicable diseases department
in HAAD. STIs can be reported within seven days after identifying the case. List of STIs that
must be reported include:
Chlamydia
Chancroid
Gonorrhea
Genital Warts
Herpes Simplex
Syphilis
Trichomoniasis
Page 8
Screening programs for STIs in Abu Dhabi:
• Antenatal screening of pregnant women for: syphilis, hepatitis B and HIV.
• Premarital screening for: HIV, Hepatitis B, human papilloma virus (HPV) and Syphilis.
• Screening of Visa applicants for HIV, Syphilis and Hepatitis B (two latter diseases for certain job
categories of applicants).
• Pre-employment screening for HIV and Hepatitis B.
Statistical figures from HAAD ID notification system
469
500
367
400
No. of reported cases
with antibiotics, but can lead to serious long-term health problems if left untreated, including
infertility.
Three bacterial STIs (chlamydia, gonorrhoea and syphilis) and one parasitic STI
(trichomoniasis) are generally curable with existing, effective single-dose regimens of
antibiotics.
For herpes and HIV, the most effective medications available are antivirals that can modulate
the course of the disease, though they cannot cure the disease.
For hepatitis B, immune system modulators (interferon) and antiviral medications can help to
fight the virus and slow damage to the liver.
300
251
173
200
100
0
2011
2012
2013
2014
Figure 3: Reported Cases of STI’s between 2011 and 2014 in Abu Dhabi Emirate.
Quarterly Summary Report: 3nd Quarter - 2015
Quarterly Summary Report: 3nd Quarter - 2015
Page 9
Sharing Reports
HAAD Immunization Information System (IIS)
No. of notified cases
250
200
150
Chlamydia Cases
Gonorrhea Cases
100
Syphilis Cases
50
0
Y2011
Y2012
Year
Y2013
Y2014
Figure 4: Reported Cases of Chlamydia, Gonorrhea, and Infectious Syphilis (2011-2014) Abu Dhabi
Emirate [Note that some of reported syphilis cases received from blood bank].
Vaccination is one of the most effective public health interventions available and save 2–3
million lives per year worldwide. Most vaccines in use today provide high levels of individual
protection against disease. In addition, most Vaccine Preventable Diseases (VPDs) are spread from
infected people to susceptible people. When high levels of immunity are achieved by vaccination
in a community, a person with VPD is unlikely to encounter a susceptible host. Consequently
transmission is blocked and exposure of others in the community who are not protected by
vaccination will be prevented.
In the Emirate of Abu Dhabi, high vaccination rates have been reached for many recommended
vaccines, leading to the near elimination of the corresponding vaccine preventable diseases listed in
table 5. While this reduction in VPDs demonstrates the great success of vaccines and the efforts of
all the entities involved in vaccination programs in the Emirate of Abu Dhabi, there is still work to be
done.
Table 4: Reported cases and rates (per 100,000 population) of vaccine preventable diseases
(2011 – 2014) in Abu Dhabi emirate:
Cases
Rates per 100,000 Population
% of notified cases
Disease
Hepatitis B
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Diphtheria
Pertussis
Chlamydin
Genital Warts
Polio
Gonorrhea
Haemophilus
influenza type B
Herpe
Simplex
0-14
15-19
20-24 25-29
Age group
30-39
Tetanus
40+
Figure 5: Distribution of Sexual Transmitted Infections by Age Group in Abu Dhabi Emirate (2011-2014).
Invasive
Pneumococcal
Disease (IPD)
Rota Virus
Measles
Mumps
Rubella
Chickenpox
Page 10
Quarterly Summary Report: 3nd Quarter - 2015
Quarterly Summary Report: 3nd Quarter - 2015
Page 11
As the end of 2015 and continuing into 2016, the UAE led by Ministry of Health has been conducting
a massive national measles campaign for children 1- 18 years of age with the aim of achieving the
measles elimination target for WHO EMRO region (The elimination target is set as <1 case/ million
population). The target population for phase 1 is 500,000. Prior to this campaign, Health Authority Abu
Dhabi has established an Immunization Information System registry that collects all vaccine information
administered in the Emirate of Abu Dhabi which has been integrated electronically with SEHA IT system.
HAAD Immunization Information System is a confidential, population based registry that records all
immunization doses administered by participating providers to persons residing within the Emirate of
Abu Dhabi regions:
• At the healthcare provider level, IIS can provide consolidated immunization histories for use by a
vaccination provider in determining appropriate client vaccinations.
• At the public health level, an IIS provides aggregate data on vaccinations for use in surveillance
and program operations, and in guiding public health action with the goals of improving
vaccination rates and reducing vaccine-preventable disease.
Immunization Information System was developed to achieve the following objectives:
1. National Program Support: HAAD IIS helps local and national immunization programs to identify
populations at high risk for vaccine-preventable diseases and target interventions and resources
efficiently.
2. Immunization Registry: HAAD IIS is an Abu Dhabi emirate wide immunization registry that collects
vaccination history information from different sources into a single record and provides official
immunization records for parents or other services that require prove of immunization entry
requirements.
3. Public Health Support: HAAD IIS helps the public health team to monitor outbreaks and adverse
events related to vaccines. IIS ensures that healthcare providers do follow the most up-to-date
recommendations for immunization practice.
4. Timely Immunization: HAAD IIS reminds families when an immunization is due or has been missed.
5. Parents Support: HAAD IIS help providers and parents to determine when immunizations are due
and help ensure that children get only the vaccinations they need.
6. Healthcare Provider’s Support: HAAD IIS is capable of exchanging immunization information with
immunization healthcare providers. Data exchange between IIS and other information systems
helps ensure timely immunizations, consolidation of records, and allows immunization providers to
work more efficiently.
Vaccine Administration by Category Abu Dhabi: January 1st to
September 30, 2015
Healthcare
Provider’s
Support
Parent’s
Support
Immunization
Program
Support
IIS
Timely
Immunizaton
AD Emirate
Wide Registry
Puplic Health
Support
Catch up
38
HPV catch up
56
Premarital screening program
674
>=65
735
Travelers
1.228
Contacts
1.821
Diabetics
5.361
Chronic Diseases
5.716
Healthcare Professionals
5.954
Others
23.121
Newborn Screening Program
25.197
Hajj and Umra
Figure 6: HAAD IIS goals.
10.772
Others Hight Risk Conditions
School
53.393
127.426
Expanded Immunization Program
385.136
Figure 7: Vaccine administration by category from January 1st to September
30th 2015. Expanded Immunization Program including all children from
birth till the age of preschool [Note that numbers indicated in the graph are
encounters/notifications, it is not coverage].
Page 12
Quarterly Summary Report: 3nd Quarter - 2015
Figure 8: HAAD childhood, school and adult immunization schedule.
Quarterly Summary Report: 3nd Quarter - 2015
Page 13
Activities
1. Infectious Diseases Notification (IDN) Education program
• Six series of training sessions were conducted in some of the private hospitals and clinics to
enhance the ID notification awareness among their Health care workers.
• The whole program was attended by 112 healthcare workers of different job professions from
the targeted healthcare facilities.
2. Malaria Prevention for Travelers
• Three training sessions about malaria prevention for travelers from UAE were conducted during
Q -3 at the three regions of Abu Dhabi Emirate, to educate healthcare professionals on the
ABC’s of malaria prevention to different malaria endemic countries and to discuss drugs used
for malaria prevention in special groups of travelers.
• A total of 120 participants attended these sessions from different job professions working at
SEHA and private HCFs in Abu Dhabi emirate.
3. Awareness session on Malaria Control Processes in farms
• One awareness session was conducted in Al Ain to educate Agricultural Extension Workers on
mosquitos’ habitat in farms and advise to farms workers and owners.
• 60 technical staff and supervisors at Farmers Services Center in Al Ain attended this awareness
session.
4. Updates on STIs and HIV management, control and counseling workshop:
• The objective of this workshop was to update the target audience about the global and national
epidemiology of HIV, to present the updated management protocols of HIV and STIs, to
explore the current situation in reporting STIs from HCFs and to discuss the best approaches in
counselling and breaking bad news in newly reported HIV and other STIs.
• A total of 108 Healthcare professionals who work in different private and public HCFs in Abu
Dhabi emirate attended the workshop.
5. Training workshop on Strengthening TB reporting and management in Private HCFs in Abu Dhabi
Emirate
• The objectives of the workshop were to define the roles and responsibilities of private health
care professionals in implementation of DOT standard for TB management, to clarify the
requirements for confirmatory tests for TB cases detected in private HCFs and to define
challenges in implementation of DOT program and how to deal with them.
• The workshop was attended by 82 health care professionals working at private HCFs in Abu
Dhabi where TB cases are seen and managed.
6. AFP and measles awareness session:
• The objective of this session was to raise the awareness of the participants to detect and report
AFP and measles cases to CDD/HAAD.
• The session was conducted in Medeor24X7 hospital- Abu Dhabi and attended by (17) HCPs
from the nurses and physicians working in the hospital.
Page 14
Quarterly Summary Report: 3nd Quarter - 2015
Flash News
I- Premarital Screening Reduces Genetic Diseases and Promotes Healthier
New Generations
Abu Dhabi - July 2015 –HAAD has revealed that since the electronic database of premarital
screening was set up, 56,226 people have had screening tests in Abu Dhabi between April 2011 and
December 2014 – with more than half of those screened being Emirati.
The premarital screening is mandatory for couples who plan to get married in the UAE; in which it is
required before a couple can be issued a marriage certificate in the UAE. The screening includes tests
for genetic diseases such as: Beta-thalassemia, sickle cell anemia and other hemoglobinopathies.
According to HAAD statistics, considerable number of applicants tested positive for genetic
diseases and others are carriers.
HAAD guides cases that have a history of genetic diseases to consultant specialists to provide
advice on genetic diseases, which enables the concerned parties to decide whether or not to
undertake the marriage and have children, a step which can have a significant impact in reducing the
transmission of genetic diseases down to future generations.
II- HAAD opens two new centers for visa screening tests in Abu Dhabi
Abu Dhabi - 9 August 2015: HAAD has licensed two new visa screening centers in the emirate; in
line with its commitment to provide integrated and efficient healthcare services to the community in all
regions of the Emirate.
Based on HAAD statistics, 1.4 million individuals benefited from visa screening services in Abu
Dhabi in 2014 and 884,000 in the first half of 2015. With the two new centers, there are now 11
visa screening centers in Abu Dhabi Emirate (four in Abu Dhabi, two in Al Ain and five in the Western
Region).
III- Pilot implementation of first malaria vaccine recommended by WHO advisory
groups.
GENEVA - The World Health Organization’s Strategic Advisory Group of Experts on Immunization
(SAGE) and the Malaria Policy Advisory Committee (MPAC) jointly recommended pilot projects to
understand how to best use a vaccine that protects against malaria in young children.
“This was a historic meeting with two of WHO’s major advisory committees working together to
consider current evidence about this vaccine,” said Professor Fred Binka, acting chair of MPAC.
“The committees agreed that pilot implementations should be the next step with this vaccine.”
The vaccine, known as RTS,S (trade name Mosquirix), is the first vaccine for malaria, but there is
one primary question. It requires four doses for a child to be fully protected and therefore requires
additional contacts with the health care system. The first three doses are given one month apart
followed by an 18-month pause before the fourth dose. Without the fourth dose, children had no
overall reduction in severe malaria.
“The question about how the malaria vaccine may best be delivered still needs to be answered,”
said Professor Jon S. Abramson, chair of SAGE. “After detailed assessment of all the evidence we
recommended that this question is best addressed by having 3-5 large pilot implementation projects.”
The malaria vaccine, RTS,S, acts against P. falciparum, the most deadly malaria parasite globally,
and the most prevalent in Africa. It offers no protection against P. vivax malaria, which predominates
in many countries outside of Africa. The vaccine is being assessed as a complementary malaria
control tool that could potentially be added to—but not replace—the core package of proven malaria
preventive, diagnostic and treatment measures.
Quarterly Summary Report: 3nd Quarter - 2015
Page 15
The volume “Flash-on-an-Illness”
Leprosy
Background
Leprosy is a chronic infectious disease of the skin caused by Mycobacterium leprae, an acid-fast,
rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the
upper respiratory tract and the eyes.
There are two different forms of leprosy, tuberculoid (TT) leprosy and lepromatous (LL) leprosy
(also called multibacillari (MB) leprosy). The latter is more contagious because the body’s immune
system is unable to mount a strong response to the invading organism. Hence, the organism
multiplies freely in the skin.
Human were thought to be the only reservoir of leprosy, but recent researches found that “feral
armadillos” in Louisiana and Texas (USA) were found to be naturally infected with Leprosy which
may pose a risk of infection to humans.
The incubation period of the leprosy bacillus varies anywhere from six months to ten years. On an
average, it takes four years for the symptoms of TT leprosy to develop. Probably because of the
slow growth of the bacillus, LL leprosy develops even more slowly, taking an average of eight years
for the initial lesions to appear.
Elimination of leprosy globally was achieved in the year 2000 (i.e. a prevalence rate of leprosy
less than 1 case per 10 000 persons at the global level). The prevalence rate of the disease has
dropped in 2000 by 90%: from 21.1 per 10 000 persons to less than 1 per 10 000 persons. Nearly
16 million leprosy patients have been cured with “Multi-Drug Therapy” (MDT) over the past 20 years.
National leprosy programs for 2011–2015 now focus more on underserved populations and
inaccessible areas to improve access and coverage. Since control strategies are limited, national
programs actively improve case-holding, contact tracing, monitoring, referrals and record
management.
According to official reports received from 103 countries from 5 WHO regions, the global
registered prevalence of leprosy at the end of 2013 was 180 618 cases. The number of new cases
reported globally in 2013 was 215 656 compared with 232 857 in 2012 and 226 626 in 2011.
So far, Leprosy has been eliminated from 119 out of the 122 countries where the disease was
considered a public health problem in 1985.
Western Pacific - Région du
Pacifique occidental, 4596 (2%)
African - Région africaine,
20911 (10%)
American - Région des Amériques,
33084 (15%)
Eastern Mediterranean Région du La Méditerranean orientale,
1680 (1%)
South-East Asia - Région du
Asie du Sud Est, 155385 (72%)
Figure # 9: Distribution of new leprosy cases reported in 103 countries, by WHO Region, 2013.
Page 16
Quarterly Summary Report: 3nd Quarter - 2015
Transmission
Although not highly infectious, it is transmitted via droplets, from the nose and mouth, during close
and frequent contacts with untreated cases.
Case Definition
Clinical description
A chronic bacterial disease characterized by the involvement primarily of skin as well as peripheral
nerves and the mucosa of the upper airway. The following characteristics are typical of the major
forms of the disease reflecting the cellular immune response to Mycobacterium leprae:
1. Tuberculoid: one or a few well-demarcated, hypopigmented, and anesthetic skin lesions,
frequently with active, spreading edges and a clearing center; peripheral nerve swelling or
thickening also may occur.
2. Lepromatous: a number of erythematous papules and nodules or an infiltration of the face,
hands, and feet with lesions in a bilateral and symmetrical distribution that progress to
thickening of the skin.
3. Borderline (dimorphous): skin lesions characteristic of both the tuberculoid and lepromatous
forms.
4. Indeterminate: early lesions, usually hypopigmented macules, without developed tuberculoid or
lepromatous features
Laboratory criteria for diagnosis
Any one of the following:
• Demonstration of acid-fast bacilli in skin or dermal nerve, obtained either by skin biopsy, slit skin
smear examination or nerve biopsy of a lepromatous lesion.
• Histopathological report from skin or nerve biopsy compatible with leprosy (Hansen’s disease)
examined by an anatomical pathologist or specialist microbiologist experienced in leprosy
diagnosis.
Case definition
Suspected:
A clinically compatible case without laboratory confirmation.
Confirmed:
A clinically compatible case that is laboratory confirmed.
Treatment
Since 1995, WHO has supplied MDT free of cost to leprosy patients in all endemic countries. The
drugs used in WHO-MDT are a combination of rifampicin, clofazimine and dapsone for multibacillary
leprosy patients and rifampicin and dapsone for paucibacillary leprosy patients. Among these
rifampicin is the most important anti-leprosy drug and therefore is included in the treatment of
both types of leprosy. Treatment of leprosy with only one antileprosy drug will always result in
development of drug resistance to that drug. Treatment with dapsone or any other antileprosy drug
used as monotherapy should be considered as unethical practice.
People who are in immediate contact with the leprosy patient should be tested for leprosy. Annual
examinations should also be conducted on these people for a period of five years following their last
contact with an infectious patient. Some physicians have advocated dapsone treatment for people
in close household contact with leprosy patients.
Quarterly Summary Report: 3nd Quarter - 2015
Page 17
Some figures from Abu Dhabi Surveillance Data
Editorial Board
17
12
No. of notified cases
- Dr. Farida Al Hosani (Acting Director / Public Health and Research, HAAD)
- Dr. Mariam Al Mulla (Section Head, Communicable Diseases Department, HAAD)
- Dr. Ahmed Abdulla (Senior Officer, Communicable Diseases Department, HAAD)
- Dr. Badreyya Al Shehhi (Section Head, Communicable Diseases Department, HAAD)
- Dr. Kamal Jaafar (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Ahmed Khudhair (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Lamees Abu Haliqa (Senior Regional Officer, Communicable Diseases Department, HAAD)
- Dr. Bashir Aden (Senior Officer, Community Health & Surveillance Department, HAAD)
- Mrs. Wafa Aldhaheri (Senior Officer, Communicable Diseases Department, HAAD)
- Dr. Faiza Ahmed (Sr. Officer / Community Health & Surveillance Department, HAAD)
- Dr. Jens Thomsen (Section Head / Environmental Health Section, HAAD)
- Mr. Darren Joubert (Sr. Officer/ Occupational & Environmental Health, HAAD)
- Dr. Jennifer Moore (Section Head / Maternal & Child Health, HAAD).
13
10
8
2011
2012
2013
Year
2014
30 Sept. 2015
6
9
9
5
4
4
3
3
2
1
1
ES
PI
IP
N
EP
N
A
N
Nationality
0
L
A
0
A
ES
SR
IL
NG
N
SH
D
LA
O
0
IA
0
BA
Figure # 11: Distribution of leprosy
cases by gender & age in 2014 – 30,
Sep. 2015.
1
IL
1
1
PH
2
IA
35 - 44 yrs
6
D
25 - 34 yrs
Male Female
2015 till
30 sep
7
D
Male Female
2
IN
3
2
2014
8
8
IN
7
6
5
4
3
2
1
0
10
No. of notified cases
No. of notified cases
Figure # 10: Reported leprosy cases in Abu Dhabi Emirate from 2011 till 30, Sep. 2015. All reported
cases were confirmed by histopathological Lab. procedures.
Figure 12: Distribution of Leprosy
cases by nationality from 2014 –
30, Sep. 2015.
Scientific Board
- Dr. Iain Blair, Co-Chair (Associate Professor, Institute of public health, UAEU)
- Prof. Tibor Pal (Professor, Department of Medical Microbiology, UAEU)
- Dr. Agnes Sonnevend (Associate 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. Martin Pitout (Senior Consultant, Microbiologist, SKMC)
- Dr. Bashir Aden (Senior Officer, Community Health & Surveillance, HAAD)
- Dr. Jamal Al Mutawa (Manager, Community Health and Surveillance Department, HAAD)
- Dr. Stefen Weber (Consultant Microbiologist / SKMC)
- Mrs. Wafa Aldhaheri, Secretariat (Senior Officer, Communicable Diseases Department, HAAD)
We are glad to invite your participation in this bulletin,
please contact:
Mrs. Wafa Aldhaheri
Communicable Diseases Department
Health Authority – Abu Dhabi
Tel: 037041 130
Fax: 037679 556
Email: [email protected]
Tuberculoid
Lepromatous
indeterminate
Not Tested
Figure # 13: Distribution of leprosy cases by type of leprosy in 2014 – 30, Sep. 2015.
Page 18
Quarterly Summary Report: 3nd Quarter - 2015
Quarterly Summary Report: 3nd Quarter - 2015
Page 19
List of infectious diseases to be notified: